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BRITISH  AND  FOREIGN 

MEDICO-CHIRUEGICAL 
KEVIEW 


OB 


QUARTERLY    JOURNAL 


ov 


PRACTICAL  MEDICINE  AND  SURGERY. 


VOL.  LVI. 

JULY— OCTOBER,  1875. 

LONDON: 
J.  &  A.  CHUECHILL,  NEW  BURLINGTON  STREET. 

MDCCCLXXV. 


4 

CONTENTS   OF  NO.  CXI. 

BRITISH    AND    FOREIGN 
MEDICO-CHIRURGICAL    REVIEW. 

JULY,  1875. 


^nalgtical  anti  (Critical  Kebietos 

PAGE 
Rev.  1. — 1.  Traite  des  Operations  qui  se  pratiquent  sar  roeil.     Par  Bdouaed 

Meter  et  A.  de  Montmeja.     Paris,  1871.  .  .  .1 

2.  Handbuch  der  gesaramten  Augenheilkunde.  B.  iii.  ('  Operationslehre/ 
von  Prof.  Aelt).     Leipzig,  1874.  .  .  .  .     ib. 

3.  Ophthalmic  Surgery  (extracted  from  *  Erichsen's  Surgery,*  6th  ed., 
1872).     By  J.  F.  Stbeatfeild  .  .  .  .    ib. 

4.  A  Practical  Treatise  on  the  Diseases  of  the  Eye.  By  Hatnes 
Walton.     3rd  edition.     London,  1875  .  .  .     ib. 

Rev.  II. — 1.  Rare  Cases  of  Congenital  Syphilis.     By  L.  D.  Bulklet,  M.D., 

A.M.     New  York.     1874  .  .  .  .  .     23 

2.  Cases  of  Disease  of  the  Nervous  System  in  Patients  the  Subjects  of 
Inherited  Syphilis.  By  J.  Hughlinqs  Jackson,  M.D.  London. 
1868        .  .  .  .  .  .  .     ib. 

3.  On  Dactylitis  Syphilitica,  with  Observations  on  Syphilitic  Lesions  of 
the  Joints.     By  R.  W.  Tatloe,  M.D.     New  York,  1871     .  .     ib. 

4.  On  Pseudo-paralysis  due  to  a  Lesion  of  the  Bones  in  Infants,  the 
Subjects  of  Inherited  Syphilis.  Paeeot,  in  *  Archives  de  Physio- 
logie,'  1872  .  .  .  .  .  .     ib. 

5.  London  Medical  Record,  vol.  i,  p.  10.  Summary  of  Contributions  to 
the  Knowledge  of  the  Pseudo-paralysis  of  Inherited  Syphilis.     By 

S.  Gee.  M.D,  .  .  .  .  .  .    ib. 

Rev.  III. —  The  Pathological  Anatomy  of  the  Nervous  Centres.     By  Edwabd 

Long  Fox,  M.D.,  F.R.C.P.     London,  1874  .  .  .32 

Rev.  IV. — On  Mycetoma ;  or,  the  Fungus  Foot  of  India.    By  H.  Vandyke 

Caetee,  M.D.,  Indian  Army.     London,  1874        .  .  .39 

Rev.  V. — The  Diseases  of  Tropical  Climates  and  their  Treatment,  with  Hints 
for  the  Preservation  of  Health  in  the  Tropics.  By  J.  A.  B.  Horton, 
M.D.  Edin.,  F.R.G.S.,  Surgeon-Major.  London,  1874.  SmaU  8vo, 
pp.657    .  .  .  .  .  .  .47 

Rev.  VI. — 1.  Heredity,  a  Psychological  Study  of  its  Phenomena,  Laws,  Causes, 
and  Consequences.  From  the  French  of  Th.  Ribot,  author  of  *  Con- 
temporary English  Psychology.'     London,  1875.     Pp.  393  .     53 

2.  Heredity  and  Hybridism.  A  Suggestion  by  Edward  S.  Cox,  S.L., 
author  of  '  What  am  I  ?"  &c.,  &c.     London,  1875.     Pp.  66  .     ib. 

3.  Hereditary  Genius,  an  Enquiry  into  its  Laws  and  Consequences.     By 

Francis  Galton,  F.R.S.,  &c.    London,  1869.    Pp.  383  .    ib. 


11  CONTENTS   OF  NO   CXI. 

PAGE 

Ret.  VII. — 1.  Ninth  Annual  Report  of  the  Sanitary  Commissioner  with  the 

Government  of  India,  1872.     Calcutta,  1873         .  .  .72 

2.  Tenth  Annual  Report  of  the  Sanitary  Commissioner  with  the  Govern- 
ment of  India,  1873.     Calcutta,  1874    .  .  .  .     ih. 

3.  Report  of  the  Sanitary  Commissioner  for  Madras,  1872.     Madras, 
1873.        .  .  .  .  .  .  .     ib. 

4.  Report  of  the  Sanitary  Commissioner  for    Madras,  1873.     Madras, 

1874  .  .  .  .  .  .  .     ib. 

5.  Ninth  Annual  Report  of  the  Sanitary  Commissioner  for  the  Govern- 
ment of  Bombay,  1872.     Bombay,  1873 

6.  Tenth  Annual  Report  of  the  Sanitary  Commissioner  for  the  Govern- 
ment of  Bombay,  1873,     Bombay,  1874  .  .  .     ib. 

7.  Annual  Report  of  the  Sanitary  Commissioner  for  the  Central  Pro- 
vinces,  1873.     Nagpur,  1874.  .  .  -  .     ib. 

8.  Report  of  the  Sanitary  Administration  of  the  Punjaub  for  the  Year 
1873.     Lahore,  1874  .  .  .  .  .     ib. 

Rev.  VIII.— Clinique  Medicale  de  l'H6tel  Dieu  de  Rouen.     Par  E.  Leudet. 

Paris,  1874  .  .  .  .  .  .90 

Rev.  IX. — Animal  Mechanism  :  a  Treatise  on  Terrestrial  and  Aerial  Locomo- 
tion.    By  E.  J.  Maeet  .  .  .  .  .98 

Rev.  X. — 1.  The  Principles  and  Practice  of  Medical  Jurisprudence.  By 
Alfeed   Swayne  Tayloe,  M.D.,  F.R.S.     Second  edition.     London, 

1873  .  .  .  .  .  .  .108 

2.  Wharton    Stille's    Medical    Jurisprudence.     Third   edition.     Phila- 
delphia, 1873  .  .  .  .  .  .     ib. 

3.  Principles    of   Forensic  Medicine.     Fourth  editiou.     By    William 

A.  Guy,  M.B.,  F.R.S.,  and  David  Feeeiee,  M.D.     London,  1875   .    ib. 

4.  A  Manual  of  Toxicology.    By  John  J.  Reese,  M.D.     Philadelphia 
and  London,  1874  .  .  .  .  .     ib. 

5.  Die    Gerichtlich-chemische     Ernmittelung    von   Giften.     Von    Dr. 
Geoeg  Deagendoeff.     St.  Petersburg,  1868  .  .     ib. 

6.  Beitrage    zur  Gerichtlichen    Chemie    einzelner  Organischer  Gifte, 
Ibid         .  .  .  .  .  ,  .     ib. 

7.  Manuel  de  Toxicologic.    Par  Deagendoeff,  traduit  par  E.  Rittee. 
Paris,  1873  .  .  .  .  .  .     ib. 

8.  Beitrage    zur    Gerichtlichen  Chemie    einzelner  Organischer   Gifte 
Von  Dr.  Deagendoeff.     Petersburg,  1872  .  .  .    ib. 

9.  Guy's  Hospital  Reports  .  .  .  .  .     ib. 
Rev.  XL — 1.  Cremation  of  the  Dead:  its  History  and  Bearings  upon  Public 

Health.    By  William   Eassie,  C.E.     With  Illustrations.     London, 

1875  .  .  .  .  .  .  .120 

2.  Cremation  :  the  Treatment  of  the  Body  after  Death.  By  Dr.  Heney 
Thompson.     2nd  Ed.     London,  1874    .'  .  .  .     ib. 

3.  On  the  Disposal  of  the  Dead.    By  Dr.  Rich  aed  son,  F.R.S.     'Popu- 
lar Science  Review  '  for  Ajiril.     London,  1875       .  .  .     ib. 

4.  The  Disposal  of  the  Dead.    '  Indian  Medical  Gazette.'    Edited  by  K. 
McLeod.     Calcutta,  April  1st,  1875    .  .  .  .     ib. 

5.  Letters  in  the  'Times'  Newspaper  on  the   Subject  of  Burial.     By, 

J.  Setmoue  Haden,  Esq.     1874-75     .  .  .  .    ib. 

6.  Proceedings  of  the  American  Medical  Society.     June  to  December, 

1874  .  .  .  .  .  .  .     ib. 

7.  Suggestions    to    Burial  Boards    providing    and    managing    Burial 
Grounds.     By  the  Inspection  under  the  Burial  Acts     1871  .     ib. 

Rev.  XII.— 1.  Guy's  Hospital  Reports.    Third  Series.     Vol.  xx.     1875         .  140 

2.  St.  Thomas's  Hospital  Reports.     New  Series.     Vol.  v.     1874  .     ib. 

3.  St.  Barthoolmew's  Hospital  Reports.     Vol.  x.     1874  .  .     ib- 

4.  St.  George's  Hospital  Reports.     Vol.  vii.     1875  .  .     ib. 
Rev.  XIIL— The  Leprous  Diseases  of  the  Eye.     With  6  Coloured  Plates.  143 

By  Dr.  0.  B.  Bull  and  Dr.  S.  A.  Hansen,  Christiania  and  London. 
1873.     8  vo,  pp.  27  .  .  .  .  .     ib. 


% 

CONTENTS   OF   NO.    CXI.  jif 


PAGE 

Aet.  I. — 1.  Histoire  de  la  Peste  Bubonique  en  Perse.     Par  J.  D.  Tholozan, 

de  la  Societe  Epidemiologique  de  Londres.    8vo,  pp.  42.    Paris,  1874  .  149 
2.  Histoire  de  la  Peste  Bubonique  en  Mesopotamie.    Par  J.  D.  Tholozan. 
Svo,  pp.  91.     Paris,  1874        .  .  .  .  .  .     ib. 

Aet.  II. — Hospitalism  and  the  Causes  of  Death  after  Operations  and  Surgical 

Injuries.     By  J.  E.  Erichsen,  F.R.C.S.,  &c.     London,  1874  .  152 

Aet.  III. — The  Sphyguiograph  :  its  Physiological  and  Pathological  Indica- 
tions. The  essay  to  which  was  awarded  the  Stevens  Triennial  Prize, 
by  the  College  of  Physicians  and  Surgeons,  New  York,  April,  1873. 
Two  hundred  and  ninety  illustrations.  By  Edgar  Holden,  A.M.,  M.D. 
Philadelphia,  1874  .  .  .  .  .154 

Art.  IV. — A  Dictionary  of  Medical  Science  with  the  Accentuation  and  Ety- 
mology of  the  Terms  and  the  French  and  other  Synonyms.  By 
Robert  Dunglison,  M.D.  A  new  edition,  enlarged  and  thoroughly 
revised,  by  Richard  J.  Dunglison,  M.D.     London,  1874.     Pp.  1131  156 

Art.  v.— Manual  of  Public  Health  for  Ireland.  By  Thomas  W.  Grim- 
SHAW,  M.D,,  &c. ;  J.  Emerson  Reynolds,  F.C.S.  ;  Robert  O'B. 
Furlong,  M.A.  ;  and  John  W.  Moore,  M.D.,  &c.     Dublin,  1875      .  157 

Aet.  VI. — Outlines  of  the  Science  and  Practice  of  Medicine.     By  William 

AiTKEN,  M.D.,  F.R.S.     London,  1874   .  .  .  .158 

Aet.  VII. — Water  Analysis  as  it  should,  and  as  it  should  not,  be  performed 
by  the  Medical  Officer  of  Health.  With  Illustrations.  By  Cornelius 
B.  Fox,  M.D.,  M.R.C.P.  Lond.     London. 

Art.  VIII. — The  Disposal  of  Slop  Water  of  Villages.     By  Cornelius  B. 

Fox,  M.D.,  M.R.C.P.  Lond.     London,  1875  .  .  .161 

Art.  IX. — A  Practical  Treatise  upon  Eczema,  including  its  Lichenous  and 
Impetiginous  Forms.  By  Dr.  McCall  Anderson.  Third  edition, 
with  seven  woodcuts.     Pp.  208.     London,  1874  .  .  .     ib. 

Art.  X. — Lectures  on  Skin  Diseases,  delivered  at  St.  Vincent's  Hospital.  By 
E.  D.  Mapother,  M.D.  With  illustrations.  Second  edition.  Dublin, 
1875.     Pp.  206       .  .  .  .  .  .  166 

Art.  XL — Notes  of  Demonstrations  on  Phys^'ological  Chemistry.     By  S.  W. 

Moore.     Pp.  ix  and  58.     London,  1874  .  .  .     ib. 

Aet.  XII.— The  West  Riding  Lunatic  Asylum  Medical  Reports.     Edited  by 

J.  Crichton  Browne,  M.D.     Vol.  iv.     London,  1874        .  .  167 

Aet.  XIII. — Lectures  on  Public  Health.     Delivered  in  the  Lecture  Hall  of 

the  Royal  Dublin  Society.     Dublin,  1874.     Pp.  203,  .  .  168 

Art.  XIV. — Remark  on  the  Report  of  the  Sanitary  Commissioner  with  the 
Government  of  India  on  the  Cholera  Epidemic  of  1872  in  Northern 
India.  By  Surgeon-Major  A.  C.  C.  deRenzy,  B.A.,  T.C.D.,  Sanitary 
Commissioner,  Punjaub.     Lahore,  1874.     Svo,  pp.  28  .  .  169 

Art.  XV. — The  Medico- Chirurgical  Tariffs  issued  by  the  Shropshire  Ethical 

Society.     Shrewsbury,  1874  .....  170 

Aet.  XVI. — The  Toner  Lectures.  On  Strain  and  Over  Action  of  the  Heart. 
By  J.  M.  Da  Costa,  M.D.,  Professor  of  Practice  of  Medicine  in  Jeffer- 
son Medical  College,  Philadelphia,     Pp.  28.     Washington,  1874         .  171 

Aet.  XVII. — 1.    Chemistry    in    its    Relations    to    Therapeutics.     By     W. 

Handsel  Griffiths,  Ph.  D.,  L.R.C.P.E  .  .  .    ib. ' 

2.  On   the    Teaching  of  Materia   Medica  and   Therapeutics.     By  W. 
Handsel  Griffiths,  Ph.D.,  L.R.C.P.E  .  .  .     ib. 

3.  Monthly  Report  on  the  Progress  of  Therapeutics.     Edited  for  the 

*  Edinburgh  Medical  Journal.'     Nos.  Ill  to  VI.     1874-75  .     ib. 

Aet.  XVIII.— 1.  The  Study  of  Life.  By  H.  Macnaughton  Jones,  M.D., 
Ch.  M.,  Fellow  of  the  Royal  Colleges  of  Surgeons,  Ireland,  and  Edin- 
burgh ;  Senior  Demonstrator  of  Anatomy,  Queen's  College,  Cork,  &c.  172 
2.  The  Simplicity  of  Life.     By  Ralph  Richardson,  M. A.,  M.D.,  Fellow 
of  the  College  of  Physicians,  Edinburgh  .  .  .     ib. 


IV  CONTENTS   OF   NO.    CXI. 

PAGE 

Abt.  XIX. — Transactions  of  the  American  Ophthalmological  Society.  Ninth 
Annual  Meeting,  Newport,  July,  1873.  Tenth  Annual  Meeting,  New- 
port, July,  1874.     New  York,  1873,  1874  .  ,  .175 

AsT.  XX. — Krankheiten  des  Weiblichen  Geschlechtes,  vom  Klinischen 
Pathologischen,  und  Therapeutischen  Handpucktes,  aus  Dargestellt. 
Von  Dr.  Hermann  Beiqel.     Vol.  i.  ...  178 

The  Diseases  of  Women  from  a  Clinical,  Pathological,  and  Therapeu- 
tical Point  of  View.     By  Dr.  Heemann  Beiqel  .  .    ib. 

Aet.  XXI, — Recherches  sur  Lymphangites  Pulmonaires.     Parle  Dr.  Emile 

Troisiee,  Interne  des  H6pitaux  de  Paris  .  .  .  180 

Aet.  XXII. — The  Management  of  Infancy  and  Childhood  in  Health  and 

Disease.     Pp.  627.     By  Howard  Baeeett,  M.R.C.S.,  &c.  .  181 

Aet.  XXIII. — Transactions  of  the  Pathological  Society  of  London.  Vol.  xxv. 

London,  1874  .  .  .  .  .  .183 

Aet.  XXIV. — Infant  Diet.    By  A.  Jacobi,   M.D.     Revised,  enlarged,  and 

adapted  to  popular  use  by  Maey  F.  Jacobi,  M.D.  New  York,  1874  .  184 

Aet.  xxv. — Clinical  Lectures  on  various  Important  Diseases,  being  a  Col- 
lection  of  the  Clinical  Lectures  delivered  in  the  Medical  Wards  of 
Mercy  Hospital,  Chicago.  By  Nathan  S.  Davis,  M-D.  Edited  by 
Feank  Davis,  M.D.     Second  edition.     Philadelphia,  1874.  .    ib. 

Aet.  XXVI. — On  the  Functional  Derangements  of  the  Liver,  being  the 
Croonian  Lectures  delivered  at  the  Royal  College  of  Physicians,  in 
March,  1874.   By  Chaeles  Muechison,  M.D.,  F.R.S.  London,  1874.  186 


(©riginal  i^Tommunicatiorts. 

Aet.  I. — The  Pathology  of  the  Contracting  Granular  Kidney.     By  J.  T. 

Maclagan,  M.D 188 

Abt.  II. — On  the  Value  of  Fluctuation   as  a  Sign.     By  T.  H.  Baetleet, 

F.R.C.S.,  &c.  202 


Qtl^tonitU  of  i^etiical  Science. 

Report  on  Physiology  and  Histology.     By  Heney  Powee,  F.R.C.S.,  M.B. 

Loud 206 

Report  on  Surgery.     By  H.  A.  Reeves,  F.R.C.S.E.  ^ 217 

Report  on  Toxicology,  Forensic  Medicine,  and  Hygiene.    By  Benjamin  W. 

RiCHAEDSON,  M.D.,  F.R.S 234 

Books  received  for  Review 250 


^ 


CONTENTS   OF   NO.  CXII. 

BRITISH    AND    FOREIGN 
MEDICO-CHIRURGICAL    REVIEW, 

OCTOBER,  1875. 


Enalgtical  mti  (txiiital  i^ebietos 

PAGB 

Kev.  1. — 1.  Cases  illustrative  of  the  Antiseptic  Use  of  Carbolic  Acid.     By 

Joseph  Bell,  F.R.C.S.     Edinburgh,  1869  .  .  .253 

2.  Address  in  Surgery  at  Annual  Meeting  of  British  Medical  Associa- 
tion held  at  Plymouth,  August,  1871.     By  Joseph  Lister,  F.R.S.     .     ib. 

3.  Lister's  Lectures  in  *  British  Medical  Journal,'  January  14th,  1871    .     ib. 

4.  An  Inquiry  into  the  Theory  and  Practice  of  Antiseptic  Surgery.  By 
James  Cummino,  M.D.,  M.R.C.P.E.,  L.R.C.S.E.     Edinburgh,  1872  .     ib. 

5.  LangstafF  on  Hospital  Hygiene,  1872  .  .  .     ib. 

6.  Du  Traitement  des  Plaies  en  General  et  en  Particulier  d'un  Mode 
Nouveau  de  Pansement  Antiseptique.     Par  le  Docteur  LoiJis  Beau 

DE  Toulon.    1873  .  .  .  .  .     ib. 

7.  Sulla  Medicatura  Antiseptica  alia  Lister  in  Chirurgia.  Pel  Dr. 
Gesualdo  Clementi.     Catania,  1874  .  .  .  .     ib. 

8.  Volkman  on  Subcutaneous  Osteotomy.     *  Edin.  Med.  Journal,'  1875  .     ib. 

9.  Papers  on  Antiseptic  Surgery.  By  Joseph  Lister,  in  '  Lancet,' 
passim,  1875,  and  in  'Edin.  Med.  Journal,'  Sept.,  1875        .  .     ib. 

10.  Annandale's  New  Operation  for  Knock-knee.  *  Edin.  Med.  Journal,' 
July,  1875,  p.  19    .  .  .  .  .  .    ib. 

11.  Klinische  Ergebnisse  der  Lister'schen  Wundbehandlung  und  iiber 
den  Ersatz  der  Carbolsaure  durch  Salicylsaure.  Von  C.  Thiersch. 
Volkmanu,  *  Sammlung  klinischer  Vortriige,'  Nr.  84  and  85  .     ib. 

On  the  Clinical  Results  obtained  by  Lister's  Treatment  of  Wounds,  and 
on  the  Substitution  of  Carbolic  Acid  by  Salicylic  Acid.  By  Professor 
C.  Thiersch,  of  Leipzig.  Volkmann's  '  Collection  of  Clinical  Lec- 
tures,' Nos.  84  and  85  .  .  .  .  .     ib. 

Rev.  II. — 1.  Le9ons  sur  les  Maladies  du  Systeme  Nerveux  faites  k  la 
Salpetriere.  Par  J.  M.  Chaecot,  Professeur  h  la  Faculte  de  Mede- 
cine  de  Paris,  &c.,  &c.  .....  281 

2.  Eight  Cases  of  Insular  Sclerosis  of  the  Brain  and  Spinal  Cord.     By 

W.  MoxoN,  M.D.,  *  Guy's  Hospital  Rejiorts,'  vol.  xx,  1875  .  .     ib. 

3.  On  the  Morbid  Histology  of  the  Spinal  Cord.  By  W.  B.  Kesteven, 
F.R.C.S.,  '  St.  Bartholomew's  Hospital  Reports,'  vol.  viii,  1872  .     ib. 

4.  Military  Sclerosis;  its  Pathological  Significance.  By  W.  B.  Kes- 
teven,  F.R.C.S.,  *  British  and  Foreign  Medico-Chirurgical  Review,' 
July,  1874  .  .  ,  .  .    ib. 


ii  CONTENTS  OF  NO  CXII. 

PAGE 
Rev.  III.— Clinical  Lectures  and  Essays.     By   Sir  JAMES   PAGET,   Bart., 
F.R.S.,  D.C.L.  Oxon.,  LL.D.  Cantab.     Edited  by  Howaed  Maksh, 
F.R.C.S.  .  .  .  .  .  .  .298 

Rev.  IV. — 1.  The  Quarterly  Paper  of  the  Edinburgh  Medical  Missionary 

Society    .  .  .  .  .  .  .307 

2.  The  Medical  Missionary  Journal.  Published  monthly  by  Dr.  Buens 
Thomson  .  .  .  .  .  .    ib. 

3.  Memorials  of  James  Henderson,  M.D.,  F.R.C.S.  Ed.,  Medical  Mis- 
sionary to  China,  1872  .  ,  .  .  .     ib. 

4.  Seedtime  in  Kashmir  j  a  Memoir  of  W.  J.  Elmslie,  M.D.,  F.R.C.S. 
Ed.,  Medical  Missionary  in  Kashmir      .  .  .  .     ib. 

Rev.  v.— 1.  The  Histology  and  Histo-Chemistry   of  Man.     By  Professor 
Heineich  Feet.     Translated  from  the  fourth  German  edition  by 
Aethite  E.  J.  Baekee,  Surgeon  to  the  City  of  Dublin  Hospital. 
London,  1874  .  .  .  .  .  .327 

2.  Handbook  for  the  Physiological  Laboratory.  Edited  by  Dr.  Buedon 
Sandeeson.  Part  I. — Histology,  by  Dr.  E.  Klein,  Assistant  Pro- 
fessor at  the  Brown  Institution.     London,  1873  .  .  .     ib. 

Rev.  VI.— a  Manual  of  Diet  in  Health  and  Disease.     By  Thomas  King 

Chambees,  M.D.,  &c.    London,  1875    .  .  .  .339 

Rev.  VII. — 1.  Microscopic  Examinations  of  Air.  By  P.  Douglas  Cun- 
ningham, M.B.,  attached  to  Sanitary  Commissioner  with  Government 
of  India.     (Not  dated.)  .  .  .  .  .348 

2.  Report  of  Microscopical  and  Physiological  Researches  into  the  Nature 
of  the  Agent  or  Agents  producing  Cholera.  By  T.  R.  Lewis,  M.B., 
and  P.  D.  Cunningham,  M.B.     Calcutta,  1872   .  .  .     ib. 

3.  Report  on  Cholera.  (Second  Series.)  By  the  same  authors.  Cal- 
cutta, 1874  .  .  .  .  .  .     ib. 

4.  On  a  Hsematozoon  inhabiting  Human  Blood,  and  its  Relation  to 
Chyluria  and  other  Diseases.  By  T.  R.  Lewis,  M.B.,  Assistant- 
SurgeoUj  attached  to  Sanitary  Commissioner  with  Government  of  India. 
Calcutta,  1872         .  .  .  .  .  .     ib. 

5.  The  Pathological  Significance  of  Nematode  Haematozoa.  By  T.  R. 
Lewis,  M.B.     Calcutta,  1874  .  .  .  .    ib. 

Rev.  VIII. — 1.  The  Marriage  of  Near  Kin,  considered  with  respect  to  the 
Laws  of  Nations,  the  Results  of  Experience,  and  the  Teachings  of 
Biology.     By  Henet  Huth.     London,  1875.     Pp.  426       .  .  363 

2.  Marriages  between  Cousins  in  England  and  their  Effects.  By  Geoege 
H.  Daewin,  M.A.,  Fellow  of  Trinity  College,  Cambridge.  1875. 
Pp.  29.     .  ...  .  .  .  .    ib. 

3.  Medical  Problems  of  the  Day.  The  Annual  Discourse  before  the 
Massachusetts  Medical  Society,  June  3,  1874.  By  Nathan  Allen, 
M.D.,  LL.D.  Lowell,  Mass.     Boston,  1874.     Pp.  92.  .  .    ib. 

Rev.  IX. — A  Manual  of   Veterinary   Sanitary   Science  and   Police.      By 

Geoege  Fleming.    Two  vols.  ....  378 

Rev.    X. — The  Complete  Handbook  of  Obstetric  Surgery.     By  Chaeles 

Clay,  M.D.     Third  edition.     1874       .  .  .  .385 


St 

CONTENTS  OP  NO.  CXII.  ItT 

PAGB 
Aet.  I. — Contributions  to  the  Mechanism  of  Natural  and  Morbid  Parturi- 
tion.    By  J.  Matthews  Duncan,  M.D.,  &c.    Edinburgh,  1875         ..  391 

Abt.  II. — Compendium  of  Children's  Diseases  :  a  Handbook  for  Practi- 
tioners  and  Students.  By  Dr.  Johann  Steinee.  Translated  from 
the  second  German  edition.  By  Lawson  Tait,  F.R.C.S.  London, 
1874        .  .  .  .  .  .  .398 

Aet.  III. — Materia  Medica  and  Therapeutics — Vegetable  Kingdom.      By 

Chaeles  D.  F.  Phillips,  M.D.,  F.R.C.S.E.    London.    Pp.  584        .  405 

Aet.  IV. — A  Practical  Treatise  on  the  Analysis  of  Tea,  Coffee,  and  Cocoa. 

By  J.  A.  Wankltn.     Pp.  viii  and  59.     London,  1874        .  .  408 

Aet.  V. — A  Dictionary  of  Chemistry.  By  Heney  Watts.  Second  Sup- 
plement.    London,  1875        .....  409 

Aet.  VI. — The  Forces  which  carry  on  the  Circulation  of  the  Blood.  By 
Andeew  Buchanan,  M.D.,  Professor  of  Physiology  in  the  University 
of  Glasgow.     Second  edition.     London,  1874       .  .  .  411 

Aet.  VII. — De  I'Arthrite  Tuberculeuse,  Demonstration  de  I'Existence  de 
cette  Affection  par  Inoculation  de  produits  synoviaux.  J^tude  accom- 
pagnee  d' Observations  recueillies  k  l'H6tel-Dieu  de  Lyon.  Par  leDr. 
J.  Roux,  Ancien  Interne  des  H6pitaux  de  Lyon      .  .  .  413 

On  Tuberculous  Arthritis,  a  Demonstration  of  the  Existence  of  this 
Affection  by  Inoculation  of  Synovial  Products.  A  Study,  accom- 
panied by  Observations  collected  at  the  Hotel-Dieu  of  Lyons.  By 
Dr.  J.  Roux,  formerly  House-Surgeon  at  the  Lyons  Hospitals  .     ib. 

Aet.  viii. — Therapeutics  and  Materia  Medica:  a  Systematic  Treatise  on 
the  Action  and  Uses  of  Medicinal  Agents,  including  their  Description 
and  History.  By  Alfeed  Stille,  M.D.,  Professor  of  the  Theory  and 
Practice  of  Medicine  and  of  Clinical  Medicine  in  the  University  of 
Pennsylvania,  &c.  Fourth  edition,  thoroughly  revised  and  enlarged. 
In  two  volumes.     Philadelphia,  1874     ....  414 

Aet.  IX. —  Commentary  on  the  British  Pharmacopoeia.      By  Waltee  G. 

Smith,  M.D.  Dublin.     Pp.  766.    London,  1875  .  .  .415 

Aet.  X. — Essay  on  the  Causes,  Symptoms,  and  Treatment  of  Burdwar  Fever, 
or  the  Epidemic  Fever  of  Lower  Bengal,  By  G.  C.  Rot,  M.D., 
F.R.C.S.,  Surgeon,  Bengal  Establishment,  &c.  Calcutta,  1874. 
Pp.92      .  .  .  .  .  .  .     ib. 

Aet.  XL — Lectures  on  Syphilitic  Osteitis  and  Periostitis.  By  John 
Hamilton,  Surgeon  to  the  Richmond  Hospital  in  London  and 
Dublin.     1874         .•  .  .  .  .  .418 

Aet.  XII. — Syphilitic  Lesions  of  the  Osseous  System  in  Infants  and  Young 

Children.     By  R.  W.  Tayloe,  M.D.     New  York,  1875       .  .  420 

Aet.  XIII. — On  Leprosy  and  Elephantiasis.  With  Plates.  By  H.  Vandyke 
Caetee,  M.D.  Lond.,  H.M.  Indian  Medical  Service.  Published  under 
sanction  of  the  Secretary  of  State  for  India.  London,  1874.  4to, 
pp.  246    .  .  .  .  .  .  .  423 

Aet.  XIV. — Manual  of  Instruction  for  the  Guidance  of  Army  Surgeons  in 
Testing  the  Range  and  Quality  of  Vision  of  Recruits,  and  in  Distin- 
guishing the  Cause  of  Defective  Vision  in  Soldiers.  By  Surgeon- 
General  T.  LoNGMOEE,  C.B.   2nd  edition.   London,  1875.   Pp.  134     .  425 

Aet.  XV. — Archives  of  Electrology  and  Neurology.     Edited  by  G.  Beaed, 

M.D.     Vol.  i.  No.  2,  1874.     New  York  .  .  .426 


/v 


U  CONTENTS  OF  NO.  CXII. 

PAOE 

Aet.  XVI. — Des  Indications  et  dea  Contre-indications  de  I'Hydrotlierapie. 

Per  M.  le  Dr.  Leeoy-Dupee     .....  428 

Aet.  XVII. — On  the  Modified  Turkish  and  Vapour  Bath,  and  its  Value  in 

certain  Diseases  of  the  Skin.     By  J.  L.  Milton.     London,  1875        .     ib. 

Aet.  XVIII. — Nomenclature  of  Disease  prepared  for  the  Use  of  the  Medical 
Officers  of  the  United  States  Marine-Hospital  Service.  By  the  Super- 
vising Surgeon,  John  M.  Woodwoeth,  M.D.     Washington,  1874    .  429 

Aet.  XIX. — Journal  of  the  Chemical  Society,  1871-4.     London    .  .     ib. 

Aet.  XX.— Cyclopaedia  of  Medicine.     Edited  by  Dr.   H.   VON   Ziemssen. 

Vols,  i,  ii,  and  iii.     London,  1875  ....  430 

Aet.  XXI. — Second  Annual  Report  of  the  Secretary  for  Agriculture,  Depart- 
ment of  Lands  and  Agriculture,  Victoria.     Melbourne,  1874  .  431 

Aet.  XXII. — A  Practical  Description  of  every  Form  of  Medico-Electric 
Apparatus  in  Modern  Use,  with  Plain  Directions  for  Mounting, 
Charging,  and  Working.  Illustrated  by  carefully  drawn  Engravings. 
By  Salt  and  Son,  of  Birmingham.    London,  1875  .  .  432 


<©tiflinal  OTommunicationg. 

Aet.  I. — On  Lung  Disease  from  Inhalation  of  Dust.  By  John  T.  Aelidge, 
M.D.,  A.B.  Lond.,  F.R.C.P.  Lond.,  Physician  to  the  North  Stafford- 
shire Infirmary,  &c     .  .  .  .  .  .  433 

Aet.  II.— Memorandum  of  the  Presence  of  Air  in  Middle  Ear  as  a  Sign  of 
Live-birth.  By  Feancis  Ogston,  M.D.,  Assistant  Professor  of  Me- 
dical Jurisprudence,  Aberdeen  University 445 


ai:f)ronicle  of  if^etiical  Science. 

Report    on   Materia    Medica    and    Therapeutics.      By    Robeet    Huntee 

Semple,  M.D.,  F.R.C.P.  Lond.,  &c.       .  .  .  .447 

Eeport  on  Pathology  and  the  Practice  of  Medicine.     By  John  T.  Aelidge, 

M.D.,  A.B.  Lond.,  F.C.C.P.  Lond.,  &c.  .  .  .  .  458 

Report  on  Midwifery,  Diseases  of  Women,  and  Diseases  of  Children.    By 

Alpeed  Wiltshiee,  M.D.,  M.R.C.P.  Lond.,  &e.  .  .  472 

Books  Received  foe  Review  .  .  .  494 


THE 

BRITISH    AND    FOREIGN 

MEDICO-CHIRURGICAL  REVIEW. 

JULY,    1875. 
^nalptical  antr  Olrtttcal  iCebietos. 


I. — Operative  Surgery  of  the  Eye.^ 

The  invention  of  the  ophthalmoscope  by  Helmholtz  in  1851 
has  been  of  greater  importance  than  was  expected  at  the  time. 
Not  only  did  its  introduction  give  an  enormous  stimulus  to  the 
study  of  ophthalmic  medicine,  but  its  use  has  since  furnished 
many  surprising  revelations,  and  its  powers  have  proved  sus- 
ceptible of  immense  development.  By  it  a  disease  of  the  retina 
can  be  diagnosed  with  the  same  certainty  as  one  of  the  cornea, 
the  effects  of  intra-cranial  as  well  as  of  intra-ocular  pressure  can 
be  directly  observed,  and  the  refractive  condition  of  the  eye  can 
be  determined  with  accuracy,  more  in  many  cases  than  by  the 
use  of  glasses. 

The  history  of  ophthalmic  medicine  naturally  divides  at  the 
period  of  this  invention.  Progress  and  change  had  been  com- 
paratively slight  since  the  time  of  Beer,  except  in  so  far  as  the 
views  current  in  general  pathology  had  been  modified,  and  such 
modification  had  produced  some  alteration  in  treatment.  The 
second  period  was  inaugurated  by  the  rise  of  the  Berlin  school, 
of  which  von  Graefe  was  the  head,  and  to  whom  it  owes  almost 
the  whole  of  its  fame.  The  first  number  of  the  ^  Archiv  fiir 
Ophthalmologic  '  appeared  in  1854,  and  commenced  with  a  paper 
by  him,  unsurpassed  in  ophthalmic  literature.  This  was  followed 
for  the  next  sixteen  years  by  a  series   of  his  communications 

1  1.  Traits  des  Operations  qui  se  pratiquent  sur  Voeil.  Par  ^Sdouaed  Meyek 
et  A.  DE  MoNTMEJA.     Paris,  1871. 

2.  Sandhuch  der gesammten  AugenheilJcunde.  B.  iii  ('  Operationslehre,'  von  Prof. 
Aelt).     Lei})zig,  1874. 

3.  Ophthalmic  Surgery  (extracted  from  *  Erichsen's  Surgery,'  6th  ed.,  1872). 
By  J.  F.  Streatfeild. 

4.  A  Practical  Treatise  on  the  Diseases  of  the  Bye.  By  HayneS  Waltow. 
3rd  edition.     London,  1875. 

Ill— LVI.  1 


2  Revieivs.  [July? 

which,  for  originality  and  importance,  will  not  be  again  ap- 
proached. About  the  same  time  the  anatomy  of  the  eye  was 
diligently  studied,  and  chiefly  by  Bovvman,  and  physiological 
optics  were  systematised  by  Helmholtz,  and  applied  to  practical 
purposes,  especially  by  Donders.  The  contributions  of  minor 
importance,  published  in  various  countries,  have  become  almost 
uncountable ;  there  were,  in  the  single  year  1870,  more  than 
600  original  works,  large  or  small,  published  on  ophthalmic 
matters,  the  anatomy  and  physiology  of  the  eye  being  included. 
The  result  of  all  this  zealous  study  is  that  this  department  has 
advanced  more  rapidly  than  any  other  in  medicine,  and  that  it  is 
now  pre-eminent  for  fulness  and  accuracy  of  knowledge,  and 
consequently  for  certain  and  successful  treatment. 

For  some  years  the  statements  of  von  Graefe  were  widely 
received  with  distrust,  too  often  in  a  hostile  spirit.  Nowhere 
was  this  more  the  case  than  in  England,  where  the  opposition 
culminated  in  an  active  controversy  on  iridectomy  in  glaucoma, 
and  revealed  a  surprising  amount  of  ignorance,  rashness,  and 
critical  incapacity,  which  might  be  admired  in  a  conservative 
politician,  but  was  deplorable  in  surgeons  supposed  to  be  "  of 
mark." 

**When  the  novelty  was  fresh,  our  statistical  notions  of  ophthalmic 
diseases  were  a  little  perturbated  at  hearing  of  the  number  of  cases  of 
glaucoma  which  were  operated  on.  We  thought  the  disease  a  rare  one, 
in  any  of  its  forms,  but  especially  in  the  chronic.  On  looking  over 
the  patients  in  general  or  special  hospitals,  in  passing  through  work- 
houses, and  inquiring  into  the  pathology  of  inmates  of  blind  asylums, 
or  examining  into  the  published  tables  from  ophthalmic  hospitals,  we 
find  the  disease  to  be  a  rare  one.  Well,  as  we  looked  more  narrowly 
into  the  records  of  the  new  cases,  we  found  they  were  not  cases  of 
glaucoma  at  all — certainly  not  according  to  the  standard  laid  down  by 
the  best  authors,  and  accepted  by  the  most  practical  teachers.  The 
young  gentlemen  who  were  twaddling  (if  we  may  use  the  expression, 
and  they  will  agree  with  us  in  its  applicability  ten  years  hence)  on  this 
subject  were  evidently  but  indifferently  educated,  we  mean  as  oculists, 
and  were  writing  about  what  they  did  not  understand,  employing  a 
jargon  of  which  they  scarcely  knew  the  meaning,  and  doing  but  in- 
different justice  to  themselves,  the  subject,  or  the  operators  they  were 
reporting."  1 

1  "  Medical  Epidemics  :  Glaucoma  and  Iridectomy,"  a  Eeview.  From  the 
'  Dublin  Quarterly  Journal  of  Medical  Science/  August,  1860,  p.  77.  The  feeling 
on  the  Continent  was  very  different.  See  Testelin's  letter  ('  Ophth.  Review,' 
i,  168),  written  in  March,  1864 : — "  La  cause  de  Tiridectomie  (appliquee  h,  la  cure 
du  glaucome)  ne  compte  pas  d'adversaire  sur  le  continent.  II  est  encore  plus 
difficile  de  supposer  que  la  discussion  passionee  et  malveillante  de  ses  antagonistes, 
que  I'ignorance  absolue  (feinte  ou  reelle)  qu'ils  deploient,  au  sujet  des  decouvertes 
de  I'oculistique  moderne,  ne  contribuent  pas  h,  jeter  sur  la  cause  qu'ils  defendent 
le  plus  profond  discredit." 

It  is  astonishing  what  may  be  written  by  even  able  men.     The  review  in  ques- 


1875.] 


Operative  Surgery  of  the  Eye.  3 


More  than  ten  years  have  passed  since  the  publication  of  the 
passage  just  quoted,  and  a  large  amount  of  evidence  has  ac- 
cumulated during  the  interval,  yet  no  general  work  has  ap- 
peared in  which  any  attempt  has  been  made  to  collect  it 
together.  It  would  be  profitable  to  examine  not  only  how 
iridectomy  in  glaucoma,  but  also  how  the  many  other  opera- 
tions introduced  or  re-introduced  during  the  last  twenty  years, 
have  stood  the  test  of  experience, — to  ask  what  operations 
should  now  be  admitted  as  established,  and  what  rejected  or 
left  for  future  decision.  A  full,  still  more  an  exhaustive  exami- 
nation of  these  questions  would  be  a  long  and  difficult  task. 
Space  and  time  would  preclude  any  but  a  hasty  and  superficial 
survey  in  this  place  of  the  whole  of  operative  ophthalmic 
surgery,  and  such  an  outline  would  necessarily  exclude  any 
exposition  of  the  reasons  and  experience  by  which  recent  inno- 
vations are  supported.  Hence  we  prefer  to  restrict  ourselves 
to  one  portion  of  this  subject,  to  the  indications  and  results  of 
the  operations  performed  on  the  cornea  and  iris,  or  for  diseases 
of  these  parts.  Even  then  we  shall  be  able  to  adduce  but  a 
little  of  the  interesting  and  valuable  matter  at  hand. 

tion  contains  many  curiously  erroneous  statements,  of  which  we  may  notice  a 
few.  Such  are  that  Keichenbach  first  recommended  iridectomy  in  1767,  and  that 
modern  iridectomists  make  "  an  aperture  either  in  the  cornea  in  front,  or  in  the 
sclerotic  behind  the  ciliary  attachment  of  the  iris."  Reichenbach's  essay  has 
been  twice  reprinted  (the  reviewer  characteristically  gives  no  reference) ;  the 
reader  will  find  it  in  the  *  Thesaurus  Dissert.'  .  .  .  ed.  E.  Sandifort,  iii,  437  ;  '  Lugd. 
Bat./  1778 ;  or  in  the  *  Dissertationes  Med.  sel.  Tubingenses '  .  .  .  ed.  C.  F.  Reuss, 
iii,  278.  Tubing.,  1785.  The  object  of  the  dissertation  is  to  show  that  in  cases  of 
cataract  with  closed  or  contracted  pupil,  the  opaque  lens  can  be  extracted,  the  pupil 
enlarging  under  its  pressure,  or  being  opened  out  by  the  needle.  "  Si  igitur  cohaesio 
pupillae  minus  arcta  mansit,  tunc  demum  consilii  est  acu,  quali  ad  depressionem 
utuntar,  et  qua  ego  ad  apertionem  capsulse  crystalline  uti  soleo,  in  extractione 
cataractse,  portam  banc  aperire,  et  linea  recta,  seu  potius  oblique  sursum  vulnus 
in  centro  infligere,  et  ita  portam  banc  arte  et  marte  aperire."  The  rest  of  the 
essay  is  correctly  epitomised  by  Reuss,  as  "  Extractio  cataractse  hie  occurrit ;  lens 
crystallina  adhserens  forcipe  separata.  Exemplum  profert  autor,  in  quo  visus  non 
redit,  aliud  extracti  corpusculi  per  vascula  adhgerentis;  rectum  scalpellum  prse- 
fert."  Reichenbach  thinks,  indeed,  that  "  si  vero  quis  acum  scindentem  refor- 
midet,  non  inepta  inventio  foret,  instrument!  cilindracei  subtilis  extremitate 
excavati  et  in  peripheria  scindentis  (quale  lorarii  seu  frenarii  ad  foramina  rotunda 
a  loris  exscindenda,  seu  quali  chirurgi  Galli  ad  cauteria  infligenda  utuntur,  quo 
uvea  pertundi,  et  formari  possit,  cujus  experimentum  facere  data  occasione 
forsan  licebit."  Such  an  operation  would  still  be  a  novelty.  The  reviewer  pro- 
bably depended  for  his  statement  on  Jiingken's  reference,  in  his  Operative  Surgery 
of  the  Eye,  to  the  last-quoted  paragraph. 

Again,  we  read  in  this  essay: — "What  benefit  arose  from  all  this  ?  Avery 
manifest  one ;  the  New  Sydenham  Society,  in  its  last  volume,  published  von 
Graefe's  *  Three  Memoirs  on  Iridectomy,'  which  form  the  subject  of  the  present 
review.  Was  not  that  a  benefit  to  the  members  of  a  society  who,  for  neither 
love  nor  money,  could  procure  a  copy  of  that  fine  old  work,  John  Woolhouse's 
Treatises  on  the  Eye,  or  Bannister's  book,  and  other  essays  on  the  diseases  of  the 
organ  of  sight  which  we  might  refer  to  !  "  John  Woolhouse  and  Bannister  ! ! 
What  a  selection ! 


4  Reviews.  [July, 

A  few  words  on  the  books  quoted  at  the  commencement  of 
this  article  are  necessary  before  we  pass  to  our  proper  subject. 
The  first  on  the  list,  by  Messrs.  Meyer  and  Montmeja,  is  a 
handsome  quarto  volume,  illustrated  by  numerous  woodcuts,  and 
twenty-two  large  photographs.  The  former  are  good  ;  the  latter 
are  indifferent,  and  must  add  much  to  the  cost.  Each  opera- 
tion is  carefully  described  j  its  indications  and  contra-indications 
are  pointed  out  in  the  manner  usual  to  systematic  writers,  but 
in  a  more  than  usually  clear  style.  We  find  almost  nothing  to 
object  to,  and  at  the  same  time  scarcely  anything  that  can  be 
fresh  to  those  acquainted  with  recent  ophthalmic  literature. 
Take  it  all  in  all,  we  can  recommend  this  work  to  any  one  in 
want  of  a  perspicuous  and  reliable  guide. 

The  second  treatise  is  one  of  a  series,  principally  by  German 
writers,  intended  to  ultimately  form  a  complete  system  of 
ophthalmology.  It  is  by  Professor  Arlt,  one  of  the  most  learned 
and  experienced  ophthalmic  surgeons  in  the  world.  It  is 
particularly  remarkable  for  the  careful  and  minute  description 
of  each  operation  ;  every  detail,  every  modification,  is  usually 
explained.  We  wish  it  had  been  still  longer;  a  bibliography 
and  index  would  have  increased  its  value.  As  mi^ht  be  expected, 
it  is  wonderfully  full  of  information ;  it  will  for  years  to  come 
be  indispensable  for  study  and  reference. 

Mr.  Streatfeild  writes  in  a  sketchy  manner,  is  rather  one- 
sided, and  makes  some  statements  which  we  think  incorrect. 
His  little  pamphlet  contains,  however,  many  just  and  interest- 
ing remarks. 

The  first  edition  of  Mr.  Walton's  book  appeared  in  1853, 
under  the  title  of  '  A  Treatise  on  Operative  Ophthalmic 
Surgery,'  and  was  most  favorably  noticed  by  the  late  Mr. 
Mackenzie  in  this  Review.^  A  large  amount  of  valuable  matter 
is  to  be  found  in  its  1200  pages,  whilst  at  the  same  time  we 
think  it  deficient  in  some  important  particulars.  Numerous 
excellent  cases  are  related,  and  Mr.  Walton  constantly  gives 
his  own  experience.  Books  of  this  class  are  never  very 
abundant,  and  we  are  thankful  to  the  author  for  this  one.  The 
practitioner  will  often  have  recourse  to  it  with  advantage. 
We  must  not  forget  to  mention  that  the  woodcuts  are  usually 
very  good,  and  that  the  coloured  drawings  of  diseases  of  the 
fundus,  as  seen  in  the  inverted  image,  are  some  of  the  best  yet 
published.^ 

1  '  British  and  For.  Med.-Cliir.  Rev.,'  xi,  433.  London,  1853.  See  also  the 
review  of  the  2nd  ed.  in  vol.  xxix,  319,  1862. 

2  The  second  figure  on  the  second  plate  must  be  wrongly  named,  and  the  third 
figure  on  the  same  plate  does  not  represent  a  typical  case  of  retinitis  pigmentosa. 
The  first  figure  on  the  next  plate  represents"  retinitis  albumiuurica  most  success- 
fuUy. 


1875.]  Operative  Surgery  of  the  Eye.  5 

The  progress  of  operative  ophthalmic  surgery  has  heen  much 
promoted  by  the  use  of  anaesthetics,  and  by  fixation  of  the  eye 
and  eyelids.  Pain  and  pressure  on  the  eye  are  objections  to 
fixation,  but  the  former  can  be  annihilated  by  an  anaesthetic, 
and  the  latter  to  a  dangerous  extent  is  usually  the  fault  of  the 
operator  or  his  assistant.  Many  minor  operations,  such  as 
paracentesis,  the  needle  operation  for  cataract,  and  removal  of 
foreign  bodies  from  the  cornea,  can  be  and  are  continually 
performed  without  these  auxiliaries,  yet  in  unsteady  or  very 
young  patients  the  necessary  manipulations  are  much  facilitated* 
and  rendered  more  exact  by  their  use. 

Peritomy  (excision  of  the  conjunctiva  around  the  cornea). 
Obstinate  pannus  was  often  treated  in  antiquity  and  in  the 
middle  ages  by  destruction  of  the  conjunctival  vessels.  Atten- 
tion was  called  again  to  this  treatment  in  1862  by  Furnari,^ 
who  advised  the  excision  of  the  conjunctiva  and  of  the  sub- 
conjunctival tissues  all  round  the  cornea,  so  as  to  completely 
denude  the  sclera,  and  the  free  application  of  the  nitrate  of 
silver  to  the  exposed  portion.  The  cauterization  has  been 
generally  abandoned  owing  to  the  risk.  Hirschberg  (Prof.  A.  v. 
Graefe's  *  klin.  Vortrage  '.  .  .  .  herausg.  v.  J.  Hirschberg,  i,  232, 
Berl.,  1871)  says  that,  as  performed  by  Furnari,  the  operation 
has  destroyed  no  few  eyes.  Restricted  to  the  removal  of  a 
small  strip,  without  cauterization,  it  has  been  found  useful  by 
many  operators.  A.  von  Graefe  recommended  it  in  (1)  tracho- 
matous pannus  after  disappearance  of  the  granulations,  (2)  in 
certain  cases  of  the  diffuse  keratitis  of  scrofulous  children,  and 
(3)  in  the  corneal  infiltrations  tending  to  sclerosis  which  ac- 
company scleritis  and  sclerotico-choroiditis.  "  Peridectomy  is 
an  excellent  means  in  these,  and,  indeed,  in  all  sclerosing  in- 
flammations of  the  cornea."^  Meyer  has  had  very  satisfactory 
results  in  cases  of  diffuse  keratitis  in  adults,  where  all  other 
means,  employed  for  months,  had  failed.^  Wells  says*  that  in 
some  cases  of  the  very  dangerous  crescentic  ulcer  of  the  cornea 
"  great  advantage  has  been  derived  from  syndectomy,  either 
partial,  if  the  ulcer  was  but  of  slight  extent,  or  complete,  if  a 
considerable  portion  of  the  cornea  had  become  involved." 
Horner  has  succeeded  in  arresting  diffuse  interstitial  keratitis 
in  some  recent  cases  by  its  use.^ 

1  He  had  previously  recommended,  after  the  example  of  Scarpa,  the  removal 
*of  a  strip  of  conjunctiva,  a  line  broad,  from  the  circumference  of  the  cornea. 

(S.  Furnari,  '  Traite  pratique  des  Maladies  des  Yeux,'  p.  325.     Paris,  1841.) 

2  See  Brecht's  papers  on  Corneal  Peridectomy  in  the  'Deutsche  Klinik,'  1871, 
p.  189,  and  the  *  Archiv  fiir  Ophthalm.,'  xx,  1,  p.  113. 

3  1.  c,  p.  200. 

4  J.  S.  Wells,  'Treatise  on  Diseases  of  the  Eye,'  3rd  ed.,  p.  116.    Lond.,  1873. 
^  P.  Jackowlewa,  "  Ueber  keratitis  interstitialis  difBusa,"  Diss.   Zurich,  1873, 

quoted  by  Prof.  Saemisch  in  '  Handb.  d.»ges.  Augenheilk.,'  iv,  269.   Leipz.,  1875. 


6  Reviews.  [July, 

Median  incision  of  the  cornea  was  introduced  in  1869  by 
Saemisch^  as  a  means  of  treating  certain  spreading  ulcers  of  tlie 
cornea,  often  with  pus  in  the  anterior  chamber,  to  which  he 
gave  the  name  of  ulcus  corneae  serpens.  The  incision  passes 
vertically  through  the  whole  thickness  of  the  cornea,  and 
should  extend  beyond  the  ulcer  into  sound  tissue.  The  incision 
is  reopened  daily,  so  long  as  appears  necessary.  He  states  in 
his  pamphlet  that  he  had  so  treated  thirty-five  cases  with  only 
one  failure.  Nieden^  reports  eighty  cases  treated  by  division  ; 
of  these  fifty  were  accurately  noted.  The  treatment  failed  in 
only  two  cases  of  extensive  ulceration  (4%).  In  forty-two  cases, 
or  84  per  cent.,  the  progress  of  the  ulceration  was  arrested  by 
the  first  slitting,  the  same  result  being  obtained  in  six  cases  or 
12  per  cent.,  by  the  second  slitting ;  the  ciliary  neuralgia,  which 
was  more  or  less  severe,  ceased  at  the  same  time  in  all  these 
cases. 

**The  ultimate  result  was  in  thirty-five  cases  (70  percent.)  opacities 
of  the  cornea,  in  eleven  (22  per  cent.),  opacity  with  adhesion  of  the  iris, 
and  in  two  (4  per  cent.)  the  patient  did  not  return.'* 

Other  operators  have  employed  a  free  incision  in  spreading 
suppuration  and  infiltration  of  the  cornea.  Mr.  T.  P.  Teale 
has  published  a  series  of  very  interesting  cas  es^  to  show  "  that 
suppurative  affections  of  the  cornea  and  iris,  which  do  not 
rapidly  yield  to  atropine  and  opiates,  ought  to  be  dealt  with  by 
direct  incision  through  the  median  part  of  the  cornea  into  the 
anterior  chamber,  just  as  much,  as  a  matter  of  course,  as  one 
would  incise  a  whitlow  or  a  thecal  abscess." 

He  noticed — 

*•  That  on  incising  in  its  early  stage  a  circumscribed  abscess  in  the 
layers  of  the  cornea,  a  small  white  body  sometimes  escapes  from  the 
opaque  spot,  which,  when  placed  under  the  microscope,  proves  to  be 
broken-down  corneal  fibre,  infiltrated  with  pus;" 
in  fact,  a  corneal  slough,  like  the  core  out  of  a  boil.  He  asks — 

"May  we  not  hope  that  the  same  treatment  may  prove  to  be  of 
equal  value  in  threatened  sloughing  of  the  cornea  from  purulent 
ophthalmia,  in  the  exceptional  cases  of  glaucoma  which  iridectomy 
fails  to  relieve,  and  in  most  acute  affections  of  the  eye  which  threaten 
the  vitality  of  the  cornea?  " 

Some  forms  of  suppurative  keratitis  are  probably  due  to 
infection.  It  has  long  been  known  that  chronic  inflammations. 
of  the  lachrymal  sac  considerably  diminish  the  prospect  of 
success  in  extraction  of  cataract.     Saemisch's  remark  that  this 

1  T.  Saemisch,  '  Das  Ulcus  Cornese  Serpens.'     Bonn,  1870. 

2  Nieden,  "On  the  Treatment  of  Ulcus  Corneae  Serpens,"  in  the  'Archives  of 
Ophthalmology  and  Oto]ogy,'  iii,  1,  p.  238.     New  York,  1873. 

3  *Ophth.  Hosp.  Eeports,'  viii,  61.     Lond.,  1874. 


1875.] 


Operative  Surgery  of  the  Eye. 


relatively  common  disease  renders  even  very  slight  injuries, 
which  would  otherwise  have  produced  scarcely  the  least  effect 
on  the  eye,  most  dangerous,^  is  worth  remembrance  in  regard 
to  the  treatment  of  obstinate  cases  of  lachrymal  disease.  Hirsch- 
herg,2  in  80  per  cent,  of  the  cases  of  what  he  calls  torpid  in- 
filtration of  the  cornea,  found  blennorrhoea  of  the  lachrymal  sac 
of  old  date,  and  remarks  that  "  special  stress  is  to  be  put  on  the 
epithet  old ;  by  no  means  rarely  the  patients  in  question  are 
exceptionally  stinking,  with  inveterate  ozsena.  Rhinitis 
ulcerosa."  Saemisch  found  the  same  state  of  the  lachrymal  sac 
in  32  per  cent,  of  his  cases  of  ulcus  cornese  serpens  at  Bonn. 
Recent  experiments  of  Eberth,  Leber,  and  Stromeyer  have 
rendered  it  probable  that  the  blennorrhcea  is  even  more  closely 
connected  with  the  keratitis  than  had  been  supposed,  and  that 
possibly  the  process  is  due  to  infection  with  septic  substances 
contained  in  the  discharge  from  the  sac.  Partly  as  a  con- 
sequence, further  trials  have  been  recently  made  with  dis- 
infectants directly  applied  to  the  eye  (see  the  remarks  by 
Horner,  Schiess,  and  v.  Welz,  *  Klin.  Monatsbl.  fiir  Augenh.,'  xii, 
432.     Stuttg.,  1874). 

Staphyloma  cornece, — The  old  operation  of  excision  is  liable 
to  be  followed  by  considerable  loss  of  vitreous,  intra-ocular 
haemorrhage,  and  suppuration ;  the  result  being  a  small  and 
inefficient  stump.  For  these  reasons  the  wound  has  been  sutured 
by  Mr.  Wilde,  Mr.  Critchett,  and  others,  the  threads  being 
passed  through  the  sclera,  or  through  the  conjunctiva  and 
eniscleral  tissue  (Knapp),  or  simply  through  the  conjunctiva 
(Wecker).  It  has  been  objected  to  sutures  passed  through 
the  sclera,  that  they  "  sometimes  give  much  pain  and  keep 
up  inflammatory  symptoms  during  the  protracted  healing  " 
(Streatfeild,  1.  c,  p.  51).  Even  sympathetic  disease  of  the 
other  eye  is  said  to  have  been  excited  by  them  (Knapp  in 
'Arch,  fiir  Ophth.,'  xiv,  1,  273).  v.  Oettingen  records  a  case  in 
which  the  sutures  caused  an  extremely  painful  panophthalmitis 
(*  Jahresber.  iib.  d.  Leist.  u.  Fortschr.  im  Gebiete  d.  Ophth.,' 
1871,  p.  231,  from  the  '  Dorpater  Med.  Zeitschr.,'  Bd.  ii).  Ac- 
cording to  Anagnostakis,  excision  of  the  projection  with  sub- 
sequent suture  of  the  wound  is  mentioned  by  Celsus,  Galen, 
Paulus  -^Egineta,  and  Aetius.  Two  needles  were  passed  cross- 
wise through  the  base  of  the  staphyloma,  which  was  then 
excised ;  the  wound  was  closed  by  tightening  the  threads 
('  Annal.  d'Ocul.'  vol.  Ixviii,  1872).  Abscission  of  nearly  the 
anterior  half  of  the  eye  has  been  preferred  by  some  surgeons  to 
excision  of  the  staphyloma  alone. 

J  J  ^^  ^  g  • 

2  '  Klin.  Vortr./  p.  210. 


8  Reviews,  [July, 

"  The  object  of  the  operation  is  to  remove  a  useless  and  painful  or 
unsightly  feature,  and  to  gain,  instead  of  it,  a  low  stump  as  a  good 
foundation  for  an  artificial  eye.  If  we  are  careful  to  remove  the  lens, 
which  is  liable  to  chalky  and  other  degenerations,  and  the  ciliary  body, 
which  is  full  of  muscular  tissue,  nerves,  and  blood-vessels,  together 
with  the  offending  parts,  we  get  rid  of  future  sources  of  offence,  and 
very  much  lessen  the  chances  of  irritation  and  inflammation  in  it,  and 
of  sympathetic  irritation  and  inflammation  in  the  other."  (Streatfeild, 
1.  c,  p.  50.) 

A  greater  improvement  has  been,  however,  the  substitution 
of  enucleation  in  certain  cases.  Arlt  remarks  that  total,  even 
partial,  excision  is  dangerous,  when  the  eye  is  amaurotic  from 
increased  intra-ocular  pressure.  Beer  long  ago  opposed  the 
operation  in  cases  where  there  are  symptoms  of  what  he 
considered  cirsophthalmia,  which  we  now  call  secondary  glau- 
coma. During,  or  at  all  events  after,  the  operation,  the  veins 
at  the  outer  side  of  the  choroid  give  way ;  retina  and  choroid 
are  forced  forwards  through  the  wound,  with  excruciating  pain; 
excision  of  the  parts  prolapsed  is  usually  required  to  stop  the 
bleeding  and  relieve  the  suffering.  Then  comes  panophthal- 
mitis. In  such  cases  it  is  not  good  practice  to  excise  the 
staphyloma ;  the  eye  should  be  enucleated  (1.  c,  p.  377). 

Kiichler  preferred  (*  Neue  operat.  Heilmethode/  Braunschw., 
1853,  quoted  by  Arlt,  p.  379)  as  a  certain  cure  at  any  stage  of 
total  staphyloma,  division  of  the  projection,  evacuation  of  the 
lens,  and  a  frequent  reopening  of  the  wound.  His  directions 
have  been  strictly  observed  by  Arlt,  who  has,  however,  aban- 
doned this  treatment,  owing  to  the  occurrence  of  panophthal- 
mitis. For  the  same  reason  the  latter  surgeon  does  not  approve 
of  the  passage  of  a  thread  through  the  base  of  the  staphyloma. 

*•  If  the  thread  is  removed  too  early,  there  is  no  shrinking ;  if  it 
remains  till  there  is  greater  reaction,  especially  till  there  is  oedematous 
swelling  of  the  conjunctiva  bulbi  and  eyelids,  the  occurrence  of 
panophthalmitis  cannot  always  be  prevented"  (1.  c,  p.  379). 

Passing  over  opacities  of  the  cornea  with  the  remark  that 
Wecker  has  introd  uced  a  mode  of  colouring  them  with  indian  ink, 
and  has  found  that  both  appearance  and  sight  are  greatly  im- 
proved by  the  tattooing,  we  come  to  Conical  cornea.  Many 
attempts  have  been  made  to  improve  vision  in  this  affection. 
Arlt  says  in  respect  to  iridectomy  which  was  recommended  by 
von  Graefe  ('  Arch,  fiir  Gphth.,'  iv,  2,  271),  that  it  can  be  of 
use  only  when  the  projection  is  slight  and  does  not  extend  far 
towards  the  periphery  of  the  cornea,  or  when  the  object  is  to 
nse  a  latent  portion  for  the  attainment  of  tolerably  good  vision. 
He  thinks  it  probable,  from  four  cases   operated  on  during  the 


1875.]  Operative  Surgery  of  the  Eye.  9 

first  year  of  existence  of  this  disease,  that  its  progress  may  be 
arrested  by  early  iridectomy  (from  the  pupillary  to  the  ciliary 
edge).  A  year  later  the  disease  was  stationary  in  two  eyes, 
and  in  the  other  two  there  was  an  improvement  in  comparison 
with  the  state  before  the  operation  (1.  c,  p.  344).  Other 
methods,  such  as  iriddesis  (Critchett,  Bowman),  production 
of  a  contracting  cicatrix  (v.  Graefe),  excision  of  a  small  portion 
of  the  apex  (Bader,  Galezowski,  Bowman,  Wecker),  have  also 
been  tried.  It  must,  however,  be  admitted  that  all  these 
proceedings  are  yet  upon  their  trial. 

Corelysis. — Mr.  Streatfeild,  who  introduced  this  operation, 
says : 

**  If  iris  adhesions  be  few  in  number,  tbree  or  four  perhaps,  and 
these  be  not  wide,  if  the  iritis  have  occurred  but  once,  at  least  two  or 
three  months  previously,  and  the  iris  seem  otherwise  healthy,  able  and 
ready  to  dilate,  as  much  as  could  be  expected,  considering  the  adhesions, 
under  the  influence  of  atropine,  and  the  latter  remedy  have  been  fairly 
tried  (a  drop  of  a  strong  ^lution  placed  in  the  eye  three  or  four  times 
a  day  for  a  week)  and  have  failed,  I  have  been  in  the  habit  of  detaching 
them  with  a  spatula-hook  passed  between  the  iris  and  the  lens.  There 
is  no  fear  of  wounding  the  lens.  But,  now,  unless  circumstances  be 
altogether  favorable,  according  to  the  above  data,  I  am  afraid  of  lighting 
up  a  fresh  iritis,  and  of  getting  readhesions  after  the  detachment  has 
been  done."^ 

The  propriety  of  any  operative  proceeding  is  questionable  in 
such  cases,  and  the  surgeon's  decision  will  evidently  be  largely 
influenced  by  the  greater  or  less  importance  attributed  by  him 
to  a  few  narrow  adhesions,  von  Graefe's  views  have  been 
much  exaggerated  by  some  surgeons ;  what  he  asserted  about 
numerous  broad  synechise  has  been  extended  to  all  cases.  He 
considers  the  recurrence  of  iritis  to  be  chiefly  due  to  the  former; 
yet  the  emphatic  manner  in  which  he  speaks  of  the  kind  of 
adhesion  seems  to  have  been  often  overlooked. 

*'  The  existence  of  posterior  synechia  is  in  most  cases  the  true  cause 
of  the  tendency  to  recurrence.  Iritis  cured  without  posterior  synechia 
seldom  evinces  any  tendency  to  recur.  Iritis  with  slight  and  extensible 
adhesions  sometimes  recurs,  but  in  comparatively  few  cases.  Iritis 
with  many  broad  adhesions,  resisting  all  artificial  mydriasis,  will  very 
generally  recur,  and  there  is  scarcely  any  exception  to  this  rule  when 
synechia  posterior  totalis — a  perfect  exclusion  of  the  pupil  by  exuda- 
tion— has  occurred. "2 

On  the  other  hand,  excellent  surgeons,  as  Arlt  and  Schweigger, 

1  Loc.  cit.,  p.  29. 

2  •'  Three  Memoirs  on  Iridectomy,"  p.  252,  New  Syd.  Soc.,  1859.  It  deserves 
mention  that  v.  Grafe  afterwards  adopted  the  more  correct  appellation  of  annular 
synechia  for  these  cases  :  see  the  *  Ophthalmic  Review,'  i,  23 — 25. 


10  Reviews.  [July> 

attribute  scarcely  any  influence  in  this  respect  to  adhesions  that 
are  insufficient  to  cause  exclusion  of  the  pupil.  Arlt  says 
(I.e.,  p.  346): 

"It  cannot  be  unconditionally  admitted  that  the  existence  of 
posterior  synecbise  is  the  chief  cause  of  iritic  recurrences.  The  syn- 
echiae  can  be  counted  only  among  the  causes  of  recurrence.  Posterior 
synechiae,  even  though  broad  and  inextensible,  cannot  in  and  by  them- 
selves indicate  iridectomy  or  any  other  operation  ;  the  inflammation 
must  have  ah-eady  recurred,  or  at  all  events  threatened  (persistent  or 
frequently  recurring  sensibility  to  light  and  exertion,  pain  or  tension 
in  the  eye  or  its  proximity,  slight  redness  induced  by  occupation, 
change  of  temperature,  or  mental  excitement)  :  we  should,  besides, 
investigate  the  state  of  the  other  eye  and  general  condition,  and  whether 
any  consequent  indication  should  be  attended  to  previously  or  at  the 
same  time.  Iridectomy  can  remove  only  what  may  be  termed  a 
mechanically  acting  cause.  It  will  very  often  disappoint  both  us  and 
the  patient  if  we  ask  more. 

"When,  for  example,  a  patient  with  chronic  iritis  and  synechias  is 
syphilitic,  we  should  certainly  not  be  content  to  perform  iridectomy 
alone.  Many  suff"erers  from  chronic,  frequently  recurring  iritis  show 
indisputable  signs  of  scrophulosis  ;  in  other  cases  of  the  kind  we  have 
to  do  with  people  whose  nutrition  has  been  impaired  by  privation  or 
weakening  influences.  (For  example,  irido-cyclitis  after  famine- 
typhus).  Both  eyes  are  attacked  in  such  cases,  one  after  the  other, 
generally  in  striking  symmetry,  yet  we  are  not  usually  justified  in 
considering  the  affection  of  the  second  eye  to  be  due  to  sympathy.  I^ 
have  been  able  to  watch  for  years  many  patients  on  whom  the  opera- 
tion has  been  performed  for  this  reason.  There  has  mostly  been  no 
subsequent  attack.  In  many,  however,  there  has  been  a  recurrence 
once  or  more  at  some  later  period,  notwithstanding  a  perfect  opera- 
tion and  healing  of  the  wound.  The  recurrent  inflammation  has 
been  attended  by  pericorneal  injection,  discoloration  of  the  iris,  dotted 
opacities  on  the  membrane  of  Descemet,  and  more  or  less  haziness  of 
the  vitreous,  whilst  the  coloboma,  large  and  reaching  to  the  periphery, 
has  not  changed.  On  the  other  hand,  I  have  seen  many  patients  for 
years  (one  from  his  34th  to  his  55th  year),  whom  I  had  treated  for 
bilateral  iritis,  and  in  whom  both  eyes,  not  only  the  one  iridectomised, 
but  also  the  one  with  numerous  synechias,  have  continued  free  from 
inflammation. 

*  Idiopathic  iritis  is  closely  related  to  another  form  of  disease,  the 
only  difference  during  the  attack  and  throughout  their  course  being 
the  frequent  recurrence.  Such  patients  are  for  an  uncertain  period 
liable  to  recurrences  of  iritis,  the  duration  of  the  intervals  and  the 
severity  of  the  inflammation  being  uncertain.  We  cannot  then  be 
surprised  that  as  the  rule  they  present  a  number  of  iritic  adhesions. 
Yet  this  fact  alone  supports  the  assertion  which  is  pretty  generally 
admitted,  that  the  synechiae  are  the  cause  of  recurrence.'  *Tiie 
possibility  of  such  a  causal  relation  cannot  of  course  be  denied,  yet 
the  individuals  with  extensive  posterior  synechia  who  do  not  suffer 


1875.]  Operative  Surgery  of  the  Eye.  11 

from  recurrent  iritis  are  too  numerous  for  the  mechanical  influence  of 
the  adliesions  to  be  blamed  without  more  ado  as  the  cause  of  recurrence, 
and  on  the  other  hand  recurrence  takes  place  quite  independently  of 
synechise.  I  have  met  with  cases  treated  adequately  by  atropine  from 
the  very  commencement,  where  no  adhesions  were  left,  and  yet  in 
which  there  were  frequent  recurrences  without  any  assignable  cause 
such  as  syphihs.'i     I  have  repeatedly  seen  the  very  same." 

Arlt  is,  consequently,  not  favorable  to  corelysis. 

"I  have  hitherto  preferred  iridectomy  when  any  operation  was 
required.  Even  the  excision  of  a  small  piece  of  the  sphincter  relaxes 
the  parts  fixed  by  synechiee.  Iridectomy,  as  we  shall  see  in  respect  to 
glaucoma  (§  101),  modifies  at  the  same  time  the  circulation  of  the 
uveal  tract,  and  this,  not  to  speak  of  medical  and  dietetic  treatment,  is 
certainly  of  more  importance  when  '  there  is  a  tendency  to  recurrence,* 
than  the  removal  of  any  dragging,  which  may  be  imagined,  but  is,  at 
all  events,  not  directly  proved  '*  (1.  c,  p.  348). 

Two  slightly  different  methods  of  separating  the  adhesions, 
one  by  a  very  small  incision,  the  synechias  being  torn  by  a  hook 
(spatula-hook,  Streatfeild),  the  other  by  a  larger  incision  for  the 
introduction  of  forceps  (Passavant),  have  been  employed.  In 
addition  to  the  older  observations  of  Streatfeild,  Weber,  and 
Hasner,  we  may  notice  that  Passavant  operated  more  than  fifty 
times  according  to  the  second  method  without  any  accident ;  he 
separated  a  single  adhesion  at  a  time  Q  Arch,  fiir  Ophth.,'  xv, 
1,  p.  259,  Berl.,  1869).  He  has  been  followed  by  Mauthner 
('Wiener  Med.  Presse,'  quoted  in  *  Jahresbericht  iiber  d.  Leist. 
und  Fortschr. im  Gebiete  d.  Ophthalm.,'  ler  Jahrg.,  1870,  p.  303) , 
who  has  operated  many  times  and  always  with  good  results; 
and  by  A.  Reuss  (ibid.,  p.  304),  who  thus  treated  a  case,  in 
which  there  was  a  dense  pupillary  membrane,  with  the  eflfect  of 
improving  the  vision ;  a  part  of  the  edge  of  the  pupil  remained 
free  and  the  membrane  shrank  considerably.  Wecker,  on  the 
other  hand,  rejects  the  operation  because  he  finds  that  it  usually 
results  in  adhesion  of  the  iris  to  the  cornea  ('  Wiener  Med. 
Wochenschr.,'  quoted  in  the  '  Jahresbericht  iib.  d.  Leist., 
u.  s.  w.,'  2er  Jahrg.,  1871).  To  this  Passavant  replies  that 
if  his  operation  is  performed  exactly  according  to  his  direc- 
tions, it  has  no  bad  effect.^  Finally,  we  have  two  short 
but  interesting  communications  to  the  American  Ophthal- 
mological  Society  ('  Trans.,'  7th  annual  meeting,  p.  67, 
New  York,  1871 ;  and  8th  annual  meeting,  p.  130,  New  York, 

^  Schweigger,  '  Handbuch,'  1871,  p.  321. 

2  Profi  Nagel  (ibid.,  p.  304)  has  operated  repeatedly  with  a  good  result.  Twice 
the  posterior  was  replaced  by  an  anterior  adhesion ;  in  one  case  the  latter  was 
again  easily  separated.     The  iris  sometimes  readhered  to  the  capsule. 


12  Reviews.  [July, 

1871).  From  these  we  learn  that  the  operation  was  performed 
on  nine  eyes  in  eight  patients ;  that  there  were  twenty -four 
operations,  and  that  more  than  one  adhesion  was  separated  on 
some  occasions  :  that  the  adhesions  numbered  from  one  to  at 
least  five  (in  one  case  perhaps  annular,  and  "  pupil  covered 
with  a  film  of  deposit  ") ;  they  are  thrice  noted  as  broad  or 
strong.  The  result  was  a  free,  movable  pupil  in  six  eyes,  and 
in  one  it  was  circular ;  in  respect  to  two  the  result  is  not 
stated.  The  only  accident  was  the  escape  of  some  blood  into 
the  anterior  chamber  in  one  case.^ 

Iridodesis. — Adams  (1812)  and  Himly  (1816)  recommended 
displacement  of  the  pupil  by  means  of  a  small  prolapse  left  in 
the  corneal  wound  (Iridenkleisis.)  van  Onsenoort  (1822)  punc- 
tured the  sclera  for  this  purpose.^  It  was  recommended  and 
often  used  by  Tyrrell  (see  the  chapter  "  of  changing  the  natural 
position  of  the  pupil,"  in  his  book,  ii,  499,  Lond.  1840)  in 
conical  cornea  and  central  leucoma.  Mr.  Critchett  revived  the 
operation  and  rendered  its  immediate  result  certain  by  ligaturing 
the  prolapsed  iris.  Thus  modified,  it  became  known  asiridesis, 
iriddesis  or  iridodesis.  It  was  employed  in  leucoma  of  the 
cornea,  stationary  partial  cataracts,  lateral  displacement  of  the 
lens,  and  conical  cornea.  The  operation  in  itself  proved  all 
that  could  be  desired :  thus,  for  example,  the  pupil  was  dis- 
placed from  behind  an  opacity  to  opposite  a  clear  portion  of 
the  cornea,  and  in  many  cases  this  was  in  each  respect  a 
decided  gain.  Unfortunately  it  has  been  found  that  serious 
diseases  may  arise  from  the  synechia,  even  long  after  the  ope- 
ration. Such  cases  have  been  recorded  by  A.  Graefe  (^  Arch.  f. 
Ophth.,'  ix,  3,  p.  199),;Steffan  (Ibid.,  x,  i,  p.  122),  M.  Gruber 
(a  case  under  A.  Rothmund  in^  '  Deutsche  Klinik,'  1866,  p.  149, 
and  '  Ophth.  Review,'  iii,  284),  &c.4 

1  There  are  some  inaccurate  statements  in  these  papers.  In  the  first  Dr. 
Jeffries  speaks  of  13,  and  in  tlie  second  of  scMien  operations,  whilst  according  to 
the  details  given  there  were  12  in  each. 

2  He  perforated  the  sclera  with  a  needle,  one  line  from  the  edge  of  the  cornea, 
passed  the  hook  along  the  posterior  part  of  the  iris  till  its  point  was  seen  through 
the  pupil,  and  withdrew  the  pupillary  edge  of  the  iris,  strangulating  it  in  the 
wound.  He  says  that  he  has  repeatedly  performed  this  operation  with  the  hest 
result ;  he  has  thus  operated  even  on  the  two  eyes  of  a  patient.  A.  G.  van 
Onsenoort,  '  Genees-en  heelk  Handboek  over  de  Oogziekten,'  2e  deel.,  p.  454, 
Amsterd.,  1840.  Coloured  plate  of  his  first  case  in  the  '  Annales  de  la  Medecine 
Physiologique,'  t.  ii,  p.  97.     Paris,  1822. 

3  Compare  the  account  of  the  same  case  in  Worlitschek's  '  Mittheilungen.* 
1866. 

4  Horing, "  Three  cases  of  Irido-Cyclitis  after  Iridodesis,"  in  one  case  both  eyes 
were  lost,  '  Klin.  Monatsbl.  fiir  Augenh.,'  1865,  p.  42,  and  'Ophth.  Eeview,'  ii, 
208.  Rydel,  "  Purulent  Iridocyclitis  fifteen  months  after  the  operation,"  Tetzer, 
Kydel,  and  Becker,  *  Bericht  iiber  die  Augenklinik  der  Wiener  Universitiit,' 
1863-65,  p.  80.     Wien,  1867. 


1875.]  Operative  Surgery  of  the  Eye.  13 

Arlt  says  (1.  c,  p.  345)  that  not  only  may  purulent  irido- 
cyclitis spring  from  the  cicatrix,  months,  even  years  after  the 
operation,  but  what  is  still  worse,  sympathetic  irido-cyclitis  of 
the  other  eye  rnay  be  excited.    Streatfeild  remarks  : 

*'  But  by  this  method  of  proceeding  the  ultimate  results  are  often 
very  unsatisfactory  :  the  iris  is  confined,  and  a  low  chronic  recurrent 
iritis,  &c.,  may  be  set  up,  which  leads  to  far  worse  results  than  the 
state  of  things  which  the  operation  was  intended  to  remedy.  These 
artificial  anterior  synechise  seem  to  be  as  pernicious  as  are  the  common 
iritic  posterior  synechiae.  We  have  recently  seen  many  instances 
illustrative  of  this  disagreeable  truth.  An  excision  of  iris  is  a  far  safer 
though  less  attractive  operation"  (1.  c,  p.  24). 

The  consequence  has  been  that  many  surgeons  have  entirely 
abandoned  its  use^  and  treat  conical  cornea,  in  which  it  some- 
times gave  very  good  results,  by  other  means  (see  ante),  and 
replace  it  in  other  cases  by  iridectomy  or  iridotomy. 

Iridectomy. — The  incredulity  with  which  many  surgeons 
received  the  announcement  that  this  operation  would  arrest 
such  diseases  as  irido-choroiditis  and  glaucoma  seems  to  have 
almost  disappeared,  kw  examination  of  the  principal  treatises 
published  and  of  the  statistical  tables  of  operations  performed  by 
various  surgeons  during  the  last  ten  years  shows  that  the 
indications  given  are,  with  some  slight  modifications  and 
limitations,  generally  followed. 

What  are  these  indications  ?  What  were  the  changes  intro- 
duced by  Von  Graefe  ?  "  One  of  the  first  changes  in  the  second 
period  was  the  employment  of  the  operation  in  the  very  large 
class  of  cases  in  which  the  patient  can  see  perfectly  with  one 
eye,  the  other  being  more  or  less  diseased.  So  long  as  the 
ultimate  results  of  the  operation  remained  very  uncertain,  no 
one  would,  of  course,  recommend  its  adoption,  provided  the 
patient's  other  eye  was  sound.  When,  however,  better  methods 
of  operating  had  become  more  generally  known,  and  success 
could  reasonably  be  expected,  many  surgeons  began  to  operate, 
also,  in  cases  where  the  vision  was  perfect  on  the  other  side. 
Thus,  Prof.  A.  von  Graefe,  who  had  adopted  iridectomy  in  all 
cases  as  the  only  means  of  making  artificial  pupils  with  cer- 
tainty, utterly  rejecting  division  of  the  iris,  or  separation  of  it 
from  its  ciliary  attachments,  had,  before  1856,  performed  it  in 
more  than  300  cases  of  blindness  limited  to  one  eye,  the  other 
being  sound.  The  question  may  be  considered  as  settled  since 
the  time  when  he  published  his  paper  (' Archiv  Ophth.,'  ii,  Abth. 
2,  p.  193 ;  and  'Med.  Times  and  Gaz.'  1857,  ii,  267),  in  which  he 
showed,  by  an  analysis  of  these  cases,  that  in  some  persons" 
there    resulted    binocular    vision    with    its    many   important 


14  Reviews.  [July, 

advantages,  such  as  the  accurate  estimation  of  distance ;  that 
in  the  less  successful  cases,  the  appearance  of  the  patient  was 
improved,  and  the  field  of  vision  enlarged  ;  that  even  if  squint 
or  double  vision  occurred,  they  were  quite  amenable  to  treat- 
ment ;  in  short,  that  it  was  always  advisable  to  operate  on  the 
blind  eye,  the  other  being  healthy,  provided  the  artificial  pupil 
could  be  made  in  a  tolerably  central  position. 

"  In  the  very  next  paper  in  the  same  journal  we  meet  with 
the  celebrated  article  in  which  von  Greefe  recommended  iridec- 
tomy in  a  great  number  of  diseases,  with  an  entirely  different 
object  from  the  one  of  allowing  light  to  pass  to  the  retina ;  and 
this  essay  was  soon  followed  by  two  others,  published  in  1857 
and  1858  respectively,  in  which  he  still  further  extended  its 
applications.  As  translations  of  these  papers  have  been  pub- 
lished by  the  New  Syd.  Soc,  it  would  be  quite  superfluous  for 
me  to  do  more  than  rapidly  to  enumerate  the  cases  for  which 
Graefe  recommended  this  operation.  Instead  of  taking  them 
in  the  order  in  which  they  are  mentioned  in  these  papers,  it 
will  be  better,  I  think,  to  classify  them  under  four  heads.  1. 
As  a  prophylactic,  to  prevent  future  attacks  of  iritis,  or  the 
extension  of  iritic  disease  to  the  choroid;  to  avoid  the  evil 
effects  of  the  pressure  of  a  swollen  lens,  either  after  cataract 
operations  or  in  accidents;  in  certain  cases,  to  prevent  sympa- 
thetic disease  of  the  other  eye.  2.  To  relieve  inflammation,  or 
even  only  violent  pain,  as  in  some  cases  of  choroidal  inflamma- 
tion, in  iritis  resisting  other  treatment,  in  corneitis  where  there 
is  extensive  ulceration,  in  sympathetic  disease  of  a  previously 
sound  eye.  S.  To  diminish  in  some  cases  the  intraocular 
pressure,  as  in  glaucoma,  staphyloma,  &c.  4.  As  the  best 
means  of  removing  small  foreign  bodies  impacted  in  the  iris."^ 

The  assertion  that  these  indications  are  generally  followed 
may  be  proved  by  a  reference  to  almost  any  recent  treatise,  and 
scarcely  calls  for  further  remark,  A  short  account  of  some 
statistics  more  particularly  full  and  reliable,  may  illustrate  the 
present  practice.  (See  also  Cohn,  '  Vorarbeiten  fiir  eine  Geogra- 
phic der  Augenkrankheiten.'     Jena,  1874.) 

Dr.  A.  Rothmund,  junior,  performed  iridectomy  89  times  out 
of  a  total  of  420  operations  in  1864 :  he  distinguishes  the  results 
as  good,  moderate,  or  none. 

Good,  Moderate.  None. 

For  restoring  vision        .         .         .     49     .     .     28     .  .     15     .  .  6 

As  an  antiphlogistic        .         .         .     30     .     .     16     .  .     10     .  .  4 

Preparatory  to  cataract-extraction .     10     .     .     10     .  .     —     .  .  — 

89 54 25 10 

1  T.  Windsor,  "  The  Operation  for  Artificial  Pupil :  its  history  and  present 
state,"  •  Brit.  Med.  Journal,'  1862,  ii,  464. 


1875.] 


Operative  Surgery  of  the  Eye. 


15 


It  was  performed  as  an  antiphlogistic  7  times  in  inflam- 
mation of  the  iris  and  choroid,  thrice  for  continually  increasing 
posterior  synechise,  once  in  ulcer  of  the  cornea,  and  19  times  in 
glaucoma  (3  acute,  6  subacute,  and  10  chronic).  The  result 
was  always  very  good  in  acute  glaucoma.  In  the  other  cases 
the  vision  was  decidedly  improved  only  9  times.  In  one  case  of 
subacute  glaucoma  intra-ocular  haemorrhage  took  place  during 
the  night  after  the  operation  and  ended  in  atrophy  of  the  eye.^ 

Dr.  A.  Mooren  performed  MO  iridectomies  in  the  year,  1865- 
QQ,  out  of  a  total  of  665  greater  operations,  of  which  he  gives 
the  following  table ;  the  figures  i,  ii,  show  that  the  operation 
was  performed  on  one  or  both  eyes : 


I. 

II. 

L  eucom a  cornese  centrale  vel  cicatrix  adbcGrens  .         .     46     . 

8 

Pra^cipltata  plumbea 

1     . 

— 

Pterygium 

1     . 

— 

Symblepharon 

^ 

2     . 

— 

Ulcus  rodens  cornese    .... 

1     . 

— 

Abscessus  vel  ulcus  cornea)  cum  hypopio 

13     . 

— 

Vuluus  cornese 

2     . 



Cicatrix  cornea)  ectatica 

4     . 

— 

Perforatio  cornea)  cum  prolapsu  iridis 

6     . 



Corpus  alienum  in  iride 

1     . 

— 

Kerato-iritis 

6     . 

— 

Iritis  parencbymatosa 

13     . 

1 

Irido-cyclitis 

3     . 

— 

Irido-choroiditis 

23     . 

1 

Irido-cboroiditis  sympatbica 

2     . 

Cboroiditis 

3     . 



Glaucoma 

15     . 

4 

Cataracta  accreta         .... 

6    . 

„         traumatica  .... 

18     . 



Iridectomia  cum  extractione  cataracta^ 

2     . 



„            cum  extr.  linear!  per  corneam 

11     . 

1 

„            prseparatoria  pro  extr.  catar. 

9     . 

6 

„           cum  extract,  catar.  secundaria) 

6     . 

2 

Total 


194 


23 


The  240  iridectomies  were  performed  on  213  eyes;  in  9 
cases  the  operation  was  repeated  twice,  in  3  thrice.  In  the  first 
four  diseases  it  was  indicated  for  simply  optical  purposes.^ 

De  Wecker  in  Paris  had,  in  the  second  half  of  1871,  61  iridec- 
tomies— 28  optical,  S^  antiphlogistic — out  of  a  total  of  248 
operations  : 


^  K.  "VVorlitschek,  *  Mittbeilungen  aus  der  Heilanstalt  fiir  Augenkranke  des 
Prof.  Dr.  A.  Rotbmund,  junr  zu  Miincben/  1860. 
2  A.  Mooren,  '  Opbtbabmiatriscbe  Beobachtungen,'  p.  179-181.     Berlin,  1867. 


16  Reviews.  [July, 


Results. 

Good.       None 

Optical— 

for  opacity  of  the  cornea  with  or  without  adhesion 

of  the  iris 

1}- 

19    .      5 

„     simple  closed  pupil 

„     congenital  cataract 

1     . 

—    .    — 

Antiphlogistic — 

for  partial  staphyloma  of  the  cornea 

4     . 

4     .     — 

„     recurrent  iritis            ...... 

4     . 



„     irido- choroiditis 

15     . 



,,     acute  glaucoma 

1     . 



„     simple  chronic  glaucoma 

9     . 

—     .     — 

In  3  of  the  cases  of  choroiditis,  patients  who  could  hardly  see 
to  walk  before  the  operation,  could  after  it  count  lingers  at 
twenty  feet.^ 

The  same  surgeon  had,  in  1872,  157  iridectomies  in  a  total  of 
630  more  important  operations. 

Optical — 

Opacity  of  the  cornea  .         .         .         .         .         .         .         .         .31 

Leucoma  adhaerens 11 

Simple  closed -pupil 10 

Congenital  cataract 2 

Post,  polar  cataract  .        .         * 2 

56 

A  NTIPHLOGISTIC — 

Corneal  abscess 1 

Partial  staphyloma  corneae 9 

Recurrent  iritis 8 

Irido-choroiditis 30 

Acute  glaucoma 3 

Glaucomatous  keratitis 1 

Chronic  glaucoma 36 

Wound  of  the  cornea  with  adh.  ii'is 10 

Displacement  of  the  lens         .         .         .      * 3 

101 

Dr.  J.  Hirschberg,  in  Berlin  Q  Berl.  kl.  Wochenschr.,'  1870), 
performed  29  iridectomies  in  25  patients  ;  4  times  for  glaucoma, 
thrice  for  abscess  of  the  cornea,  once  for  progressive  sclerosis 
cornese,  7  times  for  iritis,  and  the  rest  for  leucoma  corneae  and 
closed  pupil.  The  same  surgeon  reports  from,  September,  1870 
to  September,  1872,117  iridectomies;  72  antiphlogistic,  44 
optical,  and  1  for  removal  of  foreign  body  from  the  iris.  (^  Klin. 
Beobacht.  aus  der  Augenheilanstalt,'  von  Dr.  J.  Hirschberg, 
p.  110.     Wien.,  1874.) 

1  "Releve  Statistique,"  par  G.  Martin,  in  the  *Annales  d'Oculistique,'  vol.  67, 
p.  157.     Brux.,  1872. 

2  "  Clinique  Ophthalmologique,  du  Dr.  de  Wecker,  h  Paris.  Releve  Statis- 
tique,"  par  le  Dr.  Georges  Mai'tin.    Paris,  1873. 


1875.]  Operative  Surgery  of  the  Eye.  17 

As  to  the  performance  of  this  operation  in  glaucoma  we  find 
that  in  the  St.  Petersburg  Eye  Hospital  during  the  four  years 
1860-63  there  were  95  cases  of  glaucoma  with  158  affected 
eyes  (39  men  and  56  women)  out  of  1943  in-patients. 

"The  cases  were  generally  treated  by  iridectomy — an  operation 
which,  indeed,  was  performed  101  times;  once  the  eyeball  was 
enucleated,  and  once  paracentesis  of  the  anterior  chamber  was  employed. 
In  respect  to  the  curative  action  of  iridectomy  on  the  glaucomatous 
process,  the  results  were  perfectly  satisfactory  .  .  .  The  operation  was 
performed  fourteen  times  in  glaucoma  consummatum,  when  there  was 
total  bhndness,  simply  for  the  purpose  of  reUevmg  severe  cihary  pains  ; 
87  operations  therefore  remain,  from  which  some  action  on  vision 
could  be  expected.  The  results  may  be  arranged  in  the  following 
manner :  Vision  was  improved  54  times ;  it  remained  just  as  before 
the  operation  26  times ;  and  7  times  it  deteriorated  after  the  operation, 
thrice  from  accidental  cataract,  the  lens  being  wounded  during  the 
operation,  and  four  times  from  advancing  atrophy  of  the  optic  nerve." 

The  cases  were  thus  distributed  :  Incipient  glaucoma  (pre- 
monitory stage)  10,  acute  glaucoma  12,  chronic  inflammatory 
glaucoma  57,  glaucoma  simplex  11,  secondary  or  complicated  5, 
and  eyes  lost  from  glaucoma  63.^ 

Dr.  L.  Rydel  has  given  a  full  account  of  the  cases  observed  at 
the  Ophth.  Clinic  of  the  Vienna  University  (^  Bericht  lib.  die 
Augenklinik  der  Wienier  Universitat,'  1863-65,  p.  132.  Wien, 
1867).  There  were  in  the  three  years  79  cases  (46  men  and 
33  women);  in  15  one  eye  was  affected,  in  64  both  were 
diseased  (or  in  all  143  eyes) ;  of  these  42  were  totally  lost. 
Iridectomy  was  performed  in  79  cases,  in  53  on  one  eye,  in  22 
on  both  eyes  (or  in  all  97  times) ;  90  times  with  the  view  of 
preserving  or  improving  vision,  7  times  on  account  of  violent 
pain,  &c.  The  results  were  as  satisfactory  as  could  be  expected 
with  one  exception.  Many  of  the  more  interesting  cases  are 
related  by  Dr.  Rydel  at  length.^ 

The  use  of  iridectomy  in  partial  staphyloma,  glaucoma 
simplex,  and  exclusion  of  the  pupil  deserves  some  further 
notice. 

Partial  staphyloma  of  the  cornea  and  projecting  corneal  cica- 
trices.— Beer  observed  so  long  ago  as  1806  that  the  prominence 
sometimes  receded  after  this  operation.  The  same  effect  was 
noticed  after  him  by  Rosas,  Heiberg,  and  Flarer.  Chelius,  jun. 
('  Staphyl.  der  Hornhaut,'  p.  48,  Heid.,  1847)  says  positively 
that,  if  possible,  an  artificial  pupil  should  be  made  in  every 

1  See  Dr.  Magawly,  "  Contribution  to  the  Clinical  History  of  Glaucoma," 
*  Ophth.  Eeview,'  i,  233,  from  the  *  St.  Petersb.  Med.  Zeitschrift,'  vi,  193,  1864. 

2  A  series  of  cases  of  iritis,  irido-choroiditis  and  glaucoma  will  be  found  in  the 
appendix  to  Bonders'  2nd  report.    Utrecht,  1861,  pp.  277-420. 

111.— LVI.  2 


is  Heviews,  [July, 

partial  staphyloma.  "  By  this  means  the  partial  staphyloma  is 
changed  into  a  simple  synechia  and  any  further  increase  pre- 
vented." Arlt  says  (1.  c,  p.  365)  that  a  conical  projection  is 
more  liable  to  be  followed  by  secondary  glaucoma  than  a  spherical 
one,  whether  partial  or  totah^  Perception  of  light  may  continue 
for  years  in  the  latter ;  it  is  lost  in  a  few  weeks  or  months  in  the 
former.  Von  Graefe  makes  some  important  remarks  in  his  last 
paper  on  glaucoma  (^Arch.  fiir  Ophth./ xv,  3,  p.  108,  and 
*  Ophth.  Hosp.  Reports,'  vii,  p.  92.  Lond.,  1871).  He  has  seen 
by  no  means  unfrequently  cicatrices  after  central  ulcers  from 
blennorrhoic,  diphtheritic,  or  pustular  ophthalmia,  where  there 
had  been  no  perforation,  followed  by  expansion  of  the  anterior 
chamber  and  ultimately  by  glaucomatous  tension. 

"  Inclusion  of  the  iris  much  intensifies  the  danger.     For  this  reason 
it  is  of  great  importance  to  prevent  synechia  anterior  in  perforating 
ulcers  and  wounds,  just  as  it  is  to  avoid  synechia  posterior  in  iritis.  As 
to  both  forms  glaucomatous  tension  follows  in  only  the  minority,  for- 
tunately for  the  patients,   yet  both  are  attended  by  permanent  risk  in 
every  case.     We  have  noticed  not  unfrequently,  that  eyes  affected  with 
synechia  anterior  or   leucoma  adhaerens,   after  being  good   for   many, 
many  years,  are  ultimately  attacked  by  glaucoma  on  the  approach  of 
old  age."     '*The  greatest  attention  must  be  paid  to  all  the  objective 
symptoms,  for  these   processes  usually  occur  during  childhood,  when 
no  great  reliance  can  be  placed  on  functional  examination,  and  the  effect 
of  the  treatment  depends  on  the  stage  of  the  disease.     It  is  indeed 
mournful  how  many  eyes,  after  escaping  entire  destruction  from  ulcera- 
tion, as  in  ophthalmia  neonatorum,  are  afterwards  rendered  blind  by 
secondary  glaucoma,  for  which   active  treatment  has  not  been  used  in 
time  ...  No  doubt  it  seems   desirable  for  many  reasons   to  postpone 
iridectomy  in  a  child.     Yet  there  is  one  urgent  indication,  never  to  be 
overlooked,  owing  to  which  the  operation  must  be  performed  at  any 
age  ;  that  is,  an  increase  of  the  intra-ocular  tension.  Its  first  symptom 
in    children  with  leucoma  is  usually  an  expansion  of    the    anterior 
chamber.  .  .  .  To  delay  in  leucoma  adhaerens  after  ophthalmia  neona- 
torum till  the  increased  tension  can  be  estimated  by  the  touch,  would 
usually  be  to  wait  till  too  late." 

Iridectomy  in  Glaucoma  Simplex. 

"  Whilst  the  operation  has  a  perfectly  uniform  effect  in  simple  in- 
flammatory glaucoma,  whilst  in  secondary  glaucoma  its  various  results 
may  be  naturally  deduced  from  the  nature  of  the  primary  cause,  we 
are  obliged  to  admit  that  cases  of  glaucoma  simplex  vary  extremely  in 
their  ultimate  course,  even  when  the  pre-existing  conditions  appear  to 
be  exactly  similar.  The  result  is  often  very  satisfactory  in  a  relative 
sense,  when  the  operation  is  performed  at  a  late  period  ;  I  mean  that 
after  six  or  seven  years  the  patients  continue  to  see  decidedly  better  than 
at  the  time  of  the  operation ;  in  some,  operated  on  at  an  early  period, 
the  vision  remains  for  many  years  in  the  same  state  then  gradually 


1875.] 


Operative  Surgery  of  the  Eye,  19 


deteriorates ;  in  some,  again,  the  disease  is  not  rendered  perfectly 
stationary ;  and  finally,  some,  fortunately  very  rare,  patients  become 
rapidly  blind  after  the  operation.  When  we  accurately  determine  and 
record  the  tension,  we  find  that  these  dijBferences  more  immediately 
depend  upon  its  variations.  Thus  iridectomy  reduces  the  tension 
directly  and  permanently  to  its  normal  amount  in  most  cases  of  simple 
glaucoma.  It  reduces  it  considerably,  but  does  not  render  it  quite 
normal  in  others ;  the  vision  usually  continues  in  the  same  state,  the 
eye  acquiring,  as  it  were,  a  sort  of  adaptation  to  a  moderate  increase  of 
tension  ;  yet  not  unfrequently  the  sight  becomes  again  worse  after  a 
time,  or  the  pressure  again  increases  slightly  and  gradually,  until  in 
either  event  by  a  second  operation,  which  I  shall  afterwards  describe, 
it  is  rendered  permanently  normal  and  the  vision  secured.  In  a  third 
series,  the  tension  is  normal  or  but  little  increased  soon  after  the 
operation,  whilst  at  a  later  period  there  are  from  time  to  time  consider- 
able increases,  which  do  not  always  permanently  yield  to  a  second 
operation.  Lastly,  iridectomy  is  sometimes  followed  by  greater  instead 
of  less  tension,  the  result  being  that  vision  is  lost  by  progressive  impair- 
ment or  by  a  sudden  attack  resembling  acute  glaucoma. 

*' Hence  it  would  almost  seem  as  if  iridectomy  had  such  an  uncer- 
tain effect  in  simple  glaucoma  as  to  render  its  indication  doubtful. 
This  conclusion  is  found  to  be  quite  erroneous  when  we  consider  the 
numerical  distribution  of  the  varieties  described.  It  has  been  already 
mentioned  that  in  more  than  half  the  cases,  a  single  operation  renders 
the  pressure  permanently  normal,  and  not  only  preserves,  but  even 
gradually  improves,  the  vision  for  a  long  period.  The  second  category 
includes  fully  one  fourth  of  the  cases,  and  though  our  object  cannot  be 
said  to  be  fully  attained,  yet  the  result  is  generally  satisfactory  ;  it  may 
be  necessary  to  repeat  the  operation  in  some  few  cases  in  order  to 
secure  permanent  snccess.  A  second  operation  sometimes  stops  the 
progress  of  the  blindness  in  the  third  category  where  the  disease  recurs  ; 
it  at  all  events  renders  the  deterioration  slower  in  comparison  with  the 
spontaneous  course.  The  last  variety  alone  is  thoroughly  unfavorable, 
blindness  being  hastened  by  the  operation.  Yet  this  '  malignant*  course 
is  extremely  rare ;  I  have  seen  it  fully  developed  only  five  times  in 
some  hundred  cases  of  simple  glaucoma  on  which  I  have  performed 
iridectomy.  Judging  not  only  by  my  own  practice  but  also  by  that 
of  others,  it  does  not  form  two  per  cent,  of  the  cases  of  glaucoma  sim- 
plex submitted  to  operation.  Now  an  operation  that  gives  permanent 
protection  from  blindness  in  more  than  90  per  cent.,  renders  the  course 
slower  in  the  majority  of  the  remainder,  and  does  harm  in  less  than 
two  per  cent.,  is  indisputably  indicated,  though  exceptional  bad  results, 
such  as  never  occur  in  an  analogous  manner  in  inflammatory  glaucoma, 
may  necessitate  prudence  in  the  prognosis '\(1.  c,  p.  99). 

Arlt  states  that  his  experience  is  essentially  the  same  (1.  c, 
p.  358). 

The  iridectomy  should  he  repeated  when  errors  in  the  opera- 
tion  or  after-treatment  appear  to   cause   the   continuance   or 


20  Reviews.  [July, 

recurrence  of  the  glaucomatous  pressure.  The  formation  of  a 
second  and  large  coloboma  at  the  diametrically  opposite  side  is 
also  advisable  when  the  tension  remains  great  or  again  increases 
after  the  first  operation. 

*'Many  comparative  trials  in  the  years  1865-67  proved  that  excision 
of  the  opposite  piece  of  iris  had  a  far  more  decided  effect  on  the  tension 
than  that  of  the  adjacent  (even  extremely  large)  portion  of  iris.  Tliese 
trials  were  made  a  few  times  when  both  eyes  were  in  almost  exactly 
the  same  state  ;  the  result  was  decisive,  for  excision  of  the  adjacent 
piece  had  afterwards  to  be  supplemented  by  that  of  the  opposite 
portion  of  iris.  I  must  indeed  confess  that  I  have  become  dubious 
whether  excision  of  the  adjacent  piece  has  any  influence  over  the 
tension  ;  it  is,  at  all  events,  very  slight,  and  will  generally  not  suffice 
in  cases  where  the  first  iridectomy  has  had  no  sufficient  or  permanent 
effect.  On  the  contrary,  I  could  adduce  at  least  a  dozen  cases  where 
excision  of  the  opposite  piece  has  had  a  permanent  effect  after  failure 
of  the  first  iridectomy.''     (von  Graefe,  1.  c,  p.  106.) 

'*A  man,  eet.  53  ;  left  eye  atrophied  from  glaucoma  ;  right  eye  with 
good  central  vision,  but  great  contraction  of  the  field  ;  in  the  spring 
of  1858  a  violent  inflammatory  attack  before  the  operation,  which  had 
been  already  arranged,  was  performed.  The  amount  excised  was  in- 
sufficient, owing  to  the  patient,  who  was  not  thoroughly  under  chloro- 
form, moving  when  the  iris  was  seized.  The  symptoms  continued, 
though  to  a  less  degree.  Operation  repeated  on  the  tenth  day ; 
patient  more  completely  chloroformed.  Coloboma  enlarged  downwards 
and  inwards.  Rapid  diminution  of  the  symptoms  of  pressure  and 
inflammation,  but  very  slow  improvement  in  vision,  which  had  sunk 
to  mere  perception  of  light.  Even  in  the  sixth  week  the  patient  did 
not  dare  to  walk  out  alone.  From  the  eighth  week  decided  improve- 
ment, so  that  in  the  autumn  Jager  No.  3  could  be  read  with  convex  10. 
Prom  that  time  till  now  (autumn,  1873)  no  change  whatever,"  (Arlt, 
1.  c,  p.  360.) 

Posterior  synechia. — Though  the  influence  of  isolated  adhe- 
sions in  respect  to  recurrences  of  iritis  is  not  estimated  so 
highly  by  many  surgeons  as  it  was  by  von  Graefe,  there  is  no 
doubt  of  the  correctness  of  his  assertion  that — 

**  exclusion  of  the  pupil  is  the  point  from  which  the  further  complica- 
tions proceed,  especially  chronic  choroiditis  (with  progressive  am- 
blyopia, and  in  the  end  atrophia  bulbi).  By  exclusion  of  the  pupil  I 
understand  simply  the  total  adhesion  of  the  pupillary  margin  with  the 
capsule."! 

Iridectomy  is  indicated  in  exclusion,  i.e.  posterior  annular  syn- 
echia, even  though  the  centre  of  the  pupil  is  clear,  and  the 
vision  relatively  good.  It  may  also  be  employed,  it  may  be 
indispensable,  in  blind  eyes  to  arrest  chronic  inflammation  of 
the  iris  and  ciliary  body,  and  to  prevent  further  changes,  even 

i  '  New  Syd.  Soc.  Monographs,'  p.  257.     Lond.,  1859. 


1875.]  Operative  Surgery  of  the  Eye,  21 

sympathetic  disease  of  the  other  eye.  The  prognosis  is  at  first 
good  ;  it  becomes  worse  when  (1)  glaucomatous  tension  and 
excavation  of  the  disc  occur  owing  to  serous  exudation  into  the 
posterior  chamber  and  vitreous  body ;  or  (2)  when,  on  the 
contrary,  the  vitreous  body  shrinks  from  the  very  beginning  or 
after  some  temporary  increase  of  tension,  and  the  retina  sepa- 
rates from  the  choroid  (contracting  exudations  on  the  inner 
side  of  the  ciliary  body  and  in  the  vitreous);  or  finally  (3),  when 
a  layer  of  exudation  between  the  capsule  and  iris  unites  them 
and  the  ciliary  processes  firmly  together  (total  posterior  syn- 
echia). In  the  latter  the  posterior  chamber  is  entirely  or 
almost  entirely  absent ;  it  may  be  abnormally  large  in  annular 
synechia.  Occasionally  the  operation  has  to  be  repeated  three, 
four,  or  five  times  before  the  disease  is  arrested,  and  a  sufficiently 
large  pupil  persists.! 

In  respect  to  the  complication  first  mentioned.  Von  Graefe 
says  ('  Ophth.  Hosp.  Rep.,'  vii,  77) : — 

"  Posterior  synechiae,  the  effects  of  iritis,  are  very  often  the  cause  of 
secondary  glaucoma.  As  a  general  rule,  we  may  say  that  the  danger 
of  ultimate  increase  of  tension  is  proportionate  to  the  extent  and 
number  of  the  adhesions,  though  occasionally  glaucoma  is  excited  by 
perfectly  circumscribed,  pointed  synechise.  The  degree  of  danger  is 
also  influenced  by  various  conditions,  such  as  the  age,  with  which  it 
increases.  On  the  other  hand,  the  tension  may  remain  normal  through- 
out life ;  this  is,  indeed,  numerically  speaking,  the  rule  even  when  the 
adhesions  are  numerous  and  extensive.  As  soon,  however,  as  they 
completely  encircle  the  pupil,  causing  exclusion,  the  tension  seems  to 
me  to  increase  almost  invariably.  There  must,  of  course,  be  no  mistake  ; 
the  most  careful  examination  will  sometimes  fail  to  show  minute 
apertures,  through  which  fluid  will  pass.  In  my  o^miou,  projection  of 
the  iris  by  ret?'o-iritic  fluid  is  the  only  sign  of  complete  exclusion. 
When  this  state  is  clearly  shown  by  the  well-known  prominences  of 
the  iris,  glaucoma  is  sure  to  ultimately  occur,  and  the  patient  is 
fortunate  if  it  is  not  already  present." 

The  use  of  iridectomy  has,  as  we  have  seen,  been  somewhat 
restricted  by  the  introduction  of  other  operations,  such  as 
median  incision  of  the  cornea.  It  seems  probable  that  it  will 
be  replaced  in  some  cases  by  iridotomy.  Wecker,  who  divides 
the  iris  with  forceps-scissors,  has  frequently  performed  the  opera- 
tion and  speaks  strongly  in  its  favour.  The  results  of  seven- 
teen cases  operated  on  by  Prof.  Rothmund  have  been  recorded 
by  Dr.  Garvens  (' Annales  d.  Ocul.,'  vol.  Ixx,  p.  123,  1873  ;  vol. 
Ixxi,  p.  115, 1874;  and  vol.  Ixxiii,  p.  118,  1875.  E.  H.  Garvens, 

1  Arlt,  1.  c,  p.  348.  The  case  at  p.  350,  quoted  evidently  from  memory,  is 
Bomewhat  incorrectly  reported,  if,  as  there  seems  no  reason  to  doubt,  it  is  the 
aame  as  Case  17,  in  'Bericbt  u.  d.  '  Augenkliuik  der  Wiener  Univ.,'  p.  72.  Wien, 
1867. 


22  Reviews,  [Ju^^ 

'Uber  die  Iridotomie.'  Miinchen,  1874;  many  historical  details 
will  be  found  in  this  pamphlet).  Many  operators  avoid  it  also 
in  the  acuter  stages  of  iritis  and  irido-choroiditis.  Arlt  expressly 
remarks,  to  prevent  misunderstanding,  that  it  should  not  be 
performed  in  iritis  or  irido-cyclitis  whilst  the  inflammation  is 
florid,  but  at  least  during  a  distinct  remission.  The  only  excep- 
tion is  when  increase  of  tension  forbids  longer  delay. 

Its  failure  is  well-nigh  constant  in  sympathetic  irido-cyclitis. 
Mr.  Critchett^  was  the  first  to  urge  that  enucleation  is  of  little 
or  no  value  when  sympathetic  ophthalmia  has  once  commenced, 
that  iridectomy  does  not  arrest  the  disease,  and  consequently 
that  operative  treatment  should  be  delayed  till  the  inflam- 
mation has  entirely  ceased.  Mooren,  Stellwag  and  Schweigger 
are  strongly  opposed  to  any  operation  before  the  end  of  the 
inflammation.  Mooren  thinks  that  iridectomy  in  the  progressive 
stage  hastens  the  destruction  of  the  eye.^ 

It  would  almost  seem  as  if  iridectomy  was  considered  by 
some  surgeons  to  be  free  from  all  danger,  yet  the  fact  is  that, 
however  well  performed,  it  may  be  followed  by  destruction  of 
the  eye.  Not  to  speak  of  such  accidents  as  traumatic  cataract, 
loss  of  vitreous,  cystoid  cicatrisation,  which  may  be  due  to 
defects  in  the  operation  or  after-treatment,  we  find  it  followed 
by  purulent  infiltration  of  the  cornea  (case  of  leucoma  adhserens, 
'St.  Petersb.  Med.  Zeitschr.,'  viii,  p.  50,  1865  ;  preliminary  to 
extraction  of  cataract,  Mooren,  *  Ophth.  Beobacht.,^  p.  181,  1867 ; 
V.  Graefe,  *  Arch,  fiir  Ophth.,'  xii,  i,  p.  214)  and  by  panoph- 
thalmitis (arising  from  a  cystoid  cicatrix,  von  Graefe,  '  Ophth. 
Hosp.  Rep.,'  vii,  p.  92 ;  in  leucoma  adh.,  Wecker,  'Clin.  Ophth.' 
p.  6.  Paris,  1873).  Sympathetic  disease  has  also  occurred 
(Arlt,  von  Graefe).  Mooren  counts  on  an  average  |  to  1  per 
cent,  of  such  unfortunate  results  (1.  c,  p.  181).  Desmarres  out 
of  161  ordinary  cases  of  artificial  pupil  lost  two  eyes  from 
chronic  irido-choroiditis  ending  in  atrophy,  and  had  one  case  of 
phlegmon  of  the  eye,  whilst  at  the  same  time  he  had  out  of 
twenty-eight  cases  two  of  phlegmon  from  iridectomy  in  blind 
eyes  C  Ann.  d.  Ocul.,'  vol.  xlvii,  p.  221,  1862). 

How  can  the  effect  of  iridectomy  be  explained  ?     Arlt  thinks 


1  '  Ophth.  Review,'  i,  178,  Lond.,  1865,  from  the  *  Klin.  Monatshl.  f .  Augenh.,* 
i,  440. 

2  '  Sympathische  Gesiehtsstorungen.*  See,  on  the  opposite  side,  H.  Miiller  in 
his  thesis  '  Zur  Casuistik  der  Cyklitis,'  p.  47-49,  Greifsw.,  1873.  Over-estimation 
of  iridectomy  sometimes  led  to  neglect  of  other  treatment.  E.  D.  Denis  (Etude 
8ur  la  Nature  et  le  Traitement  de  certaines  formes  d'irido-choroidite,'  Paris,  1873) 
gives  examples  of  the  good  effect  of  general  treatment  after  the  failure  of 
iridectomy.  He  advises  that,  when  due  to  a  dyscrasia,  it  should  be  treated  by 
appropriate  means,  any  operation  being  of  secondary  importance. 


1875.]  On  Inherited  Syphilis.  23 

scarcely  otherwise  than  by  its  influence  over  the  circulation  in 
the  iris  and  choroid.  We  have  to  account  for  two,  apparently 
opposite,  effects  ;  in  ihe  one  class  of  cases  it  causes  a  diminution 
in  the  intra-ocular  pressure,  whilst  in  the  other,  where  the  eye 
is  abnormally  soft,  it  is  followed  by  greater,  even  normal,  tension. 
He  quotes  some  recent  researches  by  Dr.  Exner,  Prof.  Briicke's 
assistant  ('  Sitzungsber.  d.  k.  Akad.  d.  Wiss.,'  B.  Ixv,  1872,  and 
*  Wiener  Med.  Jahrb.,'  1873).  Direct  anastomoses  hetioeen  the 
arteries  and  veins  were  found  in  the  iris  peripheral  to  the 
portion  which  had  been  excised  two  to  four  weeks  previously 
(dog,  rabbit).  If,  as  in  man,  the  iris  is  cut  off  on  the  pupillary 
side  of  the  circulus  art.  irid.  maj.,  the  proximal  portion  of  the 
larger  vessels  remains,  whilst  the  greater  part  of  their  branches 
and  capillaries  is  removed.  The  blood  cannot  circulate  as 
before ;  large  anastomoses  are  formed,  probably  by  dilatation 
of  previously  existing  minute  vessels,  so  that  the  arterial  blood 
passes  at  once  into  the  veins,  without  the  intervention  of  any 
proper  capillary  system.  Should  these  researches  be  confirmed, 
the  explanation  would  be  easy  of  many  practical  points  ;  thus 
a  broad  coloboma  would  increase  the  number  of  anastomoses, 
whilst  total  removal  of  the  iris  from  its  ciliary  attachment  would 
rather  increase  than  diminish  the  intra-ocular  tension. 

Thomas  Windsor. 


II. — On  Inherited  Syphilis  .^ 

It  may,  we  suppose,  be  stated  as  a  general  rule  that  our 
interest  in  a  disease  is,  or  ought  to  be,  in  proportion  to  the 
frequency  of  its  occurrence  ;  for  the  more  common  a  disease,  the 
greater  is  the  amount  of  suffering  it  produces,  the  more  often 
shall  we  have  to  attack  it,  and  the  more  important  therefore  is 
it  that  we  should  understand  its  nature  and  its  treatment. 
Inherited  syphilis  certainly  has  this  claim  upon  our  attention ; 
but  it  has   also  another,  quite  as  important,  namely,  its  amen- 

1  1.  Hare  Cases  of  Congenital  Syphilis.   By  L.  D.  Bulklet,  M.D.,  A.M.    New 

York.     1874. 

2.  Cases  of  Disease  of  the  Nervous  System  in  Patients  the  Subjects  of  Inherited 
Syphilis.     By  J.  Htjghlings  .Tackson,  M.D.     London.     1868. 

3.  On  Dactylitis  Syphilitica,  toith  Observations  on  Syphilitic  Lesions  of  the 
Joints.     By  R.  W.  Tayloe,  M.D.    New  York,  1871. 

4.  On  Pseudo-paralysis  due  to  a  Lesion  of  the  Bones  in  Infants,  the  Subjects  of 
Inherited  Syphilis.    Pakeot,  in  *  Archives  de  Physiologie,'  1872. 

5.  London  Medical  Record,  vol.  i,  p.  10.  Summary  of  Contributions  to  the 
Knowledge  of  the  Pseudo-paralysis  of  Inherited  Syphilis.     By  S.  Geb,  M.D^ 


24  Reviews.  [July* 

ability  to  treatment.  It  is  one  of  the  commonest  diseases 
affecting  the  children  of  the  poor  ;  but  fortunately,  if  we  except 
the  most  aggravated  cases,  it  is  also  one  of  the  most  curable ; 
wherefore,  it  seems  very  desirable  that  we  should  be  able  to 
recognise  certainly  all  its  manifestations,  which  are  many  and 
diverse ;  and  it  may  be  useful  to  review  briefly  our  present 
knowledge  of  the  disease,  and  especially  to  draw  attention  to 
some  of  its  rarer  and  less  recognised  symptoms. 

It  will  be  well  to  premise  that  our  remarks  will  be  confined 
to  Inherited  or  Congenital  syphilis,  that  is  to  say,  to  that  variety 
of  the  disease  which  is  communicated  to  the  ovum  in  utero, 
and  will  not  concern  the  Infantile  variety,  which  is  acquired 
by  the  infant,  either  in  its  passage  from  the  uterus  into  the 
world  by  contact  with  sores  on  the  mother  ;  or  after  birth,  by 
other  means  of  inoculation,  such  as  contact  with  sores  upon  a 
nurse,  or  vaccino-syphilisation ;  which  is  in  fact  ordinary  ac- 
quired syphilis  occurring  in  a  child,  and  is  a  comparatively  rare 
disease.  We  have  said  that  inherited  syphilis  is  a  common 
disease.  This  is  certainly  the  fact  in  London,  for  a  large  pro- 
portion of  the  children  attending  as  surgical  out-patients  at  the 
hospitals  are  suffering  from  some  form  of  the  disease  ;  but  it  is 
right  to  modify  this  assertion  by  stating  that  there  is  a  remark- 
able absence  of  the  affection  among  the  children  in  many  of  the 
manufacturing  districts  of  the  north  of  England.  Then  again 
it  is  doubtless  more  common  among  the  children  of  the  poor 
than  among  those  of  the  rich,  because  the  poorer  classes  are 
less  careful  to  get  cured  of  syphilis,  and  probably  more  often 
marry  while  under  its  infection ;  also  because  their  poverty,  and 
its  attendant  deprivations  and  lack  of  hygiene,  renders  them 
more  vulnerable  to  the  disease,  and  allows  it  to  run  its  course 
with  less  restraint.  Nevertheless  it  is  sufficiently  common 
among  the  children  of  the  upper  classes,  and  is  apt  in  them, 
probably  for  the  reason  that  it  is  to  a  greater  extent  modified  by 
the  treatment  of  the  parents,  to  present  more  of  the  uncommon 
forms  of  the  disease.  And  without  touching  upon  the  general 
questions  involved  in  the  application  of  the  Contagious  Diseases 
Act,  we  cannot  help  expressing  our  opinion  that  a  strong 
argument  in  its  favour  is  afforded  by  the  consideration  that  as 
long  as  syphilis  is  allowed  to  run  rife,  thousands  of  innocent 
children  must  every  year  be  born,  either  destined,  after  a  few 
weeks  of  wretched  existence,  to  a  premature,  though  in  their 
case  not  to  be  lamented  death,  or  with  the  miserable  prospect 
of  years  blighted  by  the  sufferings  which  pertain  to  one  of  the 
most  dreadful  of  diseases,  and  of  carrying  to  their  graves  the 
indelible  marks  of  their  direful  inheritance. 

As,  in  doubtful  cases,  the  diagnosis  of  inherited  syphilis  is 


3875.]  On  Inherited  Syphilis.  25 

greatly  aided  by  the  condition  and  history  of  the  parents,  it  is 
very  necessary  to  bear  in  mind  the  several  sources  and  methods 
of  infection.     These  we  briefly  state. 

1st.  It  may  be  derived  from  the  father,  who,  being  the  subject 
of  syphilis,  conveys  the  disease  to  the  ovum  by  means  of  the 
semen.  2nd.  From  the  mother,  by  means  of  the  placental  cir- 
culation, whereby  the  infected  blood  is  conveyed  from  the 
mother  into  the  system  of  the  foetus.  3rd.  Both  parents  may 
be  syphilitic,  and  therefore  both  the  above-named  modes  of 
infection  take  effect.  And  it  may  here  be  remarked  that  the 
reverse  of  the  second  method  of  infection  may  take  place,  that 
is  to  say,  a  healthy  mother  may,  by  means  of  the  placental  cir- 
culation, be  infected  by  a  syphilitic  foetus,  which  derives  the 
disease  from  the  vitiated  semen  of  the  father — an  occurrence 
which  explains  the  cases  in  which  a  woman  who  has  never 
had  primary  syphilis,  may  exhibit  secondary  symptoms  after 
nourishing  an  infected  embryo. 

The  fact  that  syphilis  can  be  conveyed  to  the  offspring  by 
inheritance  seems  to  have  been  first  definitely  stated  by  Para- 
celsus in  1529,  though  before  that  time  obscurely  hinted  at. 
Very  few  facts,  however,  were  observed  or  recorded,  and  these 
were  soon  lost  in  the  clouds  of  speculation  in  which  the  period 
was  so  prolific,  until  Boerhaave  in  the  beginning  of  the 
eighteenth  century  shed  the  light  of  his  genius  upon  the  subject, 
and  once  more  revived,  or  rather  perhaps  originated,  the  intel- 
ligent study  of  the  disease.  Since  then  it  has  been  the  subject 
of  much  careful  investigation  both  in  this  country  and  on  the 
Continent,  and  though  every  year  brings  us  some  fresh  know- 
ledge concerning  it,  yet  it  still  remains  a  disease  affording  wide 
scope  for  fruitful  study. 

The  malignity  of  the  disease  is  in  proportion  to  the  intensity 
of  the  infection,  and  this  is  affected  by  two  causes  :  first,  the 
mode  of  derivation ;  secondly,  the  period  of  the  disease  in  the 
progenitor.  As  to  the  mode  of  derivation,  that  is,  whether  from 
father,  mother,  or  both  parents,  the  rule  is  that  the  infection  is 
most  intense  if  both  parents  are  diseased ;  that  disease  of  the 
mother  alone  is  the  next  most  potent  cause ;  and  of  the  father 
alone  the  least.  And  as  to  the  period  of  the  disease  in  the  pro- 
genitor, it  is  well  established  that  the  more  remote  the  time 
of  impregnation  from  the  period  when  the  parent  first  contracted 
the  disease,  the  less  profound  will  be  the  infection  of  the 
children.  This  is  the  case  even  independently  of  treatment. 
Thus  a  common  history  is  such  as  the  following.  A  woman  the 
subject  of  syphilis  had  three  children  born  dead ;  at  the  fourth 
conception  a  living  child  was  born,  but  so  powerfully  infected 
that  it  soon  died ;  the  fifth  child  was  less  diseased  and  by  care 


26  Reviews,  [July, 

and  treatment  was  reared.  Should  there  he  other  children  they 
may  each  be  less  infected  until  the  latest  may  only  present  one 
or  two  symptoms,  which  in  the  absence  of  the  history,  would 
hardly  be  recognised  as  syphilitic.  In  the  majority  of  cases  the 
symptoms  of  inherited  syphilis  do  not  appear  until  a  few 
weeks  after  birth,  although  the  child  often  seems  feeble  and  the 
skin  of  an  unhealthy  hue :  there  is  no  doubt,  however,  that  a 
child  may  be  born  with  symptoms  of  the  disease.  The  greater 
number  appear  healthy  at  birth,  and  first  show  symptoms  of 
infection  about  a  month  afterwards.  As  Trousseau  remarks,  it 
is  unusual  for  the  symptoms  to  occur  before  the  second  week, 
ox,  for  the  first  time,  after  the  eighth  month.  But  it  is  important 
to  remember  that  a  child  who  has  been  in  apparent  health  for 
months,  or  even  years,  may  suddenly  show  symptoms  of  inhe- 
rited syphilis,  it  may  be  thought  for  the  first  time.  We  have 
lately  seen  a  girl  of  14  years  in  whom  this  occurred.  But  on 
investigation  it  will  almost  always  be  discovered,  as  in  the  case 
alluded  to,  that  the  child  had  some  manifestations  of  the  disease 
soon  after  birth,  to  which  perhaps  but  little  importance  was 
attached,  or  which  soon  subsided  under  treatment,  and  which 
having  lain  latent  for  a  long  time,  were  only  again  educed  by 
some  depressing  influence,  such  as  one  of  the  acute  specific 
diseases  of  childhood,  bad  hygienic  condition,  or  the  like. 

It  is  not  necessary  to  enter  upon  a  description  of  the  ordinary 
symptoms  of  inherited  syphilis,  which  are  sufficiently  well 
known  ;  but  there  are  a  few  of  these  which  we  think  are  of 
greater  value  than  the  text-books  would  lead  one  to  suppose. 
For  instance,  there  is  none  more  striking  than  the  physiognomy 
of  the  infant.  The  physiognomy  of  disease  generally  is  a  subject 
well  worth  study ;  every  one  must  recall  instances  in  which  he 
has  diagnosed  from  the  face  alone,  cases  of  peritonitis,  phthisis, 
chorea,  and  other  affections ;  and  in  no  disease  is  the  facies  more 
characteristic  than  in  inherited  syphilis.  Trousseau  has  given  of 
this,  as  of  so  many  other  diseases,  a  most  graphic  description.  He 
describes  the  complexion  as  of  a  bistre  tint ;  and  there  is  a 
striking  look  of  premature  old  age  about  these  infants  ;  the 
skin  too  is  shivelled,  the  body  emaciated,  and  often  there  is  a 
peculiar  smell  about  the  patient,  for  which  we  know  of  no  better 
comparison  than  that  of  a  damp  vault. 

One  of  the  earliest  and  most  constant  symptoms  is  what  is 
known  among  the  poor  as  "  the  snuffles,'^  that  is,  a  thick  dis- 
charge from  the  nasal  mucous  membrane,  which  blocks  up  the 
nares  and  causes  a  snuffling  with  the  respiration,  and  a  great, 
and  sometimes  serious  obstacle  to  sucking.  It  also  produces  an 
alteration  in  the  voice,  so  that  the  infant's  cry  has  a  peculiarly 
high-pitched  or  twangy  sound.     Then  there  are  very  constantly 


1875.] 


On  Inherited  Syphilis,  27 


sores  about  the  nates^  flat  mucous  tubercles,  or  round  copper- 
coloured,  rather  shining  spots  having  a  tendency  to  desquama- 
tion. Mucous  tubercles  occur  also  about  the  organs  of  generation, 
the  mouth,  the  genito-crural  fold,  the  axilla,  between  the 
fingers  and  toes,  between  the  chin  and  lower  lip ;  in  fact,  as 
Diday  has  remarked  (giving  the  true  explanation  of  their  cha- 
racter) in  any  part  where  the  skin  is  *'  thin,  moist,  and  exposed 
to  friction."  The  same  kind  of  eruption  takes  place  on  the 
mucous  membranes^  and  if  the  mouth  is  examined,  there  are 
frequently  found  white  patches  or  ulcerations  of  a  round  or 
crescentic  form,  scattered  about  its  lining  membrane.  A  favorite 
position  for  these  is  the  point  of  reflexion  of  the  mucous  mem- 
brane of  the  lips  on  to  the  gums,  and  the  frsenum  of  the  upper 
lip ;  another  is  the  border  of  the  isthmus  of  the  fauces.  The 
extension  of  this  eruption  to  the  larynx  gives  rise,  according  to 
Diday,  to  another  symptom  frequently  met  with,  namely,  hoarse- 
ness, not  the  high-pitched  note  associated  with  snuffles,  but  a  true 
hoarseness,  very  unlike  the  usual  note  of  an  infant's  cry.  Diday 
says  this  depends  upon  the  eruption  specially  affecting  the  edges 
of  the  aryteno-epiglottidean  folds. 

Of  the  other  eruptions  the  most  common  is  a  roseola,  and  this 
has  less  of  the  coppery  hue  than  the  other  syphilides  of  infants. 
It  chiefly  affects  the  chest,  neck,  and  inner  part  of  the  thighs, 
is  an  early  symptom,  and  is  distinguished  from  the  other  exan- 
themata, such  as  scarlatina,  but  not  being  accompanied  with 
febrile  disturbance,  by  its  imperfect  disappearance  on  pressure, 
and  "  by  its  maintaining  the  same  colour  and  degree  until  its 
termination."  On  the  palms  of  the  hands  and  soles  of  the  feet 
there  is  commonly  desquamation,  giving  an  appearance  of  psori- 
asis. This  is  very  characteristic  of  inherited  syphilis.  Besides 
this  there  is  a  kind  of  intertrigo  seen  very  often,  which  differs 
from  the  ordinary  intertrigo  in  its  surface  having  a  less  bright  red 
colour,  but  a  much  more  shining  or  polished  appearance,  accom- 
panied by  a  tendency  here  and  there  to  slight  desquamation. 
Eczema  and  impetigo  are  also  not  unfrequent  symptoms,  and 
are  each  of  them  of  a  darker  tint  and  less  acute  character  than 
when  unassociated  with  syphilis.  There  has  been  much  dis- 
cussion as  to  whether  or  not  the  pemphigus  of  new-born  infants 
is  a  syphilitic  eruption.  We  are  hardly  able  to  assert  that  it  is 
invariably  of  syphilitic  origin,  but  certainly  the  subjects  of  it 
usually  present  other  symptoms  of  inherited  syphilis.  Such  a 
case  as  that  related  by  Dr.  Bulkley,  in  which  the  eruption  con- 
tinued to  develop  for  nearly  a  year,  and  the  child  died  of 
syphilis,  is  very  strong  evidence  of  its  syphilitic  character. 

Another  very  common  symptom  is  the  existence  of  fissures  or 
cracks  at  the  edges  of  the  lips  and  naresand  the  angles  of  the  mouth. 


28  Reviews.  l^^^Jt 

the  scars  of  which  are  often  valuable  evidence  of  former  mis- 
chief. The  hair  often  falls  oif ;  so  do  the  eyelashes,  leaving  a 
sore  edge  to  the  lids. 

Among  the  more  important  of  the  consequences  of  inherited 
syphilis  are  the  visceral  lesions.     These  occur  very  early  in  the 
disease,  are  mostly  of  the  suppurative  type,  and  progress  very 
rapidly.    It  is  these  which  account  for  the  majority  of  the  deaths 
from  inherited  syphilis.     They  differ  entirely  from  the  syphilitic 
visceral   lesions  of  adults — the  results    of  acquired  syphilis — 
which  occur  in  an  advanced  period  of  the  disease,  are  very  slow 
in  progress,  and  are  not  suppurative.  Very  little  has  been  added 
to  our  knowledge  of  these  since  the  publication  of  Diday's  well- 
known  book,  in  which  they  are  fully  described.     In  the  lungs 
they  consist  of  scattered  abscesses   surrounded  by  compact  yel- 
lowish-grey   tissue — the   symptoms  are  those  of  lobular  pneu- 
monia.    Disseminated    suppuration    of   the   thymus    gland    is 
another  of  these  syphilitic  affections.     Of  the  liver,  the  lesion 
consists  in  enlargement  and  induration  of  the  organ  in  whole  or 
in  part,  due  to  the  development  of  fibro-plastic  material  between 
the  cells  of  the  acini,  with  obliteration  of  the  vessels,  and  inter- 
ference with  the  secretion  of  bile.     The  organ  is  very  elastic ; 
a  section  exhibits  *'  on  an  uniform,  yellowish  ground  a  more  or 
less  close  layer  of  small  white  opaque  grains  like  sago."     On 
pressure  no  blood  is  forced  out,  but  only  a  yellowish  serum ;  the 
general  colour  is  sometimes  of  a  brownish-red    tint  and  the 
structure   ill-defined.     This    condition    is  generally    developed 
during   uterine   life,  and  is  rapidly  fatal.     The  symptoms  are 
vomiting,  diarrhoea,  and  tympanitis  ;    but,  strange  to  say,  no 
jaundice.     The  enlarged  and  indurated   organ  may  be  felt  by 
palpation.    It  is  probably  in  connection  with  this  condition,  that 
the  peritonitis  described  by  Simpson  as  occurring  in  inherited 
syphilis  is  found.     Diday  does  not  mention  any  affection  of  the 
spleen,  but  a  condition  very  similar  to  that  found  in  the  liver  is 
not  very  uncommon.     Dr.  Bulkley  has  described  a  case  which 
he  supposes  one  of  syphilitic  disease  of  the  lung  in  an  infant, 
and  considers   that  it  was   probably  of  the  kind  described  by 
Lorain  and  Robin  as    "  white  hepatization,"  and  quotes  Thier- 
felder's  desciiption  of  that  disease.     It  is  as  follows  : 

"  The  small  air-cells  are  separated  from  each  other  by  very  broad 
bands  of  interstitial  tissue,  which  consist,  in  addition  to  a  small  amount 
of  connective  tissue  and  a  few  spindle-shaped  cells  situated  mostly  very 
near  the  vessels,  of  irregularly  arranged  masses  of  cells  and  nuclei  of 
syphilitic  neoplasm,  much  the  same  as  observed  in  syphilitic  laryngitis. 
This  tissue  is  distributed  in  the  lungs  of  infants  either  in  the  way  of 
general  infiltration  of  the  septa,  leaving  but  small  air-interstices ;  or 
wedge-shaped    collections    are    formed,    generally   near    the    pleura, 


1875.]  On  Inherited  Syphilis.  39 

embracing  perhaps  a  lobule,  which  have  to  the  naked  eye  the  appear- 
ance of  firm,  bluish-red  masses  resembling  atelectasis." 

The  infant  alluded  to  by  Dr.  Bulkley  died,  however,  when 
less  than  four  months  old,  and  we  do  not  think  that  as  a  rule 
the  "  white  hepatization  "  occurs  at  so  early  an  age.  There  was 
unfortunately  no  post-mortem  examination,  but  as  the  child  had 
ulcerations  of  the  throat  and  laryngeal  symptoms,  it  seems  more 
probable  that  the  mischief  extended  to  the  bronchi  and  gave 
rise  to  lobular  pneumonia.  Dr.  Hughlings  Jackson  has  recorded 
some  cases  of  nervous  diseases  in  connection  with  inherited 
syphilis,  and  suggests  that  plugging  of  minute  branches  of  the 
cerebral  arteries  may  account  for  some  of  these ;  and  that  con- 
vulsions, hemiplegia,  and  even  chorea  may  thus  be  caused. 
There  is  at  present,  however,  alack  of  pathological  evidence  on 
this  point,  which  is  nevertheless  well  worthy  of  further  investi- 
gation. 

If  the  child  lives  long  enough  there  are  other  manifestations 
of  the  disease  which  it  is  important  to  recognise.  One  of  the 
best  known  of  these  is  the  characteristic  condition  of  the  upper 
permanent  central  incisor  teeth,  first  described  by  Mr.  Hutchin- 
son. These  teeth  are  ill-developed  and  therefore  separated,  soft, 
and  marked  with  a  crescentic  notch.  Moreover  the  liability  to 
caries  is  such  that  even  the  temporary  teeth  become  worn  to  a 
peg-shape.  Mr.  Hutchinson  has  also  shown  the  connection  of 
interstitial  keratitis  with  inherited  syphilis.  These  cases  are 
very  common,  and  we  think  the  symptom  a  very  valuable  aid  to 
diagnosis.  The  cornea  becomes  of  a  diffused  opacity  (and  the 
sight^is  proportionately  interfered  with),  but  does  not  exhibit 
the  patches  of  opacity  met  with  in  scrofulous  ophthalmia. 
Retinitis  and  iritis  also  occur,  but  much  less  commonly  than  in 
acquired  syphilis. 

The  disease  of  the  nails  described  by  Mr.  Hutchinson  as 
dependent  upon  inherited  syphilis  is,  we  think,  much  less 
common  and  characteristic  than  the  condition  of  the  cornea  and 
teeth. 

Deafness,  ulcerations  of  the  pharynx  and  tongue,  laryngitis, 
and  lupus  are  also  among  the  less  common  of  the  later  manifesta- 
tions of  the  disease.  We  remember  to  have  seen  an  unfortunate 
child  who  was  very  nearly  blind  from  interstitial  keratitis,  quite 
deaf,  greatly  disfigured  about  the  face  from  lupus,  and  in  whom 
tracheotomy  had  been  performed  for  laryngitis — a  suificiently 
striking  example  of  the  effects  of  inherited  syphilis.  Warts  on 
the  mucous  surface  are  of  not  uncommon  occurrence.  They 
are  found  chiefly  upon  the  hard  palate  and  back  of  the  tongue, 
and  at  that  stage  of  the  disease  when  the  keratitis  occurs.  They 
are  usually  multiple,  large,  and  sessile. 


30  Reviews.  [July, 

Another  condition  dependent  upon  inherited  syphilis,  which, 
though  not  uncommon,  we  have  not  seen  anywhere  described, 
is  a  circumscribed  chronic  cellulitis.     This  is  one  of  the  later 
symptoms  and  is  often  found  in   connection   with   the  notched 
teeth    and    interstitial   keratitis.     It    is    characterised    by    the 
occurrence  of  limited  indurations   of  the  subcutaneous  cellular 
tissue.     They  differ  from  the  commencement  of  a  subcutaneous 
abscess  in  that  they  are  defined,  not  painful,  nor  hot ;  the  skin 
over  them  is   natural,   they  often  remain  stationary  for  a  long 
time,  are   unaffected  by  local  treatment,   but  generally  eventu- 
ally soften  and  degenerate  into  a  material  which  can  hardly  be 
called    pus,  but  is   composed   of  the   debris  of  the    connective 
tissue.     When    this    has    occurred    the    skin   slowly    becomes 
thinned  and  ulcerated,  and  one  or  more  openings  occur  whereby 
this  debris  escapes,  leaving  a  portion  of  the  skin  undermined, 
and  an  indolent  ulcer  upon  the  surface.     These  indurations  are 
defined,  often  of  linear  shape,  not  generally  extending  to  more 
than  two  or  three  inches,  and  when  cut  into  appear  to  be  due  to 
a  chronic  cellulitis,  and  not  to  any  specific  growth  or  infiltration. 
Their  favorite  sites  are  the   buttocks  and  outer  and  back  parts 
of  the  thighs  and  legs,  and,  to  a  less  extent,  the  arms.  Attention 
has  been  called  during  the  last  few  years  to    a  disease  of  the 
bones  dependent  upon  inherited  syphilis,  which,  though  by  no 
means  uncommon,  is  not  usually  described  among  the  symptoms 
of  the  disease.     It  has  been  called  by  Parrot,  whose  description 
of  the   disease  we  have  had  opportunities  of  confirming,  the 
"  pseudo-paralysis  of  inherited  syphilis."     The  name  gives  an 
idea   of  the  most   striking  characteristic  of  the   disease.     The 
child  is  usually  brought  to  the  surgeon  on  account  of  inability  to 
use  some  of  its  limbs,  which  hang  down   as  in  paralysis  or  frac- 
ture ;  or  are  held  fixed  as  in  articular  disease.  Sometimes  almost 
all  the  limbs  are  affected  and  the  child  presents  a  most  helpless 
appearance.     Parrot  says  that  there  are  often  large  abscesses  in 
the  neighbourhood  of  the  joints,  which  are  then  fixed  and  bent, 
and  that  crepitus  can  sometimes  be  felt  between  the  shaft  and 
the  epiphysis  of  the  bone.     These  symptoms  depend  upon  an 
inflammatory  affection  of  the  end  of  the  shaft  of  the  bone,  and  of 
the    ossifying  layer  of   the  epiphysial  cartilage,   whereby    the 
epiphysis  is  often   separated  from  the  diaphysis.     The  ends  of 
the  bones  become  thickened  externally  and  softened  within  ;  and 
may  eventually  be  destroyed  by  a  puriform  infiltration  leading 
to  destruction  of  the  lamellae  and  the  formation  of  cavities.    The 
joint  is  not  usually  involved,   the  muscles  and   nerves  are  un- 
affected. Several  bones  are  always  affected,  and  there  are  usually 
other  well-marked  symptoms  of  inherited  syphilis.    The  order  of 
frequency  in  which  the  bones  are  affected  is,  according  to  Parrot, 


1875. J  On  Inherited  Syphilis.  31 

as  follows  :  the  femur,  humerus,  tibiaj'ulna,  radius,  fibula,  ribs, 
ilium,  scapula,  clavicle,  tarsal,  and  carpal  bojies.  This  disease 
is  definite  and  not  easily  mistaken,  and  we  have  no  doubt  cor- 
rectly attributed  to  inherited  syphilis,  of  which  it  is  one  of  the 
earliest  symptoms.  We  think,  however,  that  suppuration  is  of 
less  frequent  occurrence  than  would  be  supposed  from  Parrot's 
description.     The  disease  yields  rapidly  to  mercurial  treatment. 

Dr.  R.  W.  Taylor,  of  New  York,  has  laid  much  stress  upon 
an  affection  of  the  fingers  and  toes,  which  he  considers  to  depend 
upon  inherited  syphilis,  and  which  he  describes  under  the  name 
of  "  dactylitis  syphilitica."  It  consists  of  an  enlargement  of 
the  phalanges,  due  to  the  growth  of  a  lowly  organized  form  of 
connective  tissue  in  the  soft  parts  around  the  bone,  and  an  in- 
flammation of  the  bone  itself.  The  swelling  is  chiefly  on  the 
dorsal  aspect  of  the  bone  and  greatest  about  its  middle,  so  that 
the  phalanx  has  a  bulbous  appearance,  and  somewhat  of  a 
wedge-shape  on  section.  Dr.  Taylor  alludes  to  cases  reported 
by  Nelaton,  Archambault,  Liiche  of  Berne,  and  others,  and  Dr. 
Bulkley  has  also  reported  two  cases.  We  do  not  think  the 
syphilitic  character  of  this  affection  is  by  any  means  clearly 
established.  In  the  first  of  Dr.  Bulkley's  cases,  for  instance, 
which  is  quite  a  typical  one,  there  is  no  evidence  of  syphilis 
either  in  the  child  or  its  parents;  and  in  his  second  case, 
though  the  mother  was  syphilitic,  the  child  gave  no  sign  of 
infection.  Dr.  Bulkley  quotes  a  third  case,  which  he  himself 
considers  to  be  of  traumatic  origin,  in  a  scrofulous  child,  but 
in  which  we  fail  to  discover  any  distinction  from  the  preceding 
cases,  which  are  said  to  be  syphilitic. 

Dr.  Taylor  says  that  these  cases  are  to  be  distinguished 
from  scrofulous  dactylitis  by  their  chronicity,  and  the  absence 
of  pain,  but  we  should  say  that  these  are  precisely  the  characters 
of  scrofulous  affections ;  and  he  moreover  asserts  that  scrofula 
rarely  if  ever  attack  the  phalanges — a  statement  from  which 
we  entirely  dissent.  Diseases  of  the  osseous  system  are  usually 
said  to  be  rare  in  inherited  syphilis,  but  we  think  are  really 
more  common  than  is  supposed  ;  but  that  as  they  are  most  often 
met  with  as  a  late  symptom,  when  the  other  manifestations  of 
the  syphilitic  infection  may  have  passed  or  been  cured,  their 
character  is  less  well  recognised.  We  have  ourselves  seen  cases 
in  which  children  suff^ering  from  bone  caries  had  apparently  no 
sign  of  inherited  syphilis ;  yet  in  whom  we  had  had  the  oppor- 
tunity of  watching  the  usual  series  of  syphilitic  symptoms  from 
birth  upwards,  and  in  whom  the  rapid  recovery  under  anti- 
syphilitic  treatment  rendered  the  diagnosis  complete.  And  we 
have  certainly  seen  a  large  number  of  children  suffering  from 
nodes  upon,  and  caries  of  the  bones,  the  undoubted  result  of 


32  Reviews.  [July, 

inherited  syphilis.  It  is  the  more  important  that  the  character 
of  these  cases  should  be  recognised,  as  they  are  unsatisfactory 
subjects  for  operative  treatment,  but  as  a  rule  rapidly  recover 
under  anti-syphilitic  medicines.  Of  the  treatment  of  inherited 
syphilis  but  little  need  be  said,  for  it  resolves  itself  chiefly  into 
giving  mercury  in  the  early  stage,  and  in  the  later  stages 
iodide  of  potassium,  with  or  without  mercury. 

There  has  of  late  manifested  itself  in  the  profession  a 
growing  scepticism  of  the  powers  of  medicines ;  a  reaction,  as 
we  think,  such  as  we  see  in  so  many  other  matters,  from  the 
unreasoning  and  sometimes  unreasonable  belief  in  their  virtues 
which  preceded  it :  but  none  the  more  founded  upon  intelligent 
observation  and  deduction.  But  we  think  no  one  who  has 
watched  the  effects  of  mercury  given  in  cases  of  inherited  syphilis, 
ought  to  doubt  the  potency  of  at  least  that  drug.  We  know 
few  things  in  therapeutics  more  satisfactory  than  to  witness  the 
improvement  of  children  thus  treated ;  they  rapidly  fatten,  lose 
their  shrunken  aspect,  and  change  from  little  old  men,  to 
actual  infants ;  the  eruptions  fade,  the  sores  heal,  and  the 
progress  is  often  astonishing.  We  do  not  of  course  assert  that 
this  is  the  case  in  all ;  there  are  many  children  so  profoundly 
affected  by  the  disease  that  they  die  before  remedies  have  time 
to  act ;  or  they  may  be  born  with  fatal  lesions  already  developed. 
But  we  cannot  doubt  that  we  possess  great  power  over  this 
disease,  a  fact  which  alone  must  always  give  an  interest  to  its 
study^  and  an  importance  to  its  recognition. 


III. — Fox  on  Pathology  of  Nervous  Centres.! 

The  knowledge  we  possess  of  the  normal  structures  of  the 
nervous  centres,  and  our  acquaintance  with  the  pathological 
conditions  of  these  organs,  are  derived  from  researches  that  have 
been  prosecuted  within  the  period  of  the  present  generation.  So 
rapid  have  been  the  advances  in  neuro-physiology  and  patho- 
logy since  Stilling  and  Schroeder  van  der  Kolk  first  pointed  the 
way,  that  the  results  of  the  labours  of  their  followers  have  left 
the  text-books  of  their  days  so  far  behind  as  to  be  now  almost 
obsolete,  if  not  mere  vestiges  of  a  byegone  stage  in  the  science  of 
medicine.  To  a  great  extent,  however,  the  vast  mass  of  infor- 
mation that  has  accumulated  on  our  hands  is  distributed  over 

^  The  Pathological  Anatomy  of  the  Nervom  Centres.  By  Edwakd  Lono- 
Fox,  M.D.,  F,R.C,P.    London,  1874. 


1875.]  Fox  on  Pathology  of  Nervous  Centres.  33 

the  pages  of  our  periodical  literature,  and  is  daily  beinsj  added 
to  in  the  same,  we  might  almost  say,  discursive  manner.  Thanks, 
therefore,  are  undoubtedly  due  to  any  one  who  may  exhibit 
sufficient  industry,  and  possess  a  competent  knowledge  of  so  wide 
a  range  of  subjects,  as  to  be  enabled  to  bring  together  into  a 
focus  the  light  otherwise  so  dispersed.  Such  a  task  Dr.  Fox 
has  undertaken,  and,  we  may  add,  has  successfully  achieved. 
He  has  presented  us  with  the  first  complete  treatise  on  the 
pathological  anatomy  of  the  nervous  centres  that  has  appeared 
in  this  country.!  ^Yg  would  not  be  understood  to  imply  that 
Dr.  Fox's  treatise  is  simply  a  compilation — on  the  contrary,  it 
has  the  merit  of  being,  to  a  large  extent,  the  result  of  personal 
observation  and  original  investigation,  carried  on  during  seven- 
teen years  of  hospital  work  in  Bristol. 

This  treatise  is  divided  into  two  parts  ;  the  first  describes  the 
pathological  anatomy  of  the  brain  and  spinal  cord ;  the  second 
is  concerned  with  the  mode  in  which  pathological  results  are 
grouped  in  certain  conditions  to  which  symptomatically  have 
been  given  special  names,  as  mania,  melancholia,  &c. 

"This  division,"  Dr.  Fox  remarks,  "is  simply  for  the  sake  of  con- 
venience. Its  imperfections  are  manifold  ;  specially  because  in  many 
instances  it  is  logically  a  cross-division.  As  an  example,  in  the  first 
part,  the  fifth  section,  on  tumours,  stands  by  itself  without  any  connec- 
tion with  the  second  section,  on  abnormalities  of  the  vascular  system. 
Yet  tumours  of  the  brain  and  spinal  cord  are  pathologically  divided 
into  those  connected  with  the  membranes,  those  having  their  origin  in 
the  walls  of  the  vessels,  and  those  springing  from  the  neuroglia,  the 
connective  tissue  of  the  brain  and  spinal  cord." 

Dr.  Fox  submits  a  classification  of  the  lesions  of  the  various 
anatomical  constituents,  which,  although  it  involves  a  certain 
degree  of  tautology,  is  certainly,  speaking  pathologically,  a  more 
logical  division  of  the  subject. 

As  it  would  be  impossible  fully  to  do  justice  to  the  whole 
contents  of  this  volume  of  lectures,  we  propose  to  set  before  our 
readers  a  few  points  whence  we  think  they  may  judge  of  the 
entire  work. 

We  take,  as  occurring  early  in  the  volume,  the  section  on 
cerebro-spinal  meningitis.  This  affection,  sometimes  sporadic, 
sometimes  epidemic,  presents  different  characters  in  different 
cases.  In  some  instances  there  has  been  scarcely  any  trace- 
able changes  in  the  organs,  whilst  in  other  cases  there  has  been 
extensive  exudation  both  within  and  beneath   the  arachnoid. 

^  An  elaborate  German  work,  embracing  also  the  normal  anatomy  of  the 
nervous  system,  is  new  in  the  course  of  publication,  viz.,  '  AUgemeine  Pathologie 
der  Krankheiten  der  Nervensystem,'  von  Dr.  Gustav  Huguenin,  Professor  iu 
Ziivich. 

Ill— LVI.  8 


34  Reviews.  [July? 

Dr.  Fox  states  that  in  the  cords  he  has  examined  he  only  once 
found  evidence  of  disintegration,  and  adds  that  specimens  of 
local  softening  have  been  shown  by  Drs.  McDowel  and  Hayden, 
of  Dublin. 

"  Softening  of  the  substance  of  the  eneephalon,  though  also  un- 
common, appears  to  be  more  frequent  than  the  corresponding  condition 
of  the  cord.  Allusion  is  here  made  only  to  cases  of  white  softening, 
but  Klebs,  on  two  or  three  occasions,  in  rapid  cases  of  cerebro-spinal 
meningitis,  has  found  foci  of  softening,  varying  in  shade  from  straw- 
colour  to  red  in  the  centrum  ovale,  and  in  each  of  these  cases  he  has 
found  indications  of  recent  endocarditis.'* 

In  connection  with  the  description  here  given,  the  following 
sporadic  case  by  Dr.  S.  T.  Dowse^  may  be  quoted.  The  patient 
was  a  female  aged  26  years,  having  a  syphilitic  history. 
Through  the  whole  course  of  the  disease,  about  six  weeks,  the 
sensorium  was  unaffected.  Acute  muscular  pains,  formication, 
and  paralysis  occurred.  The  special  senses  were  not  impaired. 
The  temperature  was  as  high  as  105°,  whereas  in  the  epidemic 
form  it  rarely  exceeds  100°.  There  was  an  absence  of  reflex 
irritations  and  convulsive  spasms,  due  in  all  probability  to  rapid 
change  in  the  grey  matter. 

*'  The  substance  of  the  hemispheres,  as  well  as  the  central  ganglia  of 
the  lateral  ventricles,  was  healthy  ;  the  latter  contained  a  normal  quan- 
tity of  fluid.  Upon  exposing  the  base  of  the  brain  to  view,  it  gave  at 
once  the  characteristic  smell  and  appearance  of  gangrene.  Over  the 
surface  of  the  anterior  lobes,  as  well  as  over  the  middle  and  posterior, 
the  arachnoid  membrane  was  thickened  and  of  a  semi-opaque  appear- 
ance, but  in  the  immediately  central  line  over  the  parts  forming  the 
floor  of  the  third  ventricles,  and  on  either  side  in  connexion  with  the 
middle  lobes,  pons  Varolii,  crura,  and  medulla  oblongata,  it  was 
thickened,  opaque,  and  fibrillated.  Over  the  surface  of  the  lobes  of 
the  cerebellum,  on  each  side  of  the  medulla,  the  membranes,  both  pia- 
mater  and  arachnoid,  were  striking,  and  of  a  dirty  green  colour.  Upon 
their  removal,  the  brain-substance  underneath  was  found  to  be  softened 
to  the  depth  of  a  quarter  of  an  inch,  and  presented  the  same  charac- 
teristic features,  and  so  did  also  the  parts  forming  the  floor  of  the  fourth 
ventricle.  The  same  condition  pertained  to  the  parts  forming  the  floor 
of  the  third  ventricle,  as  well  as  the  corpora  quadrigemina  and  geni- 
culate bodies.  The  right  and  left  crus  were  considerably  disorganised, 
and  of  a  greyish-grepn  colour  to  the  depth  of  about  half  an  inch.  The 
arteries  forming  the  circle  of  Willis,  as  well  as  the  anterior  inferior 
cerebellar  arteries,  were  firmly  bound  down  by  inflammation.  The 
substance  of  the  pons  and  medulla  were  apparently  healthy.  The  cord 
with  its  membranes  when  removed  weighed  fifteen  drachms.  Upon 
slitting  up  and  reflecting  the  dura  mater,  the  anterior  surface  of  the 
cord  was  found  coated  iti  the  cervical  and  dorsal  regions  with  a  layer 

1  '  Lancet,'  Jan.  31,  and  Feb.  7th,  1871. 


1875.]  Fox  on  Pathology  of  Nervous  Centres,  35 

of  thick,  purulent,  lymphoid,  corpuscular  material ;  it  presented,  like 
the  hrain,  a  stinking  odour,  and  in  parts  a  greenish  colour.  The  arach- 
noid and  pia-mater  could  not  be  separated  ;  they  were  adherent  to  the 
substance  of  the  cord  itself.  All  hyper-vascularity,  if  it  had  existed, 
was  only  to  be  found  at  the  extreme  ends  of  the  cervical  portion  on 
the  one  hand,  and  the  lumbar  on  the  other.  Between  these  extremities 
the  substance  of  the  cord  differed  in  different  parts.  In  the  dorsal 
region  it  was  considerably  softened,  and  about  the  origin  of  the  sixth, 
seventh,  and  eighth  pairs  of  nerves  it  was  of  the  consistence  of  thick 
cream,  and  presented  a  mottling  of  a  greenish-blue  colour,  and  a  putrid 
smell.  In  the  cervical  and  lumbar  regions,  where  the  cord  Jiad  under- 
gone the  least  change,  the  posterior  columns  were  found  to  be  com- 
paratively healthy." 

Dr.  Fox  proceeds  to  treat  of  hydrocephalus,  and  of  myelitis. 
Under  the  latter  he  discusses  the  inflammatory  origin  of  certain 
forms  of  degeneration. 

Under  the  head  of  degenerations  he  includes  atrophy,  softening, 
and  sclerosis. 

"The  distinctions  between  these  varieties,"  the  author  admits,  "are 
arbitrary,  and  can  only  be  defended  on  the  ground  of  convenience. 
Thus  atrophy  may  depend  upon  or  be  intermingled  with  softening,  or 
again,  with  sclerosis.  It  may  be  due  to  inflammation,  as  also  may  at 
least  one  variety  of  softening,  and  it  is  an  open  question  whether  all 
forms  of  sclerosis  do  not  own  a  similar  inflammatory  origin." 

This  question  is  affirmatively  answered  by  some  Continental 
pathologists,  who  place  all  forms  of  sclerosis  under  the  cate- 
gory of  myelites  chroniques,  parenchymatous,. and  interstitial.^ 
Atrophy  also  is  usually  found  to  be  associated  with  the  evidences 
of  inflammation ;  "  thickening  of  the  meninges,  and  patches  of 
meningeal  ossification,  with  fluid  in  the  ventricles,  or,  if  the 
atrophy  is  unilateral,  with  fluid  in  the  ventricle  of  the  affected 
hemisphere,  with  thickened  ependyma,  and  indurations  of  the 
ventricular  wall.  .  .  The  process  in  order  of  sequence  being 
inflammation,  then  softening  with  fatty  degeneration,  then 
partial  absorption  and  so  atrophy." 

Atrophy  of  the  brain,  however,  may  take  place  without  the 
agency  of  inflammation.  The  cells  and  nerve-tubes  will  be 
found  shrunken.  The  vessels  will  have  undergone  also  a 
shrinking  from  the  surrounding  brain  substance  in  which  the 
nutritive  processes  having  fallen  short,  an  atrophied  condition 
has  been  the  consequence. 

Atrophy  of  the  cord.  Dr.  Fox  points  out,  will  be  found  to 
depend  either  on  atheroma  of  the  smallest  vessels,  or  on  myelitis, 
most  usually  chronic,  or  on  grey  degeneration,  or  general  or  partial 
sclerosis,  disseminated  or  non-disseminated. 


Sur  les  Myelites,"  par  M,  Clement,  '  Archives  de  Medecine,'  1874. 


36  Revieivs.  [July, 

The  opposite  condition,  hypertrophy  of  the  brain,  is  to  be 
regarded  as  merely  a  hyperplasia  of  the  connective  tissue.  There 
is,  observes  Dr.  Fox,  no  real  hypertrophy  of  nerve-cells.  It 
may,  however,  be  doubted  whether  this  proposition  can  be 
maintained — we  have  seen  some  of  the  multipolar  cells  of  the 
spinal  cord  so  markedly  large,  when  compared  with  others  near 
them,  that  we  could  but  consider  that  they  had  undergone  a 
hypertrophic  change. 

Dr.  Fox  gives  a  very  full  and  exact  account  of  the  various 
forms  of  softening  of  the  brain,  describing  the  diagnostic 
differences  of  red  or  acute,  from  those  of  the  chronic  or  white 
softening,  and  of  the  intervening  stage  of  yellow  softening, 
with  their  relation  to  the  phenomena  of  embolism.  In  like 
manner  the  author  presents  us  with  a  complete  summary  of  the 
views  at  present  entertained  upon  the  nature  of  the  wide-spread 
lesions  spoken  of  as  grey  degeneration,  sclerosis,  &c.  These 
terms,  he  observes,  are  used  variously  by  different  writers.  To 
some  they  express  various  conditions,  to  others  they  are  one  and 
the  same  thing ;  to  others,  again,  we  believe,  they  convey  no  intel- 
ligible idea.  Dr.  Fox  quotes  the  classification  of  E-indfleisch,  with 
reference  to  these  pathological  conditions,  viz.  1,  simple  non- 
inflammatory— grey  degeneration  proper  ;  2,  indurating  inflam- 
matory form — sclerosis. 

Grey  degeneration  Dr.  Fox  states  to  consist  of  "  amorphous 
matter,  finely  granular,  between  the  nerve-tubes,  disappearance 
or  atrophy  of  the  latter,  numerous  nuclei  of  connective  tissue, 
amyloid  bodies,  and  fatty  granulations."  What  these  last  may 
be,  or  how  they  may  be  distinguished,  we  are  at  a  loss  to  know. 
It  is  nevertheless  a  pathological  condition  of  which  we  find 
frequent  mention  by  Continental  writers.  The  lesion  repre- 
sented thereby  we  suspect  to  be  the  miliary  form,  that  has 
been  described  by  some  British  pathologists.  Several  well- 
drawn  illustrations  accompany  the  author's  description  of  this 
lesion.  These  give  a  very  exact  representation  of  the  spots 
of  colloid  and  amyloid  degneration,  as  well  of  the  miliary  and 
diffused  forms  of  sclerosis. 

These  forms  of  degeneration,  Ave  agree  with  the  author,  are 
very  frequently  found  together  in  the  same  case,  and  indeed 
seem  in  some  instances  so  to  run  one  into  the  other  that  it 
Avould  not  be  easy  to  distinguish  grey  degeneration,  colloid, 
and  the  so-called  miliary  sclerosis,  from  each  other.  The 
description  of  grey  degeneration  will  apply,  almost  verhatim, 
to  that  of  miliary  sclerosis — viz.  excess,  and  proliferation  of 
connective  tissue ;  compression  thereby,  and  consequent  de- 
generation of  the  nervous  filaments,  accompanied  with  a 
granular  degeneration  of  the  neuroglia. 


1875.]  Fox  on  Pathology  of  Nervous  Centres.  37 

"  The  only  anatomical  distinction,"  Dr.  Fox  very  rightly  remarks, 
"  that  can  he  drawn  between  sclerosis  and  grey  degeneration  is  in  the 
greater  or  less  proliferation  of  this  fibrous  network,  and  in  the  fact  of 
the  presence  of  corpora  amylacea  in  grey  degeneration.  It  is  wholly  a 
question  of  degree,  and  I  am  loth  to  agree  to  the  one  being  inflammatory 
and  the  other  not.  It  is  probable  that  both  are  of  inflammatory  origin." 

The  observations  of  Rindfleisch  are  quoted  as  confirmatory 
of  this  inflammatory  origin  of  sclerosis,  viz.  that  sclerosis  starts 
from  foci  having  in  the  centre  of  each  a  distended  blood-vessel 
cut  across.  That  traces  of  this  condition  may  sometimes  be 
met  with  we  do  not  dispute,  but  that  it  is  the  mode  of  com- 
mencement of  the  change  in  the  miliary  form,  our  own  exami- 
nations have  not  confirmed.  On  the  contrary,  the  spots  of 
sclerose  degeneration  may  be  traced  from  their  largest  patches 
down  to  minute  amorphous  bodies  presenting  no  contained 
structures.  That  their  origin  is  in  nerve-fibrils,  or  degenerated 
corpuscles  of  the  neuroglia,  is  much  more  consistent  with  their 
microscopic  characters. 

The  miliary  and  the  grey  degeneration  are  much  less 
frequently  met  with  in  the  grey  matter  than  in  the  white 
substance — the  latter  appears  to  be  its  special  seat,  and  only  in 
instances  of  extensive  degeneration  is  the  grey  matter  either 
of  the  cord  or  brain  invaded. 

Sclerose  en  plaques  is  a  form  of  lesion  so  called  by  French 
pathologists,  more  correctly  designated  "  insular  sclerosis"  by 
Dr.  Moxon.  It  is  met  with  both  in  the  brain  and  spinal  cord. 
Clinically  its  presence  may  be  inferred  by  paralysis  with  a 
peculiar  tremor  of  the  muscles,  as  in  paralysis  agitans.  Micro- 
scopically, it  is  similar  to  the  condition  above  described, — 
proliferation  of  nuclei  of  the  connective,  hyperplasia  of  the 
reticulated  fibres  of  the  neuroglia,  with  degeneration  of  the 
nerve-elements.  Having  thus  described  the  lesions  that  con- 
stitute the  various  forms  of  sclerosis.  Dr.  Fox  very  aptly  adds, — 
**  It  must  be  remembered  that  the  aggregate  of  symptoms  does 
not  depend  on  the  special  form  of  invasion  of  the  disease,  but 
on  the  foci  which  are  attacked ;  and  when  we  come  to  speak  of 
other  diseases,  you  will  find  there  is  in  many  cases  no  broad 
line  of  demarcation  between  them  and  cerebro-spinal  sclerosis." 

As  it  is  in  chronic  forms  of  mania  that  the  degenerations  here 
referred  to  have  been  very  frequently  met  with,  it  may  form  a 
profitable  sequence  to  the  previous  remarks  to  follow  Dr.  Fox 
in  his  observations  on  insanity,  and  to  endeavour  to  see  how  far 
his  pathological  researches  bear  out  the  statement  sometimes 
hazarded  that  in  the  majority  of  cases  of  insanity  no  change 
can  be  detected  in  the  structure  of  the  brain.  To  most  of  such 
statements  we  should  be  inclined  to  oppose  the  worthlessness 


38  Reviews.  [July, 

of  any  other  than  microscopical  examinations,  admitting  at  the 
same  time  the  possibility  that  appreciable  alterations  may  have 
existed,  and  have  disappeared  with  life. 

''  There  are,"  observes  Dr.  Fox,  *^  at  least  four  conditions 
that  may  induce  very  serious  cerebral  symptoms,  and  yet  leave 
little  or  no  change  to  be  recognised  after  death;  1,  a  condition 
of  the  blood  itself,  as  in  ursemia,  spansemia,  phthisis,  &c. ;  2, 
a  variation  in  the  normal  blood  supply  to  the  brain  ;  3,  a  reflex 
irritation,  though  this  may  perhaps  be  classed  under  the  second 
head,  as  irritation  radiating  from  some  distant  organ  would  be 
likelv  to  induce,  by  reflex  action,  contraction  of  the  arteries ;  4, 
shock." 

It  is  conceivahle  that  the  first  of  these  conditions  may  be  a 
very  efficient  and  potent  element  of  causation,  independently  of 
structural  change.  This  view,  indeed,  has  been  adopted  by 
some  very  distinguished  alienists  as  sufficient  to  account  for  the 
symptoms  in  acute  mania,  without  the  existence  of  structural 
change.^  It  is  not  so  clear,  however,  that  the  second,  third,  and 
fourth  conditions  here  laid  down  do  not  of  themselves  involve 
structural  deviation  from  the  normal  state  of  the  vessels  of  the 
brain.  In  fact,  the  lesions  of  texture  afterwards  recorded  in 
this  volume  would  seem  to  confirm  this  view.  Dr.  Fox  states 
that  Dr.  Thompson,  of  the  Bristol  Borough  Lunatic  Asylum, 
has,  by  sphygmographic  tracings  in  general  paralysis,  shown 
that  this  affection  is  marked  in  its  very  earliest  stages  by  per- 
sistent spasm  of  the  vessels.  Extensive  vascular  changes  are 
the  most  prominent  of  the  pathological  phenomena  that  are 
observed  after  death.  The  same  may  be  said,  as  the  author  also 
points  out,  of  mania  and  melancholia.  The  lesions  of  the 
vessels,  nerve-tissue  cells  and  neuroglia  found  in- chronic  mental 
maladies  are  all  of  such  character  as  may  be  referable  to  a  past 
inflammatory  condition.  The  degenerations  may  in  many  in- 
stances be  traceable  to  the  changes  incidental  to  old  age,  or  to 
premature  decay.  The  condition  of  the  vessels  and  of  the  brain 
tissue  has  been  described  with  great  care  by  Dr.  Batty  Tuke, 
whose  researches  Dr.  Fox  has  duly  studied  and  appreciated. 

Dr.  Fox  in  the  next  place  describes  the  changes  that  occur 
in  the  membranes;  and  after  referring  to  the  recorded  obser- 
vation upon  deviations  in  the  weight  of  the  brain  in  various 
forms  of  insanity,  presents  a  resume  of  the  various  lesions  that 
have  been  put  upon  record  as  met  with  in  insanity. 

From  the  preceding  remarks  our  readers  may  be  enabled  to 
form  an  idea  of  the  completeness  with  which  Dr.  Fox  sum- 
marises our  pathological  knowledge   with  reference  to  the  ner- 

1  This  doctrine  was  ably  expounded  by  Dr.  Henry  Monro,  in  a  singularly 
elegantly  written  essay  "  Ou  Insanity,  its  Nature  and  Treatment."     1851. 


1875.] 


Carter  on  Mycetoma.  39 


vous  centres.  The  work  that  is  being  carried  on  will  doubtless 
rapidly  place  in  arrear  the  extent  of  knowledge  conveyed  in 
this  excellent  treatise,  but  will  not  supersede  the  value  of  the 
volume  as  a  storehouse  of  facts  and  as  a  landmark  for  future 
investigators. 

It  is  incumbent  upon  us  to  state  that  several  other  subjects  are 
treated  of  in  these  lectures  besides  those  already  referred  to,  e.  g, 
abnormalities,  inflammation,  and  tumours ;  the  pathology  of 
delirium,  of  insanity,  and  of  the  many  forms  of  paralysis,  epi- 
lepsy, chorea,  tetanus,  hydrophobia,  &c.,  receives  consideration. 

We  must  not  omit  to  draw  especial  attention  also  to  the 
graphic  illustrations  that  Dr.  Fox  has  himself  executed, 
amounting  to  nineteen  in  number,  which  most  faithfully  repre- 
sent the  lesions  they  are  intended  to  illustrate. 

Every  student  of  pathological  science  will  do  well  to  consult 
this  comprehensive  essay  on  nerve-pathology. 


IV. — Carter  on  Mycetoma.^ 

A  STUDY  or  desire  to  learn  facts  and  the  cultivation  of  habits 
of  investigation  in  order  not  to  overlook  or  despise  little  things 
in  the  natural  processes  of  health  and  disease,  are  some  of  the 
characteristics  of  the  age  we  live  in ;  notwithstanding  that  there 
are  fewer  material  rewards  for  the  investigator  in  these  than  in 
other  departments  of  life. 

As  might  have  been  expected,  well-directed  scientific  inquiry 
is  constantly  showing  the  fallacy  of  many  views  which  were 
considered  proven  years  gone  by,  and  so  in  like  manner  our 
labours  will,  no  doubt,  in  their  turn  be  subjected  to  a  similar 
process  of  refining  or  refuting  by  our  successors. 

Perhaps  there  is  no  subject  of  greater  importance,  and 
certainly  none  which  occupies  a  higher  place  in  thinking 
men's  minds,  or  is  fraught  with  more  interests  to  humanity 
at  the  present  time,  than  the  relations  which  animal  and  vege- 
table organisms  bear  to  the  production  and  propagation  of  disease. 

It  is  a  subject  regarding  which  there  has  been  necessarily 
much  controversy,  which  still  continues,  and  leading  observers 
advocate  in  many  cases  opposite  views,  so  that  we  are  unable 
with  anything  like  absolute  certainty  to  distinguish  between 
cause  and  effect.  Regarding  the  larger  animal  parasites  the 
difiiculty  may  not  be  so  great  as  stated  ;  but  when  microscopic 
organisms    of  a    doubtful   nature  —  animal  or   vegetable — are 

^  On  Mycetoma ;  or,  the  Fungus  Foot  of  India.     By  H.  Vandyke  CJlETBE, 
M.D.,  Indian  Army.     London,  1874. 


40  Reviews.  [July, 

concerned,  it  is  no  easy  matter  to  determine  their  exact  value  in 
disease,  since  it  is  well  known  that  they  sometimes  are  found 
to  exist  in  the  perfectly  healthy  body. 

Consequently  some  microscopists  and  other  observers  have 
gone  so  far  as  to  advance  theories  and  make  statements  to  the 
effect  that  the  various  diseases  termed  zymotic,  including 
epidemic  and  many  other  diseases,  are  actually  caused  and 
propagated  by  fungi  or  bacteria,  which  multiply  and  produce 
effects  rapidly  ending  even  in  a  speedy  death.  For  a  period 
extending  over  more  than  fifty  years,  efforts  have  often  been 
made  to  trace  cholera  in  its  various  degrees  of  virulence  to  a 
fungoid  origin,  and  of  late  Professor  Hallier  of  Jena  believed 
that  he  actually  detected  the  fungus  in  cholera  evacuations ; 
but  more  recent  investigators  have  shown  that  he  was  mistaken, 
for  the  fungus  he  has  described  and  figured  is  not  peculiar  to 
cholera,  but  is  to  be  met  with  in  healthy  evacuations  in  man 
and  animals,  as  we  ourselves  have  seen. 

During  the^  last  thirty  years  Indian  surgeons  became  ac- 
quainted with,  and  reported  in  the  current  medical  journals, 
cases  of  a  peculiar  affection  of  the  foot,  which,  though  before 
that  time  known  to  native  medical  practitioners  as  keerenagrah 
(worm  disease),  tuberculous  disease  of  the  foot,  &c.,  did  not 
attract  sufficient  attention  previous  to  the  general  introduction 
in  India  of  European  surgeons.  We  are  indebted  to  Dr.  Vandyke 
Carter,  who  was  the  first  to  discover  a  fungus  in  that  disease,  and 
to  give  a  detailed  description  of  the  peculiar  appearances  and 
the  microscopic  anatomy  of  the  disease,  now  generally  known 
by  the  name  of  Mycetoma  or  fungus-foot  of  India.  Dr.  Carter's 
various  communications  on  this  subject  in  the  Transactions  of 
the  Medical  and  Physical  Society  of  Bombay,  &c.,  with  some 
additions,  have  been  embodied  in  an  elaborate  monograph, 
which  contains  eleven  well-executed  chromo-lithographs,  illus- 
trating the  external  appearances  of  the  disease  affecting  the 
hands  and  feet,  and  the  general  and  microscopic  anatomy  of 
the  diseased  tissues.  This  work  is  a  valuable  contribution  to 
the  literature  of  the  fungoid  orign  of  disease,  and  the  plates 
alone  reflect  great  credit  on  the  author  as  an  artist,  since  some 
of  them  represent  most  accurately  specimens  which  we  have 
seen  and  are  familiar  with. 

It  will  undoubtedly  be  the  means  of  introducing  the  fungus 
disease  to  the  notice  of  the  profession,  both  at  home  and  abroad, 
and  will  stimulate  to  further  investigation,  which  is  still  much 
to  be  desired,  in  order  to  determine  and  corroborate  many  points 
stated  by  the  author. 

The  name  Mycetoma  (from  Mvktjc  a  fungus)  has  been  given 
to  the  disease,  as  the  author  believes  that  it  is  produced  by  the 


1875.] 


Carter  on  Mycetoma.  41 


entrance  in  some  unknown  way  into  the  skin  and  tissues,  and 
subsequent  development  and  multiplication  there,  of  the  spores 
of  a  red  mould  of  the  genus  Mucorini,  and  named  by  Dr. 
Berkeley,  in  honour  of  the  discoverer,  Chionyphe  Carteri. 

The  natural  habitat  of  this  red  mould  of  the  genus  Chionyphe, 
whether  in  the  soil  or  in  the  water,  or  growing  on  plants,  has 
yet  to  be  determined,  but  it  appears  to  us  to  resemble  some 
forms  of  aquatic  fungi  which  we  have  seen. 

There  are  two  varieties  of  the  affection — melanoid  and  ochroid 
— to  be  distinguished,  however,  only  when  sinuses  are  formed 
in  the  foot  or  hand,  discharging  matters  which  are  characteristic 
of  each  variety,  and  from  which  the  red  mould  has  been 
produced  spontaneously  and  by  cultivation. 

It  commences  after  a  period  of  incubation  not  yet  determined, 
in  various  ways,  sometimes  by  a  little,  livid,  localised  induration 
of  the  skin  without  any  pain  or  tenderness ;  at  others  by  a 
vesicle,  an  abscess,  or  a  boil  in  the  sole,  and  the  foot  begins  to 
swell,  usually  in  a  globular  form  from  thickening  of  the  tissues, 
and  may  attain  a  size  measuring  even  twenty  inches  round  the 
dorsum.  Sinuses,  often  leading  down  to  the  bones,  form  in  the 
sole  and  at  various  places,  discharging  profusely,  and  this 
condition  may  continue  for  years,  until  the  patient's  strength 
is  exhausted,  or  until  he  is  cured  by  amputation  of  the  diseased 
mass.  With  reference  to  the  reputed  fungoid  origin  of  the 
disease,  it  is  very  important  to  observe  the  time  when  the 
fungoid  particles  are  first  detected,  or  at  what  stage  they  appear, 
and  accordingly  at  p.  14  it  is  stated,  "  Immediately  consequent 
on  the  vesicles  and  abscesses,  and  sooner  or  later  following  the 
hard  lump  (which  becomes  softened  at  one  part,  and  furnishes 
a  soft  bleb  soon  bursting),  there  appear  sinuous  openings,  from 
which  exudes  a  thin  sanious  or  sero-purulent  discharge,  con- 
taining the  characteristic  fungus  particles;"  and  again  at  p.  47, 
"  Let  me  add  that  in  order  of  time  the  fungi  are  to  be  seen  at 
the  moment  when  a  sinuous  opening  is  formed,  and  the  latter 
seems  to  be  produced  for  the  purpose  of  giving  exit  to  the 
particles."  "  The  fact  we  have  ourselves  established,  and  the 
inference  is  a  necessary  one."  If  such  be  the  case,  and  there  is 
no  reason  to  doubt  the  statement  of  such  an  accurate  observer, 
then  it  is  evident  that  the  fungus  must  have  existed,  multiplied, 
and  fructified  in  the  tissues,  previously  to  the  formation  of 
abscess  or  sinus,  and  it  is  more  reasonable  to  believe  that  the 
spores  or  sporidia  of  such  fungus  at  some  previous  period  made 
their  way  into  the  tissues  from  without,  rather  than  that  they 
should  be  developed  de  novo  from  the  tissues  in  the  interior  of 
the  foot — a  view  which  is  not  without  its  supporters. 

When  the  disease  is  far  advanced  the  whole  foot  becomes 


42  Reviews.  [July, 

disorganized  and  burrowed  by  membrane-lined  canals,  which 
usually  intercommunicate,  and  contain  in  the  melanoid  variety 
black  gritty  particles  varying  from  -^V  to  -rV  of  an  inch  in 
diameter,  made  up  of  fungi  or  their  debris ;  while  in  ^the  pale 
or  ochroid  variety  the  fungus-growths  assume  a  pink,  orange, 
or  buff  colour. 

The  appearances  on  section  are  thus  described  : — "  A  section 
of  a  much  diseased  foot  presents  at  first  sight  an  appearance  of 
general  confusion  of  parts ;  but  this  apparent  disorder  will  be 
found  upon  attentive  examination  to  resolve  itself  into  some 
degree  of  method."  "  The  pale  or  non-vascular  appearance  of 
the  section  is  another  marked  feature ;  there  is  less  vascularity 
than  even  in  health."  "  The  cavities  in  which  are  lodged  the 
fungus  particles  are  neither  abscesses  nor  cysts  ;  the  membrane 
lining  them  and  the  canals  is  sometimes  thin,  but  as  often 
thick,  velvety,  pale,  non-vascular,  and  friable ;  it  is  thrown 
into  folds  running  longitudinally  in  the  canals,  but  in  the 
larger  cavities  (which  are  but  lateral  or  terminal  dilatations  of 
these  passages,  and  on  section  give  rise  to  the  semblance  of 
cysts)  the  membrane  is  frequently  arranged  so  as  to  impart  to 
their  inner  surface  a  sacculated  or  even  follicular  aspect,  owing 
to  the  formation  by  its  foldings  of  numerous  closely  apposed 
secondary  loculi,  in  each  of  which  is  lodged  a  separate  accumu- 
lation of  fungus  particles;  probably  an  even  more  intricate 
arrangement  may  obtain  in  the  largest  growths,  but  by  patience 
the  true  disposition  can  always  be  made  out." 

Many  persons  in  India  and  in  England  acquainted  with  the 
disease  ascribe  it  to  a  constitutional  origin,  and  consequently  the 
author  takes  considerable  trouble  to  prove  by  comparison  with 
caries,  elephantiasis,  non-malignant  tumours,  &c.,  that  it  is  a 
local  affection,  and  in  doing  so  we  think  that  he  advances  strong 
arguments  and  has  to  a  great  extent  succeeded  to  substantiate 
his  opinion. 

Judging  from  the  general  description  given,  it  resembles 
caries  perhaps  more  than  any  other  disease  ;  but  the  author 
states  that  it  has  neither  the  typical,  local,  nor  common  general 
characters  of  caries,  and  also  that  it  possesses  a  special  feature 
in  its  attendant  discharge  of  small  organic  particles,  which 
caries  in  Europe  has  never  been  known  to  present  for  notice. 

The  bones  are  usually  affected  either  primarily  or  secondarily, 
and  in  a  few  cases  myeloid  cells  were  observed,  but  considered 
to  be  merely  accidental  products.  The  changes  in  the  bones 
are  described  as  peculiar  and  different  from  those  of  caries,  &c., 
inasmuch  as  they  contain  small  spherical  cavities,  surrounded 
by  healthy  bone,  averaging  from  i  to  f  of  an  inch  in  diameter,  and 
communicate  with  one  another  and  with  the  sinuses.     The  cavi- 


1875.]  Carter  on  Mycetoma.  43 

ties  contain  fungoid  masses  of  a  globular  form,  which,  by  pressure 
on  the  surrounding  healthy  bone,  produce  the  excavations.  The 
joints,  it  is  stated,  are  never  primarily  affected,  but  may  become 
diseased  from  pressure  of  the  foreign  bodies. 

The  malady  prevails  chiefly  among  the  agricultural  population, 
in  men  more  than  women  in  a  proportion  of  about  10  to  1,  and 
is  common  from  puberty  to  old  age.  It  is  strange  that  it  has 
never  been  noticed  in  a  European  or  Indo-European,  though  it 
affects  the  rich  natives  equally  with  the  poor.  Patients  usually 
date  the  onset  or  commencement  from  a  scratch,  puncture, 
abrasion,  hurt  or  prick  of  a  spine  of  some  prickly  bush. 

It  is  now  many  years  since  Carter's  views  were  made  public, 
and  we  are  not  aware  of  any  inoculation  experiments  with  the 
mould  (^Chionyphe  Carteri)  having  been  made  on  man  or  animals. 

There  could  not  be  any  grave  objections  to  inoculate  con- 
demned criminals  or  animals  with  the  spores  of  the  mature  plant, 
or  with  the  fish-roe-like  particles,  or  the  pink  particles  or  the 
black  particles  of  the  melanoid  variety.  In  future  investigations 
it  would  be  well  to  observe  if  the  disease  spreads  from  one 
member  of  a  family  to  another,  or  in  hospital  from  one  person 
to  another,  in  other  words,  if  it  be  contagious. 

Nothing  certain  is  known  as  to  the  manner  of  introduction  of 
the  spores,  but  Carter  assumes  it  to  be  through  the  medium  of 
hair  follicles,  or  of  the  orifices  of  sebaceous  glands  and  sweat- 
ducts,  or  else  by  abrasions  of  the  surface.  This  notion  is,  how- 
ever, purely  hypothetical,  for  the  spores  have  never  yet  been  found 
in  the  above  situations.  The  early  symptoms  of  the  disease  most 
commonly  commence  in  the  sole,  in  which  there  are  the  orifices 
of  the  sweat- ducts,  and  of  course  the  entrance  of  the  spores 
in  that  region  is  quite  possible  ;  but  we  think  that  the  discharge 
from  the  ducts  would  tend  rather  to  prevent  them  from  entering. 

The  author  shows  that  cases  of  mycetoma,  if  left  to  nature, 
proceed  from  bad  to  worse  until  the  patient  dies  from  exhaustion 
or  the  supervention  of  some  induced  disease;  therefore  the 
prognosis  is  invariably  bad. 

A  few  pages  are  devoted  to  treatment  and  preventive  measures, 
and  as  regards  the  latter  he  recommends  the  wearing  of  shoes, 
&c.,  "  and  the  daily  application  of  wood-ashes  or  tarry  liquids  to 
the  feet  during  the  rains,"  probably  with  the  object  of  preventing 
the  entrance  of  the  fungoid  spores  ;  and  we  can  fancy  the  diffi- 
culty and  novelty  of  daily  tarring  the  soles  of  many  millions  of 
Her  Majesty's  subjects,  since  the  affection  is  *'  very  widely 
spread  in  India." 

In  proof  of  the  local  nature  of  the  disease  he  points  also  to 
the  effects  of  treatment  and  the  relatively  small  rate  of  mortality 
after  operation  (only  a  little  more  than  four  per  cent.),  and  shows 


44}  Reviews.  [Jii^v, 

that  cases  treated  by  amputation  beyond  the  affected  parts 
seldom  or  never  recur — results  which  in  a  constitutional  disease 
would  be  different.  The  same  success  can  be  attained  in  incipient 
forms  by  the  use  of  other  measures,  such  as  excisions  of  the 
affected  skin  and  soft  parts,  nitric  acid^  potassa  fusa,  the  actual 
cautery,  &c.,  and  cases  illustrating  the  beneficial  effects  of  the 
various  methods  of  treatment  adopted  by  different  surgeons  are 
recorded.  In  ordinary  fungus  diseases  of  the  skin,  tonics  and 
general  treatment  are  beneficial,  but  in  mycetoma  they  are 
unattended  with  decided  benefit — another  proof,  the  author 
thinks,  of  its  local  and  parasitic  nature.  There  appears  to  have 
been  no  trials  made  of  the  effects  of  injecting  into  the  sinuses 
the  various  reputed  chemical  solutions  which  are  extensively 
employed  locally  in  diseases  of  supposed  parasitic  origin,  but  the 
subject  is  referred  to  as  worthy  the  attention  of  future  in- 
vestigators. 

A  minute  description  of  the  hard  black  particles  of  the  mela- 
noid  variety  is  given  at  length.  These  were  formerly  considered 
to  be  collections  of  fungoid  structures,  but  are  now  held  to  be 
*' sclerotia,"  composed,  as  in  the  common  mildew  and  other 
moulds,  of  mycelium  filaments.  He  shows  by  a  series  of  figures 
in  Plate  IX  that  the  masses  are  made  up  of  fungi,  but  admits 
at  page  72  that  there  may  be  varieties  of  the  sclerotioid  particles 
in  which  the  fungus  structure  is  lost  or  destroyed,  so  that  an 
ordinary  observer  examining  such  specimens  might  reasonably 
infer  that  a  fungus  structure  never  existed  in  them.  Would 
such  an  explanation  serve  to  show  why  other  observers  have  not 
been  successful  in  detecting  a  fungus  in  cases  of  Mycetoma  ? 
The  effects  of  reagents  on  these  bodies  are  slight;  acetic  acid, 
the  alkalies,  and  ether  have  but  little  influence  on  them,  while 
iodine,  it  is  stated,  produces  a  brown  tint,  distinctive  of  cellu- 
lose, and  hence  it  is  inferred  that  the  particles  are  of  a  true 
vegetable  nature. 

In  the  ochroid  or  pale  variety  of  the  disease  the  fish-roe-like 
masses  are  termed  malacotia,  and  "  the  fungoid  elements  assume 
the  character  of  pink,  light  brown,  yellowish,  or  pale  buff 
particles  of  minute  size  and  soft  consistence;  their  number  is 
immense,  and  their  prevalence  is  universal  in  the  affected  foot." 

In  a  specimen  of  a  foot  with  madura  disease,  the  only  one  of 
its  kind  ever  seen,  the  new  material  was  of  a  general  pinkish  hue, 
and  under  a  high  magnifying  power  appeared  to  be  formed  of 
round,  ovoid,  quadrate,  dumb-bell  shaped,  double  or  even  quad- 
ruple-shaped bodies,  the  figures  of  such  being  quite  different  from 
any  structures  we  have  been  accustomed  to  examine,  and  what 
their  pathological  significance  may  be  is  a  matter  of  conjecture. 

The  soft  particles  generally  met  with  are  composed  of  a  cen- 


1875.]  Carter  on  Mycetoma.  45 

tral  body  from  -^V  to  ^i^,-  of  an  inch  in  diameter,  and  surrounded 
by  colourless  crystalline  spiculae  not  freely  acted  on  by  reagents. 
The  author  says,  page  76  :  "  This  indifference  of  these  pale,  soft 
particles  to  chemical  influence  is  to  me  strong  evidence  of  their 
vegetable  rather  than  animal  nature,  and  the  occasional 
absence  of  amyloid  material,  &c.,  is  no  objection  whatever  to 
the  conclusion  which  is  here  drawn." 

This  view  of  the  composition  of  these  bodies  has  been  disputed 
by  other  microscopists,  who  could  detect  no  trace  of  fungus  after 
the  application  of  various  reagents;  but  it  is  stated,  nevertheless, 
that  from  one  of  such  particles  after  cultivation  in  rice,  the 
growth  of  Chionyphe  was  observed  by  the  author. 

In  some  sections  of  the  diseased  parts  in  both  varieties,  pink 
coloured  streaks  were  observed  in  various  situations  and  adjacent 
to  the  canals,  and  were  supposed  to  indicate  the  commencement 
of  the  fungoid  growth  by  ante-inoculation  from  pre-existing 
spores  in  the  sinuses.  The  pink  deposit  referred  to  is  composed 
of  minute  bright-tinted  and  clear  globules  from  ^~'o"o  to  tuVo 
of  an  inch  in  diameter,  and  their  connection  with  bacteria  is  con- 
jectured. "  In  short,"  Dr.  Carter  writes, ''  the  first  known  trace  of 
the  entophytic  growth  occurs  under  a  form  seemingly  referable  to 
a  bacteroid  origin,"  and  this  is,  no  doubt,  an  inference  from  the 
fact  that  "  according  to  the  opinions  of  competent  observers  from 
the  spore  of  a  fungus  may  directly  proceed  bacteroid  bodies,  and 
that  as  a  normal  process.^'     (Hallier,  Huxley,  &c.) 

This  appears  to  us  a  very  poor  guess,  but  the  author  goes  fur- 
ther, and  traces  a  resemblance  in  structure  between  the  pale 
particles  of  mycetoma,  the  micrococcus-colonics  of  Hallier,  the 
bacteria  colonies  of  Klebs,  and  a  peach-coloured  bacterium 
described  by  Mr.  E.  R.  Lankester  as  occurring  in  putrescent 
water.  In  a  note,  page  83,  he  writes  :  "  It  is,  I  may  add,  satis- 
factory to  myself  to  have  at  last  found  the  type  of  structure  to 
which  may,  to  all  appearance,  correctly  be  referred  these  hitherto 
anomalous  bodies  found  in  the  human  disease,"  and  again  at 
page  84,  "  Once  for  all,  I  would  state  that  the  presence  of  a 
Bacterium,  whether  moving  or  motionless  in  connection  with  the 
early  (or  perhaps  any)  stage  of  Mycetoma  has  not  been  demon- 
strated." No  assistance  will  be  rendered  in  future  investigations 
into  the  pathology  of  the  disease  by  reckless  speculation  or  by 
stating  that  "  the  soil  of  both  field  and  lane  in  India  so  invari- 
ably swarms  with  decaying  vegetable  matter,  and  this  at  certain 
seasons  in  a  moist  condition,  that  one  can  only  wonder  that  the 
barefooted  native  does  not  far  oftener  become  affected  with  the 
fungus  disease." 

The  Rev.  Dr.  Berkeley  hazards  the  conjecture  (page  93)  that 
the  disease  might  be  produced  by  the  spores  of  Saprolegnia  in 


46  Reviews,  [July, 

stagnant  pools.  Saprolegnia  is  an  aquatic  fungus  found  growing 
parasitically  on  the  bodies  of  dead  flies,  lying  in  water,  also  on 
fish,  frogs,  &c.,  and  occasionally  on  decaying  plants, 

A  specimen  of  diseased  foot  (Carter's  pale  or  ochroid  variety) 
was  exhibited  by  Dr.  Tilbury  Fox  before  a  meeting  of  the  Patho- 
logical Society  of  London  in  1869,  and  the  Report  of  the  Com- 
mittee appointed  to  examine  it  was  to  the  effect  that  **  there 
was  no  trace  of  structure  that  could  be  set  down  as  that  of 
fungus. '^  In  1871  a  specimen  of  the  melanoid  variety  was 
exhibited  before  the  same  society,  and  reported  on  by  Dr.  Bris- 
towe,  who  found  fungoid  structures  abundant;  but  he  could  not 
"  decide  whether  the  fungus  is  the  cause  of  the  bone  disease  or 
only  a  consequence  of  it." 

Dr.  Fayrer,  of  the  Indian  army,  has  recently  published  a  work 
entitled  ^'^  Clinical  and  Pathological  Observations  in  India,"  and 
at  page  637  reference  is  made  to  a  case  of  Madura  foot.  It  was 
carefully  examined  microscopically  by  himself,  Professor  Ewart, 
and  Dr.  Timothy  Lewis  without  finding  anything  to  support  the 
theory  that  the  disease  is  due  to  the  presence  of  a  fungus. 
Fayrer,  who  has  had  a  great  deal  of  experience  in  Indian  diseases, 
inclines  to  the  belief  "  that  the  fungoid  growths,  when  they  do 
occur,  may  be  aconsequence  and  not  a  cause  of  the  disease,  whose 
affinities  are  more  probably  to  be  referred  to  Elephantiasis  or  some 
allied  constitutional  disorder  than  to  the  presence  of  a  vegetable 
growth  possessing  the  strange  and  seemingly  improbable  power 
of  finding  its  way  into  the  depths  of  the  tissues  forming  the 
foot." 

Dr.  T.  Lewis,  of  the  Army  Medical  Department,  well  known 
for  his  investigations  in  India,  endeavoured  to  cultivate  the 
fungus  by  adding  thirteen  specimens  of  the  material  forming  the 
diseased  patches  in  the  case  above  quoted,  to  thirteen  various 
cultivating  media  or  their  combinations  placed  in  moist  cham- 
bers. The  specimens  were  watched  from  the  14th  of  August  to 
the  7th  of  November,  1871,  and  so  far  as  the  appearance  of  any 
peculiar  fungus  was  concerned,  the  results  were  negative.  On 
the  other  hand.  Dr.  Carter  accounts  for  the  failure  of  these  cul- 
tivation experiments  by  the  lateness  of  the  season  at  which  they 
were  undertaken,  and  on  this  point  writes  that  "  the  new 
growth  appeared  only  at  a  certain  time  of  the  year,  which  for 
Bombay  may  be  regarded  (other  facts  being  corroborative)  as 
the  close  of  the  hot  season  and  setting  in  of  the  rains,  or  from 
April  to  July  or  August." 

In  the  February  number  of  the  *  Indian  Medical  Gazette,' 
there  is  an  article  on  '^  The  Etiology  of  the  Madura  Foot,"  and 
though  the  name  of  the  writer  is  not  given,  it  has  evidently 
been  written  by  one  possessing  a  knowledge  of  fungi  in  general 


1875.]  HoRTON  on  Diseases  of  the  Tropics.  47 

and  of  this  subject  in  particular.  Any  accurate  observations  by 
a  person  as  it  were  present  on  the  spot  where  the  disease  is 
endemic  should  have  due  consideration,  and  this  observer,  no 
doubt  from  a  study  of  the  disease,  differs  from  the  conclusions 
arrived  at  by  Dr.  Carter,  or,  in  other  words,  does  not  admit  as 
proven  that  the  affection  is  produced  by  a  fungus. 

Dr.  Carter  hints  at  some  relation  between  fungus  foot  and 
guinea-worm  disease,  and  it  is  difficult  to  comprehend  what  that 
relation  is ;  but  it  certainly  seems  strange  that  the  spores  of  a 
fungus  should  enter  the  integument,  penetrate  the  solid 
tissues,  and  form  canals  on  something  like  a  definite  plan  and 
sometimes  in  situations  which  give  the  least  resistance. 

This  subject  is  well  worth  investigation  both  with  regard  to 
the  other  points  we  have  noted  and  to  many  others.  As  we  have 
seen,  there  is  above  all  no  unanimity  regarding  the  etiology  of 
the  disease. 

The  book  contains  a  good  deal  of  repetition,  possibly  from  a 
desire  of  the  author  to  impress  his  views  deeply  on  the  minds 
of  his  readers  ;  nevertheless  we  recommend  it  as  a  most  valuable 
and  careful  record  of  investigations  into  the  nature  of  a  disease 
still  surrounded  with  a  great  deal  of  mystery. 


V. — Horton  on  Diseases  of  the  Tropics.^ 

It  is  now  fifteen  years  since  the  last  work  of  any  size  or 
pretensions  which  treated  generally  of  the  diseases  of  the 
tropics  appeared  in  England.  Some  small  works  on  the 
diseases  of  India  by  Peete,  Moore,  and  others,  have  come  out 
since,  but  do  not  seem  to  be  extensively  known,  and  the  second 
edition  of  Morehead^s  clinical  researches  continues  to  be  our  best 
and  most  modern  work.  Not  that  there  has  been  any  want  of 
labourers  in  the  field  of  Indian  medicines.  Detached  papers 
in  Indian  journals,  and  admirable  official  reports,  such  as  those 
of  Bryden,  Cunningham,  Cornish,  Lewis,  and  Cunningham,  are 
abundant.  Indeed,  it  may  be  a  question  whether  these  public 
documents  do  not  to  a  certain  degree  interfere  with  the  labours 
of  individuals.  We  have  had  of  late  years  a  few  articles  and 
books  of  some  consideration  on  Indian  medicine,  as  Gordon, 
Macpherson,  Macnamara  on  cholera,  Chevers  on  public  health, 
and  Oldham's  ingenious  discussion  on  malaria.  But  we  have  not 
been  supplied  with   any  general  view  of  the  present  state  of 

1  The  Disease  of  Tropical  Climates  and  their  Treatment,  with  Hints  for  the 
Preservation  of  Health  in  the  Tropics.  By  J.  A.  B.  HoETON,  M.D.  Edin., 
F.R.G.S.,  Surgeon-Major.     London,  1874.    Small  8vo,  pp.  657. 


48  Reviews.  [July, 

Indian  medicine,  and  especially  with  no  work  that  brings  into 
one  focus  all  our  most  recent  knowledge  respecting  the  fevers  of 
India,  and  endeavours  to  determine  their  relations  to  each  other. 
In  former  days  there  was  no  lack  of  such  works,  many 
of  them  bearing  the  impress  of  the  individual  character 
of  their  authors.  Lind  and  Clarke  were  followed  by  James 
Johnson,  Twining,  Annesley,  Gedder,  Martin,  Macgregor,  Mac- 
kinnon,  and  the  series  seems  to  have  wound  up  with  Morehead. 
In  like  manner  for  the  West  Indies,  besides  the  various  works 
on  the  diseases  of  sailors,  we  had  Hunter,  Bell,  RoUo,  Manby, 
Chesterton,  and  others.  But  of  late  years,  with  the  exception  of 
the  reports  on  yellow  fever,  and  Milroy's  late  report  on  leprosy, 
we  have  little  but  what  is  to  be  found  in  the  official  reports  of 
the  army  and  navy.  The  French  have  contributed  good 
material  in  their  accounts  of  the  semi-tropical  climate  of  Algiers 
and  of  parts  of  Africa;  and  Boudin  and  Armand  have  illustrated 
the  geography  of  tropical  disease.  Some  American  writings  on 
the  climates  of  their  southern  States  are  also  of  value.  Still  we 
are  not  aware  that  any  country  has  furnished  a  good  manual 
of  tropical  disease.  Every  one  complains  of  the  non-existence 
of  such  a  work,  and  a  laudable  desire  to  supply  the  want  has 
induced  Dr.  Horton  to  come  forward.  It  was  a  bold  task  for 
him  to  undertake,  living  in  a  situation  of  comparative  isolation 
on  the  western  coast  of  Africa,  and  away  from  libraries,  but 
he  has  performed  it  with  very  creditable  success.  It  was  scarcely 
to  be  expected  that  he  should  be  able  to  produce  a  completely 
satisfactory  work,  embracing  an  outline  of  the  whole  subject.  He 
seems  to  have  consulted  all  the  authorities  he  could,  and  he 
mainly  rests  on  the  labours  of  others ;  he  especially  follows 
Martin,  whose  work  having  grown  out  of  Johnson's  older  one, 
was  never  quite  up  to  the  knowledge  or  practice  of  the  day, 
and  we  see  no  evidence  of  his  being  really  acquainted  with  the 
writings  of  Morehead,  although  he  makes  reference  to  them  when 
speaking  of  the  use  of  ipecacuanha.  We  think  Dr.  Horton  would 
have  been  better  occupied  in  giving  an  account  of  his  personal 
experience  of  the  diseases  prevalent  on  the  coast  of  Africa.  All 
works  giving  a  faithful  picture  of  actual  observation  are  valuable, 
but  the  present  book  is  singularly  deficient  in  the  local  information 
which  he  must  be  well  able  to  supply.  It  is  not  necessary  to 
enter  into  a  lengthened  review  of  a  work  which  handles  so 
many  subjects,  but  we  shall  glance  at  a  few  points  which  have 
struck  us.  We  could  easily  take  exception  to  the  style,  which 
is  often  ungrammatical  and  obscure.  We  do  not  quite  under- 
stand his  selection  of  subjects  ;  why,  for  instance,  dyspepsia,  con- 
stipation, and  rheumatism  should  be  specially  selected  for  dis- 
cussion in  a  work  on  tropical  diseases. 


1875.] 


HoRTON  on  Diseases  of  the  Tropics.  49 


One  of  the  best  chapters  is  on  splenic  enlargement,  and  its 
occurrence  as  a  result  of  endemic  influences,  or  of  simple  chronic 
malaria  poisoning  independently  of  any  accession  of  fever.  This, 
we  believe,  is  of  more  frequent  occurrence  than  is  usually  sup- 
posed, and  is  developed  chiefly,  as  our  author  remarks,  in  per- 
sons of  mixed  blood,  and  in  those  who  are  born  in  the  tropics. 
He  states  that  occasionally  infants  are  born  with  enlarged  spleens 
like  their  parents.  We  hope  that  he  has  entirely  satisfied  him- 
self as  to  the  accuracy  of  this.  It  is  difficult  to  know  what  Dr. 
Horton  thinks  on  the  subject  of  dracunculus  in  infants ;  he  says, 
"  one  is  sometimes  told,"  that  it  attacks  children  a  few  months 
or  weeks  after  birth.  He  does  not  say  that  no  such  case  is 
Avithin  his  own  personal  knowledge :  but  that  the  worm  could 
not  be  transmitted  through  the  mother,  as  the  embryo  worms 
are  too  large  to  make  that  possible.  Then,  again,  in  the  case  of 
Guinea-worm  in  the  scrotum,  he  ascribes  this  to  direct  local 
contact  with  an  infected  person,  which  is  surely  an  impro- 
bable cause.  The  chapter  on  ardent  continued  fevers  is  one  of 
the  least  satisfactory.  Febris  perniciosa,  malignant  or  typhoid 
fever  of  the  tropics,  are  given  as  synonymous  terms.  Now,  if  by 
febris  perniciosa  is  meant  the  jievre  pernicieuse  of  the  French, 
that  is  an  aggravated  remittent  or  intermittent,  which  is  some- 
thing entirely  different ;  and  as  to  typhoid  fever  of  the  tropics, 
although  he  does  mention  ulceration  of  Peyer's  patches,  surely 
he  does  not  describe  enteric  fever.  However,  this  is  the  only 
notice  he  gives  of  that  disease,  and  perhaps  after  all  he  does 
allude  to  it,  as  he  says  that  its  true  cause  is  putrefying  animal 
matter,  and  the  contamination  of  drinking  water  by  it.  His 
treatment,  which  consists  of  1  grain  calomel,  %  grains  of  quinine, 
and  -^  grain  of  opium  every  hour,  is  remarkable,  but  does  not 
throw  much  light  on  the  question  of  what  sort  of  fever  he  had 
in  view. 

Dr.  Horton  often  lays  down  the  causation  of  disease  in  a 
somewhat  positive  manner,  which,  however,  is  a  not  very 
uncommon  practice  at  the  present  day.  He  tells  us  that  "  when 
the  system  is  much  surcharged  with  miasmatic  effluvia,  it 
(what?)  makes  its  escape  through  the  intestine  by  causing 
irritation  in  its  coats ;  this  form  of  disease  is  called  malarial 
diarrhoea."  He  informs  us  that  when  there  is  much  ozone  in 
the  air,  there  is  less  malarious  fever ;  and  also  that  when  this 
is  the  case,  smaller  doses  of  quinine  are  sufficient  to  cure  it : 
interesting  facts,  no  doubt,  if  they  have  been  duly  ascertained. 

A  more  important  statement,  and  one  opposed  to  the  ordinary 
belief,  is  that  it  is  a  mistake  to  suppose  that  Africans,  and 
especially  that  West  Indian  blacks,  enjoy  any  immunity  from 
malarious  fevers.    Dr.  Horton  says  that   in  dysentery  *'  evacua- 

111— LVI.  4 


50  Reviews,  [July, 

tion  is  mostly  in  lumps  or  hardened  balls  resembling  forced- 
meat-balls,  but  harder,  but  they  are  by  no  means  frequent." 
Does  he  mean  that  these  hardened  balls  or  the  evacuations  are 
rare? 

The  accounts  of  endemic  diseases  are  on  the  whole  poor,  that 
of  dracunculus  the  best.  The  remarks  on  treatment  are 
generally  judicious.  Dr.  Horton  does  not  care  for  very  large 
doses  of  quinine,  and  thinks  that  eight-grain  doses  will  answer 
almost  any  purpose.  He  believes  in  the  usefulness  of  quinine 
taken  in  small  doses  as  a  prophylactic  against  fever — a  matter 
which  is  very  questionable.  He  speaks  nearly  as  sanguinely 
as  others  of  late  have  done,  of  the  specific  effect  of  ipecacuanha 
in  dysentery,  although  he  has  occasionally  observed  alarming 
effects,  he  thinks,  from  too  long  continued  doses. 

It  is  wonderful  what  vicissitudes  of  unlimited  employment 
and  of  nearly  as  universal  disuse  in  dysentery,  that  root  has 
gone  through.  Dr.  Cockburn  wrote  in  1736,  "We  were 
religious  adorers  of  a  specific,  the  ipecacuanha,  as  well  as  the 
French  for  half  a  century,  but  the  French  have  been  cured 
of  their  credulity  for  some  years."  Its  first  employment  was 
nearly  as  early,  at  least  as  early  known  to  us,  as  bel,  the 
remedy  for  chronic  diarrhoea.  We  are  able  to  confirm,  from 
personal  experience,  what  is  said  of  the  valuable  effects  of 
sugar  of  lead  in  some  cases  of  dysentery,  especially  in  natives 
of  the  tropics.  We  think  Dr.  Horton  need  not  dread  the  produc- 
tion of  symptoms  of  lead  poisoning.  He  does  not  seem  to  have 
heard  of  the  use  of  large  enemata  in  that  disease — a  practice 
for  a  time  in  vogue  in  India,  on  official  recommendation,  but 
one,  we  believe,  now  nearly  forgotten.  He  maintains  a 
judicious  reserve  as  to  almost  miraculous  effects  in  spleen  and 
in  goitre,  ascribed  by  very  competent  authorities  of  late  years 
to  the  local  application  of  ointment  of  iodide  of  mercury. 

Of  his  remarks  on  tropical  hygiene  we  shall  only  say,  that 
the  maxims  culled  from  various  sources  are  sensible  enough, 
but  many  are  redundant,  and  clothed  in  such  queer  language, 
that  they  almost  seem  intended  to  cast  ridicule  on  the  subject. 
For  instance,  "  A  strict  moral  principle  is  beneficial  in  the 
tropics  :  "  "  The  Christian  religion  has  a  more  beneficial  influ- 
ence on  the  minds  of  men  in  the  tropics  than  either  Moham- 
medanism or  any  other  religious  tenets." 

It  would  be  easy  to  point  out  many  such  strange  and  barely 
intelligible  statements.  Nevertheless,  with  all  its  defects,  the 
book  is  one  that  is  not  without  its  use  to  medical  men  visiting 
the  tropics  for  the  first  time. 

Instead  of  following  Mr.  Horton  further,  as  we  have  said 
that  a  book  on  tropical  diseases  is  a  desideratum,  it  may  be  better 


1875.]  HoRTON  on  Diseases  of  the  Tropics.  61 

to  sketch  our  notion  of  the  sort  of  treatise  that  is  wanted,  and 
of  the  subjects  which  it  should  comprise.  Of  all  the  works 
that  we  have  seen,  Morehead^s  is  the  most  satisfactory,  and  a 
new  edition  of  it,  with  certain  modifications  and  additions, 
would  be  most  valuable,  but  a  little  known  book  was  published 
in  India  in  the  year  1848  by  the  late  Dr.  K.  Mackinnon,  which 
in  its  scheme  embraced  nearly  every  subject  which  should  find  a 
place  in  a  work  such  as  we  contemplate,  although  its  execution 
was  not  equal  to  its  design.  Indeed,  such  a  subject  cailnot  be 
treated  adequately  in  a  book  no  larger  than  his  or  than 
Dr.  Horton's  manual.  When  we  talk  of  a  manual  being 
urgently  wanted,  it  is  not  so  much  that  there  are  many 
important  novelties,  either  in  the  pathology  or  the  etiology 
of  tropical  diseases,  which  have  only  been  made  out  of  late 
years.  But  in  all  sciences  we  like  to  have  new  '^  present- 
ments "  of  the  subject.  Even  if  the  matter  is  chiefly  old,  still 
we  like  to  have  it,  like  our  coats,  shaped  according  to  the 
fashion  of  the  day. 

We  have  already  alluded  to  some  of  the  chief  sources  from 
which  aid  in  the  construction  of  such  a  work  should  be  derived. 
It  is  to  be  hoped  that  ample  references  will  be  given  to  those 
sources — a  want  of  such  references  makes  us  often  entirely 
forget  that  the  ground  we  are  going  over  has  already  been 
trodden  by  other  observers. 

A  writer  who  shall  put  together  a  satisfactory  work,  must  be 
able  to  combine  in  his  own  person  both  a  knowledge  of  the 
opinions  of  others,  and  a  practical  familiarity  with  disease. 

Many  sanitary  reports,  both  in  Europe  and  in  the  tropics, 
are  drawn  up  (and  in  a  very  positive  and  confident  tone  also) 
by  men  of  little  actual  experience  of  disease.  Many  popular 
manuals  have  been  produced  by  writers  who  knew  little  or 
nothing  of  the  bedside.  Useful  though  such  works  may  be, 
the  practitioner  on  referring  to  them  cannot  fail  to  observe 
a  certain  want  of  practical  knowledge,  which  detracts  greatly 
from  their  value.  The  latest  microscopical  researches,  and  the 
most  recent  modes  of  treatment  are  too  often  advanced  in  an  un- 
qualified way  as  matters  entirely  beyond  question,  instead  of 
being  received  and  considered  in  a  judicial  frame  of  mind. 
This  leads  us  to  remark,  in  passing,  that  the  two  Indian 
microscopists,  Drs.  Lewis  and  Cuningham,  distinguish  them- 
selves from  many  of  their  brethren  in  Europe,  by  the  caution 
with  which  they  avoid  hasty  generalisations.  A  work  of  the 
kind  we  speak  of,  might  easily  be  made  to  include  whatever 
was  special  to  the  case  of  sailors  or  of  coolie  emigrants, 
or  to  the  condition  of  soldiers,  and  no  doubt  would  be  welcomed 
by  army  and  navy  surgeons,  as  well  as  by  those  of  our  mercantile 


52  Reviews,  [July, 

marine.  It  is  comparatively  an  easy  thing  to  plan  such  a  work 
— to  execute  it  would  be  a  matter  of  difficulty  and  of  labour. 
Different  modes  of  arranging  the  material  will  suggest  them- 
selves to  different  minds,  but  a  work  of  the  sort  we  speak  of, 
might  treat  of  the  following  subjects. 

The  differences  between  climates  temperate  and  tropical, 
extremes  of  variation  of  diurnal  temperature ;  of  atmospheric 
pressure,  amounts  of  rainfall  and  of  moisture  in  the  air,  of  what 
is  termed  malaria ;  the  effects  of  seasons  on  the  prevalence  of 
particular  diseases  ;  a  slight  sketch  of  the  geography  of 
disease. 

Hygiene  of  the  tropics ;  hints  on  food  and  drink  and  dress  ; 
improvement  in  the  value  of  European,  query,  of  native  life  (on 
which  there  has  been  much  interesting  discussion  lately);  effects 
of  change  of  place,  everywhere  an  important  remedy,  but  espe- 
cially so  in  the  tropics.  This  would  include  some  account  of  the 
effects  of  diminished  and  increased  atmospheric  pressure  on  the 
system,  of  mountain  climates,  and  of  hill-stations. 

Endemic  diseases  might  be  more  fully  alluded  to  than  has 
usually  been  the  case.  They  have  never  hitherto  been  treated 
of  with  the  completeness  that  might  have  been  expected.  If  we 
now  enumerate  chiefly  diseases  of  the  natives  of  the  East 
Indies,  it  is  because  we  happen  to  be  more  familiar  with  them. 
Some  affections  of  the  digestive  organs,  as  dry  belly-ache,  dirt 
eating,  colic,  aggravated  dyspepsia  as  pet  sool  /  of  respiratory 
and  circulatory  organs,  as  epidemic  catarrh  or  nacra,  affections  of 
lungs  ;  prevalence  of  aneurism  and  of  nervous  diseases,  as  teta- 
nus, especially  in  women  and  new-born  infants ;  liability  to  pa- 
ralysis from  early  excess,  from  cold  ;  local  ansethesia,  burning  of 
the  feet ;  insanity  induced  by  drugs ;  sleeping  disease  of  Africa  ; 
nyctalopia,  amaurosis,  spleen,  land  scurvy,  beri-beri,  leprosy, 
elephantiasis  Arabum,  endemic  hydrocele,  syphilis. 

Cutaneous  affections,  boils,  cracks  in  soles  of  feet,  calculus, 
chylous  urine,  bloody  urine,  goitre,  and  cretinism. 

Helminthiasis,  dracunculus,  generation  of  maggots,  bites  and 
stings,  of  mosquitoes,  sand  flies,  chique,  serpents,  jackals,  dogs, 
hydrophobia. 

Other  divisions  of  the  subject  may  be  more  briefly  alluded  to, 
as  they  are  obvious  to  every  one.  What  are  called  ordinary 
tropical  diseases  are  : 

Fevers  and  their  varieties,  coup  de  soleil,  cholera,  diarrhoea, 
dysentery,  liver  diseases  and  their  effects,  chronic  diarrhoea, 
visceral  enlargements,  neuralgia,  local  paralysis,  and  anaemic 
conditions.  These  might  be  treated  of,  as  they  are  influenced  by 
hill-climates,  sea-voyages,  and  residence  in  Europe.  On  the  in- 
fluence of  European  climate  Sir  R.  Martin's  book  is  of  value,  and 


1875.]  Heredity.  53 

we  might  hope  to  have  the  experience  of  the  hospital  atNetley  and 
especially  of  Professor  Maclean.  Affections  with  which  we  are 
most  familiar  in  Europe  should  likewise  be  treated  of  as  they  are 
modified  by  tropical  climate, — eruptive  fevers,  scrofula,  phthisis, 
heart  and  lung  affections,  diseases  of  the  kidneys,  rheumatic 
gout,  haemorrhoids,  delirium  tremens,  and  syphilis.  Morehead 
has  worked  out  portions  of  this  division. 

Additional  chapters,  too,  are  wanted  on  the  diseases  of  women, 
and  the  influence  of  tropical  life  on  their  systems ;  and  on  the  dis- 
eases of  children.  In  these  last  the  mildness  of  eruptive  fevers  is 
counterbalanced  by  the  severity  of  the  affections  of  the  ali- 
mentary canal.  To  fill  in  the  sketch  we  have  made,  would 
necessarily  be  a  work  which  could  not  be  executed  well,  unless 
it  were  written  with  due  deliberation. 

But  as  we  have  already  remarked,  our  most  pressing  want  is 
an  account  of  fevers  as  they  occur  in  the  tropics,  a  consistent 
history  of  their  varieties.  Besides  differences  of  opinion  about 
yellow  fever,  there  are  diverse  ideas  regarding  enteric  fever  in 
India,  regarding  the  nature  of  the  devastating  Burdwan  fever, 
and  the  gaol  fever  of  the  Punjab.  A  good  account  of  the  fevers 
of  the  tropics  might  be  furnished  with  comparative  ease  by  some 
of  those  who  are  now  labouring  in  the  field  of  tropical  medicine. 

While  this  is  passing  through  the  press,  we  observe  that 
several  French  works  have  appeared  on  tropical  climatology 
and  disease. 


VI.— Heredity.^ 

Is  hereditary  taint,  tendency,  and  transmission  an  established 
and  trustworthy  truth,  and,  if  so,  what  are  the  elements  handed 
down  from  generation  to  generation  ?  The  present  seems  to  be 
a  suitable  stage  in  the  progress  of  science  to  attempt  to  discover 
an  answer  to  this  question,  when  the  subject  has  assumed  such 
vast  proportions  and  is  ever  widening  its  range,  when  it  pos- 
sesses a  voluminous  and  ever-increasing  literature  of  its  own, 
when  we  have  introduced  Gallicisms  into  our  language  in  order 
to  give  greater  precision  to  the  inquiry,  and  when  the  inherit- 
ance of  forms  and  qualities  is  employed  as  a  universal  solvent  for 
physiological  and  pathological  difficulties  otherwise  irremov- 
able, and,  we  suspect,  for  many  such  difficulties  as  are  to  a 

1  1.  Heredity,  a  Psychological  Study  of  its  Fhenomena,  Laws,  Causes  and  Con- 
sequences. From  the  French  of  Th,  Eibot,  author  of  Contemporary  English 
Psychology.     London,  1875.     Pp.  393. 

2.  Heredity  and  Hyhridism.  A  suggestion  by  Edwaed  S.  Cox,  S.L.,  author 
of  What  am  /?  &c.,  &c.     London,  1875.     Pp.  66. 

3.  Herediiarij  Genius,  an  JiJnqinri/  into  its  Laws  and  Consequences.  By 
J^BANCIS  GALTOJf,  F.R.S.,  &c.     London,  1869.     Pp.383, 


54  ,  ileviews.  [JuV» 

certain  class  of  minds  altogether  insoluble.     The  all  but  uni- 
versal assent  with  which  the  dogma  of  heredity  is  accepted  by 
the  learned  and  unlearned  alike  is  referable,  we  conceive,  to 
the  observation  of  the  similarity  in  form,  feature,  and  character, 
in  families  and  races — in  fact,  to  the  recognition  of  what  con- 
stitutes species — when   science  was   not,  to  the  equally  early 
perpetuation    of  castes,   occupations,   trades ;    to    the   popular 
craving  for  wonder-working  influences,  and,  above  all,  to  the 
sanction  afforded  by  the  scattered  memorabilia  collected  by  me- 
diaeval physicians.  Since  the  age, however,  when  common  Fevers, 
even  a  Quartan  Ague,  were  supposed  to  be  transmissible  from 
mother  to  child,  and  since  that  time,  when  Haller  recorded  that 
the   Bentivoglios  had  a  slight   tumour  on  the  body,  and  when 
superstition  or  fancy,  we  hope,  added  that  this  nsevus  warned 
them  of  changes  in  the  weather,  and  increased  in  size  before  the 
approach  of  moisture,  the  province   conceded   to  heredity  has 
been  so  enormously  enlarged  as  to  embrace  all  diseases,  disposi- 
tions, depravities,  peculiarities    in  form,  function,  even  some 
acquired  habitudes  and  oddities,  descending  from  the  noblest 
attributes  of  Reason  to  intolerance  of  the  touch  of  metals  (as 
exemplified  in  an  existing  noble  family),  and  has  been  elevated 
into  the  rank  of  a  symptom  or  the  substitute  for  less  palpable 
symptoms    in    disease,   and   in  the   instances  of  insanity  and 
responsibility  to  take  the  place  of  better  appreciated  and  more 
justifiable   grounds   for   depriving  the  victim  of  his    personal 
liberty  and  social  rights.     The  heterogeneity  of  the  various  in- 
ternal and  external  marks  of  defect  or  redundancy,  traced  in 
large  families  and  long  lineages,  might  be  legitimately  urged  as 
a  valid   objection  to  the  whole  theory,  but  is  here  introduced 
merely  to  indicate  the  lack  of  simplicity  and  the  data  upon 
which  it  is  founded,  and   in  order  to  show  that  there  must  be  a 
multiplicity  of  factors   at  work,  and   totally  different  laws  in 
operation  in  the  process  of  trar.F^mission,  should  such  a  process 
be  found  actually  to  exist.     It  will  now  be  seen  that  the  terms 
of  the  question  initiating  these  remarks  were  advisedly  selected, 
and  that  the  descent  or  diffusion  of  syphilis  cannot  be  identified 
with  a  tendency  to  drink,  steal,  or  to  seek  and  obtain  distinction 
in  oratory  or  music,  and  that  neither  can  have  any  affinity  with 
the  reappearance  of  muscular  strength  and  rickets,  of  personal 
beauty  and  elegance  and  deformity,  in  a  long  line  of  relatives. 
How   clumsily  such  morbid  genealogies    are   sometimes   con- 
structed  may  be  illustrated  by  that  of  the   Caesars,  which  is 
generally  advanced  as  a  clieval  de  hataille  in  such  encounters. 
In  this  stream,  supposed  to  be  so  continuous,  it  falls  to  be  noted 
that  the  mother  of  the  great  Caesar  was  no  ordinary  woman, 
that  his  daughter,  who  married  Pompey,  was  famed  for  feminine 
wit  and  beauty ;  that  the  heritage  of  these  rulers  of  the  world 


1875.]  Heredity.  55 

appears  first  in  talents  so  great  and  varied  that  they  would 
have  distinguished  either  a  statesman  or  a  soldier,  but  asso- 
ciated with  epilepsy ;  next  in  Augustus  as  valetudinarianism ; 
then  in  Tiberius  as  ichorous  disease  of  the  skin  and  face; 
fourth,  in  Caligula,  as  pallidity,  pervigilium,  and  delirium ; 
fifth,  in  Claudius,  as  physical  imbecility  ;  and,  lastly,  it  is  con- 
summated in  Nero,  as  unequivocal  insanity.  The  enumeration 
is  not  cited  as  a  reductio  ad  ahsurdum,  but  as  embodying  many 
of  the  vices  and  defects  detectable  in  the  attempt  to  demonstrate 
the  course  and  features  of  Heredity.  Here  there  are,  first,  a 
fountain  of  intellectual  power  and  bodily  perfection,  but  giving 
forth  turbid  and  polluted  springs,  which  have  not  only  lost  their 
original  purity,  but  are  gradually  poisoned  by  additions,  which 
appear  to  have  little  connection  with  each  other,  and  can  scarcely 
be  regarded  as  showing  a  common  origin,  or  even  a  similarity, 
between  the  different  causes  from  which  they  may  have  pro- 
ceeded. By  an  extreme  stretch  of  imagination  we  may  admit 
that  the  epilepsy  of  Caesar  and  the  madness  of  Nero  were  of 
kindred  root,  but  no  recourse  to  ingenuity  or  to  the  hypothesis 
of  atavism  could  invent  a  link  between  the  valetudinarianism  of 
Augustus,  the  skin  disease  of  Tiberius,  and  the  physical  weak- 
ness of  Claudius.  In  fact,  history  tells  little  more  than  that 
this  family  were  of  diseased  constitution,  and  remarkable  by 
their  power,  position,  mental  strength,  or  moral  weakness. 
The  practice  of  endeavouring  to  establish  a  law  of  heredity  by 
pointing  out  the  liability  of  certain  families  or  communities  to 
certain  classes,  though  not  to  the  same  class  of  diseases,  is  pre- 
valent in  the  present  day,  and  we  have  elaborate  treatises  and 
tables  to  prove  that  scrofula,  phthisis,  gout,  rheumatism,  con- 
vulsive affections,  and  insanity  frequently  afiect  members  of 
the  same  family  or  their  collateral  connections,  with  the  implied 
or  appended  inference  that  thiey  are  congeneric  afiiections,  and, 
though  separated  so  widely  by  the  tissues  involved,  and  the 
nature  and  event  of  the  maladies  themselves,  they  may  be 
traced  to  a  common  factor  in  hereditary  tendency.  To  this 
generalisation  the  character  of  the  latter  member  of  the  series, 
insanity,  although  believed  by  many  to  have  its  seat  in  an  im- 
material principle,  and  by  many  more  to  be  influenced  and 
cured  exclusively  by  moral  agents,  seems  to  present  no  insur- 
mountable obstacles  to  the  authors  of  these  speculations.  To 
mental  diseases  the  advocates  of  the  doctrine  of  the  propagation 
of  psychical  contamination  have  constant  recourse,  as  affording 
abundant  and  inexpugnable  evidence  upon  the  subject.  This 
step  is  natural  and  justifiable,  as,  apart  from  the  publicity  given 
by  gaps  in  the  social  circle  and  the  misfortunes  they  entail  when 
patients  thus  afflicted  are  consigned  to  hospitals,  where  the 


56  Reviews.  [July, 

cause  and  concomitant  circumstances  of  their  malady  are  re- 
corded, their  antecedents  may  be  approximately  ascertained. 
But,  in  examining  such  cases,  and  running  over  the  items 
founded  upon  such  histories,  and  finding  there  three  or  four 
generations  and  several  individuals  belonging  to  each  genera- 
tion, it  is  impossible  to  avoid  the  conclusion  that,  in  order  to 
admit  even  a  modified  heredity,  we  must  take  these  items  in 
the  lump  as  shadowing  forth  the  proneness,  the  susceptibility 
of  certain  consanguine  groups  to  cerebral  disturbance,  but  not 
to  the  same  kind  or  phase  of  mental  perversion.  We  saw, 
upon  one  occasion  in  the  same  institution,  a  mother,  her  son, 
and  daughter,  and  the  daughter  of  the  latter,  who  were  all 
insane ;  but,  on  investigation,  it  appeared  that  the  mother  was 
a  composed,  though  garrulous,  incendiary,  who  set  fire  to  her 
cottage  when  it  contained  all  her  children  ;  that  the  son  was  a 
coarse,  drunken,  delirious  person,  of  limited  capacity  ;  that  the 
daughter  was  a  violent,  destructive,  paroxysmal  maniac ;  while 
her  daughter  was  a  weak-minded  melancholic ;  so  that,  though 
connected  by  blood  and  a  common  lot,  there  was  no  other  rela- 
tion between  their  several  conditions  than  that  of  mental  dis- 
order. Moreau  de  Tours  has  estimated  that  of  lunatics  nine 
tenths  are  hereditarily  affected.  Other  authorities  make  the 
proportion  one  tenth  ;  but  M.  Ribot  calculates  that  one  half  or 
one  third  owe  the  origin  of  the  disease  to  this  cause.  But,  if 
this  gross  number  be  analysed,  it  will  become  obvious  that  the 
predisposition  to  lypemania,  or  to  other  very  distinct  species  of 
depression,  may  have  been  sanguinary  and  impulsive  mania ; 
that  the  vain  monomaniac  or  proud  general  paralytic  may 
have  had  a  progenitor  who  committed  suicide,  and  that  indi- 
viduals labouring  under  confirmed  dementia  have  had  among 
their  ancestry  odd  or  excitable  and  intemperate  notabilities. 
That  many  instances  of  dipsomania  and  drunkenness  may  occur 
in  the  same  family,  may  eventuate  in  lunacy  or  even  structural 
disease  of  the  nervous  system,  and  may  recur  in  descendants,  can- 
not be  doubted;  but,  unless  the  whole  postulate,  that  the  required 
habits  and  vices  are  inherited,  and  unless  the  effects  of  imita- 
tion, similarity  of  disposition,  and  positive  training,  be  ignored, 
it  will  be  difficult  to  trace  out  satisfactorily  such  a  heritage ; 
but  the  most  striking  feature  in  the  supposed  influence  of 
drunkenness  over  the  moral  constitution  of  progeny  is  con- 
tained in  the  proposition  first  enunciated  by  Howe,  now  received 
almost  as  an  axiom,  that  more  than  one  third  of  the  idiots  in 
America  are  the  offspring  of  intemperate  habits.  In  this  country, 
although  examples  of  such  causation  may  be  met  with,  their  fre- 
quency is  not  so  great,  nor  would  it  be  philosophical  to  dissociate 
this  cause  from  the  general  dissoluteness,  tht>  disease,  and  the 


1875.J 


Heredity.  57 


poverty,  which  may  exercise  a  greater  influence  over  such  a 
result;  but,  even  if  idiocy  and  imbecility  could  invariably  be 
connected  with  habitual  intoxication  on  the  part  of  a  father,  it 
is  difficult  to  see  why  the  temporary  saturation  of  the  brain 
with  alcohol,  on  the  one  side,  should  lead,  by  any  law  of 
heredity,  to  the  non-development  of  intellect  upon  the  other; 
it  is  difficult  to  see  why  the  brief  obscuration  of  mind  in  the 
propagator  should  almost  always  lead  to  structural  deformity 
and  imperfection  in  the  propagated,  and  still  more  difficult  to 
concede  that,  if  the  law  of  heredity  be  inflexible,  as  is  repre- 
sented, the  stalwart  frame  of  the  father,  as  well  as  his  brief 
obscuration  of  intellect,  should  not  have  been  imparted  con- 
temporaneously to  the  child.  But  in  many  respects  this  law  is 
neither  rigid  nor  regular  in  its  application.  Confining  our 
present  view  to  pathological  considerations,  it  is  notorious  that 
the  morbid  taint  often  passes  over  a  generation,  that  perfectly 
healthy  and  robust  individuals  may  be  the  only  connecting 
media  between  others  suffering  from  gout  or  consumption  ;  and, 
in  order  to  obviate  this  apparent  contradiction,  the  theory  of 
atavism,  the  recognition  of  which  is  attributed  to  Haller,  has 
been  propounded.  While  it  is  inconsistent  with  even  what  is 
generally  admitted  as  to  heredity,  to  affirm  that  a  pure  and  un- 
vitiated  stock  should  produce  a  corrupt  seed,  the  obstacles  to  a 
clear  comprehension  of  the  relations  of  these  links  in  the  chain 
become  insuperable  when  several  generations  have  been  free 
from  disease,  when  the  proclivities  of  collaterals  have  to  be 
taken  into  account,  when,  in  the  search  for  some  peculiar  or 
poisoned  source,  we  are  carried  back  for  scores — perhaps  a  cen- 
tury— of  years,  during  which  the  stream  of  life  has  been  flowing 
apparently  without  contamination  or  marked  deviation  from  its 
natural  course.  But  this  artificial  expedient  of  reversion  is  found 
to  be  inadequate  to  connect  the  phenomena,  and  cross  or  inter- 
current between  the  sexes,  collateral,  and  even  avuncular  heredity 
is  resorted  to,  which  M.  Piorry,  though  viewing  with  suspicion, 
and  ignoring  altogether  the  effects  of  old  and  strong  over  youno* 
and  feeble  minds,  of  punishment,  praise,  and  of  the  instruction, 
so  often  usurped  by  uncles  and  aunts,  conceives  to  be  probable. 
But  this  difficulty  is  obviated  by  another  hypothesis,  which,  with 
all  deference  to  those  who  hold  it,  may  be  styled  untenable  and 
undemonstrable.  In  order  to  bridge  over  the  gap  between  the 
persons  affected  with  disease,  whether  that  gap  include  one  or 
many  undiseased  persons,  it  is  asserted  that  the  taint  is  present 
in  all,  but  lies  latent,  dormant,  inactive,  but  is  infallibly  ulti- 
mately called  forth.  We  are  much  tempted  to  quote,  as  appro- 
priate, '^De  non  apparentibus  et  existentibus,  &c.,"  but  shall 
content  ourselves  with  suggesting  the  rashness  of  arguing  upon 
latent,  that  is,  non-appreciable,  qualities,  upon  taints  which  have 


58  Reviews,  l^^^Jy 

no  symptoms,  upon  tendencies  which  tend  to  nothing  in  the  indi- 
vidual, wliether  they  affect  the  species  or  not,  and  with  the  for- 
midable commentary  that  this  latent  germ  does  not  bud  nor  bear 
fruit  until  called  forth — that  is  to  say,  until  vivified  by  surround- 
ings which  are  in  themselves  perfectly  equivalent  to  the  produc- 
tion of  the  effect  attributed  to  heredity.  Were  the  doctrines  of 
atavism  and  latency  pushed  to  extremity,  in  place  of  pointing 
to  exceptionally  degenerate  races,  we  would  fail  to  discover  a 
single  clan,  tribe,  family,  exempt  from  the  causes  of  such  dete- 
rioration, or  in  which  the  tenure  of  life  and  sanity  was  not 
precarious. 

Let  it  be  supposed  that  the  fact  of  latency  were  admitted,  it 
is  next  incumbent  to  determine  what  the  thing,  the  undeveloped 
germ  which  passes  through  a  succession  of  living  beings,  but 
appears  in  certain  members  only  of  the  series,  whether  it  be  a 
faculty  or  force,  a  primordial  form  or  fantasm,  a  poison  or  a 
panacea ;  or  whether  we  must  rest  content  with  the  vague 
generalisation  of  a  beatific  or  morbific  proclivity,  slumbering 
far  down  or  awaking  as  the  case  may  be,  in  the  depths  of  struc- 
ture or  sensibility.  But  the  perplexity  is  augmented  when  it 
is  considered  that  many  such  proclivities  must  run  through  the 
same  channel,  sometimes  connate,  sometimes  antagonistic, 
sometimes  mutually  destructive.  Authors  alive  to  the  import- 
ance of  these  views  have  attempted  various  explanations.  In 
reference  to  the  transmission  of  mental  powers  or  perversions, 
it  has  been  held  to  depend  upon  the  form  of  the  head,  the 
quantity  or  quality,  or  the  proportions  of  the  cerebral  sub- 
stances, but  this  dependence  of  the  issue  upon  the  natural  or 
malformed  cerebrum  where  distinguished  talents  or  irregulari- 
ties of  conduct  appear  as  characteristic  manifestations,  or  where 
imbecility  occurs,  or  where  age  or  circumstances  press  too 
heavily  upon  some  weak  or  wounded  part  and  the  whole  fabric 
falls  ;  was  obviously  begging  the  whole  question.  Again,  it  was 
argued  that  insanity  and  all  the  allied  deviations  of  eccentricity, 
extravagance,  weakness,  might  be  propagated  as  specific  diseases, 
depending  upon  an  unhealthy  condition  of  the  brain  or  of  some 
other  organ  acting  dynamically,  which  was  roused  into  activity 
by  the  slightest  causes,  and  may  burst  forth  into  disease  from  the 
acceleration  of  the  circulation  in  fever  or  passion,  or  from  the 
influence  of  internal  emotions  or  external  events.  But,  as  such 
causes  directly  produce  similar  consequences,  there  does  not 
appear  to  be  any  necessity  for  speculating  as  to  latency,  but, 
where  these  consequences  do  not  follow,  such  exemption  may 
generally  be  referred  to  one  of  three  sources  :  1.  Either  one  of 
the  parents  has  been  of  robust  and  pure  constitution.  2.  The 
natural  physical  powers  and  training  of  the  individual  exempt 
have  been   such  as   to   afford  protection ;  or,  3.  It  is  rank  or 


1875.]  Heredity.  69 

position,  or  profession  in  society,  has  removed  him  from  the 
influence  of  the  excitement,  fluctuations,  and  reverses  of  fortune 
which  are  so  fertile  of  clanger.  In  scrofula,  gout,  lepra, 
syphilis,  a  distinct  virus  has  heen  supposed  to  be  the  medium 
of  communication,  where  particular  features,  departures  from 
ordinary  conformation,  or  actual  deformities,  appear  in  families, 
a  change  of  type,  effected  by  external  or  internal  in- 
fluences, of  which  we  know  nothing,  has  been  believed  to  take 
place.  But,  if  deficiency  or  redundancy  of  fingers  or  toeS;,  dis- 
tortions of  the  limbs,  ears,  nose,  be  produced,  be  acquired  by 
any  external  cause  acting  upon  the  structures  of  one  individual, 
it  will  become  necessary  to  show  why  circumcision,  tatooing, 
disfigurement  of  the  cranium,  as  practised  in  certain  nations, 
have  not  become  permanent  forms  transmissible  by  heredity. 
Where  no  such  flagrant  deviations  from  nature  either  took 
place  or  were  to  be  expected,  a  taiiit,  an  infection,  an  un- 
healthy element,  was  suspected  of  interpenetrating  the  system, 
which  cannot  have  been  other  than  disease  in  its  first  stage  ; 
which  cannot  explain  the  development  of  new  diseases  such  as 
smallpox,  syphilis,  &c.,  dependent  upon  social  customs  or 
corruptions,  nor  the  origin  of  epidemics  or  contagious  diseases. 
Again,  a  tendency  or  predisposition  has  been  conjectured  to 
exist  which,  if  it  means  anything  more  than  "as  the  twig  is 
bent  the  tree's  inclined,"  must  express  the  fact  that  certain 
individuals  from  defects  in  structure  or  strength,  from  certain 
pursuits,  propensities,  &c.,  are  more  exposed  to  external  cir- 
cumstances than  others.  Again,  a  laxo  is  imagined  to  be  im- 
pressed "  in  our  members,"  which  cannot  be  otherwise  under- 
stood than  as  that  form  of  organization  and  those  functions 
which  constitute  the  species  to  which  we  belong.  But  still 
more  transcendental  solutions  have  been  essayed ;  certain  of 
these  have  been  sought  in  chemistry,  certain  in  mathematics  ; 
and  Serjeant  Cox  has  sought  refuge  in  anatomy.  The  learned 
Serjeant  conceives  that  reproduction  is  not  the  initiation  of  a  new^ 
but  the  iteration  of  an  old  life  j  that  while  there  is  a  homo- 
geneous germ  of  life  common  to  all  organised  beings  conferring 
the  type  of  species,  the  character  and  form  are  eliminated  from 
this  by  nerve  influence.  But  even  were  it  conceded  that  the 
ovum  is  not  merely  a  congeries  of  molecules,  but  a  force,  we 
must  demur,  as  Wollaston  demurred,  to  the  notion  that  the 
Soul,  or  even  *^  a  manifestation  of  soul,"  is  thus  transmitted. 
Serjeant  Cox  goes  on  to  say  that  considering  the  simplicity  of 
nature  it  would  be  a  fallacy  to  attribute  to  one  parent  what 
must  be  due  to  both,  and  regards  the  more  recent  as  the 
more  rational  theory,  that  the  father  supplied  the  germ,  and 
the  mother  was  the  nurse.  The  twofold  is  not  duplex,  as 
a  sculptor  would  have  made  it,  but  two  halves.     These  two 


60  Reviews.  [Ju^y^ 

germs,  which  are  undeveloped  nerve-centres,  are  attracted  to 
each  other  by  a  force  unknown  to  us,  and  thus  acquire  the 
material  necessary  for  unity.  Upon  such  germ,  which  is  defined 
to  be  a  cell,  not  a  protoplasm,  are  stamped  life,  shape,  qualities, 
the  type  not  merely  of  the  species,  but  of  the  individual  animaVs 
progenitors,  which  are  not  obliterated  when  the  minute  creature 
grows  by  expansion.  It  is  not  regarded  as  an  exact  fac-simile 
of  the  parents,  but  as  in  conformity  with  their  original  and 
developed  nervous  systems.  Upon  this  compound  development 
appears  to  hinge  the  learned  Serjeant's  doctrine  of  heredity,  the 
interfusion  of  the  maturer  or  developed  qualities  of  the  respective 
factors  preserving  uniformity,  but  preventing  multiplicity  in  the 
characteristics  handed  down  to  the  offspring.  This  duplicity  in 
union  is  advanced  to  elucidate  the  existence  of  double  organs, 
symmetry,  the  occurrence  of  twins,  of  monstrosities,  &c.,  and 
it  might  have  been  pushed  as  an  explication  of  the  contrariety 
of  disposition  in  the  same  mind ;  of  the  dissimilarity  of  the  two 
sides  of  the  body,  the  one  resembling  the  father,  the  other  the 
mother,  and  of  Dr.  Wigan's  notion  as  to  the  independent  action 
of  the  two  hemispheres  of  the  brain.  Dr.  Coxe  imagines  that 
this  likeness  to  parents  is  more  detectable  in  the  mental  than 
the  bodily  qualities,  and  that  the  cropping  out  of  such  traits  in 
the  descendants  is  the  proof  of  the  original  hybridism. 

Had  there  been  perfect  stationariness  and  immutability  in 
the  operation  of  inneite  and  heredity,  it  is  quite  clear  that  we 
must  have  remained  the  exact  representatives  or  simulacra  of 
the  primeval  inhabitants  of  the  earth  ;  that,  notwithstanding 
the  omnipotence  of  evolution,  the  transition  and  the  steps 
by  which  the  passage  was  made  from  the  bone  to  the  stone, 
from  the  stone  to  the  copper,  &c.,  ages,  would  become  incom- 
prehensible, that  the  influence  of  external  impressions  and  in- 
fluences would  have  been  nullified,  that  the  efforts  of  genius 
and  discovery  could  have  but  feebly  elevated  the  destiny  of 
our  race,  and  that  this  institution  of  natural  primogeniture 
would  have  bequeathed  to  us  an  enslavement  of  fatalism  un- 
heard of  in  ethical  or  religious  systems.  Of  course  such  an 
outcome  does  not  prove  that  the  premises  are  destitute  of 
validity,  and  it  is  prudent  to  trace  out  the  process  which,  al- 
though binding  nature  "  fast  in  fate,"  may  have  "  left  free  the 
human  will.''  It  is  confidently  asserted  that  heredity  is  the 
original  factor  of  instinct  and  psychological  development;  al- 
though, unless  there  be  growth,  addition  from  one  point  to 
another,  that  is  a  departure  from  and  in  the  element  trans- 
mitted, it  is  impossible  to  grasp  the  origination  here  indicated. 
If  the  mechanism  upon  which  heredity  depends  explains  the 
rise  of  the  lower  instincts,  it  may  likewise  explain  the  develop- 
ment of  higher  psychical  conditions;  but  if  it  fails  in  the  former 


1875.] 


Heredity.  ^^^^^T'        61 


it  must  fail  in  the  latter.  The  next  assumption  is  that  instinct 
is  an  unconscious  form  of  intelligence  determined  by  organi- 
sation, in  other  words,  a  product  of  cerebral  matter,  underlying 
what  we  know  or  feel,  deep  down  in  the  profundities  of  latent 
mind,  or  '^  unconscious  cerebration,"  and  only  coming  within 
the  sphere  of  our  conceptions  when  they  have  acquired  a  new 
and  complex  psychical  nature.  Without  suspending  this 
analysis,  it  should  be  here  pointed  out  that  unconscious  cere- 
bration, which  appears  to  us  to  be  nothing  more  than  inatten- 
tively perceived  and  imperfectly  remembered  impression,  is  here 
made  to  contain  or  embody  an  instinct  which  has  not  previously 
existed,  or  which  has  not,  at  least,  emerged  into  the  sphere  of 
consciousness.  Even,  according  to  M.  Ribot,  unconsciousness 
is  not  the  zero  of  the  condition,  but  the  minimum  of  con- 
sciousness. If  we  go  back  from  composite  to  simple  strata 
in  mentalisation,  we  arrive  at  what  may  be  called  rudimentary 
states  or  principles,  from  which  all  higher  expansions  of  in- 
telligence may  be  held  to  be  derived ;  but  there  is  no  evidence 
that  these  two  apparent  extremes  of  the  mental  pole  differ  from 
each  other  in  degree  or  dignity,  that  there  has  been  ascent  or 
descent  from  the  one  to  the  other,  that  there  has  been  pro- 
gression at  all.  These  primitive  states  or  instincts  have  the 
same  relations  as  cell  to  organization,  and  what  may  have  been 
originally  reflex  actions  grow  into  habits  fixed  by  heredity. 
How  reflex  actions  grow  into  habits  founded  on  volition  is  dif- 
ficult of  elucidation.  It  is  thus  affirmed,  and  truly,  that  the  meli- 
pona  would  have  gained  by  making  its  cells  closer,  and  it  is  then 
rather  summarily  concluded  that  their  gain  has  been  accom- 
plished in  the  perfect  constructions  of  the  hive-bee,  by  evolution. 
To  those  who  are  of  opinion  that  instincts,  whether  simple  or 
complex,  perfect  or  imperfect,  as  well  as  all  higher  mental  func- 
tions, have  been  from  the  origin  of  the  species  and  formed  a  part 
of  the  specific  type  as  much  as  brain,  teeth,  antennae,  &c.,  and 
that  such  instincts,  though  affected  by  environments,  have 
never  changed  in  their  intimate  characteristics,  neither  by  one 
species  improving  upon  the  errors  of  another,  or  by  new  creations, 
these  speculations  are  futile  or  unsatisfactory  ;  but  it  is  asserted 
that,  plus  the  original  mental  constitution,  the  experience  of 
countless  generations  is  conserved  in  each  individual.  This  is 
extended  to  individual  nerves  which  are,  hypothetically  we 
hope,  endowed  with  memory  of  the  impressions  transmitted 
along  their  course,  and  necessarily  with  perception  and  con- 
sciousness, and  upon  this  basis  is  founded  the  proposition  that 
the  constant  repetition  of  acts  and  movements,  or  sensation  as 
represented,  as  involving  the  latter,  become  so  inextricably  asso- 
ciated as  to  constitute  habit,  which  is  identified  with  heredity  ; 
nay,  it  is  positively  asserted  that "  the  permanent  effects  of  a  par- 


^i  R€i)iew3.  [July, 

ticular  virus,  such  as  that  of  variola  or  syphilis,  in  the  constitu- 
tion, show  that  the  organic  element  remembers ,  for  the  remainder 
of  its  life,  certain  modifications  it  has  received ''  (Maudsley). 
In  truth,  the  supposition  that  a  nerve  force  can  be  transmuted 
into  a  state  of  consciousness  is  purely  gratuitous,  for  even 
Tyndall  admits  that  the  chasm  between  love  and  the  right- 
handed  spiral  motion  in  the  brain  is  impassable.  It  is,  more- 
over, fanciful  to  speculate  upon  the  conservation  and  conver- 
tibility of  moral  forces  as  laws  resembling  those  of  heat, 
electricity,  &c.  (p.  52).  A  gleam  of  light  was  conceived  to  be 
thrown  upon  the  ascension  of  new  thoughts  and  combinations 
into  consciousness,  the  birth  of  genius  in  fact,  by  what  Bayne 
has  designated  spontaneous  activity,  having  an  essential  con- 
nection with  voluntary  acts,  which,  if  estabUshed,  might  be 
correctly  called  a  personal  factor,  as  originating  what  has  not 
been  transmitted.  But,  although  not  inclined  to  dispute  either 
innateness  or  spontaneity,  this  inherent  independent  activity 
is  no  discovery,  but  is  the  same  with,  or  a  synonyme  for,  the 
motives,  desires,  pain,  which  excite  the  volition,  and  which 
whether  full-grown  instincts  or  not,  arise  and  control  mental 
and  corporal  acts,  without  recognisable  causation ;  but  the 
latitude  given  to  modern  theories  upon  these  points  may  be 
learned  from  the  argument  that,  although  confessing  inability 
in  following  out  the  transition  from  the  period  of  no  thought 
to  thought,  we  are  entitled,  according  to  M.  Ribot,  to  say  that 
the  organ  of  thought,  the  brain,  may  be  modified  not  only  by 
things,  but  by  the  relations  of  thing,  space,  time  and  causality, 
the  relations  of  bought  (pp.  316  &  318).  Here,  then,  there 
is  thought  and  its  relations,  which  are  the  products  of  the 
organ  of  thought,  modifying  this  organ,  and  consequently  its 
function,  through  its  structural  and  formal  constituents. 

It  is  superfluous  to  indicate  that  all  such  considerations  in- 
validate the  fixidity  or  perpetuation  of  heredity,  and  that  Darwin, 
in  affirming  all  acquired  instincts  to  be  insoluble  or  irremovable, 
must  be  incorrect,  and  his  error  is  still  better  exposed  by  the 
history  and  phenomena  of  neuter  insects,  where  instincts  are 
displayed,  which  were  not  exercised  by  the  progenitor,  and 
which  are  arrested  in  the  possessor.  But  even  a  better  illus- 
tration of  the  fallacy  and  untenability  of  such  views  may  be 
found  in  the  progressive  stages  of  lepidopterous  insects.  In  the 
e^^  must  rest  not  merely  multifarous  but  almost  contradictory 
laws  of  heredity,  which  pass  on  to  the  crawling,  gluttonous,  self- 
entombing  caterpillar,  which  again  pass  on  to  the  dormant,  foodless, 
and  scarcely  mobile  pupa,  suspended  by  gossamer  from  a  twig, 
differing  altogether  in  structure  from  the  matrix,  but  where 
growth  and  vivification  gradually  go  on ;  and  which  are  ulti- 
mately expanded  in  new  forms,  new  habits  and  a  new  destiny  in 


1875.]  Heredity.  63 

the  butterfly.  There  is  even  a  more  profound  truth  shrouded  in 
these  transmutations,  that  of  identity,  for  that  a  faint  shadowing 
of  egoism  must  run  through  all  the  stages,  may  be  inferred  from 
the  care  of  the  perfect  insect  for  its  eggs,  from  the  care  of  the 
caterpillar  for  the  safe  and  suitable  disposal  of  its  successor. 
M.  Ribot  says,  "  that  psychology,  even  experimental  psycho- 
logy, must  admit  a  certain  element  which  comes  before  us  as  a 
fact ;  this  we  call  the  ego,  the  person,  the  character  :  no  other 
word  will  designate  it  properly,  but  of  it  we  can  only  say  that  it 
is  that  which  in  us  is  inmost,  and  which  distinguishes  and 
differentiates  us  from  what  is  not  ourselves  ;  this  it  is  by  which 
our  ideas,  our  sentiments,  our  sensations,  our  volitions,  are 
given  to  us  as  ours,  and  not  as  the  phenomena  of  some- 
thing outside  ourselves"  (p.  343).  This  seems  to  concede 
the  whole  matter  in  debate.  It  is  quite  obvious  that 
whatever  may  be  thought  of  M.  Cousin's  extension  of 
the  fact,  the  feeling  of  personality  precedes  all  other 
mental  conditions,  moreover  it  includes  all  others,  the  entirety 
of  conscious  states ;  it  is  unassailable  by  growth,  disease,  age, 
decay  ;  it  may  overrule  and  extinguish  all  habits  and  tendencies 
from  whatever  source  derived,  and  stands  prominently  forward 
in  contradistinction  both  to  qualities  supposed  to  be  trans- 
mitted, and  to  qualities  imparted  by  education  and  external 
impressions.  Unless  it  be  held  that  the  whole  soul  potentially  or 
actually  is  inherited,  it  is  impossible  to  assign  a  distinct  sphere 
to  heredity  in  conjunction  with  personality.  But  if  personal 
identity  or  egoism  cannot  be  handed  down,  how  can  the  mental 
conditions  which  constitute  self?  M.  Ribot  appears  awakened 
to  this  difficulty  and  inquires.  Is  there  not  a  nescio  quid,  the  ego 
which  does  not  and  cannot  pass  from  parent  to  child  ?  But 
after  contending  that  character,  determinism,  in  fact  indivi- 
dualism, may  in  some  sense  be  transmitted,  he  gives  up  the 
argument  as  inextricable  (p.  344).  But  there  are  other  points 
at  which  M.  Ribot  makes  similar  concessions,  such  as  when 
attempting  to  demonstrate  the  conversion  of  external  impres- 
sion into  cognitions  in  the  grey  matter ;  where  he  comments 
upon  the  failure  ofGalton  in  establishing  psychological  here- 
dity; where  he  confesses  the  irreconcilability  of  heredity  Avith 
free-will  as  an  insolvable  enigma.  Moreover,  there  frequently 
occur  apparent  contradictions  and  obscurities  which  may  be  re- 
ferred either  to  difficulties  in  the  process  of  translation  or  to 
the  intractableness  of  the  subject  itself.  Of  the  former,  we  may 
cite  the  discrepancies  between  the  whole  theory  of  heredity  and 
of  the  declaration  that  people  arise  by  civilisation  to  conscious- 
ness, and  that  it  was  perhaps  in  the  last  century  that  this  was 
reached ;  although  the  highest  act  of  ihis  subjectivity,  what 
Goethe  calls  converse  with  God,  must  have  been  coeval  with 


64  Reviews.  [Ju^y 

the  very  advent  of  reason.  And  further  this  defect  is  shown 
in  the  aid  which  he  seeks  from  historians  in  support  of 
heredity  in  races  and  the  impossibility  of  changing  national 
character,  who  depict  the  French  of  to-day  as  the  same  as 
the  Gauls  in  the  time  of  Csesar,  with  the  same  levity,  war- 
like propensity  and  incurable  variety,  forgetting  altogether 
the  individualism  of  Napoleon,  Descartes,  Laplace,  <&-c.,  and 
his  subsequent  admission  (p.  324)  that,  after  eliminating 
all  the  elements  peculiar  to  the  wars,  social  and  religious 
disturbances  of  mediaeval,  even  recent  ages,  the  state  of 
the  French  intellect  was  not  then  the  same  as  to-day,  and 
that  the  difference  between  the  two  epochs  is  constitutional, 
organic.  The  degeneracy  of  whole  nations  once  great  and 
powerful,  such  as  the  Italians  and  Spaniards,  and  the  extinction 
and  the  present  degradation  of  many  smaller  communities, 
present  pertinent  and  palpable  exemptions  to  the  assumed  reign 
and  rule  of  heredity  and  evolution,  but  we  prefer  to  examine 
such  influence  and  laws  as  traced  through  individuals  and 
families.  Of  the  latter  the  following  may  suffice.  It  should 
be  premised  that  M.  Ribot  has  dipped  his  pen  so  constantly  in 
the  ink  of  Herbert  Spencer,  whom  he  repeatedly  quotes,  and  has 
become  so  deeply  imbued  with  both  his  philosophy  and 
phraseology,  that  it  is  difficult  to  distinguish  between  the  obser- 
vations of  the  master  and  his  disciple.  The  two  heredities 
being  thus  reduced  to  one,  we  again  sought  for  the  cause  of 
heredity,  and  found  only  a  hypothesis,  probable  indeed,  but 
which,  lying  beyond  the  limits  of  experience,  cannot  be  verified. 
The  definite  result  of  these  researches,  and  the  point  is  so  im- 
portaat  that  it  must  be  again  and  again  repeated,  is  that 
heredity  is  identity  as  far  as  possible ;  it  is  one  being  in  many. 
"  The  cause  of  heredity,"  says  Hackel,  "  is  the  partial  identity 
of  the  materials  which  constitute  the  organism  of  the  parent  and 
child,  and  the  division  of  this  substance  at  the  time  of  reproduc- 
tion." ''Heredity,  in  fact,  is  to  be  considered  only  as  a  kind  of 
growth  like  the  spontaneous  division  of  a  unicellular  plant  of 
the  simplest  organization."  Again,  having  introduced  the 
w^ords  of  Herbert  Spencer,  "  And  if  it  be  asked  whence  these 
physical  forces  which  through  the  intermedium  of  the  vital 
forces  produce  the  social  forces  ?  we  reply,  as  we  have  all  along, 
from  solar  radiation."  M.  Ribot  says,  "  In  a  world  where  all 
things  are  so  firmly  linked  together,  what  place  is  there  for 
free-will?  What  right  have  you,  say  the  determinists,  to 
break  up  the  series  of  effects  and  causes  for  the  purpose  of 
bringing  in  an  unintelligible  spontaneity  ?  You  say  when  I  wish 
to  move  my  arm  I  move  it;  but  this  movement  is  not  as  you 
suppose  a  creation — it  must  have  already  existed  in  your 
organism  under  a  different  form ;  and  the  very  act  whereby 


1875.]  Herediiy.  65 

you  form  your  resolution  is  conditioned,  is  subject  to  deter- 
minism. There  is  ground  for  believing  that  every  mental  state 
is  determined  by  organic  conditions,  and  that  consequently  it 
conies  indirectly  under  the  laws  of  universal  determinism.  Even 
though  you  dispute  this,  you  are  in  no  better  case,  for  at  least 
you  must  concede  that  this  state  depends  on  those  which  pre- 
cede it,  and  that  it  is  subject  to  the  laws  of  association,  called 
into  existence  by  association  ;  but  these  laws  of  association  are 
only  one  form  of  determinism  "  (p.  337). 

When  attention  is  given  to  the  rise  and  gifts  of  heroic 
and  representative  men,  to  the  bursting  forth  of  genius, 
whether  in  virtue  of  or  in  opposition  to  surrounding  circum- 
stances, we  cannot  fail  to  be  struck  with  the  slender  con- 
nection which  subsists  between  those  powers  which  perhaps 
regenerated  or  revolutionised  the  world  and  a  superior  mother 
or  a  clever  grandfather.  But  even  in  the  instances  adduced 
in  proof  of  heredity  it  is  instructive  to  note  that  only  two 
generations  are  recorded,  and  that  where  the  members  of 
the  series  are  more  numerous,  flaws  may  be  detected  either 
in  the  line  of  descent  or  by  the  intervention  of  remote  or 
extraneous  influences.  Where  the  basis  is  narrow  the  dura- 
bility and  tenacity  of  transmitted  tendencies  cannot  be  tested 
in  contrast  to  the  effects  of  struggles  for  moral  life  and  of 
collateral  interruptions.  On  this  point  Lucas  says  ascending 
movement  of  exalted  faculties  is  arrested  in  fourth  generation, 
and  Galton  has  found  that  eminent  are  less  numerous  by  one- 
half  than  illustrious  men,  and  that  such  limitation  may  be  ex- 
plained by  distinguished  statesmen,  judges,  and  so  on  marrying 
for  money,  while  the  daughters  of  highly  intelligent  and 
cultivated  families  are  disinclined  to  marry  at  all.  From  such 
and  greater  and  graver  obstacles  the  stream  of  heredity  has 
been  so  arrested,  curbed,  and  carried  from  its  direct  course,  that 
even  in  aristocracies  and  close  corporations,  which  would 
naturally  be  adduced  as  conservative,  there  is  no  nobility  said 
to  be  of  earlier  creation  than  three  centuries.  But,  while  the 
same  names  and  titles  may  not  appear  in  genealogies  and  heralds' 
Red-Books,  many  families  may  be  traced  back  by  indirect 
descent  for  a  thousand  years;  although  their  memorials  and 
traditions  might  be  fairly  introduced  to  disclose  how  varied  the 
talents  and  tendencies  of  the  individuals  composing  this  long 
lineage  have  been,  how  inefficient  noble  birth  and  training  and 
intermarriage  are  to  prevent  diff'erentiation,  and  how  often  the 
highest  attributes  dwindle  and  die  out  in  imbecility  and 
decrepitude. 

Proceeding  upon  the  assumption  that  heredity  augments 
intelligence  by  accumulation,  that  acquirement,  or  the  facility 
of  making  acquirement,  goes  on  progressively,  and  thus  the  mind 

111— LVI.  5 


^6  Reviews.  [July, 

is  rendered  capable  of  further  development,  it  has  been  postu- 
lated that,  given  one  illustrious  man,  we  may  calculate  the 
number  of  eminent  descendants  by  whom  he  may  be  succeeded. 
It  would  be  profitless  to  enter  upon  Mr.  Galton's  per-centages, 
or  even  in  detail  upon  M.  Ribot's  commentaries,  but  certain  of 
the  facts  may  be  examined,  the  real  dimensions  of  the  foun- 
dations upon  which  the  superstructure  of  heredity  has  been  built. 
Taking  high  reputation  as  a  pretty  accurate  test  of  high  ability, 
the  three  hundred  families  of  statesmen,  judges,  divines,  &c.j 
cited  by  Galton,  comprised  one  thousand  individuals,  of  whom 
four  hundred  and  fifteen  were  distinguished  by  talents  of  some 
kind  and  degree.  Does  this  say  much  more  than  that  of  three 
hundred  families,  highly  placed,  highly  educated,  restrained  in 
the  choice  of  wives  solely  by  rank  and  riches,  moving  in  highly 
cultivated  and  polished  society,  in  fact  in  the  circumstances  most 
favorable  for  the  development  of  different  mental  powers,  four 
hundred  and  fifty  were  gifted  individuals,  but  gifted  in  various 
modes.  In  order  that  this  should  swell  the  proof  of  heredity,  it 
would  be  necessary  to  show  that  the  line  of  descent  was  direct, 
whereas  cousins,  half-nephews,  uncles,  step-brothers,  and  other 
degrees  of  affinity  are  all  included  in  the  calculation  ;  secondly,  to 
prove  that  the  talent  transmitted  was  the  same,  whereas  judges 
are  traced  to  statesmen,  statesmen  to  litterateurs,  &c. ;  thirdly,  it 
would  be  necessary  to  show  not  merely  the  number,  but  the 
nature  of  the  exceptional  cases,  not  merely  those  of  mediocre  or 
non-eminent  talent,  but  where  imbecility  or  depravity  indicated 
that  the  course  of  heredity  had  been  arrested  or  modified.  But 
if  the  different  classes  of  which  the  republic  of  learning  and 
genius  and  letters  is  composed  be  examined,  still  greater  incon- 
sistencies are  encountered.  Thus  out  of  fifty  poets,  including 
names  little  known  to  modern  ears,  such  as  Sappho,  Lucan,  &c., 
twenty  had  eminent  relations.  But  when  we  find  that  the 
degree  of  consanguinity  in  Ariosto  was  brother  and  nephew ; 
in  Aristophanes  three  sons,  one  of  which  was  doubtful ;  that 
in  Byron  the  distinction  consisted  in  having  an  eccentric  mother, 
a  dissolute  father,  an  uncle  a  navigator,  and  that  all  his  other 
ancestors  were  either  bad  or  mad ;  and  that  in  Burns  and 
Schiller  the  only  imaginative  influence  mentioned  is  the  sensi- 
bility of  their  mothers,  we  are  struck  with  surprise  rather  than 
with  conviction.  Of  the  remainder  it  seems  that  six  had  one,  five 
had  two,  one  had  three,  three  had  four  members  in  their  family 
worthy  of  note,  but  in  this  estimate  all  degrees  of  relationship 
and  kinds  of  noteworthiness  are  included.  Of  painters  twenty- 
one  out  of  forty-two  had  celebrated  kindred.  The  following 
examples  are  the  most  important : — Bassano  had  four ;  Veronese 
four,  but  one  of  these  failed;  Caraccia  five,  but  style  totally 


1875.]  Heredity,  6? 

distinct ;  Murillo  three,  all  painters ;  Titian  nine,  but  this 
enumeration  is,  so  far,  only  conjectural.  Of  musicians  the 
most  conspicuous  examples  are,  Amati,  with  three  musical 
relatives ;  Benda,  with  nine ;  Mendelssohn,  with  one,  but  tliese 
were  the  offspring  of  philosophers  and  authors  ;  Mozart  four,  but 
one  a  failure ;  Sebastian  Bach,  possessing  musical  representatives 
for  200  years,  of  whom  twenty-nine  obtained  distinction;  audit 
is  recorded  that,  upon  one  occasion,  more  than  one  hundred  per- 
sons bearing  his  name  assembled  together.  Allowing  ample 
force  to  these  anecdotes,  it  is  probable  that  they  embody  little 
more  than  an  instance  of  an  hereditary  trade. 

Among  men   of  science  there  occur  actual  exceptions  to  the 
law  of  heredity  in   Blumenbach,  Berkeley,  Brewster,  Comte, 
Hegel,  Hume,  Kant,  Locke,  Malebranche,  Priestley,  &c.    But 
from  data  gathered  from  biographical  dictionaries  and  equally 
exceptional  authorities,  we  learn  that  Arago  had  four  remark- 
able relatives  \  but  these  comprise  philosophers,  artists,  &c. ;  that 
of  the  nine  connections  of  Bernouilli  some  were  naturalists  and 
teachers  in  different  branches;  that  of  the  Boyle  family  seven- 
teen were  savants;  that  of  three  Cuviers  one  was  the  mother 
who  superintended  the  education  of  the  others ;  of  D'Alembert's 
family,  that  he  was  the  bastard  of  a  witty  woman  and  an  artillery 
officer,  and  that  one  of  two  remaining  celebrities  was  a  dramatic 
author ;  of  four  Darwins  one  was  a  poet,  two  physicians,  and 
one  their  present  representative;  of  three  Galileos  the  father 
was  a  musician,  one  the  famous  astronomer,  and  one  a  clock  con- 
structor ;  of  the  St.  Hilaires,  the  father  was  an  officer,  the  two  sons 
naturalists;  of  the  group  of  fifteen   Gregories  some  were  phy- 
sicists, some  physicians,  some  mathematicians ;    three  Hallers 
are  ranked  as  one  lawyer,  one   physiologist,  one   litterateur ; 
seven  Herschels  are  divided  into  two  musicians,  five  astronomers; 
the  brothers  Hunter  are  examples  of  connateness ;  six  Jussieus 
may  be  accepted  as  a  family  of  botanists.     It  may  be  said  that 
we  have  arrived  at  the   bathos  or  the  microscopic  outcome  of 
heredity,  when  we  describe  the  five  Watts    as    including   a 
superior  mother,  an  astute  Glasgow  baillie,  a  professor  of  mathe- 
matics, the  Watt  an  engineer,  and  his  son  a  geologist.     It  should 
be  kept  prominently  in  view  that  of  the  causes  which  broke  in 
upon  the  preceding  mediocrity  and  monotomy  of  such  lives  as 
the  Bernouillis  and  Boyles,  and  called  into  life  and  fame  their 
great  progenitors,  we  know  nothing  whatever,  and   that  the 
general  result  is  the  discovery  of  circles  rather  than  of  succes- 
sions of  clever  people. 

The  following  examples  may  be  given  of  the  development  ot 
genius  in  tribes  of  authors.  Addison's  father  was  a  learned 
divine,  but  his  daughter  was  an  imbecile,  and  cannot  be  claimed 


68  Reviews.  [July, 

as  an  example  of  heredity.  In  the  two  Bossuets  the  trace  again 
becomes  microscopic,  as  the  one  has  no  other  merit  than  that  of 
editing  the  works  of  the  other.  The  three  Brontes  were  of  con- 
nate genius,  the  father  being  either  mad  or  eccentric.  There 
were  four  Etiennes,  philologists.  The  Sept  Grotius  contained 
the  expositor  of  international  law  ;  his  grandfather,  a  scholar ; 
his  father,  curator  of  University  of  Leyden ;  an  uncle,  professor 
of  philosophy  and  jurisprudence ;  and  his  son,  a  diplomatist. 
Of  the  Hallams,  the  parents  are  spoken  of  as  remarkable  ;  the 
historian  was  still  more  so,  and  his  two  sons,  one  of  whom  was 
the  subject  of  "  Tn  Memoriam,"  were  youths  of  promise.  Of 
the  well-known  Lambs  one  was  a  drunkard,  one  a  maniac.  Of 
the  five  Macaulays,  the  progenitor  is  said  to  have  been  an  elo- 
quent preacher  in  a  small  highland  town  ;  his  son,  a  merchant 
and  abolitionist  of  slavery,  who  was  the  father  of  the  celebrated 
historian,  who  had  an  uncle  a  general  officer.  The  two  Scaligers 
indicate  how  short  the  influence  of  heredity,  even  when  the 
quality  transmitted  is  in  its  most  intense  degree.  M.  de 
Sevigne  had  three  sons  and  a  cousin  notorious  as  clever  de- 
bauchees. The  De  Staels  comprise  one  lawyer,  one  statesman, 
one  authoress  and  wit,  one  mathematician,  and  two  naturalists, 
one  of  the  latter  presenting  a  tincture  of  mental  obliquity. 

The  effort  to  establish  the  heredity  of  propensities  and  senti- 
ments may  be  called  almost  romantic.  It  proceeds  upon  a  sort 
of  gradus  of  petitions.  If  heredity  be  specific  condition  of  deve- 
lopment of  intelligence,  and  if  evolution  of  sentiments  be  in 
accordance  with  other  intelligence,  these  sentiments  depend 
upon  heredity ;  and  pride,  and  piety,  and  brutism  may  run  in 
the  blood  parallel  to  scrofulus  taint.  What  is  designated  the 
acquired  feeling  of  fear,  the  proof  of  such  acquisition  depending 
upon  the  pseudo-fact  that  the  Falkland  Island  dogs  had  no 
fear — not,  in  fact,  until  they  were  frightened — has  been  affirmed 
in  utter  forgetfulness  that  there  are  tribes  of  animals  naturally 
timid  as  well  as  others  naturally  courageous,  and  that  not 
merely  in  the  same  species,  but  in  the  same  litter  different  in- 
dividuals display  totally  different  degrees  of  courage.  Whim- 
sical peculiarities  in  men  and  animals,  idiosyncrasies,  antipathies, 
are  all  resorted  to  in  order  to  illustrate  the  principle,  but,  so  in- 
determinate are  the  states  of  our  moral  nature,  that  it  is  impossible 
to  prove  transmission.  It  is  true  that  dipsomania,  or  the  involun- 
tary tendency  to  inebriation,  has  been  seen  in  several  members 
of  the  same  family,  but  the  propagation  of  this  morbid  craving 
can  most  frequently  be  seen  in  certain  of  its  consequences,  such 
as  insanity,  idiocy,  paralysis,  and  physical  defects.  It  is  like- 
wise well  established  that  whole  clans,  even  sections  of  the 
community  associated  by  blood  and  breeding,  are  sunk  in  crime. 


1875.]  Heredity,  69 

but  when  the  intricacies  of  this  tangled  and  rotten  web  are 
unravelled  it  becomes  apparent  that  the  kind  of  crime  may  differ 
widely.  In  fifteen  offenders,  named  Chretien,  the  depravity  ap- 
peared in  four  as  murderers,  with  or  without  robbery ;  the  wife 
of  one  of  them  was  of  an  incendiary  stock ;  in  six  as  robbery  or 
theft;  and  one  died  a  violent  death.  To  these  may  be  added 
that  kleptorhania  has  occasionally  been  seen  as  the  offshoot  of 
great  genius  or  insanity,  and  has  been  associated  with  brilliant 
parts. 

That  a  similar  effort  to  demonstrate  the  heredity  of  will  is 
open  to  the  same  objections  and  exceptions  may  be  learned  from 
an  epitome  of  the  ancestors  and  collaterals  of  statesmen  and 
generals^  of  whom  this  quality  is  regarded  as  the  prominent 
characteristic.  Colbert,  the  distinguished  minister,  had  a  brother, 
a  statesman ;  a  son,  a  general  officer ;  another,  an  archbishop ; 
and  a  nephew,  a  diplomatist.  Of  Cromwell  the  descendants 
were  of  mediocre  capacity,  but  Waller,  the  poet,  was  the  nephew 
of  his  cousin,  Hampden,  the  patriot.  The  Lamoignons,  num- 
bering twenty  or  more,  all  embraced  the  exercise  of  law,  justice, 
or  charity  as  professions,  and  there  was,  besides,  one  precocious 
child.  It  may  be  fairly  suspected  that  their  biography  would 
disclose  position,  nepotism,  and  cliquism,  and  family  interests 
and  arrangements,  as  adjuncts  to  any  general  law.  The  same 
remark  is  applicable,  with  some  modifications,  to  the  Medicis 
and  Peels.  The  five  Sheridans  are  represented  by  the  grand- 
father, who  was  a  friend  and  correspondent  of  Swift's  ;  the 
father,  who  wrote  a  dictionary  and  was  manager  of  Drury 
Lane ;  the  brilliant  orator  himself,  his  son  Tom,  defined  as  a 
Sheridan  all  over,  and  the  Honorable  Mrs.  Norton.  The  fol- 
lowing commentary  by  Galton  will  expiscate  the  bearing  of 
this  genealogy  upon  the  topic  we  are  considering.  "  The  name 
of  Sheridan  is  peculiarly  associated  with  a  clearly  marked  order 
of  brilliant  and  engaging,  but  ^  ne'er-do-weel '  qualities,  reckless 
prodigality,  gambling,  and  wild  living.  .  .  .  These 
qualities  are  found  in  a  greater  or  less  degree  among  numerous 
members  of  the  Sheridan  family."  (P.  120.)  Berwick,  as  an 
illegitimate  son  of  James  II,  and  of  a  daughter  of  the  Duke  of 
Marlborough,  may  claim  a  royal  as  well  as  a  military  origin. 
The  Bonapartes  had  an  astute  mother,  but  deserve  consideration 
rather  from  their  connate  birth  than  hereditary  talent.  Of  the 
Colignys,  grand  and  pure  though  the  admiral  may  have  been, 
it  is  enough  to  say  that  they  were  a  family  of  princes.  Prince 
Eugene,  classed  by  Napoleon  with  Turenne  and  Frederick  the 
Great,  had  the  priest-politician.  Cardinal  Mazarin,  as  a  grand- 
uncle.  The  kingly  race  who  bore  the  name  Gustavus  com- 
prehended patriots,  heroes,  philosophers,     The  reputfition  of 


70  Beviews»  [July, 

^Napier,  the  discoverer  of  logarithms,  was  handed  down  through 
eight  generals  and  statesmen.  Besides  his  relationship  to  the 
house  of  Orange,  Turenne  derived  lustre  from  his  father  the 
leader  of  the  Huguenots.  But  how  immeasurably  separated 
in  kind  are  the  wisdom  and  the  bravery  or  warlike  abilities  of 
these  statesmen  and  soldiers. 

Even  the  details  of  deaf-mutism  so  triumphantly  referred 
to  in  such  investigations  are  more  specious  than  convincing, 
for  of  148  pupils  in  the  London  Institution  at  one  time,  there 
was  one  in  whose  family  were  five  deaf  mutes;  another  in 
whose  family  were  four ;  in  the  families  of  eleven  of  the  pupils 
were  three  each,  and  in  those  of  nineteen  two  each.  Were  the 
comparatively  insignificant  number  of  the  instances  of  Dal- 
tonism, sex-digitism,  and  of  porcupine  skin  subjected  to  a 
similarly  crucial  examination,  our  experience  would  be  very 
nearly  the  same. 

It  is  marvellous  that  when  the  elaboration  of  the  descent 
of  mental  tendencies  and  faculties  has  been  worked  out  with 
so  much  solicitude  and  ingenuity  that  so  little  importance 
has  been  attached  to  education,  training,  example,  imitation, 
even  physical  impressions,  position,  stern  poverty,  in  creat- 
ing and  constituting  character,  in  correcting  passions,  pro- 
pensities, in  engrafting  tastes  and  knowledge,  in  short,  in 
transforming  whatever  may  be  due  to  Inn^ite,  heredity,  or 
spontaneity,  into  new  powers,  in  giving  infinite  variety  and 
multiplicity  to  human  development,  in  making  man  to  difi'er  as 
much  from  the  primitive  mode  or  type  and  from  all  the  links 
by  which  he  is  connected  with  it,  as  the  mature  difi'ers  from  the 
infantile  and  the  civilized  from  the  savage  mind.  It  would  be 
rash  with  Lamarck  and  his  followers  to  refer  all  physical  and 
moral  changes  to  the  environments,  to  the  exclusion  of  native 
energy ;  or  to  assert,  with  Locke,  that  of  a  hundred  men  ninety 
are  good  or  bad  in  consequence  of  external  circumstances,  but  it 
is  certain  that,  without  the  co-operation  of  these,  progress  or  evo- 
lution in  its  non-technical  sense  would  be  a  mockery.  Even  one 
of  the  grand  arguments  advanced  in  favour  of  heredity,  the 
results  of  consanguine  marriages,  appears  to  militate  materially 
against  the  theory.  The  application  of  this  argument  formerly 
assumed  the  form  of  inferring  degeneracy  as  their  inevitable 
result.  This  conclusion  is  now  held  to  be  erroneous,  but  had  it 
been  true  it  would  have  merely  proved  the  danger  or  evil  of  the 
union  of  two  diseased  constitutions.  But,  in  the  first  place, 
consanguinity  in  breeding  animals  is  found  to  be  advantageous 
in  the  development  of  new  qualities,  as  size,  beauty  of  form, 
increased  secretion,  obesity  in  sheep  and  oxen ;  and  gracileness 
and  speed  in  Kace-horses  where  intercourse  has  been  going  on 
for  two  hundred  years.      And,  in  the  second  place,  putting  out 


1875.]  Heredity.  71 

of  view  the  castes  in  India  where  separation  is  maintained 
more  by  custom,  occupation,  habits  and  cultivation,  than  by- 
race,  it  is  well  ascertained  that  while  intermarriage  even  between 
near  relatives  has  gone  on  for  centuries  among  the  Jews,  small 
Moslem  communities  in  Hindostan,  the  inhabitants  of  the  coasts 
of  Barbary,  &c.,  there  exists  as  much  dissimilarity  in  form  and 
features,  and  as  much  individualism  in  faculties,  motives,  and 
course  of  action,  as  can  be  detected  in  other  races  and  nations 
where  such  unions  are  not  tolerated  and  occur  very  rarely. 

By  a  certain  class  of  thinkers  M.  Ribot's  work  will  be  hailed 
as  the  most  profound  disquisition  upon  the  many  subjects  em- 
braced which  has  ever  appeared ;  by  all  it  may  be  accepted  as 
an  attempt  to  produce  a  philosophical  disquisition  on  what  has 
been  vaguely  and  fragmentally  believed.  There  is  a  constant 
and  strained  effort  to  prove  and  explain  much  that  must  remain 
for  more  advanced  stages  of  science,  and  the  result  has  been 
that  rash  or  premature  hypotheses  have  been  ventured  upon 
where  data  are  insufficient  or  obscure,  and  many  of  the  contro- 
versies now  agitating  the  world  are  treated  as  if  adjusted,  and 
what  are  still  mere  postulates  are  built  upon  as  propositions 
either  demonstrated  or  demonstrable.  In  dealing  with  the 
author's  speculations,  which  we  regret  are  more  metaphysical 
than  logical,  it  has  been  our  aim,  while  embodying  his  particular 
opinions,  avoiding  what  appeared  paradoxical  in  them,  to  point 
out  the  various  grounds  which  render  it  impossible  to  admit 
heredity  otherwise  than  conditionally  and  provisionally,  without 
adopting  a  positively  hostile  or  antagonistic  course.  It  may  be 
readily  conceded  that  heredity  exists,  so  far  as  the  characteristics 
of  species,  genera,  and  classes  are  concerned;  but  we  must  pause 
when  called  upon  to  believe  that  "  as  what  intelligence,  fixed  by 
memory,  is  to  the  individual,  progressive  experience,  fixed  by 
heredity,  is  to  the  species."  We  would  willingly  receive  a  sketch 
of  the  ascertained  phenomena  and  their  relations  in  heredity 
similar  to  the  tracing  made  by  navigators  in  the  Arctic  circle  of 
lands  certainly  discovered,  but  separated  by  gaps  when  the  shore 
line  has  been  imperfectly  observed,  or  has  not  been  seen  at  all ; 
but  we  must  decline  a  chart  filled  up  and  finished,  but  which 
unites  imaginary  continents  and  perhaps  dream-land  with  the 
solid  basis  on  which  the  truths  of  physiology  and  philosophy 
at  present  rest. 

Notwithstanding  these  objections,  the  chart  actually  before  us 
is  ably  executed,  is  in  many  of  its  features  interesting  and  at- 
tractive, and  should  a  second  edition  be  required,  as  may  be 
expected,  and  be  pruned  of  certain  obscurities  and  transcenden- 
talisms in  theory  and  expression,  the  work  would  be  fairly 
entitled  to  rank  beside  or  above  the  valuable  treatise  of  M. 
Lucas. 


72  Reviews.  [July^ 


VII. — Review  of  Sanitary  Work  in  India.^ 

The  registration  of  the  deaths  of  the  civil  population  in  those 
provinces  of  Hindostan,  under  British  rule,  which  was  com- 
menced in  1865,  has  since  been  steadily  continued.  It  was 
at  first  very  imperfect,  and  though  considerable  improvements 
have  been  effected,  the  results  are  still  very  far  behind  what  we 
are  accustomed  to  in  this  country;  nevertheless,  the  compilers  of 
the  various  reports  which  form  the  basis  of  these  remarks  all 
agree  that  it  has  afforded  a  view  of  the  varying  distribution 
and  incidence  of  certain  diseases,  far  exceeding  any  previously 
available,  the  importance  and  value  of  which  is  becoming 
apparent  in  the  modification  of  opinion  which  it  is  gradually 
leading  to.  We  shall  endeavour,  in  the  remarks  which  follow, 
to  place  a  few  of  these  before  our  readers,  and  to  point  out  their 
bearings  on  questions  agitating  medical  opinion  throughout 
the  world. 

As  might  be  expected,  cholera  forms  the  chief  topic  in  the 
Indian  reports,  and  while  that  country  presents  an  unrivalled 
amount  of  material  for  its  study,  the  system  of  registration  now 
in  operation  over  an  area  nearly  as  large  as  Europe,  though  in- 
terfered with  at  various  points  by  districts  under  native  rule, 
still  affords  a  continuous  and  uniform  record  of  its  visitations 
which  has  not  yet  been  attained  elsewhere.  Though  there  can 
be  no  question  that,  for  the  complete  investigation  of  cholera, 
the  course  of  epidemics  in  every  other  country  as  well  as  in 
India  must  be  studied,  yet  it  is  of  vast  importance  to  have  se- 
cured a  fair  record  of  its  manifestations  in  so  extensive  a  field, 
with  which  the  scantier  notices  from  neighbouring  regions  may 
be  connected  in  the  first  instance,  and  ultimately  brought  into 
their  proper  places  in  the  general  system.  In  the  Ninth  Annual 
Report  of  the  Sanitary  Commissioner  with  the  Government  of 
India,  the  author.  Dr.  Cuningham,  writes  : 

'*  It  is  only,  as  I  have  before  remarked,  by  collecting  every  fact 

1  1.  Ninth  Annual  Report  of  the  Sanitary  Commissioner  loith  the  Government 
of  India,  1^12.     Calcutta,  1873. 

2.  Tenth  Annual  Report  of  the  Sanitary  Commissioner  with  the  Government  of 
India,  1873.     Calcutta,  1874. 

3.  Report  of  the  Sanitary  Commissioner  for  Madras,  1872.     Madras,  1873. 

4.  Report  of  the  Sanitary  Commissioner  for  Madras,  1873.     Madras,  1874. 

5.  Ninth  Annual  Report  of  the  Sanitary  Commissioner  for  the  Government  of 
Bombay,  1872.     Bombay,  1873. 

6.  Tenth  Anmial  Report  of  the  Sanitary  Commissioner  for  the  Government  of 
Bombay,  1873.     Bombay,  1874. 

7.  Annual  Report  of  the  Sanitary  Commissioner  for  the  Central  Provinces,  1873. 
Nagpur,  1874. 

8.  Report  of  the  Sanitary  Administration  of  the  Runjaiib  for  the  Year  1873, 
J^abore,  1874. 


1875.]  Review  of  Sanitary  Work  in  India.  73 

that  can  be  gathered  regarding  an  epidemic  from  its  commencement 
to  its  close,  that  we  can  be  in  a  position  even  to  attempt  to  understand 
the  phenomena  which  it  presents.  The  collection  of  facts  from  all 
countries  attacked,  facts  observed  and  narrated  apart  from  and  un- 
biassed by  any  theory,  is  of  the  greatest  importance.  If  we  only 
knew  all  the  facts,  the  framing  of  correct  conclusions  would  be  easy." 
(Par.  114.) 

Then  with  reference  to  cholera, he  says: 

"  Its  sudden  and  fatal  character  has  made  it  appear  as  if  cholera 
were  more  mysterious  than  any  other  disease,  but  it  is  just  as  difficult 
to  account  for  the  epidemic  spread  of  other  diseases,  of  epidemic  ma- 
larial fever  for  example,  or  for  smallpox,  as  it  is  for  cholera."  (lb., 
par.  116.) 

And  further  • 

*'  Smallpox,  it'  is  argued,  is  a  contagious  disease,  and  spreads  only 
by  contagion.  Cholera  belongs  to  the  same  class  of  contagious 
diseases,  therefore  it  also  spreads  by  contagion,  and  by  contagion 
only.  But  do  w^e  know  that  smallpox  spreads  only  by  contagion? 
Its  annual  rise  and  fall  in  this  country  recurring  steadily  year  after 
year,  its  comparative  dormancy  for  a  term  of  years,  and  then  a  year  of 
epidemic  violence,  are  facts  altogether  inexplicable  on  the  doctrine  of 
contagion,  and  prove  incontestably  that  the  law  of  contagion  is  not 
that  law  which  governs  the  spread  of  smallpox.  The  obscure  problems 
connected  with  the  epidemic  prevalence  of  disease  are  to  be  solved,  not 
by  fancied  analogies,  but,  like  every  other  truly  scientific  inquiry,  on 
the  evidence."     (lb.,  par.  117.) 

In  the  Ninth  Annual  Report  for  India,  the  course  of  the 
cholera  epidemic  of  1872  is  detailed,  and  in  the  Tenth  the 
distribution  of  the  disease  in  1873  ;  we  cannot  extract  these 
here,  but  may  render  their  more  striking  features  apparent  by 
giving  the  number  of  deaths  registered  each  year  in  the  various 
provinces  into  which  the  country  is  divided.  In  the  following 
table  these  are  arranged  from  north  to  south,  as  nearly  as  can 
be,  except  British  Burmah,  which  being  to  the  east  of  the 
Bay  of  Bengal,  cannot  be  placed  among  the  others  ;  the  deaths 
registered  in  1871  have  been  added  to  give  a  more  extended  view 
of  the  course  of  the  disease. 


Punjaub  .... 
North-western  Proviuces  . 
Oudh  .... 

Bengal  Proper   . 
Central  Provinces 
Berar  .... 

Bombay  Presidency  . 
Madras  Presidency  . 
British  Burmah 

The  distribution  of  cholera  in  these  years,  a§  sjiown  in  the 


1871. 

1872. 

1873. 

369 

8,727 

148 

3,473 

50,565 

15,268 

16,032 

26,566 

3,961 

20,396 

46,901 

64,366 

19 

1,592 

344 

581 

1,578 

5,855 

15,642 

283 

17,656 

13,247 

840 

162 

640 

8,109 

74  Reviews.  [July* 

maps  accompanying  the  Reports  of  the  Sanitary  Commissioner 
with  the  Government  of  India,  is  very  striking  and  instructive. 
In  1871  there  was  a  continuous  body  of  the  disease  extending 
from  the  southernmost  point  of  the  peninsula  up  to  the  19th 
parallel  of  latitude,  fi*om  the  east  coast  to  the  meridian  of  80° 
E.,and  west  of  that,  to  a  line  passing  north-west  from  the  point 
where  the  19th  parallel  intersects  the  80°  meridian  to  the  river 
Taptee^  and  along  that  to  the  sea.  In  this  extensive  area  the 
whole  of  the  table-land  of  the  Mysore  and  the  west  coast  dis- 
tricts, extending  from  11-^°  to  to  IG^l-^  N.,  and  from  long.  78° 
westward  to  the  sea,  was  free  from  the  disease.  Another 
cholera  field  occupied  Bengal  proper,  Oudh,  and  part  of  the 
North-western  Provinces ;  this  was  bounded  by  a  line  extending 
from  the  coast  at  Pooree  north-westerly  to  the  meridian  of  80°  E., 
in  lat.  27°,  and  that  parallel  indicates  the  northern  limit  of  the 
epidemic  to  the  eastward.  Thus  not  only  was  the  Mysore 
free  from  the  epidemic,  though  surrounded  by  it  on  three  sides, 
but  right  through  Central  India  the  two  cholera  fields  were 
separated  by  a  tract  of  some  400  miles  in  width,  in  which  at 
most  but  a  few  sporadic  cases  were  met  with. 

In  1872  all  this  was  changed;  cholera  as  an  epidemic  had  dis- 
appeared from  the  southern  part  of  the  peninsula,  unless  in  a 
mild  form,  and  in  a  limited  district  between  the  rivers  Cauvery 
and  Palar,  and  occupying  half  the  space  from  the  scarp  of  the 
Mysore  table-land  towards  the  coast.  After  a  considerable  in- 
terval it  commenced  again  in  the  low  land  on  the  east  coast, 
north  of  the  Kistna,  and  occupied  this  tract  as  far  as  Pooree, 
where  it  joined  the  epidemic  area  of  Bryden  ;  to  the  westward 
it  had  occupied  a  portion  of  the  space  left  clear  in  1871,  and 
its  eastern  margin  came  up  to  a  line,  from  lat.  13°  on  the  west 
coast,  extending  north-east  to  the  point  where  the  20th 
parallel  of  latitude  cuts  the  meridian  of  80°,  then  due  north  to 
where  that  meridian  meets  the  24th  parallel,  then  north-westerly 
to  lat.  25-1^°  on  the  meridian  of  75°  E.,  from  which  it  curved 
down  to  the  sea  at  Surat.  The  Bengal  cholera  field  of  1872 
had  retired  from  the  high  ground  of  Chota  Nagpoor,  which  lies 
between  the  coast  and  the  valley  of  the  Ganges,  but  had  also 
extended  to  the  north-west  as  far  as  the  Indus,  just  touching 
Mooltan  on  the  one  hand,  and  Peshawur  on  the  other,  but 
nowhere  approaching  that  previously  mentioned  within  100 
miles.  In  fact,  including  the  limited  outbreak  in  the  south, 
there  were  three  continuous  cholera  fields  in  Hindostan  this  year, 
two  of  them  of  very  great  extent,  and  which  manifested  con- 
siderable invasive  powers,  yet  at  no  time  did  they  coalesce  at  a 
single  point. 

In  1873   there  is  again  a  marked  change  on  the  face  of  the 


1875.]  Review  of  Sanitary  Work  in  India.  75 

map,  the  whole  of  Southern  India  being  free  from  epidemic 
cholera,  except  a  slight  outbreak  in  theNellore  district  in  January 
and  Februar)',  causing  476  deaths,  and  a  much  slighter  one  in 
the  Kulladghee  district  in  the  south  of  the  Bombay  presidency, 
where  90  deaths  occurred  from  January  to  March,  and  Bombay 
(city)  itself,  where  93  deaths  were  registered  in  the  course  of  the 
year.  In  the  north  there  was  a  severe  epidemic  in  Bengal,  extend- 
ing into  the  North-western  Provinces;  its  western  limit  was  a 
line  extending  from  Ganjam  on  the  coast  to  Agra,  and  from  that 
point  north-east  to  the  high  ground,  along  the  base  of  which  it 
skirted  more  or  less  closely  to  the  south-east.  Coincident  with 
this  epidemic  was  the  severe  outbreak  in  British  Burmah. 

With  his  previous  acquaintance  with  cholera,  and  having  the 
details  of  the  1872  epidemic,  of  which  an  outline  has  just  been 
given,  before  him.  Dr.  Cuningham,  the  Sanitary  Commissioner 
with  the  Government  of  India,  was  induced  to  express  his 
doubts  as  to  the  soundness  of  the  opinion  then  entertained  by 
various  authors  as  to  the  causes  of  cholera,  and,  in  his  Report 
for  1873,  after  the  further  experience  of  that  year,  he  gives 
his  conclusions  in  the  following  terms  : 

"  1st — That  if  human  intercourse  plays  any  part  in  the  dissemina- 
tion of  cholera,  it  must  be  a  very  secondary  part. 

**  2nd — That  the  facts  of  individual  outbreaks,  and  especially  the 
remarkable  immunity  of  the  attendants,  are  altogether  opposed  to  the 
doctrine  that  the  disease  is  spread  by  communication  with  the  sick. 

"3rd — That  the  theory  which  would  explain  the  phenomena  on  the 
supposition  that  in  a  year  of  epidemic  prevalence  very  many  sources  of 
water-supply  over  an  enormous  area  had  been  polluted  with  cholera 
discharges,  while  in  a  year  when  cholera  is  dormant  such  pollution  has 
either  been  rare  or  has  not  taken  place  at  all,  fails  altogether  to  ex- 
plain the  facts  either  of  wide-spread  prevalence  or  of  individual  out- 
breaks. 

"  4th — That  there  is  no  evidence  to  show  that  a  person  affected  with 
cholera  multiplies  within  himself  any  specific  poison,  or  that  he  dis- 
seminates any  such  poison  either  by  means  of  the  intestinal  or  any 
other  discharges. 

"  5th — That  cholera  in  India  appears  to  be  due  to  certain  conditions 
of  air  and  soil,  or  of  both  combined,  as  yet  little  understood,  which 
are  always  more  or  less  present  in  the  Lower  Provinces  of  Bengal — 
the  endemic  area,  and  which  appear  only  occasionally  in  the  Upper 
Provinces,  the  intervals  between  the  times  of  their  appearance  increas- 
ing as  we  proceed  to  the  North-West,  and  being  so  short  in  the  imme- 
diate neighbourhood  of  the  Lower  Provinces  that  it  is  impossible  to 
define  exactly  where  the  endemic  limit  ends. 

*•'  6th — That  these  conditions  would  appear  to  be  often  singularly 
localized  both  in  the  endemic  and  epidemic  areas,  as  is  evidenced  by 
the  very  local  character  which  so  distinguishes  outbreaks  of  the 
disease. 


76  Reviews,  [July, 

"  7th — That  the  great  danger  arises  from  exposure  to  these  con- 
ditions, and  not  from  exposure  to  any  emanations  from  the  sick. 

"  8th — Tiiat  even  if  the  contagious  character  of  cholera  could  be 
proved  beyond  all  manner  of  doubt,  any  general  system  of  quarantine 
sufficiently  strict  to  be  effectual  is  impracticable,  and  must  do  much 
more  harm  than  good. 

"  9th — That  the  great  safeguards  against  cholera  are  sanitary  im- 
provements— the  improvement  of  drainage,  of  water  supply,  of 
dwellings,  of  everything,  in  short,  which  can  contribute  to  health.  Of 
water  supply  it  may  be  remarked,  not  that  it  may  be  safe  only  against 
cholera  evacuations  and  the  results  which  have  been  theoretically 
ascribed  to  them,  but  that  it  may  be  safe  against  every  form  of 
impurity."   (Pages  17,  18.) 

In  his  Report  for  187^  Dr.  Cuningham  anticipated  the 
announcement  of  these  views  would  call  forth  vigorous  protests 
from  those  who  entertained  the  opinions  he  questioned,  and 
that  they  would  complain  that  if  we  accept  his  position  we 
virtually  go  back  to  the  state  of  ignorance  we  were  in  many 
years  ago.  To  this  he  replied  that  "if  we  are  on  the  wrong 
road,  the  sooner  we  go  back  the  better,  but  the  question  is  not 
what  will  be  the  consequence  to  any  opinions.  The  only  point 
of  importance  is — what  is  the  truth  1  Facts  cannot  be  too  care- 
fully scrutinized  before  they  are  accepted,  nor  conclusions  too 
carefully  drawn  from  them."     (Par.  118.) 

The  real  cause  of  difference  between  Dr.  Cuningham  and  his 
opponents  lies  rather  in  the  conclusions  they  consider  themselves 
justified  in  drawing  from  certain  facts,  than  in  their  recognition 
of  the  facts  themselves,  always  supposing  that  these  have  been 
carefully  ascertained,  and  are  not  what  we  meet  with  so  often 
in  descriptions  of  disease,  basements  of  fact  with  superstruc- 
tures of  fancy,  which  are  deserving  of  no  weight  in  any  scientific 
investigation.  We  shall  endeavour  to  place  the  views  now 
springing  up  in  India  on  this  question  before  our  readers,  that 
they  may  be  in  a  position  to  judge  for  themselves  which  party 
is  pursuing  the  proper  course  to  clear  it  up. 

In  the  fifth  conclusion,  given  above.  Dr.  Cuningham  states 
his  belief  that,  in  India,  cholera  appears  to  be  due  to  certain 
conditions  of  air  and  soil,  or  of  both  combined,  as  yet  little  un- 
derstood, which  are  always  more  or  less  prevalent  in  Lower 
Bengal,  but  which  appear  only  occasionally  in  the  Upper  Pro- 
vinces. These  conditions  appear  to  exist  in  some  other  parts  of 
India  as  well,  for  instance,  in  the  South  Arcot  district  in 
Madras,  where,  from  the  commencement  of  the  registration  of 
deaths,  in  1866,  to  the  end  of  1873,  there  has  not  been  a  single 
month  without  one,  but  much  more  commonly  numerous  deaths 
from  cholera ;  and  in  the  Tanjore  (district,  which  adjoins  it,  in 


1875.]  Review  of  Sanitary  Work  in  India.  7?' 

the  same  period,  August,  October,  November,  and  Decem- 
ber, 187;^,  and  January,  1873,  were  the  only  months  in  which 
there  was  no  death  from  cholera  registered  ;  the  district  of 
Trichinopoly,  in  the  same  locality,  had  deaths  registered  erery 
month  to  the  end  of  1872,  but  none  during  1873,  so  that  for 
eight  years,  at  least,  the  causes  of  cholera  had  been  permanently 
in  operation  in  this  locality.  For  the  city  of  Bombay,  too,  the 
monthly  returns  of  deaths  from  cholera  are  available  from  1848 
to  1873,  inclusive  (with  the  exception  of  1866),  or  for  twenty- 
five  years ;  during  that  period  there  were  seven  months  in  1848 
and  1849  without  a  death,  but  since  then  only  December,  1867, 
and  February,  1868.  The  disease  has  undergone  great  fluctua- 
tion in  both  those  localities  in  the  periods  mentioned,  as  it  has 
done  in  what  Dr.  Bryden  has  denominated  the  endemic  area  in 
Lower  Bengal. 

It  will  occur  to  every  inquirer  to  ask  what  leads  to  these 
fluctuations — what  could  have  led.  to  such  an  extensive  develop- 
ment of  cholera  throughout  Hindostan  in  1872,  the  incidence 
of  which  in  1873  was  so  altered  that  cholera  had  almost  dis- 
appeared from  Southern,  Western,  and  Northern  India,  while 
a  severe  epidemic  prevailed  in  Bengal  and  Burmah  ?  It  was  a 
point  much  urged  by  a  certain  school  of  epidemiologists  that 
cholera  never  travelled  faster  than  man,  and  the  Constantinople 
Conference,  in  1866,  was  rash  enough  to  commit  itself  to  the 
opinion  that  now  the  means  of  locomotion  were  greatly  in- 
creased, and  much  more  rapid  than  formerly,  it  would  be  found 
that  the  diff'usion  of  cholera,  and  other  epidemic  diseases  would 
be  accelerated  proportionately.  Facts  existed,  at  that  time  which 
should  have  caused  the  delegates  to  hesitate  before  coming  to 
this  conclusion,  and  the  experience  of  Europe  since  then  has 
shown  so  completely  that  extensive  and  rapid  communication 
is  insufficient  to  cause  the  epidemic  diff'usion  of  cholera,  that 
the  late  Conference  at  Vienna,  with  greater  caution,  fell  back 
on  the  former  position,  and  did  not  reassert  the  latter.  The 
experience  of  India  is  altogether  to  the  same  effiect.  The  lines 
of  railway  now  open  in  that  country  enter  and  leave  the  various 
cholera-fields  without  indicating  the  least  power  to  advance  the 
limits  of  these  fields  beyond  the  line  which  marks  them  out  for  a 
long  way  on  either  side  of  the  railway,  and  far  beyond  its  influence 
on  the  direction  of  the  traffic.  In  1871,  for  instance,  the  rail- 
way from  Calcutta  to  Allahabad  was  in  the  cholera-field,  from 
Allahabad  to  Cawnpore  it  was  at  its  outer  margin,  and  from 
Cawnpore  northwards  the  cholera-field  would  not  extend,  the 
railway  facilities  notwithstanding.  Similarly,  between  Allaha- 
bad and  Bombay,  the  railway  left  the  cholera  field  a  little  south 
of  Allahabad,  then  ran  through  a  country  for  about  400  miles 


f8  RtivtewSk  [J^Vi 

free  from  the  epidemic,  after  which  it  entered  the  other  cholera- 
field  at  that  time  existing  in  the  Bombay  presidency.  In  1872, 
when  there  was  little  cholera  in  the  Madras  presidency,  the 
railway  from  Madras  to  the  west  coast  at  Beypoor  passed 
through  the  cholera-field  between  the  Palar  and  Cauvery  rivers 
without  conveying  the  disease  beyond  these  streams  towards 
either  terminus.  This  year,  too,  though  the  Bombay  cholera- 
field  had  advanced  considerably  to  the  northward,  there  Avas 
still  a  wide  zone  between  that  and  the  other  field  including 
Allahabad,  through  which  the  railway  ran,  but  to  which  the 
epidemic  did  not  extend.  In  1873  this  feature  was  repeated  ; 
the  railway  from  Allahabad  to  Bombay,  after  running  about 
100  miles  in  the  cholera-field,  suddenly  left  it  without  causing 
any  extension  of  the  epidemic  towards  the  latter  place;  and 
the  line  from  Allahabad  to  the  Punjaub  left  the  cholera-field  at 
Agra  in  the  same  manner ;  there  was  a  slight  isolated  epidemic 
in  the  Delhi  and  Goorgaon  districts,  as  had  occurred  elsewhere 
this  year,  but  beyond  these  places  there  was  none.  In  addition 
to  these  recent  facts,  Drs.  Cuningham  and  Bryden  have  fre- 
quently stated  that  their  investigations  have  shown  that 
cholera  does  not  travel  faster  in  India  now  than  it  did  fifty 
years  ago,  when  locomotion  was  much  less  rapid,  and  that,  even 
at  the  present  day,  in  its  epidemic  form,  it  spreads  over  portions 
of  country  beyond  the  influence  of  railway  traffic  quite  as  fast 
as  through  those  in  which  the  railways  run. 

Again,  though  the  traffic  of  the  country  goes  on  from  year  to 
year,  with  little  change  in  those  parts  of  it  which  have  not  been 
affected  by  railways  or  steam  navigation,  and  much  as  it  went  on 
many  years  ago,  that  traffic  seems  unable  to  extend  the  limits  of 
a  cholera-field,  as  determined  for  the  time  by  circumstances 
we  are  as  yet  but  little  acquainted  with,  so  as  to  embrace  neigh- 
bouring populations  within  the  spread  of  the  epidemic.  No 
one  can  look  at  the  map  for  1873,  for  instance,  without  feeling 
surprised  that  the  traffic,  which  must  have  gone  on  much  as 
usual  from  the  districts  under  the  epidemic  to  those  around 
them,  failed  to  cause  the  extension  of  the  epidemic  into  these, 
were  all  that  is  necessary  for  this  purpose  the  mere  introduction 
of  persons  labouring  under  the  disease.  There  are  many  cases 
of  individuals,  who  have  been  exposed  to  the  causes  of  cholera 
in  one  locality,  moving  into  another  where  these  did  not  seem  in 
operation,  before  the  disease  became  developed,  yet,  when  this 
took  place,  cholera  did  not  spread  among  the  surrounding  popu- 
lation so  as  to  become  epidemic.  Dr.  Townsend,  the  Sanitary 
Commissioner  in  the  Central  Provinces,  in  his  Report  for  1873 
gives  the  following  case  : — In  the  end  of  January  the  head- 
quarter wing  of  the  31st  Madras  Native  Infantry,  left  Berham* 


1876.]  Review  of  Sanitary  iVork  in  India,  ?y 

pore  for  Raepore;  at  Sonepore,  on  February  8th,  cholera  appeared 
among  the  men  of  the  regiment  and  the  followers,  and  up  to 
the  19th  inclusive  there  were  81  attacks  and  31  deaths,  of 
whom  5  were  soldiers  and  26  followers.  During  this  time  the 
wing  continued  its  march,  and,  by  the  19th,  reached  the  river 
Jonk,  when  the  disease  ceased.  After  the  troops  had  passed,  a 
number  of  cases  appeared  among  the  inhabitants  of  the  villages 
bordering  on  the  route  followed  by  them.  Some  of  these  had 
been  in  communication  with  the  troops,  others  not.  Dr.  Town- 
send,  who  thinks  importation  is  largely  concerned  in  spreading 
cholera,  naturally  concludes  that  this  regiment  introduced  the 
epidemic  into  the  district,  assisted  by  the  pilgrims  who  at  that 
time  were  returning  from  the  Dhole  Jatra  festival,  which  is  held 
at  Pooree  annually,  in  February.  The  inhabitants  were  in- 
structed to  maintain  cleanliness  in  their  villages,  to  prevent 
bathing  or  washing  of  clothes  in  the  tanks  or  pools  from  which 
their  drinking  water  was  obtained,  and  to  prevent  communica- 
tion -with  infected  places  or  people.  With  reference  to  these 
recommendations  Dr.  Townsend  remarks  : 

"  How  far  the  measures  of  prevention  which  were  adopted  by  the 
District  Officers  and  by  the  people  themselves  contributed  towards 
limiting  the  duration  of  the  epidemic  and  the  area  over  which  it  spread 
cannot  be  determined,  but  that  they  were  to  some  extent  eifectual 
seems  probable  from  the  circumstance  that  while  in  former  epidemics, 
which  commenced  with  the  return  of  the  pilgrims  from  the  Dhole 
Jatra  in  February  and  March,  the  disease  continued  prevalent  through 
the  hot  weather  and  rains,  the  epidemic  of  18/3  began  to  dechne  as 
soon  as  the  stream  of  pilgrims  had  passed  through,  and  it  had  disap- 
peared altogether  by  the  middle  of  April."     (Par.  88.) 

And  he  adds  the  following  most  important  remark : 

"  Moreover  the  fact  that  although  cholera  was  brought  into  a  large 
number  of  villages  it  spread  in  comparatively  few,  plainly  shows  that 
the  local  conditions  which  favour  the  spread  of  cholera  were  not  at  the 
time  common  in  the  district."  (Par.  89.) 

This  brings  us  face  to  face  with  something  else  than  the  sup- 
posed introduction  of  the  germ  or  contagium  of  cholera  by  the 
troops  and  pilgrims,  and  without  the  co-operation  of  which, 
though  the  disease  obtain  a  footing,  it  cannot  maintain  itself. 
Dr.  Townsend,  we  believe,  refers  to  water  impure  from  any  form 
of  decomposing  animal  matter  (not  necessarily  cholera  evacua- 
tions), but,  if  so,  with  his  description  of  the  condition  of  the 
supply  in  the  Central  Provinces,  this  state  of  the  water  must  be 
present  to  a  great  extent  in  the  early  months  of  every  year  in 
the  Sumbulpur  district,  where  the  occurrences  under  considera- 
tion took  place,  and  there  is  no  alternative  but  to  fall  back  on 


Bo  Reviews.  [July» 

something  still  more  general  in  its  operation.  Under  such 
circumstances  are  not  those  epidemiologists  who  trust  to  personal 
communication,  or  water  contaminated  with  cholera  discharges, 
to  explain  the  spread  of  epidemics,  open  to  the  criticism  that 
they  confine  themselves  to  minor  questions,  and  attribute  to 
these  the  influence  exercised  by  the  more  general  cause  or 
causes  just  mentioned,  and  so  invest  them  with  a  degree  of  im- 
portance they  are  in  no  wise  entitled  to  ?  No  one  investigating 
a  point  in  any  other  branch  of  natural  science,  who  found  him- 
self confronted  by  a  cause  controlling  all  the  supposed  minor 
factors  patent  to  him,  would  think  of  assigning  to  these  the 
sole  influence  in  producing  the  result;  on  the  contrary,  he 
would  be  aware  that  until  he  had  acquired  a  tolerably 
precise  knowledge  of  the  mode  of  operation  of  the  more 
powerful  cause,  he  could  form  but  a  very  imperfect  idea  of 
how  far  the  minor  factors  contributed  to  the  result,  or  even 
whether  they  were  in  any  way  essential  to  it.  In  epidemiology, 
unfortunately,  these  considerations  are  too  often  disregarded, 
and,  as  a  consequence,  with  all  the  zeal  and  activity  expended 
upon  it  of  late  years,  our  progress  in  generalizing  has  been  too 
often  slow,  if  not  sometimes  actually  retrograde. 

Dr.  Townsend  w^ould,  no  doubt,  take  up  the  position  that 
whatever  may  be  the  extent  of  operation,  or  nature  of  the  in- 
fluences he  refers  to,  still  the  introduction  of  the  contagium 
of  cholera  is  necessary.  We  find,  however,  that  not  only  he 
himself  refers  to  cases  which  have  appeared  without  any  known 
communication  with  others  labouring  under  the  disease,  but 
Mr.  Cornish,  who  also  considers  cholera  is  spread  by  man, 
in  the  Report  for  Madras  for  1873,  tells  us  that  "  there  is  in 
South  India  an  endemic  form  of  cholera  which  seems  to  difler 
from  the  epidemic  variety  only  in  not  spreading"  (par.  394) ; 
that  is,  at  a  time  when  cholera  is  not  epidemic,  cases  spring 
up  sporadically,  without  any  known  connection  with  previous 
cases,  which  are  not  distinguishable  from  those  which  occur 
during  an  epidemic.  Their  causes,  then,  so  far  as  our  knowledge 
goes,  are  connected  with  the  locality  or  habits  of  the  indi- 
vidual attacked,  and  independent  of  the  occurrence  of  previous 
cases.  With  such  a  fact  before  us  for  one  part  of  India,  and 
with  similar  evidence  from  many  others,  if  not  so  constant  yet 
open  to  as  little  doubt,  we  think  those  who  insist  on  the  ne- 
cessity of  the  introduction  of  the  germ  or  contagium  of  the 
disease  by  persons  or  fomites,  are  under  this  difficulty,  that 
they  have  failed  to  exclude  the  local  origin  of  the  disease,  and 
until  that  be  done,  they  can  never  claimfor  communication  by  per- 
sonal intercourse,  anything  beyond  a  low  degree  of  probability. 

It  is  frequently  alleged  that  malignant  cholera,  when  it  occurs 
sporadically,  differs  in  its  nature  from  malignant  cholera  when 


1875.]  Review  of  Sanitary  Work  in  India.  81 

epidemic ;  but  is  there  any  ground  for  such  an  opinion  ?  No 
one,  for  instance,  considers  a  sporadic  case  of  smallpox  to  differ 
from  those  met  with  during  an  epidemic,  because,  under  the 
latter  condition,  the  cases  are  more  numerous  ;  this  fact  merely 
indicates  that  there  is  something  at  work  which  then  determines 
the  more  frequent  occurrence  of  cases,  without  proving  there 
is  any  difference  in  their  nature.  Hitherto  all  attempts  to 
show  a  distinction  between  the  cases  of  malignant  cholera 
which  appear  sporadically  and  those  which  constitute  an 
epidemic  have  failed,  and  therefore  we  are  not  justified  in  as- 
signing to  the  latter  a  power  which  we  admit  the  former  do  not 
possess,  merely  to  accommodate  them  to  a  theory.  As  with 
smallpox,  the  only  inference  the  facts  authorise  is  that,  when 
epidemic,  there  is  something  which  determines  the  greater 
frequency  of  the  disease  than  when  it  occurs  sporadically,  not 
being  an  attribute  of  the  individual  cases,  but  independent  of 
them,  and  which  may  be  in  operation  without  any  cause  ap- 
pearing, though  we  cannot  be  certain  of  its  being  so  in  any 
locality  unless  we  see  cases  arise.  We  shall,  no  doubt,  be  met 
with  the  old  objection  here,  that  were  such  an  influence,  or 
series  of  influences  in  operation,  every  place  within  their  range 
should  show  their  effects  by  having  cholera  developed  in  them ; 
to  which  we  reply,  that  if  we  wish  to  ascertain  the  process 
followed  by  nature  in  the  production  of  epidemics,  whether  of 
cholera  or  other  diseases,  we  must  not  start  by  laying  down  the 
limits  within  which  we  think  she  should  confine  her  operations, 
but  must  endeavour  from  a  close  study  of  phenomena  to  find 
out  the  limits  which  she  herself  has  imposed. 

The  description  given  above  of  cholera  in  1872  and  1873,  in 
Bengal,  leaves  no  doubt  of  its  causes  having  been  unusually 
active  both  years,  particularly  so  in  the  latter.  In  1872  the 
districts  of  Sambalpur  and  Bilaspur  were  not  included  in  the 
cholera  field,  but  in  1873  the  boundary  of  this  extended  some- 
what to  the  south-west,  and  embraced  the  former,  while  it  just 
touched  the  latter.  The  course  of  the  epidemic  in  these,  and  the 
adjacent  districts  in  the  Bengal  Presidency,  is  shown  by  the 
following  numbers  from  the  monthly  returns  of  deaths  in  1873. 


Jan. 

Feb. 

March 

April 

May 

Balasore 

67 

255 

416 

185 

.        95 

Cuttack 

164 

343 

640 

242 

.        55 

Pooree 

40 

84 

70 

14 

Sambalpur     . 

— 

40 

190 

69 



Bilaspur 

— 

— 

20 

— 

— 

So  that  there  was  considerable  mortality  from  cholera  at  its 
appearance  in  January,  which,  in  Balasore  and  Cuttack,  went 
on  increasing  till  March,  after  which  it  declined  till  May.     In 

111— LYI.  6 


§i  MemeiDs.  [July, 

Sambalpur  tlie  disease  commenced  in  February,  but  culminated 
in  March,  and  fell  off  in  April ;  while  Bilaspur  was  reached  only 
when  the  epidemic  was  at  its  height  in  the  other  districts. 
The  same  wave,  therefore,  which  was  experienced  at  Balasore 
and  Cuttack,  and  to  a  smaller  extent  at  Pooree,  extended  to 
Sambulpur  in  a  slighter  degree,  and  was  just  felt  in  Bilaspur. 
Dr.  Townsend  thought  the  cholera  was  introduced  into  Sam- 
balpur by  the  troops,  assisted  by  the  pilgrims  returning  from 
the  great  festival  at  Pooree,  in  February  and  March.  Now,  in 
February,  1872,  there  was  almost  as  much  cholera  in  the  Pooree 
district  as  in  February  1873,  and  the  probability  of  pilgrims 
contracting  it  there  would  have  been  much  the  same  in  both 
years,  yet  in  1872  they  returned  through  Sambalpur  (not  in- 
cluded in  the  cholera  field  that  year)  without  any  appearance 
of  the  disease  in  their  track,  while  in  1873,  when  Sambalpur 
was  embraced  in  the  cholera  field,  both  pilgrims  and  residents 
began  to  suffer,  and  Bilaspur  beyond  it  and  outside  the  cholera 
field,  but  through  which  a  stream  of  pilgrims  passed,  was 
scarcely  affected.  Thus  this  history  is  merely  a  repetition  of  the 
experience  afforded  by  the  railways,  and,  like  that,  shows  that 
persons  who  have  been  exposed  to  the  causes  of  cholera  within 
a  cholera  field  may  proceed  beyond  that  before  the  disease 
becomes  apparent,  but  that  no  active  de^/elopment  of  the 
malady  takes  place  unless  within  those  limits  which  bound  the 
field,  and  which  vary  from  year  to  year  quite  independently  of 
the  usual  course  or  amount  of  the  traffic.  We,  therefore,  think 
Dr.  Cuningham  is  quite  justified  in  announcing  ''  that  if 
human  intercourse  plays  any  part  in  the  dissemination  of 
cholera,  it  must  be  a  very  secondary  part." 

Dr.  Cuningham  objects,  in  his  third  conclusion,  to  the 
theory  which  attributes  the  spread  of  cholera  epidemics  solely  or 
chiefly  to  the  employment  of  water  contaminated  by  cholera 
discharges.  That  the  use  of  such  water  during  an  epidemic 
period  may  be  followed  by  cholera  in  some  of  those  who  drink 
it,  we  presume  he  would  not  deny,  but  that  it  contains  the  germ 
of  the  disease,  which  so  finds  a  way  of  entrance  into  the  system, 
he  is  not  prepared  to  admit.  The  evidence  adduced  on  this 
point,  we  confess,  has  always  appeared  to  us  as  insufficient  to 
establish  it ;  water  contamination  can  never  take  place  without 
a  first  case,  and  the  causes  which  sufficed  to  originate  that  are 
quite  ignored  when  we  come  to  talk  of  fresh  cases  supposed  to 
have  been  excited  by  the  water  into  which  the  discharges  from 
it  had  passed,  though  these  causes  may  still  continue  in  operation. 
When  cholera  is  prevailing,  or  threatening,  anything  which  will 
derange  the  stomach  or  induce  diarrhoea  is  very  apt  to  excite 
it,  and  in  India  it  is  well  known  that  at  such  times  a  dose  of  any 


1875.]  Review  of  Sanitary  Work  in  India*  S^. 

of  the  usual  saline  purgatives,  or  even  of  the  milder  vegetable 
laxatives,  will  frequently  lead  to  cholera,  and  decomposing 
organic  matter,  whether  animal  or  vegetable,  taken  as  food  or  in 
water,  frequently  does  the  same.  All  we  know  of  the  efficiency 
of  cholera  discharges  in  exciting  cholera  amounts  to  no  more 
than  this,  that  when  taken  into  the  stomach  they  are  inert 
when  quite  fresh,  but  after  undergoing  a  certain  amount  of 
change  they  acquire  the  property  of  lighting  up  the  disease, 
and,  again,  that  after  a  certain  period,  this  property  is  lost. 
But  those  phenomena  only  take  place  when  cholera  is  already 
present,  and,  at  such  times,  the  use  of  decomposing  meat  or  fish, 
or  ascescent  fruit,  may  be  followed  by  the  same  result,  though 
there  be  no  reason  to  suppose  that  any  of  these  have  been 
in  contact  with  cholera  discharges. 

Drs.  Lewis  and  D.  Cuningham  have  injected  cholera  dis- 
charges, both  fresh  and  putrid,  unmixed  and  diluted  with 
water,  into  the  veins  of  dogs,  and  found  that  in  all  these  con- 
ditions they  produce,  in  a  certain  percentage  of  cases,  an 
intestinal  affection  which  they  denominate  "haemorrhagic  gastro- 
enteritis," the  lesions  and  attendant  phenomena  of  which  they 
state  are  not  identical  with  those  of  cholera.  Drs.  Lewis  and 
Cuningham  also  injected  a  solution  of  fseculent  matter  from  a 
healthy  man,  both  fresh  and  putrid,  and  found  it  produce  results 
indistinguishable  from  those  following  the  introduction  of  the 
cholera  discharges,  only  in  a  reduced  proportion.  To  ascertain 
whether  these  results  were  dependenton  the  presence  of  any  germ, 
or  other  living  organism,  which  might  increase  in  the  system, 
both  the  cholera  and  healthy  discharges  were,  in  a  number  of 
experiments,  boiled  immediately  before  injection ;  in  these  the 
toxic  effects  w^ere  even  more  decided  than  when  the  infecting 
material  had  been  injected  without  having  been  heated  pre- 
viously. The  general  result  showed  that  45  per  cent,  of  those 
animals  in  which  cholera  material  was  injected  were  affected, 
whilst  only  21  per  cent,  of  those  in  which  healthy  fseculent 
matter  was  employed  suffered.  With  reference  to  these  expe- 
riments these  gentlemen  remark : 

"Why  material,  whether  choleraic  or  non-choleraic,  should  exert  its 
power  in  some  instances  and  not  in  others,  or  why  choleraic  material 
should  appear  to  possess  this  power  more  frequently  than  ordinary 
material,  we  cannot  explain.  .  .  .  Something,  however,  is  present 
which,  as  we  have  already  said,  is  capable  of  exercising  a  singularly 
pernicious  effect  on  animal  life,  the  most  prominent  local  manifestation 
of  its  action  being  observed  in  the  intestinal  canal."  {Tenth  Annual 
Report  of  Sanitary  Commissioner  with  the  Government  of  India, 
Appendix  A,  p.  107.) 

And  again— 


84  Reviews,  [July> 

"  Therefore  until  it  be  found  that  living  substances  can  withstand 
immersion  in  a  fluid  at  a  temperature  of  212°  F.  of  some  minutes'  dura- 
tion, we  have  no  hesitation  in  stating  that  the  morbid  phenomena  which 
we  have  observed  to  follow  the  introduction  into  the  animal  economy  of 
strained  solutions  of  choleraic  and  normal  alvine  discharges,  and  of 
other  decomposing  animal  substances,  are  not  the  result  of  infection 
with  a  material  the  poisonous  properties  of  which  are  dependent  on  its 
possessing  vitality.     (Ibid.,  p.  108.) 

Drs.  Lewis  and  Cuningham  have  made  many  examinations 
of  the  blood,  both  from  healthy  persons  and  from  cholera  cases. 
They  found  the  chief  character  of  the  latter  to  be  an  unusual 
quantity  of  white  corpuscles,  and  what  they  describe  as  a  "  dif- 
fluent condition  of  the  red  corpuscles  "  which  "  showed  itself  in  a 
tendency  manifested  by  the  corpuscles  to  aggregate  in  irregular 
masses  in  place  of  forming  the  normal  rouleaux,  and  in  ordinary- 
preparations  where  any  pressure  was  exerted,  and  in  which  there 
was  any  movement  of  the  fluid,  in  the  ease  with  which  the 
corpuscles  altered  their  forms,  were  drawn  out  into  irregular  pro- 
cesses or  adhered  to  one  another  by  elastic  protrusions  "  (Ibid., 
p.  82).  There  was  a  complete  absence  of  bacteria,  or  fungi, 
or  other  extraneous  bodies. 

We  imagine  few  can  examine  the  maps  showing  the  varying 
distribution  of  cholera  in  India  from  year  tc  year,  attentively, 
without  being  led  to  the  inference  that  there  must  be  some  one 
or  more  factors  of  extensive  operation  concerned  in  producing 
such  general  results.  As  yet  Dr.  Bryden  is  the  only  person  who 
has  endeavoured  to  indicate  the  nature  of  this  general  cause, 
so  far  as  cholera  is  concerned,  and,  as  many  may  be  aware,  he 
believes  that  a  material  is  produced  in  the  endemic  area  in  Lower 
Bengal  which  the  natural  currents  of  the  atmosphere  carry  through 
the  country,  and  that  when  deposited  in  a  suitable  locality,  under 
favorable  circumstances,  it  is  reproduced,  causing  cholera  among 
those  who  are  exposed  to  the  new  product,  and  also  aff'ording 
seed  for  a  fresh  growth  at  the  spot,  or  for  being  carried  to  a 
farther  point,  where,  under  suitable  conditions,  the  same  process 
would  be  repeated.  Dr.  Bryden  thinks  that  this  material,  con- 
veyed from  the  endemic  area  by  the  winds  at  various  seasons, 
may  account  for  the  distribution  of  cholera,  not  only  over 
Hindostan,  but  also  over  other  countries,  including  the  East 
Coast  of  Africa,  and  Islands  in  the  Indian  ocean.  What  leads 
to  the  issue  of  this  body  of  cholera  (as  Dr.  Bryden  occasionally 
calls  it)  from  the  endemic  area  being  repeated  at  intervals  of 
several  years,  Dr  Bryden  has  not  mentioned,  though  it  is 
clearly  a  very  important  question.  Dr.  Cunningham  evidently 
thinks  well  of  Dr.  Bryden  s  theory,  though  he  does  not  consider 
it  has  as  yet  been  fully  established.     Its  chiefest  opponents  have 


1875.]  Review  of  Sanitary  Work  in  India.  85 

been  those  who  believe  they  could  explain  the  varying 
phases  of  cholera  epidemics  by  personal  communication,  or  by 
water  supply  contaminated  by  cholera  discharges ;  as  these 
gentlemen,  however,  are  now  beginning  to  admit  the  necessity 
of  something  else  to  account  for  the  spread  of  cholera,  it  is  not 
improbable  that  ere  long  the  operation  of  general  causes  may  be 
commonly  admitted,  and  the  course  of  investigation  placed  on  a 
more  correct  basis  than  hitherto,  when  the  facts  we  have  to  deal 
with  will  be  interpreted  in  quite  a  different  manner  from  what 
has  been  customary  of  late.  We  believe  this  change  is  impend- 
ing, and  that  its  advent  will  be  hastened  in  no  inconsiderable 
degree  by  the  results  of  the  registration  of  deaths  in  India,  and 
by  the  outspoken  manner  in  which  Dr.  Cunningham  has 
expressed  the  opinions  which  the  study  of  those  returns  has 
enabled  him  to  form. 

The  year  1872  was  remarkable  for  the  very  extensive  preva- 
lence of  Dengue  in  India,  and  elsewhere  in  the  East.  In  1824- 
25  it  had  spread  extensively  through  the  East,  and,  subsequently, 
it  seems  to  have  appeared  at  Calcutta  in  1836,  1844^  1853-4, 
and  isolated  cases  were  met  with  almost  every  year.  On  this 
occasion  the  first  report  of  Dengue  having  appeared  as  an  epi- 
demic was  received  from  Zanzibar,  where  it  broke  out,  abruptly, 
in  July,  1870,  after  the  termination  of  the  cholera  epidemic  of 
that  year.  The  next  account  of  it  was  received  from  Aden, 
where  it  commenced  in  the  middle  of  June,  1871,  and,  after 
prevailing  very  extensively,  ceased  in  the  middle  of  September. 
In  November  it  was  frequent  at  Port  Said  on  the  Suez  Canal. 
At  Calcutta  one  case  at  least  was  met  with  in  September,  1871. 
It  was  only  in  1872,  however,  that  Dengue  became  extensively 
diffused  in  India;  it  was  first  remarked  in  a  detachment  of 
European  troops  sent  from  Bombay  to  Cannanore,  in  January, 
in  the  Dalhousie  steamer.  On  landing  the  cases  were  segre- 
gated, and  there  were  but  two  or  three  subsequently  among  the 
residents  in  the  cantonment ;  there  were  thirty  cases  in  Janu- 
ary, and  one  in  February,  and  no  others  there  during  the  year, 
either  among  the  European  or  native  troops.  There  was  a  single 
case  at  Rangoon  in  February  among  the  European  troops,  but 
it  was  only  in  April  they  became  frequent.  At  Calcutta  there 
were  a  few  cases  in  March,  but  in  April  they  became  more 
numerous  ;  the  North-western  Provinces  were  not  affected  to  any 
extent  until  July  and  August;  the  epidemic  culminated  in  them 
in  September,  after  which  it  gradually  declined.  The  furthest 
point  reached  by  the  disease  was  Loodianah  ;  at  Umballa  there 
were  a  few  cases  in  October,  November,  and  December,  among 
the  European  troops.  Among  the  native  troops,  and  prisoners 
in  the  jails,  the  distribution   and  period  of  occurrence  of  the 


86  Reviews.  [July, 

disease  seem  much  the  same  as  among  the  European  troops.  In 
the  Bombay  Presidency  Dengue  first  appeared  at  Poona,in  April, 
during  which  about  a  tenth  of  the  European  troops  were  attacked; 
in  Bombay  itself  they  became  affected  in  May ;  and  in  the  Ma- 
dras Presidency  the  epidemic  (except  the  outbreak  at  Cannanore 
already  mentioned)  began  in  April.  The  Straits  Settlements  were 
affected  early  in  the  year,  and  the  disease  was  common  in  China, 
at  Shanghai  in  June,  at  Amoy  in  August,  and  at  Mecca  among 
the  pilgrims  about  February.  In  1873  there  was  a  slight  return 
of  the  malady,  but  its  force  was  much  reduced  everywhere,  and 
the  number  of  stations  affected  was  much  smaller  in  the  Ben- 
gal and  Bombay  Presidencies,  but  the  epidemic  still  retained 
considerable,  though  diminished  force,  in  that  of  Madras.  The 
large  expanse  of  country  from  the  Punjaub  down  to  the  Central 
Provinces  was  scarcely  at  any  time  under  the  influence  of  the 
disease. 

Mr.  Cornish,  in  the  Keport  for  Madras  for  187^,  points  out  the 
extraordinary  immunity  from  Dengue  of  the  prisoners  in  the  jails. 
Those  in  the  Madras,  Nellore,  and  Tanjore  jails  only  were 
affected.  At  Vellore,  Dengue  prevailed  among  the  civil  population 
from  May  to  October,  the  jailor  and  many  of  the  warders  were 
attacked,  but  none  of  the  prisoners,  the  average  strength  of  whom 
was  943.  At  Trichinopoly,  three  fourths  of  the  people  in  the  town 
were  prostrated  by  the  disorder ;  the  native  troops  also  were  very 
extensively  affected,  but  not  a  single  case  occurred  in  the  jail, 
where  the  average  number  of  prisoners  during  the  year  w^as 
875 ;  and  at  many  other  stations  where  the  native  troops  suf- 
fered to  a  large  extent  the  prisoners  escaped  altogether.  When 
European  and  native  troops  were  quartered  at  the  same  station 
the  latter  were  attacked  in  larger  proportion  than  the  former. 
The  comparative  immunity  of  the  prison  population  in  the  Ben- 
gal presidency  was  also  remarkable,  though  the  ratios  of  attacks 
among  the  European  and  native  troops  were  much  closer  than 
in  Madras.  In  the  Bombay  returns  the  attacks  of  Dengue  are 
not  given  for  the  prisoners,  so  we  have  no  means  of  ascertaining 
whether  they  escaped  the  disease  to  anything  like  the  same 
extent  as  in  Bengal  and  Madras. 

With  respect  to  the  circumstances  connected  with  the  recent 
spread  of  Dengue  in  India,  and  elsewhere.  Dr.  Charles,  of  the 
Calcutta  Medical  College,  while  regarding  the  disease  as  a  con- 
tagious malady,  remarked  in  1872  : 

"I  do  not  attach  very  much  importance  to  our  being  able  to  trace 
where  the  first  case  of  dengue  in  Calcutta  came  from,  as  other  conditions 
besides  the  existence  of  a  previous  case  of  the  disease  are  necessary 
before  the  disease  can  extend  as  an  epidemic.  In  our  ignorance  of 
what  these  conditions  are,  we  term  such  conditions  epidemic  influence. 


1875.]  Review  of  Sanitary  Work  in  India.  87 

To  my  mind  the  important  point  seems  to  be  that  such  a  widespread 
atmospheric  or  other  cosmic  state  existed  during  the  present  time  as  to 
favour  the  diffusion  of  dengue  from  person  to  person  over  Egypt,  Arabia, 
and  India.'*  ....  "As  soon  as  these  unknown  conditions  necessary 
to  allow  the  existence  of  an  epidemic  are  over,  a  long  series  of  years  will 
follow  during  which  sporadic  cases  of  Dengue  will  occur  in  Egypt, 
Arabia,  and  India,  as  well  as  in  other  places  in  which  it  is  endemic, 
and  yet  the  disease  will  not  spread.  Under  such  circumstances  we 
shall  have  small  communities  suffering  from  local  outbreaks,  single 
towns,  or  it  may  be  some  parts  of  towns,  more  or  less  disturbed  by 
this  most  unwelcome  visitor,  but  the  pandemic  wave  which  is  at 
present  favouring  the  universal  diffusion  of  the  disease  over  thousands 
of  miles  being  wanting,  Dengue  will  under  the  altered  conditions 
spring  up  and  die  down  within  comparatively  narrow  limits  (^Eighth 
Annual  Report  of  Sanitary  Commission  with  the  Government  of  India, 
p.  112.) 

Though  vaccination  is  inculcated  assiduously  by  the  authori- 
ties in  various  parts  of  India,  its  influence  in  diminishing  small- 
pox is  still  but  limited,  and  epidemics  of  that  disease  spread 
over  the  country  every  few  years  causing  great  mortality.  In 
1867-8  there  was  a  severe  epidemic  in  the  Madras  Presidency, 
which  declined  there  in  1869,  but  in  that  year  embraced  the 
Central  Provinces,  and  Berar,  Oudh,  the  North-western  Provinces, 
and  the  Punjaub,  where  also  the  epidemic  declined  in  1870.  It 
may  be  remembered  that  early  in  1870  smallpox  became  very 
active  in  the  south  of  France,  and  in  the  course  of  that  year 
passed  northwards,  and  towards  its  close  showed  signs  of 
increased  activity  in  this  country,  passing  into  the  severe 
epidemic  of  1871-2. 

Smallpox  was  at  its  minimum  over  nearly  all  India  in  1870. 
From  that  date  it  increased  in  the  Madras  Presidency,  year 
by  year,  until  1873,  when  there  were  51,872  deaths  from  it 
registered,  or  1'70  per  1000  of  the  population.  In  the  Bombay 
Presidency  the  increase  went  on  to  1872,  when  1*83  per  1000 
of  the  population  died  of  it ;  but  in  1873  the  millesimal  ratio  of 
deaths  was  just  one  third  of  this,  or  '61.  Berar,  like  the 
neighbouring  territory  of  Bombay  reached  its  highest  ratio, 
3-83,  in  1872,  but  remained  at  381  per  1,000  in  1873  ;  while  in 
the  Central  Provinces,  adjoining  it,  in  Oudh,  and  the  North-wes- 
tern Provinces,  the  deaths  from  smallpox  became  more  numerous 
each  successive  year  after  1870,  and,  in  the  last  two,  amounted 
to  2*15,  and  3' 15,  per  1000  respectively.  Until  the  epidemic 
pass  over  it  is  not  possible  to  define  the  exact  bearing  of  the 
provincial  manifestations  to  each  other,  nor  to  indicate  its  future 
progress ;  the  subject,  however,  is  a  most  interesting  and  sug- 
gestive one,  which  the  system  of  registration  of  deaths  now 
followed  in  India  is  likely  to  throw  much  light  upon. 


88  Reviews.  [July, 

A  very  large  number  of  deaths  among  the  civil  population 
are  returned  under  the  term  fever,  but  inasmuch  as  the  vast 
majority  of  these  are  registered  on  the  information  derived  from 
people  unacquainted  with  the  subject,  all  the  authorities  seem 
agreed  that  no  great  reliance  can  be  placed  on  the  numbers  so 
recorded.  Cholera,  smallpox,  or  bowel  complaints,  have  all 
sufficiently  distinct  characters  to  admit  of  most  persons  of 
ordinary  observation  distinguishing  them  after  a  very  limited 
experience,  and  hence  the  returns  may  be  accepted,  as  far  as  they 
go,  as  representing  those  diseases  with  tolerable  accuracy,  but  to 
distinguish  fevers  properly  so  called,  from  diseases  merely  pre- 
senting febrile  symptoms  during  their  course,  requires  special 
education,  which  does  not  now  exist  even  to  a  moderate  extent, 
and  which  cannot  be  expected  to  be  generally  available  for  many 
years  to  come.  Dr.  Cuningham,  however,  is  inclined  to  look 
on  the  variation  in  the  number  of  deaths  from  year  to  year  as 
affording  a  fair  indication  of  the  fluctuations  of  fever  over  the  face 
of  the  country,  especially  when  the  statistics  are  borne  out  by  the 
returns  of  the  sickness  among  the  European  and  native  troops, 
and  in  the  jails.  As  the  registration  of  deaths  becomes  more 
complete  as  to  numbers,  fevers,  as  well  as  other  diseases,  will 
appear  to  have  increased  above  the  average  of  previous  years  ;  but 
the  fluctuations  just  referred  to  may  still  be  detected  among  the 
different  districts,  and  when  borne  out  by  the  military  and  jail 
returns,  may  be  deemed  sufficiently  reliable  to  show  the  inci- 
dence of  fevers  at  various  points,  though  not  precise  enough  to 
form  the  basis  of  accurate  statistical  inquiry. 

A  large  portion  of  the  fevers  met  with  in  India  are  of  the 
malarial  class,  intermittent  or  remittent  in  form  ;  and,  where 
these  are  common,  other  descriptions  of  fever  may  present  more 
or  less  of  the  remittent  type,  and  thus  mask  their  real  character. 
Those  who  have  not  had  to  watch  fever,  or  indeed  other  diseases, 
in  the  tropics,  or  in  a  very  malarious  locality,  can  have  little 
idea  how  much  they  are  often  obscured  by  a  tendency  to  alle- 
viation or  increase  of  their  symptoms  at  definite  intervals.  To 
this  in  some  measure  must  be  due  the  tardy  recognition  of 
enteric  fever,  for  instance,  which  now  seems  not  uncommon  in 
India,  and  which,  presumably,  was  equally  common  formerly. 
Notwithstanding  the  attention  which  has  been  drawn  to  this  sub- 
ject of  late  years  by  Dr.  Bryden,  it  may  be  doubted  whether 
even  yet  more  than  a  small  proportion  of  the  cases  which  occur  be 
diagnosed  during  their  progress;  for,  among  the  European 
troops  in  the  three  Presidencies,  while  there  were  110  deaths 
from  enteric  fever  in  187^,  the  admissions  during  that  year  were 
only  221 ;  and  in  1873,  with  79  deaths,  there  were  only  210 
admissions  ;  while  our  experience  in  this  country,  as  to  the  mor- 


1875.] 


Review  of  Sanitary  Work  in  India. 


tality  attending  this  disease,  would  lead  us  to  expect  a  much 
larger  number  of  cases  would  have  come  under  treatment.  It 
was  doubtful  for  some  time  whether  enteric  fever  occurred 
among  the  natives,  and  Dr.  Cuningham  adverts  to  the  diffi- 
culty of  recognising  the  disease  with  certainty  in  a  person  with 
a  dark  skin,  and  the  necessity  of  caution  in  adopting  such  a 
diagnosis  without  the  corroborative  evidence  afforded  by  post- 
mortem examination.  In  the  report  for  the  Punjaub  for  1873 
three  fatal  cases  in  natives  are  given  by  Surgeon-Major  Johnson, 
5th  Goodha  Regiment,  in  which  the  characteristic  intestinal 
lesion  was  well  marked,  which  shows  the  possibility  of  their 
occurrence  beyond  doubt ;  indeed,  there  was  no  very  clear  reason 
why  enteric  fever  should  not  affect  the  dark  races  of  Hindostan 
as  well  as  those  elsewhere  ;  for  it  has  been  known  for  many 
years  that  the  negro  is  quite  as  susceptible  of  it  as  the  white 
man.  Mr.  De  Renzy,  Sanitary  Commissioner  of  the  Punjaub, 
suggests  that  as  the  exciting  cause  of  enteric  fever  is  so  generally 
present,  a  very  small  percentage  of  native  children  escapes  that 
disease  in  infancy,  and  hence  when  they  grow  up  they  are  less 
liable  to  another  attack. 

As  to  the  general  prevalence  of  fevers  in  1872  the  ratio  per 
1000  among  the  civil  population  showed  an  increase  over  that 
in  1871  in  the  Madras,  and  still  more  in  the  Bombay  Presidency. 
The  rise  also  was  very  marked  in  Berarand  the  Central  Provinces, 
and  to  a  less  extent  in  the  North-western  Provinces,  and  the 
Punjaub.  The  increase  in  Madras  was  chiefly  confined  to  the 
Ganjam,  Vizagapatam,  Godavery,Kistna,  and  Nellore  districts, 
on  the  east  coast,  and  to  Kurnool  in  the  centre  of  the  peninsula. 
In  Bombay  it  was  apparent  in  Kulladghee,  adjoining  Kurnool, 
and  was  continued  northwards  in  the  Satara,  Poona,  Ahmed- 
nuggur,  Nassick,  and  Khandeish  districts,  which  last  adjoin 
Berar.  There  being  no  registration  for  the  territories  under 
native  rule  in  the  centre  of  the  country,  round  which  these  dis- 
tricts are  situated,  the  state  of  fever  there  is  unknown.  In  1873 
the  deaths  from  fever  were  very  much  less  in  nearly  all  the 
districts  mentioned. 

The  fever  became  prevalent  in  the  Madras  districts,  above 
named,  after  the  setting  in  of  the  rains,  which  were  very  heavy. 
Although  this  has  frequently  been  the  case  elsewhere,  it  must  not 
be  concluded  from  these  instances  that  all  that  is  required  to 
ensure  the  prevalence  of  malarial  fever  is  merely  abundance  of 
rain ;  experience,  both  in  India  and  in  other  countries,  has 
shown  not  only  that  the  rainfall  may  have  been  unusually 
great,  and  as  far  as  regards  fever,  the  season  healthy,  but  on 
the  other  hand  fever  may  have  become  epidemic  while  the 
rainfall  for  the  period  had  been  much  less  than  common.  There 


90  Reviews,  [July, 

was  a  widespread  and  severe  outbreak  of  fever  in  India,  in  1869, 
embracing  the  Punjaub,  North-western  Provinces,  Central 
Provinces,  and  even  Kurrachee  at  the  mouth  of  the  Indus. 
Some  of  the  sanitary  officers,  who  had  under  their  supervision 
districts  in  which  there  was  much  irrigation,  attributed  the 
prevalence  of  the  disease  to  that,  but  Dr.  Cuningham  showed 
that  in  other  districts  where  there  was  no  irrigation,  fever  pre- 
vailed quite  as  severely,  or  even  more  so  than  in  those  where 
that  was  in  full  operation.  Fever,  no  doubt,  is  met  with  in  wet 
and  malarious  districts  generally,  and  in  ordinary  seasons,  in 
greater  frequency  than  in  those  which  are  drier,  and  free  from 
marshy  ground ;  but  from  time  to  time  it  becomes  epidemic 
over  a  large  area,  embracing  both  descriptions  of  country,  and, 
as  mentioned  above,  it  may  then  prevail  to  as  great  or  even 
greater  extent,  in  the  latter  class  of  localities  than  in  the 
former.  There  must,  therefore,  be  some  factor  or  factors  of  ex- 
tensive operation,  and  variable  incidence  concerned,  such  as 
Dr.  Cuningham  has  shown  are  necessary  to  account  for  the 
diffusion  of  cholera  or  smallpox,  and  which,  as  Dr.  Clark  re- 
marks, in  our  ignorance  of  their  nature,  we  term  epidemic  hi- 
fiuences,  and  until  we  become  better  acquainted  with  these,  and 
are  willing  to  interpret  the  phenomena  which  occur  within 
their  area  of  activity,  in  subordination  to  them,  it  is  hopeless  to 
expect  we  can  emerge  from  the  confusion  of  opinion  which 
prevails  at  present  on  the  mode  of  propagation  of  epidemics. 


VIII.— Leudet's  Clinique  Medicale.^ 

The  author  of  this  volume  is  the  Director  and  the  Professor 
of  Clinical  Medicine  in  the  Rouen  School  of  Medicine.  He 
writes  from  twenty  years  experience  and  clinical  observation 
in  the  large  hospital  of  that  city,  following  upon  an  "  internat" 
of  six  years  in  the  hospitals  of  Paris  under  the  direction  of  their 
world -renowned  physicians,  and  a  period  devoted  to  travel  and 
study  in  foreign  lands.  Yet  Dr.  Leudet  has  deemed  it  neces- 
sary to  write  an  apologetic  preface,  bewailing  his  exile  from  the 
capital,  and  referring  with  much  humility  to  his  position  as  a 
provincial  physician  deprived  of  the  many  advantages  derivable 
from  association  with  the  celebrities  of  the  great  city,  and  of 
the  means  of  research  available  to  investigators  whose  better 
fortune  has  lodged  them  in  Paris. 

^    Clinique  Medicale  de  VEotel  JDien  de   Honen.     Par  E.  Leudet.     Paris, 
1874. 


1875.]  Leudet's  Clinique  Medicale.  91 

And,  without  question,  the  practitioners  of  a  capital  enjoy 
advantages,  social  and  scientific,  not  attainable  by  those  of  the 
provinces.  Yet  they  may,  as  we  can  testify  Dr.  Leudet  has 
done,  render  great  service  to  the  advancement  of  medicine,  and 
need  not  be  ashamed  of  the  work  they  accomplish.  Moreover, 
as  our  author  points  out,  physicians  of  provincial  hospitals  enjoy 
greater  opportunities  of  getting  a  knowledge  of  the  history  of 
their  cases,  as  well  as  of  following  out  that  history  in  the 
course  of  repeated  admissions  into  the  local  institution.  For 
example,  he  remarks  that,  of  800  or  900  patients  annually  ad- 
mitted into  his  department  of  the  Rouen  hospital,  150  at  least 
have  on. an  average  been  previously  under  his  observation.  And 
as  he  takes  notes  of  all  his  cases  he  is  consequently  able  to  get  a 
more  or  less  complete  history,  and  to  arrive  at  a  comprehensive 
clinical  review  of  their  maladies. 

The  volume  produced  is  essentially  a  practical  one,  made  up 
of  cases  carefully  observed  and  clearly  reported,  with  comments 
on  pathology  and  treatment.  The  author  attempts  no  syste- 
matic descriptions  of  maladies,  but  presents  a  selection  of  cases, 
mostly  illustrative  of  the  less  usual  forms  of  disease.  Some  of 
the  essays  have  heretofore  appeared  in  the  medical  journals  ; 
these  he  has  taken  the  opportunity  to  revise.  Altogether 
seventeen  subjects  are  more  or  less  fully  discussed,  some  of 
them  at  considerable  length  ;  and  it  is  satisfactory  to  observe 
that  he  has  in  his  observations  referred  to  the  contributions 
both  of  German  and  of  English  physicians.  Among  the  patho- 
logical questions  treated  are — suppurative  pylephlebitis  conse- 
cutive to  diseases  of  the  liver  and  biliary  ducts ;  the  pathogeny 
of  cerebral  accidents  in  acute  articular  rheumatism ;  annular 
ulcerations  and  strictures  of  the  small  intestines;  encysted 
pleurisies  and  their  terminations ;  chronic  meningitis  and  its  in- 
■fluence  in  the  production  of  polyuria;  congestion  of  spinal 
cord  following  falls  and  strains  ;  the  curability  of  ascites,  and  the 
advantages  of  capillary  puncture  in  the  treatment  of  that  dis- 
ease. Long  chapters  also  are  given  illustrating  the  clinical 
history  of  entozoa,  of  glycosuria,  and  of  the  influence  of  alco- 
holic drinks  in  producing  inflammations  of  the  liver.  The 
conclusions  arrived  at  on  the  review  of  the  clinical  histories 
detailed  are  marked  by  sound  practical  reflections,  and  are 
very  usefully  summarised  at  the  end  of  each  essay.  Several 
such  summaries  might  profitably  be  quoted,  but  it  must  suffice 
to  give  two  or  three  by  way  of  example. 

The  cerebral  disturbances  occurring  in  the  course  of  acute 
rheumatism  have  not  been  so  fully  elucidated  as  they  demand. 
According  to  Leudet's  experience  they  are  due  to  several  causes. 
In  the  first  place  we  must  distinguish  from  them  intercurrent 


93  Reviews.  [July, 

nervous  symptoms,  dependent  on  an  anterior  neuropathic  state, 
such,  for  instance,  as  epileptic  and  hysteric  crises,  provoked  by  the 
rheumatism,  as  they  might  equally  be  by  any  other  acute  malady. 
Other  like  intercurrent  conditions  obtain  in  the  case  of  previously 
produced  alcoholic  saturation,  of  a  scorbutic  state,  and  of  a 
hsemorrhagic  diathesis.  The  brain  and  its  membranes  are  not 
often  attackedby  a  true  phlegmasia,  although  now  and  then  the 
meninges  exhibit  traces  of  inflammation.  Congestions,  or  other- 
wise angemia,  of  the  brain  and  of  the  upper  portion  of  the  cord 
are  the  most  frequent  changes  observed.  The  base  of  the  brain, 
the  superior  portion  of  the  cord,  the  areolar  tissue  outside  the  dura 
mater,  the  meninges,  and  the  cord  itself,  may  be  the  seat  of  true 
inflammation.  This  variety  of  congestion  is  tolerably  fre- 
quent. Lesions  of  the  heart,  of  the  pericardium  and  endocar- 
dium, and  of  the  blood,  frequently  provoke  cerebral  disturb- 
ances in  the  course  of  acute  rheumatism.  Among  such  are 
pericarditis,  endocarditis,  myocarditis,  clots  of  spontaneous  for- 
mation within  the  heart,  the  haemorrhagic  diathesis  and  purulent 
infection.  Likewise  rheumatic  nephritis  has  a  share  in  their  pro- 
duction. The  forms  of  cerebral  rheumatism  are  very  variable,  a 
special  variety  occurs  in  infancy,  and  has  been  well  studied  by 
H.  Roger. 

The  disordered  cerebral  phenomena  may  appear  isolated,  or 
else  may  be  united  in  groups.  The  brusque  onset  of  comatose 
symptoms  or  of  delirium,  causing  rapid  death,  is  commonly 
associated  with  cardiac  lesion :  the  same  probably  holds  true 
with  regard  to  the  maniacal  and  melancholic  forms  of  attack. 
Convulsions  seem  generally  due  to  renal  complication.  As  to 
treatment,  its  indications  must  be  sought  in  an  acquaintance 
with  the  causes  of  the  intercurrent  cerebral  disturbances. 

The  author  relates  two  instances  of  pleurisy  with  displace- 
ment of  the  spleen — a  condition  respecting  which  conflicting 
views  have  been  held.  Splenic  engorgement  and  enlargement, 
common  in  other  inflammations,  is  a  concomitant  condition  of 
the  displacement  in  question.  Another  factor  concerned  in  the 
matter  is  a  relaxed  state  of  the  attachments  of  the  spleen ;  but 
there  is  no  direct  relation  between  the  degree  of  displacement 
and  the  amount  of  eff'usion  in  the  pleural  sac. 

The  clinique  of  chronic  meningitis  in  relation  to  its  influence 
in  producing  polyuria  exibits  no  more  than  the  occasional  oc- 
currence of  this  disorder  where  meningitis  exists,  and  does  not 
sufiice  to  establish  a  connection  between  the  two  morbid  con- 
ditions in  the  way  of  cause  and  efi'ect ;  although  this  much 
appears,  that  an  aggravation  of  the  symptoms  of  meningeal 
inflammation  is  attended  by  an  increased  flow  of  urine.  It 
would,  nevertheless,  be  vain  to  ignore  the  accumulated  evidence^ 


1875.]  liEUDET^s  Clinique  Medicale.  9^ 

derived  from  a  host  of  observers,  of  a  correlation  between  brain 
lesions  and  even  passing  cerebral  disorder,  and  the  occurrence 
of  polyuria,  and,  still  more,  even  of  glycosuria.  We  have,  how- 
ever, yet  to  learn  to  discriminate  those  lesions  of  the  nerve- 
centres  which  do  provoke  polyuria  from  those  that  do  not.  We 
have  still  to  unravel  the  various  causes  of  polyuria,  and,  we 
may  add,  of  glycosuria  also. 

The  excessive  discharge  of  simple  urine  was,  in  Leudet's 
cases,  unaccompanied  by  emaciation  and  by  cachexia — a  cir- 
cumstance not  always  predicable  in  that  functional  disturbance. 

The  examination  of  his  cases  of  chronic  meningitis  leads 
Leudet  to  results  differing  in  no  respect  from  those  arrived  at 
by  other  observers.  Like  others  he  notes  occasional  absence  of 
intellectual  disorder,  even  where  the  motor  and  sensitive  nerve- 
functions  are  intensely  deranged.  And  he  remarks  that  at 
times  the  disturbed  nervous  phenomena  manifest  themselves  in 
the  splanchnic,  or  in  the  vaso-motor  nerves,  and  give  rise  to 
simultaneous  or  alternate  perversions  of  mobility  and  sensibility, 
or  to  herpetic  eruptions  in  the  course  of  the  nerves. 

M.  Leudet's  experience  of  cases  of  entozoa  has  been  con- 
siderable. The  T(B)iia  armata  is  the  only  species  of  Tcenia  he 
has  met  with  at  Rouen ;  but  38  cases  have  occurred  to  him, 
35  of  which  were  among  private  practice.  Cysticerci  have  been 
met  with  by  him  in  the  brain  in  5  instances,  in  the  heart  in  1, 
and  in  the  muscles  in  5. 

Hydatids  he  has  found  in  the  brain  in  3  cases  ;  in  the  pelvis 
and  broad  ligament  in  2 ;  in  the  liver  in  24,  and  in  the  lungs 
in  3.  The  youngest  sufferer  with  T(B)iia  noticed  by  him  was  a 
child  five  years  old.  In  his  experience  the  labouring  classes 
suffer  less  frequently  than  those  of  higher  social  position.  He 
refers  despondently  to  the  results  of  treatment  of  tape-worm, 
but  does  not  inform  us  what  drugs  he  has  employed.  His 
recorded  cases  are  well  worthy  of  study,  particularly  those  of 
hydatid  disease  ;  but  his  general  remarks  on  the  natural  history 
and  the  migration  of  entozoa  show  a  want  of  acquaintance  with 
some  of  the  most  recent  researches  on  such  matters,  and  we 
regret  to  find  that  he  is  not  acquainted  with  the  very  lucid  and 
conclusive  researches  of  Spencer  Cobbold. 

Lead-poisoning  is  common  in  Normandy,  and  much  of  it  is 
due  to  the  cider-drinking  habits  of  the  inhabitants.  The  tra- 
ditional belief  is  that  the  poisoning,  recognised  by  the  public 
mainly  in  the  phenomena  of  colic,  is  due  to  the  acidity  or  other 
unwholesome  condition  of  the  cider,  and  is  consequently  a 
vegetable  colic.  But  such  a  variety  of  colic  is  not  known  to 
Leudet;  who,  on  the  other  hand,  finds  lead  colic  common, 
together  with  the  severer  consequences  of  lead-poisoning.     He 


64  Meviews.  [July, 

concurs  with  Dr.  Todd  in  the  recognition  of  lead-gout,  and 
states  that  chronic  parenchymatous  nephritis  is  common  among 
the  sufferers  from  lead.  Cardiac  lesion,  usually  in  the  form  of 
simple  hypertrophy  of  the  left  ventricle  is  another  consequence 
of  lead-poisoning.  Lead  at  one  time  had  the  reputation  of 
preventing  pulmonary  tuberculosis,  but,  as  Leudet  shows,  it 
rested  on  no  satisfactory  evidence. 

On  these  conclusions  we  may  remark  that  the  causal  con- 
nection between  lead-poisoning  and  cardiac  disease,  in  the 
shape  of  hypertrophy  of  the  left  ventricle,  first  suggested  by 
Duroziez,  and  now  much  more  confidently  put  forward  by 
Leudet,  is  not,  in  our  opinion,  made  out.  The  latter  bases  the 
hypothesis  mainly  on  the  post-mortem  examinations  of  24  cases 
of  death  among  sufferers  from  lead,  17  of  which  presented 
cardiac  lesions.  But  besides  these  in  8  other  such  sufferers, 
who  did  not  succumb,  what  he  terms  an  anomalatrophy  of  the 
heart  was  met  with,  thus  raising  the  number  of  instances  of 
cardiac  disease  to  25  of  a  total  of  184  cases  of  lead-poisoning. 
Of  the  17  examples  of  such  lesion,  as  found  after  death,  14 
consisted  in  hypertrophy  of  the  left  ventricle.  In  one  of  the 
remaining  the  opposite  condition  of  atrophy  was  found;  but  if 
the  tendency  of  lead  is  to  induce  hypertrophy,  the  reverse 
condition  can  scarcely  be  attributed  to  it. 

We  have  seen  a  great  deal  of  lead-poisoning,  although  very 
few  fatal  cases,  and  cannot  appeal  to  the  positive  evidence  for 
or  against  the  coexistence  of  cardiac  disease  furnished  by 
examinations  after  death.  But  in  the  many  instances  we  have 
had  under  treatment  we  have  found  no  such  prevalence  of 
heart  disease  as  Leudet  would  make  out.  This  negative  evi- 
dence, however,  cannot  have  great  weight  assigned  to  it,  since, 
as  Leudet  asserts,  the  muscular  contractions  of  the  heart  are 
enfeebled,  and  the  force  of  the  pulse  is  likewise  considerably 
diminished,  as  proved  by  the  sphygmograph.  In  other  words, 
the  signs  of  hypertrophy  are  wanting  during  life ;  and  no  one 
consequently  can  gainsay  the  inference  of  Leudet  that,  although 
he  can  get  proof  of  only  22  examples  of  hypertrophy  of  the 
heart  in  184  cases,  yet  it  may  be  assumed  the  lesion  was  over- 
looked in  a  considerable  number.  Nevertheless,  with  such  facts 
as  he  advances,  we  would  hint  that  a  cardiac  change  in  one  of 
eight  cases  of  lead-poisoning  is  a  proportion  scarcely  sufiicient 
to  establish  an  immediate  pathological  relation  between  that 
cause  of  sickness  and  cardiac  hypertrophy  ;  and  that,  besides,  we 
need  know  many  particulars  of  the  history  of  the  cases  exhibit- 
ing the  two  conditions,  so  that  recognised  concurrent  causes  of 
heart  disease  might  be  eliminated,  before  we  can  accept  even 


im.] 


Leudet^s  Clinique  Medicate.  §8 


the  figures  furnished  and  deduce  from  them  stable  statistical 
facts. 

On  the  assumed  correlation  between  lead-poisoning  and 
renal  disease  we  must  also  express  much  doubt.  At  least  we 
do  not  find  evidence  of  it  during  life.  The  lesion  almost  always 
noted  by  those  who  have  made  autopsies  is  parenchymatous 
inflammation,  leading  to  contracted  granular  kidney.  When 
we  look  to  Leudet's  experience  we  find  only  two  of  the  24 
cases  of  death  from  lead  attributed  to  "  albuminous  nephritis/' 
although,  indeed,  at  a  subsequent  page,  he  tells  us  that  of  the 
17  individuals  who  exhibited  heart  disease  after  death,  10  of 
them  also  presented  atrophy  of  the  kidneys  with  granulations 
of  the  surface  of  the  parenchyma.  Hence  all  the  evidence 
Leudet  has  to  bring  forward  to  establish  his  position,  that  lead- 
poisoning  and  renal  disease  are  related  as  cause  and  effect, 
appears  to  be  that  in  12  of  184  cases  of  lead  intoxication  there 
was  parenchymatous  nephritis ;  for  he  makes  no  mention  of  the 
signs  of  this  lesion  among  the  160  patients  who  escaped  his 
pathological  investigations.  In  our  humble  opinion,  therefore, 
the  relation  assumed  cannot  be  regarded  as  proven ;  and  more 
particularly  wh"en  we  have  the  facts  before  us  that  the  victims 
of  lead-poisoning  at  Rouen  belong  chiefly  to  the  class  of  house- 
painters,  and  that  alcoholic  drinks  are  much  abused  by  the 
working  classes  of  that  city,  who,  in  other  respects,  fare  very 
badly  as  to  diet. 

The  curability  of  ascites  forms  the  subject  of  one  of  the 
longest  chapters  in  the  book,  and  it  is  certainly  a  topic  of  great 
interest  and  well  deserving  full  consideration.  Yet,  admitting 
the  value  of  his  cases  clinically  as  exponents  of  the  history,  the 
causes,  course,  concomitant  features,  and  pathological  characters 
of  the  malady,  we  must  confess  to  disappointment  when  we 
examine  them  for  the  purpose  of  discovering  a  foundation 
whereon  to  base  a  truly  curative  treatment. 

Of  idiopathic  ascites  he  has  no  experience,  and  believes  that 
the  presumed  instances  of  this  affection  were  examples  of 
pathological  states  unrecognised  during  life.  In  his  own 
practice  cases  have  occurred  seemingly  referable  to  such  a 
variety,  but  the  opportunity  of  a  post-mortem  examination  has 
been  fatal  to  the  supposition  by  proving  the  existence  of  some 
serious  organic  lesion  of  one  or  other  organ. 

Peritoneal  eff"usion  in  young  children  appears  to  be  in  a 
large  proportion  of  cases  curable,  but  even  cases  of  this 
sort  Leudet  cannot  admit  as  furnishing  evidence  of  idiopathic 
ascites.  He  narrates  a  case  of  such  ascites  in  a  scrofulous  boy, 
four  years  of  age,  appearing  after  an  attack  of  hooping-cough. 
Cod-liver  oil  and  iodide  of  iron  were  administered  and  the  dropsy 


96  Reviews.  [July, 

vapidly  disappeared ;  but  when  this  had  happened  signs  of  hip 
disease  came  on,  which  in  its  turn  yielded  to  treatment.  In 
this  patient  Leudet  concludes  that  there  was  temporary  tuber- 
culosis either  of  the  lymphatic  glands  of  the  belly,  or  of  the 
peritoneum. 

The  next  two  cases  narrated  are  connected  with  tubercular 
disease  and  happened  in  adults.  In  the  first  the  ascites  accom- 
panied tuberculosis  of  the  lungs  and  right  pleuritic  effusion. 
Under  the  influence  of  iodide  of  potassium  and  of  iodine  applied 
externally  the  effusion  both  in  the  pleura  and  abdomen 
vanished,  and  in  course  of  time  the  patient  recovered.  The 
dropsy  in  this  instance  Leudet  attributes  to  a  subinflammatory 
action  in  connection  with  the  onset  of  the  tuberculosis  of  the 
lungs,  and  probably  itself  due  to  the  presence  of  tubercular 
matter  which  does  not  advance  beyond  a  first  stage,  or  one  in 
which  it  only  produces  irritation  of  the  tissue  in  which  it  is 
deposited.  The  second  case  described  agrees  in  its  principal 
features  with  the  foregoing. 

A  further  example  of  the  spontaneous  disappearance  of  ascites 
is  given  in  the  case  of  a  man  who  for  years  had  urethral  stric- 
ture and  chronic  double  pyelonephritis  consequent  upon  it.  The 
ascites  did  not  appear  till  after  the  lapse  of  ten  years  from  the 
date  of  urethral  troubles,  and  after  lasting  nearly  six  months 
passed  away  with  an  excessive  discharge  of  urine.  The  man 
himself  subsequently  died,  seven  months  after,  from  an  attack 
of  pneumonia,  the  dropsy  having  never  returned.  Here  Leudet 
assigns  the  ascites  to  effusion  consequent  on  a  cachectic  state 
and  a  subacute  inflammation  of  the  peritoneum,  probably  con- 
nected pathologically  with  the  chronic  urethral  and  renal 
disease.  This  form  of  ascites  he  calls  fibrinous  ascites.  He 
likens  this  case  last  mentioned  to  those  intra-peritoneal  effusions 
sometimes  met  with  in  lying-in  women  and  in  instances  of 
some  affections  of  the  abdominal  viscera,  an  example  of  which 
he  quotes,  where  the  autopsy  revealed  chronic  gastritis  with 
considerable  hypertrophy  of  the  coats  of  the  stomach  at  the 
pyloric  end,  hsemorrhagic  effusion  in  the  peritoneum,  and 
recent  false  membranes  on  the  intestinal  convolutions.  The 
liver,  spleen,  kidneys,  and  the  blood-vessels,  were  healthy. 

The  next  group  includes  cases  of  heart  disease  accompanied 
by  general  dropsy  and  ascites,  but  their  examination  proves  no 
more  than  that  the  ascites  may  sometimes  pass  away  for  a 
time ;  that  tapping,  if  not  long  delayed,  may  be  usefully  em- 
ployed, and  its  repetition  be  borne  many  times,  not  only  without 
injury,  but  with  much  relief  to  the  patient.  Leudet  would  go 
further,  and, — from  the  appearances  of  fibrinous  bands  and  adhe- 
sions found  within  the  abdomen  of  two  patients  who  unfortunately 


1875.] 


Leudet's  Clinique  Medicate,  S? 


died  and  so  deprived  him  of  the  opportunity  of  adducing  positive 
evidence  of  the  truth  of  his  opinion — contend  that  ascites  asso- 
ciated with  heart  disease  and  anasarca  is  curable  by  a  subinflam- 
matory  state  of  the  peritoneum.  The  author's  hopefulness  of 
cure  in  the  ascites  of  spirit  drinkers  with  cirrhosis  of  liver  is 
equally  remarkable.  His  patients  die,  but  not  before,  to  his 
mind,  they  exhibit  signs  of  approaching  cure  of  their  ascites  by 
the  agency  of  a  subacute  peritonitis  with  fibrinous  effusion. 

He  concludes  this  chapter  by  a  notice  of  a  case  of  ascites  in 
a  rachitic  female  suifering  with  syphilis,  hypertrophy  of  liver, 
albuminuria  and  iritis.  By  means  of  calomel  and  iodide  of 
potassium  the  ascites  and  albuminuria  were  removed  and  her 
general  condition  so  greatly  improved  that  she  was  able  to  be 
discharged.  This  example  of  the  cure  of  ascites  dependent  on 
syphilitic  disease  of  the  liver  does  not  stand  alone,  but  is 
confirmatory  of  the  experience  of  others. 

As  a  rider  to  this  chapter  on  ascites,  Leudet  introduces  a 
short  one  detailing  two  cases  in  which  he  practised  capillary 
puncture  through  an  umbilical  sac  communicating  with  the 
peritoneum,  for  the  purpose  of  curing  the  dropsy.  In  the  first 
case  tapping  had  been  twice  previously  resorted  to  and  effected 
by  a  large  trocar  and  canula,  but  was  followed  by  severe  prostra- 
tion on  each  occasion.  On  the  next  occasion  that  the  evacua- 
tion of  the  dropsical  fluid  became  necessary  Leudet  tried  punc- 
ture with  a  fine  capillary  trocar,  and  was  very  successful 
both  in  the  relief  afforded  and  in  the  avoidance  of  all  the  un- 
pleasant symptoms  that  had  ensued  after  ordinary  paracentesis. 
This  capillary  tapping  he  continued  to  practise  over  a  period  of 
thirteen  months,  when  the  patient  succumbed  to  the  general 
anasarca  consequent  upon  a  diseased  heart,  cirrhosis  of  the  liver, 
and  glycosuria.  His  other  case  was  also  a  fatal  one  from  heart 
disease,  but  the  same  mode  of  practice  gave  great  relief  to  the 
ascites  during  the  seven  months  it  was  carried  on. 

A  few  extracts  may  be  made  from  the  last  chapter  but  one 
of  this  instructive  volume.  It  is  on  the  question,  often  debated, 
of  the  influence  of  alcoholic  excess  on  the  production  of  pul- 
monary tuberculosis.  In  the  course  of  twenty  years  and  among 
15,000  patients,  Leudet  asserts  that  he  has  not  met  with  more 
than  thirty-seven  cases  of  pulmonary  tuberculosis  among  those 
addicted  to  alcoholic  excess  and  presenting  signs  of  alcoholic 
dyscrasia.  Moreover,  from  a  tabulated  statement  of  his  cases  of 
tubercular  spirit  drinkers,  he  concludes  that  alcoholism  does  not 
manifestly  predispose  to  phthisis;  and,  further  on,  he  remarks 
that  the  visceral  lesions  due  to  alcoholic  drinks,  while  they,  on 
the  one  hand,  do  not  hinder  the  development  of  tuberculosis,  on 
the  other  do  not  favour  its  production.     In  like  manner,  in  his 

111— LYI.  7 


9S  Reviews.  [«fuly, 

experience,  miliary  tuberculosis  cannot  be  attributed  to  the 
prolonged  abuse  of  spirituous  liquors.  On  the  contrary,  tuber- 
culosis may  be  chronic  in  the  victims  of  spirit  drinking.  But 
alcoholism  multiplies  intestinal  accidents  in  tubercular  disease, 
in  the  form  of  hsemorrhage  and  of  peritoneal  mischief,  a  result  of 
the  coexistence  of  amyloid  and  fatty  degenerations  of  the  liver 
and  kidneys. 

The  space  we  have  given  to  this  review  indicates  our  appre- 
ciation of  Leudet's  volume  of  clinical  medicine  as  an  honest 
attempt  to  portray  disease,  particularly  in  some  of  its  rarer 
forms,  in  a  practical  aspect,  and  to  advance  our  knowledge  as 
well  of  pathology  and  pathological  anatomy  as  of  treatment. 


IX. — Marey  on  Animal  Mechanism.^ 

It  cannot  be  expected  that  the  reviewer  of  a  book  like  this  of 
Marey' s  on  animal  mechanism  should  be  in  a  position  to  criticise 
experiments  which  he  has  heard  of  for  the  first  time  in  his  hfe — or 
even  be  in  a  position  to  repeat  the  experiments  for  the  mere  sake 
of  finding  out  mistakes  either  in  details  or  results.  Instead  of 
being  a  critic  the  reviewer  is  reduced  to  the  more  pleasant  position 
of  a  student  acquiring  valuable  information  from  the  pen  of  a 
master  of  experimental  physics.  The  pathway  of  research  of  the 
present  day  is,  if  more  difficult  to  follow,  more  pregnant  with 
beneficial  results  to  mankind  at  large.  The  study  of  the  move- 
ments of  animals  is  not  one  of  recent  date,  but  probably  greater 
progress  has  been  made  in  this  branch  of  science  during  the  last 
two  centuries  than  previously.  Since  the  time  of  the  first  John 
Bornoulli  the  action  of  muscles  has  been  a  constantly  recurring  sub- 
ject of  research  to  Continental  and  Enghsh  anatomists.  But  pro- 
gress has  been  of  exceedingly  slow  growth,  and  not  any  more 
accurate  for  its  tardiness.  Little  more  than  a  hundred  years  ago  we 
find  a  learned  professor  of  anatomy  writing  as  follows  : — '^  The  par- 
ticular mechanism  or  immediate  cause  of  muscular  action  has  very 
much  tortured  the  brains  of  many  philosophers.  The  extreme 
delicacy  of  the  texture  of  a  moving  fibre,  and  a  great  number  of 
phenomena,  some  of  them  very  obvious,  which  have  not  been  at- 
tended to,  have  hitherto  prevented  the  discovery  of  this  mystery." 
He  shows  that  muscular  fibre  had  been  supposed  to  be  spongy,  vas- 
cular,  vesicular i  contorted,  elastic,  &c.  And  concerning  the  con- 
currence of   different  fiuids  with  the  supposed    structure  of   the 

'  Animal  Mechanism :  a  Treatise  on  Terrestrial  and  Atrial  Locomoiion.  By 
E.  J.  Maeey. 


1875.] 


Animal  Mechanism.  90 


fibre,  systems  have  even  been  founded  wholly  on  the  spring  or  elas- 
ticity of  the  solid  parts  of  which  a  muscle  is  composed."  Further, 
the  same  author  remarks,  "  Till  some  lucky  discovery  is  made,  what 
can  hitherto  be  gathered  from  the  structure,  confirmation,  and 
action  of  the  muscles,  is,  that  their  strength  depends  on  the 
number  of  their  fleshy  fibres,  and  the  extent  of  their  action  on  the 
length  of  these  fibres.^'  This  is  a  fair  summary  of  that  which  was 
known  to  anatomists  a  hundred  years  ago.  The  next  advance  made 
on  the  knowledge  of  muscle  tissue  is  due  to  the  microscope ;  and 
although  not  absolutely — yet  almost  so,  this  instrument  has  taught 
us  structure  only.  The  muscular  wave — the  zig-zag  of  Magendie — 
had  never  been  accurately  defined  before  the  researches  of  Prevost 
and  Dumas.  The  same  authors  determined  a  long  doubted  ques- 
tion, namely,  whether  contracting  muscle  was  increased  or  dimi- 
nished in  regard  to  volume.  Borelli  maintained  that  there  was  an 
augmentation;  Glisson  maintained  and  illustrated  by  experiment 
the  contrary.^  Others  continued  these  experiments  with  variable 
results — that  of  Barzoletti  satisfying  Magendie  that  "  the  volume 
of  the  muscles  changes  not  during  contraction,  and  whether  it  did 
or  not  was  not  of  much  consequence." 

Modern  researches  have  not  only  determined  this  their  dis- 
puted point,  but  have  materially  extended  our  knowledge  of  the 
physical,  chemical,  and  electrical  properties  of  muscles.  This 
knowledge  has  been  arrived  at  by  actual  experiment.  Helmholtz 
well  observes  that  '^  we  of  the  present  day  have  already  sufficient 
insight  to  know  that  the  laws  of  nature  are  not  things  which  we 
can  evolve  by  any  speculative  method.  On  the  contrary,  we  have 
to  test  them  by  repeated  observation  or  experiment,  in  constant 
new  cases,  under  ever-varying  circumstances ;  and  in  proportion 
only  as  they  hold  good  under  a  constantly  increasing  change  of 
conditions,  in  a  constantly  increasing  number  of  cases,  and  with 
greater  delicacy  in  the  means  of  observation,  does  our  confidence 
in  their  trustworthiness  rise.^'  No  one  has  contributed  more  to 
the  science  of  fact  than  M,  Marey.  Long  known  and  long  re- 
spected as  an  able,  talented,  and  patient  searcher  after  truth — truth 
based  upon  carefully  conducted  experiments — he  has  boldly  entered 
into  intricate  fields  of  investigation,  which  frightened  more  timid 
would-be  discoverers — and  succeeded  in  elucidating  by  his  Herculean 
industry,  mechanical  skill,  and  undaunted  perseverance,  facts  in  sub- 
stitution of  what  previously  were  mere  conjectures  at  the  best. 
But  he  has  advanced  our  knowledge  in  many  other  respects,  and  in 
no  one,  probably,  more  than  in  giving  to  the  world  of  English 
readers  a  book  so  [simply  yet  so  ably  written,  embodying,  as  it 
does,  much  that  it  is  necessary  to  know  concerning  animal 
mechanics. 

1  Magendie,  *  Compendium  of  Physiology.' 


lOO  tieviews.  t'^^uly, 

The  introduction  of  instruments — previously  exclusively  used  in 
the  science  of  meteorology — modified  to  suit  altered  conditions, 
into  the  physiological  laboratory,  marked  a  new  era  in  scientific 
research.  Much  that  previously  it  was  impossible  to  determine 
can,  by  the  aid  of  delicate  instruments,  be  demonstrated.  These 
instruments  have  been  introduced  into  physiology  by  Yolkman, 
Ludwig,  Helmholtz,  and  Marey,  and  are  used  by  almost  every  prac- 
tical teacher  of  physiology  in  the  schools  of  this  and  other  countries. 

In  the  chapter  on  animal  motion  one  of  these  instruments, 
"  the  myograph,'"*  is  described  and  figured,  and  its  function  clearly 
explained.  Tracings  are  given  to  sliow  the  character  of  the  move- 
ments produced  when  electrical  shocks  are  transmitted  to  muscles. 

One  of  the  most  beautiful  phenomena  in  connection  with  muscle 
is  its  wave.  The  author  has  given  a  figure  of  the  appearance  pre- 
sented  by  a  wave  in  muscular  fibre.  It  is  not  a  decided  success. 
But  readers  of  the  book  must  examine  a  specimen  under  the  micro- 
scope, and  then  they  will  understand  muscular  contraction  more 
readily  than  from  the  figure  in  question. 

The  chapter  on  "  Harmony  between  the  Organ  and  the  Tunction'^ 
is  very  interesting.  The  author  shows  that  there  is  harmony  be- 
tween the  form  and  function  of  the  muscles.  "Whenever  function 
varies  in  analogous  muscles  it  is  attended  by  a  corresponding  change 
in  the  configuration  of  the  muscles.  This  fact  is  illustrated  by  the 
short  sternum  and  thick  pectoral  muscles  of  birds  with  short  wings 
and  the  long  sternum  and  thin  muscles  of  birds  with  long  wings, 
the  latter  during  flight  offering  proportionately  a  less  area  of  the 
whole  wing  surface  than  the  former.  Hence  the  necessity  of  greater 
and  more  concentrated  motor  power. 

"  The  comparison  of  homologous  muscles  in  mammals  of  dififerent 
kinds  is  not  less  instructive  under  the  aspect  in  which  we  are  now 
considering  them.""  No  doubt  they  are  instructive  enough.  But 
the  author  naively  remarks,  "One  is  often  embarrassed  in  this 
comparison  by  the  difficulty  of  recognising  the  homology." 

"The  discrepancies  are  oftentimes  so  striking  that  anatomists 
have  described  under  various  names  the  same  muscle  in  different 
species."  If  anatomists  had  confined  themselves  to  so  simple  a  sin 
of  commission — misleading  and  perplexing  though  it  is — there 
would  have  been  very  little  mischief  done  to  the  progress  of  science ; 
but  anatomists  have  for  nearly  a  century  vainly  struggled  in  the 
pathway  of  confusion  to  pair  muscles  of  one  with  those  of  the 
other  limb,  forgetting  that  difference  in  function — whatever  may 
have  been  the  determining  conditions  of  the  differences  in  the 
two  limbs,  or  how  many  hundred  or  thousand  generations  it  may 
have  taken  to  determine  the  decided  difference  in  function  between 
the  two  limbs — is  the  power  or  factor  which  modifies  and  induces 
muscle  change.     Muscle  is  merely  a  mechanical  agent,  acted  on  by 


1875.]  Animal  Mechanism.  101 

a  superior  force ;  and  if  the  superior  force  wills  that  the  inferior 
should  move  in  a  certain  direction,  owing  to  new  and  inaccessible 
wants,  and  the  muscle  cannot  do  it,  the  superior  force  is  capable  of 
educating  the  inferior  until  it  can  do  so.  Hence,  in  a  succession 
of  generations,  that  which  the  first  cultivator  of  the  application  of 
a  new  direction  of  force  could  not  do  without  practice  its  descendants 
could  easily  do,  and  to  a  greater  degree,  even  approaching  to  w4iat 
may  be  considered  to  be  a  new  direction,  though  an  extension 
virtually  of  the  limited  original  motion  of  its  ancestor. 

The  author  considers  that  "  in  the  greater  number  of  cases  the 
homology  of  muscles  is  not  doubtful.'"'  "  It  is  implicitly  admitted 
by  the  fact  of  an  identical  designation  being  applied  to  certain 
muscles  in  different  species.^'  Well,  it  is  evident  enough  that  the 
muscles  which  extend  and  flex  the  toes  in  the  two  limbs  are  homo- 
logous and  receive  similar  names ;  but  where  the  difficulty  practi- 
cally lies  is  not  in  those  which  are  so  self-evident  as  between  those 
muscles  present  in  one  limb  and  not  in  another,  and  in  the  limbs 
of  one  animal  and  not  in  those  of  another  one.  The  higher  we 
proceed  in  the  animal  scale,  the  more  difficult — in  fact,  impossible — 
it  becomes  to  adhere  to  a  law  of  homology;  neither  is  such  a 
law  desirable,  even  if  it  could  be  applied  without  the  aid  of  an 
active  imagination. 

Discussing  the  easy  recognition  of  the  biceps  femoris,  &c.,  the 
author  states  that  "  If  one  can  rely  on  the  anatomical  plates  of 
Cuvier  and  of  Laurillart,  the  negro  has  the  perineal  insertion  of 
the  biceps  not  so  high  as  in  the  white  man,  thus  approximating  to 
its  position  in  the  ape.'^  If  this  were  the  case  it  would  be  a  fact 
antagonistic  to  the  theory  of  evolution.  The  fact  is  that  in  both 
ape,  black  and  white,  the  biceps  attains  a  similar  point  of  attach- 
ment indirectly.  The  ischiatic  ligament  is  nothing  more  than  an 
aborted  part  of  the  muscle.  Beyond  these  and  a  few  other  minor 
points  of  no  particular  moment,  the  chapter  on  organ  and  function 
is  of  great  interest. 

The  chapter  on  "  The  Development  Theory  "  is  a  brief  resume  of 
the  views  held  by  the  two  schools,  the  Creationists  and  the  Evolu- 
tionists. The  author  has  evidently  a  conviction  that  the  old  school 
will  in  process  of  time  be  defeated.  The  great  mistake  which  both 
schools  fall  into  is  the  requirement  of  definite  productions  from  a 
given  status.  The  Creationist  shelters  himself  behind  the  "unassail- 
able " — in  the  "beginning''  creation — out  of  nothing  into  perfection. 
The  Evolutionist  in  the  beginning  nothing  but  protoplasm.  Erom 
this  status  time  and  circumstances  have  produced  everything. 
Mere  argument  will  not  advance  our  knowledge  one  jot  or  tittle. 
And  thus  no  amount  of  research  will  ever  be  able  to  illustrate  the 
various  phases  which  life  has  manifested  in  and  on  the  earth.  Nor 
^ill  it  demonstrate  to  us  how — if  we  ^re  to  take  protoplasm  as  % 


102  Reviews.  [July, 

starting-point — the  immense  number  of  different  species  of  plants 
and  animals  have  attained  their  present  status,  and  maintained  so 
persistently  their  characteristic  features  when  perpetuated  through 
such  long  periods.  If  animals  can  select,  plants  cannot,  and  the 
latter  equally  with  the  former  preserve  in  the  majority  of  instances 
isolated  characteristics  peculiar  to  their  kind.  But  it  must  be 
granted  that  the  Evolutionist  has  many  facts  in  support  of  his 
theory.  It  is  not  natural  selection.  If  the  latter  is  a  potent  agent 
in  modifying,  it  does  not  account  for  all  the  peculiarities  met  with 
in  anatomical  tissues  and  the  gradual  but  steady  and  persistent 
invasion  of  nerve  substance  and  nerve  force.  There  is  an  inde- 
pendent force  which  modifies  tissues,  and  what  that  force  is,  and 
how  that  force  acts,  is  the  task  which  present  and  future  scientific 
observers  have  to  determine.  Even  Mons.  J.  Guerin's  pithy  formula, 
" Function  makes  the  organ"  though  a  mere  reversion  of  an  older, 
equally  as  pithy  a  one,  is  like  its  more  ancient  axiom  a  diminutive 
truth  shorn  of  its  chief  glory,  ''  the  necessity  "  which  creates  the 
function.  And  this  again  leads  to  the  final  cause  to  be  sought, 
wherefore,  or  how,  the  necessity?  But  speculation  beyond  the 
stage  of  easy  appreciation,  borne  out  by  facts,  is  absurd  and  useless. 
Let  the  past  remain  in  its  arctic  tomb  until  we  can  read  the  present. 
The  very  tendons,  which  M.  Marcy  has  not  altogether  a  very  clear 
idea  of — that  is,  as  to  their  true  significance — teach  us  one  of  the 
most  instructive  and  forcible  lessons  in  evolution  capable  of  easy 
demonstration.  It  is  a  lesson  which  neither  the  creation  nor 
natural  selection  theories  can  explain,  and  it  answers  the  very 
question  asked  by  the  antagonists  of  evolution. 

The  fibrous  tissue  of  tendons,  aponeuroses,  ligaments,  &c.,  are,  in 
the  appendicular  parts,  aborted  remnants  of  muscle  tissue.  Tendon 
is  not  lost,  at  all  events,  as  M.  Marey  thinks,  in  descending  the 
animal  scale  ;  but  on  the  other  hand  it  is  gained  as  we  ascend  the  scale — 
the  higher  the  animal  and  the  more  definite  and  declared  its  tendons. 
Muscle  wastes  in  the  inverse  ratio  to  the  accession  of  brain  tissue. 
But  natural  selection  does  not  satisfactorily  account  for  this  irre- 
futable fact  any  more  than  it  is  able  to  explain  the  fragments  of 
muscles  perfect  in  lower  animals,  the  peculiarities  of  bone,  and  the 
progressive  massiveness  and  complexity  of  nerve  tissue,  found  in 
higher  animals.  Everything  that  we  know  of  seems  to  exhibit  a 
progressive  law  of  evolution.  Whatever  the  beginning,  it  was  evi- 
dently simple  in  status,  simple  in  material,  and  simple  in  organisa- 
tion— whether  by  creation,  natural  selection,  or  evolution,  or  a  com- 
bination of  any  two  or  the  whole  of  these  forces,  is  not  of  vital 
importance.  Oi^anized  and  unorganized  are,  as  exhibited  to  us  now, 
complicated  enough.  But  analysis  undoubtedly  shows  us  that  each 
and  every  tissue  in  both  kingdoms  have  been  vastly  more  simple  in 
texture  than  they  appear  to  us  now. 


1875.]  Animal  Mechanism.  103 

But  M.  Marey  admits  the  influence  of  a  force  or  power,  whether 
natural  selection  or  evolution  matters  not.  ''If  it  be  true  that 
every  foetus  brings  into  the  world  a  contorted  humerus,  it  is  no  less 
true  that  this  form  may  be  considered  as  the  effect  of  muscular 
action  accumulated  from  generation  to  generation/'  The  latter 
assertion  is  not  so  self-evident  as  it  might  be  when  contrasted  with 
previous  assertions  as  to  bone  markings  and  bone  ridges,  &c.  There 
is  decided  law  in  regard  to  these  markings.  They  are  not  entirely 
due  to  degree  of  muscle  appended  to  them,  any  more  than  the 
number  of  sternal  ribs  depends  upon  the  degree  of  development  of 
the  ventral  trunk  muscles.  The  variability  of  the  muscular  system 
in  its  transit  from  childhood  to  old  age  is  not  so  decided  in  the 
human  subject.  As  M.  Marey  states,  "The  function  of  the  muscles 
changes  with  the  different  periods  of  life,  and  becoming  more  and 
more  restricted  employs  continually  less  contractile  fibre,"  &c.  Age 
cannot  account  for  the  invasion  of  tendon  already  mentioned,  and 
its  differentiation.  Moreover,  it  is  impossible  to  explain  how  nerve 
force  can  split  tendon  from  its  distal  end,  and  split  it  so  gradually 
that  in  different  beings  every  stage  of  a  muscle  may  be  seen,  from  a 
short  distal  differentiation  of  a  tendon  to  its  complete  and  perfect 
isolation  from  the  parent  mass  as  a  distinct  and  independent  muscle. 
The  learned  Borelli  says,  "  It  is  worthy  of  admiration  that  in  so 
great  a  variety  of  motions,  as  running,  leaping,  and  dancing,  nature's 
laws  of  equilibration  should  always  be  observed ;  and  when 
neglected  or  wilfully  transgressed,  that  the  body  must  necessarily  and 
immediately  tumble  down."  Locomotion,  especially ''terrestrial," 
has  long  been  a  subject  of  interest. 

The  brief  description  given  of  walking,  p.  112,  embodying  some 
of  the  analyses  of  M.  G.  Carlet,  does  not  materially  differ  from  that 
of  Magendie — in  fact,  there  is  little  beyond  difference  in  words. 
But  M.  Marey's  description  of  his  experimental  shoe  and  registering 
apparatus,  to  illustrate  pressure  on  the  ground  and  its  intensity,  is 
as  intelligible  as  it  is  unanswerable  and  illustrative  of  his  great 
mechanical  genius. 

The  modes  of  progression  used  by  man  and  the  paces  of  the 
horse  are  now  no  longer  subjects  of  conjecture,  but  of  absolute 
knowledge.  The  author  truly  remarks,  "  There  is  scarcely  any  branch 
of  mechanics  which  has  given  rise  to  more  labour  and  greater  con- 
troversy than  the  question  of  the  paces  of  the  horse.""  Again, 
"  Any  one  who  proposed  at  the  present  time  to  write  a  treatise  on 
the  paces  of  the  horse  would  have  to  discuss  many  different  opinions 
put  forward  by  a  great  number  of  authors.'' 

There  seems  to  be  a  certain  unanimity  amongst  authors  as  to  the 
movements  of  the  hmbs  in  the  simpler  paces  of  the  horse,  such  as 
in  walking  and  ambling.     Various  contrivances  have  been  resorted 


104  Reviews.  [July, 

to  to  interpret  that  which  was  almost  impossible  by  unaided 
observation. 

Marey  has  succeeded  by  the  direct  application  of  ingenious  regis- 
tering apparatus  in  producing  a  series  of  experiments  alike  interest- 
ing to  the  physiologist  and  artist.  From  these  experiments  the 
former  ^^can  derive  the  expression  of  the  duration,  actions,  and 
reactions  of  each  pace,  the  energy  and  duration  of  each  movement, 
and  the  rhythm  of  their  succession  •/'  while  the  latter  (the  artist) 
knows  ^'  exactly  the  attitude  which  corresponds  with  each  move- 
ment, and  is  thus  enabled  to  represent  it  faithfully  with  the 
various  poses  which  characterise  it.'''' 

These  experiments  have  been  carried  out  to  verify  and  amplify 
the  principles  already  known  and  established  by  Yincent  and  Goiffon, 
Baron  Curnien,  &c. 

M.  Marey  has  not  discussed  aquatic  locomotion.  His  reason  for 
not  doing  so  is  that  the  recent  experiments  of  Mons.  Ciotti  have 
thrown  great  light  on  the  propulsive  action  of  the  tails  of  fishes ; 
not  that  they  have  overthrown  the  theory  held  ever  since  the  time 
of  Borelli  concerning  the  mechanism  of  swimming,  but  they  have 
approached  the  question  in  another  manner,  that  of  synthetic  repro- 
duction of  this  phenomenon.  This  method  will  certainly  permit  us 
to  determine  with  a  precision  hitherto  unknown  both  the  motive 
work  and  resistant  work  in  aquatic  locomotion.  It  will  therefore 
be  advisable  to  wait  for  the  results  of  experiments  which  are  now 
being  made,  and  which  will  be  of  equal  service  both  to  mechanicians 
and  to  physiologists. 

It  is  evident,  even  to  the  most  superficial  observer,  that  whilst 
terrestrial  locomotion  can  be  readily  studied,  serial  locomotion  pre- 
sents a  series  of  formidable  difficulties  to  be  overcome  before  trust- 
worthy knowledge,  based  upon  actual  experiment,  can  be  obtained. 
In  the  former  there  is  a  fixed  and  tangible  surface  of  reaction, 
whereas  in  the  latter  there  is  merely  an  attenuated  and  shifting 
medium,  to  which  the  organs  of  locomotion  impart  a  certain  volume 
of  moving  force  in  a  direction  contrary  to  that  in  which  the  animal 
moves.  Hence  it  is  only  in  proportion  to  the  rapidity  with  which 
it  is  displaced  that  the  air  resists  the  impulse  of  the  wing. 

In  studying,  therefore,  the  phenomena  of  flight  of  insects  greater 
ingenuity  and  delicacy  of  manipulation  are  required  than  in  demon- 
strating the  paces  of  a  horse.  The  questions  to  be  determined, 
according  to  Marey,  are— 

1.  What  is  the  frequency  of  the  movements  of  the  wing  of 
insects  ? 

2.  What  are  the  successive  positions  which  the  wing  occupies 
during  its  complete  revolution  ? 

3.  How  is  the  motor  force  which  sustains  and  transports  the 
body  of  the  aniinal  developed  ?^ 


1875.]  Animal  Mechanism.  105 

These  three  questions  the  author  proceeds  to  answer,  illustrating 
his  explanations  by  a  series  of  beautiful  and  admirably  conducted 
experiments.  On  reading  the  chapter  on  "  Flight  of  Insects'^  we 
find  ourselves  more  and  more  impressed  with  the  already  established 
conviction  that  we  are  in  the  hands  of  one  thoroughly  master  of  his 
subject.  The  method  of  determining  the  frequency  of  the  wing 
movements,  the  influences  which  modify  their  frequency,  the  syn- 
chronism of  the  action  of  the  two  wings,  the  changes  of  plane,  &c. 
are  honestly  demonstrated  by,  what  seems  to  us,  experiments  as 
accurate  as  they  are  unanswerable. 

It  has  long  been  an  established  fact  that  the  frequency  of  the 
movements  of  the  wings  varied  according  to  species.  But  it  had 
not  been  determined  with  the  same  precision  as  by  M.  Marey.  The 
graphic  is  far  superior  to  the  old  musical  note  method.  "It  enables 
ns  to  ascertain  almost  to  a  single  beat  the  number  of  movements  made 
2^er  second  by  an  insect^ s  wing." 

Pettigrew  (-Animal  Locomotion,'  p.  121)  says,  "The  wing  of  the 
blowfly  is  said  to  make  300  strokes  per  second,^'  &c.  "  Now,  it 
appears  to  me  that  muscles  to  contract  at  the  rate  of  18,000  times 
in  the  minute  would  be  exhausted  in  a  very  few  seconds/'  &c.  "  I 
am  therefore  disposed  to  believe  that  the  number  of  contractions 
made  by  the  thoracic  muscles  of  insects  has  been  greatly  overstated  ; 
the  high  speed  at  which  the  wing  is  made  to  vibrate  being  due  less 
to  the  separate  and  sudden  contractions  of  the  muscles  at  its  root 
than  to  the  fact  that  the  speed  of  the  different  parts  of  the  wing  is 
increased  in  a  direct  ratio  as  the  several  parts  are  removed  from  the 
driving  point."  Marey  says,  "These  exceedingly  complicated 
movements  [of  the  wings)  would  induce  us  to  suppose  that  there 
exists  in  insects  a  very  complex  muscular  apparatus,  but  anatomy 
does  not  reveal  to  us  muscles  capable  of  giving  rise  to  all  these 
movements,''  &c.  He  explains  at  length  his  reasons  for  the  assertion 
that  "  an  upward  and  downward  motion  given  by  the  muscles  is  suf- 
ficient to  produce  all  these  successive  acts,  so  well  co-ordinated  with 
each  other ;  the  resistance  of  the  air  effecting  all  the  other  movements?^ 

This  brings  us  to  the  consideration  of  the  following  passage, 
p.  187 : — "  We  thought  that  we  had  been  the  first  to  point  out  the  form 
of  the  trajectory  of  the  wing  of  the  insect,  but  Dr.  J.  B.  Pettigrew, 
an  English  author,  informs  us  that  he  had  already  mentioned  this 
figure-of-8  appearance  described  by  the  wing,  and  had  represented 
it  in  the  plates  of  his  work.^  It  will  be  seen  presently  that,  notwith- 
standing this  apparent  agreement,  our  theory  and  that  of  Dr. 
Pettigrew  differ  materially  from  each  other."  Again,  in  describing 
the  propulsive  action  of  the  wings  of   insects,    p.   199,    Marey 

I  "  On  the  Mechanical  Appliances  by  which  Flight  is  maintained  in  the  Animal 
]^ingdom,"  *  Trans,  Linn.  Society,'  1867. 


106  Reviews,  [July, 

says,  "Each  stroke  of  the  wing  acts  on  the  air  obliquely,  and 
neutralizes  its  resistance,  so  that  a  horizontal  force  results  which 
impels  the  insect  forwards.  This  resultant  acts  in  the  descent  of 
the  wing,  as  well  as  in  its  upward  movement,  so  that  each  part  of  the 
oscillation  of  the  wing  has  an  action  favorable  to  the  propulsion  of 
the  animal."'''  Further,  contrasting  the  direction  of  movements  in 
the  trajectory  of  the  wing,  Marey  shows  that  the  movement  is  in 
opposite  directions  in  the  two  branches  of  the  8.  Pettigrew  makes 
them  run  in  the  same  direction,  and,  '^  in  order  to  explain  the  form 
which  he  assigns  to  this  trajectory,  Dr.  Pettigrew  admits  that  in  its 
passage  from  right  to  left  the  wing  describes  by  its  thicker  edge  the 
thick  branch  of  the  8,  and  the  thin  branch  by  its  narrow  edge.  The 
crossing  of  the  8,  therefore,  would  be  formed  by  a  complete  reversal 
of  the  plane  of  the  wing  during  one  of  the  phases  of  its  revolution. 
In  fact,  the  author  seems  to  perceive  in  this  reversal  of  the  plane 
an  action  similar  to  that  of  a  screw,  of  which  the  air  would  form  the 
nut.'^ 

Now,  it  must  be  granted  that  as  far  as  the  mere  discovery  of  the 
figure-of-8  movement  is  concerned  Dr.  Pettigrew  is  entitled  to 
priority  of  discovery.  But  Marey^s  independent  discovery  and  ex- 
planation of  the  figure-of-8  movement  of  the  insect's  wing  is  as 
different  from  that  of  Pettigrew' s  as  the  second  law  of  Kepler  (that 
the  planetary  orbits  are  elliptical,  having  the  sun  for  their  common 
focus)  is  to  that  of  the  abstract  theory  of  the  curve  of  the  old 
Greek  geometers.  But  Dr.  Pettigrew  is  not  of  this  opinion;  at  all 
events  was  not  last  year.  Eeplying  to  a  criticism  on  his  book  by 
Euskin  ('English  Mechanic,'  Eeb.  13th,  1874),  Pettigrew  sum- 
marises his  views  as  follows  : — "  Quadrupeds  walk,  and  fishes  swim, 
and  insects,  bats,  and  birds  fly  by  figure-of-8  movements.''  '^  The 
flipper  of  the  sea  bear,  the  swimming  wing  of  the  penguin,  and  the 
wing  of  the  insect,  bat,  and  bird,  are  screws  structurally,  and 
resemble  the  blade  of  an  ordinary  screw  propeller." 

"  Those  organs  are  screws  functionally,  from  their  twisting  and 
untwisting,  and  from  their  rotating  in  the  direction  of  their  length, 
when  they  are  made  to  oscillate. 

"  They  have  a  reciprocating  action,  and  reverse  their  planes  more 
or  less  completely  at  every  stroke. 

"  The  wing  describes  a  figure-of-8  track  in  space  when  the  flying 
animal  is  artificially  fixed,"  &c. 

There  can  be  no  question  of  the  fact  that  either  Marey  is  right 
and  Pettigrew  wrong,  or  the  reverse.  Erom  a  careful  contrast  of 
the  two  explanations  and  from  other  evidence  it  seems  to  us  that 
Dr.  Pettigrew's  views  are  not  in  accordance  with  fact,  and  he  would 
do  well  either  to  repeat  his  own  and  Marey's  experiments  or  grace- 
fully allow  to  Marey  the  honour  to  which  he  seems  to  us  so  justly 
entitled.     Dr.  Pettigrew  cannot  honorably  persist  in  the  statement 


1875.]  Animal  Mechanism.  107 

thatMarey  admitted  the  priority  of  his  (Dr.  Pettigrew's)  discovery. 
That  statement  was  made  under  a  mistaken  idea  of  the  general 
bearing  of  Dr.  Pettigrew's  discovery  ;  Marey  now  repudiates  it,  and 
he  has  shown  that  there  are  just  and  decided  grounds  for  so 
doing. 

Thus  far  Marey 's  researches  on  flight — and  difficult  and  tedious 
these  researches  have  been — verify  more  or  less  completely  the 
theory  of  flight  propounded  by  Borelli.  Dr.  Pettigrew  maintains 
in  opposition  to  several  observers  whom  he  himself  quotes  in  his 
work,  and  also  to  Marey,  "  that  a  natural  wing,  or  a  properly  con- 
structed artificial  one,  cannot  be  depressed  either  vertically  down- 
wards or  downwards  and  backwards.  It  will  of  necessity  descend 
downwards  and  forwards  in  a  curve.  This  arises  from  its  being 
flexible  and  elastic  throughout,  and  especially  from  its  being  care- 
fully graduated  as  regards  thickness,  the  tip  being  thinner  and  more 
elastic  than  the  root,  and  the  posterior  margin  than  the  anterior." 

Again,  "  The  flat  surfaces  of  the  wings  are  consequently  made  to 
strike  downwards  and  forwards,  as  they  in  this  manner  act  as  kites 
to  the  falling  body,  which  they  bear,  or  tend  to  bear,  upwards  and 
forwards." 

'^  In  no  instance,  however,  unless  when  the  bird  is  everted  and 
flying  downwards,  is  the  posterior  margin  of  the  wing  on  a  higher 
level  than  the  anterior  one." 

Dr.  Pettigrew  has  been  severely  taken  to  task  more  than  once  for 
the  above  statements.  Still,  he  appears  to  be  remarkably  confident 
in  his  own  views,  and  even  repeats  them  after  criticism.  It  would 
be  premature  at  the  present  time  to  decide  upon  the  merits  of  the 
two  observers,  Marey  and  Pettigrew. 

We  prefer  to  wait  until  Marey's  further  researches  on  the  im- 
portant subject  of  flight  have  been  published.  In  the  meantime 
Dr.  Pettigrew  may  probably  deem  it  necessary  either  to  bring 
forward  more  decisive  evidence  in  support  of  his  statements,  or 
show  more  conclusively  than  he  has  yet  done  that  the  views  of  his 
opponents  are  contrary  to  facts. 

M.  Mare/s  book  is  one  that  will  be  widely  read.  If  it  is  not 
the  pioneer  into  long  unexplored  fields  of  research,  it  is  the  guide 
to  them.  We  have  no  doubt  that  it  will  be  the  means  of  stimulat- 
ing many  enthusiastic  workers  to  greater  discoveries  than  even  M. 
Marey  has  made.  We  wish  M.  Marey  as  great  and  as  well-deserved 
success  in  his  future  as  in  his  past  labours. 


108  Reviews.  [July, 


X. — Recent  Works  on  Medical  Jurisprudence.^ 

The  list  of  works  we  have  placed  at  the  head  of  this  article  indi- 
cates pretty  clearly  in  what  direction  modern  medical  jurisprudence 
has  made  its  chief  advances.  It  will  be  observed  that  most  of  the 
above  volumes,  except  those  relating  exclusively  to  toxicology,  are 
new  editions  of  old  and  standard  works.  It  is  in  toxicology,  then, 
that  medical  jurisprudence  has  chiefly  progressed  during  the  last 
decade.  Nor  can  this  be  wondered  at.  When  it  is  considered 
what  a  host  of  new  remedies  are  beiug  yearly  added  to  our  list  of 
materia  medica — many  of  them  containing  principles  of  great 
potency  for  good  or  evil — and  the  astonishing  advances  made  by 
modern  organic  chemistry,  mainly  in  the  direction  of  the  discovery 
of  new  compounds,  it  can  hardly  be  an  object  of  wonder  that  the 
studies  of  medical  jurists  have  been  much  devoted  to  toxicology.  It 
is  true,  nevertheless,  that  considerable  advances  have  been  made  in 
other  branches  of  the  science,  but  not  to  a  commensurate  extent. 

In  order  to  verify  our  remarks  let  any  one  take  up  and  compare 
the  third  edition  of  Guy's  *  Principles  of  Forensic  Medicine '  with 
the  fourth  edition,  now  before  us,  brought  out  jointly  by  Drs.  Guy 
and  Terrier.  We  advise  a  comparison  of  the  two  most  recent  edi- 
tions of  this  work,  because  it  may  fairly  be  considered  to  be  the 
usual  text-book  read  by  Enghsh  students,  just  as  the  '  Principles  and 
Practice  ^  of  Dr.  Taylor's  is  the  standard  work  of  reference  among 
lawyers.  Both  treatises,  then,  being  the  writings  of  able  and  prac- 
tical men,  may  be  fairly  taken  to  represent  adequately  the  assured 
facts  and  assured  opinions  of  medical  jurists  of  the  present  day.  It 
will  be  found  that  the  first  two  parts  of  the  last  edition  of  Dr,  Guy's 
manual  are  substantially  the  same  as  those  of  the  previous  editions, 
whilst  the  third  part  of  the  new  edition,  treating  on  toxicology,  is 
much  enriched,  and,  as  we  learn  from  the  preface,  this  has  been  done 
by  Dr.  Perrier.     It  is  true  that  a  chapter  on  personal  identity  is 

^  1.  The  Principles  and  Practice  of  Medical  Jurisprudence.  By  Alfeed 
SwAYNE  Tatloe,  M.D,,  F.R.S.     Second  edition.     London,  1873. 

2.  Wharton  Stille's  Medical  Jurisprudence.  Third  edition.  Philadelphia, 
1873. 

3.  Principles  of  Forensic  Medicine.  Fourth  edition.  By  William  A.  Gtjt, 
M.B.,  F.R.S.,  and  David  Feeeiee,  M.D.     London,  1875. 

4.  A  Manual  of  Toxicology.  By  John  J.  Reese,  M.D.  Philadelphia  and 
London,  1874. 

5.  Die  Gerichtlich-chemische  Ernmittelung  von  Qiften.  Von  Dr.  Geoeo- 
DEAaENDOEFP.     St.  Petersburg,  1868. 

6.  Beitrdge  zur  Gerichtlichen  Chemie  einzelner  Organischer  Gifte.     Ibid. 

7.  Manuel  de  Toxicologic.  Par  Deagendoeff,  traduit  par  E.  Rittee.  Paris, 
1873. 

8.  Beitrdge  zur  Oerichtlichen  Chemie  ein?elner  Organischer  Gifte.  Von  Dr, 
Deagendoeff.    Petersburg,  1872, 

p,  Guy's  Hospital  Reports, 


iSr^.j  Recent  Works  on  Medical  Jurisprudence.  i09 

added,  a^nopos  of  the  Tichborne  case ;  but  this  is  interesting,  not  on 
account  of  new  researches  or  discoveries,  but  because  old  and  well- 
known  principles  are  applied  in  the  elucidation  of  a  special  and  highly 
complicated  case. 

Not  many  years  have  elapsed  since  toxicology  was  nearly  exclu- 
sively confined  to  the  consideration  of  inorganic  or  mineral  sub- 
stances, and  rarely  travelled — at  all  events  as  a  science — further 
than  these  and  to  a  few  organic,  or,  as  they  are  now  generally 
termed,  carbon  compounds,  such  as  prussic  acid  and  morphine.  The 
use  of  strychnine  in  a  few  cases  which  became  causes  celebres  turned 
the  attention  of  men  of  science  to  the  organic  principles  known  as 
alkaloids ;  and,  still  more  recently,  the  discovery  and  application  in 
the  industrial  arts  of  aniline,  and  the  multitudinous  hosts  of  products 
derived  from,  or  allied  to,  that  substance,  have  greatly  extended  our 
knowledge  of  nitrogenous  organic  bodies.  Moreover,  the  increased 
study,  especially  on  the  Continent,  of  the  physiological  action 
of  poisons  and  remedies  generally,  has  vastly  extended  the  area  of 
toxicology.  Nor  has  the  study  of  the  chemical  reactions  of  organic 
bodies  been  neglected ;  indeed,  550  octavo  pages  of  the  Trench 
edition  of  Dragendorft's  '  Manual  of  Toxicology '  are  nearly  exclu- 
sively devoted  to  chemical  analysis,  and  of  these  about  100  are 
taken  up  with  the  subject  of  testing  for  the  alkaloids.  Such  a  vast 
array  of  matter  indicates  activity  of  research,  more,  perhaps,  than 
exactitude  of  knowledge. 

It  is  evident  that  our  Continental  chemists  are  far  ahead  of  our 
English  brethren  in  their  experimental  knowledge  of  the  alkaloids. 
Dr.  Guy  treats,  indeed,  of  but  some  seven  or  eight  of  the  alkaloids, 
and  Dr.  Eeese  of  about  the  same  number ;  whilst  Dr.  Dragendorff 
gives  us  the  chemical  characteristics  of  about  thirty  of  those  interest- 
ing principles,  all  of  which  may  be  met  with  in  toxicological  inves- 
tigations, and  his  descriptions  are  much  fuller  and  more  exact  than 
those  of  the  English  author.  With  true  insular  prejudice  British 
chemists  in  great  measure  despise  the  alkaloids,  and  for  this  reason, 
apparently,  that  their  chemical  constitution  is  to  us  still  so  much  a 
mystery.  Indeed,  one  recent  systematic  English  writer  of  a  treatise 
on  organic  chemistry  has  entirely  omitted  all  mention  of  the  alka- 
loids from  his  work,  evidently  because  their  relation  to  other  well- 
understood  carbon  compounds  has  not  been  satisfactorily  estabhshed. 
And  thus  it  happens  that,  with  a  few  brilliant  exceptions,  little 
has  been  done  in  this  country  to  advance  our  knowledge  of  the 
chemistry  of  the  alkaloids. 

But  though  our  knowledge  of  the  chemical  relations  and  constitu- 
tion of  the  alkaloids  is  still  immature,  their  reactions  are,  fortunately 
for  the  practical  toxicologist,  better  known,  and  they  are  as  a  class 
marked  off  from  other  carbon  compounds  by  their  multitudinous 
so-called  colour  reactions,  which,  if  not  affording  evidence  for  their 


110  tieviews.  [•'^uly, 

detection  of  the  highest  order  of  certainty,  may,  if  taken  in  conjunc- 
tion with  their  physiological  actions,  afford  a  body  of  evidence 
sufficient  to  enable  us  to  draw  sound  conclusions  as  to  the  presence 
or  absence  of  a  given  poison.  It  would  be  out  of  place  here  to  enter 
into  details  as  to  chemistry  proper ;  but  the  student  of  toxicology 
will  find  the  fullest  and  latest  information  as  to  toxicological  analysis 
in  the  French  edition  of  Dragendorff's  manual,  which,  we  may  add, 
embodies  nearly  all  that  is  contained  in  the  two  volumes  of  Dragen- 
dorflp,  written  in  the  German  language,  whose  titles  we  have  placed 
at  the  head  of  this  article. 

Physiological  research  has  during  the  last  decade  done  much  to 
extend  our  knowledge  of  the  action  of  poisons ;  and  our  German 
brethren  have  been  very  active  in  pursuing  this  branch  of  scientific 
investigation ;  but  even  on  this  side  of  the  Channel  we  have  not 
been  idle,  and  we  have  among  us  energetic  and  able  workers  in  this 
field.  We  only  hope  that  their  labours  may  not  be  abridged  by  the 
persistent  attacks  of  the  Society  for  the  Prevention  of  Cruelty  to 
Animals ;  for  we  believe  that  pain  inflicted  upon  animals  by  physio- 
logical experiments  cannot  for  one  moment  be  placed  in  comparison 
with  the  good  resulting  from  the  discoveries  which  are  made 
through  this  mode  of  investigation. 

Sufficient  attention  has  perhaps  not  been  given  to  the  application 
of  physiological  taste  for  organic  poisons,  although  some  ten  years 
ago  the  attention  of  the  profession  was  prominently  directed  to  this 
promising  line  of  search.  Indeed,  in  1856,  Dr.  Marshall  Hall  first 
suggested  the  tetanic  spasms  produced  in  frogs  by  strychnine  as  a 
means  of  detecting  that  poison ;  and  in  1864  on  the  occasion  of  the 
trial  of  M.  de  la  Pommerais  for  the  murder  of  Madame  de  Pauw,  phy- 
siological tests  for  digitaline  were  chiefiy  relied  on  as  evidence  of  the 
administration  of  digitaline.  In  1865  Drs.  Pagge  and  Stevenson 
communicated  a  long  experimental  research  on  this  subject  to  the 
Eoyal  Society,  their  object  being  to  show  that  physiological  tests 
may  be  made  independent  of  any  relation  between  the  action  of 
poisons  on  man  and  on  the  lower  vertebrata.  They  endeavoured  to 
avoid  altogether  the  difficult  question  of  identity  of  action  of  poisons 
upon  men  and  the  lower  animals  upon  which  all  physiological  evi- 
dence in  cases  of  poisoning  had  up  to  that  time  been  based;  and  it 
appeared  to  them  sufficient  that  the  action  of  the  substance  supposed 
to  contain  the  poison  on  the  animal  experimented  on  be  identical 
with  the  known  effects  of  that  poison  upon  the  same  hind  of  animal, 
and  that  these  effects  be  capable  of  being  produced  by  no  other 
agent,  or  only  by  a  limited  number  of  such  agents.  And,  shortly 
after.  Prof.  Penny  and  Dr.  Adams,  in  describing  the  methods  pur- 
sued by  them  in  their  search  for  poisons  in  the  case  of  Pritchard, 
also  arrived  at  the  conclusion  that  it  was  of  little  moment  that  the 
phenomena  manifested  in  rabbits  to  which  a  supposed  poisonous 


1875.]         Recent  JVorks  on  Medical  Jurisprudence,  111 

liquid  had  been  administered  should  differ  from  those  manifested  by 
the  human  subject  when  under  the  influence  of  the  same  agent,  so 
long  as  the  toxic  action  was  uniform  and  characteristic  when 
employed  on  the  same  animal.  The  principles  thus  clearly  laid  down 
do  not,  nevertheless,  appear  to  have  been  generally  adopted  by  toxi- 
cologists ;  and  we  imagine  the  reason  for  this  lies  in  the  fact  noted 
by  Drs.  Tagge  and  Stevenson  that  a  limited  group  consisting  of 
few  poisons  may  be  apparently  identical  in  their  action  when  ad- 
ministered to  the  lower  animals :  physiological  tests  may  point 
to  a  group  of  poisons,  but  fail  to  differentiate  any  single  poison  of 
the  group.  Spite  of  this  radical  defect  physiological  tests  are  of 
great  value  and  in  many  cases  cannot  be  dispensed  with,  since 
chemical  tests,  so  far  as  is  at  present  known,  are  not  always  compe- 
tent to  determine  the  presence  of  some  of  the  organic  poisons. 
Another  circumstance  militating  against,  though  not  absolutely 
vitiating,  the  application  of  physiological  tests  for  poisons  is,  that 
extracts  made  from  the  gastric  contents  of  the  higher  animals  may, 
as  pointed  out  by  Drs.  Fagge  and  Stevenson,  under  certain  circum- 
stances exercise  a  toxic  influence  upon  the  lower  animals,  as  e.g» 
frogs,  animals  which  are  above  all  others  most  available  for  the 
purposes  of  the  toxicologist. 

For  a  reason  we  have  already  alluded  to,  namely,  that  it  is 
the  most  concise  English  manual  of  medical  jurisprudence,  and 
is  also,  as  we  believe,  the  one  most  generally  read  by  medical 
students,  we  shall  chiefly  confine  our  criticisms  to  the  work  of  Drs. 
Guy  and  Perrier ;  only  noticing  the  other  works  named  at  the  head 
of  this  article  where  special  mention  appears  requisite. 

The  manual  of  these  authors  does  indeed  form  a  compact  and 
handy  book  of  reference,  and  in  it  the  ordinary  medical  man  will 
find  all  that  is  necessary  to  guide  him  in  his  practice ;  though 
lawyers  and  medical  jurists  will,  we  imagine,  greatly  prefer  the 
larger  and  more  ponderous  volumes  of  Dr.  Taylor.  The  great 
defects  of  Dr.  Guy's  manual  are  that  accuracy  is  occasionally 
sacrificed  for  the  sake  of  brevity ;  that  statistical  details  are  given 
with  undue  minuteness,  and  valuable  space  is  thus  sacrificed 
to  the  exclusion  of  valuable  matter;  and  that  the  book  has  a 
certain  hardness  and  dryness  of  style  which  renders  it  somewhat 
repulsive  reading,  spite  of  the  interesting  nature  of  the  subject.  We 
will  endeavour  to  illustrate  these  statements  by  examples  taken  from 
the  work  itself. 

The  section  in  Dr.  Guy's  'Principles'  which  treats  of  the 
detection  of  spots  of  blood  is  not  altogether  satisfactory.  Its 
chemistry  is  obscure  and  not  altogether  precise  and  accurate.  Thus, 
in  order  to  discriminate  between  blood  pigment  and  the  red  sulpho- 
cyanate  of  iron  it  is  stated  that  the  latter  gives  ''  a  white  precipitate 
of  oxide  of  iron "  when  treated  with  ammonia,  though  no  white 


112  keviews.  [July, 

hydrate  is  known  to  chemists.  Again,  the  mode  of  applying  the 
guaiacum  test  is  given  without  any  of  the  precautions  clearly  laid 
down  by  Dr.  Taylor,  and  usually  adopted  by  the  medical  jurist. 
Moreover,  it  is  stated  that  in  the  microscopical  examination  of  a 
blood-stain  a  quarter-inch  object-glass  is  as  high  a  power  as  it  is 
necessary,  '^  or,  perhaps,  desirable,'^  to  use ;  and  it  is  said  that  the 
corpuscles  can  be  well  seen  with  a  good  half  inch.  We  imagine 
that  few  experts  would  nowadays  be  content  with  the  use  of  an 
object-glass  of  less  focal  length  than  an  eighth  of  an  inch,  and  most 
microscopists  would  prefer  to  use  one  of  still  greater  magnifying 
power.  Indeed,  some  go  so  far  as  to  use  immersion  lenses  of  -oV, 
and  even  3-^  inch  focal  length ;  and,  it  is  said,  with  advantage. 

Their  treatment  of  the  subject  of  life  insurance  is  far  more  satisfac- 
tory ;  and  here  Dr.  Guy  is  thoroughly  at  home.  Into  the  compass  of 
nine  or  ten  pages  they  manage  to  compress  a  vast  amount  of  valuable 
matter — statistical  and  medical — which  the  practitioner  will  find  of 
great  service  in  enabling  him  to  arrive  at  sound  coiiclusions  when 
investigating  lives  for  insurance  purposes.  Of  course,  details 
cannot  be  entered  into,  but  the  general  principles  inculcated  are 
excellent.  The  young  practitioner  may  study  this  chapter  with 
profit,  for  it  touches  upon  a  branch  of  practice  which  he  will  in  vain 
have  sought  to  gain  some  knowledge  of  in  the  schools.  Neverthe- 
less, the  statistics  with  which  this  cha})ter  is  interlarded  are  at  once  too 
brief  and  unreliable  to  be  of  essential  service  to  the  practitioner,  and 
would  have  been  well  omitted.  They  are  based  upon  the  essen- 
tially unreliable  returns  of  the  Registrar- General,  which,  useful  as 
they  are  in  many  respects,  are  valueless  in  estimating  the  mortality 
from  such  indefinite  diseases  as  "apoplexy'^  and  "heart-disease^' — 
names  too  often  used  by  medical  men  in  certifying  the  causes  of 
death  without  using  much  discrimination. 

In  view  of  the  expedition  of  the  exploring  ships,  the  Alert  and 
Discovery,  to  the  arctic  regions,  the  subject  of  death  from  cold 
possesses  an  absorbing  interest;  and  the  best  means  of  averting 
the  effects  of  low  temperatures  has  received  great  attention.  To 
the  ordinary  medical  man  practising  in  this  country  the  topic 
usually  presents  less  of  interest  than  its  importance  deserves ;  since 
the  same  means  must,  as  a  rule,  be  taken  to  avert  the  lesser  as  wtII 
as  the  greater  and  lethal  effects  of  cold. 

In  estimating  the  effect  of  cold  on  the  human  body,  Drs.  Guy 
and  Terrier  lay  down  three  modes  by  which  the  body  is  cooled — by 
cutaneous  exhalation,  by  conduction  of  the  air  in  contact  with  it, 
and  by  radiation.     They  say — 

**The  cutaneous  exhalation  is  increased  by  dry  and  diminished 
by  moist  air.  Hence  the  body  parts  with  its  heat  more  rapidly  in  a 
dry  atmosphere.  On  the  other  hand,  the  body  is  cooled  by  conduc- 
tion^ when  the  air  is  moist ;  so  that  the  body  is  cooled  alike  by  dry 


1875. J         Recent  IVorks  on  Medical  Jurisprudence.  ll^ 

cold  air  and  by  cold  moist  air.  Cold  humid  winds  lower  the  tem- 
perature of  the  body  in  a  very  striking  degree.  A  rapid  renewal  of 
the  air,  as  in  a  brisk  cold  wind,  lowers  the  temperature  of  the 
body,  both  by  evaporation  and  conduction  "  (p.  341). 

Now,  we  have  here  no  statement  of  the  regulative  action  of  the 
nerves  upon  the  animal  body  by  which  the  system  is  enabled  to 
ward  ofP  or  resist  the  effects  of  cold.  Considering  the  misappre- 
hensioijs  which  exist  as  to  the  means  by  which  the  effects  of  cold 
are  resisted,  such  an  account  would  perhaps  have  not  been  super- 
fluous. The  human  body  is  provided  with  a  set  of  nerves — the 
vaso-motor  nerves — which  regulate  the  size  of  the  blood-vessels, 
and  this  apparatus  is  constantly  in  a  state  of  activity  without  our 
being  conscious  of  it.  Should  the  media  surrounding  the  body  fall 
in  temperature,  immediately  the  above-described  apparatus  closes 
more  and  more  the  paths  by  which  heat  escapes  from  the  body,  i.e., 
by  the  pores  of  the  skin  and  cutaneous  exhalation.  It  is  literally 
true,  as  has  been  well  said,  that  the  cooling  of  the  skin  protects 
the  interior  of  the  body  for  a  time  from  too  great  loss  of  heat ; 
and  the  converse  is  equally  true.  Alternations  of  temperature 
seem  necessary  to  keep  the  vaso-motor  regulative  apparatus  in 
healthy  activity ;  and  no  small  part  of  the  effects  of  prolonged  cold 
are  doubtless  due  to  the  loss  of  this  activity. 

The  extract  we  have  quoted  also  exhibits  a  manifest  inacquaint- 
ance  with  the  real  meaning  of  the  term  '^dryness"  as  applied  to 
the  atmosphere.  The  term  dryness  has  a  purely  relative  meaning, 
and  is  intended  to  express  the  state  of  saturation  or  non-saturation 
of  the  air  with  moisture.  The  quantity  of  moisture  which  the  air 
is  capable  of  taking  up  at  different  temperatures  is  very  various. 
Thus  at  35°  Fahr.  a  cubic  foot  of  air  will  take  up  two  and  a  quarter 
grains  of  aqueous  vapour,  at  60°  it  will  take  up  five  and  a  half  grains, 
and  at  80°  ten  and  a  quarter  grains.  Now,  a  cubic  foot  of  air  at 
35°,  containing  two  grains  of  moisture,  and  a  cubic  foot  at  80°, 
containing  ten  grains,  may  both  be  said  to  be  equally  dry,  since 
they  are  both  capable  of  taking  up  the  same  amount  of  moisture, 
viz.  a  quarter  of  a  grain.  But  in  another  sense  the  air  at  80° 
may  be  said  to  be  much  the  moister  of  the  two,  since  it  contains 
five  times  so  much  water  as  the  air  at  35°.  \Ve  are  not  aware 
whether  any  experiments  have  been  made  to  ascertain  the  relative 
conductivities  for  heat  of  air  at  different  temperatures,  when  charged 
with  varying  proportions  of  aqueous  vapour;  but  we  imagine  that 
the  conductivity  will  be  found  to  be  proportionate  to  the  percentage 
of  moisture  in  the  air,  and  not  to  its  dryness,  i.e.  relative  saturation 
with  aqueous  vapour. 

The  interesting  subject  of  spontaneous  combustion  is  treated  of, 
as  a  matter  of  course,  from  the  sceptical  point  of  view.  Orfila  was, 
nevertheless,  a  believer  in  the  possibility  of  this  form  of  death. 

Ill— LTI.  8 


Il4  Reviews,  [July, 

Eewj  we  imagine,  would  now-a-days  be  inclined  to  adopt  Orfila's 
opinion  on  the  subject.  The  cases  cited  by  Guy  and  Eerrier  are 
too  ancient  to  either  prove  or  disprove  the  statement  that  spon- 
taneous combustion  is  a  possibility.  There  are  more  recent  and 
better  reported  cases  than  those  cited  by  the  authors  we  have  just 
named;  and  it  would  have  been  well  for  them  to  have  given  a 
critical  account  of  the  case  of  Mrs.  Warrack  detailed  by  Wharton 
and  Stille  (§  865). 

The  remarks  of  these  authors  on  the  subjects  are  worthy  of  at- 
tentive consideration,  and. embody  a  cautious  and  philosophical  view 
of  the  question  at  issue.     They  say  : 

"  Admitting  that  the  phenomena  of  spontaneous  combustion,  so 
called,  are  incongruous  with  the  laws  of  combustion  so  far  as  they 
are  known,  it  does  not  follow  that  we  should  with  these  chemists 
(Liebig  and  Bischoff),  reject  as  unworthy  of  belief  the  many  curious 
and  authentic  facts  on  record.  These  may  be  true,  although 
incorrectly  accounted  for.  Indeed,  there  are  many  examples  of  the 
spontaneous  combustion  of  organic  and  inorganic  matter,  which 
chemistry  is  unable  satisfactory  to  explain.  But  the  number  of 
cases  now  known,  amounting  to  between  forty  and  fifty  (some  of 
them,  perhaps,  indeed  fictitious),  the  uniformity  in  the  description 
of  the  phenomena,  and  often  age  and  habits  of  the  persons  attacked, 
require  us  to  regard  them  as  scientific  facts  yet  unexplained" 
(§867). 

The  subject  is  one  which  certainly  cannot,  in  view  of  the  recorded 
facts,  be  dismissed  with  a  sneer. 

In  treating  of  the  important  subject  of  burns,  Dr.  Guy  adopts 
the  conclusions  of  Chambert,  though,  oddly  enough,  "  with  modifi- 
cations suggested  by  the  more  certain  of  the  results,'^  not  of  the 
later  but  "  of  the  earlier  writers."  Nevertheless,  though  the  pre- 
ference is  thus  given  to  the  earlier  rather  than  to  the  later  authorities, 
his  descriptions  are  generally  good,  and  his  conclusions  such  as  are 
accepted  by  most  modern  medical  jurists.  We  note,  however,  some 
obscurity  of  diction,  and  fancy  that  the  average  medical  student 
will  be  at  a  loss  after  reading  the  text  of  the  book  to  know  what 
are  the  precise  signs  by  which  he  might  discriminate  between  ante 
and  post-mortem  burns.  Thus,  it  is  stated  (p.  336)  that  burns  in 
the  living  body  caused  by  substances  which  do  not  char  and  destroy 
the  tissues,  produce  two  characteristic  appearances — redness  and 
vesication.  The  redness  seen  after  the  infliction  of  burns  during  life 
is  next  described,  and  then  the  blisters,  in  which  it  is  laid  down  that 
the  albumen  is  more  abundant  when  wholly  due  to  vital  action 
than  when  the  burn,  being  inflicted  at  the  point  of  death,  the  vesicle 
forms  when  life  is  extinct.  But,  it  is  added,  "  these  appearances 
belong  equally  to  burns  made  at  the  point  of  death  and  to  those 
made  twenty  hours  previously/^     From  this  it  would  almost  appear 


1875.]         Recent  Worhs  on  Medical  Jurisprudence.  115 

that  the  authors  thought  that  the  appearances  exhibited  by  burns 
made  at  the  point  of  death  were  generally  identical  with  those  made 
twenty  hours  before  death — a  conclusion  which  is  at  variance  with 
other  statements  made  by  the  authors. 

In  the  portion  of  their  book  devoted  to  a  description  of  death 
by  lightning,  we  find  a  brief  summary  of  most  that  is  of  practical 
importance  relative  to  this  most  interesting  mode  of  death.  Yet 
we  note  that  there  is  an  entire  absence  of  any  mention  of  the  effects 
of  different  forms  of  electric  discharge  upon  the  animal  body,  a 
subject  which  has  been  carefully  elucidated  by  Dr.  B,  W.  Richardson. 
This  section  of  the  volume  will  also,  we  venture  to  surmise,  be 
disappointing  to  those  who  are  skilled  in  physical  science.  Judging 
by  their  language,  the  authors  appear  to  hold  most  materialistic 
views  as  to  the  existence  of  one  electric  fluid.  Thus,  in  describing 
what  is  known  as  death  from  the  return  stroke,  they  say — '^  Death 
may  be  caused  by  an  electric  shock  other  than  the  electric  stroke. 
This  happens  when  a  cloud  near  the  earth  is  negatively  electrified, 
while  the  earth  is  positive,  and  the  human  body  serves  as  the  con- 
ductor, by  which  the  equilibrium  is  restored.""  In  reahty  death 
from  return  stroke  is  as  much  a  death  from  hghtnhig  stroke  as  is  any 
other  form  of  death  from  lightning.  A  short  account  of  the  theory 
of  electric  induction  would  have  been  much  more  intelhgible  than 
the  description  we  have  extracted ;  which,  indeed,  conveys  no  real 
idea  to  the  mind  of  the  reader  as  to  what  a  return  stroke  is.  It 
would  appear  also  from  the  text  of  the  book  that  the  authors 
thought  that  the  mere  passage  of  an  electric  current  through 
articles  of  iron  and  steel  was  sufficient  to  communicate  to  them 
magnetic  properties.  The  true  relation  of  electrical  currents  to 
magnetic  properties,  and  the  exhibition  of  magnetic  properties  by 
all  metallic  conductors  and  electric  currents  are  omitted. 

The  interest  attaching  to  the  subject  of  personal  identity  has,  during 
the  last  few  years,  been  all-absorbing.  The  Tichborne  trial  has 
attracted  an  undue  amount  of  public  interest,  and  the  proofs  and 
disproofs  of  the  personal  identity  of  living  persons  have  been  the 
subject  of  conversation  in  every  drawing-room  and  every  tap-room. 
Hitherto  the  cases  quoted  in  the  text-books  of  medical  jurisprudence 
were  those  of  historical  rather  than  recent  interest ;  but  since  the 
close  of  the  leviathan  trial  it  might  be  expected  that  the  lesser  cases 
would  in  those  works  give  place  to  the  greater.  Unfortunately, 
when  the  second  edition  of  Dr.  Taylor's  '  Principles  and  Practice  of 
Medical  Jurisprudence'  was  passing  through  the  press  in  1873, 
the  second  Tichborne  trial  was  still  dragging  along  its  weary  length. 
We  know,  indeed,  that  the  distinguished  author  kept  back  the  proof 
sheets  containing  his  comments  on  the  marks  of  personal  identity 
on  the  claimant  of  the  Tichborne  estates,  hoping  against  hope  that 
the  trial  would  shortly  come  to  a  close ;  and  that  it  was  only  on  the 


Il6  Reviews.  [July, 

advice  of  the  late  Chief  Justice  Bovill  that  the  edition  was  at  length 
sent  to  the  press  minus  the  sheets  already  prepared.     Dr.  Taylor^s 
volumes  are  hence  deprived  of  much  of  the  interest  they  would 
otherwise  have  possessed.     The   loss  has  in  some   measure   been 
repaired  by  the  publication  in  the  *  Guy's   Hospital  Eeports '  of 
the  omitted  remarks  on  tatoo-marks  as  evidence  of  personal  identity. 
It  is  to  be  feared,  however,  that  they  have  here  much  less  prospect  of 
coming  before  the  medical  and  legal  professions  than  they  would  have 
if  they  had  appeared,  as  itw^as  intended,  in  the  body  of  Dr.  Taylor's  now 
classical  volumes.  Eveninthe  workof  Drs.  Guy  and  Terrier,  though 
bearing  date  September,  1874,  an  appendix  to  the  chapter  on  per- 
sonal identity  has  been  added,  having  exclusive  reference  to  the  Tich- 
borne  case,  for  the  sheets  containing  the  chapter  on  personal  identity 
were  already  in  the  press  ere  that  case  was  concluded.   Dr.  Taylor  con- 
fines his  observations  to  tatoo-marks  exclusively,  whilst  Dr.  Guy  enters 
into  the  whole  question  of   the  identity   or    non-identity  of   the 
claimant  with  the  real  Eoger  Tichborne.    We  must  say  that  neither 
author  gives  us  entire  satisfaction.     Dr.  Taylor  is  as  usual  full  and 
luminous  in  his  description  of  all  that  relates  to  tatooing,  but  his 
remarks  lack  condensation.     He  appears  to  us  also  to  be  in  one 
respect  decidedly  prejudiced  and  unwilling  to  receive  evidence,  since 
he  seems  to  disbelieve  the  assertion  that  tatoo-marks  may  disappear 
in  the  course  of  time.     He  says  that  ^^it  has  been  rather  hastily 
assumed  that  in  a  certain  percentage,  tatoo-marks  spontaneously 
disappear  in  the  course  of  time.''     He  admits,  however,  that  in  a 
few  cases  these  marks  may  fade  or  become  less  visible ;  but  he  adds 
that  *'  the  fading  of  these  marks  most  probably  arises,  not  from 
removal  of  the  colouring  matter  by  the  absorbents,  but  from  the 
fact  that  in  some  cases  the  tatooing  has  been  superficially  performed 
on  a  thick  skin,   with  colours    of   a  fugitive  kind  or  too  much 
diluted."     He  sums  up  by  saying  that  the  theory  of  absorption  into 
the  neighbouring  absorbent  glands    "to  explain  the  removal  of 
insoluble  powders  like  vermilion  or  charcoal  is  unsatisfactory,"  and 
that  tatoo-marks    once    properly  made    are  practically   indehble. 
Nevertheless  he  adduces  instances  where  tatoo-marks  were  actually 
detected  during  the  process  of  at  all  events  partial  disappearance, 
the  pigment  having  been  plainly  seen  in  the  neighbouring  glands  as 
well  as  in  the  absorbents  leading  from  the  tatoo-marks  to  those 
glands.     We  agree  with  the  doctor  that  it  would  in  all  such  cases 
be  more  satisfactory  to  separate  the  insoluble  colouring  matter,  and 
not  to  rely  upon  colour  as  an  absolute  proof  of  the  presence  of  the 
pigments.     We  have  ourselves  seen  in  the  dissecting  room  glands 
and  absorbents  in  the  proximity  of  tatoo-marks  so  coloured  with 
pigments  as  to  leave  no  doubt  whatever  in  our    mind   that   the 
marks  had  actually  undergone  to  some  extent  a  process  of  partial 
removal  by  absorption. 


1875.]         Recent  Works  on  Medical  Jurisprudence.  117 

In  his  description  of  the  Tichborne  case  Dr.  Guy  follows  perhaps 
too  implicitly  the  summing  up  of  the  Lord  Chief  Justice  to  be  quite 
fair  in  his  remarks,  wliich,  indeed,  are  considerably  biassed ;  but  we 
believe  his  conclusions  to  be  in  the  main  correct.  He  introduces, 
moreover,  much  matter  that  is  irrelevant  to  a  work  of  medical 
jurisprudence,  such  as  the  ignorance  exhibited  by  the  claimant,  his 
supposed  loss  of  intellectual  power,  his  forgetfulness,  and  the  like  : 
matters  of  supreme  importance  to  the  determination  of  the  question 
of  the  identity  of  Orton  with  Roger  Tichborne,  but  still  matters  not 
strictly  pertaining  to  the  purview  of  the  physician  ;  and  it  is  to  be 
regretted  that  in  a  short  manual  the  author  has  not  strictly  confined 
himself,  to  his  immediate  subject.  Notwithstanding  these  blemishes 
—or,  rather,  redundancies — we  can  conscientiously  recommend  an 
attentive  perusal  of  this  most  interesting  appendix  to  the  work  to  all 
medical  men.  The  authors,  too,  are  to  be  commended  for  the  manner 
in  which  they  have  introduced  engravings  of  the  portraits  of  the  real 
and  of  the  would-be  Eoger  into  their  pages,  and  the  manner  in  which 
they  have  availed  themselves  of  the  skilful  assistance  of  Mr.  Piercy, 
the  memorial  portrait  painter.  Mr.  Piercy 's  clever  mode  of  so  adjust- 
ing the  portraits  as,  without  impairing  their  accuracy,  to  bring  out  the 
salient  points  of  difference  of  form  and  feature,  is  very  happy. 

Tf  the  subject  of  the  identity  of  a  living  person  is  beset  with 
great  difficulty,  what  shall  be  said  as  to  the  identity  of  the  dead  ? 
There  is,  in  truth,  no  branch  of  medical  jurisprudence  beset  with 
greater  difficulty  than  this.  The  alterations  produced  in  the  features 
within  a  short  period  after  death  are  so  marked  as  to  deceive  even 
those  most  intimately  familiar  with  those  features  during  life ;  and  it 
is  perhaps  never  safe  to  speak  as  to  the  identity  of  a  corpse  without 
the  examination  of  marks,  defects,  or  deformities  as  additional  means 
of  verification.  Even  then  we  may  be  deceived,  as  the  following 
case  related  by  Wharton  and  Stille  from  Henke  will  prove  : 

"  The  body  of  a  man  between  sixty  and  seventy  years  of  age  was 
found  slightly  embedded  in  sand,  on  the  bank  of  a  river ;  both  eyes 
had  been  picked  out  by  hooded  crows,  but  decomposition  had  made 
no  progress.  The  left  ear  and  the  first  finger  of  the  left  hand  were 
wanting,  having  the  appearance  of  having  been  lost  in  early  life.  The 
body  was  conveyed  to  a  suitable  place,  and  persons  were  requested 
by  advertisements  to  come  and  identify  it.  After  some  time  two 
young  women  claimed  it  as  the  body  of  their  father,  who,  they 
stated,  was  a  lawyer,  that  he  was  in  the  habit  of  leaving  home  for 
two  or  three  weeks  at  a  time,  without  informing  them  where  he 
went,  and  that  he  had  lost  the  left  ear,  and  first  finger  of  his  left 
hand.  They  apparently  recognised  the  clothes  and  the  body,  and 
gave  vent  to  expressions  of  grief  on  the  event.  Subsequently 
doubts  in  the  mind  of  one  sister  were  overruled  by  the  confident 
affirmatives  of  the  other.  The  funeral  took  place  accordingly, 
and  was  attended  by  the  daughters  and  friends  of  t^e  supposed 


118  Reviews,  [July^ 

deceased  lawyer.  Eetiirning  from  the  funeral,  the  boatman  of  the 
ferry  which  they  had  to  cross  asked  them  for  whom  they  were  in 
mourning,  and,  upon  receiving  their  answer,  laughingly  informed 
them  that  he  had,  only  half  an  hour  before,  ferried  their  father  over 
alive  and  well,  and  directed  them  where  they  would  find  him.  This, 
to  their  great  joy,  proved  true." 

On  the  whole,  we  know  of  no  manuals  of  forensic  medicine  so 
excellent  as  those  of  Dr.  Taylor  and  Drs.  Guy  and  Perrier.  Dr. 
Taylor's  is  unequalled  in  its  elaborate  and  carefnl  record  of  cases, 
but  is,  perhaps,  too  volaminous  a  work  for  the  ordinary  student. 
Dr.  Guj's  manual,  on  the  other  hand,  forms  a  useful  handbook, 
and  is  of  such  moderate  dimensions  that  the  reading  of  it  is  a  task 
not  beyond  the  powers  of  every  student  of  medicine. 

Of  Dr.  Eeese's  '  Manual  of  Toxicology '  we  cannot  speak  very 
favorably.  The  book  is  fairly  well  got  up,  and  forms,  doubtless,  a 
useful  manual.  The  author  has,  however,  followed  Dr.  Taylor 
almost  slavishly,  which  is,  perhaps,  a  sign  of  his  own  not  very  ex- 
tended practical  knowledge  of  the  subject  of  which  he  treats.  Dr. 
Taylor's  name  appears,  indeed,  on  nearly  every  page  of  the  volume. 
A  few  good  American  cases  are  given,  which  add  to  the  value  of  the 
work.  Dr.  Eeese  has  evidently  made  himself  acquainted  with  what 
has  been  written  in  English  by  approved  writers  or  toxicology,  and 
he  occasionally  ventures  to  quote  such  well-known  Prench  authors 
as  Orfila  and  Tardieu.  He  appears  to  have  unaccountably  omitted 
to  refer  to  most  that  has  been  done  by  the  great  German  toxicolo- 
gists,  with  the  exception  of  Casper,  who  is  quoted  a  few  times,  but 
whose  writings  on  toxicology  form  the  least  important  of  his  splendid 
contributions  to  forensic  medicine. 

The  third  edition  of  the  well-known  work  of  Wharton  and  Stille 
maintains  the  high  reputation  of  its  predecessors.  The  three  hand- 
some volumes  in  which  it  appears  have  had  the  advantage  of  careful 
editing.  The  first  of  these  still  appears  under  the  auspices  of  its 
original  author.  Dr.  Wharton,  and  treats  exclusively  of  mental  un- 
soundness and  psychological  law ;  and  since  the  speciality  of  psy- 
chological law  has,  since  the  publication  of  the  previous  edition,  in 
1860,  undergone  a  revolution,  it  was  necessary  to  write  a  substan- 
tially new  treatise.  This  the  accomplished  author  has  done  with 
marked  ability.  The  volume  is  filled  with  the  record  of  instructive 
and  interesting  cases,  and  innumerable  authorities  are  quoted,  so 
that  the  book  is  rendered  not  only  a  valuable  text-book  for  the  medical 
jurist,  but  also  an  indispensable  addition  to  the  library  of  the  legal 
practitioner.  We  specially  commend  to  the  perusal  of  our  brethren 
the  study  of  the  chapter  on  ^^  moral  insanity,''  in  which  views  are 
inculcated  as  far  removed  from  sentimental  romanticism  as  from  the 
repulsive  barbarism  which  at  one  time  disgraced  our  treatment  of 


1875.]        Recent  Works  on  Medical  Jurisprudence.  119 

crime  and  insanity.     The  key-note  to  the  position  maintained  is 
thus  stated  by  Dr.  Wharton  in  his  preface : 

•'  Since  1880  a  great  change  has  taken  place.  Before  that  period, 
we  may  say  generally,  there  had  been  no  positive  and  final  repudia- 
tion by  psychological  science  of  the  theory  of  criminal  monomanias. 
Since  then  medical  as  well  as  psychological  science  has  rallied,  and 
from  all  quarters  there  has  risen,  as  will  hereafter  be  shown  more 
fully,  almost  an  unbroken  denunciation  of  a  scheme  of  psychological 
romanticism,  which  sober-minded  men  have  learned  to  feel  is  as 
repugnant  to  science  as  it  is  hostile  to  society.  And  this  advance 
of  science  towards  a  common  reconciliatory  stand-point  is  now  met 
[in  America  and  on  the  Continent]  by  a  corresponding  advance  of 
law.  It  has  been  just  stated  that  one  of  the  causes  of  early  judicial 
confusion  on  this  topic  was  the  revulsion  from  the  excessive  punish- 
ments assigned  by  the  old  law  to  offences  of  even  lighter  grade. 
Civilisation  was  shocked  at  seeeing  a  man  who,  from  nervous,  or 
mental,  or  physical  disorder,  was  incapable  of  cool  premeditation  or 
exact  intent,  hurried  to  the  gallows  for  what  might  be  a  comparatively 
venial  crime ;  and  it  was  to  the  desire  to  save  such  that  the  toleration 
of  the  idea  of  irresponsibility  in  such  cases  is  in  a  large  measure 
traceable.  But  it  was  soon  found  that  this  enlargement  of  the  idea 
of  irresponsibility  worked  badly.  It  exposed  many  persons  virtually 
sane  to  the  pains  and  penalties  of  insanity.  It  enfranchised  a 
dangerous  class  of  outlaws,  too  insane  to  be  punished  for  crime,  and 
yet  too  sane  to  be  restrained.  It  involved,  on  the  part  of  the  State, 
the  abdication  of  one  of  its  chiefest  functions — the  building  up  of  a 
right  moral  sense  in  those  of  its  subjects  in  whom  such  moral 
sense  is  deficient." — Preface,  xiii. 

But  to  enter  upon  the  wide  field  of  the  medical  relations  of 
insanity  would  be  to  undertake  a  task  to  which  our  space  would  not 
enable  us  to  do  adequate  justice.  Indeed,  an  article  itself  would  have 
to  be  devoted  to  this  topic  alone.  We  must  with  reluctance  part 
from  these  interesting  volumes.  Their  perusal  has  afforded  us  much 
pleasure.  Dr.  Eeese's  work  is,  perhaps,  least  satisfactory  of  them, 
since  we  should  have  desired  him  to  have  more  explicitly  admitted 
that  his  manual  is  a  mere  compilation  of  the  writings  of  others 
rather  than  an  original  manual  of  toxicology. 


120  Reviews.  [July, 

XI.— The  Controversy  on  Disposal  of  tlie  Dead.' 

I. 

The  long  list  of  books,  essays,  and  papers  that  lie  before  us  at 
this  moment  testifiy  to  the  interest  that  is  now  felt  on  the  subject 
of  the  disposal  of  the  dead.  In  the  controversy  that  has  been  and 
that  is  still  being  waged  varied  combatants  present  themselves. 
The  hardy  man  of  science  and  the  studious  divine,  the  enthusiastic 
layman  and  the  sympathetic  laywoman — indeed,  we  might  include 
in  the  controversy  all  who  expect  to  be  disposed  of  after  death 
without  greatly  perverting  the  history  of  our  time  in  relation  to  the 
question  that  lies  before  us. 

The  writer  of  the  article  in  the  ^Popular  Science  Review^ 
assigns,  as  the  reason  for  so  much  controversy  and  so  much  differ- 
ence of  opinion  on  a  very  simple  subject,  the  diversities  of  sentiment 
which  have  ever  existed,  and  which  still  exist,  between  different 
families  of  men  on  the  solemn  subject  of  death  and  after-existence. 
To  bury,  to  embalm,  to  cremate,  he  asserts,  are  acts  the  incli- 
nation to  either  of  which  depends  altogether  upon  the  disposition  of 
those  who  have  to  carry  these  acts  into  practice.  This  disposition, 
he  further  assumes,  depends,  not  on  reasoning,  but  on  instinct. 
This  instinct  depends,  not  on  accident,  but  on  the  most  veritable  of 
all  human  endowments — on  the  organic  origin  and  build  of  the  man, 
and  of  the  men  from  whom  the  man  springs ;  in  other  words,  upon 
racial  and  family  dispositions  and  qualities.  From  this  point  he 
traces  out  the  instinctive  peculiarities  of  the  representatives  of  the 
different  civiHsations,  and  comes  ultimately  to  the  conclusion  that, 
in  this  country,  a  modified  system  of  burial  in  the  earth  is  the  only 
possible  large  reform  for  the  interment  of  the  dead  that  is  possible 
in  the  present  civilisation. 

The  view  that  the  varied  modes  of  disposal  of  the  dead  are  indica- 
tions of  varied  forms  of  civiHsation  is  indirectly  supported  by  all  the 

1  1.  Cremation  of  the  Dead :  its  Kistory  and  Bearings  upon  Pullic  Health. 
By  William  Eassie,  C.E.     With  Illustrations.     London,  1875. 

2.  Cremation :  the  Treatment  of  the  Body  after  Death.  By  Dr.  Heney 
Thompson.     2nd  Ed.     London,  1874. 

3.  On  the  Disposal  of  the  Dead.  By  Dr.  KiOHAEDSON,  F.R.S.  Popular 
Science  Review  for  April.     London,  1875. 

4.  The  Disposal  of  the  Dead.  Indian  Medical  Gazette.  Edited  by  K. 
McLeod.     Calcutta,  April  1st,  1875. 

5.  Letters  in  the  *  Times'  Newspaper  on  the  Subject  of  Burial.  By  J.  Set- 
MOTJE  Haden,  Esq.     1874-5. 

6.  Proceedings  of  the  American  Medical  Society.     June  to  December,  1874. 

7.  Suggestions  to  Burial  Boards  providing  and  managing  Burial  Grounds. 
By  the  Inspector  under  the  Burial  Acts.     1871. 

8.  Burials  in  Charcoal.    Journal  of  Public  Health,  September,  1855. 


1875.]       The  Controversy  on  Disposal  of  the  Dead,  121 

other  writers  whose  works  have  reached  us.  On  the  whole,  the 
balance  of  opinion  on  the  two  questions — "  earth  to  earth/'  or 
"  ashes  to  ashes '' — is  pretty  nearly  equal,  and  the  care  with  which 
either  ceremony  is  performed  shows  that  both  are  regarded  with 
befitting  solemnity,  even  by  the  most  uncultivated  societies.  We 
know  how,  amongst  our  poorest  and  most  ignorant  masses,  the  most 
respectful  and,  we  may  add,  costly  attention  is  paid  to  and  for  the 
act  of  burial.  The  same  care  and  cost  is  in  like  manner  paid  by  the 
poor  of  other  communities  for  the  act  of  cremation.  On  this  ground, 
therefore,  of  mere  personal  respect  for  the  dead  the  one  plan  is 
much  the  same  as  the  other  in  value. 

The  writer  of  the  article  in  the  '  Indian  Medical  Gazette '  sums 
up  all  the  modes  of  disposal  of  the  dead  except  two.  The  Hindoos, 
he  says,  burn  their  dead  ;  the  Mahomedans  bury  witliout  any  coffin  ; 
the  Europeans  bury  with  a  coffin  ;  the  Parsees  expose  their  dead  to 
be  eaten  by  birds  of  prey.  To  these,  if  he  had  added  that  they 
who  live  on  the  sea  commit  their  dead  to  the  deep,  and  that  a  few 
wealthy  persons  still  call  in  the  embalmer  for  the  exercise  of  his 
skill,  the  narrative  would  have  been  complete. 

We  are  indebted  to  this  author  (who,  by  the  way,  though  he 
does  not  give  his  name,  we  suspect  to  be  Dr.  K.  McLeod)  for  one 
or  two  graphic  pictures  of  the  mode  of  cremation  that  prevails 
amongst  the  Hindoos,  and  of  the  mode  of  burial  without  any  coffin 
which  prevails  amongst  the  Mahomedan  populations.  As  these  and 
other  modes  of  disposal  of  the  dead  are  each  being  considered  and 
discussed  at  the  present  time,  we  may  with  advantage  cull  one  or 
two  interesting  details  respecting  them. 

II. 

To  commence  with  the  Hindoo  system — that  is  to  say,  with  the 
mode  of  cremation  in  its  natural  home — we  read  the  following  facts  : 
— The  body  is  dressed  in  its  best  garments,  and,  after  being  deco- 
rated with  flowers,  is  placed  in  the  sitting  posture,  and  is  surrounded 
with  piles  of  wood,  the  richer  classes  using  the  scented  sandal-wood. 
Then,  if  the  deceased  be  a  noble  or  native  magnate  of  some  parts  of 
India,  the  heir  first  breaks  open  the  skull  of  the  corpse  with  a 
hatchet  (to  make  sure,  we  presume,  that  the  assumed  dead  man  shall 
not  be  burned  alive),  after  which  he  (the  heir)  lights  the  funeral 
pyre.  If  there  be  sufficient  wood,  and  the  wood  is  a  good  fuel- 
wood,  and  has  been  artistically  arranged,  nothing  offensive  is  ])re- 
sented  to  either  the  sense  of  smell  or  of  vision.  The  devouring 
element  rapidly  envelopes  the  different  faggots  until  the  whole  is  a 
mass  of  blaze,  giving  the  beholder  a  very  vivid  idea  that  the  '^rite" 
of  suttee  could  not  have  entailed  a  very  painful  or  prolonged  death. 
Even  should  the  looker-on  allow  the  wind  to  pass  between  the 


12i  Reviews.  [July, 

flames  and  his  nobility,  he  distinguishes  nothing  except,  perhaps, 
the  odour  of  burning  wood,  and  he  sees  nothing  except  fire.  Above 
the  blaze  and  below  the  smoke,  when  the  latter  occurs  from  damp 
wood,  there  is  a  bright  ethereal  glimmer,  somewhat  resembling,  but 
more  diamond-like  by  far,  the  appearance  of  the  distant  atmosphere 
on  a  hot  day.  Then,  as  minutes  pass,  this  ghmmer  subsides,  and 
the  flame  lessens  until  nothing  remains  but  an  insignificant  heap  of 
greyish  ashes.  The  body  has  changed  to  something  else  as  different 
as  the  soul  in  its  new  Pythagorean  abode.  A  pyre  as  big  as  that 
of  Sardanapalus  affords  no  protection  to  the  ashes  of  the  dead. 
Everything  has  gone,  not,  perhaps,  to  dust,  but  into  those  still  more 
subtle  ultimate  elements  from  which  the  dust  itself  is  derived. 
There  is,  indeed,  as  a  result  of  a  well-conducted  funeral  pyre,  an 
utter  annihilation  of  the  body.  It  can  never,  says  our  author — it 
can  never  again,  as  a  substance,  do  either  harm  or  good,  either  by 
resolution  or  by  putrefaction.  It  has,  in  short,  ceased  to  exist.  Of 
course  consumption  is  not  thus  complete  at  every  funeral  pile.  At 
most  Hindoo  burning-places  bodies  half  destroyed  by  fire  may  be 
seen  in  great  numbers,  and  it  not  unfrequently  happens  that  during 
the  process  of  burning  there  is  some  unpleasant  efiluvium.  This, 
however,  is  simply  the  result  of  want  of  precaution  or  want  of  fuel, 
and  is,  therefore,  only,  or  at  least  chiefly,  noticed  at  the  funeral  rites 
of  the  poor  and  needy.  With  sufficient  wood  the  destruction  may 
always  be  rendered  as  complete  as  has  been  described. 

From  this  excellent  description  of  the  Hindoo  method  of  crema- 
tion we  may  turn  with  interest  to  an  account  of  a  similar  process, 
as  it  is  conducted  by  the  subtribe  of  Path-Utes  known  as  the  Cotton 
Wood,  Corn  Creek,  Spring  Mountain,  and  Pah-rimp  Spring  Indians. 
The  description  is  supplied  to  the  ^Transactions  of  the  American 
Philosophical  Society'  by  Mr.  W.  J.  Hoffman,  who  in  1871-2  was 
attached  to  Lieutenant  Wheeler's  expedition  through  the  territories 
of  the  American  Indian  tribes.  The  tract  of  country  in  which  Mr. 
Hoffmann  found  the  practice  of  cremation  to  exist  lies  between  110° 
and  115°  35'  west  longitude  and  latitude  north  35°  and  36'.  Spring 
Mountain  is  the  stronghold  of  the  tribe,  and  is  located  just  north  of 
the  "  Old  Spanish  Trail."  Upon  the  death  of  one  of  these  Indians, 
Hoffman  tells  us,  a  pile  of  wood  is  prepared  in  the  immediate 
vicinity ;  this  is  so  arranged  as  to  form  a  rectangle,  to  the  height 
of  from  two  to  three  feet.  The  corpse  is  laid  upon  this,  when  the 
fire  is  started,  after  which  wood  is  continually  thrown  across  the 
pile  until  the  body  is  reduced  as  much  as  possible.  Mesquite,  pine, 
and  cedar  are  usually  employed,  and  form  excellent  coals  and  an 
intense  heat.  All  the  remaining  property — as  wearing  apparel, 
arms,  blankets,  dogs,  and  horse  (if  the  deceased  possessed  any  such) 
— is  also  burned.  According  to  the  belief  of  these  Indians,  when 
an  Indian  dies  his  spirit  goes  to  the  East,  which  they  consider  the 


1875. J        The  Controversy  on  Disposal  of  the  Bead.  123 

"  white  man's  hunting-ground/'  and  where  he  would  be  unable  to 
hunt  were  his  spirit  deprived  of  these  valuable  aids.  The  remains 
are  then  covered  with  earth.  Whether  they  were  really  buried  the 
author  could  not  ascertain.  Amongst  thirty  subtribes  of  the  same 
Indian  region  the  Pah-Utes  is  the  only  one  that  "  cremates/' 

Such  is  an  outline  of  primitive  cremation  as  it  is  at  present 
carried  on  in  uncivilised  nations.  How  far  it  resembles  the 
ancient  methods  of  Greek  and  Eoman  days  our  readers  are  as 
capable  as  ourselves  of  forming  an  estimate.  The  modern  civi- 
lised cremationist  discards  these  methods  of  cremation.  They  are 
to  him  rude  and  costly  and  slow.  He  calls  into  his  aid  the 
skill  of  modern  science,  and  if  he  does  not  destroy  the  dead  organism 
and  tear  it  into  its  elements  with  quite  the  same  rapidity  as  the 
noble  author  of  the  "  Coming  Eace"  with  its  "  Kill  force/'  he  makes 
some  approach  to  that  last-named  wonderful  imaginary  agency.  In 
the  following  description  we  take  from  Sir  Henry  Thompson  an 
account  of  an  experiment  in  which  he  cremated  the  body  of 
an  animal  that  weighed  no  less  than  227  lbs.,  and  was  not 
emaciated.  The  body  was  placed  '^  in  a  cylindrical  vessel  about  seven 
feet  long  by  five  or  six  in  diameter.  The  interior  of  the  vessel  was 
already  heated  to  about  2000°  P.  The  inner  surface  of  the  cylinder 
was  smooth,  almost  polished,  and  no  solid  matter  but  that  of  the  body 
was  introduced  into  it.  The  product,  therefore,  could  be  nothing 
more  than  the  ashes  of  the  body.  No  foreign  dust  could  be  intro- 
duced, no  coal  or  other  solid  combustible  being  near  it;  nothing 
but  heated  hydrocarbon  in  a  gaseous  form  and  heated  air.  Nothing 
was  visible  in  the  cylinder  before  using  it — a  pure,  almost  white, 
interior — the  lining  having  acquired  a  temperature  of  white  heat.  In 
this  case  the  gases,  given  off  from  the  body  so  abundantly  at  first, 
passed  through  a  highly  heated  chamber,  among  thousands  of  inter- 
stices made  by  intersecting  fire-bricks  laid  throughout  the  entire 
chamber  lattice  fashion,  in  order  to  minutely  divide  and  delay  the 
current  and  expose  it  to  an  immense  area  of  heated  surface.  By 
this  means  they  wxre  rapidly  oxidized,  and  not  a  particle  of  smoke 
issued  by  the  chimney  ;  no  second  furnace,  therefore,  is  necessary  by 
this  method  to  consume  any  noxious  matters,  since  none  escape.  The 
process  was  complete  in  fifty-five  minutes;  and  the  ashes,  which 
weighed  about  five  pounds,  were  removed  with  ease.^' 

Mr.  Eassie,  whose  enthusiastic  work  on  cremation  we  have 
included  in  our  list,  in  speaking  of  the  results  of  the  cremation 
of  the  human  subject  as  practised  in  a  Siemen's  furnace  in  Dresden, 
says  that  in  the  course  of  the  process  nothing  whatever  is  seen  that 
can  in  any  way  be  considered  objectionable.  The  body  remains  of 
itself  perfectly  motionless  and  without  visible  contraction  or  convul- 
sion. Several  late  human  cremations,  he  states,  have  been  pur- 
posely witnessed  by  eminently  scientific  men  and  others,  through  the 


124  Reviews.  [July, 

glass  panel  door  which  is  always  provided  for  the  use  of  the  manu- 
facturing operator,  and  the  utter  absence  of  anything  which  could 
prove  the  least  distressing  to  the  mind,  the  eye,  or  the  imagination 
is  vouched  for  by  all.  The  current  of  combined  air  and  gas  simply 
plays  upon  the  body  with  a  transparent  flame  until  the  whole 
becomes  incandescent.  There  is  not  even  the  least  effluvium.  Once  in- 
candescent the  body  soon  assumes  a  hue  of  translucent  white  and  then 
speedily  crumbles  into  ashes.  Entering  still  further  into  detail  Mr. 
Eassie  suggests  that  if  the  practice  should  at  all  become  general  the 
body  to  be  cremated  would  be  enclosed  befqre  cremation.  The  body, 
he  thinks,  would  be  placed  in  a  coffin  made  of  some  light  material, 
and  taken  in  due  time  to  the  mortuary  ready  for  conveyance  to  the 
cinerator ;  and  as  it  is  desirable  that  the  ashes  of  the  body  should 
be  kept  separate  from  those  of  any  coffin,  a  shroud  of  some 
imperishable  material  will  be  carefully  sought  after  by  inventors. 
The  ancient  Greeks,  he  adds,  made  use  of  asbestos,  which  is  a  fibrous 
form  of  horneblende ;  and  those  Egyptians  who  performed  cremation 
enclosed  the  body  in  a  receptacle  of  amianth,  a  similar  incombustible 
mineral  substance.  Whether  these  materials  will  resist  the  intense 
heat  of  a  Siemen's  furnace,  he  (Mr.  Eassie)  is  not  able  to  say,  but 
wood,  at  all  events,  is  likely  to  be  rejected  on  account  of  the  residue 
of  carbon  which  might  not  be  easily  separated  from  the  more 
precious  relics.  Lead  would  be  equally  objectionable.  In  all  pro- 
bability the  most  suitable  material  for  the  inner  coffin,  which  aloue 
is  to  be  submitted  to  the  impingement  of  the  hot  blast,  will  be  zinc. 
This  metal  would  entirely  disappear  in  the  furnace  heat,  the  reason 
being  that  it  is  volatile,  and  would  distil  off  below  the  minimum 
temperature  that  would  reign  in  the  chamber  of  the  apparatus. 

This  same  author  (Mr.  Eassie)  further  prearranges  for  the 
changes  in  the  service  or  ritual  in  the  case  of  a  dead  body  dis- 
posed of  by  cremation.  He  tells  us  that  in  one  Dresden  arrange- 
ment the  body  is  lowered  into  a  receiver  below,  and  the  idea  of 
interment  is  thus  in  a  manner  preserved.  In  the  English  arrange- 
ment,— which  by  the  way  has  not  yet  been  carried  out  on  the  human 
subject, — the  coffin  is  made  to  slide  gradually  into  the  receiver  like  a 
ship  launched  into  water.  The  anguish  induced  by  the  moment  of 
departure  is  in  this  way,  he  opines,  somewhat  ameliorated,  as  there 
is  no  noise  of  lowering  machinery  to  grate  upon  the  ear.  He  adds 
suggestively  that  at  certain  appointed  words  in  our  beautiful  funeral 
service — for  instance  at  the  words  '^ashes  to  ashes'" — a  curtain  might 
be  partially  withdrawn,  and  the  body,  enclosed  in  a  suitable  shell, 
would  gravitate  slowly  into  the  chamber  of  the  apparatus,  whicli 
would  then  immediately  close  noiselessly,  to  be  opened  only  after 
the  due  reduction  of  the  body.  The  utmost  privacy  would  be  en- 
sured, and  no  strange  eyes  could  gaze  upon  the  body  during  the 
period  of  incineration.    Mr,  Eassie  further  suggests  that  the  funeral 


1S75.]        The  Controversy  on  Disposal  of  the  Dead.  12.^ 

service  could  if  desirable  be  made  to  occupy  the  whole  of  the  time 
necessary  for  sublimation ;  or  an  eulogy  or  other  reference  to  the 
departed  might  form  the  subject  of  a  discourse.  The  ashes  could 
afterwards  be  collected  and  reverentially  placed  on  an  urn  and 
conveyed  to  their  last  resting  place. 

The  unciviHsed  and  the  civilised  methods  of  cremation,  the  pro- 
posed and  the  actual,  are  now  before  the  reader.  We  may  contrast 
these  methods  with  some  others  that  are  suggested  as  modifications 
of  burial  in  the  earth. 

III. 
A  modification  of  the  ordinary  system  of  burial  common  in  this 
country  is  proposed  by  Mr.  Haden  as  an  improvement  on  the  furnace 
system  of  cremation  that  has  just  been  narrated.     Mr.  Haden  pro- 
poses practically  the  mode    of   burial  which  is    practised  by  the 
Mahomedans,  with  this  difference,  however,  that  whereas  the  Maho- 
medan  places  the  corpse  directly  in  earth,  enclosed  at  most  in  a 
shawl  or  garment,  Mr.  Haden  recommends  that  it  be  enclosed  in  a 
wicker  basket  or  coffin  surrounded  with  flowers  or  enclosed  in  a 
layer  of  charcoal  if  the  cause  of  death  has  been  an  infectious  dis- 
order.    He  instructs  us  that  the  body  "  as  soon  after  death  as  may 
be  is  to  be  sponged,  the  eyes  are  to  be  closed,  the  chin  supported, 
the  limbs  composed,  and  the  hands  crossed  upon  the  breast.  Super- 
fluous bedclothes,  together  with  the  impediments  and  rejectments  of 
the  sick  room,  are  to  be  removed  and  a  window   is  to  be  opened  a 
few  inches  both  at  the  top  and  at  the  bottom.     The  papers  of  the 
deceased  may  then  be  examined,  and,  if  these  contain  nothing  to 
forbid  it,  the  first  preparations  for  the  funeral  may  be  made  in  the 
following  way.     As  part  of  the  ordinary  stock-in-trade  of  every 
turner,   brushmaker,  or  basketmaker    will    be  found,  nested  one 
within  the  other,  and  of  every  form  and   dimensions,  the  necessary 
covering  or  coffin ;   at  every   herbalist's  or  florist's,  its  garniture. 
Both  being  light  and  portable  maj   be  delivered  at  the  house  in  an 
hour  or  two,  and   the  body  may  be  at  once  laid  in  it  and  strewn 
(except  the  face  and  hands,  which  should  be  left  exposed)  with  its 
evergreen  covering.     All  this  may  be  done  by  the  nurses  or  older 
servants  or  members  of  the  family,  and  no  stranger  need  be  admitted. 
There  is  now  ample  time  to  consider  arrangements — for  the  visit  of 
the  physician  or  surgeon  charged  to  verify  the  fact  of  death,  to 
telegraph  to  friends,  and  to  make  final  preparations  for  the  inter- 
ment.    The  morrow  come,  and  everything  prepared  inside  and  out, 
the  necessary  agents  for  the  interment  will  enter  the  house  for  the 
first  time  and  the  last,  and  remove  the  body  in  a  suitable  carriage, 
either  by  railway  or  by   water,  to  its  resting-place  outside  the  city, 
one  of  the  male  representatives  of  the  family  in  every  case  accom- 
panying it.     There  will  be  no  procession  through  the  streets— no 
opportunity  for  display— nothing  to  ehcit  either  the  sympathy  or 


126  Reviews.  fjuly, 

the  criticism  of  the  neighbourhood  (both  on  such  an  occasion  equally 
out  of  place)  ;  but^  arrived  at  the  cemetery,  the  body  will  wait  in 
the  mortuary  chapel  attached  to  it  with  those  who  are  to  be  present  at 
its  interment.  These,  having  been  informed  of  the  death,  will  go 
and  return,  as  their  desires,  affections,  or  respect  for  the  dead  impel 
them.  The  assembly  will  be  in  the  chapel,  and  at  the  grave-side 
only,  where  the  mourners,  men  and  women  (for  since  there  is  to  be 
no  public  display  both  may  go),  will  find  the  trellissed  coffin  on  its 
bier — garnished  and  beautified  by  loving  hands — awaiting  them. 
Not  a  word  of  our  burial  service  will  be  omitted,  though  more  may 
be  said  in  the  chapel  and  less  at  the  grave-'side,  and  then  all  will  be 
over.  There  will  be  no  reunion  at  the  house  of  death.  The  con- 
ventional feast  will  not  be  spread.  The  formal  reading  of  the  will 
will  be  at  the  office  of  the  legal  adviser  of  the  family  on  a  day  ap- 
pointed for  the  purpose ;  and  the  inmates  of  the  house  of  mourning 
will  return  to  it  and  be  allowed  to  remain  undisturbed.  Next  day 
every  one  will  to  his  business.' '' 

In  the  article  on  the  disposal  of  the  dead  in  the  'Popular 
Science  Eeview/  to  which  reference  has  once  before  been  made, 
the  author  holds  a  similar  opinion  to  that  which  has  been  quoted 
from  Mr.  Seymour  Haden.  He  insists  that  '^it  would  be  vain  to 
construct  the  best  burial-ground  if  the  present  system  of  enclosing 
the  dead  in  coffins  of  wood  or  iron  or  lead  were  to  continue.  The 
coffin  should  be  nothing  more  than  an  easily  destructible  shroud, 
in  which  the  mortal  remains  may  be  concealed  from  view  until  they 
are  deposited  in  the  earth.  The  present  coffin  is  after  the  mode  of 
an  Egyptian  sarcophagus,  and  is  probably  an  imitation  of  that 
receptacle.  In  the  form  of  this  receptacle  there  is  nothing 
objectionable,  and  if  the  popular  taste  wills  that  it  shall  be  main- 
tained, so  be  it.  But  the  structure  must  be  so  modified  that  the 
instant  the  body  is  placed  in  the  earth  it  shall  either  be  in  direct 
contact  with  the  surrounding  earthy  matter  or  shall  be  separated 
from  it  by  some  simple  organic  material  that  is  easily  and  rapidly 
destroyed.  The  newly  proposed  wicker  coffins  would  probably 
answer  the  purpose  intended,  fairly ;  but  they  have  the  fault  of  not 
being  sufficiently  destructible.  A  return  to  the  ancient  bier  and  to 
the  primitive  mode  of  simply  enveloping  the  body  in  cloth  would 
be  by  far  the  most  rational  modification.  It  is  presumed  by  some 
who  advocate  this  direct  mode  of  burial  that  interment  should 
in  all  cases  be  carried  out  within  a  short  interval  after  death ;  that 
a  period  of  not  less  than  thirty-six  hours  should  be  allowed  to 
elapse  between  the  cessation  of  life  and  the  disposal  of  the  hfeless 
body  in  the  ground.  There  can  be  no  doubt  that  the  method  of 
placing  the  body  in  the  coffin,  and  of  partially  or  temporarily 
closing  it  up,  has  led  to  much  error  in  the  manner  of  detaining  the 
dead  among  the  living,  and  it  is  not  less  doubtful  that  when,  in  any 


187&.  j  The  Controversy  on  Disposal  of  the  Dead.  127 

instance,  actual  decomposition  of  the  tissues  has  commenced^  the 
time  for  interment,  however  short  it  may  be,  has  fairly  arrived. 
The  system  of  burying  without  the  coffin  would  therefore  in  a 
sanitary  point  of  view  be  of  advantage.  It  would  lead  to  inter- 
ment, in  every  case,  so  soon  as  the  direct  evidence  of  decomposition 
had  set  in,  and  in  the  majority  of  instances  that  would  be  within 
forty-eight  hours  from  the  time  of  the  demise.  Third- day  burials 
would  become  the  rule.  This  period  would  be  sufficient  to  estabhsh 
the  fact  of  death  on  the  one  hand,  and  to  prevent  injury  to  the 
living  on  the  other.-'' 

In  relation  to  the  kind  of  earth  that  should  be  placed  in  the 
cemetery,  and  in  which  the  dead  should  be  buried,  this  author 
enters  into  some  minuteness  of  detail.  According  to  his  view, 
"the  construction  of  the  soil  of  the  burial-ground  is  of  first 
moment,  and  might  readily  be  made  matter  of  legislation.  The 
soil  that  is  most  fitting  for  this  purpose  is  a  fine  carboniferous 
mould,  or  a  mixture  of  carbon  and  sand.  In  such  a  soil  the  com- 
plete removal  of  the  body  might,  under  proper  conditions  of  burial, 
be  secured  within  a  period  of  five  years ;  and  in  such  a  soil  renewal 
of  burial  might  be  carried  out  after  every  such  interval.  In  Naples 
it  has  been  customary  to  bury  in  pits  of  earth  in  which  lime  has 
been  placed ;  ^to  bury  so  many  bodies  in  one  section  on  a  given  day, 
to  allow  that  section  to  rest  for  a  year,  then  to  remove  the  whole  of 
the  earth  of  the  section  with  its  organic  remains,  to  refill  with 
new  earth  and  bury  again  for  the  year  in  the  new  earth.  In  this 
country  such  a  prompt  system  would  not  be  tolerated ;  but  the 
method  of  burial  in  a  destructive,  but  more  slowly  destructive,  bed 
would  meet  probably  every  view,  without  creating  undue  prejudice 
at  the  commencement  of  the  reformation.  In  some  localities  a 
natural  soil  would  yield  all  that  is  wanted  for  a  perfect  burial  in 
earth.  In  other  localities  the  earth  would  have  to  be  specially  con- 
structed. A  series  of  carefully  conducted  experiments  on  the 
destructive  powers  of  various  earths  are  required  before  a  perfect 
system  can  be  evolved.  It  will  probably  be  found  that  an  earth 
composed  of  equal  parts  of  fine  carbon  soil,  sand  and  lime,  would 
be  the  most  rapid  of  all  combinations  for  the  destruction  of  the 
animal  matter  with  absorption  of  the  products  of  decomposition. 
In  a  cemetery  correctly  constructed,  with  twelve  feet  of  prepared 
earth  as  its  basis,  the  soil  might  remain  undisturbed,  except  for 
the  purposes  of  burial,  for  many  years.  Long  enough,  certainly, 
for  the  burial-place  of  the  majority  of  the  dead  to  be  forgotten, 
and  for  the  dead  body  to  pass  into  entire  reunion  with  the  earth 
from  whence  it  sprang.  After  a  given  and  due  time,  without  any 
injury  to  sentiment,  the  soil  could  be  removed  in  sections,  and  could 
be  resupplied  with  new  matter  for  new  burials. 

'*  The  artificial  soil  which  would  prove  the  most  efFective  for  the 


128  Ueviews,  [Ju^i 

purposes  of  burial  is  suggested  from  the  facts  the  author  has 
gleaned  during  direct  observation  of  the  action  of  different  sub- 
stances on  dead  organic  matter.  Specimens  of  such  matter  buried 
in  pure  carbon,  in  virgin  carboniferous  earth,  in  a  mixture  of  car- 
boniferous earth  and  sand,  and  in  this  latter  mixture  to  which  lime 
had  been  added,  were  found  to  undergo  quick  resolution,  in  the  last 
most  effectively,  in  the  first  least.  A  fresh  carboniferous  earth  answers 
exceedingly  well,  far  better  than  simple  vegetable  carbon.  The 
rapidity  with  which  it  deodorizes  even  decomposing  animal  matter 
is  most  remarkable.  It  may  be  said  to  act  in  a  matter  of  minutes. 
The  rapidity  with  which  it  produces  destruction  of  the  organic 
substance,  especially  if  it  be  kept  dry,  is  equally  surprising.  The 
complete  destruction  may  be  included  in  from  twenty  to  thirty 
weeks.  It  is  worthy  of  remark,  however,  that  all  the  parts  of  an 
animal  body  are  not  equally  destroyed.  The  integumentary  parts 
and  the  membranes  are  more  slowly  destroyed  than  the  muscular^ 
and  the  muscular  parts  are  more  slowly  destroyed  than  the  nervous. 
The  bony  parts  are  more  resistant  to  destruction  than  the  integu- 
ments, and  the  pigments  are  more  resistant  than  bone. 

"  It  is  not  assumed  that  the  above-named  description  of  a  pre- 
pared earth  for  the  cemetery  is  perfect.  It  is  an  approximation  to 
the  truth.  A  carefully  conducted  series  of  new  experiments  are 
required  to  bring  out  the  precise  facts."" 

It  is  possible,  and  indeed  probable,  that  in  course  of  time  many 
of  the  details  which  we  have  quoted  will  gradually  come  into 
action.  The  most  probable  reform  is  that  which  relates  to  cofiBns. 
It  is  not  likely  that  the  English  people,  in  imitation  of  Mahomedan 
populations,  will  ever  cast  the  body  of  the  dead  man  into  the  ground 
"like  a  dog"  when  it  is  committed  to  the  earth;  but  that  the 
heavy  wooden  coffin  and  the  costly  covering  of  lead  will  be  dispensed 
with  we  have  little  doubt.  At  this  moment  that  we  are  writing  a 
collection  of  wicker  coffins,  on  Mr.  Haden's  plan,  is  being  ex- 
hibited at  Sutherland  House  by  permission  of  the  Duke  of  Suther- 
land ;  and  although  v\'e  do  not  suppose  that  such  exhibition  will  in 
itself  be  more  than  a  nine  hours'  wonder,  it  indicates  at  least  by 
the  fact  that  it  is  permitted  and  patronised  a  tendency  on  the  part  of 
the  people  to  consider,  under  a  new  light,  an  old  and  hallowed 
subject. 

IV. 

The  silent  garden  of  the  Parsee,  in  which  he  exposes  his  departed 
to  the  havoc  of  the  carnivorous  birds  of  prey,  is  a  practice  of  dis- 
posal of  the  dead  which  amongst  the  civilised  nations  of  the  earth 
would  not,  we  think,  gain  friends  even  if  the  birds  of  prey  were 
ready  to  perform  the  task  of  burial.  Diogenes  himself,  sharp  as 
was  his  satire  when  he  begged  for  the  little  stick  to  be  laid  by  his 


1875.]        The  Controversy  oh  Disposal  of  the  Dead.  l29 

dead  body  that  he  might  drive  off  the  carnivora,  and  trite  as  was  his 
argument  founded  upon  the  request,  could  hardly  persuade  the 
modern  European,  American,  or  other  representatives  of  civilisation, 
as  it  now  exists,  to  follow  the  Parsee  to  the  place  of  his  dead. 


The  mode  of  disposal  of  the  dead  by  the  process  of  embalming,  a 
mode  very  ancient,  and,  in  respect  to  the  disposal  of  illustrious  per- 
sonages, all  but  universal,  is  still  likely  to  maintain  its  place.  In 
America  this  method  has  recently  undergone  a  revival,  and  it  is  not 
uncommon  in  England  to  hear  that  an  embalmment  has  been  performed. 
Quite  recently  in  the  '  Medical  Times  and  Gazette '  a  series  of 
lectures  on  the  art  of  embalming  have  been  published,  in  which  all  the 
necessary  details  are  fully  suppHed.  In  the  article  in  the  '  Popular 
Science  Review '  the  facts  about  embalmment  as  a  modern  practice 
are  condensed  in  a  few  lines,  and  the  circumstances  under  which  it 
is  justifiable,  because  useful,  are  defined. 

Embalming,  says  the  author,  has  in  these  days  been  brought  to 
such  "  perfection  that  it  may,  when  required,  be  effected  without 
danger  to  any  one  except  to  the  operator.  It  is  performed  rapidly 
by  the  process  of  injection  of  a  preserving  fluid  into  the  intestines 
of  the  dead  body.  This  solution  consists  of  chloride  of  zinc  dis- 
solved in  water ;  and  when  the  process  is  effectively  carried  out,  the 
body  is  left  with  all  its  tissues  solidified,  so  that  it  is  all  but  as  rigid 
as  stone  itself. 

"  In  the  case  of  persons  who  die  far  from  their  home,  and  whose 
friends  wish  to  have  them  retained  unburied  until  they  can  inter 
them  in  the  same  burial-ground  with  other  members  of  the  family, 
the  feeling  which  dictates  embalming  is  fairly  gratified.  In  the  case 
of  unknown  persons  who  are  found  dead,  and  around  whose  deaths 
some  doubts  hang  which  nothing  but  identity  can  solve,  the  feeling 
which  dictated  the  preservation  of  the  body  may  be  sanctioned  by 
the  requirements  of  public  justice.  But  when  the  desire  for  embalm- 
ment is  meant  only  to  gratify  a  morbid  craving,  on  the  part  of  a  few 
living  persons,  to  retain  the  mere  animal  remains  of  the  dead,  then 
the  conditions  are  changed,  and  the  only  circumstances  that  can 
justify  the  demand  fully  are  those  which  relate  to  history.  It  may 
be  urged  that  great  historical  personages  may  be  embalmed  with 
advantage ;  it  may  be  urged  that  persons  who  are  not  in  any  sense 
great,  but  who  from  some  peculiarity  of  physical  construction  are  of 
interest  to  the  natural  historian,  may  be  embalmed  with  advantage ; 
and  here  we  think  the  argument  in  favour  of  embalmment  rightfully 
ends."  Whether  such  historical  personages,  illustrious  or  peculiar, 
would  like  to  be  subjected  to  the  process  if  they  knew  the  base  uses 
to  which  they  might  ultimately  come,  we  will  not  decide. 

Ill— LVI.  9 


130  keviews.  [J^^Vj 


VI. 

The  suggested  plan  of  burial  in  the  deep  sea  carries  with  it  many 
inducements.  It  ensures  a  method  for  the  immediate  disposal  of  the 
dead  as  effective  as  cremation,  in  so  far  as  the  living  are  concerned, 
and,  from  what  we  know  of  it  as  a  practice  at  sea,  it  is,  to  the 
mourners,  as  simple  and  inoffensive  as  the  burial  in  the  earth.  It 
has  the  disadvantage  that  it  is  not  readily  available  to  inland  popu- 
lations, and  that  it  too  effectively  disposes  of  the  body  to  satisfy,  in 
every  case,  the  demands  of  the  law. 

VIT. 

Practically,  we  are  at  this  moment  driven  to  deal  with  cremation 
and  burial  in  the  earth  as  the  two  modes  for  the  disposal  of  the 
dead  most  consonant  with  our  modern  civilisation.  Eor  our  part, 
we  are  free  of  all  personal  prejudice  as  to  these  modes ;  or,  if  our 
own  feelings  were  really  influenced,  it  would  be  towards  cremation. 
We  confess  that  we  feel  as  the  English  lady,  whose  remains  were 
subjected  to  the  cinerator  at  Dresden  during  last  year,  that  the 
readiest,  most  certain,  most  wholesome  way  of  being  disposed  of  after 
death  is  to  go  through  the  fire  and  remingle  with  the  air.  What 
therefore  we  have  to  say  in  respect  to  these  methods  and  their 
relative  values  will  be  based  on  what  seems  to  us  the  true  scientific 
and  legal  aspects  of  the  question. 

Speaking,  in  this  sense  alone,  of  cremation,  while  we  admit  for  it 
that  it  is  quite  practicable  as  a  general  process,  inexpensive,  free 
from  any  except  morbid  objections  in  matter  of  feeling,  and  as  a 
mere  sanitary  measure  excellent,  there  are  against  it  two  objections 
which  seem  to  us  so  powerful  as  to  render  it  impossible  of  intro- 
duction, for  general  application. 

The  first  of  the  grand  objections  to  cremation  has  been  advanced 
with  great  force  and  effect  by  Professor  Mohr.  It  is  that  if  the 
process  were  universally  adopted  and  all  animal  remains  passed  for 
ultimate  destruction  as  organic  matter  into  the  hands  of  the  cre- 
mator, the  organic  world  would  lose  one  of  its  important  constituents. 
If  cremation  is  to  be  adopted  there  must,  he  urges — and  indeed  all 
admit  this  argument — there  must  be  such  complete  combustion  that 
not  a  trace  of  organic  vapour  or  gas  can  escape  from  the  retort. 
Any  trace  of  odours  and  foetid  compounds  escaping  from  the  retort, 
anything  in  the  nature  of  a  distillation,  would  be  so  revolting  that 
no  one  would  tolerate  the  procedure,  and  no  idea  of  value  from 
the  products  thus  given  off  would  compensate  for  the  effects 
that  would  be  experienced.  To  produce  the  perfect  combustion 
the  temperature  must  be  raised  to  a  degree  that  shall  render  the 
combustion  final.     The  very  gases  that  are  evolved  from  the  burn- 


1875. J        The  Controversy,  on  Disposal  of  the  Bead,  13l 

ing  of  the  body  must  pass  through  heated  earthenware  lattice  work^ 
so  that  they  may  be  transformed  into  what  can  fairly  be  designated 
true  inorganic  parts.  Nothing  must  remain  but  carbonic  acid, 
nitrogen,  water,  and  ash. 

In  this  complete  combustion  there  is  the  widest  possible  departure 
from  the  mode  in  which  nature,  by  her  own  processes,  disposes  of 
dead  animal  matter.  Her  plan  is  to  produce  in  the  course  of 
decay  secondary  or  intermediate  products  which  shall  again  prove  of 
service  to  the  vegetable  and,  through  the  vegetable,  to  the  animal 
kingdom.  One  of  these  products,  the  staple  of  the  vegetable 
kingdom,  is  that  combination  of  hydrogen  and  nitrogen  known  as 
ammonia.  As  yet  we  have  in  chemistry  no  artistic  synthesis  of  this 
body  by  which  it  can  be  made  available  for  the  purposes  of  organic 
growth,  and  so  we  depend  for  the  natural  development  of  it,  we  may 
say  exclusively,  upon  the  natural  decomposition  of  dead  animal  or- 
ganic remains.  What,  therefore,  would  be  the  ultimate  fate  of  the 
living  organic  world  if  the  whole  of  the  dead  organic  matter  derived 
from  the  bodies  of  the  dead  were  swept  at  once  by  intense  heat  into 
inorganic  compounds  which  have  no  sustaining  property  for  the 
vegetable  kingdom?  In  the  simple  natural  process  the  inter- 
mediate product,  the  ammonia  resulting  from  decomposition,  escapes 
into  the  air  or  is  washed  into  the  soil,  is  absorbed  by  the  plants,  is 
transformed  into  nitrogenous  tissue  by  them  and  becomes  in  turn 
available  as  food  for  animals.  By  this  wise  and  provident  means  a 
continuous  circulation  of  ammonia  between  the  animal  and  the 
vegetable  kingdoms  is  sustained.  If  we  stop  all  source  of  the  sup- 
pHes  thus  afforded  we  disturb  the  balance  of  natural  supplies,  we 
draw  upon  the  ammonia  capital  of  the  globe,  and  in  the  course 
of  time,  if  the  spendthrift  proceeding  were  kept  up,  the  loss  that 
would  be  sustained  could  not  but  be  felt  through  the  whole  of  the 
animal  kingdom,  and  could  not  but  lead  to  a  reduction  of  animal 
life.  In  the  case  of  the  loss  of  ammonia  the  mischief  is  incon- 
ceivable. There  is  here  no  order  of  compensation  going  on  in 
nature,  as  in  the  process  of  the  renewal  of  atmospheric  oxygen  by 
breathing  animals,  but  the  deduction  is  from  a  finite  quantity,  and 
the  descendants  of  the  present  races  would  have  to  bear,  should  we 
subject  them  to  the  ordeal  by  our  short-sighted  poHcy,  the  evil  of 
our  error  as  we  have  now  to  endure  the  results  of  the  folly  of  our 
ancestors  who  ruthlessly  cut  down  vast  forests,  thereby  incurring  the 
penalties  of  drought  in  some  regions  and  of  flood  and  inundation  in 
others. 

"What  is  more,  in  the  act  and  art  of  cremation  we  incur  a  second 
evil  of  deduction  from  a  finite  quantity.  To  cremate  we  must 
employ  fire  :  to  employ  fire  is  to  deduct  so  much  from  the  finite  mate- 
rials which  give  forth  heat.  In  a  word,  we  burn  the  candle  at  both 
ends  and  have  no  manner  of  compensation  beyond  the  present  satis- 


13^  Reviews,  [Ju^j 

faction  rendered  to  a  few  minds  from  the  favour  or  caprice  of  a 
fashion  that  defies  natural  capital  and  natural  law. 

There,  however,  is  another  side  to  this  question  of  economy  of 
the  resources  of  nature  which  should  in  fairness  be  put  forward.  Sir 
Henry  Thompson  sees  in  the  application  of  the  bone  ash  of  the 
burned  dead  what  we  may  call  a  "  quid  pro  quo"*'  for  loss  entailed 
by  other  means.  We  will,  that  we  may  miss  no  point  of  the  argu- 
ment, give  this  author's  view  in  full.  Let  us,  says  he,  glance  at  the 
economic  view  of  the  subject  of  cremation. 

"  It  is  not  so  important  as,  unconsidered,  it  may  appear.  For 
it  is  an  economic  subject  whether  we  will  it  or  not.  No  doubt  a 
sentiment  repugnant  to  any  such  view  must  arise  in  many  minds,  a 
sentiment  altogether  to  be  held  in  respect  and  sympathy.  Be  it  so, 
the  question  remains  strictly  a  question  of  prime  necessity  in  the 
economic  system  of  a  crowded  country.  Nature  will  have  it  so, 
whether  we  like  it  or  not.  She  destines  the  material  elements  of 
my  body  to  enter  the  vegetable  world  on  purpose  to  supply  another 
animal  organism  which  takes  my  place.  She  wants  me,  and  I  7)iusf 
go.  There  is  no  help  for  it.  When  shall  I  follow — with  quick  obe- 
dience, or  unwillingly,  truant-like,  traitor-like,  to  her  and  her  grand 
design  ?  Her  capital  is  intended  to  bear  good  interest  and  to  yield 
quick  return  :  all  her  ways  prove  it — "increase  and  multiply"  is 
her  first  and  constant  law.  Shall  her  riches  be  hid  in  earth  to  cor- 
rupt and  bear  no  present  fruit ;  or  be  utilised,  without  loss  of  time, 
value,  and  interest,  for  the  benefit  of  starving  survivors  ?  Nature 
hides  no  talent  in  a  napkin  ;  we,  her  unprofitable  servants  only, 
thwart  her  ways  and  delay  the  consummation  of  her  will. 

"  Is  a  practical  illustration  required  ?  Nothing  is  easier.  London 
was  computed,  by  the  census  of  1871,  to  contain  3,254,260  persons, 
of  whom  80,430  died  within  the  year.  I  have  come  to  the  conclusion, 
after  a  very  carefully  made  estimate,  that  the  amount  of  ashes  and 
bone  earth,  such  as  is  derived  by  perfect  combustion,  belonging  to 
and  buried  with  those  persons,  is  by  weight  about  206,820  lbs.  The 
pecuniary  value  of  this  highly  concentrated  form  of  animal  solids  is 
very  considerable.  For  this  bone-earth  may  be  regarded  as  equiva- 
lent to  at  least  six  or  seven  times  its  weight  of  dried  but  unburned 
bones,  as  they  ordinarily  exist  in  commerce.  The  amount  of  other 
solid  matters  resolvable  by  burning  into  the  gaseous  food  of  plants, 
but  rendered  unavailable  by  burial  for,  say,  fifty  or  a  hundred  years 
or  more,  is  about  5,584,000  lbs.,  the  value  of  which  is  quite 
incalculable,  but  it  is  certainly  enormous  as  compared  with  the 
preceding. 

"  This  is  for  the  population  of  the  metropohs  only  :  that  of  the 
United  Kingdom  for  the  same  year  amounted  to  31,483,700  persons, 
or  nearly  ten  times  the  population  of  London.  Taking  into  con- 
sideration a  somewhat  lower  death-rate  for  the  imperial  average,  it 
will  at  all  events  be  quite  within  the  limit  of  truthful  statement  to 
multiply  the  above  quantities  by  nine  in  order  to  obtain  the  amount 
of  valuable  economic  material  annually  diverted  in  the  United 


1875.]       The  Controversy  on  Disposal  of  the  Dead.  133 

Kingdom  for  a  long  term  of  years  from  its  ultimate  destiny  by  our 
present  method  of  interment. 

"  The  necessary  complement  of  this  ceaseless  waste  of  commodity 
most  precious  to  organic  life,  and  which  must  be  replaced,  or  the 
population  could  not  exist,  is  the  purchase  by  this  country  of  that 
same  material  from  other  countries  less  populous  than  our  own,  and 
which  can,  therefore,  at  present  spare  it.  This  we  do  to  the  amount 
of  much  more  than  half  a  million  pounds  sterling  per  annum. 

"  Few  persons,  I  believe,  have  any  notion  that  these  importations 
of  foreign  bones  are  rendered  absolutely  necessary  by  the  hoarding 
of  our  own  some  six  feet  below  the  surface.  The  former  we  acquire 
at  a  large  cost  for  the  original  purchase  and  for  freight.  The  latter 
we  place,  not  in  the  upper  soil  where  they  would  be  utilised,  but  in 
the  lower  soil,  where  they  are  not  merely  useless,  but  where  they 
often  mingle  with  and  pollute  the  streams  which  furnish  our  tables. 
And  in  order  to  effect  this  absurd,  if  not  wicked  result  we  incur  a 
lavish  expenditure  !  I  refer,  of  course,  to  the  enormous  sums  which 
are  wasted  in  effecting  burial  according  to  our  present  custom,  a  part 
of  the  question  which  can  by  no  means  be  passed  over.  For  the 
funeral  rites  of  the  80,000  in  London  last  year,  let  a  mean  cost  of 
ten  pounds  per  head  be  accepted  as  an  estimate,  which  certainly  does 
not  err  on  the  side  of  excess.  Eight  hundred  thousand  pounds  must 
therefore,  be  reckoned  as  absolute  loss  to  the  costs  already  incurred, 
in  the  maintenance  of  the  system.  Thus  we  pay  every  way  and 
doubly  for  our  folly." 

To  this  the  same  author  adds  in  a  subsequent  paragraph  : 

"  The  problem  to  be  worked  is — Griven  a  dead  body,  to  resolve  it 
into  carbonic  acid,  water,  and  ammonia,  and  the  mineral  elements, 
rapidly,  safely,  and  not  unpleasantly." 

"With  this  proposition  we  entirely  concur.  It  is  in  truth  the 
problem.  Our  argument  is  that  the  problem  is  not  solved  by  the 
process  of  cremation. 

It  is  perfectly  clear  that  the  error  which  the  advocates  of  crema- 
tion fall  into  when  they  advance  the  economical  side  of  the  question 
is  twofold  at  least.  They  obviously  overlook,  in  the  first  place,  the 
all-important  fact  that  by  the  very  perfection  of  their  art  they  break 
up  the  most  valuable  of  the  products  of  natural  decomposition,  viz. 
the  ammonia.  If  they  did  not  succeed  so  far  their  process  would 
give  rise  to  the  emanation  and  distribution  of  vapours  that  would 
be  detected  by  the  smell,  and  the  success  of  perfect  purity  to  every 
sense  which  they  claim  to  have  attained  would  be  utterly  forfeited. 
On  this  ground,  consequently,  the  economy  they  assert  is  not  main- 
tainable in  the  controversy,  The  process  is  one  of  the  direst  waste, 
for  by  it  the  very  organic  matter  of  the  skeleton,  which  is  so  valuable 
as  an  ammonia-yielding  product,  is  resolved  into  its  primary  parts_, 
its  nitrogenous  plant-forming  value  unredeemed. 

Jn  tjie  second  place  an  error  not  less  important,  and  exceedingly 


134  Reviews.  [July, 

obvious^  creeps  into  the  advocacy,  when  the  subject  of  the  value  of 
the  bone  earth  comes  before  us.  No  one  would  deny  the  value  of 
the  bone  earth  as  a  fertilising  substance,  and  no  one  would  deny,  we 
presume,  that  in  cremation  the  inorganic  bone-dust  is  very  effectively 
preserved.  But  it  is  not  easy  to  see  how  this  precious  material — 
precious  as  a  relic  of  the  dead  —  precious  as  manure — can  act 
both  kinds  of  preciousness  at  one  and  the  same  time.  We  mean 
by  this  that  if  it  be  stowed  away  in  an  urn  it  cannot  fertilise  the 
earth.  But  we  allow  that  in  due  course  of  time  it  will  by  chance 
of  fate  come  at  last  to  the  earth,  and  therefore  will  not  be  lost. 
Here  the  cremationists  are  right ;  but  they  are  wrong,  and  in  this 
their  second  great  economical  error  lies,  that  they  consider  them- 
selves performing  a  novel  and  wonderfully  saving  plan  by  bnrning 
instead  of  burying  dead  bones.  As  if  bones  did  not  resolve  in  the 
earth !  As  if  the  phosphorus  and  Hme  which  make  up  the  inorganic 
residue  of  bone-matter  could  ever  be  lost  by  the  act  of  banking  it 
in  the  place  from  whence  it  came  !  We  need  push  the  argument 
no  further.  The  man  that  burns  a  bone  and  puts  the  ash  in  an 
urn  is  certainly  not  doing  more  for  the  earth  than  the  man  who 
directly  restores  the  bone  to  the  earth.  The  difference  simply  is, 
that  the  first  is  a  miser,  the  second  a  prudent  husbandman. 

Looking  at  the  subject  of  cremation,  then,  from  these  points  of 
view — looking  at  it  as  a  conservation  or  a  destruction  of  the  natural 
order  of  events  and  material  changes — we  hold  it  to  be  a  failure  on 
the  principle  of  natural  economy. 

The  next  grand  objection  to  cremation  is  of  a  different  order,  and 
although  in  course  of  time  it  might  lose  its  force,  it  is  at  present 
potent  in  the  first  degree.  The  objection  is  medico-legal.  It  is 
urged  that  if  a  body  destroyed  intentionally  by  poison,  or  by  any 
other  secret  and  unlawful  means,  could  be  carried  straightway  to  the 
furnace,  and,  in  the  course  of  an  hour,  could  be  resolved  into  its  all 
but  elementary  form,  the  course  of  justice  would  constantly  be 
arrested;  and,  not  to  mince  the  matter,  the  cremator  would  not 
unfrequently  be  the  unwitting  slave  and  instrument  of  the  murderer. 

The  difficulty  in  the  way  of  cremation,  from  the  risk  above  stated, 
is  not  ignored  by  the  cremationists.  They  treat  it  as  ^'  an  episode" 
in  the  discussion — a  mode  of  treatment  ingeniously  expressed,  but 
indifferently  reasoned.  Sir  Henry  Thompson  would  meet  this  diffi- 
culty by  having  appointed  over  the  dead  a  new  officer — a  sort  of 
universal,  omnipresent  coroner,  who  should  take  the  place  of  the 
''  Medecin  Verificateur"  of  Paris,  without  whose  permission  no  burial 
whatever  can  take  place.  In  cases  where  there  existed  any  doubt  as 
to  the  cause  of  death  he  (Sir  Henry)  would  take  a  strong  precautionary 
measure.  He  would  have  the  stomach  and  a  portion  of  one  of  the 
viscera  preserved,  say  for  fifteen  or  twenty  years,  or  thereabouts, 
so  that  in  the  event  of  any  suspicion  subsequently  occurring  greater 


1875.]        The  Controversy  on  Disposal  of  the  Dead.  135 

facility  for  examination  would  exist  than  by  tlie  present  method  of 
exhumation/' 

We  need  not  dwell  at  any  length  on  these  propositions.  In  this 
country,  where  the  coroner  has  even  now  so  much  to  contend  with 
in  conducting  his  comparatively  simple  inquiries — simple,  we  mean, 
in  so  far  as  the  liberty  of  the  subject  is  concerned — the  ''  Medecin 
Verificateur^'  would  indeed  stand  a  poor  chance  of  being  able  to  carry 
out  his  onerous  duty.  Here,  in  fact,  such  an  officer  and  such  an 
office  would  be  utterly  impossible,  and  simply  repugnant  to  the 
genius  of  the  people.  The  second  proposition,  that  in  suspected  cases 
of  poisoning  portions  of  the  dead  body  should  be  kept  m  terrorem 
over  the  heads  of  persons,  known  or  unknown,  personally  guilty  of 
murder,  were  even  more  inconceivable  than,  the  first.  Where  would 
such  relics  be  stowed  ?  How  would  the  continuance  of  their  identity 
be  maintained  ?  How  could  it  be  proved  that  in  the  course  of  "  fifteen 
or  twenty  years,  or  thereabouts,"  between  the  times  when  they  were 
stowed  away  and  the  times  when  they  were  taken  out  to  be  analysed, 
they  had  been  free  of  all  possible  chance  of  contamination  ?  More 
than  this,  when  a  body  has  to  be  exhumed  there  is  proof  that  the 
person  or  persons  suspected  of  foul  play  has  or  have  succeeded  in 
getting  the  body  buried  before  the  suspicion  occurred.  If  such 
cunning  and  wicked  persons  could  succeed  in  committing  the  body 
to  the  earth,  could  they  not,  under  the  proposed  new  system,  succeed 
also  in  committing  it  to  the  fire,  and,  if  they  did  succeed,  of  what 
value  were  the  analytical  skill  that  has  so  certainly,  under  the 
present  system,  led  to  the  detection  of  crime  ?  We  speak  with  no 
diffidence,  because  it  is  our  duty  to  speak  with  earnestness,  and  our 
privilege  to  speak  with  the  authority  of  forensic  knowledge,  on  this 
subject ;  and  we  affirm  that  in  the  present  social  state  the  introduc- 
tion of  cremation  as  a  general  system  of  disposal  of  the  dead  would 
be  a  direct  and  efiective  incentive  to  the  perpetration  of  the  most 
hideous  of  crimes.  Let  no  man  deceive  himself  or  others  on  an 
issue  so  solemn.  The  living  world  is  not  yet  sufficiently  purified  in 
its  soul  to  purify  itself  from  its  dead  tenements  of  soul,  by  the 
unanswerable  fire. 

VIII. 

So  we  come  at  last  back  to  the  old,  old  story.  The  earth  gave 
up  to  us  from  itself  the  substance  of  our  corporeal  organization — the 
earth  demands  the  substance  back  again.  This  is  the  order  of  nature, 
and  to  fight  against  the  fact  is  waste  both  of  word  and  labour.  On  the 
line  with  nature  we  may  improve  as  we  like  (to  invent  is  impossible), 
and  remain  secure.  Off  the  line  we  may  make  noise,  and  astonish  the 
mere  lookers-on,  but  go  straight  away  we  cannot.  It  is  open  to  us 
to  improve  the  process  of  burial,  and  many  of  the  plans  which  have 
recently  been  suggested  are  deserving  of  our  best  consideration*    The 


136  Reviews*  [July, 

suggestions  to  burial  boards  issued  by  the  inspector  under  the  Burial 
Acts  indicate  on  every  page  the  desire  to  introduce  every  available 
improvement,  and  we  do  not  doubt  but  that  the  present  agitation 
will  tend  to  direct  public  opinion  in  the  right  way  to  some  greater 
advancements  in  the  art  of  burial.  To  these  advancements  we  have 
to  refer  in  detail. 

We  have  'already  seen  what  one  of  our  authors  considers  would 
be  the  best  soil  in  which  to  place  the  dead.  To  understand  the 
practical  value  of  his  suggestions,  and  the  reforms  that  would  have 
to  take  place  before  they  can  be  carried  out,  it  is  necessary  to  recall 
the  views  which  are  entertained  by  our  Government  authorities  who 
hold  office  under  the  Burial  Acts.  The  report  of  the  very  able 
Inspector  under  the  Burial  Acts  (Mr.  Holland)  comes  before  us  with 
great  effect  at  this  point  of  our  subject.  As  many  of  our  readers 
may  not  have  had  an  opportunity  of  studying  the  official  suggestions 
that  have  been  supplied,  we  shall  be  rendering  a  service  by  devoting 
a  few  paragraphs  to  them.  In  speaking  of  the  character  of  the 
soils  of  burying  grounds  as  a  subject  of  great  importance,  the 
Inspector  says  that  '^  dry,  open  soils  which  readily  admit  air  and 
moisture,  allowing  the  rain  which  falls  upon  the  surface  to  enter 
readily,  carrying  air  down  with  it,  facilitate  decay,  and  permit 
graves  to  be  sooner  reopened  for  subsequent  interments.  Porous 
soils,  mixed  with  vegetable  mould,  absorb  and  decompose  the 
products  of  decay,  and  prevent  the  escape  of  injurious  emanations, 
if  the  quantity  of  animal  matter  be  not  too  large  in  proportion  to 
the  area,  and  if  the  soil  near  the  coffin  be  left  undisturbed  until 
decomposition  is  completed.  Dense  clay  soils  are  in  all  respects 
undesirable ;  they  exclude  air  and  moisture,  retard  decomposition, 
and  render  it  improper  to  reopen  a  grave,  to  nearly  its  original 
depth,  within  any  reasonable  period.  In  some  such  soils  coffins 
have  remained  undecayed  for  thirty  years  or  more,  and  therefore 
graves  in  such  soils  can  be  used  a  very  limited  number  of  times 
only.  They  are,  moreover,  expensive  to  drain ;  they  retain  the 
gases  of  decomposition,  and  sometimes  crack,  possibly  allowing 
dangerous  exhalations  to  escape.  It  is  so  difficult  and  expensive 
to  remedy  these  defects,  that  it  is  better  to  select  an  open  than  a 
clay  soil,  even  though  the  site  be  moderately  more  distant,  or  more 
costly.  In  some  such  cases  the  plan  has  been  adopted  of  enclosing 
separately  every  coffin  buried  in  concrete  or  cemented  stone  or 
brick -work,  the  extra  cost  of  which  is  to  be  set  against  the  dimin- 
ished cost  of  less  excavation,  and  less  rapid  filling  of  space. 

"  Soils  which  have  no  proper  mould,  and  which  consist  chiefiy  of 
stone,  may  allow  of  the  passage  of  undecomposed  emanations,  and 
it  is  difficult  and  expensive  to  supply  the  mould  in  which  they  are 
deficient.     It  is  always  desirable^  before  deciding  upon  a  site,  to 


1875.]        The  Controversy  on  Disposal  of  the  Dead.  137 

have  the  soil  examined  in  various  places  to  the  depth  of  at  least  eight 
feet." 

Much  attention  has  been  paid  to  the  planting  of  burial  places, 
and  we  know  that  now  in  the  cemeteries  near  to  our  large  towns 
considerable  taste  is  shown  both  in  fencing,  planting,  and  cultivating 
vegetation.  In  his  supplementary  report  on  the  practice  of  inter- 
ment in  towns,  '^  Mr.  Loudon  recommends  for  planting  in  cemeteries 
trees  cliiefly  of  the  fastigiate  growing  kinds,  which  neither  cover  a 
large  space  with  their  branches  nor  give  too  much  shade  when  the 
sun  shines,  and  which  admit  light  and  air  to  neutralize  any  mephitic 
effluvia.  Of  these  there  are  the  oriental  arbor  vitte,  the  evergreen 
cypress,  the  Swedish  and  Irish  juniper,  &c.  Por  the  same  reason, 
trees  of  the  narrow  conical  forms,  such  as  the  red  cedar,  and 
various  pines  and  firs,  are  desirable.  In  advantageously  situated 
cemeteries,  some  of  the  larger  trees,  such  as  the  cedar  of  Lebanon, 
the  oriental  plane,  the  purple  beech,  the  dark  yew,  and  the  flowering 
ash,  sycamores,  mountain  ash,  hollies,  thorns,  and  some  species  of 
oaks,  such  as  the  evergreen  oak,  the  Italian  oak,  with  flowering 
trees  and  shrubs,  would  find  places  in  due  proportion."  The  article 
in  the  '  Popular  Science  Review'  suggests  that  under  a  perfect  system 
of  burial  there  would  be  demanded  a  modification  of  the  present 
plan  of  planting  the  surface  of  the  cemetery.  The  recommendations 
offered  are  not  very  different  from  those  of  Mr.  Loudon,  but  they 
may  be  noted.  The  author  is  of  opinion  that  to  surround  the  place 
with  trees,  not  too  thickly  set,  to  plant  small  and  handsome  trees  in 
different  parts  of  the  grounds  by  the  side  walks  and  in  odd  spots 
where  the  earth  remains  undisturbed,  would  be  unobjectionable.  The 
rugged  elm  and  yew  tree's  shade  might  still  encircle  the  homes  of 
the  dead,  but  inasmuch  as  the  earth  in  which  the  burials  are  made 
should  be  a  movable  earth  it  would  be  impossible,  except  in  parti- 
cular instances,  to  plant  over  any  one  body  any  special  or  lasting 
tree  or  shrub.  The  ground  levelled  at  once  after  burial  should  be 
covered  with  rapidly  growing  vegetation ;  such  quick-growing 
grasses  as  can  be  mown  and  utilised  either  as  food  for  herbivorous 
animals  or  as  manure  for  other  land.  Thus  the  products  of  de- 
composition from  the  dead,  which  by  diffusion  would  find  their  way 
to  the  surface,  would  be  removed,  by  their  transformation  into  new 
forms  of  matter,  as  rapidly  as  they  were  evolved  and  distributed. 

Mr.  Holland,  who  also  favours  the  planting  of  evergreen  and 
quick-growing  trees  in  cemeteries,  supplies  useful  directions  on  the 
position  the  trees  and  shrubs  should  hold  in  the  grounds.  It  is  of 
importance,  he  tells  us,  "  that  trees  and  shrubs  should  not  cover  too 
large  a  portion  of  the  burial  ground,  and  that  they  should  not  be 
too  closely  planted,  or  should  be  thinned  out  as  they  grow  large,  to 
avoid  interfering  with  the  ventilation  and  with  the  free  passage  of 
air.     A  suitable  disposal  of  trees  or  shrubs  along  roads  or  pathways 


138  Reviews,  [July, 

would  afford  shelter  to  persons  visiting  graves,  and  to  funeral  pro- 
cessions. It  is  customary  in  well-regulated  cemeteries  to  avoid  bury- 
ing close  to  the  boundary  fence.  On  many  accounts  this  is 
advisable,  as  there  is  no  law  to  prevent  houses  being  built  and 
wells  sunk  close  to  a  burial  ground;  there  is,  moreover,  a  disposi- 
tion to  erect  houses  in  the  vicinity  of  ornamental  cemeteries.  Much 
of  the  evil  may  be  prevented  by  draining  the  ground  in  such  a  man- 
ner as  to  prevent  the  water  passing  into  the  subsoil  of  the  neighbour- 
hood, and  by  the  adoption  of  proper  regulations  as  to  burial ;  but  it 
would  nevertheless  be  advisable  to  leave  a  belt  of  land  for  planting 
between  the  fence  and  the  nearest  graves.  This  strip  of  ground 
would  not  be  wasted,  for  part  of  it  might  be  used  as  a  walk,  and 
part  for  ornamental  shrubs.  A.  surrounding  belt  of  shrubbery 
would  contribute  to  the  seclusion  of  the  ground,  and  need  not  be  so 
close  as  to  check  too  much  the  free  passage  of  air." 

It  happens  in  some  localities  that  these  requirements  for  particular 
soils  and  vegetations  are  next  to  impossible.  The  carboniferous  soil 
does  not  exist  near  to  the  communities  for  which  it  is  required,  and 
in  the  hard  clayey  bed  of  earth  which  is  alone  obtainable  the  resolu- 
tion of  the  dead  body  is  long  delayed.  Cemeteries  fixed  in  such 
grounds  are  of  all  the  most  difficult  to  keep  in  proper  condition,  and 
many  schemes  in  the  way  of  draining  have  been  proposed  in  vain. 
If  any  cemeteries  are  actually  dangerous  to  the  community  these 
are,  and  so  long  as  the  cemetery  system  lasts  they  will  remain  an 
equal  trouble  to  the  sanitarian  and  the  engineer. 

The  best  mode  of  burying  in  such  localities  is  probably  that  which 
was  indicated  twenty  years  ago  in  the  ^  Journal  of  Public  Health 
and  Sanitary  Eeview.^  This  consists  in  enveloping  the  dead  in  a 
layer  of  charcoal,  a  process  which,  says  the  writer,  is  nothing  more 
nor  less  than  a  slow  combustion.  As  a  proof  of  the  effects  of  char- 
coal in  this  respect  it  is  recorded  that  the  Messrs.  TurnbuU,  the 
well-known  manufacturers  of  charcoal  in  Glasgow,  made  the  experi- 
ment of  burying  a  horse.  They  surrounded  the  carcase  of  the  animal 
with  eight  inches  of  charcoal,  and  discovered  that  every  portion  of 
the  carcase,  except  the  skeleton,  was  destroyed  within  twelve  months. 
They  observed  that  during  the  whole  of  this  time  there  was  no  trace 
of  deleterious  exhalation  from  the  decomposing  body;  and  they 
further  observed  that  moisture  from  rain  did  not  materially  modify 
the  destructive  process.  In  commenting  on  this  experiment  he 
author  adds  that  he  had  confirmed  it  on  a  smaller  scale,  and  that  the 
had  the  authority  of  Dr.  Stenhouse  for  stating  that  peat  charcoal 
would  answer  for  the  same  purpose,  and  that  the  reduction  of  the 
substance  to  a  state  of  fine  division  is  not  necessary. 

Since  the  above-named  proposition  was  made  in  1855  the  system 
advocated  has  many  times  been  carried  out,  and  we  believe  with 
success.    The  difficulties  of  its  extension  have  arisen  from  the  cir- 


1875.]  The  Controversy  on  Disposal  of  the  Dead.  139 

cumstances  that  the  introduction  of  peat  charcoal  into  common  use 
has  been  much  less  easy  than  was  originally  anticipated,  and  that 
the  price  of  ordinary  vegetable  charcoal  has  considerably  increased. 
These  difficulties,  we  fear,  are  not  likely  to  be  lessened  in  the 
future. 

IX. 

As  we  glance  over  that  which  we  have  written  and  take  a  final 
survey  of  the  books  which  have  served  us  for  our  texts,  we  are 
brought  sharply  to  the  conclusion  that  after  all  there  is  nothing 
before  us  that  is  new ;  nothing  on  which  we  are  able  to  form  any 
conclusion  of  a  novel  character ;  nothing  that  strikingly  indicates  a 
great  revolution  in  modes  of  disposal  of  the  dead.  Cremation,  with 
all  the  fascinations  of  science  which  surround  it,  and  with  all  the 
advantages  which  spring  from  science  practically  supporting  it,  is, 
as  we  have  seen,  simply  impossible  at  this  imperfect  stage  of  civili- 
sation. It  may  one  day  take  a  prominent  place,  and  it  might, 
under  an  exceedingly  wise  legislative  enactment,  be  permitted  in 
this  country  at  a  comparatively  early  day.  Concerning  it  we  can 
say  nothing  further. 

On  the  matter  of  burials  in  the  earth  we  are  convinced  that 
steady  improvements  will  continue.  No  one  who  recalls  the 
old  and  loathsome  grave-yards,  and  who  contrasts  these  with  the 
new  and  beautiful  cemeteries  which  chasten  and  even  adorn  our 
towns  and  villages,  can  doubt  that  since  the  days  of  Mr.  Walker's 
magnificent  protest  advancements  have  been  made  which  that 
ardent  reformer  could  hardly  have  anticipated.  What,  therefore, 
may  be  the  greater  advancements  in  coming  years,  when  the  public 
mind  is  so  earnestly  being  directed  to  and  led  into  a  study  which 
it  has  previously  avoided  rather  than  courted,  it  is  impossible  to 
say.  But  the  duty  of  the  man  of  science,  in  his  capacity  as  a 
practical  teacher  of  the  people,  is  clear.  It  is  his  duty,  without 
too  severely  wounding  deeply-rooted  prejudices,  which  after  all  have 
their  origin  in  the  sentiments  of  reverence  and  affection,  to  teach 
that  nature  demands  for  the  perpetuation  of  the  living  present,  not 
the  destruction,  but  the  return  of  the  materials  of  the  dead.  That 
the  world  of  life,  constructed  from  a  limited  supply  of  matter, 
rebuilds  itself  out  of  the  quarry  of  death,  and  that  every  plan 
which  has  for  its  object  the  restoration  of  the  body  to  the  earth, 
with  the  least  possible  interruption  to  the  ordination  of  nature, 
should  be  accepted  as  the  wisest  plan,  the  best  for  the  present,  the 
best  also  for  the  future  generations  of  mankind. 


140  Reviews.  [July* 


XI. — Hospital  Reports.^ 

Regarding  hospitals,  and  particularly  those  of  the  metropolis, 
with  their  attached  schools,  their  staff  of  medical  officers  enjoying 
European  reputation,  their  large  fields  of  experience  and  unequalled 
opportunities  of  turning  that  experience  to  account  for  the  advance- 
ment of  medical  and  surgical  knowledge  both  theoretically  and  prac- 
tically, as  the  chief  centres  of  medical  instruction  and  observation  in 
the  country,  no  division  of  medical  literature  would  seem  to  have  a 
higher  claim  upon  our  attention  than  the  reports  of  the  work  car- 
ried on  within  their  walls.  As  we  especially  look  for  the  enlarge- 
ment of  chemical  knowledge  to  systematic  and  continuous  work 
in  an  extensive  and  well-ordered  laboratory  under  the  direction  of 
one  or  more  chemists  of  repute,  so  we  might  naturally  look  pre- 
eminently to  hospitals,  viewed  as  laboratories  for  examining  and 
analysing  morbid  conditions,  and  for  the  extension  of  therapeutical 
science.  And  doubtless  medicine  and  surgery  are  indebted  very  largely 
for  the  advancement  they  have  made,  both  directly  and  indirectly, 
to  hospitals  as  fields  of  practice  and  inquiry.  Yet  this  good  result 
has  not  for  the  most  part  appeared  as  the  direct  outcome  of  our 
hospitals,  but  has  been  filtered  to  us  through  the  written  works 
and  lectures  of  their  physicians  and  surgeous ;  and,  what  is  more, 
has  been  represented  only  in  one  or  more  phases  dictated  by  the 
special  views  of  the  particular  writers  or  teachers.  Consequently 
there  seems  reason  for  the  production  of  reports  of  the  general 
work  done  in  hospitals ;  that  the  extent,  nature,  and  tendency  of 
that  work  may  be  known;  that  the  purposes  aimed  at  and  the 
results  achieved  may  be  understood,  and  that  the  defects  and  weak- 
nesses in  our  principles  and  practice  may  be  displayed  by  the 
experience  the  wards  supply.  By  thus  laying  open  before  the 
profession  the  doings  of  the  several  principal  hospitals  of  London 
and  other  chief  towns,  the  professional  mind  might  be  made  cogni- 
zant of  the  direction  of  modern  medical  opinion  and  of  the  modes 
of  practice  most  approved.  And  as  the  general  public  resort  to  a 
chemical  laboratory  to  obtain  an  analysis,  so  the  members  of  the 
profession  should  be  able  to  look  to  the  records  of  hospital  work  in 
elucidation  of  difficult  problems,  or  might  submit  questions  in 
pathology  and  practice  to  one  or  other  hospital  for  solution.  This 
subject  of  hospital  utilization  is  one  for  an  essay,  and  not  for  the 
introductory  observations  to  a  notice  of  Hospital  Eeports.      We 

^  1.  Gu^'s  Hospital  Eeports.     Vol.  xx.     Third  Series.     1875. 

2.  St.  Thomas's  Hospital  Eeports.     New  Series.     Vol.  v.     1874. 

3.  St.  Bartholometo' s  Hospital  Reports.     Vol.  x.     1874. 

4.  St.  George's  Hospital  Eeports.    Vol.  vii.     1875. 


1875.]  Hospital  Reports.  l4i 

may  remark,  however,  that  no  hospital  we  know  of  at  the  present 
time  approaches  a  perfect  machine  for  evolving  medical  truths  and 
fitly  advancing  medical  science.  Nor  do  any  of  the  Hospital  Eeports 
pubhshed  reahse  to  us  the  actual  character  of  work  accomplished 
within  the  hospitals.  Only  imperfectly  do  they  deal  with  definite 
questions  in  pathology  and  practice  submitted  to  investigation,  and 
very  rarely  do  they  set  before  us  comparative  results. 

As  matters  stand,  the  several  Hospital  Eeports  published  are  collec- 
tions of  essays  and  reports  of  cases  by  the  physicians  and  surgeons  of 
each  hospital,  and  by  gentlemen — outsiders,  in  practice  here  or  there — 
who,  as  a  rule,  for  the  most  part  have  been  students  of  the  hospital;  and 
respecting  the  contained  papers,  it  may  be  observed  that  those  from 
outsiders  are,  voluntary  offerings ;  and,  as  the  maxim  directs  us 
^^  not  to  look  a  gift  horse  in  the  mouth,^'  such  contributions  cannot  be 
subjected  to  a  very  critical  ordeal  before  insertion  (and  the  less  so  as 
the  editors  of  the  reports  are  called  upon  to  make  up  a  certain  quantity 
of  matter) ;  they  are  thankfully  received,  and  prove  of  varying  im- 
portance and  interest.  Again,  as  to  contributions  supplied  by  the 
hospital  staff,  they  are  of  a  heterogeneous  character  and  now  and 
then  look  like  chance  papers,  the  stray  products  of  the  portfolio  that 
have  not  found  their  way  into  the  volumes  of  transactions  of  one  or 
other  learned  society  ;  and  the  impression  conveyed  by  such  papers 
is  that  they  have  been  thrown  out  to  appease  the  hungry  demand 
of  the  editor  for  "  copy.^'  It  may  be  assumed  that  the  editors  of 
Hospital  Eeports  endeavour,  for  the  credit  of  their  volumes  and  of 
their  schools,  to  secure  the  co-operation  of  their  most  eminent  col- 
leagues; but  here  again  a  defect  is  observable,  that  those  dis- 
tinguished individuals  are  not  uncommonly  limited,  and  not  con- 
stant contributors  to  the  reports.  In  other  words,  the  principal 
individuals  in  the  hospital  engaged  in  its  chief  work,  the  best  versed 
in  the  operations  and  experiments  performed,  and  the  best  trained 
for  research  and  the  deduction  of  truths,  are  the  least  concerned  in 
furnishing  records  of  observations  and  facts — in  a  word,  in  giving  the 
history  of  its  work.  Hence  it  happens  that  the  larger  proportion  of 
the  contents  of  the  Hospital  Eeport  is  the  production  of  the  junior 
members  of  the  staff.  We  would  not  imply  that  the  work  of  the 
latter  is  not  of  great  merit,  nor  even  that,  as  a  matter  of  course,  it  is 
inferior  in  quality  to  what  might  be  produced  by  their  seniors  in 
hospital  standing ;  we  are  arguing  only  on  the  broad  general  principle 
that  those  who  have  enjoyed  a  longer  and  wider  range  of  observation 
and  experience  are  to  be  accounted  as  more  able  to  instruct  their 
fellow-men. 

The  section  of  the  Hospital  Eeports  under  notice  that  best  repre- 
sents a  record  of  work  done  is  that  of  statistics.  But  to  these  it  may  be 
objected  tliat  they  are  deficient  in  bringing  out  facts  as  to  pathology 
and  treatment  available  to  the  practitioner,  and,  indeed,  also  to  writers 


14)1  keviews.  [July^ 

on  any  special  subject.  In  the  case  of  the  Reports  of  Guy^s  and 
Bartholomew's  Hospitals  the  statistics  are  very  bald,  and  afford  only 
the  dry  light  that  can  be  used  by  statisticians.  But  both  the  St. 
George^s  and  the  St.  Thomas's  Eeports  supply,  not  only  figures,  but 
notes  of  cases,  digests,  statements  regarding  morbid  appearances  and 
treatment.  But  in  one  and  all  of  them  we  lament  the  scarcity  of 
summaries  calculated  to  instruct  in  pathology  and  in  therapeutics,  and 
of  systematic  inquiry  pursued  with  the  purpose  of  clearing  up  the 
many  problems  inherent  in  the  principles  and  practice  of  medicine 
and  surgery,  such  as  might  naturally  be  looked  for  as  the  products 
of  hospital  experience. 

We  are  smitten  with  compunction  at  what  we  have  written.  We 
have  reversed  the  example  of  the  son  of  Beor ;  for  we  sat  down  to 
bless  altogether  the  volumes  before  us,  but  some  critical  spirit  has 
possessed  us  thus  far  and  perverted  our  generous  intentions.  We  change 
our  point  of  view,  and  now  look  upon  those  volumes  as  collections 
of  valuable  contributions  calculated  to  benefit  the  professional  world. 
We  recognise  the  painstaking  work  of  many  of  those  contributions, 
and  our  regret  is  that  we  cannot  present  an  analysis  of  them  for 
the  advantage  of  our  readers.  Their  subjects  are  very  diverse, 
ranging  over  the  whole  area  of  medical  and  surgical  knowledge, 
and  possess,  therefore,  a  varying  degree  of  interest  to  individuals 
according  to  the  particular  direction  of  their  studies.  The  number 
of  separate  articles  in  the  four  volumes  referred  to  in  connection 
with  this  notice  is  very  considerable,  and  to  make  only  a  few  notes 
on  each  of  them  would  involve  the  production  of  a  lengthened 
review  such  as  could  not  find  a  place  for  in  the  present  journal.  To 
select  some,  even  without  making  comparisons  between  the  papers 
in  the  several  Hospital  Reports,  would  be  an  invidious  task,  and  one 
open  to  muchcriticism,  inasmuch  as  ourprivate  judgment  of  the  interest 
and  value  of  this  or  that  article  must  be  much  influenced  by  our 
own  predilections  and  special  studies.  We  therefore  defer  making 
quotations,  and  feel  less  hesitation  in  so  doing  than  we  might  other- 
wise do,  for  this  further  reason,  that  those  papers  best  calculated  to 
place  on  a  surer  footing  or  to  widen  our  range  of  professional 
knowledge  are  just  those  which  will  obtain  their  due  recognition  in 
the  pages  of  this  review,  in  one  or  more  of  those  analytical  articles 
we  especially  cultivate,  intended  to  exhibit  our  present  state  of  in- 
formation with  respect  to  the  principal  subjects  in  medical  and 
surgical  science  that  arrest  attention  at  the  present  day.  There  is 
yet  another  reason  for  any  apparent  neglect  of  the  contents  of  these 
volumes,  namely,  that  some  of  the  more  important  papers  are  struck 
off  by  the  desire  of  their  authors  and  published  as  separate 
pamphlets,  whilst  others  appear  in  a  somewhat  different  dress  among 
the  recorded  transactions  of  the  medical  societies,  or  are  sooner  or 
later  expanded  into  special  treatises,  or  otherwise  get  absorbed  in 


1875.]  Hospital  Reports.  l43 

the  published  teachings  of  their  writers.  In  other  words,  in  the 
struggle  for  existence,  and  barring  those  to  which  parental  fondness 
and  determination  may  give  a  passing  existence  by  spasmodic  pains 
and  expenditure,  those  essays  best  fitted  to  maintain  an  independent 
and  worthy  vitality  are  sure  to  survive  and  to  become  sooner  or  later 
objects  of  attentive  consideration  and  due  esteem. 

We  are  glad  to  observe  the  amount  of  support  accorded  to  these 
volumes  in  the  way  of  subscriptions,  for  the  most  part  contributed 
by  former  students  of  the  hospitals  they  respectively  relate  to. 
They  are  well  worthy  of  this  support.  It  might  be  given  with  ad- 
vantage both  to  editors  and  readers  in  a  much  higher  proportion; 
for  these  publications  are  replete  with  valuable  and  useful  know- 
ledge, and  are  calculated  to  keep  their  readers  aio  courant  to  the 
latest  growth  of  medical  science,  and  there  is  nothing  like  encour- 
agement to  improve  yet  further  their  quality. 

The  critical  spirit  returns  to  us  and  compels  us,  in  spite  of  our 
admiration  of  so  many  excellencies  in  these^volumes,  to  reiterate  our 
primary  observations  and  expressed  views  as  to  what  Hospital 
Eeports  should  be,  and  to  put  forward  the  desire  that  the  so-called 
Hospital  Eeports  should  no  longer  be  a  congeries  of  contributions 
by  a  multitude  of  writers  both  connected  and  unconnected  with  the 
hospitals,  and  so  far  resemble  a  volume  of  transactions  of  a  learned 
society,  but  be  veritable  transcripts  of  the  results,  theoretical  and 
practical,  arrived  at  in  the  wards,  in  the  laboratories  connected  with 
them,  and  in  the  dead-house.  That,  moreover,  they  should  present 
series  of  observations  continued  over  a  lengthened  period,  and 
directed  towards  well  and  previously  defined  purposes.  CHnical 
lectures  delivered  to  students  are  out  of  place  in  their  pages ;  and 
scrappy  notes  of  cases,  few  in  number  and  unaccompanied  by  a 
comprehensive  review  of  the  morbid  states  they  exemplify,  are  no 
better  than  encumbrances  of  their  space. 


XII.— The  Leprous  Diseases  of  the  Eye.^ 

The  present  work  gives  for  the  first  time  a  full  account  of  the 
different  affections  of  the  eye  that  are  found  to  occur  in  consequence 
of  leprosy.  Eevision  by  an  Englishman  would  have  considerably 
improved  the  style,  though  we  must  at  once  add  that  the  authors' 
language  is  easily  understood  and  the  matter  excellent,  giving  a  clear 
insight  into  the  nature  of  these  manifold  pathological  states.  A 
short  analysis  will  suffice  to  call  attention  to  this  book,  which  we 
are  glad  to  recommend  to  all  interested  in  the  subject.     The  authors 

1  The  Leprous  Diseases  of  the  Eye.  With  6  Coloured  Plates.  By  Dr,  0.  B. 
Bull  and  Dr.  S.  B.  Hansen.    Christiania  and  London,  1873.    8vo,  pp.  27. 


144  Review^.  [July, 

distinguish  two  forms  of  leprosy^  the  tubercular  and  the  smooth : 
both  are  ordinarily  well  characterised  by  the  difference  in  their 
course.     Leprous  affections  of  the  nerves  occur  in  both  forms. 

The  diseases  of  the  eye  may  be  distributed  into  those  which  are 
the  immediate  result  of  leprosy  and  those  which  are  only  indirectly 
produced  by  it^  as  paralysis  of  the  orbicularis  following  upon  leprous 
disease  of  the  facial  nerve. 

Cornea. — A  superficial  opacity  commences  at  the  margin  of  the 
cornea^  and  gradually  spreads  over  a  greater  or  less  extent  of  it  in 
most  leprous  patients  ;  those  suffering  from  the  tubercular  form  are 
especially  liable  to  this  change.  It  usually  occurs  in  both  eyes  at 
the  same  time,  although  more  marked  in  the  one  than  in  the  other, 
and  begins  at  the  upper  and  outer  edge.  Delicate  vessels  can  be  seen 
very  often  with  a  lens,  and  sometimes  by  the  unaided  eye,  to  pass 
from  the  conjunctival  and  subconjunctival  vessels  into  the  opaque 
part,  and  they  are  sometimes  so  abundant  as  to  give  it  a  dirty  red- 
dish colour.  Small,  more  opaque,  white  spots  can  also  be  seen  in 
and  near  the  margin  of  the  opacity.  They  are  at  a  greater  distance 
from  one  another  towards  the  centre  of  the  cornea,  and  may  be 
traced  by  focal  illumination  far  within  the  more  uniform  peripheral 
obscuration,  separated  from  it  and  from  each  other  by  perfectly 
pellucid  spaces. 

Such  nebulae  may  appear  at  very  early  stages  of  leprosy ;  their 
progress  is  usually  very  slow.  The  periodicity,  which  characterises 
the  whole  disease,  may  be  also  noticed  in  their  development. 

"  The  state  remains  for  years  unchanged ;  then  suddenly  an  hy- 
peraemia  of  the  cornea  supervenes,  during  which  the  whole  obscura- 
tion may  be  overcast  with  vessels  extending  far  over  the  cornea. 
AVhen  the  hypersemia  has  existed  for  some  time  it  goes  back  again, 
but  leaves  a  greater  obscuration.  The  more  frequently  the  vascular 
injection  occurs  the  less  completely  it  usually  disappears  ;  and  in  a 
more  advanced  stage  we  have  always  found  the  obscuration  also 
microscopically  covered  with  vessels.  As  the  process  advances, 
more  and  more  of  the  cornea  becomes  obscured ;  but  it  is  an  ex- 
ceptional case  when  the  whole  cornea  is  darkened  in  this  manner. 
The  centre  usually  remains  free ;  but  we  have  seen  cases  in  which 
the  whole  surface  of  the  cornea  had  become  opaque,  and  had  the 
appearance  of  dull  ground  glass." 

Small  superficial  slices  of  the  affected  portion  of  cornea,  placed  in 
a  half  per  cent,  solution  of  chloride  of  soda,  showed  under  the  normal 
epithelium  leprous  elements  of  the  size  of  a  white  blood-globule  and 
even  less.  Alterations  of  the  corneal  cells,  which  perfectly  corre- 
spond to  those  in  traumatic  keratitis  in  rabbits,  were  found  in  a 
cornea  removed  five  hours  after  death.  The  vascular  part  of  the 
opacity  appears  to  be  anatomically  just  like  the  pannus,  which  can 
be  produced  in  young  rabbits  by  a  thread  passed  through  the  eye  in 


1875.]  Leprous  Diseases  of  the  Eye.  145 

the  region  of  the  ciliary  body.  The  author's  conclusion  is,  that  the  new 
cells  (leprous  elements)  are  derived  both  from  the  corneal  corpuscles 
and  from  the  blood-vessels  ;  the  greater  part  indeed  from  the  latter, 
"  because  the  mass  of  altered  corneal  cells  does  not  stand  in  any 
proportion  whatever  to  the  mass  of  new  cells.''' 

There  can  rarely  be  any  question  of  treatment.  A  strip  of  con- 
junctiva round  the  cornea  ought,  perhaps,  to  be  excised  in  a  few 
cases,  where  the  opacity  threatens  to  extend  in  front  of  the  pupil. 

Tuber  cornece. — Instead  of  being  diffused  over  a  large  surface  in 
a  thin  layer,  the  leprous  products  may  be  accumulated  into  a  mass, 
so  as  to  form  a  tuber.  This  is  always  preceded  by  a  superficial 
opacity,  and  commences  at  the  margin  of  the  cornea,  in  the  great 
majority  of  cases  towards  the  outer  side.  Both  eyes  are  usually 
attacked  and  the  tubers  are  placed  symmetrically  on  corresponding 
spots.  The  first  indication  of  this  process  is  given  by  a  circum- 
scribed conjunctival  and  subconjunctival  injection,  of  a  triangular 
form,  with  its  base  close  to  the  edge  of  the  cornea.  This  is  followed 
after  a  time  by  a  yellowish-red  elevation,  which,  as  it  increases  in 
size,  extends  on  to  the  cornea  ;  the  swelling  is  not  uniform,  it  slopes 
gradually  outwards,  but  ends  abruptly  on  its  inner  side.  Its  surface 
becomes  uneven.  It  may  at  last  entirely  cover  the  cornea  and  pre- 
vent closure  of  the  eyelids.  It  often  remains  for  years  unchanged ; 
finally  it  is  absorbed,  or  in  rarer  cases  ulcerates  away,  the  globe 
usually  shrinking  considerably  at  the  same  time. 

When  the  tuber  is  developed  in  the  deep  layers  of  the  cornea,  it  may 
advance  between  the  lamellae  like  a  wedge  ;  its  colour  is  then  less  red, 
but  usually  more  grey  than  when  superficial.  Such  growths  often 
appear  simultaneously  in  the  same  eye,  both  on  the  surface  and  in  the 
deeper  layers  of  the  cornea.  The  more  superficial  take  their  origin 
from  an  episcleral  formation ;  from  this  they  advance  under  the 
corneal  epithelium,  or  pass  along  the  vessels  into  the  middle  of  the 
membrane,  leaving  both  the  anterior  and  posterior  portions  pellucid. 
The  conjunctiva  is  freely  movable  over  the  episcleral  growth.  The 
most  deeply  placed  tubers  proceed  from  the  region  of  Schlemm's 
canal,  and  extend  into  the  cornea  immediately  in  front  of  the  mem- 
brane of  Descemet,  the  spaces  between  the  fibres  of  the  pectinate 
ligament  becoming  closely  packed  with  round  corpuscles. 

The  treatment  is  unsatisfactory.     The  authors  state  that — 

**  The  development  of  tubers  on  or  in  the  cornea  is  far  more  danger- 
ous for  the  sight  than  the  superficial  corneal  obscuration ;  and  these 
tubers  are  (with  the  tubers  on  the  iris)  perhaps  the  aff'ections  which 
blind  the  greatest  percentage  of  leprous  patients.  In  any  case  very 
little  can  usually  be  done  to  prevent  their  growth,  which'ia  destruc- 
tive to  the  eye. 

"  Where  as  yet  only  episcleral  infiltration  has  existed,  where  the 
tuber  is  just  begining  to  encroach  on  the  cornea,  it  has  occasionally 

111— LVI.  10 


146  Reviews.  L*^"^^* 

been  possible  to  prevent  further  progress,  for  a  time,  by  energetic 
cautery  applied  along  the  corneal  margin.  In  order  to  obtain  any 
result  the  cautery  must  penetrate  so  deeply  that  all,  not  only  the 
conjunctival,  but  also  the  submucous,  vessels  are  destroyed  by  it. 
"Wounds  from  cautery  heal  easily,  and  are  usually  not  attended  with 
much  inconvenience  to  the  eye.  If  the  tuber  has  grown  to  any 
size  all  treatment  is  fruitless.  It  has  repeatedly  been  attempted  to 
excise  parts  of  the  tubers,  and  cauterize  the  surface  of  the  wound 
with  nitrate  of  silver  ;  but  the  results  of  the  operation  have  not  been 
encouraging,  as  the  tumours  have  grown  uninterruptedly.  The  only 
thing  to  be  done  when  the  tubers  are  so  far  advanced  in  growth  that 
they  begin  to  cover  the  pupil,  which  is  frequently  fixed  by  films  of 
exudation,  is  to  make  a  coremorphosis  behind  the  most  pellucid  part 
of  the  cornea.  The  operation  has  no  influence  on  the  growth  of  the 
tuber,  and  can  only  be  considered  as  a  palliative.  Against  the  de- 
velopment of  tubers  in  the  profound  layers  of  the  cornea  we  are 
completely  powerless ;  operations  have  been  repeatedly  attempted, 
but  without  avail." 

Keratitis  punctata,  an  affection  not  specially  leprous,  often 
accompanies  iritis,  especially  in  the  tuberous  form.  Numerous  dots, 
brown  or  grey,  appear  in  the  cornea,  of  which  the  lower  half  is  the 
part  usually  affected.  In  time  the  cornea  may  again  clear,  or  on 
the  other  hand  the  spots  may  remain  for  years  without  alteration. 

The  sclera  is  scarcely  afi'ected,  apart  from  the  infiltrations  of  the 
episcleral  tissue,  which  accompany  superficial  corneal  tubers. 

Iris. — As  in  the  cornea,  the  leprous  elements  are  spread  over  a 
large  surface,  or,  which  happens  less  frequently,  collected  into 
tubers.  Traces  of  iritis  are  found  in  30  per  cent,  of  all  leprous 
patients.  In  the  smooth  form  the  iritis  is  usually  secondary  to 
corneal  ulceration  after  paralysis  of  the  orbicularis,  and  does  not 
appear  till  eight  or  ten  years  after  the  commencement  of  the  disease. 
It  is  directly  due  to  the  dyscrasy  in  some  exceptional  cases.  In 
tuberous  leprosy,  where  it  is  a  direct  result  of  the  disease,  it  is  as 
frequent  as  in  the  smooth  form.  It  is  often  chronic ;  exudations 
along  the  edge  of  the  pupil  and  adhesions  to  the  capsule  are  not 
unfrequeutly  found  in  patients  who  have  not  noticed  pain  or  im- 
pairment of  the  sight.  When  acute,  it  is  usually  attended  with 
pain;  after  severe  pain,  pericorneal  injection,  and  diminished  power 
of  vision.  The  vitreous  is  almost  always  hazy  during,  or  soon  after, 
an  acute  attack.  The  haziness  usually  disappears  in  some  months, 
though  after  repeated  attacks  floating  bodies  will  remain.  Both  eyes 
are  usually  affected. 

"  The  obscuration  of  the  corpus  vitreum,  observed  during  the  more 
acute  inflammations,  shows  that  the  corpus  ciliare  and  choroidea 
suffer  also.  Such  inflammations  are,  therefore,  to  be  considered  as 
iridocyclites  or  iridochoroidites.  We  have,  however,  not  yet  found 
circumscribed  atroj)hies,  pigmentary  spots,  nor  anything  like  rem- 


1875.]  Leprous  Diseases  of  the  Eye.  147 

nants  of  circumscribed  or  diffuse  choroiditis  in  patients  who  have 
frequently  suffered  from  acute  iritis.  On  the  other  hand,  we  have 
often  seen  that  there  has  remained  a  light  greyish  obscuration  o£ 
the  parts  of  the  retina  which  surround  the  optic  disc,  with  a 
relative  tenuity  of  the  retinal  arteries.  We  have  noticed  in  these 
cases  a  considerable  diminution  in  the  power  of  vision,  even  if 
there  has  not  been  any  synechia  or  deposit  on  the  anterior  capsule 
of  the  lens." 

The  iris  is  less  liable  to  tubers  than  the  cornea:  those  of  the 
former  part  are  not  unfrequently  accompanied  by  similar  growths  in 
the  latter.  They  always  commence  at  the  periphery,  usually  in  the 
lower  half.  A  partial  ciliary  staphyloma  at  the  place  corresponding 
to  the  tuber  is  not  uncommon.  The  anatomical  changes  are  ia  all 
essential  points  the  same  as  in  the  cornea.  The  iritis  requires  the 
usual  treatment,  atropine,  morphia  subcutaneously,  leeches,  &c. 
The  tubers  may  be  removed  by  iridectomy. 

Retina. — No  pathological  change,  attributable  to  leprosy,  has 
been  found  in  the  fundus  of  the  eye  in  more  than  200  cases  care- 
fully examined  by  the  authors,  with  the  ophthalmoscope.  A 
secondary  affection,  in  the  form  of  white  spots  near  the  ora  serrata, 
has  indeed  been  seen  in  the  dissection  of  some  eyes,  but  only  where 
the  iris  and  ciliary  body  were  much  diseased. 

The  eyebrow  is  a  region  most  liable  to  leprous  deposits.  Falling- 
off  of  the  eyebrows  is  an  early  and  characteristic  symptom  of  the 
disease.  Tubers  in  the  eyelid  may  be  excised  when  they  incon- 
venience the  patient  by  their  position  or  magnitude. 

The  conjunctiva  sometimes  becomes  infiltrated,  when  a  tuber  is 
rapidly  growing  in  the  cornea,  but  it  does  not  appear  to  be  inde- 
pendently attacked.  Paralysis  of  the  orbicularis  is  a  result  of 
leprous  disease  of  the  facial  nerve.  It  progresses  very  slowly,  never 
becomes  quite  complete,  and  is  accompanied  by  inflammatory 
changes  in  the  conjunctiva  and  cornea  in  no  way  different  from 
those  produced  by  other  causes.  The  authors  have  never  met  with 
anaesthesia  of  the  cornea,  and  do  not  believe  in  the  existence  of  the 
"  neuro-paralytic  keratitis  "  said  to  be  found  in  some  lepers.  They 
have  had  good  results  in  a  considerable  number  of  cases  of  paralytic 
ectropium,  from  sewing  up  the  whole  inner  canthus  as  far  as  the 
punctum  lachrymale.  Tarsoraphy  performed  in  the  usual  way  does 
not  answer. 

The  value  of  the  researches  of  which  this  is  a  brief  statement 
may  be  shown  by  a  few  historical  remarks.  Scarcely  anything  was 
known  except  the  simple  fact  that  the  eyes  were  often  affected  in 
leprosy,  until  Boeck  i  perceived  that  each  of  the  two  forms  which 

1  C.  W.  Boeck,  *  Om  den  Spedalske  Sygdoiu  Elephantiasis  Gra^corum/ 
Christiania,  1842.  We  quote  from  Prof.  Fuchs'  review  in  the  *  Archiv  fiir  die 
gesammte  Medicin,'  iv,  268.     Jeua,  1843. 


148  Reviews,  [July^ 

he  recognised  was  accompanied  by  a  special  disease  of  the  eye. 
He  found  that  the  eyes  were  affected  in  49  out  of  111  patients 
suffering  from  tubercular  leprosy.  The  more  usual  changes  were 
tubercles  at  the  edge  of  the  cornea,  thickening  of  the  conjunctival 
layer  in  front  of  the  cornea,  maculae  and  ulcers  of  the  cornea. 
There  were  also  noted  chronic  iritis  (six  times),  cataract  (twice)  ; 
once  the  eye  had  burst,  twice  it  was  atrophic.  On  the  other  hand, 
in  42  cases  of  lepra  glabra  (mutilans,  Fuchs,  ansesthetica,  Eobinson) 
the  eyes  were  frequently  implicated ;  they  did  not,  however,  present 
lesions  of  the  conjunctiva  and  so  on,  but  ectropium  and  lagoph- 
thalmus  (in  twenty  cases).  Ulcers  of  the  cornea,  pannus,  and 
specially  iritis,  both  acute  and  chronic,  were  also  observed. 

His  statement  that  in  the  anaesthetic  variety  leprous  matter  is 
deposited  on  the  spinal  cord  and  about  the  base  of  the  brain,  and  in 
particular  that  the  Casserian  ganglion  is  always  affected,  has  not, 
so  far  as  we  know,  been  confirmed  byother  observers.  The  expla- 
nation hence  derived,  that  the  lesions  are  due,  in  fact,  to  neuro- 
paralytic ophthalmia  (H.  J.  Vinkhuijzen  :  geneeskundige  opmerkingen 
op  eene  reis  door  het  Noorden,  p.  85,  94.  Leiden,  1865),  is,  as  we 
have  mentioned,  rejected  by  Messrs.  Bull  and  Hansen. 

The  next  considerable  advance  ^  has  been  made  by  the  publication 
of  the  worK  under  review,  in  which,  as  already  stated,  we  meet  for 
the  first  time  with  a  full  and  minute  account  of  this  subject.  It  is 
there  shown  that  the  anterior  portion  of  the  eye  is  alone  liable  to 
disease  directly  caused  by  the  deposition  of  leprous  elements ;  that 
the  latter  may  be  collected  into  masses  (tubers),  or  spread  over  a 
considerable  space ;  that  inflammatory  changes,  obscuration  of  the 
cornea,  posterior  synechise,  hazy  vitreous,  often  occur,  both  with  and 
without  the  deposition  of  leprous  elements,  and  that  they  are  some- 
times due  directly  to  the  dyscrasy,  sometimes  indirectly,  as  when 
the  eyelids  cannot  be  closed,  owing  to  facial  palsy. — T.  W. 

'  Neither  an  accurate  knowledge  of  details,  nor  any  general  view,  can  be 
derived  from  the  cases  published  by  Hubsch  ('  Gaz,  Med.  de  Paris,'  1854,  and 
'  Ann.  d'Oc.,'  t.  xxxvi,  p.  140);  Carron  du  Villards  ('  Ann.  d'Oc.,'  vol.  xxxvi,  p.  145) ; 
J.  H.  Sylvester  ('  Trans,  of  the  Med.  and  Phys.  Soc.  of  Bombay,'  1870,  and  *  Ann. 
d'Oc.,'  vol.  Ixvi,  p.  235);  Chisholm  ('Ophth.  Hosp.  Rep.,'  vi,  126);  Pedraglia 
('  Kl.  Mouatstb.  f.  Aug.,'  x,  65).  We  have  found  nothing  of  importance  in  this 
respect  in  the  more  general  essays  by  A.  Fiddes  ('Ediub.  Med.  Journ.,'  ii,  1061)  ; 
J.  Y.  Simpson  ('Edinb.  Med.  and  Surg.  Journ.,'  vol.  Ivi,  p.  301,  &c. ;  E.  Wilson 
('Lancet,'  1856,  vol.  i);  Virchow  (*  Geschwulst-Lehre,'  ii);  Haser  (' Lehrbucb 
der  Geschichte  der  Medicin,  ii,  73,  Jan.,  1865);  Pruner  (' Kraukheiten  des  Orients,' 
p.  163,  Erlangen,  1847)  ; '  Report  on  Leprosy  by  the  College  of  Physicians,'  1866 ; 
R.  Liveing  ('  Elephantiasis  Graecorum,'  Lond.,  1873),  &c.  See  also  this  'Review,' 
vol.  XXX  (1850),  and  vol.  xlv  (1870),  and  the  last  edition  of  T.  Fox's  work  on  skin 


1875.]  149 


Bibliosrapfiiral  llecorlr. 


Tholozan  on  the  Plague  in  Persia,  &c. — Dr.  Tholozan  is  well  known 
as  one  of  the  best  informed  and  most  enlightened  epidemiologists 
of  the  present  day.  During  his  long  residence  at  Teheran,  as 
principal  medical  officer  of  the  Shah,  he  has  most  assidiously 
watched  the  course  of  the  principal  epidemics  which  have  of  recent 
years  occupied  professional  attention ;  and,  being  a  good  scholar, 
his  stores  of  information  have  been  derived  from  very  ample  and 
varied  sources.  We  had  lately  occasion  to  refer  to  his  labours  in 
illustration  of  the  past  career  of  cholera,  and  we  have  now  to  draw 
attention  to  what  he  has  done  in  respect  of  certain  local  outbreaks 
of  the  true  Oriental  plague,  the  history  of  which  has  given  rise  to 
no  small  discussion  among  medical  men  throughout  Europe  in  con- 
sequence of  their  bearing  on  some  intricate  questions  of  State 
medicine. 

Like  all  other  scientific  physicians,  he  attaches  the  utmost  im- 
portance to  the  study  of  geographical  chronology  in  the  investiga- 
tion of  the  origin  and  diffusion  of  epidemic  diseases,  and  in  the 
due  appreciation  of  all  attempts  at  their  prophylaxis  or  arrest  by 
hygienic  and  sanitary  appliances. 

The  marked  unsuccess  of  most  governmental  and  international 
medical  congresses  has  been  mainly  owing,  he  thinks,  to  the  neglect 
of  this  indispensable  branch  of  preliminary  inquiry,  and  to  the 
members  of  these  commissions  proceeding  at  once  to  frame  practical 
conclusions  on  various  topics  respecting  which  their  authentic 
information  is  always  meagre  and  often  uncertain.  In  1869,  Dr. 
Tholozan  published  a  memoir  on  the  outbreak  of  plague  which 
occurred  in  1867  in  the  environs  of  Bagdad,  after  an  apparent 
disappearance  of  the  pestilence  throughout  the  Ottoman  empire 
since  1843-4,  when  it  last  prevailed  at  Erzeroom  and  other  places 
in  Asia  Minor.  His  researches  showed  that  the  development  of 
the  disease  had  been  by  no  means  so  sudden  and  unexpected  as  is 

1  1.  Histoire  de  la  Peste  Buhonique  en  Perse.  Par  J.  D.  Tholozan,  de  la 
Societe  Epidemiologique  de  Londres.     8vo,  pp.  42.     Paris,  1874. 

2.  Histoire  de  la  Peste  Buhonique  en  Mesopotamie.  Par  J.  D.  Tholozan. 
Svo,  pp.  91.     Paris,  1874. 


150  Bibliographical  Record.  L*^"^^' 

generally  imagined,  but  that  for  many  months  previously  there  had 
been  a  notable  tendency  in  the  ordinary  endemic  fevers  of  the  locality 
to  being  complicated  with  bubonic  affections  of  the  axillary  and 
inguinal  glands.  *'  La  petite  epidemic  de  peste  de  la  Mesopotamie 
en  1867  fut  precedee  de  phenomenes  pathologiques  importants  rap- 
pelant  ces  constitutions  medicales  pestilentielles  qui  dans  le  seizieme 
et  le  dix-septierae  siecle  signalerent  quelquefois  Farrivee  des  grandes 
pestes  dans  certains  pays  d'Europe/'  A  still  more  interesting  result 
is  pointed  out,  viz.,  that  a  similar  medical  constitution  prevailed  in 
some  districts  of  that  region  during  1857-8,  when  the  partial  and 
local  outbreak  of  plague  occurred  at  Benghazi  in  Western  Barbary. 
Such  synchronism  of  epidemiological  phenomena  in  countries 
remote  from  each  other,  if  well  authenticated,  is  obviously  of  ex- 
treme interest  in  the  genetic  history  of  spreading  diseases,  and  is  in 
itself  sufficient  to  attest  the  vital  importance  of  medical  geography 
and  chronology  in  setiological  studies. 

The  unscientific  conclusions  of  the  Ottoman  Board  of  Health  in 
respect  of  the  Mesopotamian  outbreak  of  1867  are  criticized  with 
just  severity  by  our  author.  Notwithstanding  the  recorded  distinct 
opinion  of  their  own  medical  secretary,  after  a  personal  examination 
of  the  disease  in  the  affected  districts,  the  Board  sitting  at  Con- 
stantinople decided  that  it  was  not  genuine  bubonic  plague,  but 
only  a  "pernicious  paludal  fever ^'  accompanied  with  glandular 
swellings, — because  the  outbreak  had  not  been  "  envahissante,'^  and 
did  not  manifest  strongly  contagious  properties  ! 

Dr.  Tholozan's  two  recent  brochures  give  an  instructive  record  of 
all  the  successive  manifestations  of  the  plague  in  Persia  and  in 
Mesopotamia,  as  accurately  as  the  very  imperfect  published  data 
on  the  subject  enable  him  to  do  so.  Together,  they  form  a  most 
valuable  contribution  to  the  history  of  the  pestilence  in  these 
regions  of  the  East.  The  evidence  he  adduces  distinctly  con- 
troverts many  of  the  statements  made  by  Dr.  Bartoletti,  the 
head  of  the  Turkish  sanitary  authorities,  in  his  late  official 
report  to  his  government  "sur  les  mesures  a  prendre  centre  la 
peste  qui  sevit  en  Perse,"  which  appears  to  have  given  rise  to 
voluminous  diplomatic  correspondence  on  the  part  of  France,  Eng- 
land, and  Eussia,  with  Turkey  and  Persia.  Now  that  the  relations 
of  Quarantine  in  reference  to  cholera  have  been  so  thoroughly 
modified  by  the  decisions  last  year  of  the  Vienna  International 
Congress,  it  may  be  reasonably  hoped  jthat  the  question  of  the  proper 
restrictive  measures  against  the  two  other  diseases  against  which 
quarantine  has  been  mainly  directed — plague  and  yellow  fever — will, 
ere  long,  be  thoroughly  investigated  by  some  competent  authority,  to 
the  benefit  of  humanity  as  well  as  of  scientific  truth.  To  one  point 
alone,  bearing  as  it  does  not  only  on  the  above  question,  but  also  on 
the  large  and  intricate  problem  of  the  genesis  of  various  fevers. 


1875.]  Tholozan  on  the  Plague  in  Persia,  151 

domestic  as  well  as  foreign,  we  shall  allude,  and  that  is  that  in  all 
the  local  outbreaks  of  plague,  which  have  occurred  during  the  last 
fifteen  years,  the  pestilence  seems  to  have  sprung  up  in  the  districts 
affected  as  a  de  novo  development,  quite  unconnected  with  any  dis- 
coverable existence  of  the  materies  morbi  from  antecedent  cases. 
Dr.  Bartoletti  distinctly  declared,  in  his  account  of  the  Benghazi 
outbreak  in  1858,  that  "cette  peste  est  nee  spontanement."  Dr. 
Naranzi,  describing  the  epidemic  near  Bagdad  in  1867,  expressed 
his  opinion  that  it  "  naissait  spontanement  dans  deux  endroits  peu 
distants  Fun  de  Tautre ;"  and  Dr.  Castaldi  uses  nearly  the  same 
language  in  reference  to  the  partial  and  scattered  outbreak  in 
Persian  Kurdistan  in  1871.  Medical  men  will  differ  as  to  their 
acceptance,  or  otherwise,  of  these  conclusions.  Only  it  behoves 
them  all  to  acquaint  themselves  with  the  ascertained  facts  of  these 
several  cases,  and  not  determine  the  point  in  their  mind  under  bias 
or  prejudgment.  No  question  of  scientific  nosology  more  strongly 
demands  a  thorough  impartial  scrutiny. 

Postscript. — Since  the  preceding  remarks  were  written,  we  have 
received  the  official  account'  of  the  late  reappearance  of  Oriental 
plague  in  that  part  of  Barbary  which  was  the  seat  of  the  unexpected 
outbreak  in  1858.  The  earliest  cases  occurred  about  the  beginning 
of  April  in  two  Arab  tent-encampments  near  the  village  of  Medje, 
which  is  eighteen  or  twenty  hours'  march  inland  from  the  coast 
town  of  Benghazi  in  the  pashalic  of  Tripoli.  It  is  believed  that 
sporadic  single  cases  had  been  seen  among  the  wretched  inhabitants 
for  several  months  previously  j  but  nothing  accurately  is  known.  Dr. 
Laval,  who  subsequently  fell  a  victim  himself,  was  the  first  to  de- 
termine the  true  nature  of  the  fever,  that  it  was  genuine  bubonic 
plague,  various  contradictory  statements  having  been  circulated 
about  it.  Dr.  Arnaud  did  not  reach  the  spot  until  the  fever  had 
begun  to  decline  in  Medje,  and  after  it  had  attacked  several  places 
in  the  neighbourhood.  Nothing  could  be  more  thoroughly  unsanitary 
than  the  foul  abodes  of  the  poor  people,  or  more  miserable  than  their 
hygienic  condition  in  respect  of  food  and  clothing.  For  four  or 
five  years  before  1874,  there  had  been  a  wasting  famine,  just  as  had 
been  the  case  for  some  years  prior  to  1858,  so  that  the  inhabitants 
had  been  reduced  to  absolute  want,  compelling  them  to  resort  to 
the  use  of  the  most  repulsive  objects  to  satisfy  the  cravings  of 
hunger.  In  both  instances,  the  harvest  in  the  plague  years  was 
more  abundant,  in  consequence  of  the  heavy  rains  which  had  pre- 
ceded and  caused  the  prohfic  vegetation.  Dr.  Arnaud  thinks  that 
the  great  humidity  of  the  ground  and  of  the  atmosphere  thus  occa- 
sioned had  something  to  do  with  the  genesis  of  the  fever  which 

^  JEssai  sur  la  Peste  de  Benghazi  en  1874.  Eapport  du  Dr.  L.  Aenatjd,  publie 
par  rAdministration  Sanitaire  Ottomane.     Constantinople,  1875.     8vo.     Pp.  62. 


152  Bibliographical  Record.  [Jii^y> 

sprung  up  among  a  population  predisposed  to  its  attack  by  their 
previous  indigence  and  starvation.  He  is  convinced  that  it  was  of 
spontaneous  origin^  as  Dr.  Bartoletti  was  in  1858  in  respect  of  the 
outbreak  that  year. 

It  is  a  most  interesting  epidemiological  fact  that  North  Africa 
was  not  the  only  region  where  plague  manifested  itself  in  1874. 
On  the  authority  of  the  Ottoman  administration,  we  learn  that 
"pen  avant  cette  epoque  la  peste  etait  signalee  en  Mesopotamie 
(Hindie,  Divanieh),  et  des  bruits  couraient  qu'une  maladie  analogue 
existait  dans  PAssyr  (Yemen).'' 

The  fever  appears  to  have  been  by  no  means  widely  spread  in  the 
district  near  Benghazi,  where  it  originated,  and  to  have  gradually 
declined  and  become  extinct  by  the  adoption  of  simple  sanitary  mea- 
sures. That  quarantine  restrictions  had  anything  to  do  with  its 
subsidence  seems  extremely  doubtful. 

Erichsen  on  Hospitalism.^ — Both  the  subject  and  the  author  of 
this  work  deserve  special  attention  ;  the  former  because  it  has  been 
a  matter  of  much  discussion  in  both  professional  and  general 
circles,  and  the  latter  because  he  is  not  only  an  eminent  surgical 
authority,  but  also  because  he  is  almost  a  specialist  on  the  subject 
on  which  he  writes. 

The  lectures  are  so  full  of  thought  and  so  suggestive  of  thought, 
and  so  decisive  in  their  teaching  that  they  must  produce  or  tend  to 
produce  one  result,  that  is,  the  extinction  of  the  word  hospitalism, 
as  expressive  of  a  necessary  condition.  The  unhealthiness  of  hos- 
pitals will  ever  make  the  general  body  of  the  medical  profession  look 
upon  hospitals  as  at  present  managed  as  not  nearly  so  healthy  as 
private  houses.  Lectures  such  as  these  which  acknowledge  the  evil 
and  point  to  certain  rational  remedies,  must,  however,  tend  to  the 
great  practical  result  desired  by  all,  viz.  reducing  the  mortality 
from  septic  diseases. 

In  Lecture  I  we  are  told — 

"  Surgery  in  its  mechanical  and  manipulative  processes,  in  its  art, 
in  fact  is  approaching,  if  it  has  not  already  attained  to,  something 
like  finality  of  perfection.  The  science  of  surgery  has  not  advanced 
proportionately  with  the  art." 

All  acknowledge  the  great  advances  made  in  surgery  since  the 
introduction  of  anaesthetics,  and  of  the  principles  of  conservative 
surgery.  Yet  there  is  still  much  to  be  done,  especially  in  the  treat- 
ment of  cicatrices  after  burns,  of  congenital  malformations,  of  stone 
in  the  bladder,  and  of  various  forms  of  pelvic  fistula.  Moreover, 
so  long  as  we  rarely  get  primary  union,  which  usually  depends  on  a 
proper   adaptation  of   surfaces,  we  cannot  look  upon  our  art  as 

1  Hospitalism  and  the  Causes  of  Death  after  Operations  and  Surgical  Injuries. 
By  J.  E.  Eeichsen,  F.R.C.S.,  &c.     London,  1874. 


1875.]  Erichsen  on  Hospitalism.  153 

perfect.  The  gist  of  tlie  whole  book,  however,  is  really  comprised 
in  the  second  statement,  viz.  that  the  science  of  surgery  has  not 
advanced  proportionately  with  the  art.  The  rate  of  mortality  has 
not  decreased  in  anything  like  the  same  proportion  as  the  art  has 
progressed ;  the  cause  of  this  mortality  is  chiefly  what  has  been 
called  hospitahsm ;  the  cause  of  the  hospitalism  is  overcrowding  of 
cases  and  want  of  sanitary  precautions  ;  the  remedy  for  this  want 
of  success  is  hygiene  in  its  widest  sense. 

Many  do  deny  that  there  is  any  such  condition  as  hospitalism ; 
whether  there  is  or  not  matters  very  little ;  the  fact  remains,  that  in 
ordinary  hospitals  maternity  wards  have  been  abolished  on  account 
of  the  high  rate  of  mortality.  Ovarian  cases  are  almost  always 
fatal;  pyaemia,  septicaemia,  and  erysipelas  are  fearfully  common; 
something  within  the  hospital  must  be  the  cause  of  this  state  of 
things,  and  it  is  only  rational  to  suppose  that,  unless  the  cause  be 
partially  or  entirely  removed,  many  surgical  wards  will  follow  the 
same  fate  as  maternity  wards  and  be  swept  away. 

Has  anything  been  attempted  or  done  to  remedy  this  state  of 
things  ?  Speaking  generally,  we  must  distinctly  say,  no  !  Individual 
surgeons,  much  to  their  credit,  have  attempted  and  done  much ;  but 
the  majority  of  surgeons  have  sought  to  ignore  facts,  and  have 
thrown  cold  water  on  attempts  at  a  theoretical  and  practical 
solution  of  the  difficulty. 

For  example.  Prof.  Lister's  antiseptic  treatment  has  been  before  the 
profession  for  several  years,  yet  it  may  be  asked  how  many  hospital 
surgeons  understand  it,  and  how  many  have  fairly  tried  it  ?  The 
number  could  be  almost  counted  on  one's  fingers;  yet  this  method 
of  treatment  professes  to  do  away  entirely  with  all  risk  of  hos- 
pitalism or  hospital  plagues.  Professor  Lister  and  others  have 
published  numerous  cases  treated  by  this  method,  and  in  the 
'Edinburgh  Medical  Journal/  for  March,  1875,  Professor  Volkmann, 
of  Halle,  contributes  a  remarkable  paper  on  antiseptic  osteotomy, 
and  shows  the  result  of  antiseptic  treatment  in  his  hands  to  be 
most  successful ;  he  says — 

"  Since  the  introduction  of  the  antiseptic  method  into  my  clinique 
now  exactly  two  years  ago  (at  the  end  of  November,  1872),  no  single 
patient  suffering  from  a  compound  fracture  in  which  conservative 
treatment  was  attempted,  has  died.  Amongst  this  number  are  in- 
cluded even  those  cases  in  which  conservative  treatment  was  only 
resorted  to,  because  the  patients  would  not  give  their  consent  to 
amputation,  and  also  in  which  we  at  first  under-estimated  the  severity 
of  the  injury,  and  afterwards  intermediate  or  secondary  amputation 
had  to  be  undertaken  on  account  o£  haemorrhage  or  gangrene.  The 
number  of  compound  fractures  successfully  treated  without  a  single 
fatal  result  in  our  hospital,  which  is  old  and  always  overcrowded, 
and    offers'  the    most   unhealthy   hygienic  conditions,  amounts  at 


154  Bibliographical  Record.  [July, 

present  to  31 ;  amongst  these  were  as  many  as  19  compound  frac- 
tures of  the  leg,  in  several  instances  much  comminuted,  and  often 
complicated  with  most  severe  bruising  and  laceration  of  the  soft 
parts.  There  were  also  two  compound  comminuted  fractures  of  the 
patella,  both  of  which  recovered  with  movable  joints.  No  case  of 
pyaemia  has  occurred  for  a  year  and  a  half,  i.e.  since  July,  1873, 
although  during  this  period  alone  about  60  major  amputations  have 
taken  place." 

The  paper  contains  other  passages  quite  as  remarkable  in  showing 
the  great  value  of  antiseptic  surgery  in  hospital  practice. 

Seeing,  then,  how  the  expectant  method  (if  one  may  use  the  term) 
in  the  treatment  of  injuries  and  wounds  in  hospitals  has  failed,  and 
how  high  the  mortality  is,  it  appears  only  a  rational  course  to  try 
other  methods,  and  especially  the  plan  advocated  by  Lister,  Erich- 
sen,  Callander,  and  others.  Hygiene  in  relation  to  surgery  means 
a  large  amount  of  attention  to  details  in  the  after-treatment  of 
wounds,  and  when  this  amount  of  attention  is  bestowed  the  surgeon 
is  usually  said  to  have  a  "  hobby"  for  that  kind  of  thing. 

Holden  on  the  Sphygmograph.^ — Every  new  instrument  of  cli- 
nical research  has  to  contend  with  two  obstacles  which  retard  its  intro- 
duction. These  are,  the  over-zeal  of  its  friends,  and  the  prejudice 
of  the  conservative  or  self-styled  practical  members  of  the  profession. 
The  history  of  the  sphygmograph  since  its  introduction  by  Marey 
illustrates  the  rule.  The  exaggerated  notions  which  were  formed 
of  its  value  have  given  practical  opponents  plenty  of  arguments  for 
a  critical  disbelief  in  its  usefulness.  If  the  sphygmograph  had  proved 
the  ready  means  of  diagnosis  in  heart  disease,  and  the  infallible  indi- 
cator of  the  state  of  the  circulation  in  fever,  which  some  observers 
announced,  its  invention  would  have  been  a  very  doubtful  advantage. 
It  will,  indeed,  be  a  sorry  day  for  medicine  when  any  instrument  is 
devised  which  will  do  away  with  the  necessity  for  careful  observation 
and  cautious  induction.  We  do  not  therefore  regret  that  the  value 
of  the  sphygmograph  was  overstated,  and  that  a  more  sober  view  of 
its  powers  now  prevails.  That  it  will  eventually  prove  a  great  boon 
to  the  physician,  we  have  no  doubt,  and  the  day  will  come  when 
objections  based  on  the  obscurity  of  its  hieroglyphics  vi'ill  be  refuted 
by  the  lucid  translation  of  all  forms  of  pulse  trace.  The  time  was, 
when  many  of  the  revelations  of  the  stethoscope  were  unintelligible, 
and  the  records  of  the  thermometer  still  often  have  a  doubtful  signi- 
ficance, bat  on  this  account  few  would  question  the  value  of  these 
instruments.     The   same  patient  work  which  has   made  these  the 

1  The  Sphygmograph  :  its  Physiological  and  Pathological  Indications.  The 
essay  to  which  was  awarded  the  Stevens  Triennial  Prize,  hy  the  College  of  Phy- 
sicians and  Surgeons,  New  York,  April,  1873.  Two  hundred  and  ninety  illustra- 
tions.    By  Edgae  Holden,  A.M.,  M.D.     Philadelphia,  1874. 


1875.]  HoLDEN  on  the  Sphygmograph.  155 

almost  inseparable  companions  of  the  practitioner  will  in  time  esta- 
blish the  value  of  the  sphygmograph.  The  chief  impediment  to 
progress  hitherto  has  arisen  from  the  attempt  to  make  the  sphygmo- 
graph a  measurer  of  arterial  tension.  This,  it  is  only  in  a  minor 
degree.  It  may  serve  as  a  comparatively  rough  test  of  arterial  ful- 
ness, but  its  great  function  is  to  record  the  forms  of  arterial  move- 
ments. The  attempt  to  perfect  it  as  an  indicator  of  tension  has  led 
to  the  numerous  modifications  which  have  been  made  in  the  form  of 
the  instrument.  Hence  has  arisen  that  confusion  in  the  work  which 
is  necessarily  the  result  of  having  a  large  number  of  observations 
which  are  not  strictly  comparable.  The  author  of  the  book  before 
us  is  a  sinner  in  this  respect.  Marey^s  sphygmograph  (which,  with 
very  slight  modifications,  is  in  our  opinion  the  best)  appeared  to 
Dr.  Holden  to  be  faulty  from  not  registering  the  displacing  power 
of  the  artery  as  well  as  its  lifting  power.  He  therefore  invented  a 
form  of  pulse  spring  to  partially  surround  the  artery  by  means  of  a 
concave  surface.  Each  pulsation  transmits  to  this  spring  a  lateral 
as  well  as  an  upward  motion,  and  the  result  is  recorded  by  a  lever 
moving  laterally  instead  of  vertically,  as  in  other  sphygmographs. 
The  second  fault  which  Dr.  Holden  sought  to  remedy  by  his  inven- 
tion was  the  mode  of  application  ;  all  the  usual  means  of  fixing  the 
sphygmograph  appeared  objectionable,  so  he  aboHshed  them,  and 
simply  holds  his  instrument  in  position  by  the  thumb  and  finger. 
Whatever  value  there  may  be  in  the  altered  shape  of  the  pulse  spring, 
and  we  cannot  estimate  this  highly,  the  method  of  application  is  in 
our  experience  sufficient  to  vitiate  the  results.  Any  one  who  has 
tried  an  ordinary  sphygmograph  by  holding  it  over  the  artery,  knows 
how  the  vibrations  of  the  hand  of  the  observer  will  spoil  most  of  the 
tracings.  It  may  not  be  so  to  the  same  extent  with  Dr.  Holden's 
instrument,  but  that  it  is  so  to  a  great  extent  the  numerous  pulse 
traces  in  his  book  prove  by  their  irregular  hues.  We  have  ourselves 
collected  many  tracings  vitiated  by  the  same  cause. 

The  book  is  divided  into  three  parts.  The  first  treats  of  the 
mechanism  of  the  sphygmograph  and  the  pulse ;  to  this  part  we  have 
alluded  sufficiently ;  the  second  part  considers  the  special  appli- 
cation of  the  instrument  to  the  study  of  pathological  conditions ;  and 
the  third,  its  value  in  therapeutical  research.  A  large  number  of 
traces  taken  in  disease  are  well  and  clearly  printed  in  the  plates,  but 
we  cannot  say  that  they  are  worthy  of  a  prize  essay.  Many  of  the 
tracings  are  so  badly  developed,  and  show  so  few  of  the  generally  recog- 
nised elements  of  the  pulse-trace,  that  they  are  of  little  value.  Others, 
which  are  more  worthy  of  study,  are  spoiled  by  the  extremely  meagre 
and  often  vague  record  given  in  the  text  of  the  cases  which  they 
illustrate. 

In  the  therapeutical  inquiries  we  are  almost  equally  disappointed. 
The  most  noteworthy  point  is  the  large  quantity  of  Cannabis  Indica 


156  Bibliographical  Record,  [July, 

taken  by  the  author — 420  drops  of  the  tincture — on  one  occasion 
in  the  course  of  three  hours,  and  in  a  second  observation  26  grs.  of 
the  fresh  alcoholic  extract  in  the  same  time.  The  physiological 
effects  in  the  first  instance  appear  to  have  been  very  slight,  and  in 
the  second  experiment  neither  the  sphygmographic  nor  the  subjective 
phenomena  were  in  proportion  to  the  courage  of  the  self-tormenting 
observer.  Other  experiments  were  made  with  aconite,  gelseminum, 
and  quinine,  but  with  little  addition  to  our  knowledge. 

We  are  sorry  not  to  be  able  to  congragulate  the  author  on  his 
work.  His  great  misfortune  was,  we  think,  the  invention  of  a  new 
form  of  sphygmograph.  With  one  of  the  original  instruments  of 
Marey,  his  patience  and  industry  would,  we  believe,  have  made  more 
important  additions  to  the  literature  of  the  sphygmograph. 

Dunglison's  Medical  Dictionary.^ — Dunglison's  dictionary  has 
acquired  an  honorable  place  in  medical  literature,  and  very  de- 
servedly so  by  reason  of  its  many  merits.  A  new  edition  was 
much  needed  on  account  of  the  vast  multiplication  of  terms  used 
in  medicine  and  the  collateral  sciences,  invented  by  actual  or  sup- 
posed discoverers,  and  particularly  in  Germany.  We  are,  therefore, 
not  surprised  to  hear  that  "  the  present  edition  will  be  found  to 
contain  many  hundred  more  terms  than  the  first,  and  to  have  expe- 
rienced numerous  additions  and  modifications.''^  Nevertheless,  it 
would  be  possible  for  the  student  versed  in  Teutonic  and  French 
medical  literature  to  find  not  a  few  terms  missing,  in  sufficient  vogue 
to  deserve  a  place.  A  defect  of  this  kind  is,  however,  inevitable  in 
any  such  compilation,  and  when  the  medical  pupil  has  a  volume  like 
the  one  before  us  placed  in  his  hands  as  constituting  a  mere  lexicon 
of  terms  or  skeleton  of  facts  that  he  must  transfer  to  his  head  and  clothe 
with  abundance  of  knowledge,  he  may  well  cry,  hold  !  enough  ! 

The  author  states  that  his  "  object  has  not  been  to  make  the 
work  a  mere  lexicon  of  terms,  but  to  afford  under  each,  a  condensed 
view  of  its  various  medical  relations,  and  thus  to  render  the  work 
an  epitome  of  the  existing  condition  of  medical  science."  This 
object  we  regard  as  too  ambitious  and  extensive  for  a  work  such  as 
Dr.  Dunglison  had  in  view,  or  was  really  demanded.  An  epitome 
of  the  shallowest  dimensions  representing  the  actual  condition  of 
medical  science,  together  with  that  of  the  several  collateral  branches 
of  that  science,  as  comprehended  in  this  volume,  is  beyond  the 
compass  of  a  dictionary  like  that  before  us,  and  beyond  the  power 
of  most  ordinary  mortals  to  produce.  And,  in  fact,  the  necessities 
imposed  upon  the  author  have  of  themselves  saved  him,  in  regard  to 

1  A  Dictionary  of  Medical  Science  with  the  Accentuation  and  Etymology  of  the 
Terms  and  the  French  and  other  Synonyms.  By  Rob  ley  Dunglison,  M.D.  A 
new  edition  enlarcred  and  thoroughly  revised  by  Richaed  J.  Dunglison,  M.D. 
London,  1874.     Pp.  1131. 


1875.]  Manual  of  Public  Health  for  Ireland.  157 

most  terms,  from  his  ambitious  project ;  and  where  he  has  ventured 
on  further  detail  than  is  necessary  to  explain  the  terms  before  him,  he 
is  often  at  fault  in  introducing  obscure  and  ambiguous  information, 
doubtful  opinions,  and  questionable  practice.  His  notes  of  treat- 
ment in  various  important  diseases  are  uncalled  for,  and  are  generally 
open  to  strong  objections.  As  a  matter  of  course  they  are  very- 
brief,  and  so  far  as  they  apply  to  disease  expressed  by  some  general 
term,  though  comprehending  pathological  conditions  of  great  variety, 
they  would,  if  acted  upon,  as  a  rule,  prove  positively  mischievous. 
Active  antiphlogistic  measures,  blood-letting  to  produce  a  decided 
effect,  antiraonials  and  kindred  agents,  are  prescribed,  accompanied 
by  few  provisoes,  in  most  inflammatory  affections. 

The  definitions  of  anatomical  terms  might,  in  various  instances, 
be  much  amended  as  regards  perspicuity  at  least,  if  not  correctness. 
The  classification  of  the  human  races,  introduced  under  the  heading 
Homo,  need  revision,  for  that  of  Blumenbach  will  not  pass  muster 
at  the  present  day  among  ethnologists. 

Another  desideratum  of  this  dictionary,  now  that  it  has  assumed  the 
character  of  an  English  publication,  issued  by  our  great  London  med- 
ical publishing  firm,  is  that,  the  formulae  of  the  British  Pharmacopoeia 
should  find  a  place  alongside  those  of  the  United  States  Pharmaco- 
poeia, which,  in  the  present  edition,  furnishes  the  basis  of  reference 
for  the  pharmaceutical  preparations  enumerated. 

Although  we  have  thus  freely  spoken  of  shortcomings,  we  are  fully 
sensible  of  the  excellencies  of  this  medical  dictionary,  and  these  in 
themselves  are  sufficient  to  secure  for  it  the  good  opinion  of  the 
profession,  and,  as  we  trust,  its  success  as  a  publication. 

Manual  of  Public  Health  for  Ireland.^ — Division  of  labour  is 
usually  valued  as  a  means  of  economizing  time  and  facilitating  pro- 
duction. The  principle  has  been  applied  in  the  production  of  the 
work  before  us ;  clearly,  however,  not  for  the  sake  of  the  end  com- 
monly aimed  at  in  the  way  of  rapid  development,  for  the  preface 
apologises  for  delay  in  execution,  but  on  the  assumption  presumably 
that  the  special  matters  comprised  within  the  scope  of  public  health 
legislation  can  be  best  treated  by  those  specially  informed  in  them. 
It  is  thus  we  account  for  the  strong  force  of  four  writers  in  the  pro- 
duction of  this  small  treatise,  viz.,  of  two  medical  doctors,  a  barrister, 
and  a  professor  of  chemistry.  At  the  same  time,  viewing  its  contents, 
we  must  say  that  the  array  of  talent  seems  much  in  excess  of  the  de- 
mand for  it.  The  sections  relating  to  legal  requirements  are  extracted, 
as  a  matter  of  course,  from  the  provisions  of  *^The  Public  Health 
(Ireland)  Act,  1874,"  and,  as  for  other  portions,  they  are  gathered 

1  Manual  of  Public  Health  for  Ireland.  By  Thomas  W.  Grimshaw,  M.D.,  &o. ; 
J.  Emeeson  Reynolds,  T.C.S.  ;  .Uobeet  O'B.  Fuelonq,  M.A.  j  and  John  W. 
MooEE,  M.D.,  &c.     Dublin,  1875. 


158  Bibliographical  Record.  puly, 

from  well-known  and  esteemed  authorities  on  the  several  subjects 
dealt  with.  In  short,  we  feel  persuaded  that  the  whole  matter 
might  have  been  readily  elaborated  by  the  general  editor,  Dr.  J .  W. 
Moore,  who  has  made  pubhc  health  a  special  study,  and  is  well 
known  as  a  medical  meteorologist. 

The  volume  is  divided  into  no  less  than  twenty-seven  chapters,  of 
which  the  first  four,  presenting  an  analysis  of  the  Health  Act,  a 
digest  of  the  laws  prescribing  the  duties  of  sanitary  officers,  a  list 
of  statutes  relating  to  public  health  in  Ireland,  and  an  index  to  the 
sanitary  acts  comprehended  within  that  list,  occupy  nearly  a  fourth 
of  the  whole ;  consequently  the  many  other  subjects  undertaken  get 
very  slenderly  treated,  as  may  be  supposed  when  we  say  that,  besides 
chapters  on  vital  statistics,  on  births  and  deaths,  on  population  and 
the  development  of  man,  an  attempt  is  made  to  examine,  in  con- 
nection with  sanitary  science,  zymotic  diseases ;  special  zymotics ; 
diseases  arising  from  insufficient  or  unwholesome  food;  diseases 
usually  termed  constitutional ;  artisans'  diseases ;  diseases  caused 
by  vicious  habits;  food;  water  supply;  examination  of  water; 
house  construction ;  air  and  ventilation ;  sewage  and  its  treat- 
ment ;  contagion  and  disinfection ;  accommodation  for  the  sick ; 
meteorology  and  climate ;  meteorological  observations,  and  influ- 
ence of  season  on  zymotic  diseases.  However,  it  is  due  to  the 
several  writers  to  state  this  much,  that  the  information  conveyed  is 
very  clearly  and  succinctly  given,  even  if  it  afi'ords  but  a  rude  out- 
line. In  proportion  to  the  extent  of  consideration  devoted  to  other 
subjects,  meteorology  and  climate  have  received  a  larger  share,  and 
so  far  may  be  regarded  to  approach  adequacy  of  treatment. 

Although  the  profession  ha^  been  well  supplied  with  manuals  of 
sanitary  medicine,  and  the  general  laws  of  health  are  alike  in  Eng- 
land and  in  Ireland,  a  reason  for  the  pubhcation  of  a  manual  for 
Ireland  specially  is  to  be  found  in  the  particular  provisions  of  the 
**  Public  Health  (Ireland)  Act,  1874;'*  notably  in  the  allotment  of 
the  functions  of  sanitary  medical  officers  to  the  dispensary  medical 
officers  of  the  country,  and  in  the  designation  of  the  local  authori- 
ties entrusted  with  the  carrying  out  of  the  Act.  We  doubt  not, 
therefore,  that  this  treatise  will  be  appreciated  by  our  Irish  pro- 
fessional brethren.  And,  indeed,  it  is  well  worthy  of  their  good 
opinion,  for  if  the  information  conveyed  be  too  largely  superficial,  it 
is  both  accurately  and  well  given. 

Aitken's  Outlines  of  Medicine.^ — This  work  is  expressly  designed 
for  the  use  of  students,  and  aims  at  furnishing  a  synopsis  of  the  most 
important  facts  regarding  the  natural  history  of  diseases,  and  the 
lines  of  treatment  by  which  remedies  are  to  be  apphed  for  the  pre- 

1  Outlines  of  the  Science  and  Practice  of  Medicine.  By  William  Aitkek 
M.D.,  F.R.S.    Loudou,  1874. 


1875.]  C.  Fox  on  Water  Analysis.  159 

vention  or  the  curative  management  of  individual  diseases.  Such  are 
the  purposes  of  this  volume  as  set  forth  in  the  preface ;  the  reputa- 
tion of  the  author  will  be  a  guarantee  that  those  purposes  are 
faithfully  and  efficiently  fulfilled.  Its  character  as  a  digest  of  ad- 
mitted facts  and  accepted  doctrine,  and  as  a  text- book  for  students, 
limits  the  task  of  the  reviewer  to  simply  recording  his  opinion  of 
the  completeness  and  correctness  of  the  matter  contained  in  it,  and 
of  the  manner  in  which  the  matter  is  conveyed.  Now  in  respect  of 
both  matter  and  manner  our  examination  of  the  treatise  has  convinced 
us  that  nothing  could  be  better.  If  fault  must  be  found  with  the 
book,  it  consists  in  the  concentrated  character  of  the  material.  It 
represents  the  very  essence  of  physic,  and  nought  but  the  strongest 
digestive  powers  could  continuously  make  use  of  and  duly  appro- 
priate-it.  For  the  special  purpose  of  upholding  the  student  through 
the  febrile  heat  of  examinations,  it  is  admirably  suited ;  but  at  other 
times,  the  learner  would  desire  more  diluted  material,  rendered  also 
more  palatable  by  a  commixture  of  practical  remarks  and  of  case 
narratives. 

To  refer  to  one  particularly  commendable  feature,  we  would  re- 
mark on  the  amount  of  valuable  information  conveyed  in  the  sections 
treating  "  of  the  methods  of  clinical  investigation  introductory  to 
those  diseases  which  are  described  in  groups  under  the  organs  or 
systems  to  which  they  respectively  belong."  Indeed,  we  know  of 
no  summary  of  the  use  of  electricity  as  a  means  of  diagnosis  equal 
to  that  contained  in  the  "  guide  to  the  clinical  investigation  and 
diagnosis  of  diseases  of  the  nervous  system.^' 

C.  Fox  on  Water  Analysis.^ — This  work  is  the  substance  of  a 
paper  read  by  its  author  in  the  PubHc  Medicine  Section  at  the 
Norwich  meeting  of  the  British  ^[edical  Association  in  1874,  and 
it  is  stated  in  the  preface  that,  in  the  discussion  which  followed  the 
reading,  the  recommendations  of  the  paper  were  endorsed.  This 
statement  forms  a  very  doubtful  recommendation  of  the  book,  seeing 
how  very  few  medical  officers  of  health  are  competent  to  form  an 
opinion  as  to  the  value  of  methods  of  chemical  analysis.  Indeed,  it 
may  be  doubted  whether  any  appreciable  number  of  these  officials 
have  had  the  opportunities  of  instituting  comparisons  between  the 
method  adopted  by  the  author  and  other  rival  methods.  We  fancy, 
too,  that  the  medical  officers  of  health  must  have  been  taken  with 
the  assertion  of  Dr.  Fox  that  '•'  a  complete  analysis,  then,  of  a  pot- 
able water  can  with  practice  be  accomplished  in  forty  minutes ''  (the 
italics  are  Dr.  Fox's).  Nay,  further,  he  states  that  the  time  occu- 
pied in  answering  the  question,  "Is  this  water  wholesome  and 
good  ?  "  can  be  answered  with  absolute  certainty  in  thirty  minutes. 

1   Water  Analysis  as  it  should,  and  as  it  should  not,  be  performed  by  the 
Medical   Officer  of  Health.     With  illustrations.     By  CoEJ^ELius  B.  Fox,  M.D 
M.R.C.P.,  Lond.    Loudou.  '* 


160  Bibliographical  Record.  [Julv, 

If  these  statements  could  be  substantiated,  water -analysis  would  be 
a  very  sim[)le  affair  indeed,  and  all  the  fuss  made  in  these  days  about 
wholesome  and  unwholesome  water  would  be  misplaced. 

The  author  of  the  brochure  before  us  states  that  it  was  written 
with  the  following  praiseworthy  objects : — (1)  For  the  purpose  of 
inducing  all  real  medical  officers  of  health  to  adopt  some  one  reliable 
method  of  water-analysis,  so  that  the  results  of  the  examinations  of 
all  might  be  comparable ;  (2)  to  demonstrate  to  them  the  superiority 
of  the  Nessler  process  to  any  other ;  and,  (8),  to  give  to  them  some 
of  the  results  of  his  experience  in  the  examination  of  potable  waters. 
The  process  on  which  Dr.  Pox  relies  for  the  determination  of  the  whole- 
someness  or  unwholesomeness  of  water  is  what  he  terms  "  the  Nessler 
process,^'  by  which  he  means  the  process  devised  by  Chapman  and 
Wanklyn,  though  the  author  does  not  state  this.  Indeed,  his  pamphlet 
is  substantially  a  reproduction  of  their  treatise,  and  he  inculcates 
theirs  as  the  one  reliable  method  of  water-analysis.  We  are  not 
prepared  to  deny  this  to  be  the  case,  but,  nevertheless,  think  that  Dr. 
Tox  is  not  happy  in  demonstrating  this  mode  of  water-analysis  as 
superior  to  all  others;  in  fact,  he  merely  shows  that  the  popular  methods 
of  smelling  a  water,  treating  it  with  permanganate,  and  testing  for 
nitrates,  are  not  reliable  tests  for  organic  contamination.  It  would, 
therefore,  have  been  well  not  to  have  attempted  ^'to  demonstrate 
the  superiority  of  the  Nessler  process  to  any  other.^"*  No  mention 
whatever  is  made  of  Prankland's  well-known  process  of  estimating 
organic  matter  in  waters.  AVe  note,  however,  with  satisfaction 
that  all  Mr.  Wanklyn's  dicta  are  not  accepted  ;  and  notably  this, 
that  a  considerable  quantity  of  free  ammonia  in  a  water  containing 
•005  per  100,000  of  albumenoid  ammonia  is  to  be  regarded  with 
suspicion.  Dr.  Fox  quotes  good  waters  which  contained  '007  of 
ammonia ;  but  he  might  have  gone  further,  since  it  is  notorious  that 
some  of  the  excellent  deep  artesian  well  waters  of  the  London  basin 
afford  seven  or  eight  times  as  much  free  ammonia  as  he  quotes. 

Notwithstanding  these  defects,  and  some  minor  blemishes,  we 
can  recommend  the  work  before  us  to  medical  officers  of  health,  as 
giving  an  outline  of  a  method  of  determining  the  organic  matter 
very  commonly  adopted.  The  modus  operandi  is,  on  the  whole, 
clearly  described.  We  must,  nevertheless,  protest  against  the  advice 
which  Dr.  Fox  gives  to  operate,  for  the  sake  of  saving  time,  upon 
minute  quantities  of  water,  e.g.,  25  cubic  centimetres  for  the  deter- 
mination of  total  solid  residue.  With  such  a  quantity,  and  even 
with  an  accuracy  of  weighing  beyond  the  skill  and  appliances  of  a 
medical  officer  of  health,  great  inaccuracy  of  results  may  result. 

It  would  be  well  for  the  author  in  a  future  edition  to  rewrite  the 
section  of  his  work  relating  to  hardness  of  waters.  Besides  a  mis- 
print of  ^^  temporary  '^  for  "  total,''  the  mode  of  calculating  the 
quantity  of  carbonate  of  lime,  or  other  salts  equivalent  in  hardness 


1875.]  McCall  Anderson  on  Eczema.  161 

to  carbonate  of  lime,  contained  in  the  waters  is  inaccurate,  and  the 
mode  given  for  estimating  the  permanent  hardness  of  a  sample  of 
water  (a  most  important  operation)  is  too  indefinite  to  be  of  any 
value, 

C.  Fox  on  Disposal  of  Slop  Water.i — This  handy  little  pamphlet 
appears  most  opportunely,  and  will  form  a  welcome  addition  to  the 
library  of  every  rural  medical  officer  of  health.  Since  the  more 
general  adoption  of  dry  systems  of  disposing  of  excrement,  great 
difficulties  have  attended  the  disposal  of  slop  water,  and  it  is  the 
endeavour  of  Dr.  Fox  to  show  how  these  difficulties  may  be  over- 
come. It  may  not  be  superfluous  to  state  that  slop  water  consists 
of  soapy  water,  rain,  dirty  water,  and  a  small  quantity  of  urine,  but 
where  a  dry-earth  system  is  carried  out  slop  water  is  not  mixed  with 
solid  faecal  matter.  Slop  water  has  in  consequence  a  minimum  of 
manurial  value,  and  as  a  matter  of  £.  s.  d.  is  valueless.  It  is  ob- 
viously inexpedient  to  discharge  slop  water  into  watercourses,  and 
although  such  stuff  is  not  sewage — a  term  which  implies  fsecal 
matter — and  hence  may  legally  be  discharged  into  a  stream ;  the 
Local  Government  Board  will  not  sanction  the  discharge  of  slop 
water  into  watercourses.  Its  disposal  without  nuisance  is  con- 
sequently a  matter  of  great  importance,  and  often  one  of  great  diffi- 
culty. 

Dr.  Fox  describes  six  different  and  simple  methods  of  disposing 
of  slop  water  other  than  its  discharge  into  streams,  and  the  cases 
must  be  rare,  indeed,  where  one  of  these  methods  is  not  available. 
For  the  description  of  these  methods,  we  must  refer  to  the  work 
itself,  which  is  one  that  ought  to  be  in  the  hands  of  every  medical 
officer  of  health.  We  can  cordially  recommend  its  perusal  to  all 
who  have  to  do  with  any  administration  of  sanitary  law.  It  forms 
a  small  but  valuable  contribution  to  sanitary  literature. 

McCall  Anderson  on  Eczema.^ — The  opening  chapter  of  this  hand- 
some volume,  which  discusses  the  character  and  pathology  of 
eczema,  is,  as  the  writer  admits,  a  reproduction  of  the  doctrines  of  the 
Vienna  school.  It  is  from  what  all  younger  English  and  American 
dermatologists  have  learnt,  either  directly  or  indirectly,  from  Pro- 
fessor Hebra,  that  our  present  knowledge  of  the  disease  differs  from 
the  views  "  which  previous  to  the  first  edition  of  this  work  were 
adopted  and  taught  by  the  majority  of  the  profession  in  this  country.^' 
Twenty  years  ago  Mr.  Erasmus  Wilson  was  the  only  man  in  the 

1  The  Dispoml  of  Slop  Water  of  Villages.  By  Coenelius  B.  Fox,  M.D., 
M.R.C.R,  Lond.     London,  1875. 

"  A  Practical  Treatise  upon  Eczema,  including  its  LicTienous  and  Impetiginous 
Forms.  By  Dr.  McCall  Anderson.  Tliird  edition,  with  seven  woodcuts. 
Pp.  208.     London,  1874. 

Ill— LVI.  11 


162  Bibliographical  Record.  [July* 

United  Kingdom  who  knew  much  more  of  diseases  of  the  skin 
than  what  had  been  taught  by  Willan  and  Bateman.  Since  then  Mr. 
Hutchinson,  Dr.  T,  Fox,  Dr.  Fagge,  Dr.  Buchanan,  and  Dr.  Ander- 
son himself,  with  many  other  good  workers,  have  made  exceedingly 
valuable  contributions  to  the  subject.  But,  on  the  whole,  modern 
dermatology  owes  to  Germany  its  present  "  pathological "  aspect, 
in  distinction  from  the  "  symptomatic "  study  of  eruptions  of  the 
older  British  school,  and  the  "diathetic^'  theories  of  Erench  writers. 
At  the  same  time  we  think  that  Dr.  Anderson  is  unfair  to  Willan 
and  Bateman,  and  fails  to  apprehend  the  true  objects  of  classifica- 
tion when  he  writes : 

*'  Defective  as  any  classification  of  skin  diseases  must  be,  there 
can  be  little  doubt  that  the  anatomical  classification  is  the  most 
objectionable  of  all ;  for  in  this  way  many  dissimilar  diseases  are 
brought  together  under  one  group,  while  violence  is  done  to  the 
symptomatology  of  many  of  them,  owing  to  the  necessity  of  placing 
them  under  the  head  of  one  of  the  elementary  lesions.  Thus  scabies 
is  ranked  with  ecthyma  and  smallpox — diseases  which  have  no  con- 
nection with  one  another  whatever  ;  and  the  first  of  these  (scabies), 
though  it  often  shows  itself  in  a  pustular  form,  is  still  more  com- 
monly met  with  as  a  vesicular  or  papular  eruption,  or  as  a  mixture  of 
all  three." 

There  is  no  necessity  for  a  classification  of  skin-diseases  to  be 
defective,  except  from  deficiency  of  knowledge.  What  is  unavoid- 
able is  that  no  single  classification  can  exhibit  all  the  likenesses  and 
differences  of  these  or  any  other  diseases,  for  the  simple  reason  that 
a  "  disease  "  is  not  a  natural  object,  but  an  artificial  and  complex 
conception,  including  a  material  cause,  a  physiological  state,  and  an 
anatomical  structure,  together  with  such  psychological  conditions  as 
pain  or  itching ;  while  even  to  these  we  must,  if  we  follow  all 
ancient  and  some  modern  teachers,  add  such  metaphysical  idola 
theatri  as  occult  terrene  miasms,  impurities  of  the  blood,  strumous 
diatheses,  dartrous  dyscrasise,  and  lymphatic  temperaments.  But  if 
the  classifier  does  not  attempt  to  classify  dissimilar  objects,  there  is 
no  difficulty  in  grouping  cutaneous  like  any  other  diseases,  accord- 
ing to  whatever  feature  may  be  selected.  Thus,  choosing  etiology 
as  a  basis,  we  have  a  natural  class  of  diseases  dependent  on  animal 
parasites,  another  on  the  presence  of  fungi,  a  third  on  syphilitic 
infection,  a  fourth  on  poisoning  by  copaiba  and  other  irritants.  Or, 
taking  a  pathological  ground,  there  is  no  difficulty  in  distinguishing 
acute  and  chronic  inflammations,  congestions,  haemorrhages, 
atrophies,  tumours,  &c.  If  this  classification  is  combined  with  an 
arrangement  according  to  the  tissue  affected,  into  diseases  of  the 
horny  cuticle,  of  the  malpighian  and  papillary  layers,  of  the  deep 
cutis  and  subcutaneous  tissue,  of  the  sweat-glands,  sebaceous  sacs, 
hair-follicles  and  nails,  there  results  the  classification  adopted  by 


1875.]  McCall  Anderson  on  Eczema.  163 

Hebra  from  Rokitansky,  which  is  perfectly  satisfactory  and  useful 
for  the  objects  intended.  Quite  independent  of  this  and  of  great 
practical  use  is  a  classification  by  locality ;  all  diseases  of  the  scalp 
have  important  points  of  similarity ;  so  have  those  of  the  face,  and 
those  below  the  knee.  The  thin  skin  of  the  fingers  and  toes,  the 
prepuce  and  the  nipple  has  a  peculiar  liability  to  scabies,  the  flexor 
surfaces  to  eczema,  the  extensor  to  psoriasis,  the  palms  and  soles  to 
syphilis.  Again,  an  instructive  arrangement  of  cutaneous  diseases 
may  be  made  according  to  their  reaction  to  remedies  —  those 
benefited  by  soothing  applications,  by  astringents,  by  caustics,  and 
those  again  which  are  almost  unaffected  by  local  treatment,  but  dis- 
appear under  mercury  or  arsenic.  Just  in  the  same  way  we  may 
classify  diseases  of  the  lung  by  their  origin  as  tubercular,  parasitic, 
syphilitic,  or  accidental ;  by  their  pathology,  as  inflammatory, 
atrophic,  cancerous,  and  so  on ;  by  the  tissue  affected,  the  bronchia, 
the  vesicles,  the  connective  tissue  or  the  pleura ;  and  locally  as  they 
affect  one  lung  or  both,  the  apex  or  the  base. 

Now,  the  anatomical  classification  of  Willan  and  Bateman  is  only 
objectionable  when  used  exclusively  and  for  purposes  of  diagnosis ; 
a  knowledge  of  the  *^  elementary  lesions  '^  of  the  skin  is  as  neces- 
sary as  a  knowledge  of  the  elementary  physical  signs  of  disease  of 
the  lungs.  A  student  must  first  be  taught  to  recognise  a  papule,  a 
scab,  or  a  vesicle  when  he  sees  it,  just  as  he  must  be  taught  to  re- 
cognise a  rattle,  a  rub,  or  a  crepitation,  when  he  hears  it.  Scabies, 
ecthyma,  and  smallpox  have  just  this  connection,  that  each  may 
produce  pustules ;  as  cancer  of  the  lung,  pneumonia,  and  phthisis 
may  each  produce  bronchial  breathing. 

After  the  paragraph  above  quoted  Dr.  Anderson  goes  on  to  say  : 

•'  There  can  be  no  doubt  in  my  mind  that  the  beat  classification 
of  skin  diseases  is  one  founded  not  upon  the  elementary  lesion,  but, 
as  far  as  possible  in  the  present  state  of  our  knowledge,  upon  the 
nature  of  the  affection.  This  is  the  basis  of  the  classification  of 
Hardy,  and  that  which  was  adopted  some  years  ago  by  my  late  col- 
league (Dr.  Buchanan)  and  myself." 

But  we  neither  know,  nor  are  likely  to  know,  anything  of  the 
"  nature  "  of  diseases  ;  we  must  be  content  to  study  their  anatomy, 
symptoms,  and  causes.  Alibert''s  showy  and  shallow  "  system'' re- 
mains a  warning  against  premature  attempts  of  the  kind,  and  derma- 
tology only  gained  a  solid  basis  in  France  when  Biett  introduced  the 
"  objectional "  classification  of  Willan.  Dr.  Buchanan's  classification, 
above  referred  to,  into  erythematous  and  phlegmonous  hiflammations, 
new  growths,  and  so  on,  was  made  on  a  pathological  basis.  Mr. 
Hardy's,  into  dartres,  scrofulides,  syphilides,  &c.,  is  essentially 
etiological,  and  each  is  valuable  for  a  different  object.  The  study 
of  dermatology  will  never  become  scientific  till  it  ceases   to  be  a 


164  Bibliographical  Record.  [July, 

specialism,  till  systems  and  classifications  are  recognised  at  their  true 
value,  and  we  no  longer  label  every  lesion  with  a  generic  and 
specific  name,  as  if  it  was  a  plant.  Diseases  of  the  skin  are,  like 
those  of  any  other  organ,  very  complex  phenomena,  to  be  studied 
under  many  different  aspects,  in  their  anatomy,  causation,  symptoms, 
and  treatment,  but  by  the  same  methods  and  principles  which  have 
introduced  scientific  knowledge  into  the  study  of  tumours  or  of 
fevers. 

Dr.  Anderson  follows  Hebra  in  recognising  the  fact  that  the 
elementary  lesion  of  eczema  is  not  always  and  of  necessity  a  vesicle. 
It  may  be  a  mere  erythema,  or  papule,  or  pustule.  Hence  the 
diseases  commonly  known  as  lichen  and  impetigo  are  mere  varieties 
of  eczema,  when  they  are  not  syphilis  or  scabies.  The  symptoms 
regarded  as  essential  are  infiltration  of  the  skin,  exudation  on  its 
surface,  formation  of  crusts,  and  burning  or  itching.  The  form 
described  by  Hardy  as  "  eczeme  fendille,^^  and  by  Dr.  Eox  as 
"  eczema  fissum,"  Dr.  Anderson  prefers  to  call  eczema  rimosum. 
As  to  pathology,  our  author  agrees  with  Eindfleisch  and  Fox  in 
calling  the  disease  a  catarrhal  inflammation  of  the  skin.  The 
affection,  however,  which  was  described  by  Hebra  as  eczema  margina- 
tum, is,  at  least  in  most  cases,  a  local  variety  of  tinea,  as  shown  by 
Kobner  and  confirmed  by  two  excellent  cases  related  by  Dr.  Ander- 
son. The  following  chapter,  on  the  histology  of  eczema,  is  illustrated 
by  drawings  from  Biesadecki,  Neumann,  and  Rindfleisch.  The 
causes  of  the  disease,  apart  from  local  irritation  and  hereditary 
transmission,  are  quite  unknown.  It  is,  we  think,  a  pity  that  so 
eminent  a  physician  as  Dr.  Anderson  should  be  content  to  repeat 
such  vague  and  contradictory  remarks  as  the  following : 

"  It  attacks  by  preference  the  rachitic,  the  scrofulous,  and  the 
debilitated  ;  indeed,  it  may  be  safely  affirmed  that  debility,  in  some 
form  or  other,  lies  at  the  root  of  a  very  great  number  of  cases  of 
eczema.  At  the  same  time  it  must  be  confessed  that  it  often  attacks 
persons  who  are  apparently  in  the  most  robust  health,  in  whom 
neither  external  nor  internal  causes  are  apparent.  These  cases  must  be 
referred  to  some  idiosyncrasy — the  dartrous  diathesis,  as  the  French 
call  it,  which  is  certainly  a  convenient  word  to  cloak  our  ignorance 
of  its  nature.^"* 

Why  reasonable  men  must  refer  diseases  to  an  idiosyncrasy  or 
diathesis,  and  why  honest  men  should  wish  to  be  thought  wiser 
than  they  are,  we  do  not  understand. 

Dr.  Anderson  remarks  that  the  skin  of  persons  who  are  subject 
to  eczema  is  darker  than  natural;  that  its  natural  lines  and' furrows 
are  deeper  and  wider  apart  than  in  health,  and  that  there  is  more 
or  less  desquamation.  In  500  consecutive  cases  treated  by  him  at 
the  Glasgow  Dispensary,  296  occurred  in  men  and  204  in  women. 
This  agrees  with  the  experience  of  Hebra   and   of    Mr.  Wilson. 


1875. J  McCall  Anderson  on  Eczema.  165 

Eczema  mercuriale  is  put  among  the  forms  due  to  local  irritants. 
Dr.  Anderson  having  never  seen  it  occur  from  the  internal  adminis- 
tration of  mercury.  A  useful  chapter  follows  on  the  differential 
diagnosis  of  eczema  from  (non-eczematous)  erythema,  from  erysipelas, 
herpes  facialis  or  preputialis — the  latter  is  actually  called  a  variety 
of  eczema  by  Hardy — scabies,  psoriasis,  pemphigus  foliaceus, 
pityriasis  rubra,  lichen  ruber,  and  syphiHs. 

Dr.  Anderson  agrees  with  Hebra  in  regarding  the  supposed 
danger  of  curing  an  eczema  as  a  mere  fancy,  and  quotes  two  cases 
of  the  disease  being  masked  by  an  attack  of  measles,  to  reappear 
when  it  passed  off.  Under  the  head  of  treatment  he  discusses  at 
length  the  benefits  derived  from  purgatives,  diuretics,  steel  and 
cod-hver  oil,  where  indicated  by  the  early  and  acute  stage  of  the 
disease,  by  "torpidity  of  the  kidneys''  or  "excessive  acidity  of 
of  the  system,^'  or  by  emaciation  and  pallor.  In  chronic  cases 
without  special  indications,  he  recommends  strychnia  and  arsenic — 
the  latter  in  increasing  doses,  which  may  occasionally  be  pushed  to 
ten,  fifteen,  or  even  twenty  minums  of  Fowler's  solution  three 
times  a  day,  with  impunity  and  with  benefit.  Alkalies  and  sulphur 
Dr.  Anderson  considers  of  little  use,  but  in  chronic  cases  he  has 
seen  good  results  from  the  internal  exhibition  of  tar,  though  not 
equal  to  those  obtained  in  psoriasis.  In  prescribing  arsenic  or 
strychnia,  the  following  excellent  rules  are  given  :  —  1.  Begin  with  a 
small  dose,  and  increase  it  until  it  disagrees  or  cures.  2.  If  it 
disagrees,  try  another  form,  or  w^ait  a  few  days  and  give  it  again. 
3.  Give  it  a  fair  trial  for  several  weeks.  4.  When  the  patient  is 
cured,  do  not  stop  the  medicine,  but  let  him  leave  it  off  gradually. 

As  to  local  treatment,  Dr.  Anderson  advises,  first,  the  various 
preparations  of  potash  introduced  from  Vienna  by  himself  and  Dr. 
Buchanan;  and  next  in  importance,  especially  for  chronic  cases, 
ointments,  soaps  and  emulsions,  containing  tar,  juniper  oil,  carbolic 
acid,  or  similar  drugs.  Some  interesting  cases  are  given  of  treat- 
ment by  the  impermeable  dressings  of  vulcanized  india-rubber, 
first  used  by  M.  Colson  of  Beauvais,  introduced  thence  by  Hardy 
into  St.  Louis,  and  thence  again  by  Hebra  to  Yienna  (see  report  in 
the  'London  Medical  Record'  for  June  9,  1875).  Dr.  Anderson 
thinks  that  this  mode  of  treatment  will  prove  an  important  addition 
to  our  means  of  combating  eczema.  The  book  concludes  with  a 
careful  and  practical  account  of  special  points  in  the  diagnosis  and 
treatment  of  the  local  varieties  of  eczema,  with  tabular  statements 
of  the  diflferences  between  eczema  of  the  scalp  and  syphilis, 
psoriasis,  or  ringworm,  attacking  the  same  region;  and  between 
eczeina  of  the  beard,  and  ringworm  or  acne  of  the  part,  which 
are  often  confounded  together  as  sycosis. — P.  S. 


166  Bibliographical  Record.  [Ju^? 

Mapother  on  Skin  Diseases.^ — These  lectures  first  appeared,  after 
delivery,  in  the  ^  Medical  Press/  and  were  subsequently  collected  in 
a  small  volume.  Their  recommendation  is  their  brevity,  coupled 
with  good  practical  information  respecting  the  leading  pathological 
features,  and  the  treatment  of  the  diseases  described.  The  note  on 
the  title-page,  "with  illustrations,'^  will  mislead  the  reader  who 
may,  in  consequence  of  it,  anticipate  figures  illustrative  of  skin 
eruptions,  for  the  illustrations  given  consist  solely  of  a  few  rough 
woodcuts  intended  chiefly  to  portray  cutaneous  parasites.  If,  as  is 
probable,  the  success  of  this  little  treatise  encourage  Dr.  Mapother 
to  issue  a  further  edition,  or  to  embark  on  a  work  of  greater  dimen- 
sions, we  would  suggest  to  him  the  propriety  of  more  attention  to 
composition,  inasmuch  as  that  of  the  present  volume  is  very  slipshod 
and  too  often  uu grammatical. 

Moore's  Physiological  Chemistry. 2 — This  is  a  very  thin  book  in 
every  sense  of  the  word.  The  title-page  is,  however,  most  attractive. 
We  want  clear,  compact,  and  trustworthy  "  notes  of  demonstrations 
on  physiological  chemistry  "  for  our  students  of  medicine,  but  we 
shall  look  in  vain  for  anything  of  the  kind  in  the  fifty  ill-written 
pages  before  us.  We  fancy  these  "notes''  were  pubhshed  last 
year  in  the  '  Chemical  News.'  If  so,  the  compiler  should,  at  least, 
have  taken  some  pains,  when  reprinting  them,  to  secure  consistency 
and  freedom  from  typographical  errors.  The  book,  as  it  now  stands, 
is  really  not  worth  the  trouble  of  detailed  criticism,  but  we  will  point 
out  a  few  of  the  mistakes  which  stare  us  in  the  face  as  we  hastily 
turn  over  the  first  fifteen  pages. 

The  statement,  on  page  2,  that  vegetable  products  "  never  reach 
the  high  atomic  weights  found  in  the  animal  kingdom"  {sic)  ignores 
the  existence  of  such  a  compound  as  vegetable  albumen.  We  deny, 
moreover,  that  "  it  is  generally  agreed  that  vegetable  products  are 
ternary  compounds  (CHO),  while  animal  substances  are  quarternary 
(CHNO)/'  Note  the  spelling  of  quaternary  in  passing.  On 
pp.  2  and  3  the  methods  given  for  preparing  the  ash  of  animal 
matters,  and  for  the  recognition  of  the  chief  organic  elements,  are 
both  inexact  and  obscure.  Here  is  an  example — "  Nitrogen,  by  the 
evolution  of  certain  odours  peculiar  to  nitrogenous  substances,  and 
familiar  as  the  ^  burnt  horn  '  smell."  Here  the  author  omits  to  state 
under  what  conditions  the  experiment  is  to  be  made,  not  even  men- 
tioning the  application  of  heat  to  the  substance  under  examination. 
His  remarks  on  the  distribution  of  the  elements  in  animal  matters 
(p.  4)  are  not  satisfactory. 

^  Lectures  on  Skin  Diseases,  delivered  at  St.  Vincent's  Hospital.  By  E.  D. 
Mapothee,  M.D.    With  illustrations.     Second  edition.    Dublin,  1875.    Pp.  206. 

2  Notes  of  Demonstrations  on  Physiological  Chemistry.  By  S.  W.  MooEE 
Pp.  ix  and  58.     London,  1874. 


1875.1  West  Riding  Asylum  Reports,  167 

Mr.  Moore  might  have  omitted  the  paragraph  on  Mulder's  protein 
(p.  5),  and  given  us  instead  such  a  description  of  the  method  of 
obtaining  pure  albumen  by  dialysis  as  would  have  conveyed  some 
notion  of  the  process.  But  our  author  leaves  out  two  of  the  con- 
ditions essential  to  success.  His  plan  of  preparing  syntonin  (p.  7) 
consists  in  "  mincing  a  portion  of  flesh  freed  from  fat,  and  digesting 
in  dilute  acid  for  some  hours,  filtering  and  neutralizing  with  sodium 
carbonate."  We  ask,  Is  fat  the  only  substance  to  be  removed  from 
the  flesh  ?  May  any  acid  be  used  ?  Will  the  precipitate  be  free 
from  myosin  ?  On  page  14  a  formula  for  glycerine  is  given,  in 
which  but  two  atoms  of  oxygen  are  shown  instead  of  three, 
while  the  radicle  is  made  a  dyad  instead  of  a  triad.  On  the  next 
page  (15)  we  find  the  term  differentiated  used  quite  wrongly,  l^ats 
are  not  "  differentiated  by  their  melting  points,'^  though  they  may 
hQ  recognised  to  some  extent  by  observing  the  temperatures  at  which 
they  become  liquid.  So,  too,  the  spectroscope  has  not  "  enabled  the 
chemist  to  differentiate  apparently  identical  "bodies  "  (p.  16),  though 
it  has  enabled  him  to  distinguish  them. 

It  would  be  tedious  and  unprofitable  to  pursue  any  further  our 
examination  of  this  pamphlet.  We  should  not  have  noticed  it  at 
all,  but  for  the  following  three  reasons  : — (1)  A  simple,  condensed, 
clear,  and  authoritative  laboratory  book  on  the  subject  is  much 
needed ;  (2)  the  title  of  the  volume  before  us  led  us  to  hope  that 
this  need  had  been  at  last  supplied  ;  (3)  the  position  of  the  author 
as  Demonstrator  of  Practical  Physiology  at  St.  George's  Hospital 
Medical  School  justified  us  in  assuming  that  our  anticipations  as  to 
the  value  of  the  work  before  us  would  be  justified. 

West  Riding  Asylum  Reports. — In  previous  numbers  we  have 
taken  occasion  to  note  the  contents  of  this  volume  of  so-called 
Reports  on  its  annual  appearance,  and  have  had  the  gratification  of 
generally  commending  them  for  their  scientific  value.  Similar  com- 
mendation is  due  to  the  volume  last  published.  Some  of  the  papers 
contained  in  it  are  valuable  on  account  of  original  research,  whilst  all 
may  be  read  with  instruction.  Amongst  those  of  the  latter  class  may  be 
mentioned  the  lecture  given  by  Dr.  W.  B.  Carpenter,  "  On  the  Phy- 
siological Import  of  Dr.  Perrier's  Investigations  into  the  Functions  of 
the  Brain."  More  notable  by  reason  of  original  observations  are  the 
papers  by  Dr.  Perrier,  Dr.  T.  Lauder  Brunton,  and  Dr.  Herbert  C. 
Major,  treating  respectively  on  "  Pathological  Illustrations  of  Brain 
Function,"  "  Inhibition  Peripheral  and  Central,"  and  the  "  His- 
tology of  the  Morbid  Brain.''  Dr.  Charles  Aldridge  continues  his 
useful  ophthalmoscopic  observations  in  mental  disease,  and  w^e  may 

^  The  West  Hiding  Lunatic  Asylum  Medical  Reports.  Edited  by  J.  Ceichton 
Beowne,  M.D.     Vol.  iv.     London,  1874. 


168  Bibliographical  Record.  [J"ly> 

fairly  look  forward  to  some  general  facts  of  practical  value  in  patho- 
logy from  such  a  series  of  observations  sufficiently  extended. 

We  trust  that  such  a  measure  of  support  may  be  extended  to  Dr. 
Crichton  Browne  as  will  induce  him  to  persevere  with  the  production 
of  this  annual  collection  of  papers  on  nervous  and  mental  maladies. 
The  title  given,  however,  is  not  favorable  to  its  success ;  for  the 
article  usually  purveyed  under  the  title  of  Asylum  Reports  is  alto- 
gether of  a  different  character,  and  commonly  remarkable  for  its 
barrenness  of  any  useful  kowledge.  Moreover,  in  no  strict  and  proper 
sense  can  the  annual  volume  under  notice  be  considered  a  Report  of 
the  West  Riding  Lunatic  Asylum.  Its  only  relation  to  that  insti- 
tution is  that  its  editor  is  its  chief  physician  and  superintendent, 
and  that  the  asylum  affords  the  field  of  observations  to  some  of  the 
authors  of  the  papers  contained  within  it. 

Dublin  Lectures  on  Public  Health.' — If  the  public  health  were 
advanced  in  proportion  to  the  amount  written  upon  it  by  way  of 
learned  counsel  and  advice,  such  a  healthful  state  of  affairs  would 
speedily  follow  as  to  render  the  office  of  sanitary  medical  officers  a 
sinecure.  But  it  is  to  be  feared  that  the  vast  amount  of  sanitary 
teaching  now  expended  on  the  public  to  reform  its  material  condi- 
tions in  reference  to  health  will  too  far  resemble,  in  its  imperfect 
results,  those  that  have  attended  on  the  preaching  of  truths  calculated 
to  improve  mankind  in  its  moral  condition.  For  though  it  may  be 
admitted  to  be  more  easy  to  move  mankind  in  behalf  of  its  material 
than  of  its  moral  interests,  yet  a  like  blindness  and  perversity  have 
to  be  contended  against  in  the  one  as  in  the  other ;  and,  what  is 
more,  the  element  of  human  selfishness  operates  with  greater  force 
in  the  case  of  the  former.  We  must,  however,  be  thankful  for  the 
efforts  made  in  the  interests  of  the  public  health,  and  must  wish  them 
"  God-speed.'' 

The  contents  of  the  volume  before  us  have  already  been  pretty 
fully  placed  before  the  profession  in  the  weekly  journals.  These 
lectures  were  initiated  by  the  Committee  of  Science  of  the  "  Royal 
Dublin  Society,''  and  carried  through  with  the  co-operation  of  the 
Council  of  the  "Dublin  Sanitary  Association;"  and  our  Irish 
brethren,  particularly  those  of  the  capital,  deserve  great  credit  for 
the  zeal  they  have  shown  in  diffusing  a  knowledge  of  sanitary  science, 
as  exhibited,  not  only  by  instituting  the  course  of  lectures  now  under 
notice,  but  also  by  the  teaching  and  other  work  carried  on  by  Drs. 
Cameron,  Mapother,  and  others. 

The  volume  opens  with  "  An  Introductory  Discourse  on  Sanitary 
Science  in  Ireland,"  by  Dr.  W.  Stokes,  whose  reputation  of  itself  was 
calculated  to  secure  public  attention  to  the  subject  he  handled.  Nine 

1  Lectures  on  JPublic  Health.     Delivered  in  the  Lecture  Hall  of  the  Royal 
Dublin  Society.     Dublin,  1874.     Pp.  203. 


1875.1    De  E/Enzy's  Remarks  on  Indian  Cholera  Reports.    169 

other  lectures  were  successively  given,  by  Prof.  J.  E.  Reynolds 
"  On  the  Discrimination  of  Unadulterated  Tood ;''  by  Dr.  J.  W. 
Moore  "  On  Meteorology  in  its  bearing  on  Health  and  Diseases  /' 
by  Dr.  James  Little  "  On  the  Geographical  Distribution  of  Dis- 
ease ;"  by  Dr.  Grimshaw  "On  Zymotic  and  Preventable  Disease;" 
by  Dr.  A.  Hudson  "On  Liability  to  Disease;"  by  Dr.  Robert 
Macdonnell  "  On  Antiseptics  and  Disinfection ;"  by  Dr.  Mapother 
"  On  the  Prevention  of  Artisans'  Diseases ;"  by  Mr.  G.  C.  Henderson, 
architect,  "  On  the  Construction  of  Dwelling-houses  with  reference 
to  their  Sanitary  Arrangement,"  and  by  Mr.  Furlong,  barrister,  "On 
Sanitary  Legislation." 

Prom  this  programme  it  will  be  seen  that  the  most  important 
topics  in  sanitary  science  or  preventive  medicine  were  discussed, 
and  that  the  volume  of  collected  lectures  may  be  turned  to — and 
from  the  scientific  standing  of  the  lecturers,  turned  to  with  confidence 
— for  information  respecting  the  questions  with  which  they  deal. 
It  is  further  right  to  add  that  several  valuable  diagrams  are  inserted 
in  elucidation  of  the  statistical  and  other  facts  brought  forward ;  and, 
in  fine,  the  volume  may  be  recommended  to  all  those  who  would 
acquaint  themselves  with  the  present  aspect  of  the  leading  questions 
touching  "pubhc  health." 

De  Renzy — Remarks  on  Indian  Cholera  Report  of  1872. — The 

author  states  in  page  1,  "  As  the  Report  is  to  a  great  extent  devoted  to 
a  refutation  of  certain  views  I  have  published  from  time  to  time  for 
the  last  five  years,  I  have  long  wished  to  offer  some  explanation  in 
vindication  of  my  opinions." 

And  as  to  the  nature  of  these  opinions,  we  find  at  page  22,  "  For 
many  generations  to  come  it  will  be  impossible  to  trace  the  cause  of 
cholera  or  other  epidemics  in  this  country  with  any  sort  of  exhaus- 
tiveness,  and  all  opinions  regarding  the  origin  of  any  particular 
epidemic  being  due  to  importation  or  not  will  deserve  very  little 
attention.  Nor  is  there  much  hope  of  our  being  able  to  connect 
any  particular  epidemic  with  the  use  of  tainted  water  by  evidence  of 
a  direct  specific  character."  And  at  page  1,  "  It  appears  to  me 
that  the  proposition  that  cholera  is  spread  by  human  intercourse  is 
so  fully  proved  that  it  would  be  superfluous  to  adduce  any  further 
evidence  in  support  of  it.  I  shall  not,  therefore,  touch  on  this 
point  any  farther  than  to  show  that  the  facts  recorded  by  Dr.  Cun- 
ingham  do  not  warrant  the  conclusion  he  draws  from  them.  As 
regards  the  dissemination  of  cholera  through  water,  I  hope  to  show 
that  the  facts  quoted  in  no  way  invahdate  the  opinion  entertained  on 

1  Remark  on  the  Report  of  the  Sanitary  Commissioner  with  the  Government 
of  India  on  the  Cholera  Epidemic  of  1872  in  Northern  India.  By  Surgeon- 
Major  A.  C.  C.  De  Renzy,  B.A.  T.C.D.,  Sanitary  Commissioner,  Punjaub. 
Lahore,  1874.     8vo,  pp.  28,  *. 


170  Bibliographical  Record.  [July^ 

this  subject  in  England,  and  that  there  are  other  facts  which  strongly 
corroborate  it/' 

We  cannot  suppose  for  a  moment  that  Dr.  Cuningham  would 
have  thought  it  necessary  to  occupy  even  a  small  portion  of  his  report 
in  criticising  the  views  of  Mr.  De  Eenzy,  merely  because  he  enter- 
tained them,  though  he  would  certainly  have  been  open  to  animad- 
version had  he  not  shown  the  bearings  of  the  evidence  which  came 
before  him  on  the  chief  opinions  now  received  as  to  the  mode 
of  diffusion  of  cholera,  opinions  entertained  by  many  others  in  the 
profession  besides  Mr.  De  Eenzy.  People  may  difTer  as  to  the  weight 
and  value  of  that  evidence,  and  Mr.  De  Eenzy  was  at  liberty  to  draw 
his  own  conclusions  from  it.  Whether  these  be  altogether  satisfac- 
tory our  readers  may  judge  for  themselves  after  perusing  the 
quotations  given  above.  We  have  gone  over  Mr.  De  Eenzy's 
'  Eemarks '  carefully,  to  find  whether  there  were  any  points  sub- 
stantiated against  the  positions  taken  up  by  Dr.  Cuningham ;  we 
have  met  with  a  good  deal  of  declamatory  writing,  but  a  great  want  of 
that  "patient  investigation  of  facts"  which  he  agrees  with  Dr. 
Cuningham  is  the  only  mode  of  settling  such  questions;  and  we 
have  finished  the  perusal  with  the  impression  that  Mr.  De  Eenzy  has 
failed  in  establishing  his  own  position,  and  that  he  has  not  materially 
affected  those  he  attacked,  while  a  good  deal  has  been  said  which, 
in  his  cooler  moments,  we  hope  he  will  regret. 

Shropshire  Medical  Tariff  Scheme.^ — This  brief  publication 
represents  a  praiseworthy  and  honest  attempt  to  form  a  basis  for 
the  valuation  of  medical  services  rendered  to  the  principal  classes  of 
society.  It  is  issued  in  the  name  of  the  society,  but  owes  its 
present  form  to  the  care  and  labour  of  Dr.  Styrap,  who  has  not  simply 
sat  in  solitary  judgment  on  what  is  right  and  proper,  but  has  sought 
counsel  and  advice  on  all  sides  among  those  most  competent  to 
render  it,  and  particularly  in  the  case  of  the  surgical  tariff,  with  which, 
as  a  physician,  he  felt  less  competent  to  deal.  We  have  considered 
the  principles  on  which  the  tariff  is  constructed,  and  have  examined 
the  tables,  and  the  impression  we  have  formed  is  that  the  scale  of 
charges  recommended  is  one  of  wide  application  in  this  country  and 
well  deserving  adoption  by  medical  practitioners.  We  cannot  here 
quote  or  discuss  details,  for  the  subject  is  one  that  scarcely  falls 
within  our  province  as  a  purely  scientific  journal,  but  we  recommend 
our  many  local  medical  societies  to  procure  copies,  which  we 
presume  will  be  willingly  placed  at  their  disposal  by  the  officers  of 
the  Shropshire  Ethical  Association. 

Unfortunately,  schemes  like  the  present  will  fail,  as  experience 

^  The  Medico- Chirurgical  Tariff's  issued  by  the  Shropshire  Ethical  Society. 
Shrewsbury,  1874. 


1875.]  Chemistry  in  relation  to  Therapeutics.  171 

shows,  like  all  other  plans  to  make  men  of  one  mind  as  regards  their 
estimate  of  duty  and  self-interest ;  for  competition,  selfishness,  and 
greed,  are  disturbing  forces  always  secretly  or  openly  in  operation, 
and,  unless  human  nature  gets  much  improved,  threaten  to  pro- 
strate all  efforts  at  co-operation  in  the  cause  of  virtue  and  mutual 
benefit,  and  in  the  promotion  of  that  much-bepraised  but  rarely 
seen  moral  duty  of  fraternity. 

The  Toner  Lectures.^ — The  "Toner  Lectures,"  of  which  the 
present  is  one,  were  instituted  at  Washington  by  Dr.  Toner,  and 
are  intended  to  encourage  the  composition  of  memoirs  or 
essays  relating  to  some  novel  or  interesting  facts  in  medical 
science.  The  discourse  of  Dr.  Da  Costa  is  devoted  to  the  con- 
sideration of  the  causes  producing  disease  of  the  heart,  which  the 
lecturer  states  to  be  on  the  increase  in  the  United  States.  He 
divides  strain  and  over-action  of  the  heart  into  two  different 
categories,  although  both  may  exist  together,  or  one  may  follow 
the  other ;  and  while  he  denotes,  by  strain,  some  injury  caused  by 
sudden  or  violent  effort,  he  defines  over-action,  over-exertion  or 
over-work,  as  a  persistent  excitement  and  derangement  due  to  less 
rapidly  acting  causes.  As  illustrations  of  the  first,  he  describes 
several  cases  in  which  actual  laceration  of  the  valves  ensued  from 
some  sudden  effort,  and  with  regard  to  the  second,  he  passes  in 
review  the  various  occupations  or  amusements  which  tend  to  cause 
hypertrophy  and  valvular  disease.  He  inclines  to  the  belief  that 
moderate  exercise,  such  as  rowing,  does  not  frequently  induce 
disease  of  the  heart,  and  he  has  examined  several  persons  who  play 
at  base-hall  (the  athletic  national  game  of  the  United  States),  and 
he  finds  that  it  is  by  no  means  a  common  cause  of  cardiac 
disorders,  although  in  those  who  indulge  in  it  immoderately  such  a 
result  sometimes  ensues,  and  he  gives  two  examples  of  the  kind. 

Chemistry  in  its  Relations  to  Therapeutics.^ — Dr.  Handsel 
Griffiths  avows  himself  to  be  an  ardent  disciple  of  the  school  of 
chemical  therapeutics,  by  which  he  means,  of  course,  the  application  of 
chemical  principles  to  the  selection  and  use  of  medicinal  agents. 
Every  one  knows  the  difficulty,  in  too  many  instances,  of  reconciling 
the  effects  of  drugs  with  their  known  chemical  characters,  and  many 

1  The  Toner  Lectures.  On  Strain  and  Over  Action  of  the  Heart.  By  J.  M. 
Da  Costa,  M.D.,  Professor  of  Practice  of  Medicine  in  Jefferson  Medical  College 
Philadelphia.     Pp.  28.     Washington,  1874, 

^  1.  Chemistry  in  its  Relations  to  Therapeutics.  By  W.  Handsel  Geipfiths 
Ph.  D.,  L.R.C.P.E. 

2.  On  the  Teaching  of  Materia  Medica  and  Therapeutics.  By  W.  Handsel 
Griffiths,  Ph.D.,  L.R.C.P.E. 

3.  Monthly  Report  on  the  Progress  of  Therapeutics.  Edited  for  the  '  Edinburgh 
Medical  Journal.'     Nos.  Ill  to  VI.     1874-75. 


172  Bibliographical  Record.  [July, 

practitioners  are  compelled  to  use  their  remedies  empirically  in  con- 
sequence of  the  absence  of  scientific  principles  for  their  guidance. 
Nor  are  they  to  be  blamed  if  they  prefer  to  employ  the  method 
which  cures  their  patients,  or  seems  to  cure  them,  rather  than  trifle 
with  their  sufferings  in  the  hope,  too  often  a  vain  one,  of  making 
therapeutics  subservient  to  pure  science.  Nevertheless,  the  efforts 
now  made  to  combine  chemistry,  both  theoretical  and  practical,  with 
the  known  laws  of  physiology,  and  to  study  both  by  the  light  of 
clinical  experience,  are  eminently  praiseworthy,  and  Dr.  Handsel 
Griffiths  deserves  special  commendation  for  his  own  efforts  in  this 
direction,  which  appear  to  lead  to  still  greater  triumphs  than  any 
yet  achieved. 

The  Study  of  Life^  is  merely  an  exposition  of  the  various  views 
held  by  the  most  advanced  scientific  men  of  the  present  day,  inter- 
spersed with  some  vague  and  somewhat  peculiar  views  of  the 
author  himself,  probably  given  forth  to  suit  the  author's  audience 
and  the  future  benighted  readers  of  his  lectures  rather  than  being 
honest  representations  of  his  own  beliefs.  Like  a  great  number  of 
other  popular  books,  this  one  had  its  origin  in  a  course  of  lectures 
given  at  a  debating  society.  Now,  many  extremely  valuable  books 
have  been  written  on  Life  by  the  most  talented  of  original  and 
advanced  observers.  These  works  are  within  the  reach  of  even  the 
poorest  of  the  poor,  and  are  written  in  language  that  even  the  most 
superficially  educated  can  understand.  Hence  we  must  recognise 
the  fact,  although  unpalatable,  that  in  this  country  at  all  events 
there  was  not  tlie  slightest  need  for  such  a  book  as  the  one  in 
question.  Literature  of  this  class  is  already  sadly  too  abundant — 
"  Magno  conatu  nugas  " — "  Trifles  with  great  effort."  Perhaps  it 
may  be  argued  that  this  class  of  writers  afford  peculiar  and  limited 
advantages  to  the  many  in  doing  good  according  to  their  lights,  by 
explaining  in  simple  language  the  views  of  advanced  thinkers,  and 
reducing  complex  problems  into  simple  and  easily  intelligible  ones, 
at  the  least  probable  sacrifice  of  truth.  But  the  question  arises,  are 
the  efforts  of  many  men  simply  confined  to  this  end  ?  Is  not  the 
end  a  distinct  purpose — and  that  purpose  to  acquire  knowledge  at 
the  expense  of  the  brains  and  labours  of  their  superiors  ?  If  we 
were  to  tabulate  all  the  books  written  with  the  twofold  view  of 
notoriety  and  self-interest,  the  number  would  be  simply  immense. 
Of  the  number  we  would  not  complain  for  a  single  moment.  What 
we  do  complain  of,  and  that  most  vigorously,  is  the  number  of 

1  1.  The  Study  of  Life.  By  H.  Macnatjghton  Jones,  M.D.,  Ch.M.,  Fellow  of 
the  Royal  Colleges  of  Surgeons,  Ireland  and  Edinburgh  ;  Senior  Demonstrator  of 
Anatomy,  Queen's  College,  Corlc,  &c. 

2.  The  Simplicity  of  Life.  By  RALPH  RiCHABDSON,  M.A.,  M.D.,  Fellow  of  the 
College  of  Physicians,  Edinburgh. 


1875.]  The  Study  of  Life.  173 

phases  under  which  original  ideas  are  embodied  by  men  largely 
possessed  of  the  cacoethes  scribendi  without  the  corresponding  power 
of  observation  to  write  anything  original,  their  faculty  being 
simply  one  of  transposing  or  metamorphosing  words.  The  book- 
writing  mania  is  becoming  at  once  a  nuisance  and  an  evil.  It  is  im- 
possible to  discover  where  actual  truth  lies,  and  searching  for  it  is 
as  arduous  and  as  thirsty  a  task  as  searching  for  water  in  an  un- 
known desert.  There  are  scores  of  books  published  without  a  single 
original  idea  in  them ;  there  are  many  scores  published  with  just 
one  original  fact,  the  fact  being  of  little  importance ;  but  to  pad  it 
and  increase  the  importance,  not  of  the  fact,  but  of  the  individual 
who  discovered  it,  the  public  must  be  gulled  and  cozened  into 
buying  a  work  that  contains  virtually  everything — with  an  exception 
— old,  and  nothing  new. 

Further,  it  is  a  notorious  fact  that  such  pseudo-authors  mistake 
flowery  language  for  original  thought ;  e.g.,  in  the  book  before  us 
the  author  speaks  of  ^'  fishes  rushing  in  countless  hosts  through  the 
paths  of  the  sea,  beholding  with  disdain  the  sluggish  movements  of 
their  gelatinous  and  crustaceous  antecedents : — of  a  gigantic  Labyrin- 
thodon  of  huge   crocodilian  form  paddling   in  water  and  roving 
midst  ferns  and  huge  horsetails  and  fir  trees,  with  vast  gaping  jaws 
of  Labyrinthian  teeth,  striking  fright  and  terror  into  all  its  weaker 
contemporaries : — of  an  extraordinary  fierce  and  remorseless  ich- 
thyosaurus,   with   enormous   orbs   and  210  teeth,  pursuing  with 
lightning  speed  its  prey  : — Of  pterodactyls  soaring  with  their  huge 
eyes    by   dayhght — darkening    heaven    with    their    outspreading 
wings,  and  terrifying  the  other  inhabitants  of  the  earth  with  the 
awakening  echoes  of  their  horrible  cries,^''  &c.  &c.     This  style  of 
language  is  certainly  grandiloquent,  but  it  is  only  fit  for  readers  of 
novels  of  the  Aurora  Floyd  type.     The  author's  ideas  are  in  other 
respects  certainly  above  the  average ;    still,  he  has  much  to  learn 
before  he  can  attain  to  the  position  of  one  familiar  with  all  that  has 
been  done  and  is  being  done  to  bridge  the  gulf  between  man  and 
the  lower  animals.     Man  is  not  separated  by  so  vast  a  generality 
of  structural  peculiarities  from  any   other   animal   as  the  author 
imagines.     The  daily  record  of  facts  from  original  observations  and 
experiments  show  beyond  the  power  of  refutation  that  man  never 
was  created  as  an  animal  separate  and  distinct  from  all  others,  but 
that,  like  others,  he  has  been  progressively  formed.     He  bears  in 
every  part  of  his  body  relics  of  a  bygone  condition,  relics  of  struc- 
tures found  in  animals  lower  in  the  scale  than  himself  in  a  state  of 
undifferentiated  perfection.     Man  does  not  possess  a  fixed  arrange- 
ment   of  the  various  tissues  of   his  body,   neither   nervous   nor 
muscular.  Further,  the  mass  of  evidence  points  most  unmistakeably 
towards  a  further  goal,  by  the  side  of  which  man's  present  integrity 
and  perfection  are  in  comparison  a  pigmy  to  a  giant.     Any  ana- 


174  Bibliographical  Record.  [July, 

tomist  who  has  carefully  contrasted  the  numerous  so-called  irregu- 
larities met  with  in  human  subjects  with  those  of  animals  lower  in 
the  scale  must  have  common  sense  enough  to  know  that  these 
irregularities  are  not — as  ancient  anatomists  once  so  fondly  be- 
lieved— "  lusus  naturse."  They  are  something  far  more  illustrative 
of  design  and  definite  end.  They  are  design  and  end  worked  out 
by  a  great  and  Almighty  power  which  has  manipulated  by  evolution, 
simple,  or  comparatively  so,  organisms  into  more  complex,  reflective, 
and  self-sustaining  ones,  with  corresponding  powers  to  maintain 
them  so.  The  osseous  element,  massive  and  grand,  and  enduring  as  it 
seems  to  us,  is  doomed  to  progressive  disintegration;  the  motive 
power,  or  complex  system  of  muscles,  is  gradually  tending  towards 
modified  simplicity,  while  the  nervous  system,  which  seems  to  be 
both  progressive  and  aggressive,  is  the  dominant  power  before  which 
every  other  kind  of  tissue  gives  way. 

The  question  of  evolution  is  not  one  to  be  superficially  discussed. 
The  more  it  is  investigated  the  more  forcibly  does  the  truth  dawn 
upon  us  that  man,  with  everything  in  nature,  has  had  a  common 
origin.  And  although  man  is  the  last  and  best  of  God's  great 
handiwork,  he  has  been  manipulated  through  multitudinous  phases 
before  he  arrived  at  his  present  status.  But  the  life  which  pervades 
him,  whether  it  be  a  cause  or  a  result  of  organization,  is  as  much  a 
mystery  to  us  at  the  present  day  as  it  was  to  the  ancients. 

The  title  of  the  second  work  under  review  is  '  The  Simplicity  of 
Life.''  But  we  say  with  the  champion  of  all  modern  English 
authors  (Carlyle)  that  "  The  mysterious  live  embers  of  vital  fire  are 
not  to  be  reduced  to  the  degraded  position  of  verbal  simplicity." 
Despite  the  logical  definitions  of  the  meaning  which  certain  words 
are  meant  to  convey  to  us,  and  in  what  sense  only  they  ought  to  be 
used,  the  author  of  '  The  Simphcity  of  Life '  has  succeeded  only  in 
telhng  us  what  should  be  meant  by  what  is  said  by  such  men  as 
Huxley  and  Beale,  as  superior  as  scientists  and  observers  as  he 
would  be  in  the  art  of  plain  speaking.  To  quote  Carlyle  again, 
"  The  speculative  mystery  of  life  grew  ever  more  mysterious  to  me," 
and  even  after  reading  '  The  Simplicity  of  Life '  this  holds  good. 
The  author  has  certainly  advanced  the  stage  of  inquiry  a  step  in  one 
direction  by  showing  that  authors  in  future  must  be  careful  in  using 
certain  terms.  But  as  regards  what  life  really  is,  he  might  just  as 
well  have  left  his  essay  unwritten  and  unpublished  for  all  the  light 
that  he  or  the  authors  he  quotes  so  extensively  have  thrown  upon 
this  perplexing  question.  At  the  present  time  we  do  not  want 
Dominie  Sampson ;  there  have  for  ages  been  ssadly  too  many  of  this 
class.  What  we  really  require  are  earnest  and  simple-minded  men, 
who  are  willing  to  undergo  the  necessary  training  to  be  able  to 
study  nature  and  her  works  to  advantage,  to  be  able  to  observe  her 
operations  and  to  record  them  in  language,  if  not  logically  correct,  at 


1875.]  American  Ophthalmological  Society.  175 

least  capable  of  being  understood  by  others  working  in  the  same 
direction.  The  science  of  so-called  metaphysics,  equally  with  logic, 
was  never  a  science  of  truth.  Any  question  raised  by  the  one  or  the 
other  can  be  argued  efficiently  from  two  distinct  sides,  the  one 
equally  as  plausible  as  the  other.  But  firet<ide  scientists,  tireside  meta- 
physicians and  logicians,  are  babes  feeding  on  milk  in  comparison 
with  the  bold  adventurers  into  the  unknown  paths  of  biology.  The 
author  of  '  Simplicity  of  Life  '  has  given  us  a  readable  work.  But 
if  he  had  been  a  worker  in  the  great  field  of  biological  science  like 
Huxley,  Beale,  and  others,  he  certainly  would  never  have  tabulated 
at  the  end  of  his  work  such  a  miserable  olla  podrida  of  oddities, 
neither  would  he  have  wasted  his  time  and  energies  in  collecting  a 
series  of  assertions  from  every  known  author  from  Hippocrates  to 
Huxley.  The  same  amount  of  time  judiciously  spent  in  actual 
observation  would  have  placed  the  author  of  the  book  in  question 
in  the  foremost  rank  of  original  observers.  It  must  be  granted  that 
he  has  given  us  a  far  more  readable  book  than  the  author  of  '  The 
Study  of  Life.'  But  we  must  say  that  both  have  much  to  learn  and 
much  to  do  before  their  names  will  be  handed  down  to  posterity  on 
terms  similar  to  the  names  of  the  two  or  three  men  whom  they 
criticise. 

Transactions  of  the  American  Ophthalmological  Society.' — We 
are  glad  to  learn  that  the  society  has  decided  to  give  more  perma- 
nent form  to  this  record  of  its  proceedings.  The  numbers  will  be 
paged  continuously,  so  that  four  or  five  together  will  form  a  volume 
of  about  700  pages.  The  first  will  consist  of  the  reports  of  the 
several  meetings  from  the  second  to  the  eighth,  and  is  to  be  fur- 
nished by  Dr.  H.  D.  Noyes,  with  a  profuse  account  of  the  forma- 
tion of  the  society,  and  a  notice  of  its  first  meeting.  We  should 
like  to  suggest  that  the  price  of  each  number  be  printed  on  the  cover. 

The  following  communications  seem  to  us  the  more  important ; 
for  them  and  for  the  rest — there  are  in  the  two  reports  before  us,  fifty 
in  all — we  must  advise  the  reader  to  examine  the  ^  Transactions  '  for 
himself. 

H.  Knapp  reports  114  extractions  of  cataract,  C.  H.  Agnew  118, 
and  H.  W.  Williams  25,  by  the  median  flap.  Iridectomy  in  one  of 
Knapp's  cases  destroyed  "  an  eye  which  before  counted  fingers  at 
five  feet.  In  this  case,  which  looked  very  favorable,  and  would  un- 
doubtedly have  done  well  had  I  made  an  ordinary  iridectomy,  I 
tried  a  new  method  of  operating.  I  made  an  opening  into  the 
lower  segment  of  the  cornea  with  a  lance-shaped  knife,  then  thrust 
the  sharp-pointed  blade  of  a  delicate  pair  of  scissors  through  the 
iris,  and  cut  it  obliquely  upward  and  outward ;  then  I  carried  the 

^  Transactions  of  the  American  Ophthalmological  Society,  Ninth  Annual 
Meeting,  Newport,  July,  1873.  Tenth  Annual  Meeting,  Newport,  July,  1874 
New  York,  1873,  1874. 


176  Bibliographical  Record.  ■  [July, 

blade  of  the  scissors  back  to  the  first  point  of  the  incision  and  made 
a  second  incision,  nearly  at  a  right  angle  with  the  former  one, 
upward  and  inward.  The  angular  piece  of  iris  thus  formed  con- 
tracted towards  its  attached  base,  and  left  a  beautifully  clear  pupil. 
The  patient  had  pain  during  the  night ;  purulent  iritis  and  par- 
ophthalmitis  followed  from  the  second  day.  This  kind  of  angular 
iridectomy  tempted  me  by  its  rational  appearance,  yet  I  had  tried  it 
with  the  same  unfortunate  termination  not  long  previously.  This 
was  in  an  eye  where  closure  of  the  pupil  had  followed  traumatic 
cataract.  I  made  the  first  steps  of  the  operation  as  I  did  in  the 
case  just  related,  then  I  endeavoured  to  pull  the  retracting  triangular 
piece  of  iris  out,  in  which  attempt  I  did  not  succeed.  Suppurative 
iritis  followed,  produced,  I  thought,  by  the  bruising  of  the  iris  in 
the  endeavour  to  draw  a  piece  of  it  out.  Since  the  avoidance  of 
such  bruising  in  the  second  case  did  not  obviate  suppuration,  I  made 
up  my  mind  never  to  try  again  the  operation." 

H.  Derby  contributes  a  paper  on  the  importance  of  an  accurate 
record  of  all  operations  for  cataract,  in  which  he  gives  a  form  for  a 
cataract-register,  and  suggests  that : — 

"  1.  Tables  of  cataract  operations  by  a  single  method,  intended  to 
serve  as  a  basis  of  comparison  with  the  results  of  other  methods, 
should  include  only  cataracts  that  are  neither  the  result  of  local 
injury,  tangible,  local,  or  general  bodily  disease. 

"2.  In  recording  vision  the  full  fraction  should  be  stated,  the 
number  of  test-type  seen,  and  the  distance  in  which  it  is  actually 
seen,  no  attempt  being  made  to  reduce  the  fraction  to  lowest  terms. 

"3.  The  test  card  should  be  artificially  illuminated  by  a  light  of 
fixed  power,  placed  at  a  stated  distance  from  the  centre  of  the  card. 

"  4.  The  date  of  testing,  as  distinct  from  that  of  the  performance 
of  the  operation,  should  be  invariably  stated.  And  every  effort 
should  be  made  to  ascertain  and  record  any  variations  in  vision  that 
may  subsequently  occur. 

"5.  A  definite  standard  of  success  should  be  agreed  upon  ;  that 
is,  that  fraction  should  be  settled  which  must  be  at  least  equalled  by 
the  acquired  vision,  in  order  that  the  result  of  the  operation  may 
justly  be  regarded  as  successful." 

J.  Green,  in  his  remarks  on  the  form  of  the  corneal  section,  re- 
commends the  use  of  diagrams,  three  in  number  (front  and  profile 
view  of  cornea,  and  a  part  view  of  the  iris),  for  securing  greater 
precision  in  reporting  operations  and  results. 

Thomas  K.  Porley  (p.  43)  reports  another  case  of  scleral  wound 
treated  successfully  by  suture.  A  case  of  herpes  zoster  ophthal- 
micus is  narrated  by  H.  D.  Noyes  (p.  70),  in  which  the  one  eye 
was  lost  during  the  attack,  and  the  other  ten  months  afterwards 
from  (sympathetic)  irido-choroiditis.  There  are  two  cases  of  herpes 
with  loss  of  the  eye  (B.  Joy  Jeff'ries,  p.  73),  one  where  the  whole 
side  of  the  nose  was  involved  without  implication  of  the  eye  (O.  F. 
Wadsworth,  p.  219),  and  twelve  cases  by  B.  J.  Jefiries  (p.  221), 


187^.]  American  Ophthatmological  Society,  177 

and  (A.  Mathewson,  p.  228).     Galvanism  gave  great  relief  to  the 
pain  in  several  of  the  latter. 

H.  Derby  gives  an  account  of  the  atropine  treatment  of  myopia 
(p.  139j,  and  appends  a  series  of  tables  containing  an  analysis  of 
the  condition  and  results  in  sixty -seven  eyes  treated  by  him  in  this 
manner. 

It  is  generally  a  very  difficult  problem,  and  one  requiring  much 
patience  for  its  solution,  to  determine  the  refraction  of  the  eye  in 
certain  myopic  complaints — astigmatism  and  amphyopia.  Theo- 
retically the  concave  glass,  spherical  or  spherico-cylindrical,  pro- 
ducing the  most  accurate  vision  of  distant  objects,  would  measure 
the  refraction,  the  ordinary  rule,  that  the  weakest  of  several  other- 
wise equal  glasses  is  chosen,  being  remembered.  In  these  cases, 
however,  the  vision  is  usually  very  defective,  even  though  the 
patient  is  provided  with  the  most  appropriate  glasses ;  their  use 
alone  cannot  prove  the  correctness  of  the  diagnosis.  The  ophthal- 
moscope gives  not  unfrequently  great  assistance.  The  results  attain- 
able and  the  difficulties  experienced  are  well  exemplified  by  some  cases 
reported  in  the  present  reports,  three  being  of  conical  cornea  cor- 
rected by  suitable  glasses  (W.  Thompson.,  p.  132)  and  one  of  extreme 
myopia  (H.  D.  Noyes,  p.  155) .  They  are  too  long  for  quotation,  and 
any  abstract  would  fail  to  do  them  justice.  A  few  words  from  the 
commencement  of  Mr.  Thompson's  paper  will,  we  hope,  induce  some 
of  our  readers  to  consult  the  original. 

"  On  inspection  the  first  presented  slight  evidence  of  the  conical 
condition,  the  second  was  more  marked,  whilst  the  third  would  be 
recognised  at  once  as  a  characteristic  case  of  conical  cornea,  with 
sight  so  imperfect  that  the  patient,  who  had  been  using  -|j  spherical 
for  several  years,  could  only  read  at  his  far  point,  with  his  glass,  viz., 
six  inches,  type  of  a  large  size;  and  whose  correction  would  have 
been  considered  by  me  impossible  by  glasses  but  for  the  experience 
obtained  from  the  study  of  the  preceding  ones.  The  high  degree  of 
acuity  of  vision,  and  the  increased  working  power  and  comfort  which 
has  been  gained  by  the  correction  in  these  cases,  would  encourage  me 
to  persevere  in  the  analysis  of  any  future  ones  that  might  present 
themselves  before  proceeding  to  any  operation ;  although  it  would 
be  impossible  in  the  limits  of  this  paper  to  give  a  true  picture  of  the 
difficulties  encountered  in  the  hours  of  prolonged  and  wearisome 
examination  into  the  refraction  of  these  eyes." 

The  fact  was  observed  by  Wollaston  and  confirmed  by  Young  that 
the  small  luminous  point  seen  through  a  prism  appears  to  be  tri- 
angular. The  eye  cannot  be  accommodated  so  as  to  make  the  whole 
spectrum  a  line ;  for,  if  the  focus  be  adapted  to  collect  the  red  rays  to 
a  point,  the  blue  will  be  too  much  refracted  and  expand  into  a  sur- 
face ;  and  the  reverse  will  happen  if  the  eye  be  adapted  to  the  blue 
rays.     The  amount  of   chromatic   aberration  can  be  measured  by 

111— LVI.  13 


178  Biblographical  Record.  [  July, 

glasses;  that  for  yellow  as  compared  with  red  equals  about  -pl^,  and 
the  total  amount  is  tt^o  or  -V.  Dr.  J.  Green  points  out  {'^  On  Colour- 
tests  for  Ametropia,  based  upon  the  chromatic  aberration  of  the  eye  " 
(p.  179),  that  this  fact  may  be  utilised  in  determining  the  refraction  of 
the  eye,  as  indeed  had  been  already  attempted  by  Helmholtz  and 
Pope.     He  says  : 

'*We  have  thus  a  direct  and  delicate  test  for  ametropia,  not 
dependent  upon  the  recognition  of  letters,  and  one  which,  unlike 
Steiner's  experiment  so  admirably  utilised  by  Thomson,  does  not 
require  a  large  pupil  for  its  application.  In  measuring  myopia  by 
this  method  I  have  succeeded  best  by  directing  the  attention  to  the 
red  apex  of  the  spectrum,  the  weakest  concave  glass,  through  which 
the  apex  appears  as  a  sharp  red  point,  being  the  measure  of  the 
myopia  for  red  rays.  Adding  to  this  the  correction  for  the  brightest 
part  of  the  spectrum,  viz.,  the  yellow,  a  correction  which  I  have  found 
to  be  about  y^^,  we  have  the  measure  of  the  actual  myopia  in  the 
meridian  corresponding  to  the  direction  of  the  refracting  edge  of  the 
prism.  Turning  the  edge  of  the  prism  then  through  any  angle,  in  a 
plane  perpendicular  to  the  axis  of  vision,  and  again  measuring  the 
•ametropia  in  the  new  meridian,  we  detect  any  difference  in  refraction, 
and  by  thus  examining  one  meridian  after  another  we  may  work  out 
even  very  complex  cases  of  asymmetry. 

'*  In  hypermetropia,  also,  it  has  seemed  to  me  most  satisfactory  to 
take  the  red  end  of  the  spectrum  for  observation,  noting  the 
strongest  convex  glass,  through  which  the  apex  appears  perfectly 
sharp,  and  applying  the  correction,  minus  -j-J^,  to  obtain  the  measure 
of  the  hypermetropia  for  yellow  rays." 

Other  noticeable  papers  are  :  Cases  of  optic  neuritis,  by  W.  F. 
Norris  (p.  163,  wdth  chromo-lithographs) ;  syphilitic  gumma  in  the 
ciliary  body,  by  E.  S.  Loring,  jun.,  and  H.  C.  Eno  (p.  174,  wdth  a 
charming  etching  by  the  latter  gentleman) ;  a  new  method  of  treat- 
ing blepharospasm,  by  A.  Mathewson  (p.  207) ;  a  band  of  india 
rubber  fastened  to  the  lid  and  to  the  forehead  so  as  to  elevate  the 
lid  moderately ;  canthoplasty,  a  clinical  study,  by  H.  Althof  (p.  232); 
and  a  new  method  of  operating  for  strabismus,  by  J.  F.  Noyes 
(p.  273).  We  have  said  enough  to  show  the  considerable  value  of 
these  transactions ;  we  are  glad  to  recommend  them  to  the  atten- 
tion of  Enghsh  ophthalmic  surgeons. — T.  W. 

Beigel  on  Diseases  of  Women.^— This  first  instalment  of  Dr. 
Beigers  work  contains  the  general  anatomy  and  pathology  of  the 


1  Krankheiten  des  WeihlicJien  QescMecMes,  voin  KliniscJien  Pathologischen,  ttnd 
Therapeutischen  Handpucktes,  aus  Dargestellt.  Von  Dr.  Heemann  Beigel. 
Vol.  i. 

The  Diseases  of  Women  fro7n  a  Clinical,  Pathological,  and  Therapeutical  Point 
of  new.     By  Dr.  Heemann  Beigel.     Vol.  i.     - 


1875.]  Beigel  on  Diseases  of  Women.  17^ 

female  organs^  the  therapeutics  of  menstruation  and  of  diseases  of 
the  ovaries.  In  treating  these  subjects  the  author  has  collected 
admitted  facts  and  enumerated  the  various  plans  of  treatment, 
instrumental  and  otherwise,  put  forward  by  the  best  writers  of  the 
day.  His  object  would  seem  to  have  been  to  lay  before 
his  countrymen  all  the  most  recent  improvements  in  gynae- 
cology, and  more  particularly  and  fully  those  introduced  by 
British  practitioners,  who  are  most  copiously  quoted. 

The  works  of  German,  Erench,  and  American  authors  have  also 
been  laid  under  contribution.  The  descriptive  anatomy  of  the 
female  organs  of  generation  is  remarkably  clear  and  minute,  aided 
by  well-executed  plates.  Following  anatomical  details  is  a  chapter 
on  the  physiology  of  these  parts.  In  this  section  the  connection 
between  the  breast  and  uterus  and  other  points  of  equal  interest  are 
touched  upon,  but  the  reader  is  disappointed  to  find  that  nothing 
new  in  the  way  of  explanation  of  the  phenomena  mentioned  is 
offered. 

The  changes  which  occur  in  the  organs  of  generation  during 
menstruation  and  pregnancy  are  next  treated  of,  Graily  Hewitt 
and  Kundrat  being  quoted  with  respect  to  the  condition  of  the 
mucous,  and  Farre  as  regards  that  of  the  muscular  tissue.  In 
illustration  of  the  facts  detailed,  plates  have  been  copied  from  the 
works  of  the  above  authors,  and  also  a  table  compiled  by  Schnept 
exhibiting  the  different  measurements  of  the  uterus  at  different 
periods  of  life.  The  physiological  chapter  is  followed  by  one  on 
the  medico-legal  proofs  of  virginity.  After  mentioning  the  import- 
ance which  has,  in  all  times,  attached  to  this  subject,  the  author 
cites  some  of  the  customs  pursued  in  regard  thereto  by  different 
people.  A  large  part  of  the  section  is  devoted  to  a  relation  of  the 
proceedings  and  ceremonies  observed  at  the  marriage  of  a  chief  of 
the  Fiji  Islanders,  with  the  view  of  proving  the  virginity  of  the 
bride.  This  account  is  taken  from  a  paper  by  Mr.  W.  T.  Pritchard^ 
published  in  the  '  Memoirs  of  the  Anthropological  Society  of 
London.' 

In  the  chapter  which  treats  of  obstetrical  diagnosis  we  have  proof 
of  the  author's  skill  in  compilation,  and  the  engravings  are  abun- 
dant. Among  the  latter  are  representations  of  the  different  couches 
recommended  for  the  purpose  of  digital  or  specular  examination, 
and  figures  of  the  different  kinds  of  instruments  in  use  for  the  aid 
of  diagnosis.  In  its  abundance  of  illustrations  the  book  at  this 
part  almost  rivals  a  '  Maw's  Catalogue,'  over  which,  however,  it  has 
one  advantage ;  the  illustrations  not  only  show  the  instruments,  but 
also  their  method  of  employment. 

Tlie  same  characteristics  stamp  the  next  section,  which  treats  of 
obstetrical  therapeutics.  Interspersed  among  the  figures  of  the 
instruments  are  prescriptions  for  pessaries,  copied  from  papers  by 


180  Bibliographical  Record.  [July, 

Tanner  and  Martin  in  the  ^Obstetrical  Transactions;'  and  formulse  for 
the  administration  of  various  drugs,  by  other  authors. 

We  next  come  to  what  is  called  the  special  part  {Specieller  Theil), 
in  which  menstruation — its  physiology,  irregularities,  and  diseases — 
is  considered. 

Some  space  is  occupied  in  the  discussion  of  the  ovular  theory 
of  menstruation.  Dr.  Barnes'  Lumleian  lectures  on  the  convulsive 
diseases  of  women,  and  the  works  of  other  authors  who  have  written 
in  opposition  to  the  ovular  theory,  are  freely  quoted. 

The  volume  closes  with  an  account  of  the  diseases  of  the  ovary. 
Towards  the  end  of  this  section  the  pages  again  present  somewhat 
the  appearance  of  an  illustrated  catalogue. 

What,  indeed,  must  strike  the  reader  of  this  first  portion  of 
BeigeFs  treatise  is,  the  large  amount  of  facts  collated,  the  number 
of  authors  consulted,  and  withal  an  almost  entire  absence  of  original 
matter. 

Troisier  on  Pulmonary  Lymphangitis.l — The  author  commences 
his  work  by  an  account  of  the  minute  anatomy  of  the  lymphatic 
vessels  of  the  lungs.  In  the  course  of  this  description  he  mentions 
several  experiments,  by  means  of  which  he  has  satisfactorily  proved 
that  there  exists  a  free  communication  between  the  lymphatics  of 
the  lungs  and  the  cavities  of  the  pleurae. 

With  regard  to  the  term  lymphangitis,  the  author  wishes  it  to  be 
distinctly  understood  that  he  does  not  by  its  use  necessarily  imply 
that  the  morbid  alterations  he  describes  are,  strictly  speaking,  of  an 
inflammatory  nature,  but  are  due  to  the  action  of  some  irritating 
cause.  The  consideration  of  the  lesion  is  divided  into  two  parts  — 
first,  of  that  form  which  is  dependent  upon  some  pre-existing  cancer ; 
and,  in  the  second  place,  of  those  less  serious  forms  which  he  calls 
adenomatous,  tuberculous,  simple,  and  purulent. 

Cancerous  lymphangitis  is  considered  under  two  forms,  distin- 
guished by  their  locality.  They  are  called  respectively  superficial  or 
pleural  lymphangitis,  and  pleuro-pulmonary  or  disseminated  lymphan- 
gitis. The  first,  as  its  name  implies,  attacks  the  lymphatic  vessels 
lying  on  the  pleural  surface  of  the  lungs.  It  presents  the  appear- 
ance of  a  number  of  whitish  nodules,  sending  off  processes  in  all 
directions.  These  processes  are,  according  to  Dr.  Troisier,  the 
lymphatic  vessels,  which  present  on  section  the  appearance  of  canals 
filled  with  a  caseous  maquia.  The  explanation  given  is  that  the 
cancer  is  propagated  along  the  lymphatics  at  the  expense  of  their 
endothelium. 

In  the  pleuro-pulmonary  lymphangitis  not  only  are  the  deeper 
lymphatic  vessels  of  the  lungs  aff'ected,  but  also  the  pulmonary, 

1  MecJierches  sur  Lymphayigites\  Pulmonaires.  Par  le  Dv.  Emile  Tkoisieb, 
Interne  des  Hopitaux  cle  Paris. 


1875.] 


Barrett  on  Infancy  and  Childhood.  181 


bronchial,  and  tracheal  glands.  The  appearances  are  described 
both  from  a  microscopical  point  of  view  and  from  that  presented  to 
the  naked  eye.  The  result  of  these  observations  leads  the  author  to 
conclude  that  cancerous  lymphangitis  of  the  lung  has  its  origin  in 
some  pre-existing  cancer.  This  disease  is  seldom  recognised  before 
death,  the  symptoms  to  which  it  gives  rise  being  common  to  it  and 
to  other  forms  of  pulmonary  and  bronchial  disease. 

The  less  malignant  forms  of  lymphangitis  described  by  the  author 
are  adenomatous,  which  is  secondary  on  a  swollen  and  inflamed 
state  of  the  lymph- glands.  Tuberculous  lymphangitis  consists  of  a 
propagation  of  the  tuberculous  matter  along  the  lymphatic  vessels, 
giving  rise  on  their  walls  to  fresh  growths  of  tubercle.  Simple 
lymphangitis  is  seen  in  cases  of  pleurisy.  If  a  section  be  made 
through  the  exudation  and  the  subjacent  pleura,  the  lymphatic 
vessels  will  be  found  gorged  with  material  of  the  same  nature  as  the 
exudation.  Purulent  lymphangitis  is  secondary  to  suppuration, 
either  of  the  pleura  or  of  the  lungs.  There  is  no  doubt  that,  in 
this  variety,  fresh  inflammatory  processes  are  carried  on  in  the 
lymphatics  themselves. 

The  fact  of  the  connection  between  the  lymphatic  vessels  of  the 
lungs  and  the  pleural  cavities  may  be  of  material  importance  in 
future  examinations  of  the  various  pathological  conditions  of  the 
lungs.  The  observations  recorded  by  the  author,  on  the  subject  of 
the  propagation  of  cancer,  may  also  lend  further  strength  to  the 
arguments  put  forward  to  prove  the  morbific  agency  of  the  lymphatic 
vessels. 

Barrett  on  Infancy  and  CMldhood.i — It  is  perhaps  doubtful 
whether  books  on  domestic  medicine  are  worthy  of  notice  in  the 
pages  of  a  scientific  review :  being  written  for  the  edification  of  the 
unlearned  amateur  they  are  of  no  intrinsic  interest  to  the  educated 
professional;  at  the  same  time. the  popular  demand  for  such  works 
makes  it  expedient  that  they  should  receive  approval  or  the  contrary 
at  the  hands  of  those  who  are  qualified  to  judge  of  their  merits.  It 
is  right  also  that  the  attention  of  the  profession  should  be  directed 
to  the  publications  of  this  kind  which  issue  from  time  to  time  from 
the  general  press. 

Mr.  Barrett  states  that  he  has  written  his  book,  firstly,  '^for 
use  in  emergencies;"  secondly,  in  order  that  mothers  who  will 
not,  or  who  from  distance,  as  in  the  colonies,  are  unable  to  obtain 
the  aid  of  "a  medical  man,  may  have  that  which  is  next  best "  [sed 
quanto  intervallo  ?]  ^^  his  written  advice;'^  thirdly,  "to  give  an 
insight  into  the  maintenance  of  health  and  the  remediability  of 
disease." 

1  The  Management  of  Infancy  and  Childhood  in  Realth  and  Disease.  Pp.  627. 
By  HowAED  Baekett,  M.R.C.S.,  &c.    London,  1875. 


183  Bibliographical  Reeord,  [July , 

The  first  part  of  the  book  treats  of  the  management  of  infancy 
and  childhood  in  health — the  diet,  clothing,  air,  and  exercise  suitable 
to  infantile  age.  The  second  and  third  parts  treat  of  the  manage- 
ment of  children  in  disease — of  fevers,  of  constitutional  diseases, 
and  disease  classified  according  to  its  situation  in  the  body ;  then 
follow  surgical  injuries  and  diseases.  The  book  concludes  with 
tables  of  diets,  of  weights  and  measures,  of  recipes  and  statistics, 
and  has  a  capital  index. 

Out  of  the  multitude  of  topics  offered  to  the  unlearned  and 
ignorant  we  shall  glance  briefly  at  those  likely  to  be  of  service  to 
them,  and  we  give  our  author  full  praise  for  the  care  with  which  he 
has  elaborated  those  subjects. 

How  infants  ought  to  be  fed,  nursed,  and  clothed,  the  evil  con- 
sequences of  improper  feeding,  the  quahties  and  uses  of  the  various 
artificial  foods  suitable  to  later  infant  life,  the  virtues  of  cleanliness, 
of  fresli  air  and  ventilation,  are  all  minutely  detailed,  and  good 
practical  advice  is  given  on  these  subjects,  so  greatly  important  to 
the  welfare  of  the  little  ones. 

Having  instructed  the  mother  as  to  her  child  in  health,  Mr. 
Barrett  comes  to  the  child  in  sickness. 

He  graphically  pourtrays  the  expression  of  the  face,  the  de- 
meanour and  gestures  of  the  sick  child,  teaches  the  mother  to 
distinguish  the  different  cries  of  her  infant — whether  they  are  caused 
by  hunger  or  pain  or  illness,  and  to  recognise  the  sleep,  the  pulse, 
the  breathing,  the  temperature  of  the  skin,  and  the  signs  afforded 
by  the  mouth  and  tongue,  the  skin  and  flesh,  and  the  evacuations 
when  they  vary  from  their  normal  conditions.  He  explains  fully  the 
benefit  vaccination  has  conferred  on  the  human  race,  nor  do  we  think 
he  has  written  a  word  too  much,  though  this  chapter  extends  over 
seventeen  pages.  The  section  on  minor  surgical  injuries  is  practical, 
and  the  directions  for  the  treatment  of  wounds,  scalds,  burns,  stings, 
sprains,  boils,  &c.,  are  clear  and  sensible.  We  do  not,  however,  find 
any  reference  to  fractures,  and  counsel  as  to  what  should  be  done 
until  the  surgeon  arrives.  Hitherto  we  have  been  well  pleased  with 
the  book,  but  we  must  take  strong  exception  to  the  chapter  on  the 
administration  of  remedies  and  to  the  second  half  of  the  book,  ex- 
cepting such  part  as  we  have  already  spoken  of,  and  we  cannot  do 
better  than  quote  the  author  himself  in  his  own  condemnation. 
He  says : 

"  The  second  half  of  the  book  is  occupied  with  descriptions  of 
disease  which  are  only  intended  as  mere  sketches.  The  informa- 
tion is  not  to  enable  the  mother  to  undertake  the  medical  care 
herself,  but  to  arm  her  with  salutary  knowledge  in  case  of  emergency. 
It  is  undesirable  and  dangerous  to  put  sharp-edged  tools  into  the 
hands  of  those  who  are  incapable  of  using  them  aright." 

We  quite  agree  with  Mr.  Barrett  in  these  strictures,  and  wish  he 


1875.]  Pathological  Society* s  Transactions.  18S 

had  adhered  to  them  in  practice,  and  not  have  written  the  pages 
which  follow  this  preface.  Instead  of  bewildering  the  mother  with 
names  of  diseases  and  numerous  brief  imperfect  pictures  Mr. 
Barrett  might  have  sketched  broadly  the  outline  boundaries  which 
separate  health  from  disease.  Had  he  limited  the  mother's  phar- 
macopoeia to  castor  oil,  senna,  sal  volatile,  Gregory's  powder  and  the 
like,  he  would  have  been  on  the  safer  side  than  in  recommending 
calomel  as  "  a  useful  purgative  in  teething  or  in  feverish  and  in- 
flammatory complaints,"  or  Grey  powder  "  as  a  most  valuable 
medicine  in  most  disorders  and  diseases  of  children." 

We  only  hope  that  the  infants  who  have  flourished  under  the 
healthy  regimen  of  the  first  part  of  the  book  may  not  be  done  to 
death  by  the  physicking  described  in  the  second,  and  that  experi- 
mental mammas  may  not  indulge  their  proclivities  in  trying  the  various 
recipes  given  in  the  appendix  on  their  neighbours'  or  their  own 
children. 

Pathological  Society's  Transactions.^ — The  '  Annual  Eeport  of 
Council '  (1873-74)  now  appears  for  the  first  time  in  the  volume  of 
the  '  Transactions/  It  congratulates  the  members  upon  the  con- 
tinued prosperity  and  usefulness  of  the  Society,  whilst  the  appended 
balance  sheet  shows  that  '^  in  financial  as  in  scientific  matters  the 
Society  continues  to  flourish." 

But  what  is  odd  in  this  Eeport,  considered  as  an  integral  part  of 
the  present  volume,  is,  that  it  refers  to  proceedings  of  a  previous 
session,  and  to  records  of  an  important  discussion  on  phthisis  and 
tubercle,  printed  in  exienso  in  a  previous  volume  ;  whilst  at  the  same 
time  it  takes  no  note  of  a  like  extended  discussion  on  cancer 
during  the  session.  1873-74,  now  reported  at  large  in  the  volume 
before  us.  The  inference  is  that  this  Annual  Eeport  of  Council 
dropped  out  by  some  mischance  from  the  volume  to  which  it  refers, 
and  that  the  Eeport  that  should  be  attached  to  the  newly  issued 
volume  has  got  mislaid. 

The  extent  of  the  discussion  on  cancer  indicates  that  the  opinion 
expressed  by  the  Council,  ^^  that  future  debates  of  the  kind  may  be 
conveniently  condensed,  so  as  to  interfere  less  with  the  ordinary 
work  of  the  Society,"  was  not  generally  concurred  in  by  the 
members.  The  debate  on  cancer  was  as  lengthy  as  that  on 
phthisis  and  tubercle,  and  occupies  in  its  report  about  an  equal  • 
amount  of  space  in  the  volume  of  ^  Transactions.' 

These  records  of  debates  on  some  leading  pathological  questions 
will,  if  not  very  contributory  to  their  definite  solution,  be  at  least 
valuable  for  historical  reference.     Besides  the  record  of  the  cancer 

^  Transactions  oj  the  Pathological  Society  of  London.  Vol.  xxv.  London, 
1874. 


184  Bibliographical  Record.  [July, 

discussion,  the  volume  is  as  usual  occupied  with  reports  on  patho- 
logical objects  exhibited  before  the  Society,  which  of  themselves 
render  it  a  valuable  addition  to  that  rapidly  augmenting  repertorium 
of  facts  upon  which  the  advance  of  scientific  pathology  must 
be  based. 

Infant  Diet.' — This  little  book  on  infant  diet  deserves  commen- 
dation. It  is  not  made  up  of  recipes  for  babies^  food,  with  milk-and- 
water  teachings  concerning  feeding;  but,  whilst  conveying  many 
valuable  practical  lessons,  endeavours  to  instruct  its  readers  re- 
specting the  physiology  and  chemistry  of  food  and  digestion  and  the 
principles  which  must  guide  them  in  the  selection  of  diet.  It  conse- 
quently demands  intelligent  and  thoughtful  study  on  the  part  of 
its  readers ;  and  if  it  errs  at  all,  errs  on  the  assumption  that  its  popu- 
lar users  are  gifted  with  good  intelligence  and  desirous  of  learning 
to  deal  with  infants  upon  physicological  principles,  in  a  higher  ratio 
than  the  state  of  society  seems  generally  to  warrant.  On  the  other 
hand,  the  circumstance  of  its  being  in  some  measure  the  production 
of  a  doctoress  will  recommend  it  to  some  readers  and  encourage  its 
perusal.  It  does  not  appear  for  how  much  of  its  contents  we  are 
indebted  to  Dr.  A.  Jacobi  on  the  one  hand,  and  to  Madam  Dr.  Jacobi 
on  the  other ;  the  contributions  of  the  two  are  so  blended  and  har- 
monised that  the  truth  of  the  proverb  that  "  two  of  a  trade  never 
agree ''  appears  fairly  contravened  in  this  example  of  harmonious  co- 
partnership of  medical  man  and  medical  wife. 

Clinical  Lectures  on  Various  Important  Diseases.^ — We  do 
not  know  if  we  are  to  accept  the  present  small  volume  as  an  average 
example  of  the  clinical  teaching  in  the  United  States,  for  it  has  not 
been  our  lot  to  meet  with  treatises  professedly  illustrating  the  style 
and  matter  of  such  teaching  in  that  great  country.  If  it  be  an 
example  of  the  current  clinical  teaching,  it  exhibits  many  commendable 
quahties,  particularly  those  of  a  practical  character.  But  when 
we  compare  these  lectures  with  those  given  to  students  and  published 
from  time  to  time  in  our  periodicals,  and  also  as  independent  volumes, 
we  observe  a  great  contrast  in  regard  to  the  minute  analysis  of 
symptoms  and  the  discussion  of  pathological  processes.  Our  Enghsh 
lecturers  are  most  minute  in  their  examinations,  and  most  fertile  in 
their  interpretation  of  symptoms  and  of  morbid  appearances,  and 
withal,  as  it  sometimes  strikes  us,  weak  in  elaborating  facts  which 
shall  stand  their  hearers  in  good  stead  when  they  are  called  upon  to 
deal  with  disease  at  the  bedside  on  their  own  account.     Such  a  fault, 

^  Infant  Diet.  By  A.  Jacobi,  M.D.  Revised,  enlarged,  and  adapted  to  popular 
nse  by  Mary  F.  Jacobi,  M.D.     New  York,  1874. 

2  Clinical  Lectures  on  Various  Important  Diseases,  being  a  Collection  of  the 
Clinical  Lectures  delivered  in  the  Medical  Wards  of  Mercy  Hospital,  Chicago. 
By  Nathan  S.  Dayis,  M.D.  Edited  by  Feank  Davis,  M.D.  Second  edition. 
Philadelphia,  1874. 


1875.]    Clinical  Lectures  on  Various  Important  Diseases.     185 

if  it  will  be  admitted  a  fault,  does  not  present  itself  in  Dr.  Davis's 
clinical  instruction.  He  examines  his  cases  less  as  a  pathologist  than 
as  a  practitioner.  He  comments  on  the  most  important  symptoms 
and  reads  them  in  the  light  of  modern  pathology,  but  he  finds  his 
most  congenial  duty  to  be  the  indication  for  treatment  to  be  pur- 
sued. 

The  subjects  selected  for  the  lectures  do  not  nearly  range  over 
the  general  field  of  pathology,  and  if  the  diseases  discussed  are,  in 
the  words  of  the  preface,  important  diseases,  they  are  so  chiefly  by 
reason  of  their  being  such  as  will  most  frequently  fall  to  the  lot  of 
the  ordinary  practitioner.  They  are  not,  that  is  to  say,  important 
by  reason  of  peculiar  features  calculated  to  throw  hght  upon  the 
less  understood  questions  of  practical  medicine. 

He  commences  with  two  lectures  on  continued  fever,  under  which 
appellation  he  includes  both  typhus  and  typhoid  fever.  We  find 
him  not  very  clear  upon  the  pathology  of  fever,  and  among  other 
things  he  refers  to  disease  of  Peyer^s  glands  as  a  feature  common 
both  in  enteric  fever  and  in  typhus.  "To  repress  the  intestinal 
evacuations "  (which,  by  the  way,  are  spoken  of  as  symptomatic  of 
continued  fever,  regarded  as  a  special  morbid  condition),  he  advocates 
the  use  of  turpentine  combined  with  opium. 

As  an  example  of  his  pathological  and  therapeutical  ideas,  we 
may  quote  his  observations  on  this  combination  "  to  repress  the  in- 
testinal evacuations.^'  He  considers  no  remedy  more  efficacious  than 
the  one  just  named ;  ''  it  not  only  exerts  a  peculiar  action  on  the 
mucous  surface  of  the  intestines,  by  which  the  tone  or  contractility 
of  the  capillaries  is  increased  and  the  accumulation  of  blood  con- 
sequently diminished,  but  it  also  increases  the  activity  of  the  whole 
capillary  vascular  system.  Hence  it  not  only  fulfils  the  local  indica- 
tion, but  adds  materially  in  accomplishing  the  third  object  named 
(viz.  to  sustain  the  functions  of  the  nervous  and  vascular  systems)." 
A  modern  rationalistic  pathologist  might  object  to  the  postulate 
implied  in  this  explanation  of  the  action  of  Dr.  Davis's  favorite 
medicine,  and  remark  on  the  want  of  precision  in  doctrine,  and  of 
demonstration  by  reference  to  approved  experiments  of  the  peculiar 
action  of  the  mixture  on  the  intestinal  surface  and  of  the  increase 
of  tone  or  contractility  of  the  capillaries. 

''To  devise  remedies  (he  adds)  that  will  relieve  the  extreme  con- 
gestion in  the  lungs,  and  promote  reabsorption  of  the  dark  blood 
infiltrated  into  the  posterior  and  lower  parts  of  these  organs,  is  no 
easy  task."*'  However,  Dr.  Davis  is  equal  to  the  task,  and  we  find 
his  suitable  remedy  to  counteract  the  pulmonary  congestion  is  a 
mixture  of  chloride  of  ammonium,  tartar  emetic,  and  morphia,  with 
syrup  of  liquorice.  He  has,  moreover,  a  second  line  of  defence 
against  "  depression  of  the  excito-motory  centres  "  besides  the  tur- 
pentine and  opium  above  quoted,  viz.,  a  mixture  of  strychnia,  nitric 


1 86  Bibliographical  Record,  V^'^Jt 

acidj  and  opium.  And  it  will  be  especially  gratifying  to  teetotallers 
to  learn  ^'  that  nearly  thirty  years  of  careful  observation  at  the  bed- 
side of  the  sick  has  satisfied  (Dr.  Davis)  that  strychnia  is  a  far  more 
reliable  remedy  for  sustaining  the  nervous  functions  than  alcohol ; 
while  the  effects  of  the  latter  in  diminishing  the  decarbonization  of 
the  blood  make  it  positively  detrimental  to  the  already  seriously 
embarrassed  condition  of  the  lungs  .^^ 

Other  lectures  are  devoted  to  the  clinical  history  of  periodical 
fever,  of  rheumatic  fever,  of  scarlatina,  of  several  respiratory  affec- 
tions and  pulmonary  tuberculosis,  of  diseases  of  the  alimentary 
tract,  of  summer  complaints  of  children,  of  dropsy  and  the  causes 
of  cardiac  disease,  of  neuralgia,  nervous  and  cerebral  affections,  of 
cerebro -spinal  disease,  of  various  cutaneous  diseases  of  mania  a 
potu  and  chronic  disease  of  the  brain,  and,  lastly,  of  pneumonia. 

The  miscellaneous  character  of  the  contents  of  this  volume  will 
appear  from  this  enumeration  of  the  subjects  lectured  upon.  The 
manner  and  the  matter  are  such  as  would  be  looked  for  from  a  good 
practical  physician  in  passing  from  bed  to  bed  in  a  hospital  ward, 
and,  as  we  commenced  by  saying,  do  not  resemble  the  well-studied 
and  elaborate  disquisitions  on  disease  delivered  in  the  lecture  rooms  of 
our  British  hospitals  under  the  title  of  clinical  lectures.  Each  de- 
scription of  teaching  has  its  advantages,  and  it  would  be  well  could 
the  two  be  combined.  But  a  volume  of  clinical  lectures  like  that 
before  us  would  be  pronounced  in  the  old  world  a  superficial 
production. 

On  the  Functional  Derangements  of  the  Liver .1 — We  owe 
an  apology  to  the  author  and  the  publishers  of  this  volume 
for  the  delay  in  noticing  it  in  our  pages.  However,  the  de- 
mand for  notice  was,  we  felt,  not  so  pressing  as  in  the  case  of  a 
book  containing  matter  for  the  first  time  made  public,  inasmuch  as 
these  lectures  have  already  been  placed  before  the  profession  both  in 
the  lecture  room  and  in  the  pages  of  our  weekly  contemporaries. 
They  will  have  consequently  won  their  position  in  pubhc  favour,  and 
need  not  a  commendatory  notice  from  us.  At  the  same  time,  it  is 
both  a  duty  and  a  privilege  to  direct  the  attention  of  our  readers  to 
the  particular  value  of  these  lectures  on  liver  derangements,  know- 
ing the  large  amount  of  instruction  they  contain. 

The  liver  is  a  well-abused  organ  both  by  the  pubHc  and  by  pro- 
fessional men,  and  particularly  so  in  years  now  passing  by.  Liver 
derangement  has  long  been  a  popular  complaint,  and  in  cases  of 
illness  where  no  satisfactory  cause  has  been  made  out  the  liver  has 
very   frequently  been  found  chargeable.      In  recent  days  liver  com- 

^  On  the  Functional  Derangements  of  the  Liver,  being  the  Croonian  Lectures 
delivered  at  the  Hoyal  College  of  Physicians,  in  March,  1874.  By  Chaeles 
MUECHISON,  M.D.,  F.E.S.     Londou,  1874. 


1875.]  Functional  Derangement  of  the  Liver,  187 

plaints  were  declining  in  fashion,  and  other  organs  were  beginning 
to  have  their  due  share  of  blame  as  sources  of  human  ills  attributed 
to  them.  But  after  reading  Dr.  Murchison's  able  lectures  we  appre- 
hend a  revulsion  of  sentiment  and  to  see  again  liver  disorders  in 
the  ascendant. 

For  a  consideration  of  the  three  functions  assigned  to  the  liver 
and  of  the  various  directions  in  which  those  functions  may  be 
deranged,  viewed  in  connection  with  the  author's  classification  of 
the  derangements,  opens  up  to  our  view  the  fons  et  origo  of  a  vast 
multitude  of  diseases  which  trouble  mankind.  It  is  sufficient  to 
notice  the  classification  in  exemplification  of  what  we  say.  Under 
it  the  derangements  stand  as — abnormal  nutrition,  abnormal  elimina- 
tion, abnormal  disintegration ;  derangements  of  the  organs  of 
digestion,  of  the  nervous  system,  of  the  organs  of  circulation,  of 
the  organs  of  respiration,  of  the  urinary  organs ;  and  abnormal  con- 
ditions of  the  skin.  How  wide  a  category  of  diseased  states  is  in- 
cluded in  the  area  of  hepatic  derangement  may  be  gathered  from 
this  classification  as  adopted  by  Dr.  Murchison  in  discussing  the 
subject  before  him. 

He  commences  his  lecture  by  a  review  of  the  past  and  present 
views  of  the  functions  of  the  liver  in  health,  and  closes  by  remarks 
on  the  causes  of  functional  derangements  and  on  their  treatment, 
passing  under  notice  the  most  celebrated  liver  medicines  in 
use.  With  respect  to  mercury,  he  does  not  look  upon  the  experiments 
made  by  Dr.  Bennett  and  others  with  that  drug  on  the  lower  animals 
as  decisive  of  its  character  as  a  cholagogue.  On  the  contrary,  he 
holds  that  in  its  action  it  is  a  true  cholagogue ;  that  besides  increas- 
ing "  the  discharge  of  bile  from  the  bowel,  mercury  exerts  a  beneficial 
action  in  many  functional  derangements  of  the  liver,  in  whatever 
way  this  is  to  be  explained 

"  It  is  not  impossible  that  the  good  effects  of  mercury  on  the  liver, 
and  in  some  forms  of  inflammation,  may  be  due  to  its  property  of 
promoting  disintegration,""  and  this  view  the  author  considers  to  be 
supported  by  the  observation  of  the  fact  of  mercury  rendering 
"effused  fibrine  less  cohesive,  and  so  more  readily  removed  by 
absorption  than  it  otherwise  would  be/^  He  likewise  prefers  mer- 
cury to  podophyllin  as  more  certain  in  its  action  and  less  likely  to 
produce  griping  and  mucous  stools. 

We  have,  in  conclusion,  only  to  repeat  our  high  opinion  of  the 
value  of  this  small  volume  of  lectures,  which,  whilst  replete  with 
pathological  facts  and  discussions,  offers  at  the  same  time  that  sort 
of  information  which  is  most  valued  by  those  practically  engaged  in 
attendance  upon  the  sick. 


188  [July, 


(J^riguial   Communuatiansi* 


I. — The  Pathology  of  the  Contracting  Granular  Kidney. 
By  T.  J.  Maclagan,  M.D. 

That  form  of  Bright^ s  disease  which  is  characterised  by  the 
presence  of  a  small,  red,  granular  kidney,  is  regarded  by  most 
pathologists,  not  as  a  local  disease  of  the  kidneys,  but  as  a  con- 
stitutional ailment,  whose  most  marked  local  manifestation  is  the 
production  of  renal  mischief.     This  view  is,  no  doubt,  correct. 

Regarding  the  manner  in  which  the  granular  contracting  kidney 
is  produced,  and  the  sequence  of  events  by  which  the  pathological 
change  in  the  organ  is  brought  about,  there  are  three  different 
opinions,  corresponding  to  the  three  different  elements  of  which  the 
kidney  is  composed.  Dr.  George  Johnson  holds  that  the  disease 
consists  "  primarily  and  essentially  in  disintegration  and  destruction 
of  the  gland-cells  which  line  the  convoluted  tubes."  Dr.  Dickinson 
and  others  believe  that  the  essence  of  the  disease  is  hypertrophy  of 
the  inter- tubular  fibrous  tissue.  Sir  William  Gull  and  Dr.  Sutton 
regard  this  form  of  Bright^s  disease  as  essentially  a  disease  of  the 
vascular  system,  which  does  not  necessarily  involve  the  renal  vessels 
first,  and  which  consists  in  a  "  hyalin-fibroid  ^^  formation  in  the 
outer  coat  of  the  vessels. 

The  disease  being  a  general  one,  we  naturally  turn  io  the  con- 
stitutional derangement  to  see  whether  from  a  consideration  of  the 
cause  of  the  local  disease  we  can  determine  which  of  the  renal 
structures  is  likely  to  be  first  affected.  Here  we  are  met  by  the 
difficulty  that  w^e  know  little  or  nothing  regarding  the  constitutional 
cause,  except  that  it  is  frequently  associated  with  the  gouty 
diathesis,  and  that  workers  in  lead  are  peculiarly  liable  to  be  affected 
by  it.  There  is  nothing  in  this  to  debar  from  consideration  any 
one  of  the  three  views  which  have  been  advanced  :  there  is  nothing 
in  it  which  particularly  favours  any  of  them. 

As  a  means  of  determining  the  question  as  to  which  of  the 
constituent  parts  of  the  kidney  is  primarily  affected,  there  remain 
to  us,  first,  a  consideration  of  the  local  changes  which  take  place 


1875.]      Pathology  of  the  Contracting  Granular  Kidney,     189 

in  these  glands ;  and,  second,  a  consideration  of  the  symptoms  by 
which  such  changes  are  accompanied. 

The  disease  comes  on  so  gradually,  and  is  so  chronic  both  in  its 
constitutional  and  local  aspects,  that  it  is  impossible  to  fix  the  date 
of  its  commencement.  The  constitutional  affection  exists  prior, 
may  be  long  prior,  to  its  local  manifestation ;  and  this  latter  has 
generally  made  considerable  progress  before  there  are  produced 
such  symptoms  as  render  an  accurate  diagnosis  possible,  or  even 
make  the  patient  feel  that  he  is  ill.  For  this  reason  the  malady 
can  never  be  detected  in  its  earliest  stages.  The  renal  affection  is 
never  studied  before  all  the  structures  of  the  kidney  are  more  or 
less  involved.  Such  being  the  case  it  is  difficult  to  see  how  from 
mere  microscopic  examination  reliable  information  can  be  got 
regarding  the  mode  of  production  of  the  changes  which  are  noted 
in  these  glands.  Such  examination  is  most  valuable  in  determining 
the  changes  which  have  already  taken  place;  it  is,  indeed,  the 
most  reliable  means  of  doing  so.  By  the  aid  of  the  microscope 
we  see  and  satisfy  ourselves  that  there  is  atrophy  of  the  tubes, 
with  hypertrophy  of  the  inter-tubular  tissue  and  of  the  minute 
arteries :  by  its  aid  we  can  also  determine  the  extent  to  which 
these  various  changes  have  taken  place.  But  in  endeavouring  to 
determine  in  which  of  the  structures  the  morbid  change  com- 
menced, we  find  the  microscope  afford  much  less  satisfactory  results 
than  the  other  methods  of  research  to  which  we  shall  have  recourse. 

The  morbid  anatomy  of  this  form  of  Bright's  disease  has  of  late 
years  been  the  subject  of  much  research  and  discussion.  I  do 
think  that  too  much  has  been  expected  from  a  study  of  its  micro- 
scopic anatomy ;  and  that  too  little  attention  has  been  devoted  to 
the  careful  study  and  interpretation  of  the  phenomena,  and  changes 
other  than  microscopic,  by  which  the  malady  declares  its  presence. 
Hitherto  microscopic  examination  has  led  only  to  diversity  of 
opinion  on  the  part  of  the  most  accomplished  observers.  That 
structure  which  Drs.  Dickinson,  Grainger  Stewart,  and  others 
regard  as  the  one  primarily  involved  in  the  renal  changes,  Dr. 
Johnson  says  has  no  real  existence.  The  vascular  changes  attributed 
by  nearly  all  other  observers  to  hypertrophy  of  the  muscular  coat 
of  the  minute  arteries  are  regarded  by  Sir  William  Gull  and  Dr. 
Sutton  as  the  result  of  a  change  in  the  outer  coat  of  the  vessels. 

Where  sucli  observers  so  widely  disagree,  I  would  not  intrude  an 
opinion  founded  solely  on  microscopic  examination  of  the  affected 
glands.  I  would  rather  attack  the  difficulty  from  another  point, 
and  try  by  a  careful  analysis  of  the  symptoms  and  changes  which 
accompany  the  development  of  the  renal  disease  to  advance  our 
knowledge  of  the  true  pathology  of  the  contracting  granular 
kidney. 

The  phenomena  with  which  we  have  to  deal  are,  first,  the  local 


190  Original  Communications.  [July, 

changes  which  take  place  in  the  kidney ;  and,  second,  the  symptoms 
and  changes  which  result  therefrom. 

The  local  changes  are  [a)  loss  of  gland  cells,  or  intra-tubular 
atrophy ;  {b)  increase  of  fibrous  stroma,  or  inter- tubular  hypertrophy ; 
and  (c)  thickening  of  arterial  coats.  Now  in  what  order  do  these 
different  structures  become  implicated  in  the  local  disease?  Can 
any  one  of  them  give  rise  to  the  other  two  ?  Can  loss  of  gland- 
cells  lead  to  increased  growth  of  fibrous  tissue  and  hypertrophy 
of  minute  arteries  ?  Can  increased  growth  of  fibrous  tissue  cause 
loss  of  gland- cells,  and  thickening  of  arterioles?  Can  hypertrophy 
of  minute  arteries  give  rise  to  increase  of  interstitial  fibrous 
tissue,  and  loss  of  glandular  apparatus  ?  Or  do  any  two  or  all 
three  changes  take  place  simultaneously  ? 

A  careful  consideration  of  each  of  these  propositions,  and 
an  unprejudiced  effort  to  explain  by  each  the  phenomena  of  the 
disease,  local  and  general,  have  led  me  to  adopt,  with  some  modifica- 
tions. Dr.  Johnson's  view  of  the  mode  of  production  of  the  renal 
changes,  and  to  regard  loss'  of  gland- cells  as  the  primary  and 
essential  feature  of  the  granular  contracting  kidney. 

Holding  this  view,  it  is  incumbent  on  us  to  give  some  explanation 
of  the  changes  which  we  regard  as  secondary. 

These  may  be  considered  {a)  as  they  affect  the  kidneys,  and  {b) 
as  they  affect  other  organs.  The  former  call  lor  attention  first. 
We  shall  commence  with  the  vascular  changes. 

These  consist  in  hypertrophy  of  the  muscular  coat  of  the  minute 
arteries.  This  change  in  the  renal  arterioles,  first  described  by 
Dr.  George  Johnson,  is  attributed  by  him  to  the  lessened  demand 
for  blood  in  the  kidneys,  consequent  on  loss  of  their  gland-cells ; 
these  vessels  contracting,  and  ultimately  becoming  hypertrophied  in 
their  efforts  to  curtail  the  blood-flow  to  the  diminished  and  diminish- 
ing renal  tissue.  That  is  a  plausible  explanation,  but  there  appears 
to  me  to  be  a  more  satisfactory  one. 

Those  products  of  retrograde  tissue-metamorphosis,  which  it 
falls  to  the  kidneys  to  eliminate,  are  not  formed  in  these  glands, 
at  least  in  any  quantity,  but  are  produced  in  other  organs  whence 
they  are  conveyed  in  the  blood  to  the  kidneys  for  elimination. 
The  formation  of  these  excreta  continuing  in  due  amount,  and  the 
glandular  surface  of  the  kidneys  diminishing  in  extent,  it  is  evident 
that  the  retention  of  urinary  excreta  can  only  be  prevented  by 
increased  rapidity  of  the  circulation  through  the  kidneys,  and  by 
increased  activity  of  what  remains  of  their  glandular  apparatus. 

1  I  prefer  this  term  to  that  of  destruction  or  disintegration  of  gland-cells.  I  do 
not  think  there  is  evidence  to  prove  that  the  cells  are  necessarily-  destroyed. 
They  unquestionably  often  do  go  throngh  a  pi'ocess  of  granular  disintegration, 
but  such  change  may  not  commence  till  after  they  are  shed,  and  have  ceased 
to  perform  any  function. 


1875.]     Pathology  of  the  Contracting  Granular  Kidney,     l9l 

We  know  that  the  kidneys  are  capable  of  eliminating  much 
more  than  the  normal  quantity  of  excreta  (witness  the  large  excess 
of  urea  which  is  thrown  off  in  many  inflammatory  and  febrile 
ailments,  in  diabetes  mellitus,  and  in  azoturia),  and  that  if  one 
gland  be  removed  or  destroyed^  the  other  may  do  as  much  work 
as  was  previously  performed  by  two.  Such  being  the  case,  we 
cannot  fail  to  see  that  loss  of  part  of  the  glandular  apparatus  may 
be  compensated  for  by  increased  activity  of  what  remains  sound,  or 
comparatively  so ;  and  that  even  a  general  and  equally  distributed 
disease  of  both  glands  may,  in  its  early  stages,  be  insufficient  to 
lead  to  such  loss  of  function  as  would  result  in  defective  excretion. 
From  what  is  observed  in  cases  in  which  one  kidney  is  somehow 
lost,  it  may  safely  be  inferred  that  retention  of  urinary  excreta 
does  not  take  place  till  the  normal  eliminating  power  of  the  kidneys 
is  reduced  one  half :  that,  as  Dr.  Bence  Jones  has  remarked,  is  a 
large  margin  for  safety. 

In  the  early  stage  of  the  contracting  granular  kidney,  the  loss 
of  gland-cells  which  characterizes  the  ailment  is  compensated  for 
by  sending  to  what  remains  of  the  glandular  apparatus  a  larger 
quantity  of  blood  for  purification.  The  earliest  result  of  the  loss 
of  the  gland-cells  of  the  kidneys  is  thus  not,  as  Dr.  Johnson  holds, 
a  diminished  flow  of  blood  to  these  glands,  but  an  efi'ort  to  com- 
pensate for  the  decrease  in  their  eliminating  surface  by  an  increased 
flow  of  blood  through  them.  . 

How  is  this  brought  about  ?  It  clearly  cannot  be  due  to  increase 
in  the  vis  a  fronte,  to  increased  attraction  for  the  nutritive  fluid  in 
the  glands  themselves :  the  loss  of  renal  structure  which  necessi- 
tates the  increased  flow  precludes  such  a  possibility.  It  must, 
therefore,  result  from  increase  in  the  vis  a  tergo,  from  greater  force 
and  frequency  of  the  heart's  action. 

The  early  stage  of  the  contracting  granular  kidney  thus  consists, 
first,  in  loss  of  secreting  cells ;  and,  second,  in  a  consequent  in- 
crease in  the  quantity  of  blood  which  flows  through  the  kidneys  in 
a  given  time ;  a  condition  which  is  more  likely  to  be  accompanied 
by  dilatation  than  by  contraction  of  the  minute  arteries. 

The  loss  of  the  gland- cells  being  progressive,  a  time  necessarily 
comes  when  increased  rapidity  of  the  circulation  through  the  kidneys 
can  no  longer  compensate  for  the  decrease  in  their  eliminating 
surface.  Urea  and  other  excretory  products  accumulate  in  the 
blood,  and  are  conveyed  to  what  remains  of  the  renal  gland-cells  in 
quantities  too  great  for  their  eliminating  powers.  This  constant 
presence  of  an  excess  of  their  normal  stimulant  cannot  fail  to  prove 
irritating  to  kidneys  unable  to  respond  to  the  call  which  is  thus 
made  upon  them.  This  impression  being  conveyed  to  the  renal 
vaso-motor  centres,  there  results  contraction  of  the  minute  arteries, 
which,  being  permanent,  necessarily  results  in  hypertrophy.     There 


l9^  Original  Communications,  [J^^y, 

is  thus  produced  that  thickened  condition  of  the  minute  renal 
arteries  which  is  noted  in  the  advanced  stage  of  the  contracting 
granular  kidney ;  a  condition  which,  it  will  be  seen,  is  an  indirect 
result  of  the  loss  of  the  renal  gland-cells. 

What  of  the  inter-tubular  fibrous  tissue?  While  agreeing  with 
Dr.  Johnson  in  regarding  loss  of  gland-cells  as  the  essence  of  the 
disease,  I  cannot  homologate  his  opinion  as  to  the  non-existence  of 
inter-tubular  fibrous  tissue.  I  agree  with  Dr.  Dickinson  in  regard- 
ing increase  of  this  tissue  as  a  part  of  the  renal  changes  :  I  disagree 
with  him  in  regarding  it  as  the  essence  of  the  disease.  I  believe 
that  there  is  some  increase  of  the  inter-tubular  tissue,  but  that  such 
increase  is  not  so  extensive  as  Dr.  Dickinson  describes ;  that  it  plays 
an  unimportant  part  either  in  the  pathology  or  symptomatology  of 
the  disease ;  and  that  it  is  always  secondary  to  the  changes  which  have 
been  described  as  taking  place  in  the  tubes  and  in  the  circulation. 

Sir  Wilham  Jenner  has  shown,  and  all  pathologists  allow  the 
accuracy  of  the  observation,  that  the  continued  presence  in  an  organ 
of  an  increased  quantity  of  blood  gives  rise  to  induration  of  its 
substance,  that  is,  to  increase  of  its  fibrous  tissue.  In  the  kidneys 
such  a  change  is  frequently  noted  as  a  result  of  venous  congestion, 
consequent  on  valvular  disease  of  the  heart,  and  is  occasionally 
observed  as  a  consequence  of  similar  congestion  resulting  from  the 
pressure  of  a  gravid  uterus.  In  these  cases  there  can  be  no  doubt 
that  the  cause  which  gives  rise  to  the  increased  growth  of  fibrous 
tissue,  which  constitutes  the  induration,  is  the  continued  presence 
in  the  kidneys  of  an  abnormal  quantity  of  blood.  The  increase  of 
fibrous  stroma  thus  produced  is  similar  to  that  which  is  noted  in 
the  contracting  granular  kidney ;  "  in  their  minute  anatomy  there  is 
no  appreciable  difference  between  the  two  forms'*'  (Dickinson). 

There  is  one  very  noteworthy  difference,  however ;  in  the  true 
granular  contracting  kidney,  the  organ  is  much  reduced  in  size 
from  shrinking  of  the  tubules ;  whilst,  in  that  form  of  induration 
which  results  from  chronic  valvular  disease,  such  marked  diminution 
is  not  observed. 

I'inriing  that  the  continued  presence  in  the  kidneys  of  an  increased 
quantity  of  blood  gives  rise  to  an  increase  in  their  fibrous  stroma 
similar  to  that  which  characterizes  the  contracting  granular  kidney ; 
and  finding  on  a  careful  examination  of  the  phenomena  of  the 
latter,  that  there  is  good  reason  to  believe  that  in  it  too  there  is, 
for  a  considerable  period,  persistent  hypersemia  of  the  affected 
glands ;  and  knowing  of  no  other  cause  which  is  capable  of  pro- 
ducing such  a  result,  we  cannot  fail  here  also  to  note  the  connexion 
between  the  two  conditions ;  to  associate  tliem,  as  in  the  other  case, 
as  cause  and  effect,  and  to  conclude  that  the  increase  in  the  inter- 
tubular  fibrous  tissue,  which  is  found  in  the  contracting  granular 
kidney,  results  from  the  continued  flow  through  these  glands  of  an 


1875.]      Pathology  of  the  Contracting  Granular  Kidney.       193 

excess  of  blood,  an  excess  which  is  rendered  requisite  by  the  loss  of 
part  of  their  gland-cells. 

Increase  of  the  inter-tubular  fibrous  tissue  we,  therefore,  regard 
as  secondary  to  the  intra- tubular  changes,  which  thus  become  the 
primary  and  essential  feature  of  the  disease. 

Other  evidence  in  support  of  this  view  of  the  pathology  of  the 
renal  changes  we  have  in  the  appearance  which  the  kidneys  present 
to  the  naked  eye.     They  are  small  in  size,  and  red  in  colour. 

Why  are  they  small?  Diminution  in  size  is,  of  course,  due  to 
loss  of  substance.  The  only  part  of  the  kidney  whose  bulk  is 
diminished  is  the  renal  tissue  proper :  the  gland-cells  are  shed,  and 
the  tubules  shrink  in  consequence.  This  shrinking  of  the  glandular 
apparatus  is  regarded  by  Dr.  Dickinson,  and  those  who  adopt  the 
cirrhotic  view  of  this  form  of  Bright^s  disease,  as  a  result  of  the 
contraction  of  the  new  growth  which  "  encloses  and  compresses 
such  parts  of  the  gland  as  are  in  its  path.''  This  seems  to  me  an 
inadequate  explanation  of  the  loss  of  bulk  which  takes  place.  Loss 
of  gland-cells  and  falling-in  of  the  tubules  are  alone  quite  sufficent 
to  produce  it.  But  if  this  change  in  the  tubules  be  brought  about 
by  the  compressing  influence  of  a  new  inter-tubular  growth,  it  is 
difficult  to  see  how  there  could  result  such  a  marked  decrease  of 
size  as  is  so  frequently  found  :  for,  assuredly,  the  great  and  continued 
increase  of  fibrous  tissue  which,  on  Dr.  Dickinson's  view,  takes 
place  as  the  malady  advances,  would  suffice  to  prevent  such  marked 
diminution  in  size  as  is  noted  in  advanced  caees.  The  gland  sub- 
stance might  waste,  but  its  place  would  to  some  extent  be  occupied, 
and  the  bulk  of  the  organ  to  some  extent  maintained,  by  the 
increased  growth  of  fibrous  tissue  whose  presence  produced,  by 
mere  physical  pressure,  the  wasting  of  the  tubular  portion. 

Why  are  they  red  ?  Clearly  because  of  the  presence  of  blood, 
and  the  absence  of  such  changes  as  would  produce  a  blanched 
appearance  of  the  glands. 

Here  again  it  is  difficult  to  see  how  such  an  appearance  is  com- 
patible with  the  changes  which  Dr.  Dickinson  describes  as  charac- 
terizing the  disease  :  for,  assuredly,  increased  growth  of  fibrous 
tissue,  which  is  colourless;  loss  of  gland- cells,  and  obliteration  of 
tubules,  the  parts  to  which  most  blood  goes ;  and  narrowing  of  the 
calibre,  and  thickening  of  the  coats  of  the  colourless  vessels  by 
which  that  fluid  is  conveyed,  are  changes  which  are  all  calculated  to 
lead  to  bloodlessness  and  loss  of  colour,  rather  than  to  the  main- 
tenance of  the  normal  red  hue  of  the  gland. 

Neither  does  Dr.  Johnson's  view  of  the  vascular  changes  consist 
with  this  appearance :  as  described  by  him  these  would  give  rise  to 
a  diminution  in  the  quantity  of  blood  supplied  to  the  glands,  and 
consequent  loss  of  colour. 

The  redness  of  the  contracting  granular  kidney  is  one  of  the 

111— LVI.  13 


194  Original  Communications.  [July, 

phenomena  of  the  disease  which  must  be  explained.  It  can  only  be 
accounted  for  by  the  presence  in  what  remains  of  the  gland  of  a 
normal  or  more  than  normal  quantity  of  blood.  It  has  already 
been  shown  that  the  loss  of  gland-cells  which  characterizes  the 
disease  is  to  some  extent  compensated  for  by  increased  activity  and 
vascularity  of  what  remains :  it  is  this  increased  vascularity  which 
imparts  to  the  contracting  granular  kidney  the  redness  which 
forms  one  of  its  characteristics.  What  remains  of  the  glandular 
structure  has  sent  to  it  more  than  a  normal  quantity  of  blood  for 
purification :  it  possesses,  therefore^  a  normal,  or  more  than  normal, 
degree  of  coloration. 

The  effect  on  the  renal  secretion  of  the  changes  which  have  been 
noted  is  very  marked.  The  condition  with  which  we  have  to  deal  is 
that  of  a  kidney  which  has  lost  its  gland-cells  to  a  greater  or  less 
extent,  and  through  which  there  is  a  consequent  and  compensatory 
increase  in  the  blood-flow.  Now  it  is  evident  that  increased  rapidity 
of  the  circulation  through  kidneys  whose  tubes  are  unobstructed, 
whose  gland-cells  are  diminished  in  amount,  and  whose  vessels 
present  no  obstacle  to  the  blood-flow,  must  result  in  increased  flow 
of  urine  deficient  in  solids.  There  is,  up  to  a  certain  period,  no 
obstruction  of  the  tubes,  no  hindrance  to  the  free  elimination  of 
water,  but  simply  loss  of  gland-cells,  and  consequent  decreased  power 
of  eliminating  solids.  Combined  with  this  is  an  increased  flow  of 
blood  which,  in  consequence  of  increased  force  of  the  cardiac  action, 
passes  through  the  renal  vessels  at  a  higher  than  normal  pressure. 
The  necessary  consequence  of  all  this  is  an  increased  flow  of  urine  of 
low  specific  gravity  ;  and  this  we  know  is  one  of  the  earliest  indica- 
tions of  renal  mischief  in  this  form  of  Bright's .  disease.  For  some 
time  after  the  onset  of  the  renal  mischief  the/amount  of  urinary  solids 
eliminated  in  a  given  time  may  be  quite  normal ;  but  in  order  to 
efi'ect  this  result  there  must  be  an  increased  flow  of  blood  through 
the  kidneys.;  a  necessary  consequence  of  this  will  be  an  increase  in 
the  quantity  of  water  eliminated  by  these  channels.  In  accordance 
with  this  we  find  that  the  increase  in  the  flow  of  urine  is  less  marked 
in  the  very  early  stages  of  the  disease,  when  the  diminution  in  the 
glandular  apparatus  and  the  compensatory  increase  in  the  renal 
circulation  are  slight,  than  it  is  when  the  renal  changes  are  further 
advanced,  and  when  the  decreasing  extent  of  eliminating  surface  calls 
for  a  greatly  increased  rapidity  of  the  blood-flow.  By-and-bye,  when 
increased  rapidity  of  the  circulation  no  longer  suflices  to  make  up 
for  the  loss  in  the  secreting  cells,  when  many  of  the  tubules  have 
become  shrunken  and  shrivelled,  when  urinary  excreta  accumulate 
in  the  blood,  and  when  the  renal  arteries  become  contracted  and 
thickened,  the  flow  of  urine  again  decreases,  and  dropsical  symptoms 
may  be  developed,  sometimes  as  a  result,  and  sometimes  without  the 
occurrence,  of  inflammatory  mischief  in  the  kidneys. 


1875.]      Pathology  of  the  Contracting  Granular  Kidney,      195 

A  decided  increase  in  the  flow  of  urine  in  this  form  of  Bright's 
disease  marks  not  the  earliest  stage  of  the  renal  mischief,  but  that 
stage  at  which  a  much  increased  rapidity  of  the  circulation  is  required 
to  compensate  for  the  loss  of  the  renal  gland-cells.  Subsequent 
diminution  in  the  amount  of  water  eliminated  marks  the  period  at 
which  the  loss  of  the  gland-cells  can  no  longer  be  compensated  for 
by  increased  blood-flow  through  the  kidneys,  when  retention  of 
urinary  excreta  becomes  inevitable,  and  when  ureemic  symptoms  may 
be  looked  for. 

We  thus  find  that  the  changes  which  take  place  in  the  renal  secre- 
tion are  likewise  such  as  may  ultimately  be  traced  back  to  loss  of 
renal  gland-cells.  In  this  connexion  we  find  an  additional  argument 
in  favour  of  the  view  which  regards  such  loss  as  the  essence  of  the 
disease.  .  - 

Here,  again,  it  is  difficult  to  see  how  the  view  which  regards  the 
increase  of  the  fibrous  stroma  as  the  primary  feature  of  the  renal 
mischief  can  adequately  explain  the  phenomenon  with  which  we  are 
dealing,  the  occurrence  of  an  increased  flow  of  urine.  According  to 
this  view  the  increased  growth  of  fibrous  tissue  gives  rise  to  such 
pressure  on  the  renal  tubules  that  their  contents  are  more  or  less 
destroyed,  and  they  themselves  have  their  calibre  greatly  diminished, 
lyiow,  it  is  evident  that  such  a  process  of  contraction  and  narrowing 
of  the  renal  tubules  could  not  go  on  for  any  length  of  time,  or  involve 
much  of  the  renal  structure,  without  producing  a  serious  physical 
obstruction  to  the  passage  of  fluid  along  these  channels,  and  con- 
sequent diminished  flow  of  urine ;  the  very  opposite  of  what  we  know 
takes  place.  According  to  Dr.  Dickinson  the  physical  changes  which 
take  place  in  the  fibrous  stroma  are  primary,  and  those  which  take 
place  in  the  tubules  secondary.  Increased  flow  of  urine  must, 
according  to  this  view,  be  secondary  to  the  constriction  of  the  tubules 
through  which  it  flows ;  a  combination  and  sequence  of  circum- 
stances which  appear  to  be  improbable,  if  not  impossible.  According 
to  the  view  which  I  advocate  the  falling-in  of  the  sides  of  the  tubules 
takes  place  only  after  their  secreting  cells  are  lost,  and  after  they 
have  ceased  to  eliminate  solids,  and  never  results  from  external 
pressure.  While  portions  of  the  kidneys  are  undergoing  this  change, 
other  parts  are  the  seat  of  a  compensatory  hyperaction  which,  while 
it  prevents  for  a  time  retention  of  excreta,  produces  an  increased  flow 
of  water.  Though  much  of  this  increased  flow  comes  from  tubules 
whose  gland-cells  are  actively  eliminating  solid  excreta,  there  can  be 
no  doubt  that  a  considerable  quantity  also  passes  along  tubules  which 
have  lost  their  cells,  but  which  have  not  yet  lost  their  power  of  ex- 
creting water.  There  is  thus  a  double  reason  why  there  should  be  an 
increased  flow  of  urine ;  first,  because  an  increase  flow  of  blood,  and 
a  corresponding  increase  in  water  elimination,  are  requisite  to  enable 
the  sounder  portions  of  the  kidneys  to  throw  off  an  extra  quantity 


196  Original  Communications,  [July, 

of  solid  excreta ;  and  second,  because  tubules  which  have  lost  their 
gland-cells,  but  are  still  pervious,  may  continue  to  be  the  channels  of 
water  elimination  after  they  have  ceased  to  excrete  solids. 

A  consideration  of  the  changes  which  take  place  both  in  the 
kidneys  and  in  their  secretion,  we  have  thus  seen,  supports  the  view 
that  the  primary  change  in  the  contracting  granular  kidney  is  loss  ot 
renal  gland- cells. 

To  the  same  source  may  likewise  be  traced  back  the  changes 
which  occur  in  other  organs.  We  shall  confine  our  attention  to 
those  which  take  place  in  the  vascular  system.  Of  these  the  most 
striking  is  hypertrophy  of  the  heart.  This  is  usually  attributed  to 
the  difficulty  which  that  organ  experiences  in  driving  along  the 
impure  blood.  Such  an  explanation  seems  to  me  unsatisfactory,  and 
that  for  two  reasons ;  first,  because  it  has  not  been  shown  that 
impure  blood  circulates  with  greater  difficulty  than  pure ;  and 
second,  because  such  hypertrophy  is  rarely,  if  ever,  noted  in  the 
inflammatory  and  waxy  forms  of  Bright's  disease,  in  which  the  blood 
impurity  may  be  as  great. 

Dr.  Johnson  regards  the  cardiac  hypertrophy  as  the  result  of  the 
increased  force  which  is  requisite  to  drive  the  blood  through  the 
contracted  arterioles.  That  is  a  much  more  feasible,  and,  to  some 
extent,  true  explanation  of  the  increased  size  of  the  heart.  But  it  is 
not  the  whole  truth :  for  though  in  the  later  stages  of  the  disease 
contraction  of  the  minute  arteries  may  increase  the  heart's  work,  it 
is  not  the  initial  cause  of  its  hypertrophy.  Nay,  I  believe  that 
cardiac  hypertrophy  not  only  exists  to  some  extent  prior  to,  and  inde- 
pendently of,  the  occurrence  of  contraction  of  the  systemic  arterioles, 
but  that  it  may  even  have  some  share  in  initiating  such  contraction. 
We  have  seen  that  one  of  the  earliest  results  of  loss  of  the 
renal  gland- cells  is  an  increased  flow  of  blood  through  the  kidneys, 
a  result  which  is  brought  about  by  increased  force  and  frequency  of 
the  cardiac  action.  This  is  the  first  step  towards  the  production  of 
hypertrophy  of  the  heart.  Be  it  noted  that  this  increased  cardiac 
action  commences  so  soon  as  the  loss  of  the  gland  cells  is  such  as  to 
call  for  increased  work  on  the  part  of  those  which  remain,  and  that 
the  demand  thus  made  on  the  heart  continues  to  increase  as  the  renal 
disease  advances.  Be  it  equally  noted  that  retention  of  urinary  ex- 
creta does  not  occur  till  a  considerably  later  period,  when  increased 
force  of  the  cardiac  action,  and  increased  rapidity  of  the  circulation 
through  the  kidneys,  no  longer  suffice  to  counterbalance  the  increased 
loss  of  renal  gland-cells.  The  necessity  for  increased  force  of  the 
cardiac  action  thus  exists  prior  to,  and  independently  of,  the  reten- 
tion in  the  blood  of  urinary  excreta.  When  such  retention  does 
take  place  (as  with  the  advance  of  the  renal  mischief  it  inevitably 
must)  there  is  brought  about  contraction  and  hypertrophy  of  the 
renal  arterioles  in  the  manner  already  explained.     The  increased 


1875.]      Pathology  of  the  Contracting  Granular  Kidney.      197 

resistance  to  the  flow  of  blood  through  the  kidneys  thus  occa- 
sioned no  doubt  tends  to  exaggerate  the  already  existing  hyper- 
trophy of  the  central  organ  of  the  circulation.  That  increased  force 
is  requisite  to  drive  the  blood  through  the  kidneys  at  this  stage  of 
the  disease  has  been  experimentally  demonstrated  by  Dr.  Dickinson. 

According  to  Dr.  Johnson  it  is  subsequent  to  the  period  at  which 
such  retention  occurs,  and  as  a  consequence  of  the  blood  impurity 
which  then  commences,  that  the  systemic  arterioles  contract  with  the 
object  of  excluding  to  some  extent  the  impure  blood.  It  is  at  a  still 
later  period,  therefore,  according  to  this  view,  that  cardiac  hyper- 
trophy begins.  Though  a  very  plausible,  I  believe  this  to  be  an 
imperfect  interpretation  of  the  somewhat  complex  and  complicated 
phenomena  with  which  we  have  to  deal.  The  true  sequence  of 
events  I  believe  to  be  as  follows : — There  is  loss  of  renal  gland- 
cells,  the  result  of  some  constitutional  cause ;  there  is  increased 
activity  of,  and  increased  transmission  of  blood  to,  the  cells  which 
remain  ;  to  effect  this  there  is  increased  force  and  frequency  of  the 
heart's  action,  which,  being  continuous,  in  time  gives  rise  to  hyper- 
trophy of  that  organ.  Now  this  central  force,  while  sending  an 
increased  quantity  of  blood  through  the  kidneys,  must  likewise  send 
that  fluid  with  equally  increased  force  to  all  the  organs  of  the  body. 
The  kidneys  being  the  only  organs  in  which  such  increased  flow  is 
called  for,  it  is  probable  that  the  minute  arteries  of  the  other  organs 
will  contract  to  some  extent  so  as  to  prevent  the  passage  to  them 
of  such  an  excess  of  blood.  The  cardiac  hypertrophy  thus 
becomes  the  initial  cause,  rather  than  a  result,  of  the  contraction  of 
the  minute  systemic  arteries,  other  than  the  renal. 

It  is  not  probable,  however,  that  the  contraction  thus  induced 
can  suffice  altogether  to  prevent  the  passage  to  other  organs  of 
more  blood  than  they  really  require.  In  this  persistent  hypera3mia 
of  other  organs,  the  liver  and  lungs,  for  example,  we  have  a  possible 
explanation  of  the  changes  which  are  frequently  noted  in  their 
intimate  structure  in  this  form  of  Bright's  disease ;  a  change  which 
essentially  consists  in  increased  growth  of  their  fibrous  tissue,  and 
is  probably  due  to  the  same  cause  (hypersemia)  as  gives  rise  to  a 
like  increase  in  the  fibrous  stroma  of  the  kidneys. 

In  the  increased  call  upon  the  heart,  and  in  this  generally  deranged 
state  of  the  circulation,  we  have  the  explanation  of  the  cardiac 
disturbance  and  irritability,  the  inability  for  exertion,  the  shortness 
of  breath  and  even  dyspncea,  the  giddiness,  the  dyspe})tic  and 
other  symptoms  which  are  so  prominent  in  this  form  of  Bright's 
disease,  even  before  there  is  retention  of  urinary  excreta. 

Though  hypertrophy  of  the  muscular  substance  of  the  heart  and 
contraction  of  the  minute  systemic  arteries  thus  exist  independently 
of  blood  impurity,  it  is  probable  that  the  occurrence  of  this  con- 
dition tends  to  exaggerate  these  changes  in  the  manner  described 


198  Original  Communications.  [July, 

by  Dr.  Johnson.  The  primary  cause  of  the  cardiac  hypertrophy, 
however,  is  not  retention  in  the  blood  of  urinary  excreta;  but  the 
effort  which  nature  makes  to  prevent  such  impurity  of  the  nutrient 
fluid  by  sending  an  increased  quantity  of  blood  to  the  kidneys  for 
purification. 


Though,  perhaps,  the  time  has  not  yet  arrived  for  giving  a  de- 
cision on  the  accuracy  or  otherwise  of  the  observations  of  Sir 
William  Gull  and  Dr.  Sutton,  it  is  impossible  to  pass  unnoticed 
their  important  contribution  to  the  literature  of  the  vexed  question 
of  the  pathology  of  the  contracting  granular  kidney. 

I  refer  to  it  the  more  willingly  as  I  believe  that  their  observations 
and  Dr.  Johnson's  are  not  so  antagonistic  as  is  usually  supposed, 
and  that  they  are  even  capable  of  being  to  some  extent  reconciled. 

It  is  admitted  that  the  granular  contracting  kidney  is  not  simply 
a  local  disease  of  the  kidneys,  but  a  general  constitutional  affection. 
Dr.  Johnson  has  studied  the  morbid  anatomy  of  the  disease  from 
the  renal  side ;  Sir  William  Gull  and  Dr.  Sutton  from  the  constitu- 
tional. The  former  has  described  the  changes  which  take  place  in 
the  minute  vessels  as  a  consequence  of  the  advance  of  the  local 
disease.  The  latter  have  endeavoured  to  find  the  evidence  of  the 
constitutional  affection,  and  the  cause  of  the  symptoms  which  exist 
prior  to  the  occurrence  of  renal  mischief,  in  morbid  change  of  the 
minute  arteries  and  capillaries,  and  have  described  under  the  name 
of  "  arterio- capillary  fibrosis  "  a  change  in  the  outer  coat  of  these 
vessels  which  they  regard  as  'Uhe  primary  and  essential  condition  of 
the  morbid  state  called  chronic  Bright's  disease,  with  contracting 
kidney." 

At  the  time  that  the  essay  of  Sir  William  Gull  and  Dr.  Sutton 
was  published,  I  had  just  finished  translating  M.  Bouchard's  work 
on  the  pathology  of  cerebral  hsemorrhage,  in  which  is  given  a 
careful  and  minute  description  of  certain  changes  which  M.  Charcot 
and  he  had  observed  in  the  minute  arteries  in  cases  of  cerebral 
haemorrhage,  and  which  are  described  by  them  under  the  names  of 
sclerous  arteritis,  chronic  peri-arteritis,  and  arterial  sclerosis.  On 
reading  Sir  William  Gull  and  Dr.  Sutton's  paper,  it  at  once  struck 
me  that  their  arterio-capillary  fibrosis  bore  a  very  close  resemblance 
to,  if  it  was  not  identical  with,  Charcot  and  Bouchard's  sclerous 
arteritis.  During  the  last  three  years  I  have  further  investigated 
the  subject,  and  have  been  led  to  the  conclusion  that  the  changes 
described  as  having  taken  place  in  the  minute  arteries  by  Sir 
William  Gull  and  Dr.  Sutton  have  a  real  existence,  and  that  what 
these  physicians  have  seen  and  described  is  the  same  morbid  con- 
dition w^hich  MM.  Charcot  and  Bouchard  had  described  five  years 
before  under  the  name  of  sclerous  arteritis.  A  comparison  of  the 
respective  descriptions  given  by  the  French  and  English  pathologists 


]875.]      Pathology  of  the  Granular  Contracting  Kidney »      199 

of  the  changes  observed  by  them  in  the  minute  vessels  will  make 
apparent  the  identity  of  the  pathological  changes  observed  by  each. 
The  following  is  a  summary  of  Charcot  and  Bouchard's'  account  of 
what  they  saw : — 

"  This  arteritis  is  diffuse  :  it  extends  to  the  entire  system  of  small 
intra- cerebral  vessels.  Studied  only  in  the  small  vessels  of  the 
brain  substance,  this  sclerous  arteritis  is  characterized  by  changes 
in  the  peri-vascular  sheath,  by  lesions  of  the  adventitious  tunic, 
and  also  by  changes  in  the  muscular  and  internal  coats.  The 
principal  changes  take  place  in  the  most  external  parts ;  they  pro- 
gress from  without  inwards,  thus  justifying  the  name  peri-arteritis. 
This  change  is  observed  in  the  arterioles  of  every  calibre,  which  are 
situated  in  the  substance  of  the  brain-tissue.  The  lymphatic  sheath 
may  present  only  a  striated,  wavy  appearance,  like  a  bundle  of 
subcutaneous  cellular  tissue.  The  cavity  of  the  sheath  generally 
presents  nothing  abnormal.  On  the  principal  arterioles  the  adven- 
titious coat  may  present  two  different  conditions.  Sometimes  there 
is  simple  thickening,  imparting  to  that  membrane  a  thickness  which 
is  occasionally  equal  to  the  calibre  of  the  vessel.  Its  substance  is 
striated  longitudinally,  like  a  bundle  of  fibrous  tissue,  and  encloses 
fusiform  corpuscles  of  connective  tissue,  arranged  in  the  direction 
of  the  axis  of  the  vessel.  At  other  times,  the  change  in  the 
adventitious  coat  may  consist  exclusively  in  a  multiplication  of  the 
connective  nuclei,  without  thickening,  and  without  a  fasciculated 
appearance  of  the  membrane. 

"  In  connexion  with  this  change  in  the  most  superficial  parts  of 
the  artery,  is  observed  a  change  in  the  muscular  coat,  sometimes 
general,  at  others  limited  to  certain  points.  This  lesion  of  the 
muscular  coat  consists  in  a  change  in  the  transverse  fibres,  without 
fatty  degeneration,  the  result  of  which  is  thinning  and  separation, 
and  at  some  points  total  disappearance  of  these  fibres.  This  simple 
atrophy  of  the  muscular  elements  does  not  appear  to  be  primary, 
but  seems  to  depend  on  the  more  superficial  change  already  described. 
Indeed,  the  peri-arteritis  is  often  seen  to  be  limited  to  the  sheath 
and  adventitious  coat,  the  muscular  showing  no  appreciable  change ; 
it  is  also  seen  that  the  superficial  arteritis  is  most  marked  at  those 
points  at  which  the  muscular  elements  are  most  defective,  or  even 
altogether  awanting. 

"  The  only  change  in  the  internal  tunic  consists  in  a  multiplication 
of  the  large  ovoid  longitudinal  nuclei  of  that  membrane.  This 
multiplication,  which  may  be  recognised  even  in  the  true  capillaries, 
seems  to  be  much  less  marked  than  it  is  in  the  adventitious  coat  or 
lymphatic  sheath ;  it  may  even  be  altogether  awanting." 

^  A  study  of  some  points  iu  the  pathology  of  cerebral  haemorrhage.  By  Ch. 
Bouchard,  M.D.,  translated  by  T.  J.  Maclagau,  M.D.,  p.  76. 


2C0  Original  Communications.  [July^ 

Sir  William  Gull  and  Dr.  Sutton  say  that  the  change  which  they 
observed  "  is  due  to  a  hyalin-fibroid  formation  in  the  walls  of  the 
minute  arteries,,  and  hyalin-granular  change  in  the  corresponding 
capillaries ;  that  this  formation  occurs  chiefly  outside  the  muscular 
layer,  but  it  also  occurs,  though  to  a  less  extent,  in  the  tunica 
intima  of  some  of  the  arterioles.  Purther,  that  the  degree  in  which 
the  affected  vessels  are  altered,  and  the  extent  to  which  the  morbid 
change  is  diffused  over  the  vascular  system  of  the  different  organs, 
vary  very  much  in  different  cases.  The  muscular  layer  of  the 
affected  vessel  is  often  atrophied  in  a  variable  degree.'^' 

On  comparing  these  two  descriptions,  it  is  evident  that  the  same 
pathological  change  has  been  observed  in  both  cases,  and  that  the 
arterio-capillary  fibrosis  of  Gull  and  Sutton  is  identical  with  the 
sclerous  arteritis  of  Charcot  and  Bouchard.  The  description  of  the 
one  would  serve,  indeed,  for  the  changes  seen  by  the  other  :  any 
little  difference  which  may  appear  being  readily  explained  by  the 
fact  that  the  French  pathologists  were  studying  cerebral  haemorrhage, 
and  the  English  pathologists  chronic  Bright's  disease  with  granular 
kidney.  Bearing  in  mind  the  frequent  and  intimate  relationship  which 
exists  between  cerebral  haemorrhage  and  this  form  of  Bright^s  disease, 
it  is  not  matter  of  surprise  that  the  French  and  English  pathologists 
should  have  found  and  described  the  same  vascular  changes. 

I  believe,  then,  that  Sir  William  Gull  and  Dr.  Sutton  have  given 
an  accurate  description  of  a  real  morbid  change  in  the  minute 
arteries  and  capillaries ;  but  that  they  have  erred  in  regarding  this 
change  as  the  primary  and  essential  condition  of  chronic  Bright's 
disease  with  contracting  kidney.  They  themselves  have,  indeed, 
pointed  out  that  such  change  may  take  place  without  the  kidneys 
being  at  all  affected. 

The  contracting  granular  kidney,  and  sclerous  arteritis,  being 
both  diseases  of  adult  or  advanced  life,  and  the  latter  being  so  very 
common,  it  is  evident  that  the  two  must  frequently  co-exist. 

If  the  former  have  the  start  and  predominate,  the  changes  in  the 
minute  arteries  described  by  Dr.  George  Johnson  will  be  more 
marked  than  those  resulting  from  the  sclerous  arteritis.  If  the 
latter  be  well  advanced  before  the  Bright's  disease  set  in,  the 
changes  consequent  on  the  onset  of  that  ailment  will  not  be  inter- 
fered with,  except  at  points  at  which  the  muscular  coat  is  atrophied ; 
the  two  conditions  will  progress  side  by  side ;  but  those  which  take 
place  as  a  result  of  the  sclerous  arteritis  will  exaggerate  the  ten- 
dency to  cerebral  symptoms  (retinitis,  headache,  dehrium,  &c.),  and, 
by  rendering  the  vessels  more  brittle^  will  greatly  increase  the  risk 
of  cerebral  haemorrhage. 

1  Both  Gull  and  Sutton,  and  Charcot  and  Bouchard  are  careful  to  point  out 
that  the  changes  which  they  describe  are  rare  in  youth,  but  common  in 
advanced  life. 


1875.]       Pathology  of  the  Co7itracting  Granular  Kidney.     201 

1  believe  that  Dr.  Johnson  on  the  one  hand,  and  Sir  William 
Gull  and  Dr.  Sutton  on  the  other,  have  represented  with  perfect 
accuracy  changes  which  really  take  place  in  the  minute  arteries ;  but 
that  the  former  only  has  dealt  with  the  changes  which  necessarily 
occur  in  connexion  with  the  granular  contracting  kidney.  The 
latter  observing  those  changes,  already  figured  and  described  by 
Charcot  and  Bouchard  under  the  name  of  sclerous  arteritis ;  and 
observing,  further,  the  frequent  co-existence  of  this  condition  of 
the  minute  arteries,  and  of  the  granular  contracting  kidney,  have 
been  led  (erroneously  I  think,)  to  regard  arterio- capillary  fibrosis 
as  having  a  necessary  and  causal  connexion  with  the  form  of  Bright's 
disease  which  we  havebeen  considering.  The  two  conditions  have, 
I  believe,  no  necessary  connexion,  though  they  very  frequently  co- 
exist. 

The  coexistence  of  this  change  in  the  vessels,  and  of  the  granular 
contracting  kidney,  has  a  decided  efi*ect  on  the  symptomatology  of 
the  latter,  and  is,  I  beheve,  one  great,  if  not  the  chief,  cause  of  the 
frequent  occurrence  of  cerebral  hsemorrhage  in  connexion  with  that 
form  of  chronic  Bright's  disease. 


202  Original  Communications.  [July, 


II. — On  the  Value  of  Fluctuation  as  a  Sign. 
By  T.  H.  Bartleet,  F.R.C.S.,  &c. 

Fluctuation  in  surgical  affections  is  a  symptom  so  common,  and 
is  in  so  many  cases  looked  upon  as  pathognomonic  of  the  presence 
of  fluid,  that  I  have  thought  it  might  be  interesting  to  consider  its 
true  value. 

I  suppose  it  has  occurred  to  most  surgeons  to  have  passed  a  knife 
into  a  swelling,  feeling  assured  that  fluid  would  exude,  but  have 
felt  surprise,  perhaps  chagrin,  at  the  crucial  test  they  had  applied, 
forcing  upon  them  the  conviction  of  an  erroneous  diagnosis. 

I  need  hardly  describe  what  fluctuation  is ;  we  all  know  that  the 
sensation  is  due  to  the  in  compressibility  of  fluid,  and  its  conse- 
quent equal  movement  in  all  directions  upon  the  application  of 
pressure.  The  degree  of  movement  felt  depends  upon  many  con- 
ditions, such  as  the  limpidity  of  the  fluid,  and  its  quantity,  the 
depth  at  which  it  lies,  and  the  compactness  of  its  covering,  the 
thickness,  and  the  compressibility  of  the  sac  enclosing  it,  and  also 
the  tension  of  the  fluid  in  its  sac.  I  need  hardly  illustrate  this, 
since  it  is  evident  that  a  fluid  becoming  nearly  solid  or  semisolid, 
would  evidently  not  even  intimate  this  sensation  as  clearly  as  a 
limpid  fluid,  and  inasmuch  as  the  depth  may  vary  from  that  of  the 
thickness  of  the  skin  to  that  of  many  inches  in  the  human  body,  and 
the  compactness  of  the  tissues  covering  it  from  cutaneous  to  osseou?, 
it  is  evident  that  this  symptom  fluctuation  must  present  various 
degrees  of  distinctness,  and  that  often  only  the  "  tactus  eruditus^' 
will  enable  a  surgeon  to  ascribe  to  a  sensation  of  fluctuation  its  true 
value.  Various  terms  have  been  given  by  surgeons  to  describe  these  dif- 
ferences of  sensation,  and  doughiness  and  elasticity  are  often  described 
as  varieties  of  fluctuation,  and  I  think  rightly  so  described,  since,  in 
very  many  cases,  a  sensation  is  perceivable  by  the  touch  which  assures 
us  of  the  presence  of  fluid,  which  sensation  is  widely  different  from 
the  undulation  or  thud,  which  is  the  most  marked  kind  of  fluc- 
tuation, and  which  is  so  distinctly  perceptible  in  thin-walled 
ovarian  cysts  or  in  many  cases  of  ascites.  I  shall  not  enter  into 
the  general  considerations  of  how  best  to  detect  fluctuation,  viz.,  by 
the  gentle  tap,  the  gentler  the  better.  I  have  often  myself  in  large 
collections  best  felt  it  by  baring  the  wrist,  placing  this,  say,  on 
the  distended  belly,  and  gently  tapping  by  one  finger  of  the  same 
hand ;  the  impulse  is,  I  think,  better  felt  in  this  way  than  by  applying 
the  two  hands,  as  usually  directed.  I  may  mention  also  that  when 
fluid  is  covered  by  oedematous  superficial  structures,  the  pressing 
out  of  the  fluid  in  the  areolar  tissue  will  frequently  enable  the 
fluctuation  to  be  more  clearly  felt. 


1875.]  On  the  Value  of  Fluctuation  as  a  Sign.  203 

I  may  also  allude  to  the  sense  of  fluctuation  which  may_,  and  some- 
times can  onlyy  be  felt  by  one  finger,  as  in  post-pharyngeal  abscess, 
or  in  retrouterine  hoematocele  or  periuterine  abscess,  where  the 
presence  of  fluid  may  be  frequently  diagnosed  with  absolute  cer- 
tainty by  a  pushing  or  ^'  prodding"  action  with  one  finger,  but  in 
certain  cases  we  undoubtedly  get  fluid  without  being  able  to  detect 
fluctuation  as  in  hydroceles,  where  from  frequent  inflammation  the 
tunica  vaginalis  has  become  much  thickened,  and  even  in  very  tense 
hydroceles,  where  the  coverings  are  still  thin ;  in  some  cases  also  of 
pus  firmly  bound  down  by  fascia  it  is  extremely  difficult  to  differen- 
tiate between  solid  and  fluid,  as  in  deep  mammary  abscess.  But  while, 
on  the  one  hand,  it  is  often  difficult  to  detect  fluid  when  present,  it  is, 
on  the  other  hand,  by  no  means  uncommon  for  even  experienced 
surgeons  to  come  to  the  conclusion  that  fluid  is  present  when  it  is 
not  so.  As  an  example,  I  may  allude  to  the  sense  of  fluctuation 
given  by  the  pulpy  degeneration  of  the  synovial  membrane  in 
white  swelling  of  the  knee,  and  to  the  prognosis  of  cysts  in 
breast  tumours,  where  on  section  none  are  found  to  exist.  But  my 
clinical  note  to-day  has  reference  to  another  cause  of  false  or  sup- 
posititious fluctuation.     Let  me  relate  a  case. 

A  man  was  under  my  care  for  a  severe  injury  to  the  left  knee, 
and  I  had  associated  with  me  in  the  case  a  surgeon  of  the  highest 
skill  and  reputation.  The  leg  became  gangrenous,  and  there  was 
considerable  oedema  of  all  the  tissues  of  the  thigh.  My  friend  in- 
sisted that  there  was  deep-seated  pus,  to  which  opinion  I  demurred 
on  strong  representation,  having  always  a  respect  for  the  opinions 
of  others ;  on  the  following  day  I  passed  into  the  most  prominent 
and  fluctuating  part  of  the  swelling  a  flne  knife,  which  I  always  carry 
in  my  case,  made  like  a  fine  tenotomy  knife,  and  which  I  am  accus- 
tomed to  say  will  go  almost  anywhere  without  injury.  I  passed 
this  to  the  bone  with  no  result.  My  friend  still  insisted  that  there 
was  a  bag  of  pus,  and  that  I  had  missed  the  sac,  so  I  requested 
him  to  try  his  hand,  and  he  made  one  or  two  incisions,  with  a  similar 
result ;  at  last  the  man  died  and  dissection  showed  the  absence  of 
any  collection  of  fluid,  although  the  symptom  "fluctuation"  had 
been  most  marked. 

Another  case,  a  woman  with  a  large  prominent  swelling  below 
the  ensiform  cartilage,  which  she  said  was  hydatid  cyst,  and  which 
had  been  tapped  by  a  metropolitan  hospital  surgeon,  and 
fluid  drawn  out.  This  patient,  too,  was  seen  by  many  skilful 
physicians  and  surgeons  who  I  believe  without  exception  came  to 
the  conclusion  that  there  was  a  bag  of  fluid  of  some  kind  or  other. 

I  passed  an  aspirator  needle,  and  by  that  I  mean  that  the  aspi- 
rator was  used  as  an  exhausted  needle,  the  stop-cock  connecting  the 
aspirator  with  the  needle  being  opened,  directly  the  needle  had 
penetrated  the  skin,  thus  insuring  that  on  sac  existing  should 
not  be  entirely  passed,  though,  and  notwithstanding  this,  no  fluid 


204  Original  Communications,  [July, 

came.  On  another  occasion  I  passed  a  small  trochar  subsequently 
connected  with  the  aspirator^  the  trochar  penetrating  1|  inches, 
while  on  the  former  occasion  the  needle  penetrated  2^  inches,  and 
still  no  fluid  came. 

Now,  there  must  be  some  peculiar  or  ill-understood  or  ill-recog- 
nised condition  which  led  many  skilful  and  careful  men  into  error, 
and  which  are  constantly  leading  our  students  into  similar  mistakes. 

I  believe  this  false  fluctuation  to  be  generally  due  to  the  combi- 
nation of  two  causes  of  error,  one  being  muscular  or  glandular 
elasticity,  and  the  other  being  muscular  or  glandular  displace- 
ment. 

I  think  any  one  who  tries  the  experiment  will  be  surprised  at  the 
sensation  of  fluctuation  which  can  be  obtaiued  by  pressing  alter- 
nately, as  in  endeavouring  to  find  the  sense  of  elasticity  or  fluctuation 
of  an  abscess,  a  muscle  across  the  direction  of  its  fibres,  say  the 
biceps,  or  by  similarly  manipulating  across  the  direction  of  the 
ducts,  a  firm  and  fairly  large  female  mamma;  either  one  of  these 
two  before-mentioned  causes  alone  might  mislead :  I  mean  either 
the  displacement  of  the  gland  or  muscle  or  the  elasticity  of  the 
gland  or  muscle :  but  when  you  get  combined  the  elasticity  and  the 
displacement,  a  supposititious  fluctuation  is  felt  so  like  to  the  real  as 
to  be  almost  if  not  quite  undistinguishable  from  it.  How,  then,  are 
we  to  be  certain,  especially  in  these  positions,  v  here  either  a  gland  or 
muscle  are  liable  to  mislead  us,  that  the  fluctuation  we  feel  is  really 
due  to  fluid  ?  By  a  very  simple  plan,  which  I  have  never  known  to 
fail,  and  which  is  not  clearly  enunciated  to  my  knowledge  in  any  of 
our  text-books,  viz.  by  practising  the  manoeuvre  of  palpation,  not 
only  across  the  line  of  the  muscular  fibres  or  of  the  gland  ducts, 
but  also  in  a  direction  at  right  angles  to  this. 

If  the  fluctuation  be  fluid  it  will  be  equally  felt  in  all  directions ; 
if  it  be  due  to  muscular  or  glandular  elasticity  or  displacement,  or 
both  combined,  it  will  be  only  felt  in  one  direction,  viz.  across  the 
muscular  fibres  or  the  gland  ducts. 

Let  me  mention  one  more  case.  I  have  at  present  under  treat- 
ment in  the  General  Hospital  a  young  man  with  hip  disease.  There 
was  present  a  barely  recognisable  pulsation  behind  the  trochanter, 
and  it  was  a  question  whether  or  no  there  was  fluid.  I  diagnosed 
that  there  was.  Now,  in  this  position  you  have  the  fibres  of  the 
gluteus  running  obliquely  downwards,  which  will  give  the  sensa- 
tion of  fluctuation,  while  beneath  these  you  have  the  gemelli 
pyriformis  tendon  and  quadratus  femoris  running  from  side  to  side, 
so  that  it  is  necessary  to  palpate  in  at  least  three  if  not  four  directions 
to  be  quite  sure  that  the  fluctuation  that  is  felt  is  not  supposititious. 
By  practising  this  manoeuvre  I  was  able  to  satisfy  myself  and  to  give 
a  positive  diagnosis  of  the  presence  of  fluid,  a  diagnosis  that  was 
conflrmed  by  the  use  of  the  aspirator.     I  would  just  sum  up  my 


1875.]  On  the  Value  of  Fluctuation  as  a  Sign.  205 

conclusions, — that  fluctuation  of  the  most  distinct  kind  may  be  caused 
either  by  the  elasticity  of  muscular  fibres  or  by  the  displacement  of 
muscle  :  by  the  elasticity  or  displacement  of  glandular  tissue ;  that  this 
only  occurs  in  one  direction,  viz.  across  the  fibres  of  the  muscle 
or  the  general  direction  of  the  gland  ducts ;  that  palpation  at  right 
angles  to  this  will  differentiate  the  false  and  the  true  fluctuation, 
inasmuch  as  false  fluctuation  is  felt  only  in  one  direction,  while 
true  fluctuation  is  felt  equally  in  all  directions ;  that  where  different 
layers  of  muscles  take  different  directions,  care  must  be  taken  to 
palpate  at  right  angles  to  each  layer  of  muscles. 


206  [July, 


Cbronitle  of  i¥leliicat  ^titntt. 


REPORT   ON   PHYSIOLOGY. 
By  Heney  Power,  F.E.C.S.,  M.B.  Lond. 

Senior  Qplithalmic  Surgeon  to  St.  Bartholomew's  Hospital. 


Blood. 

1.  Mich.  Laptschinskt.  Ueher  das  VerTialten  dev  rothen  Bluthdr- 
perchen  zu  einigen  Tinctionsmitteln  und  zur  Gerhsdure.  ('  Wiener 
Akad.  Sitzungsberichte,'  1874,  p.  148.) 

2.  R.  Thoma.     Der  Einjluss  der  Concentration  des  Mutes  und  der 

Oewehsscifte  auf  die  Form  und  Ortsverdnderungen  farhlosen 
BlutJcorper.     ('  Virchow's  Archiv,'  Band  Ixii,  1874,  p.  1.) 

3.  Ch.  Rouget.     Migrations  et  Metamorphoses  des  Globules  Blancs. 

(' Archives  de  Physiologie  Normal  et  Pathologique,'  1874, 
p.  821.) 

4.  R.  Heidenhain.  Die  Einwirhunq  sensihler  Beizung  auf  den 
Blutdruck.     ('  Pfliiger's  Archiv,'  1874,  Band  ix,  p.  250.) 

5.  Drs.  Drosdoee   and    BoTSCHETSCHKAEorr.     Die  physiologische 

Wirhung  der  Waldenhurgschen  Apparate  comprimirten  Luft  auf 
den  arteriellen  Blutdruch  der  Thieve.  (*  Centralblatt  f.  d.  Med. 
Wiss.,'  1875,  p.  65.) 

1.  Laptschinsky  has  made  experiments  upon  the  blood-corpuscles 
with  anilin  blue,  rosanilin,  tannin,  ammonia,  and  carbonic  acid  gas, 
partly  in  watery  solution,  partly  in  solutions  of  common  salt  of  various 
degrees  of  concentration,  which  have  led  him  to  the  following  con- 
clusions : — Every  corpuscle  is  composed  of  two  substances — one,  the 
stroma  of  authors,  is  smooth,  soft,  extensible ;  the  other  is  trans- 
parent, and  can  only  be  perceived  after  precipitation  or  swelling.  It 
alone  becomes  coloured  by  reagents,  and  by  its  coagulation  and  pre- 
cipitation gives  rise  to  the  most  diverse  microscopic  images.  On 
account  of  the  invisibility  of  this  last  material  the  relation  of  the  two 
substances  to  each  other  during  life  cannot  be  satisfactorily  made 
out. 

2.  Thoma  has  studied  the  influence  of  the  fluids  surrounding  the 
colourless  corpuscles  on  the  molecular  processes  of  their  amoeboid 
movements,  not  only  in  blood  withdrawn  from  the  body,  but  in  the 
living  animal.     If  frog's  blood  be  placed  in  a  gas  chamber,  and  made 


1875.]  Report  on  Physiology.  207 

richer  in  water  by  the  presence  of  watery  vapour,  so  that  the  well- 
known  influence  of  water  upon  the  red  corpuscles  is  beginning  to  be 
visible,  many  (about  82  per  cent.)  of  the  colourless  corpuscles  exhibit 
lively  changes  of  form,  especially  if  they  are  adherent  to  the  cover 
glass,  and  also  movements  of  locomotion,  whilst,  if  the  plasma  be 
made  more  concentrated  by  the  transmission  of  a  current  of  dry  air, 
only  about  12  per  cent,  of  the  cells  exhibit  movements,  and  these  are 
of  a  sluggish  character.  In  this  case  most  of  the  cells  undergo 
remarkable  molecular  changes ;  they  become  round,  strongly  refract- 
ing, their  nuclei  are  only  indistinctly  visible  or  disappear  altogether, 
and  with  high  degrees  of  concentration  the  edges  of  the  corpuscles, 
under  high  magnifying  power,  appear  to  be  beset  with  fine  and  very 
short  hair-like  projections.  Similar  changes  were  seen  when  a  drop 
of  water  was  added  to  concentrated  leucocytotic  frog's  blood  under 
a  cover  glass,  and  allowed  to  diffuse  from  one  side  of  it.  The  same 
influence  of  the  concentration  of  the  bloodTplasma  upon  the  white 
corpuscles  was  established  in  mammals,  39  per  cent,  of  those  of  dogs 
moving  actively  in  concentrated  plasma,  and  69  per  cent,  in  diluted 
plasma.  Similar  changes  were  observed  in  the  corpuscles  of  frogs 
contained  within  the  body  when  the  plasma  was  diluted  by  the  injec- 
tion of  water,  or  was  concentrated  by  the  injection  of  a  3  per  cent, 
solution  of  common  salt,  and  the  same  occurred  in  the  cells  which 
had  migrated  into  the  tissues  of  the  tongue  after  a  wound  of  the 
tongue  was  irrigated  with  a  |  per  cent,  or  1^  per  cent,  solution  of 
common  salt. 

3.  Renewed  investigations  upon  the  phenomena  of  the  circulation 
in  the  tadpole  have  satisfied  M.  Rouget  that  the  red  corpuscles  in 
their  diapedesis  through  the  walls  of  the  blood-vessels  are  com- 
pletely passive.  The  intra-vascular  pressure  forces  one  blood-cor- 
puscle after  another  through  the  cell-protoplasm  and  structureless 
cuticula  of  which  the  walls  of  the  young  capillaries  consist.  As  the 
red  corpuscles  are  not  capable  of  performing  spontaneous  move- 
ments, they  are  not  able  to  regain  their  pristine  form,  which  is  lost 
as  they  traverse  the  capillary  wall.  They  consequently  soon  break 
down  in  their  new  position.  The  white  corpuscles  originate  in  the 
multiplication  of  the  fixed  connective -tissue  corpuscles,  and  are  car- 
ried by  the  lymphatics  into  the  blood-current.  By  virtue  of  these 
amoeboid  movements  they  are  capable  of  traversing  the  capillary 
wall  independently  of  the  blood-pressure.  As  soon  as  they  come 
into  contact  with  the  red  blood-corpuscles  outside  the  vessels  they 
invest  them,  and  in  their  interior  the  red  blood-corpuscles  break  up 
into  pigment-molecules,  and  consequently  convert  the  white  cor- 
puscles into  pigment-cells.  These  last  are,  like  the  original  white 
corpuscles,  capable  of  spontaneous  movements.  They  in  part  pene- 
trate into  the  interior  of  the  vessels,  where  their  further  destiny  is 
unknown,  and  in  part  they  form  the  pigmented  tunicse  adventitise 
ofthe  vessels  and  nerves,  as  well  as  the  chromatogenous  layer  of  the 
subcutaneous  connective  tissue ;  white  corpuscles  spring,  again,  from 
the  stellate  subepidermoid  pigment-cells.  When  traumatic  stimuli 
are  applied  the  pigment-cells  originating  in  white  corpuscles  accu- 


208  Chronicle  of  Medical  Science.  [July, 

mulate  around  the  cicatrix  and  form  neoplasm,  the  structure  of 
which  is  very  like  the  "  proud  flesh  "  that  appears  in  the  wounds  of 
mammals. 

4.  Heidenhain  maintains,  in  opposition  to  Cyon,  that  irritation  of 
sensory  nerves  (when  the  activity  of  the  cerebrum  has  been  abolished 
in  order  to  eliminate  the  influence  of  pain)  increases  the  blood- 
pressure,  and  establishes  the  fact  by  new  experiments  that,  even  in 
chloral  narcosis,  the  elevation  of  pressure  only  fails  if  the  respiration 
be  coincidentally  deepened  and  hastened,  or  in  those  cases  in  which  the 
life  of  the  animal  is  in  danger  from  too  strong  a  dose  of  the  narcotic, 
or  in  which  much  blood  has  been  lost.  In  the  latter  case  elevation  of 
blood-pressure  did  not  occur  if  the  animal  (not  narcotized)  exhibited 
symptoms  of  severe  pain  in  consequence  of  the  sensory  irritation. 
If  artificial  respiration  be  performed  in  an  animal  which  under  the 
influence  of  chloral  exhibits  no  elevation  of  blood-pressure,  such 
elevation  immediately  occurs;  the  fall  which  follows  the  rise  is 
partly  the  consequence  of  the  quickening  of  the  respiration,  and 
partly  of  the  exhaustion  of  the  vaso-motor  centre. 

5.  Drs.  Drosdoff  and  Botschetschkaroff  have  made  a  series  of 
experiments,  in  Professor  Botkin's  laboratory  at  St.  Petersburgh, 
on  the  effects  of  breathing  compressed  air  upon  the  blood-pressure. 
The  method  of  experimenting  was  the  introduction  of  a  canula  into 
the  trachea,  which  could  at  will  be  supplied  with  air  from  a  chamber 
in  which  it  was  compressed,  or  from  the  ordinary  air.  The  air  in 
the  chamber  was  at  an  increased  pressure  of  34*2  mm.,  which  equals 
gV  of  the  ordinary  pressure.  They  obtained  the  following  results : — 
1.  The  blood-pressure  fell  as  soon  as  the  animal  began  to  breathe  the 
compressed  air,  and  rose  again  directly  it  breathed  ordinary  air.  2. 
Coincidentally  with  the  fall  of  the  arterial  blood-pressure  the  inspira- 
tory and  expiratory  curves  became  much  more  marked  in  comparison 
with  those  observed  in  breathing  ordinary  air,  being  two  or  three 
times  longer  and  higher  after  section  of  both  vagi.  3.  The  respiration 
of  the  compressed  air  caused  immediate  depression  of  the  blood- 
pressure,  which  fell  below  the  normal,  but  rose  again  when  the 
animal  breathed  ordinary  air,  and  the  usual  changes  seen  after 
section  of  the  vagi  are  observed.  4.  The  number  of  cardiac  beats 
was  but  little  altered  by  breathing  the  compressed  air  after  section 
of  the  vagi.  5.  The  physiological  effect  of  irritation  of  the  peri- 
pheric extremity  of  the  vagus  during  the  respiration  of  the  com- 
pressed air  was  weaker  than  on  breathing  ordinary  air.  6.  Irritation 
of  the  central  extremity  of  the  sciatic  was  not  followed  by  any 
different  effects  from  those  usually  observed  when  the  ordinary  air 
was  breathed.  On  killing  the  animal  by  bleeding,  whilst  breathing 
the  compressed  air,  no  convulsions  preceded  death. 


ClECULATION. 

1.  MM.   Tabchanoff    and  Puelma.      Sur  Veffet  de    Vexcitation 
alternative  des  deux  Fneumogastriques  sur  V arret  du  Cceur. 


1875.]  Report  on  Physiology.  209 

2.  Stuart  Eldridge,  M.D.     Mode  of  Illustrating  Lectures  on  the 
Circulation  of  the  Blood. 

1.  MM.  Tarchanoff  and  Puelma,  in  a  note  read  before  the  Society 
of  Biology  in  Paris  on  24th  April,  1875,  state  that  in  pursuing  their 
experiments  on  the  arrest  of  the  heart  in  mammals  they  have  noticed 
a  fact  which  appears  to  them  to  be  of  importance  for  the  theory  of 
the  action  of  the  pneumogastrics  in  stopping  the  heart's  action, 
and  to  which  other  experimenters  have  not  paid  attention.  They 
believed  that  they  could  maintain  the  heart  of  the  dog  in  a  state  of 
prolonged  inaction  by  exciting  alternately  the  peripheric  extremi- 
ties of  the  pneumogastrics  alternately.  With  this  object  in  view 
they  exposed  the  two  vagi  and  took  up  the  two  peripheric  extremities 
with  ligatures.  In  order  to  observe  the  action  of  the  heart,  they  in- 
troduced, through  a  hole  made  between  the  fifth  and  sixth  ribs,  a  finger 
into  the  cavity  of  the  chest,  so  that  the  movements  of  the  heart  could 
be  directly  felt.  This  method  of  observation  is  preferable  to  that 
made  with  a  manometer,  since  this  last  is  subject  to  error  in 
consequence  of  the  coagulation  of  the  blood  in  the  canula.  If  one 
of  the  vagi  of  a  dog  be  excited  with  strong  currents  till  its  action  on 
the  heart  is  completely  exhausted,  as  is  manifested  by  the  recommence- 
ment of  contraction,  and  the  opposite  vagus  be  now  immediately  ex- 
cited, arrest  of  the  action  does  not  again  occur,  nor  indeed  is  there 
any  alteration  in  its  activity.  Yet  the  nerve  last  excited  has  by  no 
means  been  exhausted.  If,  however,  one  or  two  minutes  be  allowed 
to  elapse  before  the  second  nerve  is  excited,  its  inhibitory  action  is 
fully  exerted.  This  experiment  shows  clearly  that  each  of  the  pneumo- 
gastrics calls  into  play  the  whole  of  the  inhibitory  ganglia  situated 
in  the  walls  of  the  heart,  and  that  when  once  this  apparatus  is  ex- 
hausted by  the  excitation  of  one  pneumogastric  it  cannot  be  called 
into  play  by  the  excitation  of  the  other.  It  shows  also  that  this 
state  of  exhaustion  of  the  inhibitory  apparatus  of  the  heart  rapidly 
disappears  on  repose. 

2.  Dr.  Eldridge,  who  is  Surgeon-in- Chief,  N.  District  of  Japan, 
states  that,  being  engaged  in  teaching  medicine  to  a  class  of  stu- 
dents but  few  of  whom  have  a  knowledge  of  any  western  tongue, 
and  whose  native  language  is  peculiarly  unfitted  for  conveying  ac- 
curate description,  even  with  the  aid  of  the  best  interpreter,  he 
has  found  object-teaching  of  even  greater  assistance  than  with 
students  at  home.  His  apparatus  is  ingenious,  and  serves  the  purpose 
well,  but  requires  a  woodcut  to  render  it  intelligible. 

Absoeption. 

1.  E.  Calberta.     Ein  Beitrag  zur  Kenntniss  der  Besorptionswege 
des  Humor  Aqueus, 

1.  In  order  to  settle  the  disputed  question  in  regard  to  the  nature 
and  functions  of  the  canal  of  Schlemm,  Calberta  introduced 
some  fresh  blood  mingled  with  cinnabar  into  the  anterior  chamber 
of  white  rabbits,  and,  when  the  hyphaema  had  disappeared,  hardened 
the  eyes  in  Miiller's  solution.     He  found  on  examination  that  the 

111 — LVI.  14, 


210  Chronicle  of  Medical  Science.  [Ji^ly, 

principal  part  of  the  cinnabar  was  contained  in  Fontana's  space  in 
the  stroma  and  vessels  of  the  iris,  corpus  ciliare,  and  circulus  venosus, 
and  he  is  therefore  of  opinion  that  Leber's  view  is  correct,  and  that 
Schlemm's  canal  is  not  a  lymphatic  space. 

Seceetion. 

1.  E-.  Malt.     JJntersuchungen  ilber  die  Gallenfarhstoffe.     ('  "Wien. 

Sitzungsber.,'  1874,  B.  Ixx,  Abth.  iii.) 

2.  Prince  Taechanoff.     Zur  Kenntniss  der  Gallenfarbstoffhildung , 

(*  Pfliiger's  Archiv  f.   gesammte  Physiologic,'  B.    ix,  1874,  p. 
239.) 

3.  H.  Pink.  Zur  Lehre  vom  Diabetes  mellitus  insonderheit  zur 
Lehre  von  der  Glycogenhildener.  ('  Inaug.  Dissert.,'  Konigsberg, 
1874,  and  '  Centralblatt,'  1875,  p.  43.) 

4.  G-.  Heidenhain.  Beitrag  zum  Lehre  des  Diabetes  mellitus 
insonderheit  zur  Lehre  von  der  Glycogenbildung  in  der  Leber. 
(*Inaug.  Dissert,'  Konigsberg,  1874.) 

5.  y.  WiTTiCH.  Zur  Statik  des  Leberglycogens.  ('  Centralblatt 
f.  d.  Med.  Wiss.,'  1875,  p.  113.) 

6.  D.    Feiedeich    Eeismann.      Zur   Physiologie    der    Wasserver- 

dunstung  von  der  Haut.     (*  Zeitschrif  t  fiir  Biologic,'  xi,  Heft  1, 
p  1,  1875.) 

7.  MM.  MuscuLUS  et  De  Meeme.     Sur  un  nouveau  corps  quon 

trouve  dans  Vurine  apres  Vingestion  dliydrate  de  chloral.    (Note 
read  before  the  Academic  des  Sciences,  April  12th,  1875.) 

1.  Maly  has  made  an  analysis  of  the  biliary  colouring  matter 
biliverdin,  and  finds  that  it  has  the  formula  CjgHjgN204,  Stadeler 
having  found  it  to  be  CigNgQN^O^.  He  has  also  analysed  a  gall-stone. 
It  was  composed  of  almost  one  third  of  bilirubin,  and  contained 
in  100  parts — soluble  biliary  substances  18'09,  aether  extract  5*28, 
calcium  phosphate  and  bilirubin  combined  with  lime  1'41,  bilirubin 
28-1,  ashes  and  loss  47'13.  The  residue  was  olive-coloured  ;  contained 
some  bilirubin  combined  with  lime,  humus-like  substance,  and 
inorganic  salts. 

2.  Pfliiger  remarks  that  it  has  already  been  demonstrated  by  Schiff 
that,  if  the  biliary  acids  are  injected  into  the  intestines  and  undergo 
absorption,  the  liver  appears  to  have  the  power  of  abstracting  them 
from  the  blood  and  again  excreting  them  in  the  bile.  The  liver,  ac- 
cording to  Tarchanoff,  has  the  same  power  in  regard  to  the  biliary 
colouring  matter.  Bile  excreted  in  a  given  time  presents  an  enormous 
increase  in  the  amount  of  colouring  matter  if  a  solution  of  haemo- 
globin have  been  injected  into  the  vessels,  or  even  if  only  water  have 
been  injected  (in  the  dog),  whilst  there  is  a  relative  diminution  in  the 
solid  constituency,  and  the  results  of  these  experiments  admit  of  a 
double  interpretation.  It  may  either  be  said  that  the  liver  forms 
and  excretes  an  increased  quantity  of  biliary  colouring  matter  from 
the  dissolved  blood-colouring  matter  injected,  or  that  this  transfor- 
mation takes  place  in  the  blood,  and  the  liver  only  abstracts  it  from 
thence  and  excretes  it.     In  favour  of  the  latter  view  is  the  fact  that 


1875.] 


Report  on  Physiology.  211 


after  injection  of  the  solution  of  bilirubin  there  is  an  increase  in  the 
amouut  of  biliary  colouring  matter  excreted,  and  this  is  accomplished 
so  rapidly  and  completely  that  no  biliary  colouring  matter  can  be 
demonstrated  either  in  urine  taken  from  the  bladder  or  from  the  fis- 
tula of  the  ureter.  The  same  thing  had  already  been  demonstrated 
by  Feltz  and  E/itter  in  1870,  who  injected  60  grains  of  bilirubin  into 
a  dog,  whilst  Tarchanoffonly  injected  1*5  grains.  If  to  this  be  added 
the  fact  that  biliary  colouring  matter  can  be  formed  in  the  blood 
outside  of  the  liver,  there  appears  to  be  good  reason  for  believing 
that  the  colouring  matter  of  the  bile  is  formed  outside  the  liver  and 
is  only  excreted  by  this  organ.  This  affords  an  explanation  of  the 
yellow  tint  of  the  skin  and  tissues  generally  in  icterus.  Tarchanoff 
does  not  find  that  the  injection  of  solution  of  haemoglobin  solution 
into  the  bladder  causes  any  increase  in  the  amount  excreted  by  the 
liver,  and  he  is  therefore  satisfied  that  the  bladder  is  incapable  of 
absorbing  biliary  colouring  matters  from  the  urine. 

3.  Pink  first  set  himself  to  determine  how  long  rabbits  must  be 
kept  fasting  to  render  it  certain  that  their  livers  contain  no  glycogen, 
the  method  he  adopted  being  to  examine  one  part  of  the  liver  for 
glycogen,  and  to  digest  another  with  saliva  and  test  it  for  sugar. 
He  found  five  days  of  fasting  requisite  to  remove  all  traces  of  gly- 
cogen ;  he  then  in  others,  after  this  period  had  passed,  injected  from 
30  to  45  grains  of  purchased  grape  sugar  into  the  mesenteric  vein 
and  examined  the  liver  in  the  same  way,  and  found  that  in  the  first 
portion  of  liver  there  was  glycogen,  but  only  traces  of  sugar  or 
none  at  all ;  whilst  from  the  second  portion  abundant  quantities 
of  sugar  could  be  obtained,  as  the  sugar  in  the  second  portion  could 
only  originate  from  glycogen.  Schopfer's  statement  was  corro- 
borated that  sugar  injected  into  the  mesenteric  vein  is  capable  of 
being  converted  into  glycogen.  From  experiments  with  pure  sugar 
and  with  glycerine  he  arrived,  however,  at  opposite  results,  the 
first  portion  of  the  liver,  when^wre  grape  sugar,  and  on  one  occasion 
when  glycerine,  was  injected,  containing  no  glycogen,  and  the  second 
no  more  sugar  than  the  first.  In  other  experiments  fine  sugar 
and  pure  glycerine  were  injected  into  the  stomach,  where  abundant 
formation  of  glycogen  took  place  ;  hence  Pink  arrives  at  the  con- 
clusion that  both  of  these  substances,  when  taken  by  the  mouth, 
are  in  some  way  altered  by  the  stomach  and  made  capable  of  con- 
version into  glycogen. 

4.  Heidenhain  also  occupied  himself  with  studying  the  effects  of 
the  injection  of  chemically  pure  grape  sugar  into  the  mesenteric  vein 
in  fasting  rabbits,  in  order  to  settle  the  question  whether  sugar 
really  undergoes  conversion  into  glycogen.  He  examined  one  por- 
tion of  the  liver  before  or  a  few  minutes  after  the  injection,  and  a 
second  larger  portion  after  the  lapse  of  from  20  to  45  minutes ;  the 
result  was  that,  with  only  one  exception,  there  was  always  a  greater 
or  less  increase  in  the  amount  of  glycogen  after  the  injection  of  the 
pure  sugar.  His  results  are  therefore  opposed  to  those  of  Pink ; 
nevertheless,  the  quantities  of  glycogen  obtained  were  always  re- 
latively small  when  compared  with  the  amount  of  sugar  injected. 


212  Chronicle  of  Medical  Science.  [July, 

The  latter  amounted  to  from  60  to  140  grains,  whilst  the  glycogen 
obtained  was  only  from  two  thirds  of  a  grain  to  one  and  a  half 
grains.  The  statement  of  Schopfer  that  the  liver  can  convert  nearly 
two  grains  of  sugar  into  glycogen  per  minute  is  not  correct.  The 
small  quantity  of  glycogen  present  Heidenhain  agrees  with  Pink 
in  referring  to  some  action  of  the  stomach  or  intestines  on  the  sugar, 
and  to  test  this  view  he  tied  the  pylorus,  and  then  found  that  after 
the  iujection  of  sugar  but  very  little  glycogen  was  formed,  and  there 
was  none  in  the  urine. 

5.  V.  Wittich  made  some  experiments  on  the  amount  of  glycogen 
contained  in  the  liver,  examining  first  a  piece  removed  from  the 
living  animal  after  previous  application  of  a  ligature  to  prevent 
bleeding,  and  then  determining  the  amount  of  glycogen  contained 
in  the  remainder  after  the  lapse  of  a  few  minutes ;  he  arrives  at 
the  conclusion,  which  is  in  accordance  with  the  previous  observations 
of  Heidenhain,  that  the  production  of  glycogen  is  either  not  equally 
distributed  over  the  whole  liver,  or  that  the  extirpation  of  a  lobe 
materially  diminishes  the  production  of  glycogen  in  the  remaining 
portion. 

6.  Dr.  Erismann  first  made  some  investigations  upon  the  eva- 
poration of  water  from  the  dead  skin  of  man,  and  found  that  the 
amount  of  evaporation  taking  place  from  the  free  surface  is  the 
same  whether  the  internal  surface  be  moistened  with  water  or  with 
serum.  In  other  experiments  he  found  further  that  the  amount 
of  evaporation  progressively  increases  with  the  temperatui*e ;  so 
that  whilst  at  the  lower  temperatures  a  few  degrees  make  little  or 
no  difference,  the  same  number  of  degrees  at  a  higher  temperature 
makes  a  considerable  difference  in  the  amount  of  fluid  that  eva- 
porates. Care,  he  shows,  must  be  taken  that  the  skin  be  taken  from 
the  same  or  corresponding  parts  of  the  body,  and  if  possible  from 
the  same  person,  for  fluid  evaporates  from  some  parts  much  more 
actively  than  from  others  ;  as,  for  example,  with  more  activity  from 
the  sole  of  the  foot  than  from  the  chest  or  abdomen,  notwith- 
standing the  thickness  of  the  skin  is  so  much  greater  in  the  former 
position.  It  readily  suggests  itself  that  there  is  some  connection 
between  the  number  of  the  sweat-glands  in  the  two  parts,  Krause 
having  shown  that  there  are  2685  sweat-glands  in  one  square 
inch  of  the  skin  of  the  sole  of  the  foot,  and  only  1136  in  that  of  the 
belly.  Erismann  found  that  increased  pressure  produced  by 
throwing  in  injection  into  the  vessels  did  not  augment  the  amount 
of  evaporation.  No  difference  occurred  whether  1000  or  6000  litres 
of  air  was  made  to  pass  over  the  given  portion  of  skin  in  a  certain 
time.  Little  difference  was  observed  whether  the  skin  was  covered 
with  clothes  or  not.  A  dead  body,  carefully  weighed  after  all  orifices 
had  been  plugged  with  wax,  lost  in  twenty-four  hours  617*6  grains 
in  weight ;  the  temperature  was  on  the  average  63°  Fahr.,  and  the 
relative  moisture  64  per  cent.  The  subject  was  a  young  woman  who 
died  in  childbed.  Krause,  perhaps  operating  on  a  larger  body, 
found  that  1900  grains  were  given  off"  from  the  whole  body  when 
exposed  to  air  dried  with  sulphuric  acid.     Experiments  made  upon 


1875.]  Report  on  Physiology.  2^3t 

the  living  body  showed  that  the  most  important  external  factor  in 
regard  to  the  evaporation  from  the  surface  is  the  relative  moisture 
of  the  air ;  the  next  most  important  factor  is  temperature,  the 
amount  of  evaporation  increasing  with  its  rise  ;  and  next,  the  ven- 
tilation, which,  in  opposition  to  its  effect  on  the  dead  body,  has 
some,  though  still  not  a  considerable,  influence  on  the  living.  Strong 
pressure  in  the  vessels,  as  by  drinking  a  large  amount  of  hot  fluid, 
favours  materially  the  amount  of  insensible  perspiration  in  the 
living  body  ;  work,  even  when  sweating  does  not  occur,  augments 
the  evaporation  of  fluid.  Krause  and  Bonders  are  of  opinion  that 
a  good  deal  of  the  insensible  perspiration  takes  place  through  the 
epidermis  generally,  though  sweating  is  effected  through  the  sweat- 
glands.  Eanke  and  Erismann,  however,  hold  that  very  little  of  the 
evaporation  is  effected  through  the  epidermis,  but  that  nearly  the 
whole  takes  place  through  the  agency  of  the  sweat-glands. 

7.  MM.  Musculus  and  De  Merme  observe  that  the  question 
may  be  asked,  how  and  in  what  condition  are  foreign  substances, 
introduced  into  the  body,  again  ejected  ?  and  in  reply  it  may  be  said 
that  they  may  be  divided  into  three  groups,  viz.  into — 

1.  Substances  which  traverse  the  organism  without  being  altered, 
such  as  creatine  and  acetamide,  which  are  found  intact  in  the  urine. 

2.  Substances  the  products  of  the  decomposition  of  which  are 
found  in  the  blood,  saliva,  or  urine,  such  as  leucine  and  glycocoll, 
which  yield  urea. 

3.  Substances  which  combine  chemically  with  some  product  of  the 
organism,  and  thus  pass  into  the  urine.  The  type  of  this  group  is 
benzoic  acid,  which,  in  combining  with  glycocoll,  is  eliminated  in  the 
state  of  benzoic  acid. 

Now  the  question  arises,  what  becomes  of  chloral  ?  According  to 
Liebreich,  this  body  belongs  to  the  second  group.  It  undergoes 
decomposition  by  the  blood  into  formic  acid  and  chloroform,  and  it 
is  to  this  last  that  its  narcotic  action  is  due.  Bouchut  was  the  first 
to  suggest  that  chloral  traversed  the  organism  without  being 
altered.  Madlle.  Tomaszewic,  in  Hermann's  laboratory  at  Zurich, 
has  demonstrated  the  presence  in  the  urine  of  a  small  quantity  of 
chloral  and  the  complete  absence  of  chloroform.  Recently  Feltz 
and  Eitter  have  found  in  the  urine  of  dogs  poisoned  by  chloral, 
chloral,  sugar,  and  another  organic  substance  which  was,  however, 
obtained  in  such  small  quantities  that  no  analysis  could  be  made 
of  it.  MM.  Musculus  and  De  Merme  have  administered  from 
60  to  75  grains  of  chloral  per  diem  to  various  patients,  and  have 
been  able  to  isolate  an  acid  having  the  following  properties : — It 
crystallizes  in  stellsB,  and  under  the  microscope  resembles  tyrosine ; 
it  is  very  soluble  in  water  and  alcohol,  less  so  in  alcoholized  ether, 
and  still  less  so  in  pure  ether ;  it  strongly  reddens  litmus  paper 
and  decomposes  the  carbonates  with  effervescence ;  it  is  not  dis- 
placed by  acetic  acid  ;  on  ebullition  it  reduces  the  alkaline  solutions 
of  copper,  bismuth,  and  silver ;  it  decolorizes  sulphate  of  indigo ;  it 
rotates  the  plane  of  polarised  light  to  the  left,  as  does  also  its  potash 
salt ;  it  is  rapidly  decomposed  by  heat ;  it  becomes  yellowish,  evea 


214  Chronicle  of  Medical  Science.  [July, 

at  212°  F.  ;  on  being  heated  with  a  solution  of  potash  it  becomes 
brown,  disengaging  an  odour  of  caramel  and  giving  up  its  chlorine 
to  the  potash.  The  authors  are  thus  induced  to  think  that  the 
chloral  ought  to  be  ranked  with  benzoic  acid  in  the  third  group, 
and  they  propose  to  give  the  acid  the  provisional  name  of  uro- 
chloralic  acid. 

Gland. — Secretion. 

1.   WiNKLEE.     Bau  der  Milchdriise.      ('  Jahresbericht  d.  Gesellsch. 
f .  Natur  und  Heilk.,'  in  Dresden,  1874,  p.  70.) 

1.  According  to  "Winkler's  investigation,  the  larger  lacteal  ducts 
in  rabbits  and  in  mice  possess  cubical  epithelium,  the  smaller  cylin- 
drical. In  rabbits  there  are  some  muscular  fibres  in  the  inter- 
alveolar  tissue.  In  regard  to  the  formation  of  the  milk,  Winkler 
believes  that  the  numerous  white  corpuscles  adhering  to  the  alveolar 
walls  take  part  in  the  production  of  the  milk  by  undergoing  fatty 
degeneration. 

Nervous  System. 

1.  Y.  THANHorFEE.  JJeher  den  Bau  der  spinal  Ganglionzfillen, 
(' Centralblatt  fiir  die  Med.  Wissenschaften,'  Apl.,  1875,  p. 
305.) 

2.  Otto  Soltmann.  Zur  electriscJien  Reizharheit  der  Grosshirn- 
rinde.     ('  Centrallblatt,  f.  d.  Med.  Wiss.,'  1875,  p.  209.) 

1.  Y.  Thanhoffer  states  that  from  repeated  observation  he  has 
convinced  himself  that  not  only  may  two  cells  exist  in  one  sheath  in 
the  spinal  ganglia-cells,  but  that  some  cells  in  these  ganglia  exhibit 
cell-nuclei  inflected  at  their  centre,  the  two  knob-shaped  halves 
having  a  nucleolus  at  their  distal  extremities,  all  of  which  points 
speak  strongly  in  favour  of  the  division  of  the  ganglion-cells. 

2.  Soltmann,  repeating  Hitzig's  experiments  on  young  animals, 
finds  that  the  application  of  electrical  stimuli  to  the  cortex  of  the 
cerebrum  in  new-born  puppies  causes  no  muscular  movements.  These 
first  make  their  appearance  some  days  after  birth,  from  the  ninth  to 
the  eleventh  day.  The  extent  and  form  of  the  motor  area  vary,  and 
do  not  correspond  in  young  animals  with  those  of  old  animals. 

Geneeation. 

1.  De.  Heintze.  JJeher  den  feineren  Bau  der  Decidua.  (*  Cen- 
tralblatt fiir  die  Medicinische  Wissenschaften,'  1875,  p.  33.) 

2.  John  Williams.  On  the  Structure  of  the  Mucous  Membrane 
of  the  Uterus.  (Pamphlet ;  reprint  of  paper  in  *  Obstetrical 
Journal,'  1875,  pp.  28  ;  with  three  plates.) 

1.  Dr.  Heintze,  in  investigating  the  structure  of  the  decidua, 
availed  himself  of  the  method  of  interstitial  injection  suggested  by 
Ranvier,  and  threw  in  solutions  of  osmic  acid,  common  salt,  gelatine, 
and  other  fluids,  under  a  constant  pressure  of  150  mm.  He  thus 
obtained  preparations  adapted  for  breaking  up  with  needles,  but  not 
for  section.    In  the  former  preparations  fasciculi  of  fibres  were  seen, 


1875.]  Report  on  Physiology.  215 

as  well  as  fine,  delicate,  isolated  fibres,  which  became  completely 
invisible  on  the  addition  of  glycerine.  Connected  with  and  attached 
to  these  fibres  and  fasciculi  were  flat  cells,  the  so-called  decidual 
cells,  composed  of  large,  variously  formed,  and  more  or  less  granular 
masses  of  protoplasm.  The  endothelial  cells  of  the  tissue  of  the 
decidua  were  distinguishable  from  the  endothelia  of  the  vessels, 
which  were  also  present,  only  by  their  larger  size  and  their  denser 
and  more  o^ranular  protoplasm. 

The  fibres  were  not  prolongations  of  the  decidual  cells,  but  the 
cells  were  attached  and  sealed  upon  the  fibres,  as  could  be  shown  by 
slight  pressure  upon,  and  sliding  movement  of,  the  cover  glass.  In 
order  to  cause  artificial  oedema  of  the  villi  of  the  chorion,  he  injected 
into  the  umbilical  vein  a  solution  containing  05  per  cent,  of  com- 
mon salt,  and  then  a  2  per  1000  solution  of  osmic  acid  ;  good  sections 
could  be  made  in  twelve  hours.  The  placenta  had  then  become  as 
hard  as  a  board,  and  here  and  there,  in  consequence  of  the  increase 
in  volume  of  the  villi,  fissures  had  formed  in  the  decidua  scrotina,  but 
in  otherwise  undamaged  placenta  the  villi  remained  intact.  Fine 
sections  showed  the  tissue  of  the  decidua  serotina  to  consist  of  a  net- 
work of  fine  decussating  fibres,  in  the  meshes  of  which,  and  attached 
to  the  fibres,  were  more  or  less  oval  cells,  composed  of  firmly  granu- 
lar protoplasm  and  large  nuclei.  The  structure  of  the  decidua  was 
thus  completely  analogous  to  the  mucous  membrane  of  the  non- 
pregnant uterus  ;  the  only  diflference  being  that  the  elements  of  the 
interglandular  tissue,  and  especially  the  cells,  are  hypertrophied, 
whilst  the  glands  are  transformed  into  cavities  lined  with  more  or 
less  flattened  cells. 

2.  Dr.  "Williams  refers  to  the  difficulties  which  present  themselves 
in  the  way  of  obtaining  uteri  in  which,  at  the  time  of  death,  those 
changes  were  taking  place  which  occur  normally  in  the  organ  during 
the  menstrual  flow  and  the  intermenstrual  interval.  Dr.  Williams 
has  taken  advantage  of  twelve  opportunities  that  have  presented 
themselves  to  him,  in  which  the  date  of  the  last  menstrual  period 
could  be  accurately  determined,  to  examine  the  changes  that  the 
mucous  membrane  undergoes  in  one  entire  monthly  cycle.  In  the 
first  case  the  woman  died  in  typhoid  fever  whilst  still  menstruating. 
The  cavity  contained  a  few  shreds  of  soft  membrane,  together  with 
some  bloody  mucus.  The  surface  was  blood-stained,  and  attached 
to  it  were  many  small  shreds  of  membrane,  which  gave  it  an  uneven 
or  flocculated  appearance.  On  tracing  the  lining  membrane  upwards 
through  the  cervix  of  the  uterus  it  was  found  to  terminate  abruptly 
above  the  internal  orifice  with  a  well-marked  margin,  and  above  this 
point  the  mucous  membrane  was  wanting.  In  a  second  uterus, 
taken  from  a  woman  who  had  just  finished  menstruating,  the  mucous 
membrane  was  also  found  to  be  deficient  near  the  os  internum ;  the 
muscular  fibre-cells  were  more  exposed  in  the  uterine  cavity,  but  at 
the  upper  part  they  were  covered  with  a  brown  layer  composed  of 
blood-corpuscles,  round  granular  cells,  fusiform  cells,  short  rod- 
shaped  bodies,  bits  of  gland,  and  broken  blood-vessels.  On  the 
addition  of  Liq.  Potassse  the  muscle-cells  could  be  seen  penetrating 


216  Chronicle  of  Medical  Science.  [July, 

the  stained  layer,  and  in  many  places  passing  through  it  to  the  sur- 
face. In  a  third  uterus,  taken  from  a  woman  of  twenty,  three  days 
after  cessation  of  menstruation,  the  inner  surface  of  the  uterus  w  as 
pale  and  smooth,  and  there  were  no  membranous  shreds.  The  cavity 
contained  but  little  mucus.  The  breach  of  surface  at  the  os  internum 
was  less  marked,  though  recognisable.  The  surface  was  studded 
with  small  white  points.  On  section,  the  mucous  membrane  appeared 
as  a  very  thin  pale  layer  in  the  lower  two-thirds  of  the  body,  to 
which  it  was  limited.  This  portion  of  the  cavity  was  lined  by 
columnar  epithelium,  the  cells  of  which  measured  ^^^Q^th  of  an  inch  in 
length.  The  remaining  third  of  the  body,  as  well  as  the  fundus,  was 
uneven,  having  attached  to  it  small  brownish  shreds,  similar  to  those 
found  in  the  first  two  uteri,  but  much  smaller  in  size.  They  ex- 
hibited a  structure  similar  to  that  presented  by  those  in  the  preceding 
uteri,  namely,  fusiform  and  round  cells,  in  a  state  of  fatty  degenera- 
tion, together  with  blood-corpuscles  and  ends  of  torn  blood-vessels. 
The  muscular  fibres  did  not  in  this  uterus  reach  the  surface  in  its  lower 
part,  but  was  covered  by  a  layer  of  soft  tissue,  composed  of  round 
and  fusiform  cells,  short  straight  rods,  and  glands,  embedded  in  a 
structureless  matrix.  The  glands  opening  on  the  surface  were  not 
very  numerous,  though  immediately  below  the  surface  glands  were 
found  in  great  abundance,  apparently  in  diff'erent  stages  of  develop- 
ment, and  arranged  more  or  less  obliquely  to  the  surface.  The  fifth 
uterus,  in  comparison  with  the  third  and  fourth,  showed  considerable 
development  of  the  mucous  membrane,  which  was  much  thicker, 
and  had  everywhere  a  covering  of  columnar  epithelium,  and  the 
glands  were  longer  and  more  developed.  We  must  refer  to  the 
original  for  the  details  of  the  change  undergone  by  the  uterus  in 
the  later  periods,  merely  adding  that  Dr.  Williams  is  of  opinion  that 
his  observations  tend  to  show  that  there  is  no  period  of  uterine  rest, 
but  that  the  organ  is  ever  undergoing  those  changes  which  either 
make  it  a  fit  receptacle  for  the  ovum  when  impregnated,  or  which 
prepare  to  carry  off  the  ovum  when  impregnation  has  failed.  If  any 
one  stage  of  the  monthly  interval  could  be  appropriately  termed  a 
period  of  uterine  inactivity,  that  one  would  be,  he  thinks,  the  bleed- 
ing period,  for  then  the  mucous  membrane  undergoes  fatty  degene- 
ration and  disintegration ;  while  this  disintegration,  however,  is 
going  on,  the  subjacent  muscular  wall  is  in  a  state  of  active  prolifera- 
tion for  the  formation  of  a  new  mucous  membrane,  so  that  in  reality 
there  is  no  period  of  uterine  inactivity. 


1875.] 


Report  on  Surgery.  317' 


REPORT    ON     SURGERY. 
By  H.  a.  Reeves, 

Assistant-Surgeon  and  Demonstrator  of  Anatomy,  London  Hospital ;  Surgeon  to  the  Hospital  for 
Womeu,  and  Surgeon  to  the  East  London  Hospital  for  Children  and  Dispensary  for  Women. 


Gyn^cologhcal  Surgeet. 

The  treatment  of  cancer  of  the  uterus  hy  Liq.  Ferri  Perchlor. — 
The  '  Brit.  Med.  Journ.'  of  February  13th,  1875,  contains  an  article, 
by  Dr.  C.  J.  Gibb,  of  Newcastle,  which  gives  the  results  of  his  ex- 
perience in  several  cases  of  carcinomatous  ulceration  treated  by  the 
local  application  of  the  perchloride  of  iron.  He  says — '*I  have 
always  used  the  strongest  pharmacopceial  solution  undiluted,  as  I  have 
only  used  it  to  secure  a  caustic  action.  At  first  I  applied  it  on  a  piece 
of  sponge  or  lint,  but  finally  found  cotton  to  answer  best,  as  it  sucks 
up  any  quantity  that  may  be  required,  parts  with  it  easily,  and  can 
be  moulded  into  any  form  so  as  to  fill  a  cavity  or  cover  over  and 
adhere  to  any  growth.  It  has  happened  occasionally  that  I  have 
found  the  cotton  wool  still  adherent  over  the  sore  a  week  or  more 
after  its  application,  and  when  removed  it  is  always  a  black  or  choco- 
late-coloured mass,  frequently  quite  solid  from  the  quantity  of  blood 
or  albuminous  matter  absorbed  in  its  meshes  and  clotted  therein  ; 
indeed,  one  patient  gravely  told  me  she  had  passed  a  solid  brown  egg 
a  few  days  after  one  of  her  visits.  No  doubt  it  was  the  hardened 
wool,  although  she  declared  she  had  cleared  the  vagina  the  day  after 
his  visit." 

According  to  Dr.  Gribb,  this  treatment  does  most  good,  and  appears 
to  cure  even  bad  cases,  when  the  disease  is  purely  epithelial  and 
chronic,  and  violent  in  character,  and  confined  to  the  surface.  The 
application  of  the  iron  seldom  causes  pain.  In  four  or  five  cases  the 
patients,  on  returning  home,  have  been  confined  to  bed  for  a  few  days, 
and  in  one  of  the  successful  cases  for  upwards  of  a  fortnight,  in 
consequence  of  a  severe  colicky  pain  in  the  region  of  the  uterus, 
lower  abdomen,  and  back.  Dr.  Gibb  thinks  that  in  these  cases  the 
wool  has  been  over-saturated  in  the  perchloride,  as  it  has  only  occa- 
sionally happened  that  the  solution  has  flowed  from  the  vagina  over 
the  vulva,  after  the  patient  had  left  his  consulting  room,  and 
those  parts  have  been  blistered  and  excoriated  as  a  consequence. 
He,  therefore,  is  now  very  careful  to  wash  away  with  a  syringe  all 
discharges  from  the  surface  of  the  cancer,  and  to  raise  the  breech  of 
the  patient  to  prevent  any  overflow  of  the  solution  over  the  vulva  (it 
is  much  easier  and  more  satisfactory  to  use  Dr.  P.  Smith's  expanding 
speculum,  which  secures  an  excellent  view  of  the  parts  and  makes  a 
pond  around  the  cervix),  and  after  applying  the  perchloride  to  suck 
up  with  a  sponge  from  out  of  the  bottom  of  the  vagina  any  super- 
abundant solution  which  a  slight  pressure  on  the  saturated  wool  over 
the  sore  may  cause  to  flow  out ;  after  that,  to  retain  the  wool  in  place 


218  Chronicle  of  Medical  Science.  [July, 

by  a  loose  plug  of  tow  in  the  vagina ;    and  lastly  to  dry  and  oil  the 
vulva  before  the  patient  rises  from  the  couch. 

Emphysematous  cysts  of  the  vaginal  mucous  memhrane. — These 
crepitating  tumours  have  been  observed  by  Prof.  Braun  and  by 
"Winkel  in  the  vagina,  but  Prof.  K.  Schroeder  was  the  first  to  discover 
emphysematous  cysts  in  the  vaginal  mucous  membrane  ;  he  removed 
two  small  tumours  from  this  membrane,  and  by  opening  them  under 
water  ascertained  that  they  contained  a  gas.  In  '  Schmidt's  Jahrb. 
Dr.  Kormann  states  his  belief  that  these  tumours  are  follicular  cysts 
from  whose  serous  contents  gas  has  developed. 

'Pendulous  tumour  of  the  mammary  areola.^-Dv.  McSwiney  lately 
exhibited  to  the  Dublin  Pathological  Society  a  tumour  removed  from 
the  right  breast  of  a  single  woman,  set.  50,  who  had  ceased  to  menstru- 
ate six  years  previously.  At  this  period  she  noticed  a  wart  immediately 
adjoining  the  nipple  of  the  right  breast,  which  gradually  increased  in 
size  and  became  ultimately  pendulous,  but  as  it  gave  her  no  in- 
convenience she  did  not  consult  any  one.  Seven  or  eight  weeks  before 
applying  to  Dr.  McSwiney  it  commenced  to  trouble  her,  but  was  sore 
rather  than  painful,  and  at  the  very  terminal  point  of  the  bulb  of  the 
tumour  an  abrasion  of  the  cuticle  took  place.  This  abrasion  became 
a  sore  through  the  friction  of  her  dress  in  moving  about,  and  from 
it,  after  a  time,  there  exuded  a  muddy  fluid  evidently  serous  in  cha- 
racter, for  it  stiff"ened  the  linen  wetted  by  it.  She  then  became 
alarmed,  and  asked  for  advice.  The  tumour  was  six  or  seven  inches  long 
and  pendulous,  and  the  bulbous  extremity  measured  between  five  and 
six  inches  in  circumference.  The  pedicle  sprung  from  the  areola,  and 
almost  from  the  nipple  of  the  breast,  and  included  the  greater  por- 
tion of  the  nipple.  Its  colour  was  normal.  A  considerable  artery 
could  be  felt  pulsating  in  it.  The  bulbous  extremity  had  rather  a 
remarkable  appearance ;  it  was  warty,  irregular,  fissured,  indented, 
and  of  diff'erent  colours — purple  in  one  part,  grey  in  another,  and 
perfectly  white  in  the  deep  indentations.  From  the  abrased  portions 
there  exuded  a  disagreeably-odoured  fluid.  Fearing  that  it  might,  if 
left,  undergo  malignant  degeneration,  Mr.  Kane  removed  it  at  Dr. 
McSwiney's  request.  Dr.  McSwiney  refrained  from  giving  any  his- 
tological status  to  the  growth,  but  expressed  his  opinion  that  it  was 
innocent  and  consisted  of  an  hypertrophy  of  one  or  more  of  the 
scattered  glands  and  sebaceous  follicles  which  abound  in  the  areola 
of  the  female  breast.  In  the  '  Dublin  Journal '  of  1847  Mr. 
O'Ferrall  gave  the  history  of  a  case  identical  with  the  present  one, 
and  the  drawing  accompanying  his  description  would  most  accurately 
represent  the  condition  of  the  tumour  Dr.  McSwiney  exhibited.  At 
p.  485  of  the  *  Dublin  Journal  of  Medical  Science  '  a  representative 
drawing  is  given. 

Intra-peritoneal  hcematocele  cured  hy  free  incision  and  drainage. — 
A  woman,  8Bt.  38,  consulted  Dr.  John  Hemans  for  a  tumour  six  or 
seven  inches  in  diameter  in  the  left  hypogastrium.  It  was  roundish, 
not  tender,  movable,  quite  elastic,  but  not  distinctly  fluctuating,  and 
descending  into  the  pelvis.  The  uterus  was  normal,  and  could  be 
moved  to  the  right,  but  not  to  the  left.     While  defecating  seven 


1875.] 


Report  on  Surgery.  219 


weeks  previously,  she  was  suddenly  seized  with  a  severe  pain  in  the 
left  hypochondriac  and  iliac  regions,  which  was  followed  by  chills. 
The  following  day  she  observed  a  tumour,  which  was  the  size  of  an 
egg  and  very  tender,  in  this  region.  She  had  chills  and  vomiting  at 
intervals.  After  aetherization,  Dr.  Hemans  introduced  the  needle  of 
an  aspirator  through  the  abdominal  walls,  and  about  seven  ounces  of 
dark  reddish  fluid  were  withdrawn.  The  tumour  was  thought  to  be  of 
the  same  nature  as  a  retro-uterine  haematocele.  Suppuration  in  the 
sac  followed.  Three  days  later  the  tumour  had  increased  in  size, 
and  was  very  hard.  There  were  pain  and  increase  of  temperature 
and  pulse.  She  was  sBtherized  again,  and  tapped  with  a  common 
trocar  through  the  vagina,  and  about  two  pints  of  dark  brown, 
bloody,  oifensive  fluid  escaped.  The  sac  refilled  in  a  few  days.  The 
operation  was  repeated,  the  opening  enlarged,  a  large  elastic  tube 
introduced,  and  drainage  established.  The  sac  was  washed  out 
daily  with  warm  water.  In  four  days  the  tube  was  removed,  the 
discharge  gradually  became  healthy,  induration  disappeared,  and  at 
the  date  of  the  report  only  a  little  inoffensive  serous  fluid  was 
secreted.  No  subsequent  trouble  was  experienced. — '  Boston  Med. 
and  Surg.  Journ.,'  4th  March,  1875. 

The  infantile  uterus. — The  '  Obstetrical  Journal  of  Great  Britain 
and  Ireland '  for  Feb.,  1875,  contains  an  article  by  Dr.  Grrigg  on  a 
peculiar  condition  of  the  uterus  which  is  not  unfrequently  the  cause 
of  sterility.  He  discusses  three  forms,  two  being  congenital,  of  which 
one  is,  and  one  is  not,  curable,  and  a  third  superinduced  as  a  sequence 
of  parturition  at  an  early  age,  and  is  sometimes  known  under  the 
name  of  super-involution  of  the  uterus.  Each  of  these  forms  is  briefly 
described,  also  the  various  modes  of  treatment  likely  to  prove 
available.  Dr.  Grigg  concludes  by  advising  a  careful  diagnosis,  as  the 
prognosis  diff'ers  greatly  in  the  diff*erent  varieties. 

Injection  of  tincture  iodine  into  the  cavity  of  uterus. — Although 
this  paper,  which  is  by  Dr.  Trask  and  is  contained  in  the  *  American 
Journal  of  Obstetrics,  &c.,'  has  more  special  reference  to  post-partum 
intra-uterine  injections,  yet  the  gynaecological  surgeon  may  have 
frequent  occasion  to  apply  this  method,  therefore  we  include  it  in 
our  surgical  report.  After  discussing  the  subject  of  intra-uterine 
injection  of  iron  perchloride  and  stating  its  risks,  dwelling  specially  on 
the  septicaemia  which  not  unfrequently  supervenes,  says — "  The  im- 
portant question  arises,  are  those  other  agents  at  our  command, 
which  can  be  substituted  for  the  salts  of  iron,  equally  efficient  in 
controlling  haemorrhage  and  free  from  the  risks  incident  to  these  ?  " 
The  perusal  of  the  discussion  at  the  London  Obstetrical  Society 
reminded  Dr.  Trask  of  an  article  which  he  had  read  many  years  ago 
in  the  '  North  American  Medico- Chirurgical  Eeview,'  vol.  i,  1857,. 
by  Dr.  Dupierris,  of  Havana,  recommending  the  injection  of  tinc- 
ture iodine  into  the  uterine  cavity,  and  giving  three  cases  in  which 
it  was  successful,  and  which  were  certainly  not  inferior  in  gravity  to 
those  reported  as  treated  by  injection  of  iron  salts.  Dr.  T.  says — 
"  That  recovery  should  have  taken  place  in  Dr.  D.'s  third  case  is 
very  remarkable ;  but  even  in  this  case  we  see  that  the  stimulus  of 


220  Chronicle  of  Medical  Science.  [July, 

iodine  was  sufl&cient  to  excite  the  apparently  extinct  reflex  action 
and  secure  contraction  of  the  womb."  After  discussing  and  often 
combating  the  views  of  our  leading  gynaecologists,  especially  those 
of  Dr.  Barnes,  who  introduced  the  intra-uterine  iron  injections  of 
Kiwisch  into  this  country,  and  stating  his  conviction  that  the  cases 
are  very  few  indeed  in  which  the  iron  acts  permanently  beneficially 
by  its  coagulating  power,  but  rather  by  exciting  uterine  contractions, 
and  after  referring  to  the  cases  in  which  tincture  iodine  was  success- 
fully used  by  Drs.  Emmett  and  Gr.  T.  Harrison  and  Prof.  Lusk,  he 
closes  an  interesting  and  practical  paper  thus : — "In  recapitulation  we 
may  briefly  say  that  we  have  sought  to  show — 

"  1st.  That  a  very  considerable  proportion  of  cases  in  which  the 
injection  of  salts  of  iron  has  apparently  saved  life  have  been  those 
in  which  it  accomplished  this  end  not  in  virtue  of  its  local  styptic 
action,  but  because  of  its  power  to  exite  reflex  action  when  cold, 
friction,  pressure,  ^c,  have  failed. 

"  2nd.  That  when  it  produces  coagulation  of  blood  in  the  orifices 
of  the  blood-vessels,  there  is  danger  that  the  coagulation  may  follow 
the  vessels  into  the  substance  of  the  uterus,  producing  dangerous 
thrombi ;  and  that  the  blood  already  collected  in  the  cavity  of  the 
uterus  also  may  become  converted  into  a  hard,  intractable  coagulum, 
which  the  uterus  cannot  expel,  and  which  may  after  a  few  days 
decompose  and  give  rise  to  septicaemia. 

"  3rd.  That  there  is  evidence  for  believing  that,  as  an  exciter  of 
dormant  reflex  action,  tincture  iodine  may  be  substituted  for  the  iron 
with  advantage,  from  its  efficiency  as  an  excitor  and  from  its  anti- 
septic properties. 

"  If  these  points  are  established,  the  use  of  iron  salts  in  a  solution 
sufficiently  strong  to  induce  coagulation  of  blood  in  the  uterine 
vessels  should,  at  any  rate,  not  be  resorted  to  until  tincture  iodine 
has  been  tried  and  failed." 

Vagino-cerviplasty  in  lieu  of  amputation  of  the  cervix  uteri. — Dr.  M. 
A.  Fallen,  Lecturer  on  the  Surgical  Diseases  of  Women  at  the  Uni- 
versity of  New  York,  contributes  to  the  '  American  Journal  of  Obste- 
trics, &c.,'  the  description  of  a  new  operation  which  will  be  specially 
interesting  to  gynaecological  surgeons.  Dr.  Fallen  thinks  "  that 
an  amputation  of  an  elongated  intra- vaginal  cervix,  however  great  it 
may  be,  when  the  measurements  do  not  exceed  three  inches  is  a  mutila- 
tion, and  should  not  be  done  until  other  procedures  have  failed." 
Further  on  he  says — "  The  amputation  of  the  cervix,  as  advised  and 
performed  by  Huguier  for  hypertrophic  elongation,  is  familiar  in  its 
details  to  every  gynaecological  surgeon,  but  so  enthusiastic  was  he  in 
its  recommendation,  that  its  dangers  have  in  a  measure  been  over- 
looked." 

There  are  cases  recorded  where  the  peritoneal  cavity  was  opened 
with  the  ecraseur — by  Marion  Sims,  whose  case  recovered  after 
stitching  the  wounded  surfaces ;  by  Breslau,  where  the  vaginal  sec- 
tion was  followed  by  an  extrusion  of  the  intestine  ;  by  Biefel,  where 
death  from  peritonitis  followed  an  opening  into  the  bladder ;  by 
some  Parisian  surgeon  (reported    by  Blanquinque),   where    death 


1875.]  Report  on  Surgery.  221 

ensued  from  haBmorrhage  and  peritonitis  on  the  same  day  ;  by  Langen- 
"beck,  where  the  peritoneum  was  also  w  ounded ;  by  Meadows,  who 
described  another  ;  and  by  Peter,  the  French  translator  of  Bennet, 
who. mentions  still  another  fatal  one.  Why  such  an  accident  takes 
place  during  ecrasement  is  readily  understood  when  we  recollect 
that  in  all  cases  of  hypertrophic  elongation  the  peritoneum  is 
dragged  down  with  the  cervix  sometimes  as  low  as  the  level  of  the 
sacculated  bladder,  almost  always  in  the  retro-uterine  space,  and  may 
even  pass  out  of  the  vulva,  as  in  a  specimen  in  St.  Thomas's  Museum 
and  figured  by  Barnes.  But  to  these  cases  the  procedure  of  vagino- 
cerviplasty  is  not  applicable  ;  they  are  merely  mentioned  as  illustra- 
tive of  the  dangers  of  amputation  of  the  cervix  by  linear  iecraseraent, 
to  which  may  be  added  the  further  hazards  of  haemorrhage  when  the 
conoid  operation  of  Hugnier  is  made. 

Yagino-cerviplasty  is  applicable  to  those  cases  wTiere  the  longitu- 
dinal diameter  of  the  utero-cervical  cavity  does  not  exceed  three  inches, 
but  where  the  intra-vaginal  portion  of  the  cervix  is  so  long  as  to  inter- 
fere ivith  either  locomotion^  sitting,  coition,  menstrtiation,  or  conception ; 
and  for  the  removal  of  which  Marion  Sims  devised  his  double-flap 
operation,  and  other  surgeons  the  galvano- cautery  loop. 

The  next  two  pages  are  devoted  to  a  description  of  the  operation, 
and  the  paper  concludes  with  the  following  three  cases,  which,  are 
certainly  very  encouraging^  and  indicate  that  amputation  of  the 
cervix,  except  in  malignant  disease  or  hypertrophic  elongation,  may 
give  place  to  a  plastic  operation  that  saves  the  woman  from  an 
unnecessary  mutilation." 

Case  1,  operated  on  four  years  ago,  was  that  of  a  woman,  set.  26, 
seven  years  married,  who  suffered  so  intensely  during  coitus  that  it  had 
not  been  attempted  for  three  years  prior  to  the  operation  ;  she  was 
of  course  sterile  and  somewhat  hysterical.  The  intra-vaginal  cervix 
measured  an  inch  and  eleven  lines  in  the  posterior  and  one  inch  and 
nine  lines  in  the  anterior  cul-de-sac,  and  when  the  rectum  was 
loaded  with  scybala  the  os  tinea  protruded  from  the  vulva  when 
she  sat  down.  Forty- four  months  after  the  vagino-cerviplasty  the 
intra-vaginal  portion  of  the  cervix  was  less  than  ten  lines  long,  both 
posteriorly  and  anteriorly.  "While  the  sterility  has  not  been  over- 
come, the  dysmenorrhoea  is  trifling,  and  the  dyspaneuria  does  not 
exist  ;  her  marital  relations,  which  had  been  unhappy,  are  har- 
monious, and  the  cervix  is  quite  two  ifiches  from  the  vulva. 

Case  2. — This  case  was  operated  on  in  May,  1872,  The  sound 
entered  two  inches  and  nine  lines ;  the  intra-vaginal  cervix  was 
acuminated  and  projected  from  the  posterior  cul-de-sac  one  inch  and 
nine  lines,  showing  that  the  vaginal  implantation  was  about  on  a 
level  with  the  os  internum.  The  patient  was  thirty-one  years  old, 
and  menstruated  first  when  twenty-two  years  old.  She  suifered 
greatly  from  dysmenorrhoea,  and  in  certain  positions  the  elongated 
cervix  protruded  about  half  an  inch  from  the  vulva  and  irritated  the 
clitoris.  The  consequences  of  this  mechanical  attrition  were  most 
deplorable  and  readily  explained  her  hysteria  and  hypersesthesia. 
There  was  profuse  leucorrhoea  and   the  peripheral  mucous  mem- 


222  Chronicle  of  Medical  Science.  [Ji^ly* 

branes  about  the  os  externum  constantly  eroded.  The  vaginc- 
cerviplastj  consisted  of  stripping  the  cervix  for  an  inch  and  one  line 
anteriorly  and  one  inch  and  three  lines  posteriorly.  Seven  silver 
sutures  were  passed  and  the  patient  kept  in  the  horizontal  position 
for  nine  days.  On  the  thirteenth  day  the  sutures  were  removed, 
and  menstruation,  which  was  less  painful,  supervened  three  days 
subsequently.  In  six  months  the  intra-vaginal  cervix  was  seem- 
ingly normal,  with  the  exception  of  a  very  small  os  externum  and 
her  menstruations  comparatively  comfortable.  The  hysteria  and 
hyperaesthesia  ceased  altogether.  The  patient  was  under  observa- 
tion till  September,  1874,  and  had  no  recurrence  of  her  former 
troubles,  and  was  pursuing  her  avocations  with  uninterrupted  satis- 
faction and  zeal. 

Case    3   was  that  of  a    lady,  ast.  24,  married,  and   of  course 
sterile.     Marital  efforts    had    ceased   for    about    a   year,    as    the 
dyspaneuria  was  so  great  that  it  was  followed  by  extreme  prostra- 
tion and  sometimes  by  syncope.    Leucorrhcea  was  abundant  and  con- 
stant, and  there  were  the   usual  erosions  on  the  cervix,  which  was 
slender  and  acuminated,  with  an  intra-vaginal  dip  on  its  anterior 
surface  of  an  inch  and  seven  lines,  and  upon  its  posterior  of  one  inch 
and  eleven  lines.     The  sound  penetrated  the  uterine  cavity  to  the 
depth  of  two  inches  and  ten  lines.     Here  was  another  case  of  im- 
plantation on  a  level  with  the  isthmus.     When  this  patient  suddenly 
sat  down  the  cervix  impinged  on  the  bladder,  frequently  giving  rise 
to  pain,  always  to  vesical,  and  sometimes  to  rectal,  tenesmus,  as  the 
inclination  of  the  entire  uterus  was  towards  retroversion,  but  not 
actually  retroverted  save  under  the  downward  pressure  of  the  super- 
incumbent  viscera,    when   in  the    sitting    or    squatting    position. 
Chronic  catarrh  of  the  bladder  was  likewise  a  complication.     She 
had  been  advised  to  submit  to  amputation  of  the  cervix,  and  came  to 
Mr.  P —  for  that  purpose  from  the  State  of  Tennessee,  but  vagino- 
cerviplasty  was  performed  instead,  and  the  sutures  removed  on  the 
twelfth  day.     IJnlike   the   other  two  cases,  her  menstruation  was 
usually  attended  with  so  little  pain  that  it  could  hardly  be  called 
dysmenorrhcea.     The    subsequent  vaginal    hot-salt-water    douches 
were   given,    and  the  topical    applications   made   to   the    cervical 
erosions:     The  leucorrhosa  ceased,  but  the  cystitis  persisted.     The 
cervix,  however,  had  been  shortened  in  its  dip  to  six  lines  anteriorly, 
and  eight  lines  posteriorly.     As  she  could  not  remain  in  the  city  for 
a  longer  period,  she  passed  from  observation  after  the  second  mens- 
trual period  subsequent  to  the  operation.     Mr.  P —  heard  from  her 
medical  attendant  in  July,   1874,  who  stated  that  her  dyspaneuria 
was  quite  relieved^  and  that  the  cervix  was  fully  two  inches  from  the 
vulva,  and  that  the  cystitis  had  almost  disappeared  in  consequence  of 
the  removal  of  the  irritation  caused  by  the  impinging  cervix. 

Tke  treatment  of  vaginismus. — M.  Bouchut,  of  the  Hopital  dea 
Enfants  Malades,  writing  on  this  subject  in  the  '  Grazette  des  H6- 
pitaux,'  May,  1875,  says  that  he  has  seen  several  young  women  who 
after  marriage  had  at  the  inferior  part  of  the  vaginal  orifice  near 
the  fourchette  a  small  longitudinal  fissure  which  was  very  painful  to 


1875.]  Report  on  Surgery.  223 

the  touch.  The  contact  of  the  finger  produced  an  acute  pain  just 
like  that  due  to  anal  fissure.  The  same  phenomenon  supervened  on 
attempting  coitus  and  checked  its  accomplishment.  It  is  not  correct 
to  say  that  vaginismus  is  only  seen  in  non- virgins,  as  M.  Bouchut  has 
observed  it  in  a  virgin,  affected  with  lymphatic  leucorrhcea,  who  had 
been  ordered  injections,  but  these  had  to  be  discontinued  on 
account  of  the  pain  which  the  syringe  caused.  In  this  case  a  slight 
fissure  of  the  hymen  was  the  cause  of  the  pain. 

M.  B — does  not  think  that  forcible  dilatation  of  the  vagina,  as  in  a 
similar  affection  of  the  rectum,  is  the  best  mode  of  treatment, 
and  recommends  the  following  plan  before  having  recourse  to 
operative  measures.  He  says — "  In  many  cases  I  have  cured  patients 
without  operation  and  by  the  most  simple  means,  such  that  every 
medical  man  may  employ  every  day.  These  consist  in  the  use  of 
vaginal  suppositories  containing  cacao-butter  five  grammes,  extract  of 
rhatany  three  grammes,  and  of  baths  of  bran- water.  One  supposi- 
tory should  be  introduced  night  and  morning,  then  every  day  for  an 
hour  the  patient  should  take  a  bath  of  bran-water." 

In  this  way  M.  B —  cured  several  cases  of  vaginismus  without 
having  recourse  to  an  operation  as  disagreeable  to  the  women  as  to 
their  husbands. 

Hydrocele  in  a  female. — Dr.  G-.  A.  Baxter  ('  Southern  Med. 
Eecord,'  Feb.,  1875)  narrates  the  case  of  a  woman,  set.  32,  who  two 
years  previously,  while  lifting  a  heavy  bucket  of  coal,  felt  a  sharp 
pain  in  the  inguinal  region,  which  passed  away  in  a  few  minutes. 
Some  days  after  she  experienced  pain  in  the  same  region,  extending 
into  the  labia  majora,  and  accompanied  by  swelling.  These  sym- 
ptoms continued,  when,  on  lying  down  one  day,  the  swelling  and  pain 
suddenly  and  almost  entirely  disappeared. 

The  tumour  remained  in  this  state  for  nearly  two  years,  when, 
having  fallen  over  a  chair,  the  labia  majora  became  bruised,  and  the 
tumour  began  to  increase,  without  giving  any  pain.  Dr.  Baxter 
found  a  tumour  as  large  as  an  ordinary  egg^  whose  apex  pointed  to 
the  external  inguinal  ring,  and  whose  base  was  large,  and  caused 
bulging  of  the  upper  portion  of  the  labia  majora.  The  swelling  was 
first  taken  to  be  a  hernia  or  an  abscess,  and  under  the  latter  sup- 
position it  was  opened,  when  serum  instead  of  pus  was  evacuated. 
She  rapidly  recovered. 

The  treatment  of  uterine  fibroid  by  ergotin. — The  *  Clinic  '  of 
January  23rd,  and  the  '  Philadelphia  Med.  Times '  of  May  1st,  1875, 
contain  the  account  of  a  case  of  submucous  fibroid,  recently  under 
Dr.  Bartholow's  care.  An  aqueous  solution  of  ergotin,  in  one-grain 
doses,  was  hypodermically  injected  night  and  morning.  The  follow- 
ing afternoon  the  patient  began  to  feel  expulsive  pains,  which 
increased  continually  in  severity.  After  a  fortnight  the  injections 
were  used  only  once  a  day.  A  week  later  the  pains  had  diminished 
in  severity,  and  on  examination  the  neck  of  the  uterus  was  found 
very  much  dilated  and  plugged  with  a  tumour,  which  was  then 
easily  removed  with  the  ecraseur.  Full  recovery  ensued,  and  the 
patient  has  not  made  any  complaint  since  the  growth  was  removed. 


224  Chronicle  of  Medical  Science,  [July, 

In  connection  with  this  subject  we  could  draw  the  attention  of 
our  readers  to  an  article  by  Dr.  Hildebrandt,  "  On  the  Treatment  of 
Uterine  Myofibroma  of  the  Uterus  by  the  Hypodermic  Injection 
of  Ergotin,"  in  the  *  American  Journal  of  Obstetrics  and  Diseases  of 
Women  and  Children '  of  Feb.,  1875,  which  contains  a  full  account 
of  the  preparation,  mode  of  application,  advantages,  &c.,  of  this  mode 
of  medication  in  uterine  fibro-neoplasms. 

Extraction  of  a  calculus  from  the  bladder  tJirough  a  vesico-vaginal 
fistula. — Mr.  5?eevan,  of  the  West  London  Hospital,  has  lately  had 
under  care  a  woman,  aet.  QQ,  the  subject  of  a  vesical  calculus.  There 
was  a  fistula  in  the  roof  of  the  vagina,  which  admitted  the  tip  of  the 
finger  (index  ?),  and  a  stone,  apparently  of  small  size,  was  felt  with 
the  sound,  lying  close  to  the  fistulous  opening. 

On  September  1st,  the  patient  being  setherized,  Mr.  Teevan  intro- 
duced a  pair  of  narrow-bladed  forceps  into  the  bladder  through  the 
fistula,  seized  the  stone,  which  was  lying  just  above  the  ovoid  opening, 
and  extracted  it.  The  calculus  was  phosphatic,  and  measured  1-J  inch 
in  length  and  2|  inches  in  circumference.  Though  incision  was  made 
but  few  drops  of  blood  escaped  from  the  distended  edges  of  the 
fistula.  The  bladder  was  then  examined  with  the  finger,  and  found 
to  contain  a  large  quantity  of  dShris,  which  was  mortar-like,  and 
was  removed  with  a  scoop.  The  viscus  was  washed  out,  but  no 
attempt  was  made  to  close  the  fistula,  as  the  parts  were  in  too  un- 
healthy and  inflamed  a  condition  to  admit  of  any  operation.  The 
patient  was  much  relieved,  but  still  complained  of  "  soreness," 
owing  to  the  urine  dribbling  away,  and  was  discharged  at  her  own 
request  on  September  22nd. 

Soon  after  her  return  home  she  again  began  to  pass  "grit,"  and 
complained  of  pain.  Shortly  after  her  feet  and  legs  became  dropsical, 
and  she  died  on  Dec.  6th,  rather  more  than  three  months  after  the 
stone  was  extracted. 

Mr.  Teevan  thought  that  the  fistula  was  due  to  the  ulceration 
accompanying  chronic  cystitis,  or  to  the  result  of  the  employment 
of  a  metal  catheter,  which  had  been  used  for  some  time  by  an  un- 
professional person. 

On  serous  ovarian  cysts. — Dr.  Panas  read  a  paper  on  this  subject 
at  a  recent  meeting  of  the  Academie  de  Medecine,  and  drew 
the  following  conclusions,  which  are  contained  in  '  Le  Mouvement 
Medical ' : — 

1.  That  among  the  cysts  called  ovarian  there  is  a  class  of  uni- 
locular cysts  containing  a  special  fluid,  the  treatment  of  which  is  as 
simple  as  it  is  certain  in  its  results. 

2.  The  characters  of  the  cystic  fluid  are,  complete  absence  of 
viscidity,  perfect  diaphaneity  (with  occasional  exceptions),  poverty 
in  protenious  material  (modified  albumen),  and  its  relative  richness 
in  alkaline  salts,  principally  chloride  of  sodium.  Slightly  or  not  at 
all  precipitated  by  heat  and  nitric  acid,  the  liquid  in  question  is 
precipitated  by  alcohol.  In  this  respect  this  fluid  bears  a  certain 
analogy  to  that  found  in  the  spermatic  cysts  of  men,  as  we  may  be 
convinced  by  comparison  of  the  two  fluids. 


1875.] 


Keport  on  Surgery.  !^26 


3.  We  are  at  present  ignorant  as  to  whether  the  point  of  origin 
of  these  cysts  is  actually  in  the  ovary,  or  is  not  rather  in  the  par- 
ovarium (body  of  Eosenmiiller) . 

4.  The  treatment  of  these  cysts  is  still  more  simple  than  that 
suggested  by  Boinet,  who  proposed  puncture  by  means  of  a  trocar, 
followed  by  injection  of  iodine.  A  simple  puncture  by  the  trocar 
is  sufficient  to  bring  about  a  cure,  by  removing  the  fluid  completely 
or  even  partially. 

5.  By  this  process  not  only  is  all  danger  avoided,  but  even  the 
slightest  pain  to  the  patient.  In  a  word,  the  treatment  of  these 
cysts  is  easier  than  that  of  simple  or  spermatic  hydrocele  in  men, 
which  requires,  almost  always,  the  subsequent  employment  of  caustic 
or  strongly  irritating  injections. 

"We  need  scarcely  add  that,  both  for  patient  and  surgeon,  Dr. 
Panas's  paper  is  a  most  important  one.  We  should  b*  very  glad  to 
know  if  British  or  American  experience  corroborates  the  views  set 
forth  in  it.  At  present  we  are  under  the  impression  that  our  expe- 
rience of  tapping,  even  in  such  cases,  is  not  by  any  means  so  favor- 
able, as  regards  cure,  as  that  which  Dr.  Panas  seems  to  have 
experienced. 

Dermoid  cyst  of  the  ovary. — M.  Terrier,  in  '  Bulletin  Gen.  de 
Therap.,'  15th  March,  1875,  narrates  the  case  of  a  patient  who  came 
under  his  care  for  a  large  tumour  occupying  the  right  iliac  fossa, 
and  presenting  all  the  characters  of  an  ovarian  cyst. 

An  exploratory  puncture  revealed  the  existence,  in  this  tumour, 
of  epithelial  cells,  of  hair,  and  of  a  thin  greyish-white  liquid.  An 
operation  was  decided  on,  and  was  executed  without  difficulty,  the 
results  being  favorable.  The  temperature  never  exceeded  100*5°  P. 
AVithout  appreciable  cause  the  urine  became  retained  at  the  end  of 
five  days.  (Eetention  of  urine  is  not  uncommon  after  ovarian  ab- 
dominal section,  and  it  is  the  best  practice  to  draw  off  the  urine, 
and  spare  the  patient  the  discomfort  and  straining  which  often 
accompany  voluntary  micturition  in  such  cases. — Bep.) 

Microscopic  examination  of  the  sac  showed  that  it  presented,  on 
its  internal  aspect,  the  appearance  o£  skin.  In  fact,  hair,  fatty 
granules,  sudoriferous  glands,  &c.,  were  found. 

StoUz's  operation  for  cystocele. — We  recently  saw  Dr.  Heywood 
Smith  operate,  at  the  Hospital  for  Women,  on  a  case  of  cystocele ; 
and  at  the  suggestion  of  Professor  Stoltz,  lately  of  Strasburg,  and 
now  of  Nancy,  performed  his  (Professor  Stoltz's)  operation  for  the 
relief  of  this  deformity.  The  method  consists  in  removing  a  circular 
piece  of  mucous  membrane  about  the  size  of  a  five-shilling  piece, 
and,  when  bleeding  is  checked,  in  passing  a  silk  suture  around  the 
bared  surface,  about  a  quarter  of  an  inch  from  its  margin,  in  the 
same  manner  as  is  done  in  making  an  ordinary  calico  bag.  On 
drawing  the  two  ends  together  the  edges  of  the  wound  are  approxi- 
mated, and  the  calibre  of  the  vagina  much  diminished  in  length  and 
circumference. 

The  after-treatment  resembles  that  of  otlier  plastic  vaginal  opera- 
tions.    The  result  was  very  satisfactory,  the  prolapse  of  the  uterus 

111— LVI.  15 


226  Chronicle  of  Medical  Science.  [July, 

being  overcome,  as  its  cervix  was  retained  in  a  pouch  above  the 
narrowed  vaginal  surface.     The  woman  was  middle-aged. 

We  draw  attention  to  this  operation,  not  only  because  of  its  success, 
but  also  because  we  have  not  been  able  to  find  any  account  of  in  it 
any  works  on  gynaecological  surgery  that  we  have  read. 

Four  cases  of  echinococci  in  the  female  "pelvis. — Drs.  Freund,  of 
Breslau,  and  Chadwick,  of  Boston  ('  American  Journal  of  Obstetrics, 
&c.'),  after  referring  to  the  extreme  rarity  of  this  disease,  and  showing 
that  the  cases  previously  supposed  to  be  of  this  nature  were  in  all 
probability  hydatid  moles,  refer  to  the  case  of  Dr.  Graily  Hewitt  as 
''the  first  perfectly  authentic  case  on  record  in  which  true  hydatids 
have  been  found  in  the  uterus,"  and  say  that  their  first  case  belongs 
to  the  same  category ;  it  is  as  follows  : 

Case  1. — Echinococci  in  the ])Osterior  wall  of  the  uterus ;  incision 
with  evacuation  of  hydatid  vesicles;  new  colonies  in  the  pelvic  cellular 
tissue ;  spontaneous  perforation  into  the  bladder  and  rectum. — M.  S — , 
set.  57.  Menstruation  began  in  twentieth  year,  had  always  been 
scanty;  was  married  at  twenty-five,  and  been  sterile.  Menses  ceased 
several  months  ago.  Hardness  in  lower  part  of  abdomen.  Has  sufiered 
much  for  past  six  years  from  difficulty  of  micturition  and  defecation, 
as  well  as  a  sense  of  weight  in  the  abdomen.  For  several  weeks  the 
retention  of  faeces  and  urine  has  been  nearly  complete.  Only  pro- 
duces dejections  by  means  of  large  enemata  passed  very  high  up 
through  a  long  tube. 

On  examination  the  bladder  was  found  distended  so  as  to  rise 
three  inches  above  the  pelvis,  and  was  displaced  somewhat  to  the 
right.  To  the  left  of  the  bladder,  in  the  inguinal  region,  was  a  smooth 
elastic  tumour.  The  vagina  was  reduced  to  two  thirds  of  its  normal 
length  by  an  elastic  tumour  that  completely  filled  the  small  pelvis. 
Upon  passing  the  catheter  to  evacuate  the  bladder,  the  uretha  was 
found  greatly  elongated,  as  happens  with  retroflexion  of  the  gravid 
uterus.  A  great  quantity  of  thick  urine  was  drawn  off.  The  tumour 
was  clearly  recognised  as  belonging  to  the  posterior  wall  of  the 
womb,  for  it  could  be  traced  into  the  posterior  lip  of  the  os,  which 
was  completely  drawn  out.  The  external  os  appeared  as  a  narrow 
transverse  cleft,  bounded  posteriorly  by  the  tumour,  and  anteriorly 
by  the  very  attenuated  anterior  lip.  By  the  bimanual  examination 
the  uterus  was  found  to  correspond  in  size  with  the  pregnant  organ 
at  the  third  month.  The  sound  entered  five  inches,  and  showed  that 
the  anterior  wall  was  extremely  thin  throughout  its  whole  extent. 
Sim's  speculum  brought  only  the  surface  of  the  tumour  into  view, 
the  OS  being  pressed  forward  against  the  symphysis  pubis.  Upon 
these  data  a  cystic  tumour  of  the  posterior  wall  of  the  womb  was 
diagnosed,  and  it  was  thought  to  be  a  fibro-myoma  with  a  secondary 
cyst. 

In  order  to  relieve  retention  of  urine  and  faeces,  as  well  as  to  aid 
the  diagnosis,  a  trocar  was  introduced  into  the  tumour  very  near 
the  OS.  As  a  clear  watery  fluid  gushed  from  the  canula,  the  open- 
ing was  at  once  enlarged  with  a  bistoury,  and  a  great  amount  of 
uid  escaped,  containing  numerous  vesicles  varying  in  size  from  a 


1875.]  Report  on  Surgery.  2%7 

pea  to  a  cherry.  The  posterior  wall  did  not  collapse  as  much  as 
might  have  been  anticipated  from  the  amount  of  fluid  evacuated ;  it. 
felt  thick  and  rough.  The  authors  emphasize  this  point  as  suggesting 
a  likelihood  of  the  parent- vesicle  being  located  in  the  uterine  wall. 
The  fluid  was  limpid,  contained  no  sediment,  and  only  traces  of  al- 
bumen. A  more  exact  clinical  examination  was  superfluous,  because 
the  microscope  told  the  tale ;  with  it  structureless  stratified  mem- 
branes, scolices,  and  separate  echinococci-hooks  were  seen. 

During  the  week  after  the  operation  a  thick  greenish  fluid  con- 
taining .shreds  and  flakes  of  membrane  escaped  from  the  incision. 
She  said  that  immediately  after  getting  home  she  was  taken  with 
high  fever  and  symptoms  of  gastro-enteritis,  accompanied  by  a  pro- 
fuse discharge  of  very  off"ensive  fluid  from  the  vagina.  General  health 
good,  but  micturition  and  defecation  were  few  {sic).  The  nodular  and 
enlarged  uterus  was  moderately  anteverted  ;  the  posterior  wall  still 
much  thicker  than  the  anterior,  but  in  the  right  side  of  the  anterior 
wall  were  felt  irregularities  and  round  hard  nodules.  Precisely 
similar  nodules  were  felt  behind  and  to  the  right  of  the  womb  ;  the 
bladder  was  firmly  adherent  to  this  mass,  whereas  on  the  left  side 
it  was  freely  movable  with  the  catheter  and  distensible.  With  the 
speculum  the  anterior  lip  was  seen  to  have  become  much  thicker 
than  before,  and  presented  many  degenerated  follicles.  The  posterior 
lip  was  rough,  and  of  a  grey  colour. 

In  April,  1871,  she  again  appeared  with  fresh  complaints.  She 
had  a  constant  desire  to  urinate,  and  when  successful  she  had  much 
strangury.  She  exhibited  many  vesicles  which  had  passed  with  her 
urine.  A  large  catheter  brought  away  a  little  thick  urine  filled  with 
vesicles  and  shreds  of  membrane.  She  said  that  similar  membranes 
and  pus  had  often  been  discharged  from  the  vagina  after  severe 
tenesmus.  A  firm  infiltration  of  the  cellular  tissue  to  the  right  and 
behind  the  womb  was  made  out ;  in  this  the  cervix  was  embedded. 
The  discharge  through  the  bladder  ceased  about  the  middle  of  May. 
In  October,  1872,  she  brought  vesicles  which  she  had  passed  through 
the  rectum.  She  had  had  several  profuse  hsDmorrhages  from  the 
vagina.  The  womb  was  more  firmly  held  than  before  by  the  para- 
metric infiltration,  which  then  half  enveloped  the  rectum  with  an 
unyielding  arch,  yet  the  mucous  membrane  of  the  rectum  was  only 
attached  to  the  underlying  tissues  at  one  point ;  no  perforation 
could  be  discovered.  Through  the  speculum  the  vaginal  portion  of 
was  seen  to  be  very  broad  ;  the  anterior  lip  diff'ered  completely  from 
the  posterior ;  it  surrounded  the  latter  like  a  half-moon,  and  was 
only  one  third  as  thick.  Its  appearance  was  peculiar.  The  surface 
was  smooth,  the  mucous  membrane  seemingly  intact ;  its  external 
border  was  of  carmine-red  colour,  the  rest  of  brick-red  with  brighter 
radiating  stripes  ;  in  the  spaces  between  these  latter  yellow  points, 
varying  in  size  from  a  millet-seed  to  a  pea,  were  scattered.  The  pos- 
terior lip  looked  like  a  complete  vaginal  portion ;  it  was  greyish, 
rough,  and  irregular.  The  yellow  points  in  the  anterior  lip  proved 
not  to  be  vesicles,  but  only  ovula  JN"abothi. 

The  chief  interest  of  this  case  rests  upon  the   unquestionable 


228  Chronicle  of  Medical  Science.  [July, 

presence  of  echinococci  in  the  parenchyma  of  the  uterus.  That 
this  site  of  the  vesicles  was  primary  is  more  than  can  be  asserted,  for, 
as  the  same  time  that  they  were  found  in  the  womb,  they  were  like- 
wise discovered  in  the  surrounding  tissues.  They  may  have  been 
first  developed  in  the  uterine  walls,  or  have  penetrated  into  them 
from  the  cellular  tissue,  or  even  from  the  peritoneal  cavity.  In  the 
latter  alternative,  the  case  would  be  analogous  to  those  in  which  the 
same  entozoon  has  been  known  to  pass  from  the  pericardium  into  the 
substance  of  the  heart ;  and  according  to  the  best  pathologists  it  is 
never  developed  primarily  in  the  last-named  organ.  The  case  is,  at 
any  rate,  a  new  proof  that  echinococci  may  exist  in  the  parenchyma 
of  the  uterus. 

Case  2. — Echinococci  in  the  liver,  spleen,  great    omentum,    and 
pelvic  cellular  tissue. — Miss  J — ■,  set.  22,  began  to  menstruate  when 
fifteen,  and  has  always  been  regular.     Has  been  in  poor  health  for 
three  years,  and  her  abdomen  has  been  gradually  swelling  in  its 
upper  and  middle  parts.     Catamenia  have  lately  been  more  scanty, 
and  there  is  frequent  desire  to  micturate.     Is  much  emaciated,  left 
thorax  is  somewhat  distended,  the  heart  pushed  upward  and  to  the 
right,  with  its  apex  in  second  intercostal  space.     Beneath  the  heart 
is  the  spleen,  much  enlarged,  and  extending  downwards  to  the  edge 
of  the  ribs.     The  liver  extends  from  the  fourth  rib  to  two  inches 
below  the  thorax.     Uterus  pushed  down  towards  pubes.     A  part  of 
the  stomach  can  be  made  out  by  percussion  projecting  beneath  the 
spleen.     The  ascending,  transverse,  and  descending  colon  can    be 
distinctly  traced  around  a  tumour,  whose  surface  is  broken  up  by 
smooth  prominences.  This  reaches  to  the  symphysis  pubis,  and  gives 
the  most  perfect  hydatid  tremor  on  percussion.     Vagina  much  com- 
pressed, and  uterus  held  firmly  against  pubes  by  an  elastic  tumour, 
which   projects   from   the   right  side  of  small  pelvis  towards  the 
middle.     Eectum  pushed  over  to  right  and  somewhat  constricted, 
yet   defecation  not   impeded.     Puncture   of  tumour   per   vaginam 
revealed  all  the  characteristics  of  echinococci ;  after  its  evacuation 
small  round  tumours  were  still  to  be  felt  behind  the  uterus.     The 
cyst  was  evacuated,  and  the  tumours  remaining  in  the  pelvis  are  un- 
mistakably situated  in  its  extra-peritoneal  cellular  tissue.     It  was 
assumed  that  the  hydatids  composing  the  abdominal  tumour  were 
in  the  omentum,  and  also  extra-peritoneal.     In  these  particulars 
the  case  resembles  one  reported  by  Leudat  ('  Graz.  Med  de  Paris,' 
No.  27,  1856),  where  the  diagnosis  was  corroborated  by  the  autopsy. 
Case  3. — Echinococci  of  liver,  spleen,  great  omentum,  and  probably 
of  right  ovary. — Mrs.  E, — ,  aet.  25,  first  menstruated  at  fifteen,  and 
has  had  one  child.  The  right  side  of  the  abdomen  has  been  enlarging 
for  six  months.     Menstruation  is  regular.     During  last  six  weeks 
the  tumour  has  been  growing  rapidly,  and  there  are  severe  abdominal 
pains,  fever,  great  thirst,  and  prostration.     The  heart  is  displaced 
as  in  the  previous  case,  but  the  spleen  is  even  larger  and  projects 
two  inches  below  the  edge  of  the  ribs.     The  liver  extends  from  the 
third  rib  to  three  inches  below  the  margin  of  the  ribs  ;  the  left  lobe 
IS  chiefly  enlarged,  and  forms  a  very  prominent  tumour,  which  gives 


1875.]  Report  on  Surgery,  229 

the  liydatid  tremor.  This  tumour  is  separated  from  the  symphysis 
pubis  by  convolutions  of  the  intestines.  The  uterus  is  easily- 
grasped  bi-mauually  and  is  anteverted.  Obliquely  behind  it  is  a 
small  cystic  tumour  resembling  in  every  respect  an  ovarian  tumour. 
To  relieve  the  dyspnoea  the  cyst  in  the  left  lobe  of  the  liver  was 
punctured  three  times  at  intervals  of  three  weeks.  It  discharged 
the  usual  contents  of  an  hydatid  cyst ;  the  last  time  of  tapping  the 
fluid  was  purulent  and  the  cavity  did  not  refill.  The  omental 
tumour  was  similarly  treated,  but  was  not  completely  emptied.  The 
patient  felt  so  well  that  she  declined  any  further  treatment. 

Case  4. — Echinococci,  of  hepatic  origin,  in  Douglas's  pouch. — 
Mrs.  E — ,  aet.  55,  had  a  tumour  on  right  side  of  abdomen,  but  knew 
nothing  of  its  mode  of  growth.  Abdominal  organs  seemed  healthy, 
except  the  genitals.  The  senile  uterus  was  pushed  forwards  and  to  the 
left  side  by  a  tumour  as  large  as  a  child's  head  at  birth  ;  it  was 
rough,  hard,  and  not  fluctuating,  and  seemed  to  be  adherent  to  the 
posterior  wall  of  the  uterus,  and  not  to  be  connected  with  any  other 
abdominal  organ.  Her  suiFeriugs  arose  from  repeated  attacks  of 
circumscribed  peritonitis  in  the  region  of  the  tumour.  She  died  of 
some  intercurrent  afi'ection  and  a  firm  tumour  was  found  at  the 
spot  mentioned,  which  was  adherent  to  the  uterus,  and  at  first 
appeared  to  have  no  connection  with  the  other  organs  ;  but  a  careful 
search  discovered  a  band  a  foot  long  and  as  fine  as  a  thread,  running  to 
the  right  lobe  of  the  liver.  The  tumour  consisted  of  a  dead  echinococcus 
cyst  with  an  immense  number  of  secondary  vesicles.  The  connect- 
ing band  and  the  deep  yellow  colour  indicated  the  liver  as  the  original 
site  of  the  cyst.  It  had  developed  in  the  liver,  protruded  and 
become  pediculated,  and  hanging  down  into  the  pelvis  had  formed 
adhesions  there.  In  this  connection  we  may  refer  to  a  recent  paper 
by  Dr  S.  Spiaggia  in  the  Gazette  Glinica  dello  Spedale  Civico  di 
Palermo,  January,  1875,  on  "  Oligsemia  from  Metrorrhagia  and 
Acephalocysts  of  the  Uterus,"  &c. 

Virchow  says  that  echinococci  develop  in  the  lymphatic  vessels ; 
each  cavity,  containing  a  parent  cyst,  has  two  walls,  one  belonging 
to  the  organ  and  one  to  the  animal.  The  membranes  of  the  cyst, 
when  discharged,  always  roll  up  inside  out,  raising  a  doubt  among 
the  ignorant  as  to  whether  the  animals  do  not  grow  on  the  outside. 
If  there  is  any  roughness  on  one  side  of  the  membrane,  it  is  safe  to 
conclude  it  is  the  inner  surface.  These  irregularities  are  not  as  a 
rule  young  echinococci,  but  only  pathological  appearances  common 
to  old  age.  On  section  the  membrane  is  seen  to  consist  of  many 
strata,  arranged  with  the  greatest  possible  regularity.  Each  principal 
layer  is  divided  into  many  thinner  ones.  A  similar  though  less 
regular  appearance  is  seen  in  an  ordinary  fibrinous  coagulum,  but 
acetic  acid  causes  the  latter  to  swell  and  the  stratification  to  dis- 
appear, which  is  not  the  case  with  echinococci  membrane. 

A  sediment  is  commonly  found  at  the  bottom  of  the  cyst,  con- 
sisting chiefly  of  egg-shaped  formations  of  carbonate  of  lime,  as 
deposited  in  the  body  of  the  animal.  They  only  appear  in  old 
animals  and  their  number  increases  with  age.  These  are  of  great 
value  in  the  diagnosis,  but  are  not  absolute. 


230  Chronicle  of  Medical  Science.  [July, 

Tiie  booklets  are  like  young  h}  oid  bones  in  sbape,  and  are  the 
surest  indications  of  the  entozoon  when  it  is  no  longer  present.  One 
hook  and  a  few  lime  formations  are  sufficient  for  a  diagnosis.  The 
cysticercus  has  similar  but  much  larger  hooks  and  likewise  lime 
deposits. 

The  local  treatment  of  cystitis  in  women. — Dr.  Braxton  Hicks 
communicates  his  views  of  this  subject  to  the  '  British  Medical 
Journal,'  July  lltb,  1874,  and  after  stating  that  he  has  little  faith  in 
drugs  given  by  the  mouth  as  a  direct  means  of  cure,  proceeds  to 
describe  the  local  treatment.  In  this  connection  we  may  mention 
that  we  have  recently  treated  three  or  four  cases  of  cystitis  in 
females  after  an  ocular  inspection  of  the  affected  parts  by  means 
of  simple  instruments  devised  for  the  purpose,  an  account  of  which 
will  shortly  appear  in  the  'British  Medical  Journal.'  Dr.  Hicks  says, 
"  the  first  point  to  make  out  is  whether  the  urine  be  acidulated  or  have 

become  alkaline Supposing  it  is  alkaline  and  ammoniacal, 

then  proceed  in  this  way.  Take  a  well-oiled  gum-elastic  catheter 
open  at  its  end,  and  pass  it  gently  into  the  bladder.  Draw  off  the 
urine,  but  be  careful  only  just  to  enter  the  bladder,  and  when  the 
bladder  is  on  the  point  of  being  emptied,  withdraw  the  catheter  just 
without  the  neck.  This  prevents  the  mucous  membrane  from  flap- 
ping down  on  its  end.  Then  inject  warm  water  slightly  acidulated  with 
either  nitric,  hydrochloric,  or  acetic  acid  (vinegar  does  very  well) ; 
if  nitric  or  hydrochloric  acid  be  used,  two  drops  of  the  strong 
solution  to  one  ounce  of  water  suffice.  Directly  the  patient  com- 
plains of  a  desire  to  micturate,  let  it  flow  out.  Bepeat  injection 
till  the  bladder  seems  clear  of  phosphates  and  mucus.  About 
half  a  pint  of  the  acidulated  water  will  generally  suffice.  Then  in- 
ject one  grain  of  morphia  dissolved  in  one  ounce  of  water, 
withdraw  the  catheter  quickly,  and  tell  the  patient  to  retain  the 
injection  as  long  as  possible.  It  is  a  very  rare  instance  if  this 
single  application  do  not  produce  very  marked  benefit.  In  very 
acute  cases  the  introduction  of  the  catheter  requires  tenderness 
and  care,  because  of  the  great  sensitiveness  of  the  urethra  and  lower 
bladder.  By  only  introducing  the  catheter  just  within  the  bladder, 
much  pain  is  saved.  The  exact  distance  can,  at  the  first  passing,  be 
marked  on  the  instrument.  To  avoid  the  contact  of  the  instrument 
with  the  vesical  coats,  Dr.  Hicks  always  injects  without  entering 
the  bladder,  and  if  the  injections  are  to  be  withdrawn,  then  the 
instrument  can  be  made  to  enter,  but  only  so  far  as  necessary  to 
allow  the  fluid  to  flow  out.  As  the  urine  must  be  drawn  off  at  least 
twice  daily,  the  treatment  should  be  repeated  if  the  case  be  severe 
the  same  number  of  times. 

It  is  undesirable  to  pass  the  instrument  more  frequently  than 
absolutely  needful  on  account  of  the  urethral  irritation  produced  by 
catheterisation ;  but  frequent  micturition,  itself,  causes  soreness  or 
abrasion  of  the  urethra,  so  that  if  we  succeed  in  mitigating  the 
frequency  of  urination  we  shall  compensate  for  this,  and  this  is 
effected  by  the  treatment  described.  If  the  urine  be  not  strongly 
alkaline  a  simple  morphia  injection  may  do,  but  by  first  washing  out 
the  bladder  with  warm  water  or  warm  solution  of  Pot.  Permang. 


1875.] 


Report  on  Surgery.  231 


three  times  as  strong  as  that  generally  used,  the  cure  is  much 
expedited.  After  some  days  of  this  treatment  try  a  three  to  four 
grain  solution  of  Pot.  Chloratis  ;  use  plenty,  draw  it  off  and  inject 
the  morphia,  the  dose  of  which  must  be  regulated  according  to  the 
constitutional  effect  produced.  Dr.  H.  has  never  seen  any  un- 
pleasant symptoms  from  two  grains,  but  if  blood  appear  in  the 
urine  it  is  a  sign  of  some  abrasion,  and  in  such  case  the  morphia  is 
more  likely  to  become  absorbed.  "  The  more  we  use,  without  affect- 
ing the  system  much,  the  better ;  locally  subduing  the  nerve  irrita- 
tion and  the  tenesmus  of  the  bladder,  and  the  crushing  of  the 
mucous  membrane  which  the  contraction  produces. 

As  the  acute  symptoms  subside  use  more  astringent  washes,  such 
as  two  to  three  grains  of  tannin  in  one  ounce  of  warm  water,  or 
three  or  four  drops  of  solution  of  JPerri  Perchlor.,  using  morphia 
immediately  afterwards.  If  the  urethra  be  very  tender,  omit  all 
treatment  for  a  day  or  two,  and  if,  after  a  fortnight,  the  main 
symptoms  be  subdued,  but  the  urethra  very  tender,  apply  an 
astringent  directly  to  it.  This  may  be  done  by  introducing  a  bougie 
or  catheter,  covered  with  tannin,  made  very  smooth,  and  dipped  in 
gum-water,  or  a  probe  on  which  a  film  of  Arg.  Nit.  has  been  fused. 
Pain,  of  course,  succeeds,  but  on  its  subsidence  patients  are  much 
relieved.  This  urethral  treatment  must  be  avoided  in  the  acute 
forms  of  cystitis  unless  there  be  much  irritation  of  the  passage. 
Later  on  other  remedies  may  be  tried,  such  as  fused  anhydrous 
Zinci  Sulph.,  or  mopping  the  urethra  with  solution  of  Ferri  Perchlor. 

"When  cystitis  has  become  chronic  the  injection  of  a  solution  of 
Arg.  Nit.,  five  grains  to  ten,  or  even  fifteen  to  the  ounce,  is  of  much 
service.  The  latter  strength  caused  severe  pain  for  a  short  time, 
but  much  relief  followed.  Two  grains  of  morphia  must  afterwards 
be  left  in.  This  treatment  may  be  repeated  a  week  later,  and  instead 
of  the  silver,  Perri  Perchlor.,  ten  minims  to  the  ounce,  may  be  used. 
In  the  chronic  stage  it  is  well  to  intermit  the  treatment,  to  see  how 
far  the  local  interference  may  be  keeping  up  the  irritation.  In  the 
acute  stages  the  warm  hip-bath  and  warm  sponges  to  the  genitals 
are  not  to  be  omitted,  and  general  treatment  must  be  attended  to. 

This  method  of  treatment  is  very  beneficial  in  cases  of  paralysis  ; 
and  in  malignant  disease  the  simple  injection  of  acidulated  warm 
water  gives  amazing  comfort,  removing  the  phosphates  and  ammonia, 
and  when  to  this  is  added  the  morphia  a  wonderful  comfort  is  felt. 
So  much  relief  is  felt  that  the  presence  of  a  large  calculus  in  the 
bladder  is  almost  entirely  unfelt  if  morphia  be  daily  injected. 

Irritability  commonly  exists  for  a  considerable  period  after 
cystitis  has  lasted  some  time.  This  is  much  lessened  by  occasional 
morphia  injections ;  but  when  it  is  due  to  the  contracted  state  of  the 
bladder,  which  cannot  be  quite  overcome  by  the  will,  the  patient  should 
be  instructed  to  try  and  hold  her  urine,  because  such  exercise  in- 
creases the  power  of  the  sphincter,  and  consequently  the  capacity  of 
the  bladder.  In  such  cases  we  may  often  succeed  by  gently  dis- 
tending the  bladder  with  warm  water  and  repeating  this  treatment 
till  the  capacity  and  tone  of  the  bladder  and  sphincter  are  increased. 

Erhdometritis  cured  hy  the  continuous  galvanic   current. — Dr.  T. 


232  Chronicle  of  Medical  Bcience,  l^^^Ji 

Clark,  of  Bristol  ('Brit.  Med.  Jour.,'  Feb.  27tli,  1875),  relates  the 
following  case  : — S.  H — ,  jet.  39,  married  and  had  four  children.  After 
her  fourth  confinement  she  suffered  severel}^  from  leucorrhoea,beariDg- 
down  pains,  tenderness  in  left  iliac  region,  and  dysmenorrhoea.  This 
lasted  six  months,  when  she  was  able  to  go  about  the  house.  On 
examination,  the  fundus  uteri  was  found  lying  obliquely  and  to  the 
left,  the  OS  uteri  patulous  and  superficially  ulcerated  ;  and  during  the 
introduction  of  the  fluid  a  porter-coloured  very  offensive  fluid  flowed 
from  the  OS.  Under  the  local  use  of  Arg.  Nit.,  and  the  internal  use 
of  Pot.  Bromide,  iron  and  sambul,  with  rest,  she  became  very  much 
better,  and  reported  herself  well.  In  the  November  following  she 
caught  a  severe  cold  and  all  the  symptoms  returned.  She  was  now 
confined  to  her  bed  and  no  treatment  seemed  of  use.  She  was 
ordered  away,  and  to  continue  the  iron  and  Pot.  Bromid.,  and  Arg. 
nit.  was  applied  at  intervals  of  a  week.  In  August  of  the  ensuing 
year  Dr.  Clark  introduced  a  partly  insulated  wire  into  the  uterine 
cavity,  and  attached  it  to  the  negative  pole ;  the  positive  was  con- 
nected with  a  moistened  sponge  and  applied  over  the  pubes  for  20 
minutes.  This  was  repeated  three  days,  after  which  treatment  the 
offensive  discharge  ceased  and  never  returned,  thus  effecting  that 
for  which  this  method  [was  undertaken,  viz.  altering  the  secreting 
property  of  the  uterine  mucous  membrane.  It  was  some  months 
after  that  the  hysterical  condition  subsided,  but  now,  two  years 
after,  she  is  and  has  been  perfectly  well  and  is  able  to  perform  all 
her  usual  household  duties. 

Three  cases  of  successful  removal  of  fibro-cysiic  tumours  of  the 
uterus. — Dr.  Thomas  Keith,  of  Edinburgh,  relates  the  history  of  2 
of  these  cases  in  the  'Lancet,'  of  May  15th  of  this  year,  and  his 
account  will  deeply  interest  gynaekological  surgeons.  We  need 
not  occupy  space  by  giving  the  cases,  as  no  doubt  they  are  now  fami- 
liar to  all  interested,  but  will  just  remention  one  or  two  points  of 
interest  which  occur  in  the  course  of  their  narration,  and  conclude 
with  Dr.  Keith's  remarks.  Attention  is  drawn,  in  describing  the 
first  case,  to  a  paper  by  Dr.  Foulis  in  the  Pebruary,  1875,  number  of 
the  '  Edin.  Med.  Jour.,'  which  tends  to  show  that  secondary  epi- 
thelial growths  on  the  peritoneum  may  originate  from  escaped 
epithelium  elements  from  burst  cysts  (simple  ?  or  originally  carci- 
nomatous ?)  and  set  up  exhaustive  peritonitis.  The  stump  in  this 
case  was  too  large  for  any  clamp  and  after  the  bladder  was  freed 
downwards,  a  steel  wire  was  secured  round  the  lowest  part  of  the 
uterine  neck,  just  above  the  vagina,  by  Koeberle's  instrument.  The 
healthy  right  ovary  was  not  removed,  but  the  tumour  was  cut  away 
and  the  cavity  of  the  uterus  was  opened  and  found  to  contain  a 
small  polypus.  The  wound  was  closed  tightly  round  the  neck,  a 
strong  soft  needle  bent  in  the  middle  securing  the  whole  outside. 
The  growth  weighed  eleven  pounds. 

The  tumour  in  Case  2  was  dusky  brown  and  covered  by  enormous 
veins.  It  was  attached  to  the  right  iliac  fossa,  right  lumbar  region, 
and  partly  to  the  abdominal  wall.  The  hand  could  not  be  passed 
into  the  pelvis  below  the  tumour.     More  than  sixty  ounces  of  dirty 


1875.] 


Report  on  Surgery,  233 


nmddisU  serum  were  removed  from  the  large  cyst  without  much 
diminishing  the  size.  The  hand  was  then  passed  behind,  and  with 
one  strong  sweep  of  the  arm  all  adhesions  were  brol^en  up,  the  inci- 
sion enlarged,  and  the  tumour  turned  out  of  the  abdomen  with  the 
left  ovary.  In  a  few  minutes  the  patient  became  faint  from  rapid 
loss  of  blood.  The  pedicle,  i.e.  the  neck  of  uterus,  was  treated  as 
in  the  former  case.  The  broad  ligaments  were  very  vascular,  but 
only  the  left  ovary  was  included  in  the  ligature.  From  the  previous 
elevation  of  the  cervix  the  stump  was  secured  in  the  lower  angle 
of  the  wound  with  less  tension  than  in  the  previous  case.  Several 
bleeding  points  high  up  near  the  posterior  margin  of  the  liver,  where 
the  adhesions  commenced,  were  secured  with  much  difficulty.  The 
first  part  of  the  operation  occupied  only  a  few  minutes,  but  it  was 
upwards  of  two  hours  ere  the  wound  was  closed.  A  glass  drainage 
tube  was  left,  passing  down  to  the  lowest  point  in  the  pelvis.  The 
patient  was  pulseless  when  placed  in  bed,  and  the  pulsation  did  not 
return  in  the  left  radial  for  upwards  of  half  an  hour.  The  canal  of 
lymph,  which  after  a  few  days  forms  round  the  drainage  tube, 
seemed  to  have  led  to  the  adbesion  of  folds  of  intestine  at  angles, 
and  thus  became  the  occasion  of  much  distress  and  of  no  small 
danger  to  the  patient.  As  in  the  previous  case,  the  slough  extended 
beyond  the  wire,  and  a  very  large  cavity  was  left  on  its  separation, 
which  had  quite  cicatrized  in  five  weeks. 

In  the  first  of  these  cases  there  was  a  mistake  in  diagnosis,  the 
only  one  in  194  operations,  as  hitherto  Dr.  Keith  has  had  the  good 
fortune  to  avoid  cases  of  soft  fibrous  or  fibro-cystic  tumours  of  the 
uterus,  but  as  such  a  mistake  in  diagnosis  may  occur  to  any  one.  Dr. 
K.  never  goes  to  perform  ovariotomy  without  being  prepared  to 
remove  the  uterus  if  necessary.  In  this  case,  fortunately,  the 
surgical  treatment  required  was  the  same,  as  large  fibro-cystic 
tumours  of  the  uterus  often  kill  as  rapidly  as  do  ovarian  tumours. 

These  are  the  only  cases  in  which  Dr.  Keith  has  interfered  with 
uterine  tumours  by  abdominal  section,  and  they  are  enough  to  satisfy 
him  that  the  removal  of  an  enlarged  uterus  and  ovaries  is  an  opera- 
tion not  to  be  lightly  undertaken.  The  personal  attention  afterwards 
necessary  was,  in  each  case,  greater  than  in  six  average  cases  of 
ovariotomy  ;  while  in  the  third  case  there  was  such  profuse  secondary 
haemorrhage  seven  days  after  the  operation,  that  had  not  Dr.  Keith,  by 
mere  accident,  been  on  the  spot  almost  immediately  after  the  alarm 
was  given,  the  patient  must  have  died  in  a  few  minutes. 

Dr.  Keith  deprecates  the  removal,  by  abdominal  section,  of  uterine 
growths,  even  those  that  are  pediculated  and  surgically  very  tempt- 
ing, as  our  experience  has  not  been  encouraging,  and  also  because 
the  greater  part  of  uterine  tumours,  if  not  malignant,  give  little 
trouble ;  yet  there  are  a  certain  number  of  cases  in  which  the  patients 
lead  useless,  dependent,  miserable  lives,  full  of  sufi'ering  which  ends 
only  with  life,  and  it  is  for  this  class  of  case  that  he  expresses  the 
hope  that  the  time  is  not  far  distant  when  many  of  these  unfortunates 
will  look  to  surgery  for  relief  with  as  much  confidence  as  those 
afflicted  with  ovarian  disease  now  do. 


234t  Chronicle  of  Medical  Science,  [July, 

EEPOET   ON   TOXICOLOGY,  FORENSIC  MEDICINE, 

AND   HYGIENE. 

By  Benjamin  W.  Eichabdson,  M.D.,  E.E.S. 


1.  Toxicology. 

On  poisoning  hy  the  smoke  of  tobacco. — The  subjoined  is  the  record 
of  a  case  in  which  death  was  induced  by  the  excessive  smoking 
of  tobacco.  The  facts  came  under  our  own  observation.  The  patient, 
who  was  between  thirty  and  forty  years  of  age,  was  a  small  but  well- 
built  man,  of  very  active  habits,  and  reported  to  be  exceedingly  dili- 
gent  and  able  in  commercial  pursuits.  Previous  to  the  occurrence 
about  to  be  narrated  he  had  been  very  much  worried  with  business 
aiFairs,  and  had,  no  doubt,  been  trying  to  carry  out  labours  which, 
if  not  beyond  his  own  natural  powers,  at  all  events  taxed  them 
severely.  He  returned  from  business  in  the  city  of  London  one 
evening  extremely  fatigued,  took  a  very  slight  meal,  smoked  several 
cigars  and  cigarettes — the  precise  number  being  unknown — and 
retired  to  bed.  During  the  night  he  was  heard  moving  about  as  if 
restless,  and  early  the  next  morning  he  rose  to  work.  He  dictated 
some  letters  and  other  documents  to  his  private  secretary,  and, 
declining  all  food,  recommenced  to  smoke  a  cigar.  He  continued 
this  process  of  smoking  and  dictating  during  the  greater  portion 
of  the  day,  taking  no  food  and,  except  a  small  quantity  of  brandy 
and  water,  no  drink.  In  a  period  of  less  than  twelve  hours  he  had 
smoked  forty  cigarettes  and  fourteen  full-sized,  full-flavoured  cigars. 
As  the  evening  advanced  he  became  prostrate,  excited,  and  restless, 
refusing  food  and  only  sipping  at  drinks.  Late  at  night  he  still 
refused  to  take  either  nourishment  or  medicine.  He  agreed,  however, 
to  give  up  smoking,  and  he  went  to  bed  and  essayed  for  a  few 
hours  to  sleep :  he  could  not  sleep,  but  continued  excited  and 
restless. 

Early  on  the  following  morning  he  came  for  the  first  time  under 
the  observation  of  the  reporter.  He  was  at  this  time  half  dressed 
and  out  of  bed.  He  was  in  a  state  of  continuous  muscular  tremor, 
and  when  he  moved  across  the  room  to  reach  his  bed  his  legs 
seemed  bent  or  bowed  as  if  he  were  permanently  deformed,  which, 
however,  was  not  the  fact.  He  had  evidently  lost  the  full  use 
of  the  muscles  of  the  lower  extremities,  and  he  climbed  into  bed 
with  considerable  difficulty.  When  he  reclined  in  the  bed  a  con- 
tinued movement  of  the  muscles  of  the  arms  and  legs  was  kept 
up,  and  the  facial  muscles  moved  occasionally  in  an  involuntary 
manner.  The  pupils  were  widely  dilated  and  the  eyelids  were  in 
persistent  movement,  half  voluntary.  The  tongue  was  dry  and  dark 
red  in  colour.  The  surface  of  the  body  was  cool  (96°Fahr.),  clammy, 
and  perspiring.  The  speech  was  faltering  and  the  mind  uncertain. 
The  pulse  was  soft,  full,  and  feeble.  Both  sounds  of  the  heart  were 
clear,  but  the  action  was  relaxed  and  occasionally  intermittent. 
The  respiratory  sounds,  at  this  period,  were  clear,  but  the  respiratory 


1875.]      Report  on  Toxicology ^  Forensic  Medicine ^  ^c,       235 

movements  were  irregular  aud  sighing.  The  breath  and  the  cuta- 
neous secretion  were  oppressively  charged  with  the  odour  of  tobacco. 

There  being  no  direct  antidote  yet  discovered  for  the  poison  of 
tobacco,  the  treatment  was  directed  to  sustaining  the  powers  of  the 
patient  and  to  promoting  the  elimination  of  the  poison.  Of  course 
all  farther  resort  to  the  cigars  and  cigarettes  was  forbidden,  and 
fluid  nourishment  was  ordered  as  freely  as  it  could  be  given,  together 
with  small  quantities  of  alcohol ;  it  was  directed  that  the  temperature 
of  the  room  should  be  sustained  at  70°  Fahr.,  with  free  ventilation  ; 
and  in  order  to  sustain  the  process  of  elimination  full  doses  of  the 
solution  of  acetate  of  ammonia  were  administered  every  four  hours. 
It  was  also  carefully  observed  that  the  urinary  bladder  was  kept 
free  of  distention  from  urine,  a  practical  point  of  great  importance 
in  the  treatment  of  all  forms  of  narcotic  poisoning. 

The  food  and  medicine  prescribed  for  the  patient  were  much 
objected  to  by  him,  his  mind  being  entirely  listless  and  every  exertion 
seeming  to  be  a  source  of  annoyance.  Still,  he  took  and  retained 
some  food,  and  under  its  influence  became  warmer.  But  as  the  day 
advanced  he  gradually  grew  more  and  more  unconscious,  the 
muscular  paralysis  increased,  extending  from  the  lower  limbs  to  the 
arms  ;  every  now  and  then  there  occurred  a  faint  general  convulsion, 
and  the  breathing  became  noisy  and  embarrassed.  In  the  evening 
the  patient  was  quite  unconscious ;  his  bronchial  passages  were 
filling  with  condensed  watery  fluid ;  he  was  unusually  cold ;  there 
were  constant  jactitating  movements  of  the  muscles,  and  the  collapse 
was  complete.  Death  took  place  a  short  time  after  this  change.  A 
post-mortem  examination  could  not  be  obtained,  but  the  final  mode 
of  death  was  evidently  by  asphyxia  from  the  accumulation  of  fluid 
in  the  pulmonary  bronchial  tract. 

"We  have  not  unfrequently  observed  in  confirmed  smokers  a  series 
of  symptoms  identical  with  those  recorded  above,  except  in  the 
matter  of  severity  and  in  immediate  result.  The  symptoms  tally,  in 
the  main,  also  with  those  we  have  seen  induced  in  the  lower  animals 
by  the  action  of  nicotine,  and  they  were,  we  believe,  due  entirely 
to  the  poisonous  influence  of  that  alkaloid.  The  action  was  dis- 
tinctive ;  all  the  mus(;les  that  are  under  the  involuntary  nervous 
control  were  paralysed  ;  the  semi-voluntary  muscles  were  partly 
paralysed  ;  and  the  centres  governing  the  volitional  powers  were  so 
distended  that  their  functions  were  perverted.  Together  with  these 
changes  there  was  a  reduction  of  the  animal  temperature  owing  to 
an  interference  with  the  chemical  changes  of  the  body,  and  there- 
upon the  final  catastrophe  succeeded  of  condensation  of  fluids  in  the 
pulmonary  organs,  a  catastrophe  common  as  a  direct  cause  of  death 
in  those  who  are  under  the  effects  of  other  narcotic  poisons  than 
nicotine,  as,  for  instance,  chloral  hydrate. 

The  great  question  that  remains  to  be  solved  is  the  treatment  of 
cases  such  as  the  one  described.  In  a  case  of  poisoning  by  tobacco, 
in  a  boy  who  smoked  aud  chewed  tobacco  for  the  first  time,  we  found 
an  emetic  of  signal  service  as  an  adjunct  to  treatment  by  the  em- 
ployment of  external  heat  and  the  administration  of  a  stimulant. 


236  Chronicle  of  Medical  Science,  [July, 

But  in  the  treatment  of  a  confirmed  smoker  an  emetic  would  only 
depress  the  more,  the  stomach  being  in  fact  paralysed  by  the  action 
of  the  poison.  We  have  previously  found  the  general  plan  that  was 
adopted  in  the  instance  narrated — that,  namely,  of  sustaining  the 
external  temperature  of  the  body,  promoting  free  elimination  by  the 
skin,  keeping  the  urinary  bladder  properly  relieved,  and  adminstering 
food  with  a  judicious  supply  of  alcohol — a  perfectly  successful  method. 
On  the  present  occasion  all  these  measures  proved  unsuccessful,  and 
would,  we  believe,  be  again  unsuccessful  in  so  extreme  a  case.  It 
has  occurred  to  us  since  that  perhaps  transfusion  of  blood  might 
have  saved  the  life,  and  in  another  emergency  of  a  similar  kind, 
we  should  propose  to  give  it  a  trial. — Original  Report  to  Brit,  and 
Foreign  Med.-Chir.  Rev.,  July,  1875. 

Researches  on  strychnia. — Dr.  D.  Yitali  indicates  that  the  most 
brilliant  reaction  of  strychnia  is  that  which  results  from  its  treat- 
ment with  oxidizing  agents.  A  minimum  quantity  of  the  alkaloid 
dissolved  in  concentrated  sulphuric  acid  with  the  addition  of  a 
small  proportion  of  bichromate  of  potassa,  of  binoxide  of  lead,  of 
peroxide  of  manganese,  of  ferro-cyanide  of  potassium,  or  of  per- 
manganate of  potassa,  evolves  the  magnificent  blue-violet  color, 
which  after  a  time  changes  into  a  red  wine  tint,  and  then  turns  to  a 
reddish  yellow.  Among  these  oxydizing  substances  the  bichromate 
and  permanganate  of  potassa  distinguish  themselves  by  the  readiness 
with  which  they  produce  this  reaction.  Not  long  since  Wenzel 
suggested  a  new  method  of  rendering  the  same  test  still  more 
sensitive  and  certain.  By  adopting  the  modification  proposed  by 
him  strychnia  may  be  discovered  in  a  liq^uid  more  than  nine  times 
diluted.  For  this  purpose  he  advises  the  use  of  permanganate  of 
potassa  dissolved  in  sulphuric  acid  in  the  proportion  of  one  part  of 
the  permanganate  in  two  hundred  of  the  acid.  A  few  drops  of  this 
liquid  produce  instantly,  incalculable  minute  traces  of  strychnia,  by 
the  above-mentioned  colorations. 

As  regards  the  readiness  and  rapidity  of  the  reaction  obtained  by 
this  modification  no  doubt  can  be  raised.  But  Yitali  considers  it 
ought  to  be  noted  that  its  author,  when  announcing  it,  passed  over 
one  circumstance  in  silence  which  should  be  remembered  as  of  the 
highest  importance.  "Wenzel  does  not  tell  us  whether  the  strychnia 
or  the  substance  suspected  of  containing  strychnia  ought  to  be 
found  in  the  solid  state  in  order  to  be  well  assured  of  the  ri'sult. 
Hence,  wishing  to  judge  from  the  underlined  words  above  referred 
to,  it  would  appear  that  it  was  at  least  indifferent.  That  is  not  the 
fact,  since,  passing  lightly  over  that  condition,  the  risk  might  be 
run  of  believing  in  the  presence  of  strychnia,  when  in  reality,  in  the 
liquid  under  examination,  there  does  not  exist  the  slightest  trace. 
This  is  the  reason.  The  solution  of  the  permanganate  in  the  con- 
centrated sulphuric  acid  is  of  a  green  colour.  But  when  it  is  diluted 
with  water  this  coloration  disappears  to  give  place  immediately  to  a 
vivid  violet  tint,  which  might  be  thought  to  proceed  from  strychnia 
even  when  that  may  not  be  the  case. 

Wishing  to  explain  how  it  happens  that  the  sulphuric  solution  of 


1875.]        Report  on  Toxicology,  Forensic  Medicine ,  ^c.       237 

permanganate  of  potassa,  green  in  itself,  becomes  of  a  violet  colour 
in  the  presence  of  water,  Vitali  says  first  of  all  that  the  sulphuric 
acid,  reacting  upon  the  permanganate,  would  render  the  permanganic 
acid  free  from  it  according  to  the  equation — 

But  the  permanganic  acid,  being  unable  to  exist  in  the  presence 
of  an  excess  of  concentrated  sulphuric  acid,  a  body  greedy  of  water, 
changes  itself  into  permanganic  anhydride,  which  is  the  cause  of  the 
green  colour  of  the  liquid.     In  fact, 

„/Mn03")p.\      H|^      MnOg-)^ 
^(     H     i^)-HJ^=Mn03J^ 

The  permanganic  anhydride,  then,  when  water  is  added  to  the 
sulphuric  solution,  changes  itself  into  permanganic  acid,  the  forma- 
tion of  which  is  the  cause  of  the  change  of  the  green  tint  into  a 
violet  tint. 


^iiOg")  ^  ,   H")  ^^  /MuO,  f  ,, 


He  considers  the  publication  of  the  present  note  useful  in  order 
to  prevent  any  sinister  equivocation  into  which  an  inexperienced 
person  might  possibly  be  led,  who,  having  recourse  to  Wenzel's 
method  of  reaction,  might  not  have  calculated  on  the  precautions 
suggested  in  it. — Dioscoride  Vitali.  Annali  di  chimica,  No.  3. 
Eascicolo  di  Marzo,  1875. 

Oxygen  as  an  antidote  to  phospliorus. — Professor  Thiernesse  and 
Dr.  Casse  make  mention  of  a  proposition  made  by  E-ommelaere  of 
using  the  essential  oil  of  turpentine  as  an  antidote  for  phosphorus. 
At  the  meeting  of  the  25th  of  April,  1875,  of  the  Eoyal  Academy 
of  Medicine,  this  proposition  was  under  discussion.  The  experi- 
ments of  Vigier  and  Currie,  reported  by  Currie,  should  have 
demonstrated  that  it  is  not  the  purified  essential  oil  of  turpentine 
which  exhibits  an  antidotal  virtue  against  phosphorus,  but  really 
the  oxygenated  essential  oil  of  turpentine,  because  the  former  will 
not  combine  with  the  phosphorus,  whereas  the  latter  will  produce 
a  combination  which,  even  in  not  very  large  doses,  robs  the  phos- 
phorus of  every  poisonous  effect. 

It  is  the  oxygen  presented  in  the  ozonic  state  by  the  essence  of 
turpentine  which  exerts  the  oxydizing  action  upon  the  phosphorous 
poison.  This  is  confirmed  by  the  results  obtained  by  Crocq  upon 
animals  poisoned  by  phosphorus,  in  which  the  blood  manifested 
itself  as  in  a  pitchy  state,  and  reacquired  its  normal  properties  under 
the  action  of  oxygen  or  of  oxygenated  water. 

The  following  results  reported  to  the  Belgian  Academy  of  Medicine 
were  obtained  from  twenty-two"  experiments  with  oxygen  upon  ani- 
mals.    They  indicate  that  oxygen  is  really  endowed  with  an  anti- 


2^8  Chronicle  of  Medical  Science,  [July, 

dotal  power,  as  regards  phosphorus  introduced  into  the  circulation  : 
it  neutralizes  the  pernicious  eifects  of  the  phosphorus  in  the 
blood  as  well  as  in  the  organs  which  ordinarily  undergo  serious 
mischief  from  the  presence  of  the  poison. 

In  order  to  obtain  the  desired  end,  it  is  necessary,  however,  to 
infuse  the  oxygen  in  large  quantity,  and  shortly  after  the  absorp- 
tion of  the  poison,  that  is,  before  the  poison  has  produced  serious 
changes  in  the  organism,  for  when  the  phosphorus  has  deoxydized 
and  put  to  death  the  blood-globules  the  poisoned  animal  is  fatally 
doomed.  This  is  the  reason,  in  many  cases,  why  the  poisoned  sub- 
ject cannot  be  saved  even  when  injected  with  defibrinated  blood 
charged  with  oxygen. 

Out  of  twenty- two  experiments  nineteen  gave  favorable  results 
when  the  poisoned  animal  could  be  injected  with  a  sufficient  quantity 
of  oxygen.  The  three  unsuccessful  results  may  be  explained  by 
the  circumstances,  either  that  the  poison  was  injected  in  the  form 
of  phosphorous  oil  in  too  large  doses  (viz.  10  grammes  of  oil,  con- 
taining 20  centigrammes  of  phosphorus,  into  a  dog  weighing  10 j 
kilogrammes),  or  that  the  quantity  of  oxygen  infused  was  too  weak. 

The  doses  of  phosphorus  employed  were  generally  from  16  to 
20  milligrammes,  at  least,  for  every  kilogramme  of  the  weight  of  the 
animals',  and  in  the  larger  number  of  the  cases  in  which  the  results 
were  favorable  the  phosphorus  had  been  administered  under  the 
form  of  a  yolk-of -egg  emulsion,  which  ought  certainly  to  have  aided 
in  the  absorption  of  it. 

The  experiments  performed  are  all  in  favour  of  the  intravenous 
infusion  of  the  oxygen  against  poisoning  by  phosphorus,  even  when 
used  in  large  doses  and  associated  with  materials  which  facilitate  its 
poisonous  action. 

Professor  Melsens,  invited  by  Professor  Thiernesse,  confirms  the 
opinion  that  it  is  not  the  essence  of  turpentine,  but  the  oxygen  it 
contains,  which  is  the  real  agent  endowed  with  the  antidotal  pro- 
perty  against  phosphorus ;  that  oxydized  essence  of  turpentine 
possesses  the  property  of  burning  and  oxydizing  many  substances, 
mineral  as  well  as  organic,  which  oxygen  does  not  ordinarily  attack  ; 
that  it  acts  after  the  manner  of  ozone ;  that  it  transforms,  even  at 
a  distance  from  the  air,  arsenic  into  arsenic  acid  and  phosphorus 
into  phosphoric  acid ;  that  it  attacks  divided  silver,  converting  it 
into  acetate  of  silver  in  the  presence  of  acetic  acid.  Its  powerful 
oxydizing  properties  display  themselves  perfectly  on  a  sulphuric 
solution  of  indigo;  it  discolours  this  in  the  same'way  as  doee  chlorine. 
Phosphorus,  burned  by  the  active  oxygen  of  the  essence,  is 
changed  into  phosphoric  acids,  which  are  in  fact  inofiensive  bodies 
in  comparison  with  the  corresponding  quantity  of  poisonous  phos- 
phorus. ^Annali  di  Chimica,  fascicolo  No.  5,  Maggio,  1875. 
Bulletin  de  VAcademie  Boyale  de  Mid.  de  Belgique,  t.  ix,  3rd 
serie,  No.  1.] 

On  poisoning  hjj  aconite  and  chloroform. — Dr.  John  Ellis  Blake 
reports  a  very  important  and  rare  case  of  poisoning  by  a  mixture  of 
aconite  and  chloroform.  A  young  lady  who  was  on  a  visit  at  New  York 


1875.]      Report  on  Toxicology ,  Forensic  Medicine ,  ^c,         239 

took  by  mistake  something  more  than  one  drachm  of  a  mixture  con- 
taining equal  parts  of  tincture  of  aconite-root  and  chloroform. 
Her  own  carelessness  must  be  held  solely  to  blame  for  mistaking 
the  bottle  containing  the  poison  for  another  which  held  the  simple 
medicine  she  intended  to  take ;  for  the  one  containing  the  poison 
was  plainly  marked  "  aconite  and  chloroform,"  "poison,"  "liniment." 
The  mistake  was  made  about  half-past  eleven  o'clock  a.m.  on  Feb- 
ruary 2nd,  1875.  The  burning  taste  of  the  chloroform  caused  the 
error  to  be  detected  at  once.  The  patient  herself  immediately  took 
a  potion  of  mustard  and  water,  and  then,  accompanied  by  a  friend, 
walked  to  Dr.  Blake's  house,  a  distance  of  one  eighth  of  a  mile. 
Allowing  five  minutes  for  this  walk,  it  is  assumed  that  the  patient 
was  before  Dr.  Blake  in  from  fifteen  to  twenty  minutes  after  she  had 
swallowed  the  poisons. 

So  soon  as  the  recital  of  the  accident  had  been  given,  the  author 
administered  a  full  emetic  dose  (from  fifteen  to  twenty  grains)  of 
sulphate  of  zinc.  No  vomiting  followed  U23on  this,  so  the  stomach- 
pump  was  used,  and  nearly  two  quarts  of  water  were  passed  through 
the  stomach.  The  water  returned  smelling  strongly  of  chloroform 
and  coloured  by  the  tincture  of  aconite.  Much  of  the  aconite  was 
removed  by  the  pump,  but  sufficient  had  been  absorbed  to  produce 
effect.  Numbness  of  the  cheeks  and  tongue  began  to  be  perceived 
before  the  operation  of  evacuation  of  the  stomach  was  finished,  and 
this  numbness  rapidly  extended  over  the  shoulders  and  back  and 
down  the  arms.  Some  stimulants  which  the  patient  was  able  to 
swallow  were  administered,  but  soon  afterwards  embarrassment  of 
the  respiration  was  manifested,  and  the  patient,  articulating  with 
great  difficulty  the  words,  "  All  is  dark  now,  doctor,  I  cannot  see  at 
all,"  at  once  became  unconscious.  Dr.  Blake  observes  specially  on 
the  rapidity  with  which  the  poison,  once  commencing  to  act,  over- 
whelmed life.  Within  an  hour  her  breathing  became  imperceptible, 
she  was  growing  cold,  and  she  was  pulseless.  No  pulse  whatever 
could  he  detected  even  in  the  aocilla,  and  she  remained  without  any  trace 
of  pulse  for  a  period  of  over  three  hours^  The  treatment  now  pur- 
sued was  to  keep  the  head  low  and  to  maintain  artificial  respiration. 
The  artificial  respiration  was  kept  up  by  Earadic  electricity,  passed 
in  powerful  currents  through  the  muscles  of  respiration.  One 
electrode  was  applied  on  the  right  side  of  the  neck,  the  other  "  near 
the  diaphragm  over  the  solar  plexus."  A  deep  inspiration  followed, 
and  by  breaking  and  closing  the  current  about  eighteen  or  twenty 
times  a  minute  the  action  of  natural  breathing  could  be  imitated.  The 
current  used  was  very  strong,  strong  enough  at  each  application  to 
twist  the  neck  and  body  to  one  side,  yet  it  utterly  failed  at  one  time, 
during  the  first  hour  to  excite  respiratory  action,  and  Dr.  Blake,  who 
was  now^  ably  and  devotedly  assisted  by  Dr.  T.  (iaillard  Thomas,  was 
obliged  to  resort  to  Marshall  Hall's  "  ready  method  "  of  artificial  re- 
spiration, happily  with  success.  By  these  means  respiration  was  sus- 
tained for  several  hours,  but  there  were  periods  when  it  was  more 
difficult  than  at  other  periods  to  maintain  it,  "  The  lethal  influence/* 
the  author  remarks,  "  which  was  benumbing  the  nervous  system, 


240  Chronicle  of  Medical  Science.  [July, 

although  never  seceding  entirely,  yet  at  varying  intervals  came 
rolling  in  upon  this  young  life,  as  it  were,  in  a  great  wave,  and  at 
some  times  it  was  hard  to  say  if  that  life  had  not  been  utterly 
overwhelmed."  It  was  observed  also  that  in  order  to  excite 
respiration  the  head  had  to  be  kept  very  low,  the  tendency  to 
syncope  being  great,  and  continuing  even  when  consciousness  had 
returned. 

About  the  end  of  the  first  hour  the  symptoms  were  most  critical. 
The  temperature  of  the  body  within  the  mouth  was  between  95°  and 
96°  Fahr. ;  there  was  cyanosis  of  the  face  and  the  same  symptom 
extended  to  the  nails.  At  this  point  of  the  case  Dr.  Thomas 
suggested  the  administration  of  pure  oxygen  gas  mingled  with 
common  air.  A  cylinder  of  oxygen  was  therefore  procured  and  was 
used  in  the  following  manner.  A  small  india-rubber  tube  was 
connected  with  the  copper  reservoir;  the  other  end  of  the  tube, 
terminated  by  a  small  nozzle,  was  inserted  in  one  nostril,  leaving 
the  other  nostril  free  to  admit  common  air.  A  small  jet  of  gas  being 
now  permitted  to  escape,  on  closing  the  galvanic  circuit  the  lungs 
were  filled  with  this  highly  oxygenated  air.  Keeping  up  artificial 
respiration  with  this  additional  agent,  good  efiiects  were  soon  seen  in 
a  lessening  lividity  of  the  face  and  a  less  corpse-like  look  generally. 
The  amount  of  oxygen  used  was  four  hundred  gallons. 

After  a  periodof  from  three  to  four  hours,  dating  from  the  time  when 
the  pulse  ceased  and  when  nothing  but  a  feeble  and  uncertain  flutter 
could  with  difficulty  be  heard,  at  times,  over  the  region  of  the  heart, 
and  after  artificial  respiration  with  the  oxygen  had  been  maintained 
about  two  hours,  a  feeble  thrill  at  the  wrist  could,  to  the  great  joy 
of  the  operators,  be  detected.  It  was  not  much,  it  was  not  constant, 
but  it  was  sometimes  there,  and  that  was  a  great  source  of  hope. 

By  five  o'clock  in  the  afternoon,  that  is  to  say,  five  hours  and  a 
half  after  the  poison  had  been  taken,  the  patient  was  so  far  restored 
to  consciousness  that  she  could  articulate  a  word  or  two  feebly.  It 
was  believed  now  that  the  battery  might  be  stopped  and  the  natural 
respiration  be  relied  on.  This,  says  the  author,  was  well  nigh  a 
fatal  error.  Before  six  o'clock  a  crisis  of  unusual  severity  occurred, 
and  although  both  the  battery  and  the  oxygen  were  at  once  put 
into  action  there  was  a  time  when  it  was  feared  they  had  failed. 
The  tendency  at  this  period  was  towards  death  by  coma.  The 
patient's  condition  became  as  follows.  There  was  a  strong  tendency 
to  sleep,  which,  if  permitted,  showed  a  sure  and  rapid  tendency  to 
pass  into  a  death-like  coma.  The  pulse  would  grow  more  and  more 
feeble,  and  disappear  altogether.  To  the  numbness  of  the  skin  had 
succeeded  a  state  of  hypersesthesia  of  a  sensitiveness  so  acute  that 
she  could  be  roused  by  a  current  from  the  battery  so  feeble  as  to  be 
almost  imperceptible  to  others,  but  sinking  back  at  once  into  coma 
on  its  discontinuance.  "When  so  roused  she  generally  gave  a  sharp 
scream  and  uttered  some  expression  of  distress.  The  action  of  the 
battery  was  kept  up  constantly  all  night ;  if  discontinued  for  more 
than  ten  minutes  the  pulse  would  flag  and  coma  supervene. 

Dr.  Blake  asks  at  this  point  of  his   narrative,  "  AVheuce  thi^J 


1875.]       Report  on  Toxicology,  Forensic  Medicine^  ^c.        241 

tendency  to  fatal  coma  ?  "  He  considers  that  it  was  indirectly  the 
effect  of  the  aconite  and  chloroform,  but  directly  resulted  from  the 
state  of  the  kidneys  from  paralysis  of  the  excretory  function  of  those 
organs  due  to  the  action  of  the  poisons.  A  specimen  of  the  urine  of 
the  patient  obtained  at  8  p.m.,  showed  that  the  kidneys  had  scarcely 
acted  at  all  during  the  day,  and  the  secretion  was  loaded  with 
albumen  and  with  fragments  of  casts. 

At  five  o'clock  on  the  following  morning,  the  kidneys  having 
resumed  their  activity,  the  sleep  became  natural,  and  the  use  of  the 
battery  was  discontinued  after  it  had  been  in  almost  constant  use 
for  sixteen  hours.  The  specimen  of  urine  at  this  time  obtained  was 
copious  in  amount,  and  was  loaded  as  before  with  albumen  and 
fragments  of  casts,  but  in  time  this  condition  passed  away.  Dr. 
Blake  adds  that  in  the  course  of  treatment  warmth  was  applied  to 
the  surface  of  the  body,  and  that  as  enemata  were  not  retained  he 
injected  hypodermically  thirty  minims  of  cognac  six  times  in  the 
course  of  the  afternoon.  On  February  13th  the  patient  was 
convalescent.  She  ultimately  recovered. — New  York  Medical  Journal 
for  April,  1875,  vol.  xxi,  No.  4.  ^ 

[The  case  here  recorded  by  Dr.  Blake  is,  indeed,  full  of  interest, 
as  illustrating  once  again  what  can  be  effected  by  continuous 
artificial  respiration.  In  the  patient  whose  history  has  been  given, 
the  action  of  the  heart  was  reduced  to  that  lower  tension  of  action 
which  we  have  described  in  the  Croonian  lecture  "On  Muscular 
Irritability  after  Systemic  Death,"  as  the  tension  of  syncope.  The 
heart-stroke  in  such  cases  is  sufficient  to  keep  up  a  feeble  pul- 
monic circuit  and  a  sufficient  systemic  circuit  to  prevent  pectous 
changes ;  but  the  nervous  centres  are  not  effectively  supplied,  and 
the  respiration  therefore  fails  to  be  excited.  In  such  examples,  a 
little  assistance  to  the  respiration  is  a  means  of  maintaining  the 
circulation  of  low  tension  for  a  very  prolonged  period,  and  when 
the  depression  of  the  heart  is  from  an  agent  that  is  susceptible  of 
elimination  from  the  body  under  the  continuance  of  vital  motion, 
the  artificial  respiration  becomes  a  means  of  restoring  life  that  is 
even  startling  in  the  grandeur  of  its  results. 

In  recording  Dr.  Blake's  report,  with  sincere  admiration  of  his 
and  his  colleagues'  courage,  endurance,  and  skill,  we  would  venture 
to  make  an  observation  or  two  derived  from  experimental  and 
clinical  experience  bearing  upon  the  details  of  the  treatment.  We 
think  that  in  another  similar  case,  after  the  stomach  has  been 
emptied,  it  would  be  advisable  not  to  administer  alcohol.  Alcohol 
diluted  assists  to  distribute  the  alkaloidal  poisons  the  more  actively 
through  the  tissues,  and  to  hasten  the  symptoms  of  poisoning  in  all 
their  intensity.  Then  in  respect  to  artificial  respiration,  we  would 
submit  that  in  the  cases  under  consideration,  it  is  better  to  main- 
tain it  by  the  double-acting  bellows,  that  is  to  say,  by  force  supplied 
by  another  person  than  by  the  force  of  the  patient  excited  into 
motion  by  the  electric  stimulus.  We  have  tested  the  two  methods 
by  careful  experiment  on  the  deeply  narcotized  animal,  and,  by 
means  of  the  metronome  regulation  of  the  Taradic  current,  have 

111.— LVI.  16 


342  Chronicle  of  Medical  Science.  [July, 

made  the  respiration  excited  by  the  current  as  regular  as  the 
ordinary  natural  respiration  of  the  animal.  By  this  means,  it  is 
true  that  the  artificial  respiration  can  be  long  sustained,  but  it  is 
at  the  expense  of  the  force  of  the  animal,  and  is,  therefore,  ex- 
hausting to  an  extreme  degree.  When  the  artificial  respiration  is 
sustained  by  the  operator,  it  is  equally  effective  as  an  artificial  aid, 
and  it  relieves  the  patient  of  all  exhaustion.  Between  the  two  pro- 
cesses, there  is,  in  short,  just  the  difference  that  occurs  between 
stimulating  a  worn-out  animal  to  walk  to  a  destination,  and  carrying 
it  to  the  same  destination.  Thus,  in  our  experiments,  we  found  we 
could  even  destroy  muscular  action  by  the  current  through  the 
exhaustion  it  produced,  and  when  we  succeeded  in  restoring  by  it 
it  was  always  with  the  result  of  an  after- debility  and  drowsiness 
which  is  unknown  when  the  simple  hand  method  is  employed. 
Once  in  Dr.  Blake's  case,  at  the  period  when  he  and  his  learned 
colleague  had  to  resort  to  Marshall  Hall's  plan,  this  exhaus- 
tion of  muscle  under  the  galvanic  stimulus  did  occur,  and  the  rest 
from  that  stimulus  with  mechanical  maintenance  of  respiration  was 
the  saving  modification  of  treatment. 

The  employment  of  oxygen  as  an  adjunct  to  artificial  respiration,  on 
which  Dr.  Blake  naturally  dwells  with  so  much  emphasis,  introduces 
to  our  notice  a  practical  matter  which  we  have  tried  many  times  to 
study  by  experiment.  We  have  no  doubt  that  the  use  of  the  oxygen 
in  the  diluted  form,  as  suggested  by  Dr.  Thomas,  was  of  service.  At 
the  same  time,  if  oxygen  be  not  at  hand,  no  operator  need  be  under 
any  anxiety  from  its  absence.  We  have  found  that  to  raise  the  tem- 
perature of  the  common  air  supplied  by  artificial  respiration  to  75° 
Pahr.  is  as  effective,  in  quickening  the  oxidation  of  the  blood,  as  is 
increase  of  oxygen.  Indeed,  on  the  whole,  the  warm  air  method  is 
safest,  because  an  excess  of  oxygen,  the  precise  degree  of  which 
excess  is  not  yet  defined,  is  actually  injurious. 

We  incline  altogether  to  the  view  expressed  by  Dr.  Blake  that  the 
secondary  symptoms  of  collapse  and  coma  were  due  to  a  uraem.ic 
condition.  Por  this  very  reason  we  would  urge  the  more  strongly 
the  importance  of  simple  mechanical  artificial  respiration  by  the 
double-acting  bellows — through  which  no  waste  of  tissue  or  forma- 
tion of  secondary  product  of  tissue  is  involved — to  the  muscular 
respiration  excited  by  galvanic  stimulus. 

We  fail  to  see  the  value  of  the  hypodermic  injection  of  the  cognac, 
but  we  do  not,  in  the  absence  of  inquiry  into  it,  by  direct  appeal  to 
experiment,  dispute  its  value.  On  the  whole  we  have  rarely  met,  in 
twenty  years  of  reporting  on  toxicological  subjects,  with  a  record 
more  valuable  to  medical  science  than  this  which  Dr.  Blake  has 
supplied.  As  a  result  it  is  one  of  the  practical  fruits  of  experimental 
research  which  every  true  investigator  must  recognise,  especially 
at  this  moment,  with  extremest  satisfaction.] 

On  the  presence  of  alkaloids  in  decomposing  organic  substances 
and  in  the  bodies  of  the  dead.  —  We  have  noticed  in  a  previous 
report  the  fact  that  some  Continental  authors  have  been  testing  the 
tissues  of  the  dead  for  evidences  of  alkaloidal  bodies  which  have 


1875.]      Report  on  Toxicology,  Forensic  Medicine^  ^c,         243 

formed  spontaneously  in  the  processes  of  decomposition.  The  inquiry 
has  been  further  pursued  by  M.  Schwanert,  who  has  obtained  from 
decomposed  human  livers,  spleens,  and  intestines,  a  non-crystalline 
alkaloid,  which  cannot  be  obtained  from  fresh  corpses.  This  sub- 
stance was  obtained  in  quantity  sufficient  for  some  little  examination 
from  the  organs  of  a  corpse  that  had  remained  sixteen  days  at  about 
30°,  and  was  quite  decomposed.  The  viscera,  either  alone  or  mixed 
with  zinc  chloride,  were  repeatedly  treated  with  alcoholic  tartaric 
acid,  and  the  extract  thus  obtained  purified  by  the  Stas-Otto  process, 
and  then  shaken  with  ether  ;  excess  of  alkali  being  then  added  the 
new  base  was  extracted  from  the  liquor  by  ether.  By  evaporation, 
at  as  low  a  temperature  as  possible,  the  substance  is  left  as  a  yellow- 
ish oil  which  does  not  solidity,  and  possesses  a  peculiar  odour  recalling 
that  of  propylamine,  but  has  no  bitter  taste  ;  it  volatilises  completely 
on  long  standing  or  when  heated,  and  changes  red  litmus  to  a  deep 
blue  ;  it  forms  a  crystalline  deliquescent  hydrochloride,  readily  vola- 
tile, readily  soluble  in  water,  less  so  in  alcohol,  and  developing  white 
vapours  of  a  peculiar  unpleasant  odour  on  addition  of  soda-ley. 

Sulphuric  acid  dissolves  the  hydrochloride,  forming  a  colourless 
solution,  gradually  becoming  a  dirty  brown  colour  after  standing, 
and  greyish-brown  on  warming :  the  colourless  solution  yields,  on 
warming  with  sulphuric  acid  solution  of  sodium  molybdate  a  beau- 
tiful blue  shade,  which  gradually  becomes  green  ;  with  potassium 
dichromate  it  becomes  first  red  brown  and  afterwards  grass-green. 
Nitric  acid  dissolves  the  compound,  producing  a  yellow  colour. 

The  platinum  ssalt  is  a  dirty-yellow  precipitate  consisting  of  micro- 
scopic six-sided  stars,  and  contains  3135  per  cent,  platinum.  Gold 
chloride  gives  with  an  alcoholic  solution  of  the  hydrochloride  an 
amorphous  yellow  precipitate ;  mercury  chloride  a  white  crystalline 
precipitate  ;  potassio-mercuric  iodide  a  dirty  white,  and  iodised  potas- 
sium iodide  a  clear  brown  precipitate.  Tannic  acid  gradually 
renders  the  liquid  turbid ;  sodium  phospho-molybdate  gives  a  yellow 
precipitate,  clotting  together  and  becoming  blue  with  ammonia. — 
Deut.  Che7n.  Ges.  Bet.,  vii,  1332,  and  Journal  of  the  Chemical 
Society,  March,  1875. 

[The  subject  here  broached  is  not  new,  as  some  of  the  recent  experi- 
menters seem  to  suppose,  but  is  one  of  those  experimental  inquiries 
which  observers  in  England  have  for  many  years  past  had  under  in- 
vestigation. !So  far  back  as  1862  Dr.  Letheby  pointed  out  that  organic 
decomposing  bodies  yield,  not  only  ammonia,  but  also  other  volatile 
nitrogenous  substances  which  are  peculiar  to  organic  decomposition. 
Dr.  Stenhouse,  as  Letheby  has  shown,  described  in  1849,  in 
speaking  of  the  products  of  decomposition  of  nitrogenous  organic 
matters,  that  whenever  ammonia  is  generated  in  large  quantities  from 
complex  substances,  either  animal  or  vegetable,  it  is  always  accom- 
panied by  the  formation  of  a  larger  or  smaller  amount  of  volatile 
organic  bases. 

Dr.  Grace  Calvert  discovered,  in  the  volatile  alkalies  of  some  putre- 
fying flesh,  complex  chemical  bodies  yielding  carbon,  hydrogen, 
nitrogen,  phosphorus,  and  sulphur.      Dr.  Odling  detected  in  similar 


244  Chronicle  of  Medical  Science.  U^Y* 

substances  complex  volatile  alkalies  containing  carbon,  and  we 
ourselves  in  1865  isolated  from  the  serum  derived  from  the  peritoneal 
cavity  of  the  human  subject  an  alkaloidal  body  which  possessed 
poisonous  qualities  found  to  be  communicable  and  to  which  we  gave 
the  name  of  septine.  It  is  but  just  to  claim  for  the  English  school 
the  priority  in  these  advances  of  science  before  they  are  retranslated 
here  from  foreign  sources  and  reproduced,  as  they  assuredly  will  be, 
in  a  manner  intended  to  convey  the  idea  of  an  origin  anywhere  rather 
than  in  the  English  mind.] 

II. — FoEENsic  Medicine. 

Survivorship  after  injuries  to  the  head.  —  Some  of  the  most 
curious  cases  on  record,  in  a  forensic  point  of  view,  are  those  which 
relate  to  survivorship  after  injuries  to  the  head.  Dr.  Day,  of 
Stafford,  has  enriched  medical  literature  with  a  most  interesting 
record  of  a  case  in  which  a  man  travelled  on  foot  a  long  journey 
(from  Stafford  to  London)  with  a  portion  of  a  gun-lock  lodged  in 
his  cranium.  Some  further  valuable  illustrations  bearing  on  the 
same  class  of  injuries  are  recorded  by  Mr.  Eobert  Harvey  in  a 
report  of  the  Madras  legal  returns  received  from  civil  surgeons  of 
the  Bengal  Presidency  during  the  years  1870-73. 

The  question,  says  Mr.  Harvey,  as  to  how  long  a  patient  could 
have  lived  after  a  fatal  injury  to  the  head  is  frequently  asked  in 
courts  of  justice,  and  is  of  practical  importance.  The  point  is  men- 
tioned in  too  few  cases  to  allow  of  any  fixed  rules  being  laid  down, 
but  a  sufficient  number  is  given  to  show  that  one  opinion,  which  is 
not  unfrequent,  viz.,  that  a  certain  injury  must  have  caused  instan- 
taneous death,  can  very  seldom  be  justified,  numerous  cases  of  life 
being  prolonged  for  many  days  after  very  severe  injuries  are  recorded. 
A  few  have  been  incidentally  noticed  already  in  connection  with 
inflammation  within  the  skull.  Mr.  C.  L.  Eox,  civil  medical  officer 
of  Muzuffargarh,  gives  the  case  of  a  Mussulman!,  aged  25,  in  hia 
return  for  August,  1872.  She  had  been  struck  three  blows  on  the 
head  with  a  plough-handle  as  thick  as  a  man's  wrist.  All  the  bones 
of  the  face,  except  the  lower  jaw,  were  fractured  ;  the  lower  part  of 
the  parietal  bone,  both  orbits,  and  the  lesser  wings  of  the  sphenoid 
were  comminuted,  many  fragments  being  driven  into  the  brain, 
which  also  protruded  from  the  external  wounds ;  she  died  on  the 
fifth  day.  A  man  at  Delhi  lived  seven  days  after  receiving  blows 
from  a  blunt  weapon,  which  produced  a  compound  fracture  of  the 
lower  jaw  and  extensive  fracture  of  the  base.  Another  at  Kohat 
died  of  cerebritis  ten  days  after  a  fracture  through  the  left  orbit  into 
the  base.  Two  men  at  Sitapur  lived,  one  16,  the  other  17,  days  after 
extensive  fractures  extending  into  the  nose.  In  a  case  at  Jhilum  a 
man  hit  on  the  head  on  the  2nd  of  April,  1870  sustained  a  fracture  of 
the  left  parietal  and  frontal  bones,  involving  the  orbit.  Head 
symptoms  came  on  the  4th,  and  he  was  trephined,  dying  next  day. 
Surgeon  J.  P.  "Wright  gives  a  good  case  in  the  Nursingpur  return 
for  December,  1870 : 
Subject,  a  Brahmin,  aged  60 ;  admitted  on  the  18th  November  1 


1875.]      Report  on  Toxicology,  Forensic  Medicine,  ^c.         245 

with  ten  contused  wounds  on  the  head,  apparently  caused  by  a  blunt 
cutting  weapon.  Fracture  of  outer  table  of  skull  to  right  of  fore- 
head. Partially  unconscious,  but  could  be  roused  with  difficulty. 
Began  to  improve  on  22nd,  and  went  on  well  till  1st  December, 
when  "  his  appetite  fell  off  and  he  began  to  lapse  into  insensibility, 
not  complete,  but  of  evil  omen."  Several  pieces  of  bone  were 
removed,  but  he  continued  to  sink,  and  died  on  the  7th  of  Decem- 
ber. Post-mortem  examination  revealed  "  extensive  fracture  of  the 
frontal  bone  with  an  abscess  formed  in  the  brain  and  considerable 
effusion  of  black  blood  on  the  surface.  The  separated  portions,  four 
in  number,  had  been  removed  during  life,  and  the  brain  protruded 
through  the  vacant  space.  The  injuries  are  quite  sufficient  to  cause 
death,  and  it  is  only  a  matter  of  surprise  that  he  lived  as  long  as  19 
days." 

In  the  Mirat  return  for  November,  1870,  is  the  case  of  a  man  who 
died  of  compression  of  the  brain  six  days  after  an  injury  which  caused 
extensive  fracture  of  the  vertex  with  effusion  of  blood  on  and  beneath 
the  membranes.  He  had  left  hemiplegia,  and  was  insensible 
throughout.  A  man  at  Maimansing  lived  three  days  after  a  starred 
depressed  fracture  at  the  fronto-parietal  point,  with  blood  on  the 
brain.  He  also  was  comatose,  as  in  all  probability  most  of  them 
were. 

In  other  cases  the  patient  lived  a  few  hours  only.  A  man  at 
G-ujranwala  lived  16  hours  after  a  blow  from  a  stick,  which  separated 
the  coronal  suture,  and  another  at  the  same  station  16  hours  with 
depressed  fracture  of  the  vertex,  and  separation  of  the  sagittal  and 
right  lambdoidal  sutures.  Another  at  Pmd,  Dadan  Khan  survived 
26  hours  with  a  depressed  fracture  of  the  skull  and  laceration  of  the 
brain  ;  and  a  man  at  Muzaffargarh  ten  hours  after  a  similar  injury. 
The  most  remarkable  case  is  one  by  Mr.  E.  P.  Eoberts,  of  Kaniganj. 
A  Hindu,  aged  35,  was  hit  on  the  head  by  a  fragment  of  a  burst 
boiler.  "  The  right  side  of  the  skull  had  been  driven  in,  and  a  large 
portion  of  the  brain  forced  out,"  yet  he  lived  for  an  hour  and  a  half. 
Similar  instances  might  be  multiplied,  but  those  given  are  sufficient 
to  show  that  patients  may  survive  for  long  periods  after  head 
injuries,  and  do  in  fact  seldom  die  instantaneously.  In  some  of  the 
cases  where  death  was  reported  as  immediate,  a  fact  is  no  doubt 
recorded,  but  in  many  it  is  an  opinion  merely,  and  the  following 
shows  how  easily  mistakes  may  be  made.  A  civil  surgeon  in  the 
north-west  provinces,  finding  a  transverse  fracture  extending  from 
the  vertex  down  to  and  right  across  the  base  in  a  man  who  had  been 
felled  by  a  lathi  blow  from  behind,  reported  that  "  death  must  have 
ensued  instantaneously."  It  was  proved  on  the  trial,  however,  that 
in  spite  of  the  very  serious  injury  he  had  received,  he  had  lived  about 
an  hour  after  being  carried  home.  No  harm  was  done  in  this  case, 
and  death,  though  not  instantaneous,  was  very  rapid;  but  had  the 
man  lived  for  some  days,  as  it  is  obvious  from  some  of  the  cases 
above  quoted  he  might  have  done,  serious  discredit  might  have 
attached  to  the  medical  officer. — Indian  Medical  Gazette,  April  1, 
1875. 


246  Chronicle  of  Medical  Science.  [July, 

III. — Hygiene. 

On  the  origin  of  cerebrospinal  meningitis. — Dr.  Henry  B.  Baker, 
of  Lancing,  Michigan,  reports  to  the  State  Board  of  Health  upou  an 
epidemic  in  Monroe  and  Lenawee  counties,  in  Michigan,  and  adds 
to  his  report  a  study  of  some  other  facts  relative  to  the  cause  of  this 
disease.  The  author  has  collected  evidence  concerning  eighty-eight 
cases.  An  abstract  of  this  report  has  already  been  published,  and 
Was  the  subject  of  comment  in  this  country  as  well  as  in  America 
last  year.  We  shall,  therefore,  now  only  notice  certain  of  the  new 
facts  that  are  embodied  in  this  elaborate  report.  (1.)  Dr.  Baker 
disputes  the  propriety  and  correctness  of  the  name  given  to  this 
epidemic  disease.  The  lesions  of  the  cerebrum  and  of  the  spinal 
cord  which  are  usually  found  may,  he  thinks,  be  secondary  only. 
He  inclines,  on  the  whole  to  accept  the  name  suggested  by  Dr. 
Bodenstein,  and  to  call  the  malady  ^^  tetanoid  fever.'"  (2.)  The 
definition  of  the  disease  by  its  symptoms  he  supplies  from  Dr. 
Clymer : — "  It  is  an  acute  specific  disorder,  commonly  happening  as 
as  an  epidemic,  general  or  limited,  and  rarely  sporadically,  caused 
by  some  unknown  external  influence  ;  of  sudden  onset,  rapid  course, 
and  very  fatal.  Its  chief  symptoms,  referable  to  the  cerebro-spinal 
axis,  are — great  prostration  of  the  vital  powers,  severe  pain  in  the 
head  and  along  the  spinal  column,  delirium,  tetanic  and  occasionally 
clonic  spasms,  and  cutaneous  hypersesthesia,  with,  in  some  cases, 
stupor,  coma,  and  motor  paralysis,  attended  frequently  with  cutaneous 
haemic  spots ;  its  morbid  anatomical  characters  being  congestion  and 
inflammation  of  the  membranes  of  the  spinal  cord,  particularly  the 
pia  mater,  although  there  is  reason  to  believe  that  the  evidence  of 
these  changes  may  be  wanting  even  in  cases  of  long  duration."  (3.) 
On  the  subject  of  the  communicability  of  the  disease,  Dr.  Baker  states 
that  the  majority  of  observers  have  come  to  the  conclusion  that  the 
disease  is  incommunicable  from  the  sick  to  the  healthy.  But  a 
minority  hold  a  diff'erent  opinion,  and  he  cites  certain  details  which, 
as  far  as  they  go,  corroborate  this  view.  His  own  observation  is  that 
contagiousness  of  a  like  character  to  that  of  smallpox,  scarlet  fever, 
or  typhus,  is  not  possessed  by  the  malady  under  consideration.  The 
question  is — Does  epidemic  meningitis,  like  typhoid  fever  or  cholera, 
possess  a  peculiar  contagiousness  of  its  own,  a  property  of  communi- 
cability peculiar  to  itself?  This  question  still  remains  to  be  solved. 
(4.)  The  symptoms  which  characterise  the  cerebro-spinal  meningitis, 
or,  properly  speaking,  tetanoid  fever,  are  more  correctly  and  fully 
described  in  this  essay  than  in  any  we  have  previously  seen.  The 
records  are  from  the  pens  of  six  physicians,  namely,  Drs.  Paquette, 
S.  L.  Jones,  G-.  W.  Jackson,  M.  Wilcox,  C.  T.  Southworth,  and 
H.  C.  Wyman,  all  evidently  most  careful  and  thoughtful  observers, 
and  all  residents  and  attendants  of  the  sick  in  the  affected  districts. 
Prom  these  records  it  is  clear  that  the  epidemic  showed  differing 
shades  of  character  and  intensity  in  the  area  of  its  temporary 
locality.  The  symptoms  varied  from  those  of  an  ague  to  those  of 
an    extreme    tetanus.      Erom    these    learned    observers    we    find 


1875.]       Report  on  Toxicology,  Forensic  Medicine ^  ^c.        247 

that  in  the  remarkable  epidemic  they  witnessed  the  leading  sym- 
ptoms were  as  follow  : — The  symptoms  varied  somewhat  in  different 
cases  according  to  the  period  of  time  in  which  they  were  in  pro- 
gress, but  they  represent  a  more  perfect  whole  of  the  phenomena 
of  the  malady  than  has  yet  been  recorded.  At  first  there  was 
fever,  which  often  ran  high,  but  was  not  always  persistent ;  in  some 
examples,  indeed,  the  fever  was  so  intermittent  that  the  earlier 
attacks  resembled  ague.  Upon  the  fever  there  followed  delirium, 
which  was  sometimes  associated  with  deafness.  The  eyes  were 
commonly  affected  with  squint,  which  was  generally  convergent, 
but  now  and  then  divergent.  The  eyes  were  glassy,  with  a  peculiar 
stare  ;  the  lids  did  not  freely  raise  or  lower,  they  did  not  wink  with 
natural  frequency:  The  pupils  were  generally  dilated,  but  they 
contracted  under  the  influence  of  opium.  There  was  always  pain  in 
the  head,  headache  usually  most  severe  in  the  back  of  the  head  and 
extending  down  the  back.  The  head  was  often  drawn  back,  and  in 
a  few  instances  there  was  lock-jaw.  The  mouths  were  dry.  These 
were  the  leading  phenomena  aftecting  the  head,  face,  and  mouth. 

Most  of  the  patients  suffered  from  vomiting,  and  this  symptom, 
which  came  on  early,  was  often  very  troublesome.  The  vomited 
matter  looked  like  chopped  grass  in  water.  The  bowels,  as  a  rule, 
were  constipated.  The  surface  of  the  body  was  tender  to  the  touch, 
the  tenderness  being  most  marked  over  and  along  the  spine.  The 
skin  was  generally  spotted,  the  eruption  consisting  of  bluish 
evanescent  spots  which  disappeared  on  pressure.  The  temperature 
of  the  body  was  irregular,  it  was  sometimes  raised  at  first,  and  then 
would  become  lower  than  natural.  Dr.  Jackson  notes  that  the 
highest  temperature  he  observed  was  105°  Eahr.  The  pulse  was 
frequently  almost  normal,  sometimes  slower  than  usual,  but  acce- 
lerated after  a  few  days.  It  was  very  often  intermittent.  The 
respiration  was  irregular.  The  most  marked  symptoms  of  all  were 
shown  in  the  muscular  and  nervous  systems.  Dr.  Paquette  uses  on 
this  point  a  very  quaint  expression,  which,  we  agree  with  Dr.  Baker, 
embodies  an  important  fact.  He  (Paquette)  says,  the  nerves  were 
**taut,"  by  which  he  means  that  there  was  general  muscular  tonicity 
which  was  increased  by  any  irritation  of  the  skin,  because  of  its 
increased  sensitiveness.  With  this  tonicity  of  the  muscular  system 
there  occurred  tetanic  convulsion,  sometimes  locked  jaw,  and 
delirium.  Dr.  Southworth  alt^o  names,  as  a  characteristic  symptom, 
a  falling-in  of  the  abdominal  walls,  the  abdomen  appearing  as  though 
it  had  been  dug  out  or  emptied  of  its  viscera.  The  urine  was  not 
passed  freely,  and  was  of  high  colour,  resembling  coffee  grounds  in 
some  cases.  Tiie  duration  of  the  disease  was  extremely  varied. 
Some  cases  terminated  fatally  in  so  short  a  time  as  three  hours. 
Others  extended  over  several  days. 

A  very  careful  inquiry  into  the  cause  or  causes  of  tetanoid  fever 
is  finally  recorded  by  Dr.  Baker.  He  shows  that  atmospheric  cold 
and  the  reaction  which  arises  from  it  is  a  powerful  disposing  agent 
to  the  malady.  He  shows  again  that  the  mental  condition  known 
as  fear  is  another  equally  important  disposing  influence.     But  as 


248  Chronicle  of  Medical  Science.  [July* 

regards  the  actual  cause  of  the  malady  his  argument  in  the  main 
supports  our  original  theory  that  the  disease  is  a  form  of  ergotism, 
that  the  active  agent  is  a  fungus  or  smut  occurring  in  the  grain,  and 
that  the  bread  food  from  such  grain,  eaten  by  the  sufferers,  is  the 
source  of  the  poison. — Second  Annual  Beport  of  the  State  Board 
of  Health  of  Michigan,  1875. 

ly. — Summary. 

On  the  Bfects  of  Strychnia.  By  P.  A.  Falh,  M.D.  Bevue  ThSrapeu- 
tique  Medico-Chirurgicale,  15  Juillet,  1874. — The  physiological  action 
of  strychnia,  its  place  as  a  poison,  and  the  tests  by  which  it  is  recog- 
nisable, are  noticed  by  the  author,  who,  if  he  adds  little  that  is 
origiuai,  writes  with  sound  judgment  and  knowledge. 

Diseases  of  the  Mystics,  Louise  Bateau.  By  M.  Warlomont.  Ba 
Bevue  Scientifique,  April  10,  1875.  — This  is  a  report  made  tohe 
Academy  of  Medicine  of  Belgium  on  the  whole  case  of  the  stigmatic 
bleeding  and  fasting  girl  of  the  village  of  Bois  d'Haiue  in  Hainaut, 
Louise  Lateau.  It  is  a  splendid  answer  to  the  work  of  M.  Lefebvre  on 
the  same  subject.  Warlomont  throwing  aside  all  the  superstition, 
exaggeration,  and  we  may  say  imposture,  which  surrounds  this  case, 
faces  the  facts  on  physiological  and  pathological  grounds,  and  shows 
the  pure  physical  nature  of  the  phenomena. 

Bagjpootana  Dispensary,  Vaccination,  Jail  and  Sanitary  Report 
for  1873.  Calcutta.  By  W.  J.  Moore,  Surgeon-major.  Published 
by  authority. — The  report  is  short,  but  is  an  admirable  condensation 
of  a  series  of  observations  which,  considering  the  area  of  the  districts 
the  author  had  to  study  and  the  mass  of  facts  with  which  he  had  to 
deal,  are  truly  laborious.  We  observe  two  striking  notes  in  respect 
to  the  origin  of  cholera:  (a)  that  human  intercourse  alone  did  not 
explain  the  irregular  extension  of  the  disease  in  Eajpootana  in 
1869,  and  (b)  that  the  malady  was  extended  by  human  intercourse 
after  it  had  once  originated. 

The  Science  of  Disinfection..  By  John  Dougall,  M.D.  Separate 
Treatise.  Glasgow,  1875. — This  paper  was  read  before  the  Health 
Department  of  the  Social  Science  Congress  of  1874.  It  defines  very 
clearly  the  physical  difference  between  the  processes  of  fermentation 
and  putrefaction.  It  shows  also  that  many  so-called  antiseptics  have 
for  their  specific  properties  the  power  of  preserving  organic 
poisonous  substances,  and  that  to  quench  decomposition  of  organic 
bodies  is  a  very  different  thing  from  the  art  of  killing  infection. 
Every  practitioner  will  read  this  short  and  able  paper  with  profit. 

The  Longevity  of  Brainworkers.  By  George  M.  Beard,  A.M.,  M.D. 
Separate  pamphlet.  New  York,  1875. — Dr.  Beard  assigns  as  the 
causes  of  the  exceptional  longevity  of  great  brainworkers — 1.  That 
great  men  usually  come  from  healthy,  long-lived  ancestors.  2.  That 
a  good  constitution  usually  accompanies  a  good  brain.  3.  That  great 
men  who  are  permanently  successful  have  corresponding  greater  will 
than  common  men,  and  force  of  will  is  a  potent  element  in  determin- 
ing longevity.     The  one  requisite  of  great  success  is  "yr^V."     4. 


1875 .J       Report  on  Toxocology,  Forensic  Medicine,  ^c,       249 

Great  men  work  more  easily  than  ordinary  men.  5.  Great  brain- 
workers  have  not  all  been  rich  nor  all  been  poor ;  the  majority  have 
been  most  of  the  time  surrounded  with  at  least  moderate 
comforts. 

The  Diagnosis  of  Blood- stains.  By  Joseph  G.  Bichardson^  M.D. 
American  Journal  of  the  Medical  Sciences,  April,  1875. — Dr.  Joseph 
Kichardson  in  this  short  paper  defends  his  previous  position  from  an 
attack  made  upon  it  by  Dr.  J.  J.  Woodward  in  the  previous  issue 
of  the  above-named  journal.  Dr.  Woodward  maintains  that  we  can 
never  affirm  truthfully  on  the  strength  of  microscopical  investigation 
that  a  given  stain  is  positively  composed  of  human  blood.  Dr.  Joseph 
Richardson  agrees  with  this  as  being  literally  true,  but  not  the 
whole  truth,  because  it  often  happens  m  practice  that  evidence  other 
than  microscopical  narrows  down  the  conditions  of  a  case  to  the 
question  :  Is  this  stain  human  blood  or  that  of  an  ox,  pig,  or  sheep  ? 
The  question  thus  narrowed  can  be  answered  by  the  mrcroscopist 
according  to  our  author,  and  we  entirely  agree  with  him  in  his 
opinion.  We  further  agree  with  him  in  the  caution  he  displayed  in 
his  former  paper  in  not  suggesting  to  the  criminal  population  what 
bloods  of  inferior  animals  are  difficult  of  differentiation  from  human 
blood. 

Biver  Pollution,  with  a  special  reference  to  the  Bv/re  Water  Supply  of 
Towns.  By  Jabez  Hogg.  Beprintfrom  the  Journal  of  the  Society  of 
Arts,  May  12th,  1875. — Mr.  Hogg,  in  his  interesting  paper,  argues 
that  the  use  of  the  large  supplies  of  water  stored  up  in  the  deepest 
recesses  of  the  earth  w  ill  alone  remove  the  evils  of  water  supply 
under  which  we  labour.  Such  water  stores  are  absolutely  pure  and 
brilliant.  They  are  entirely  free  from  all  suspended  matters,  from 
decaying  organic  substances,  and  faecal  refuse.  JN'either  spores,  seeds, 
fungi,  ova,  nor  the  larvae  of  animalcules  can  possibly  penetrate  to  the 
deep  recesses  of  the  earth.  Deep  well  water  contains  probably  the 
inorganic  products  of  the  thunderstorm  of  a  century  or  more  ago — 
a  little  lime  dissolved  out  of  the  chalk  as  it  passes  through  the  rock, 
a  little  chloride  of  sodium,  washed  out  of  the  sea  ages  gone  by  and 
deposited  in  the  soil,  but  it  contains  no  ammonia  in  organic  com- 
bination, and  no  albuminoid  ammonia.  It  contains  what  we  prefer, 
fixed  air,  which,  while  it  imparts  a  briskness  to  it,  renders  it  in  no 
way  unsuited  for  domestic  and  dietetic  uses. 


250 


Books,  ^c,  received  for  Review. 


[July, 


BOOKS,  PAMPHLETS,  &c.,  RECEIVED  FOR  REVIEW. 


A  Manual  of  Diet  in  Health  and  Disease. 
By  Thomas  Kinp^  Chambers,  M.D.,  &c. 
London,  Smith,  Elder  &  Co.  1875.  pp. 
352. 

A  Course  of  Lectures  on  Physiology,  as 
delivered  by  Professor  Kiiss,  of  Strasburg. 
Edited  by  Mathias  Duval.  Translated  by 
Robert  Amory,  M.D.  Illustrated  by  150 
woodcuts.  Boston,  James  Campbell.  1875. 
pp.  531. 

Clinical  Lectures  on  Diseases  peculiar 
to  Women.  By  Lombe  Atthill,  M.D. 
Third  Edition.  Dublin,  Fannin  &  Co. 
1875.     pp.  294. 

St.  George's  Hospital  Reports.  Edited 
by  J.  W.  Ogle,  M.D.,  and  Timothy  Holmes, 
F.R.C.S.  Vol.  VII,  1872-4.  London, 
Churchills,  IB75.    pp.  396. 

Consumption  in  Australia.  By  C.  E. 
Reeves,    M.D.      Melbourne,    J.    Brooks. 

1874.  pp.  154. 

On  Leprosy  and  Elephantiasis.     With 

?lates.  By  H.  Vandyke  Carter,  M.D. 
,ond.,  H.  M.  Indian  Service.  Published 
under  the  sanction  of  the  Secretary  of 
State  for  India.  London.  1874.  Large 
4to.,  pp.  248. 

On  Life,  and  on  Vital  Action  in  Health 
and  Disease;  being  the  Lumleiau  Lectures. 
By  L.  S.  Beale,  M.B.,  F.R.S.  London, 
Churchills,  1875.    pp.  110. 

Manual  of  Instructions  for  the  Guidance 
of  Army  Surgeons  in  testing  the  range 
and  quality  of  vision,  and  in  distinguish- 
ing the  cause  of  defective  vision  in  sol- 
diers. By  Surgeon-General  T.  Longmore, 
C.B.  Second  Edition.  London.  1875. 
pp.  134. 

On  Paralysis  from  Brain  Disease  in  its 
Common  Forms.  By  H.  Charlton  Bastian, 
M.D.,  F.R.S.  With  illustrations.  London, 
Macmillan  &  Co.     1875.    pp.  340. 

Anatomv,  Descriptive  and  Surgical.  By 
Henry  Gray?  F.R.S.  Seventh  Edition. 
With  an  Introduction  on  General  Ana- 
tomy and  Development.  By  T.  Holmes, 
M.A.  Loudon,  Longmans.  1875.  pp. 
788. 

On  Diet 'and  Regimen  in  Sickness  and 
Health  ;  and  on  the  Interdependence  and 
Prevention  of  Diseases,  and  the  Diminu- 
tion of  their  Fatality.  By  Horace  Dobell, 
M-D.  Sixth  Edition,  revised  and  enlarged. 
London,  Lewis.     1875.     pp.  248. 

Cyclopaedia  of  the  Practice  of  Medicine. 
Edited  by  Dr.  H.  von  Ziemssen.  Vols.  I, 
ir,  and  III. :  Acute  and  Chronic  Infectious 
Diseases.     London,  Sampson  Low  &  Co. 

1875.  pp.  708  and  751. 

Guy's  Hospital  Reports.  Edited  by  H. 
G.  Howse,  M.D.,  and  Frederick  Taylor, 
M.D.  Third  Series,  Vol.  II.  London, 
Churchills.     1875.     pp.  624. 

Syphilitic  Lesions  of  the  Osseous  System 
in  Infants  and  Young  Children.  By  R. 
W.  Taylor,  M.D.     New  York,  Wood  & 


Co. ;  London,  Sampson  Low  &  Co.     1875. 
pp.  179. 

Lectures  on  Diseases  of  the  Respiratory 
Organs,  Heart,  and  Kidneys.  By  Alfred 
L.  Loomis,  M.D.  New  York,  Wood  & 
Co. ;  London,  Sampson  Low  &  Co.  1875. 
pp.  549. 

St.  Thomas's  Hospital  Reports.  New 
Series,  Vol.  V.  London,  Churchills.  1874. 
pp.  451. 

Clinical  Lectures  and  Essays.  Bv  Sir 
James  Paget,  Bart.,  F.R.S.  Edited  by 
Howard  Marsh.  F.R.C.S.  London,  Long- 
mans.    1875.     pp. 428. 

Sixth  Annual  Report  of  the  State  Board 
of  Health  of  Massachusetts.  Januarv, 
1875.    Boston,  Wright  &  Potter,    pp.  379. 

Medical  Reports  by  the  Surgeons  to  the 
Customs  at  the  Treaty  Ports  of  China. 
Shanghai,  1875. 

Transactions  of  the  Obstetrical  Society 
of  London.  Vol.  XVI  for  the  year  1874. 
Accompanied  by  a  General  Index  to  the 
Transactions,  Vols.  I  to  XV.  London, 
Longmans.     1875.     pp.  303. 

On  Diseases  of  the  Skin,  including  the 
Exanthemata.  By  Ferdinand  Hebra, 
M.D.,  and  Moriz  Kaposi,  M.D.  Vol.  IV. 
Translated  and  edited  by  Waren  'J'ay, 
F.R.C.S.  New  Sydenham  Society.  1875. 
pp.  247. 

The  Marriage  of  Near  Kin,  considered 
with  respect  to  the  Laws  of  Nations,  the 
results  of  Experience,  and  the  teachings 
of  Biology.  By  Alfred  Henry  Huth. 
London,  Churchills.  1875.  pp.  359; 
with  appendix,  pp.  67. 

On  the  Psoriasis,  or  Lepra.  By  George 
Gaskoin.  London,  Churchills.  1875. 
pp.  206. 

Health  in  India  for  British  Women  ;  or, 
the  Prevention  of  Disease  in  Tropical 
Climates.  By  E.  J.  Tilt,  M.D.  Fourth 
Edition.  London,Churchills.  1875.  pp.134. 

Cases  in  Surgery  illustrative  of  a  New 
Method  of  applying  the  Wire  Ligature  in 
Compound  Fractures  of  the  Lower  Jaw. 
By  Hugh  Owen  Thomas.  Second  Edition. 
Liverpool,  T.  Dobb  &  Co.     1875. 

Nouveau  Dictionnaire  de  Medecine  et 
de  Chirurgie  Pratique,  illustre  de  figures 
intercalees  dans  le  texte.  Tome  XX. — 
Lacr,  Lux.  Paris,  J .  B.  Bailliere  et  fils. 
1875.     pp.  802. 

Parasites  des  Organes  Sexuels  Femelles 
de  I'homme  et  de  quelques  animaux. 
Par  le  Dr.  D.  Haussmann.  Traduit  par 
le  Dr.  P.  E.  Walther.  Paris,  J.  B. 
Bailliere  et  fils.     1875.     pp.  198. 

Recherches  sur  Lymphangites  Pulmo- 
naires.  Par  Dr.  Emile  Troisier.  Paris, 
Masson.     1874. 

Etude  sur  I'Hypertrophie  generale  de 
la  Glande  Mammaire  chez  la  Femme. 
Par  le  Dr.  E.  Labarraque.  Paris,  J.  B. 
Bailliere  et  fils.     1875.     pp.138. 


1875.] 


Books  J  S^c.j  received  for  Review. 


251 


De  I'Arthrite  Tuberculeuse :  demon- 
stration de  r  existence  de  cette  affection 
?ar  inoculation  de  produits  synoviaux. 
'ar  le  Dr.  J.  Roux.  Paris,  J.  JB.  Bailliere 
et  fils.     187/5.     pp.  50. 

Le<jons  sur  la  Structure  et  les  Maladies 
du  Systeme  Nerveux.  Par  J.  Luys.  Re- 
cueillies  par  J.  Dave.  Paris,  J.  B.  Bailliere 
et  tils.     1875.    pp.  79. 

Traite  des  Injections  sous-cutanees  a 
effet  local.  Par  le  Dr.  A.  Luton.  Paris, 
J.  B.  Bailliere  et  fils.     1875.     pp.  380. 

De  la  Localisation  dans  les  Maladies 
Cerebrales.  Par  le  Dr.  K,  Lepine.  Paris, 
J.  B.  Bailliere  et  fils.     1875.     pp.  160. 

Des  Paralysies  Bulbaires.  Par  le  Dr. 
Eallopeau.  Paris,  J.  B.  Bailliere.  1875. 
pp.  152. 

Des  Contractures.  Par  le  Dr.  Isidore 
Strauss.  Paris,  J.  B.  Bailliere.  1875. 
pp.  94. 

Etude  sur  le  Traitement  de  quelques 
Complications  des  Beirecissements  de 
I'Urethre.  Par  Edouard  Martin,  M.D. 
Paris,  J.  B.  Bailliere  et  fils.  1875.  pp. 
207. 

Hypospadias  Peno-scrotal  complique  de 
condure  de  la  Verge,  redressement  du  penis 
et  urethroplastie  par  inclusion  cutanee ; 
guerison.  Par  M.  Theophile  Auger. 
Paris,  G.  Masson.     1875.J' 

Cliuique  Chirurgicale  de  I'Hotel  Dieu 
de  Lyon.  Par  A.  D.  Valette.  Avec 
figures  intercalees  dans  le  texte.  Paris, 
J.  B.  Bailliere  et  fils.     1875.     pp.  720. 

Sulla  Teoria  della  Febbre  indagini,  del 
Dott.  Augusto  Murri.  Fermo.  1874.  pp. 
132. 

Estadisticas  Clinicas  de  los  Hospitales 
San  Jose  y  San  Lazaro  de  Lisboa.  (Capi- 
tulo  IX.) 

Pamphlets. 

Dispensary,  "Vaccination,  Jail,  and  Sani- 
tary Report  of  Rajpootana  for  1873.  Cal- 
cutta.    1874. 

Typhoid  Fever,  its  Cause  and  Preven- 
tion. By  Eben.  Duncan,  M.D.  Glasgow, 
1875. 

The  Longevity  of  Brain  Workers.  By 
G.  M.  Beard,  MiD.     (New  York.) 

An  illustrated  Report  of  the  Chemical 
and  Microscopical  Examination  of  the 
potable  Water  of  Cape  Coast  Castle  during 
the  late  Ashantee  War.  By  J.  Fleming, 
M.D.,  Surgeon  and  Pathologist  to  the 
Expedition. 

On  some  Microscopic  Leaf  Fungi  from 
the  Himalaya.  By  Joseph  Fleming, 
M.D.,  &c.     (Reprint.) 

Reports  of  the  Asylums  of  Middlesex, 
Sussex,  Hants,  Halifax  (Nova  Scotia), 
Hereford,  Edinburgh,  New  York  State 
Asvlum,  Utica. 

Reports  (weekly  and  monthly)  of  Births 
and  Deaths  from  the  Registrar  General. 

The  Army  Medical  Service  in  the  Past 
and  Future;  an  Expostulation  By  A. 
M.  D.    Loudon,  Churchills.     1875. 


On  the  Excretion  of  Nitrogen  in  the 
Urine.  By  J.  B.  Power.  (Reprint.) 
Dublin.     1875. 

Scleritis  Syphilitica,  its  Pathology, 
Course,  and  Treatment.  By  F.  It. 
SturgisM.D.    (Reprint.)  New  York. 1875. 

The  Patent  Question  in  1875  :  the  Lord 
Chancellor's  Bill  and  the  Exigencies  of 
Foreign  Competition.  By  R.  A.  Macfie. 
London,  Longmans. 

Twenty-seventh  Annual  Report  of  the 
Trustees  of  the  Massachusetts  School  for 
Idiotic  and  Feeble-minded  Youth.  Boston. 
1875. 

Forty-third  Annual  Report  of  the 
Trustees  of  the  Perkins  Institution  and 
Massachusetts  Asylum  for  the  Blind. 
Boston.     1875. 

Address  of  the  President  of  the  Royal 
College  of  Physicians  to  the  Fellows  at 
the  Annual  Meeting,  22nd  March,  1875. 

Wildungen,  its  Baths  and  Mineral 
Waters.  By  Dr.  A.  Stoecker.  Translated 
from  the  German  by  Charles  Harrer,  M.D. 
London,  Triibner.     1875. 

The  Present  Status  of  Electricity  in 
Medicine.  By  W.  F.  Hutchinson,  M.D. 
Providence,  Rhode  Island.     1875. 

Report  of  the  Sanitary  Condition  of 
Birkenhead  for  1874.  By  Francis  Vacher, 
Medical  Officer  of  Health. 

The  Province  of  Psychology.  The  In- 
augural Address  at  the  first  meeting  of 
the  Psychological  Society  of  Great  Britain. 
By  the  President,  Mr.  Serjeant  Cox. 
London,  Longmans.     1875. 

Contributions  to  Clinical  Thermometry. 
By  James  Sawyer,  M.D.  (Reprint.)  Bir- 
mingham.    1875. 

The  Medical  Press  and  Homoeopathy. 
(Reprint.)     London.     1875. 

Rupture  of  the  Perinaeum,  with  a  De- 
scription of  a  New  Operation.  By  D.  W. 
Brickell,  M.D.     (Reprint.) 

The  Graphical  Representation  of  the 
Movements  of  the  Chest-wall  in  Respira- 
tion. By  Arthur  Ransome,  M.D.  Loudon. 
1875. 

An  Address  delivered  at  the  Annual 
Meeting  of  the  Bath  and  Bristol  Branch 
of  the  British  Medical  Association,  1874, 
on  the  Progress  and  Changes  in  Oph- 
thalmic Surgery.  By  Frederick  Mason, 
President  of  the  Branch.     Bath.     1874. 

On  the  Sense  of  Taste,  and  its  Relation 
to  Facial  Paralysis  and  Anaesthesia.  By 
A.  Davidson,  M.D.,  Physician  to  the 
Liverpool  Northern  Hospital,  &c. 

On  the  Treatment  of  Secondary  Syphilis. 
By  J.  L.  Milton.     (Reprint.)     1875. 

Rules  for  the  General  Management  of 
Infants,  recommended  by  the  Obstetrical 
Society  of  London.     1875. 

Myringomycosis  Aspergillina  (Fungus 
Ear  Disease).  By  J.  P.  Cassells,  M.D. 
Glasgow.     1875. 

The  Science  of  Disinfection.  By  John 
Dougall,  M.D.     Glasgow.     1875. 

Sir  Charles  Bell  and  Sir  James  Simpson : 


252 


Books,  §-c.,  received  for  Review.  [July,  1875. 


a  Biographical  Study.  By  Sampson  Gam- 
gee,  F.R.S.E.  Birmingham.     (Reprint). 

Delancey  Fever  Hospital  Keport  for 
1874.     Cheltenham. 

Professor  Volkmannon  Antiseptic  Osteo- 
tomy.    Edinburgh.     1875.     (Reprint). 

Impressions  of  German  Surgery.  By 
James  F.  "West,  F.R.C.S.  Birmingham. 
1875. 

On  the  Mechanical  Structure  of  the 
Cancellous  Tissue  of  Bone.  By  W.  W. 
Wagstaffe.     (Reprint.)     London.     1875. 

New  Inventions  in  Surgical  Mechanisms. 
ByRichard  Davy,  F.R.C.S.  London.  1875. 

Ichthyosis  of  the  Tongue  and  Vulva. 
By  Robert  F.  Weir,  M.D.  (Reprint.) 
New  York.     1875. 

Medical  Reports  for  the  half  year, 
1874,  forwarded  by  the  Surgeons  to  the 
Customs  at  the  Treaty  Ports  in  China. 
Shanghai.     1875. 

Annual  Report  of  the  Devonshire  Hos- 
pital and  Buxton-Bath  Charity  for  1874. 

Pythogenic  Pneumonia.  By  T.  W. 
Grimshaw,  M.D.,  aud  J.  W.  Moore,  M.D. 
(Reprint.)     Dublin.     1875. 

Opiophagism  ;  or,  Psvchology  of  Opium- 
eating.  By  W.  A.  F.  Browne,  M.D. 
(Reprint.)     London.     1875. 

Remarks  on  the  Origin,  Varieties,  and 
Terminations  of  Idiocy.  By  G.  W. 
Grabham,  M.D.     Earlswood.     1875. 

Analysis  of  One  Thousand  Cases  of  Skin 
Disease ;  with  Remarks  on  Treatment. 
By  L.  D.  Bulkley,  M.D.  (Reprint.) 
Louisville.     1875. 

On  the  Treatment  of  Simple  Fracture 
of  the  Shaft  of  the  Clavicle.  By  Francis 
Vacher.     (Reprint.)     1875. 

Note  sur  le  Cerveau  d'une  Imbedle. 
ParleDr.  S.Pozzi.  Paris,  E.  Leroux.  1875. 

Ectasie  Aneurismoide  interne  de  1' 
Art^re  radiale  consecutive  a  une  Brulure. 
Par  le  Dr.  S.  Pozzi. 

Jahresbericht  der  allgemeinen  Poli- 
kUnik  in  Wien  fiir  1874.     Wien.     1875. 


Journals. 
Dublin    Journal    of   Medical    Science. 
(Monthly.) 
Edinburgh  Medical  Journal.  (Monthly.) 
Journal  of  Mental  Science.    (Quarterly.) 
Journal  of  Anatomy   and   Physiology. 
Conducted   by   G.    M.    Humphry,   M.D., 
F.R.S.,  and  W.  Turner,  M.B.,  &c.   Second 
Series.     No.  XVI.     London,  1875. 
Irish  Hospital  Gazette.     (Monthly.) 
Journal  of  Psychological  Medicine  and 
Mental  Pathologv.    Edited  by  L.  S.  Forbes 
"Winslow,  M.B.,  D.C.L.  New  Series.  No.  I. 
April,  1875.    London,  Smith,  Elder  &  Co. 
Indian  Medical  Gazette.     (Monthly.) 
Canada  Medical  and  Surgical  Journal. 
(Monthly.) 

Medical  and  Surgical  Review  (Austral- 
asian).   (Monthly.) 

Melbourne  Medical  Record.    Vol.   IV. 
1875.     (Weekly.) 


Lancet,  Medical  Times  and  Gazette, 
Journal  of  the  British  Medical  Association, 
and  the  Medical  Press  and  Circular. 
(Weekly.) 

New  York  Medical  Journal.    (Monthly.) 

Chicago  Journal  of  Nervous  and  Mental 
Disease.     (Monthly.) 

The  American  Practitioner.    (Monthly.) 

Archives  of  Dermatology  :  a  Quarterly 
Journal  of  Skin  and  Venereal  Diseases. 
Edited  by  L  D.  Bulkley,  M.D.  New  York. 
Nos.  I.  and  II. 

The  American  Journal  of  Obstetrics  and 
Diseases  of  Women  and  Children.  Edited 
by  Paul  F.  Munde,  M.D.     (Quarterly.) 

The  Druggist.    New  York.    (Monthly.) 

Philadelphia  Medical  Times.  (Weekly.) 

New  Remedies  :  a  Quarteily  Retrospect 
of  Therapeutics  and  Pharmacy.  Edited 
by  F.  A  Castle,  M.D.  New  York  April, 
1875. 

Schmidt's  Jahrbiicher  der  Gesammten 
Medicin.     (Monthly.) 

Archiv  fUr  Gynakologie  redigirt  von 
Crede  und  Spiegelberg.  Bund  VII. 
Berlin.     1875. 

Archiv  fiir  Pathologische  Anatomie  und 
Physiologie.  Von     Rudolf    Virchow. 

Monthly.    1875. 

Vierteljahresschrift  fiir  Dermatologie 
und  Syphilis.  Heft  2  und  3.  Wien. 
1874. 

Deutsches  Archivfur  Klinische  Medicin . 
Band  XV.  Heft  3  und  4.  Leipzig. 
1875.  ^    ^ 

Nordiskt  Medicinskt  Arkiv,  Redigeradt 
af  Dr.  Axel  Key.  Stockholm,  1875. 
Bund  VII.     Heft  1. 

Archives  Geuerales  de  Medecine. 
(Monthly.) 

Bulletin  General  de  Therapeutique. 
(Fortnightly.) 

Gazette  Hebdomadaire.     (Weekly.) 

Revue  des  Sciences  Medicales  en  France 
eta  I'E Iran ger.     (Quarterly.) 

Gazette  Medicale  de  Bordeaux.  (Fort- 
nightly.) 

Journal  des  Sages-Femmes.  Edited 
by  H.  Fontan.     (Fortnightly.) 

Annales  des  Maladies  de  I'Oreille  et  du 
Larynx.  No.  I.  March,  1875.  Paris, 
Masson. 

Annales  de  Dermatologie  et  de  Syphili- 
graphic  publiees  par  le  Dr.  A.  Doyon. 
Paris,  Masson. 

Bulletins  et  Memoires  de  la  Societe  d« 
Chirurgie  de  Paris.  Tome  I.  No.  4. 
Paris,  Masson.     1875. 

Annali  Universali  di  Medicin  a  e  Chi- 
rurgia.     March  aud  May.     1875.     Milan. 

Lo  Sperimentale  for  March,  1875. 
(Monthly.) 

0  Correio  Medico  de  Lisboa.  (Fort- 
nightly.) 

El  Amfiteatro  Anatdmico  Espanol. 
(Weekly.) 

Gaceta  Medico-Quirurgica  Jerezana. 
Ano  I.     No.  3.     Abril,  1875. 


THE 

BRITISH    AND    FOREIGN 

MEDICO-CHIRURGICAL  REVIEW. 

OCTOBEE,    1875. 
^nalptical  anli  OTritical  Mebietog. 


I. — The  Present  Position  of  Antiseptic  Surgery  from  a  Practical 
Point  of  View. 

What  is  "  antiseptic  surgery  "  in  the  sense  in  which  Lister 
and  those  who  have  endeavoured  to  understand  and  follow  out 
his  process  and  method  understand  the  term  ?  This  is  by  no 
means  a  very  easy  question  to  answer. 

In  the  first  place  it  is  not  a  wild,  energetic,  and  indiscrimi- 
nate use  of  carbolic  acid  as  a  lotion,  an  unguent,  a  paste,  or  a 
bandage.  No  amount  of  carbolic  acid,  unless  used  under  special 
precautions  and  with  special  aims,  can  of  itself  make  a  dressing 
antiseptic  in  Lister^s  sense  of  the  word.  The  keynote  of  his 
method  is  struck  when  the  surgeon  says  I  am  to  aim  at  the 

^  1.  Cases  illustrative  of  the  Antiseptic  Use  of  Carbolic  Acid.  By  Joseph 
Bell,  F.K.C.S.     Edinburgh,  1869. 

2.  Address  in  Surgery  at  Annual  Meeting  of  British  Medical  Association  held 
at  Plymouth,  August,  1871.     By  Joseph  Listee,  F.R.S. 

3.  Lister's  Lectures  in  'British  Medical  Journal,'  January  14th,  1871. 

4.  An  Inquiry  into  the  Theory  and  Practice  of  Antiseptic  Surgery.  By  JAME3 
CuMMiNG,  M.D.,  M.K.C.P.E.,  L.R.C.S.E.     Edinburgh,  1872. 

5.  Langstaff  on  Hospital  Hygiene,  1872. 

6.  Du  Traitement  des  Plaies  en  General  et  en  Particulier  d'un  Mode  Nouveau 
de  Pansement  Antiseptique,    Par  le  Docteur  Louis  Beau  de  Toulon,  1873. 

7.  Sulla  Medicatura  Antiseptica  alia  Lister  in  ^hirurgia.  Pel  Dr,  Gesualdo 
Clementi.     Catania,  1874. 

8.  Volkman  on  Subcutaneous  Osteotomy.     '  Edin.  Med.  Journal,'  1875. 

9.  Papers  on  Antiseptic  Surgery.  By  Joseph  Listee,  in  '  Lancet,'  passim, 
1875,  and  in  '  Edin.  Medical  Journal,'  Sept.  1875. 

10.  Annandale's  New  Operation  for  Knock-knee.  '  Edin.  Med.  Journal,'  July, 
1875,  p.  19. 

11.  Klinische  Ergebnisse  der  Lister'schen  Wundbehandlung  und  ilber  denJErsatz 
der  Carbolsaure  durch  Salicylsdure.  Von  C.  Thieesch.  Volkmann,  •  Samm- 
lung  klinischer  Vortrage,'  Nr.  84  and  85. 

On  the  Clinical  Results  obtained  by  Lister's  Treatment  of  Wounds,  and  on  the 
Substitution  of  Carbolic  Acid  by  Salicylic  Acid.  By  Professor  C.  Thieesch,  of 
Leipzig.    Volkmann's  '  Collection  of  Clinical  Lectures,'  Nos.  84  and  85. 

112— LYI.  17 


254  tieviem.  [Oct., 

prevention  of  putrefaction  in  a  given  sore,  abscess,  amputation 
wound,  or  compound  fracture.  I  am  not  to  be  satisfied  by 
deodorizing  it  or  concealing  it  when  it  has  once  begun.  Carbolic 
acid  may  be,  and  doubtless  is,  often  with  advantage  used  as  a 
deodorizer,  in  the  same  way  that  permanganate  of  potash  in 
solution  is  most  valuable  in  a  ward  or  applied  to  a  sore  fetid 
with  the  gases  of  putrescence.  It  may  make  an  excellent  stimu- 
lant and  caustic  to  a  sloughing  chancre,  and  act  in  its  own  way, 
as  nitric  acid  or  bromine  do,  with  the  best  effects ;  but  in  none 
of  these  ways  does  it  act  as  an  antiseptic  dressing  in  the  sense 
in  which  Lister  uses  the  word. 

Nor  is  it  necessary  for  an  antiseptic  dressing  that  carbolic 
acid  be  used  at  all.  There  are  other  agents  which  have  been 
used,  and  others  may  be  discovered,  far  better  for  the  purpose. 
Carbolic  acid  has  many  inconveniences  and  even  disadvantages. 
We  believe  that  many  of  the  misconceptions  regarding  the  mode 
of  treatment,  and  much  of  the  want  of  confidence  felt  in  its 
results,  have  arisen  from  the  confusion  in  the  minds  of  surgeons 
between  carbolic  acid  as  a  general  panacea  for  surgical  ills,  and 
the  special  use  which  Lister  has  made  of  it  as  a  convenient 
vehicle  in  his  antiseptic  dressing. 

Let  us  inquire,  then,  first.  What  is  the  principle  on  which 
true  antiseptic  surgery  is  based  ?  2nd,  What  are  the  methods 
by  which  he  endeavours  to  carry  out  and  apply  this  principle  ? 
and  -this  second  head  will  demand  a  little  historical  retrospect 
into  the  past  as  well  as  a  description  of  the  present ;  and,  ord. 
What  are  the  results  obtained  by  Lister  and  others  ?  There 
will  also  open  up  to  our  mind  a  fourth  most  difficult  question 
to  settle — we  fear  almost  impossible  with  our  present  knowledge, 
and  yet  one  for  which  the  profession  must  ask  for  an  answer : 
i.  e.  Is  this  great  theoretical  discovery  to  become  a  practically 
useful  one  ;  is  mankind  to  be  the  better  for  it  -,  can  it  be  used 
in  private  as  well  as  in  an  hospital;  is  the  ordinary  practitioner, 
in  his  country  rounds,  bound  to  make  himself  the  slave  of  a  most 
elaborate  and  expensive  and  time-consuming  mode  of  dressing 
his  patients  ?  If  he  does  not  do  so  is  he  diminishing  their 
chances  of  recovery  ?  If  he  does  use  it  is  he  alleviating  their 
sufferings,  shortening  their  sickness,  and  hastening  their  cure  ? 

These  are  questions  to  the  conscientious  and  painstaking 
surgeon  of  almost  infinite  importance ;  the  responsibility  is  great 
in  trying  to  answer  them ;  and  alas  !  as  yet  the  data  are  few. 
While  theoretical  castles  in  the  air  raise  their  heads  into  an 
ether  in  which  all  germs  have  been  either  killed  or  rendered 
harmless,  the  steady  foundation  of  well-recorded  cases,  with 
accurate  observations  of  pulse  and  temperature,  are  few  and  far 
between.     Isolated  cases,  wonderful  in  their  loneliness,  general 


1875.]  Present  Position  of  Antiseptic  Surgery.  255 

conclusions,  dealing  in  the  vaguest  manner  with  hospital 
hygiene,  tell  ns  too  much  or  not  enough.  "  Pysemia  and  hos- 
pital gangrene  have  been  banished  from  the  hospital  since  the 
antiseptic  methods  have  been  used;"  indeed,  very  gratifying, 
but  not  so  remarkably  confirmatory  of  the  value  of  antiseptics, 
if  they  have  been  banished  equally  from  the  wings  of  the  hos- 
pital in  which  antiseptic  surgery  has  been  used  and  those  in 
which  it  has  not. 

In  this  short  notice  we  can  do  little  more  than  group  together, 
in  as  short  and  compact  a  way  as  possible,  a  few  of  the  scattered 
materials  we  have  on  which  to  form  an  estimate  of  the  method, 
value,  and  results  of  the  surgical  dressing  known  as  Lister's 
antiseptic  dressing. 

The  principle  on  which  the  antiseptic  method  of  treatment  is 
based  may  appear  to  be  comparatively  unimportant ;  it  might  be 
supposed  to  be  sufficient  to  carry  out  the  details  aright.  Not 
so,  however,  is  it  in  the  estimation  of  Professor  Lister.  While  we 
do  not  find  him  saying  that  the  method  must  stand  or  fall  into 
Pasteur's  theory,  yet,  in  his  opinion,  it  is  on  this  theory  that 
the  antiseptic  system  of  treatment  is  based.  In  July,  1868,  in 
an  address  delivered  before  the  Medico-Chirurgical  Society  of 
Glasgow,  in  directing  the  attention  of  the  society  to  an  experi- 
ment founded  on  one  of  Pasteur's,  but  with  slight  modification, 
he  says — 

*'  On  this  theory  the  antiseptic  system  of  treatment  is  based,  and 
I  venture  to  say,  that  without  a  belief  in  the  truth  of  that  theory 
no  man  can  be  thoroughly  successful  in  the  treatment.  If  any  one 
believes  that  putrefaction  through  atmospheric  influence  is  due  to 
the  operation  of  the  atmospheric  gases  alone  upon  the  putrescible 
materials,  he  will  be  perpetually  meeting  with  the  most  perplexing 
anomalies,  and  will  be  liable  to  commit  the  most  serious  practical 
blunders  ;  the  truth  being  that  on  the  one  hand  the  most  complete 
exclusion  of  the  gases  of  the  air  affords  no  security  against  the 
occurrence  of  putrefaction,  and  that  on  the  other  hand  the  freest 
admixture  of  air  into  the  putrescible  contents  of  a  wound  or  abscess 
will  fail  to  induce  putrefactive  changes,  if  the  germs  if  that  air 
have  been  removed  by  filtration  or  deprived  of  vitality  by  a  germ 
poison."  1 

Again,  in  1871,  Mr.  Lister  gives  still  stronger  expression  to 
the  same  opinion,  and,  to  avoid  repetition,  and,  at  the  same 
time,  to  state  fairly  his  own  views,  we  must  allow  him  to  speak 
for  himself  as  to  the  importance  of  the  principle : — 

"Among  the  causes  which  have  hitherto  interfered  with  the 
general  acceptance  of  this  mode  of  treatment,  by  far  the  most  preju- 
dicial is  the  doubt  of  its  fundamental  principle  instilled  by  various 

1  *  British  Medical  Journal '  for  July  IStli,  1868,  p.  54. 


256  Reviews,  [Oct,^ 

authors  who  have  opposed  the  germ-theory  of  putrefaction,  and  who, 
supposing  themselves  to  be  advocating  the  cause  of  truth,  have  not 
only,  as  it  appears  to  me,  espoused  the  side  of  error,  but  have  un- 
consciously inflicted  an  amount  of  material  evil  upon  their  fellow- 
creatures  such  as  mere  speculative  opinion  is  seldom  able  to  produce. 
Tor  few  medical  men  in  active  practice  have  the  leisure  to  sift  and 
weigh  the  facts  and  arguments  of  such  a  discussion;  yet,  if  they 
lose  firm  faith  in  the  guiding  principle  of  the  treatment,  the  attain- 
ment of  a  full  measure  of  success  becomes  with  them  a  matter  of 
impossibility.  *  Felix  qui  potuit  rerum  cognoscere  causas '  was 
never  more  applicable  than  here." 

And  next  as  to  the  facts  on  which  the  principle  is  founded  : 

*'  Those  of  which  I  have  first  to  speak  have  reference  to  the  well- 
known  experiment  of  Pasteur  of  boiling  a  putrescible  liquid  in  a 
flask  with  an  attenuated  and  contorted  neck.  It  is  now  nearly  four 
years  since  I  introduced  portions  of  the  same  specimen  of  urine  into 
four  glass  flasks,  so  as  to  make  each  about  one  third  full,  and,  after 
washing  their  necks,  drew  them  out  with  a  spirit-lamp  into  tubes 
less  than  a  line  in  diameter,  and  then  bent  three  of  them  at  various 
acute  angles,  while  the  fourth  was  left  short  and  vertical,  though 
equally  narrow.  Each  flask  was  then  boiled  for  five  minutes,  the 
steam  issuing  freely  from  the  orifice ;  after  which  they  were  left 
with  the  ends  of  the  necks  still  open,  so  tliat  air  might  pass  in  and 
out  freely  in  obedience  to  the  condensation  and  expansion  caused  by 
the  diurnal  changes  of  temperature.  The  boiling,  I  need  hardly  say, 
was  for  the  purpose  of  killing  any  organisms  contained  in  the  liquid 
or  adhering  to  the  side  of  the  glass :  the  bending  of  the  necks  in 
three  of  the  flasks  was  with  the  view  of  intercepting  particles  of 
dust,  which,  according  to  the  germ-theory,  are  the  cause  of  putre- 
faction, as  distinguished  from  the  atmospheric  gases ;  while  the 
fourth  neck  was  left  short  and  vertical  for  the  sake  of  contrast,  to 
aff'ord  opportunity  for  dust  to  fall  into  the  liquid,  where  such 
portions  of  it  as  had  the  nature  of  living  organisms  might  propagate 
and  induce  in  the  fluid  any  changes  of  which  they  were  capable.  The 
result  was,  that  in  the  vessel  with  short  and  upright  neck  two 
different  kinds  of  fungi,  visible  to  the  naked  eye,  soon  made  their 
appearance,  and  these  grew  steadily  till  they  had  attained  large 
dimensions,  the  liquid  meanwhile  gradually  changing  from  its  pale 
straw  colour  to  a  deep  amber  tint,  implying  alteration  in  its  chemi- 
cal constitution.  But  in  the  flasks  with  bent  necks  the  fluid  remains 
to  this  day  entirely  unaltered.^  I  regret  that  the  distance  from 
Edinburgh  to  Plymouth  is  too  great  to  permit  me  to  bring  these 
objects  before  you.  One  perilous  journey  they  have  already  had, 
when  I  took  them  from  Glasgow  to  Edinburgh  nearly  two  years 
ago,  nursing  them  carefully  during  the  railway  journey,  to  the 
amusement  of  my  fellow-travellers ;  and  in  the  drive  from  the  station 

^  Some  minute  sliining  crystals  have  of  late  been  deposited  on  the  bottom  of 
the  flasks,  probably  from  condensation  through  the  very  slow  evaporation  con- 
stantly go'mg  on. 


1875.]  Present  Position  of  Antiseptic  Surgery,  257 

to  my  house  the  violent  rocking  of  the  vehicle  churned  up  their 
contents  till  the  upper  part  of  the  body  of  each  flask  was  full  of  a 
frothy  mixture  of  the  putrescible  liquid  with  the  atmospheric  gases  ; 
yet  no  harm  resulted,  and  the  fluid  in  the  bent  flasks  still  retains  its 
original  pellucid  clearness  and  pale  hue.  Briuging  these  in  imagina- 
tion before  you,  as  represented  in  this  diagram,  consider  what  these 
facts  imply.  Let  us  not  push  them  one  tittle  beyond  their  inevitable 
interpretation.  The  drops  of  moisture  deposited  in  the  bent  tubes 
from  condensation  of  the  steam  when  the  lamp  was  removed  dried 
up  in  a  few  days,  so  that  the  necks  have  been  for  nearly  four  years 
open  and  dry  from  end  to  end.  Comparing  the  capacity  of  the  part  of 
the  body  of  the  flask  containing  air  with  that  of  the  narrow  neck, 
it  is  manifest  that  a  considerable  portion  of  fresh  air  has  passed 
into  the  flask  every  night,  in  consequence  of  the  fall  of  the  tempera- 
ture, a  corresponding  portion  passing  out  again  by  day,  though  not 
the  same  which  entered ;  for  the  difi"usion  of  gases  would  ensure 
its  mixing  freely  with  that  previously  present.  Hence,  during 
nearly  four  years  this  putrescible  liquid,  this  boiled  urine,  has  been 
freely  exposed  to  the  influence  of  the  atmospheric  gases,  yet  it  has 
not  putrefied.  About  half  a  year  after  the  commencement  of  the 
experiment  I  decanted  a  little  of  the  liquid  from  one  of  the  bent 
flasks  into  a  wineglass,  and  found  it  sweet  in  odour  and  faintly  acid 
to  test-paper,  while  an  honest  search  with  a  powerful  glass  failed  to 
detect  even  the  minutest  organism.  Covering  the  glass  to  prevent 
evaporation,  I  found  it  in  two  days  stinking,  while  under  the  micro- 
scope it  already  teemed  with  various  organisms,  and  a  few  days  later 
it  showed  fungi  to  the  naked  eye.  Thus  the  fluid  was  demonstrated 
to  be  still  putrescible  and  a  favorable  nidus  for  organic  develop- 
ment ;  yet  both  these  changes  have  been  prevented  for  nearly  four 
years  by  the  circumstance  that  the  air,  in  gaining  access  to  it,  had 
to  pass  through  a  narrow  bent  tube  of  clean  dry  glass.  Now  such 
a  tube  could  not  by  possibility  arrest  any  atmospheric  gas.  It  can- 
not possibly  have  stopped  anything  but  the  atmospheric  dust.  It 
follows,  therefore,  not  as  a  matter  of  theory,  but  as  an  inevitable 
inference  from  fact,  or,  in  other  words,  as  a  truth,  that,  so  far  as 
this  particular  instance  of  a  putrescible  liquid  is  concerned,  both  the 
development  of  such  organisms  as  the  microscope  enables  us  to 
detect,  and  the  concomitant  putrefactive  changes,  are  occasioned  by 
particles  of  dust  suspended  in  the  atmosphere,  but  not  by  the  at- 
mospheric gases.  I  confess,  Mr.  President,  I  am  ready  to  blush 
for  the  character  of  our  profession  for  scientific  accuracy  when  I  see 
the  loose  comments  sometimes  made  upon  this  experiment ;  and  I 
am  tempted  to  doubt  whether  some  of  the  commentators  can  have 
enjoyed  the  advantages  of  sufficient  education  either  in  chemical 
physics  or  in  logic.  The  simplicity  and  perfect  conclusiveness  of 
the  experiment  constitute  its  great  charm,  and  render  it,  as  it  appears 
to  me,  deserving  of  your  careful  consideration.  Yet,  having  before 
published  an  account  of  it,  although  nearly  two  years  have  since 
elapsed,  so  as  to  add  considerably  to  its  weight,  I  do  not  know  that 
I  should  have  felt  justified  iri  bringing  it  forward  on  the  present 


258  Reviews.  -  [Oct., 

occasion,  if  I  have  not  an  additional  fact  to  communicate  respecting 
it  besides  the  results  of  further  lapse  of  time.  We  have  seen  that 
we  have  been  forced  to  the  conclusion  that,  though  the  gases  of  the 
air  certainly  pass  into  the  body  of  the  flask  and  out  again  every 
twenty-four  hours,  its  dust,  even  though  of  extreme  minuteness, 
must  be  arrested  by  the  contorted  tube.  Now,  inevitable  as  this 
inference  is,  it  will  be  satisfactory  to  have  it  converted  into  the 
position  of  an  observed  fact.  This  Professor  Tyndall's  simple  but 
beautiful  mode  of  investigation  with  a  condensed  beam  of  light  has 
lately  enabled  me  to  do.  Having  prepared  two  dry  glass  flasks, 
one  of  them  having  the  neck  drawn  out  and  contorted,  I  arranged 
them,  through  tbe  kind  assistance  of  my  colleague.  Professor  Tait, 
BO  that  the  body  of  each  was  pierced  by  a  beam  of  highly  condensed 
sunlight  in  an  otherwise  dark  apartment.  The  beam,  scattered  by 
the  floating  particles  of  dust,  showed  white  in  the  surrounding  dark- 
ness, within  the  flasks  as  well  as  without,  proving  that  the  air  within 
the  flasks  was  dusty  like  that  outside.  I  now  closed  with  sealing- 
wax  the  orifice  of  the  unbent  flask,  and,  leaving  the  other  open, 
allowed  both  to  remain  undisturbed  in  the  laboratory.  A  fortnight 
later  I  again  submitted  them  to  the  solar  beam,  condensed  as  before, 
and  now  found  that  in  both  flasks  alike  the  visible  part  of  the  beam 
terminated  abruptly  at  the  glass  on  each  side,  showing  that  in  both 
the  air  was,  as  Tyndall  expresses  it,  "  optically  empty,"  or,  in  other 
words,  that  it  was  destitute  of  even  such  minute  particles  of  floating 
matter  as  could  produce  the  faintest  nebulosity.  During  the  time 
between  the  two  observations,  the  force  of  gravity  had  led  to  the 
subsidence  of  even  the  minutest  floating  particles ;  and,  though  the 
changing  temperature  of  the  laboratory  had  of  necessity  induced  the 
daily  entrance  of  air  into  the  open  flask,  the  bent  form  and  fine 
calibre  of  the  tube  by  which  it  was  admitted  had  effectually  filtered 
it  of  suspended  material,  though  in  a  very  dusty  apartment. 

**  The  other  class  of  facts  in  this  division  of  the  subject  to  which 
I  am  anxious  to  direct  your  special  attention  was  also  suggested  by 
one  of  Tyndall's  experiments  with  the  condensed  luminous  beam — 
that,  namely,  in  which  he  proved  the  perfect  manner  in  which  cotton- 
wool filters  the  air  of  its  suspended  particles,  by  blowing  against  the 
beam  with  a  pair  of  bellows  having  a  mass  of  the  cotton  tied  over 
the  nozzle  ;  the  result  being  that  the  beam,  elsewhere  white  from 
illuminated  dust,  became  perfectly  black  at  the  part  on  which  the 
current  was  directed  through  the  cotton-filter:  hence  the  idea 
naturally  suggested  itself  that  cotton-wool  might  be  used  with  ad- 
vantage as  an  antiseptic  dressing.  Of  course  it  would  be  useless  to 
apply  ordinary  cotton  without  special  precautions,  for,  according  to 
the  germ-theory,  putrefactive  particles  must  exist  among  the  fibres 
and  lie  scattered  over  the  wool.  But  if  the  cotton  were  impregnated 
with  some  volatile  material  capable  of  destroying  the  vitality  of  the 
septic  organisms,  and  then  placed  upon  the  wound  after  washing  it 
with  a  lotion  containing  the  same  substance  in  solution,  the  result 
ought  to  be,  supposing  the  theory  true,  that,  after  the  volatile  anti- 
septic had  become  dissipated  by  diff'usion  from  the  dressing  and  from 


1 


1875.]  Present  Position  of  Antiseptic  Surgery.  259 

the  wound,  the  cotton-wool,  though  destitute  of  any  chemically  anti- 
septic properties,  should  effectually  prevent,  by  its  filtering  pro- 
perty, the  access  of  any  putrefactive  agents,  and  keep  the  wound 
sweet,  while  in  itself  a  perfectly  bland  and  unstimulating  applica- 
tion. Accordingly  I  prepared  four  samples  of  cotton- wool  by 
diffusing  through  each,  one  of  the  following  substances — chlorine 
gas,  sulphurous  acid  gas,  carbolic  acid  vapour,  and  the  vapour  of 
benzine — four  materials  very  dissimilar  in  chemical  properties,  but 
having  a  common  hostility  to  low  forms  of  life.  Chlorine,  sulphurous 
acid,  and  carbolic  acid,  are  well  known  to  have  such  a  property ; 
and,  knowing  that  benzine  is  used  by  the  entomologist  for  killing 
insects,  and  having  ascertained  by  experiment  the  potency  of  its 
vapour  for  the  destruction  of  pediculi,  I  thought  it  probable  that  it 
would  also  answer  our  purpose.  I  then  dressed  with  these  four 
kinds  of  prepared  cotton-wool  various  suppurating  sores,  excoria- 
tions, and  contused  wounds,  after  washing  the  surface  with  the 
corresponding  lotion,  or,  in  the  case  of  benzine,  with  the  undiluted 
material.  The  results  in  every  instance  corresponded  exactly  with 
theory.  After  about  twenty-four  hours'  exposure  at  the  temperature 
of  the  body,  the  cotton-wool  was  found  to  have  lost  the  odour  of  the 
antiseptic,  yet  the  blood,  serum,  or  pus,  as  the  case  might  be-,  re- 
mained perfectly  sweet  for  an  indefinite  period,  while  healing 
advanced  in  the  satisfactory  manner  that  might  be  anticipated  from 
the  absence  of  all  irritating  quality  in  the  dressings.  There  was, 
however,  one  circumstance,  highly  instructive  in  itself,  which  inter- 
fered sadly  with  the  utility  of  this  application ;  namely,  that,  if  the 
discharge  happened  to  be  sufficiently  copious  to  soak  through  the 
cotton-wool  and  appear  at  its  external  surface,  putrefaction  occurred 
throughout  the  entire  mass  of  the  moistened  part  down  to  the 
wound,  even  within  the  first  twenty-four  hours  after  the  dressing, 
if  the  fluid  were  sufficiently  copious  to  penetrate  within  that  period. 
It  is  only  when  dry  that  cotton-wool  can  arrest  the  progress  of 
microscopic  organisms,  which  have  ample  room  to  develope  among 
its  meshes  when  filled  with  a  putrescible  liquid. 

"  And  now,  gentlemen,  allow  me,  at  the  risk  of  seeming  tedious, 
to  endeavour  to  bring  home  to  you  a  little  more  closely  the  inference 
that  is  to  be  drawn  from  these  facts.  But,  first,  let  me  describe  in 
detail  the  manner  in  which  the  dressing  with  carbolated  cotton-wool 
was  practised.  The  cotton-wool  having  been  impregnated  with 
about  a  two  hundredth  part  of  its  weight  of  the  acid  in  the  form  of 
vapour,  the  surface  of  a  granulating  sore  or  abrasion  was  washed, 
together  with  a  portion  of  the  surrounding  skin,  with  a  solution  of 
the  acid  in  about  forty  parts  of  water.  A  piece  of  oiled  silk  of  the 
size  of  the  sore  was  then  applied,  to  prevent  the  dressings  from 
sticking  through  dryness.  Over  this  was  placed  a  piece  of  folded 
linen  rag,  rather  larger  than  the  oiled  silk,  and  impregnated  with 
the  carbolic  acid  vapour  in  the  same  manner  as  the  cotton- wool ;  the 
object  of  the  rag  being  to  absorb  the  discharge  and  prevent  it  from 
trickling  down,  as  it  was  otherwise  apt  to  do,  below  the  slightly  ab- 
sorbent cotton,  involving  its  early  appearance  at .  the  surface  and 


260  Reviews,  [Oct., 

consequent  spread  of  putrefaction  to  the  wound.  Lastly,  a  well 
overlapping  mass  of  the  carbolised  cotton-wool  was  securely  fixed 
by .  a  bandage.  The  result,  as  before  stated,  was  that,  though  all 
chemical  antiseptic  virtue  left  the  dressing  within  a  day  or  two, 
putrefaction  was  excluded  by  the  cotton-wool  for  any  length  of  time, 
provided  the  discharge  did  not  penetrate  to  the  exterior  of  the  mass. 
Consider,  now,  the  circumstances  of  the  serum  or  pus  that  oozed 
from  beneath  the  edges  of  the  oiled  silk  into  the  folded  rag  ;  let  us 
suppose  a  week  after  the  application  of  the  dressing,  when  all  traces 
of  the  volatile  antiseptic  had  certainly  disappeared.  Here  was  a 
highly  putrescible  liquid,  not  subjected  to  boiling,  as  in  the  flask  ex- 
periment, or  acted  on  by  any  chemical  agent  whatever,  yet  remaining 
free  from  putrefaction  in  a  rag  moistened  with  it  at  the  temperature 
of  the  human  body,  simply  because  it  was  covered  over  with  pure 
dry  cotton-wool.  How,  then,  did  this  cotton-w^ool  exclude  the  causes 
of  putrefaction  in  the  atmosphere  ?  It  certainly  did  not  keep  out 
any  of  the  atmospheric  gases.  The  same  cause  that  led  to  the 
escape  of  the  volatile  antiseptic  necessarily  occasioned  a  perpetual 
intermingling  between  the  external  air  and  that  between  the  meshes 
of  the  fabric,  as  any  one  acquainted  with  Graham's  beautiful  re- 
searches into  the  laws  of  gaseous  diffusion  must  at  once  admit.  The 
only  constituent  of  the  atmosphere  which  the  cotton-wool  would 
possibly  exclude  is  its  dust ;  and  this  we  know,  from  Tyndall's 
experiment,  it  did  exclude.  Here,  then,  we  have  another  inevitable 
inference  from  fact,  another  truth,  and  that  in  itself  all-sufficient, 
with  reference  to  the  antiseptic  system  of  treatment ;  the  truth, 
namely,  that  pus,  blood,  and  the  dead  tissues  in  contused  wounds 
do  not  putrefy  through  the  influence  of  the  atmospheric  gases,  but 
through  the  operation  of  particles  of  dust,  which  may  be  permanently 
deprived  of  septic  energy  by  the  vapour  of  an  agent  like  carbolic 
acid.  I  do  not  ask  you  to  believe  that  the  septic  particles  are 
organisms.  That  they  are  self-propagating,  like  living  beings,  and 
that  their  energy  is  extinguished  by  precisely  the  same  agencies  as 
extinguish  vitality,  such  as  heat  and  the  various  chemical  substances 
to  which  I  have  referred,  is  certain,  and  is  of  the  utmost  practical 
importance.  But  if  any  one,  in  spite  of  these  facts,  and  in  spite  of 
the  strong  analogy  of  the  yeast-plant,  and  the  various  kinds  of  fungi 
which  we  term  mould,  prefer  to  believe  that  the  septic  particles  are 
not  alive,  and  to  regard  the  vibrios  invariably  present  in  putnefying 
pus  or  sloughs  as  mere  accidental  concomitants  of  putrefaction,  or 
the  results,  not  the  causes,  of  the  change,  with  such  an  one  I,  as  a 
practical  surgeon,  do  not  wish  to  quarrel.  Nor  do  I  enter  upon  the 
question  whether  spontaneous  generation  can  take  place  at  the 
present  day  upon  the  surface  of  our  globe.  To  do  this  would 
be  to  engage  in  doubtful  disputations  which  I  promised  to  avoid. 

"  But  I  do  venture  earnestly  to  beg  of  all  of  you  who  are  engaged 
ill  surgical  practice,  that  you  will  give  these  simple  facts  your  care- 
ful consideration  ;  and  if  you  think  the  interpretation  I  have  given 
a  sound  one,  do  not  let  any  statements,  whether  in  books  or  in 
journals,  shake  joiir  belief  in  the  truth  that  putrefaction,  under 


1875.1  Present  Position  of  Antiseptic  Surgery.  261 

atmospheric  influence,  as  it  occurs  in  surgical  practice,  is  due  to 
particles  of  dust  ever  present  in  the  atmosphere  that  surrounds  our 
patients,  and  endowed  with  wonderful  chemical  energy  and  power 
of  self-propagation,  yet  happily  readily  deprived  of  energy  by  various 
agents  which  may  be  employed  for  the  purpose  without  inflicting 
serious  injury  upon  the  human  tissues.  With  this  as  your  guiding 
principle,  you  will  find  yourselves  successful  with  the  antiseptic 
system  of  treatment ;  but  without  it,  whatever  theory  you  adopt, 
you  will  ever  be  walking  in  the  dark,  and  therefore  ever  liable  to 
stumble." 

Having  thus  briefly  described  the  principle  on  which  anti- 
septic treatment  is  founded  as  far  as  possible  in  the  inventor's 
own  words,  we  will  now  give  a  brief  historical  resume  of  the 
stages  through  which  the  use  of  carbolic  acid  as  an  antiseptic 
agent  has  passed  in  the  hands  of  its  inventor  and  his  disciples, 
describing  at  some  length  and  in  full  detail  the  present  mode, 
and  then,  before  passing  on  to  discuss  results  and  objections, 
give  a  brief  notice  of  one  or  tw^o  other  antiseptic  agents  recently 
introduced,  either  as  handmaids  to  or  supplanters  of  carbolic 
acid. 

As  an  illustration  of  the  gradual  manner  in  which  the  anti- 
septic method  has  been  evolved,  and  the  numerous  changes 
through  which  it  has  passed  and  may  still  have  to  pass,  though 
the  principle  always  remains  the  same,  we  may  give  a  brief 
abstract  from  Dr.  Cumming's  excellent  thesis,  of  the  various 
ways  in  which  abscess  has  been  opened  and  dressed  antisepti- 
cally  between  1866  and  1871.  These,  again,  may  be  contrasted 
with  the  present  method,  described  afterwards. 

In  1866  a  piece  of  rag,  soaked  in  an  oily  solution  of  carbolic 
acid,  one  part  of  acid  to  four  of  oil,  is  laid  over  part  to  be 
opened.  The  upper  edge  of  this  being  kept  in  position  by  an 
assistant,  the  lower  edge  is  raised  by  the  surgeon,  and  liis  knife, 
previously  dipped  in  the  same  oily  solution,  is  plunged  into  the 
abscess,  under  the  curtain  of  the  rag,  which  is  at  once  dropped 
over  the  aperture  as  the  knife  is  withdrawn.  The  pus  is  then 
squeezed  out  from  under  the  rag,  a  piece  of  lint  soaked  in  the 
same  oily  solution  put  in  the  wound  to  keep  it  open,  and  the 
wound  is  then  covered  by  a  piece  of  block  tin,  on  the  under  sur- 
face of  which  a  layer  of  carbolic  paste  or  putty,  a  quarter  of  an 
inch  in  thickness,  is  spread.  (This  was  the  oil  mixed  with  pre- 
pared chalk,  and  seems  to  have  been  both  a  dirty  and  trouble- 
some application.)  The  tin  was  laid  on  with  adhesive  plaster, 
and  a  folded  towel  fixed  over  all  so  as  to  absorb  discharge,  and 
secured  by  a  bandage. 

At  every  subsequent  dressing  new  pieces  of  rag,  block  tin 
putty,  &c.,  were  to  be  used. 


262  Reviews.  [Oct., 

(Both  faith  and  patience  must  have  been  needed,  and  must 
have  been  often  severely  tried,  to  tempt  a  surgeon  in  this  nine- 
teenth century  to  work  away  with  such  troublesome  and  filthy 
applications.) 

1868. — A  double  layer  of  plaster  (lined  with  gutta  percha  and 
brushed  over  with  bisulphide  of  carbon)  was  substituted  for  the 
paste  dressing. 

(This  is  all  Dr.  Gumming  tells  us  of  the  plaster,  so  we  do  not 
know  its  constituent  parts.) 

1869. — Additional  cautions  are  needed.  Anoint  the  neigh- 
bouring parts  well  with  oily  solution  and  remove  any  hairs. 
The  piece  of  lint  as  drain  is  to  be  soaked  in  a  weaker  solution, 
1 — 10.  A  new  preparation,  consisting  of  shellac  1 — S  (?),  is 
applied  as  a  dressing,  overlapping  the  wound  by  several  inches, 
fixed  by  pieces  of  adhesive  plaster  two  and  a  half  inches  in 
breadth  (applied  equally  on  the  plaster  and  the  skin) .  A  syringe 
charged  with  carbolic  lotion  is  used  in  changing  the  dressings, 
the  nozzle  to  be  inserted  beneath  the  edge  of  the  plaster  to  refresh 
the  wound.  Sinuses  to  be  injected  with  a  lotion  of  1  part  of 
carbolic  acid  to  5  parts  of  methylated  spirit.  When  the  discharge 
has  diminished  a  weaker  shellac  plaster  may  be  used,  1 — 6. 

May,  1871. — Antiseptic  gauze  introduced  as  now  in  use, 
instead  of  the  lac  dressing,  changed  under  the  protection  of 
dropping  from  a  syringe  containing  a  1 — 40  solution  of  carbolic 
acid  in  water. 

Thus  there  has  been  a  double  line  of  improvement  steadily 
going  on  in  (1)  means  used  for  purifying  air  and  preventing 
entrance  of  germs  during  an  operation,  and  (2)  in  the  means  of 
dealing  with  the  inevitable  soaking  of  discharges,  blood,  serum, 
or  pus,  after  the  operation.  For  the  first,  the  lint  or  rag  soaked 
in  carbolized  oil  of  1866  has  improved  into  the  syringing  of 
1869-71,  the  hand  spray-producer  of  1871-75,  up  to  the  steam 
spray-producer  of  1875 ;  while  the  dressings  have  altered  from 
oiled  rag,  putty,  or  paste  on  block  tin,  shellac  plaster,  up  to 
antiseptic  gauze.  So  far  all  the  alterations  seem  to  have  been 
improvements,  though  still  to  many  surgeons  the  complexity  of 
the  dressings  and  the  constant  supervision  and  care  required 
will,  we  fear,  act  as  stumblingblocks  to  their  acceptance  of  the 
method. 

Listeria  Practice  in  1875. 

To  do  justice  to  his  method  it  is  still  necessary  to  give  details, 
for  success  depends  on  the  closest  attention  to  every  step  in  the 
process.  Let  us  take  the  mode  of  dealing  with  an  abscess,  a 
compound  fracture,  and  an  amputation  respectively. 

1.  An  abscess. — Let  us  suppose  a  p^ons  or  lumbar  one  which 


I 


1875.]  Preserit  Position  of  Antiseptic  Surgery,  J^63 

must  be  opened.  The  skin  in  the  neighbourhood,  after  the  most 
careful  washing,  is  still  further  to  be  purified  and  deprived  of 
any  septic  organisms  by  a  thorough  sponging  with  a  saturated 
watery  solution  of  carbolic  acid  (1 — 20).  The  dressing  is  to  be 
prepared,  drainage  tubes  of  various  sizes  at  hand,  a  piece  of  oil- 
silk  protective,  and  some  pieces  of  carbolic  gauze,  in  a  basin  with 
1 — 40  solution,  with  which  also  a  syringe  is  ready  loaded.  The 
knife  to  be  used  and  any  other  instrument  required  are  all  to  be 
previously  soaked  in  the  1 — SO  solution. 

The  dressing  is  composed  of  eight,  twelve,  sixteen,  or  even 
thirty- two  layers  of  the  carbolic  gauze.^  This  is  intended  to 
absorb,  and  at  the  same  time  to  render  harmless,  all  the  dis- 
charges which  are  to  come  from  the  abscess  between  the  first 
and  second  dressings;  but  lest  these  discharges  should  soak 
through  all  the  layers,  and  thus  reach  the  external  air,  and 
thence  absorb  septic  organisms,  there  is  put  between  the  outer 
layer  of  the  dressing  and  the  one  next  it  a  layer  of  some  imper- 
vious substance  (macintosh  cloth).  The  dressing  should  be 
large  enough  to  overlap  the  wound  to  be  made,  for  many  inches 
in  every  direction,  and  its  size  should  to  a  certain  extent  be 
proportioned  to  the  amount  of  discharge  expected  and  its 
nature. 

All  being  ready,  and  the  patient,  if  need  be,  thoroughly  under 
chloroform,  the  part,  hands  of  operator  and  assistants  being  again 
soaked  in  the  solution,  the  antiseptic  spray  is  set  to  work  over 
the  part,  either  by  hand-spray  producers,  or,  what  is  far  better, 
by  the  steam-engine  lately  introduced  for  the  purpose.  This 
spray  should  reach  the  part  in  a  state  of  fine  division,  and  not 
weaker  than  1 — 40.  The  knife,  previously  dipped,  should  then 
be  used  to  open  the  abscess  freely,  so  that  all  its  contents,  not 
merely  pus,  but  fragments  of  connective-tissue,  masses  of  coagu- 
lated albumen,  &c.,  be  freely  evacuated  without  pressing  or 
undue  squeezing.  The  incision  should  be  large  enough  to  avoid 
all  risk  of  retention  of  subsequent  discharge  and  consequent  in- 
flammatory tension.  A  drainage  tube  of  sufficient  calibre  is 
then  to  be  inserted  into  the  abscess,  long  enough  to  reach  to  the 
deeper  parts  of  it,  yet  not  so  long  as  to  curl  up  or  exert  any 
pressure.  Its  orifice  should  be  flush  with  the  surface,  and  it  is 
to  be  prevented  from  falling  into  the  abscess  and  being  lost,  by 
pieces  of  knotted  carbolized  threads,  which  are  to  be  left 
outside. 

A  good  illustration  of  the  method,  defects,  and  dangers  of  any 
mistake  in  the  use  of  drainage  tubes  is  found  in  the  following 
account  of  the  progress  of  a  case  in  which  Mr.  Lister  recently 

^  For  a  full  description  of  the  appearance  and  preparation  of  this  material, 
fiee  the  '  Lancet '  for  March  13th,  1875. 


264  Reviews.  [Oct., 

opened  into  an  inflamed  knee-joint  with  antiseptic  precautions 
and  inserted  a  drainage  tube.^ 

"  The  subsequent  progress  of  this  case  has  illustrated  well  the 
remarks  made  at  the  demonstration,  with  regard  to  the  effects  of  a 
free  opening,  or  the  contrary,  under  antiseptic  management.  When 
I  saw  the  patient  on  the  following  day,  I  learned  that  he  suffered 
unusual  pain  in  the  afternoon  after  the  operation,  which  became  very 
severe  during  the  night,  and  though  somewhat  less  in  degree  at  tlie 
time  of  my  visit,  was  still  very  considerable.  The  temperature  had 
risen  on  the  previous  evening  to  102'4°  F.,  and  was  now  101  "8°.  Such 
a  state  of  things  would  at  one  time  have  alarmed  me,  and  would  have 
made  me  fear  that  putrefaction  had  occurred.  This,  however,  I  felt 
confident  could  not  have  been  the  case,  and  another  probable  expla- 
nation suggested  itself.  The  peculiar  bulging  above  alluded  to, 
situated  over  one  of  the  pouches  of  the  synovial  capsule  beside  the 
ligamentum  patellae,  had  tempted  me  to  make  the  opening  in  that 
situation  ;  but  the  bulging  part  collapsing  on  escape  of  the  fluid,  the 
only  way  in  which  I  could  ensure  complete  introduction  of  the 
drainage-tubes  into  the  joint  was  by  passing  their  ends  under  the 
ligamentum  patellae  ;  and  I  thought  it  not  unlikely  that  they  might 
have  been  compressed,  and  their  function  so  interfered  with.  Accord- 
ingly, on  changing  the  dressing,  I  found  that  the  gauze  presented  a 
bloody  stain,  which  appeared  sufiiciently  accounted  for  by  oozing  from 
the  surface  of  the  wound  while  the  joint  was  fully  distended.  And 
it  appeared  that  the  disturbance  to  which  the  articulation  had  been 
subjected  had  led  to  unusually  rapid  effusion  from  the  synovial  sur- 
face, and  this  being  unable  to  escape,  had  produced  great  tension, 
attended  with  pain  and  fever.  I  at  once  placed  him  under  chloroform, 
and  made  a  fresh  incision  at  the  outer  side  of  the  limb  into  the  pouch 
above  the  patella,  and  introduced  a  drainage-tube  larger  in  diameter 
than  the  little  finger,  after  pressing  out  the  clear  serous  and  fibrinous 
contents  of  the  capsule.  This  was  of  course  done  with  antiseptic 
precautions,  and  a  dressing  like  that  employed  the  day  before  was 
applied.  The  result  was  that  almost  immediately  after  awaking 
from  the  chloroform  sleep,  he  felt  himself  entirely  relieved  of  his 
pain ;  and  not  only  has  that  which  was  induced  by  the  first  operation 
left  him,  but  he  has  entirely  lost  that  which  had  annoyed  him  for  so 
long  a  period  previously.  The  temperature  in  the  evening  was  found 
to  have  fallen  to  99°  F.,  and  has  since  remained  normal,  and  the 
discharge,  which  has  continued  to  be  merely  serous,  has  so  diminished 
in  quantity,  that  when  I  last  saw  him  (15th  August)  I  substituted  a 
drainage-tube  of  medium  size  for  the  large  one,  and  was  able  to  direct 
that  an  interval  of  three  days  should  be  allowed  to  pass  before  the 
next  dressing.  I  must  add,  that  he  has  tested  the  limb,  contrary  to 
orders,  by  getting  out  of  bed  and  resting  his  weight  upon  it,  but 
without  any  of  the  pain  which  he  had  formerly  experienced  on  so 
doing.     In  all  other  respects  he  is  in  perfect  health." 

If  a  drainage  tube  is  not  at  hand,  a  piece  of  lint  soaked  in  oil 
'  J  *'£din,  Medical  Journal,'  Sept.  1875,  pp.  198,  109, 


1875.]  Present  Position  of  Antiseptic  Surgery.  265 

in  1 — 10  carbolic  acid  will  make  an  excellent  substitute  ;  part  of 
it  should  be  inserted  between  the  lips  of  the  wound.  The  oil- 
silk  protective  strip  is  then  put  next  the  wound,  a  piece  of 
dipped  gauze  over  it,  and  the  large  dressing  over  all.  When  next 
day  the  surgeon  comes  to  dress  the  wound,  there  will  be  very- 
little  to  be  squeezed  out  of  it,  perhaps  only  a  little  transparent 
serum.  The  drainage  tube  may  be  withdrawn,  cleansed  in  car- 
bolic acid,  and  reintroduced  with  as  little  disturbance  as  pos- 
sible, and  new  dressing  applied  in  same  manner  as  before, 
still  under  the  protection  of  the  spray.  Day  after  day,  soon  at 
intervals  of  three  or  four  days,  this  may  be  repeated  ;  the  abscess 
cavity  rapidly  contracts  so  that  the  drainage  tube  must  be 
shortened  at  every  dressing  and  in  time  the  abscess  will  heal. 
But  till  the  last  trace  of  discharge  of  serum  is  gone  no  relaxa- 
tion in  the  vigilance  of  the  surgeon  can  be  permitted  and 
fullest  antiseptic  precautions  must  be  used,  or  all  may  go  Avrong. 
This  is  exceedingly  likely  to  take  place  from  weariness  on  the 
part  of  patient  or  surgeon  in  cases  of  psoas  or  lumbar  abscess 
connected  with  diseased  vertebrae,  in  which  the  duration  of  the 
treatment  must  be  measured  by  years  rather  than  months  or 
weeks. 

2.  A  compound  fracture.  The  wound  being  thoroughly 
washed  externally  and  if  necessary  the  hair  shaved  cleanly  off 
all  the  vicinity  of  the  injured  parts,  the  bone  is  replaced  and 
adjusted,  all  completely  loose  fragments  being  removed  and 
those  still  adherent  to  periosteum  replaced  in  position.  If  this 
cannot  be  done  without  undue  tension  a  portion  of  the  pro- 
truded end  of  bone  may  often  be  removed  with  advantage.  If 
recently  inflicted  it  is  then  sufficient  to  wash  out  the  wound 
carefully  by  a  syringe  loaded  with  1 — 40  carbolic  lotion.  If  of 
long  standing  a  stronger  lotion  may  be  needed.' 

3.  An  amputation.  If  sufficient  pains  be  taken,  an  antiseptic 
management  is  both  possible  and  may  be  very  advantageous. 
Let  us  suppose  a  railway  smash  involving  an  amputation  of  the 
thigh  in  a  muscular  man,  one  of  the  most  fatal  of  all  surgical 
injuries.  Such  a  case  will  exhibit  the  difficulties  and  disadvan- 
tages of  the  procedure  as  well  as  its  possible  gains. 

Collapsed  and  cold  as  the  patient  may  be,  the  first  essential  is 

1  For  cases  of  compound  fracture  seen  for  the  first  time  several  hours  after  tlie 
accident,  Mr.  Lister  has  of  late  used  a  still  stronger  antiseptic  in  the  form  of  one 
part  of  carbolic  acid  dissolved  in  five  parts  of  spirit  of  wine,  introduced  into  the 
recesses  of  the  wound  by  means  of  a  gum-elastic  catheter  connected  with  asyrinije 
by  a  piece  of  caoutchouc  tube.  In  this  way  the  antiseptic  is  made  to  penetrate 
the  coagula  in  the  various  parts  of  the  wound  more  effectually  than  it  could  be 
by  forcing  it  in  through  the  external  orifice,  while  at  the  same  time  we  avoid  the 
needless  disturbance  which  this  procedure  may  entail  in  consequence  of  the 
irritating  liquid  being  driven  for  a  greater  or  less  distance  through  the  cellular 
interstices  of  uninjured  parts. — '  Lancet,'  March  13th,  1875. 


266  Revieios.  [Oct,, 

the  removal  of  his  wet  dirty  clothing  and  the  most  careful  wash- 
ing of  the  limb  above  the  seat  of  injury  with  carbolic  lotion  ;  the 
hair  is  to  be  shaved  from  the  limb.  The  shattered  remains  of 
the  leg  are  to  be  enveloped  in  a  towel  wrung  out  of  carbolic 
acid,  and  confided  to  a  dresser.  The  tourniquet,  being  put  on 
high  up,  the  limb  and  operator  are  to  be  sprayed  upon  in  the 
freest  manner  all  through  the  operation.  The  vessels,  even  the 
femoral,  are  to  be  tied  with  carbolized  catgut ;  every  bleeding 
point  is  to  be  secured,  and  the  surface  of  the  wound  thoroughly 
washed  with  1 — 40  lotion.  The  edges  are  then  to  be  brought 
together  with  carbolized  silk  sutures  and  the  whole  wound  must 
be  thoroughly  drained,  to  prevent  retention  of  discharges,  either 
by  two,  three,  or  more  short  tubes  stuck  in  at  intervals,  or,  in 
some  situations  more  conveniently,  by  one  long  drainage  tube 
pierced  with  numerous  and  large  side-apertures  drawn  through 
the  whole  breadth  of  the  flaps  near  its  base.  Just  before  the 
dressings  are  applied  a  final  washing  of  the  stump  may  be 
given  by  syringing  through  the  drainage  tubes  with  1 — 40  lotion. 
A  large  dressing  is  then  ready  which  (after  the  exact  edge  of 
the  wound  has  been  first  covered  by  a  strap  of  oilsilk  protective 
and  a  deep  dressing  of  dipped  gauze')  is  to  be  rolled  round 
the  stump,  overlapping  it  by  some  inches  below,  and  reaching 
up  at  least  as  far  as  the  perinseum.  It  is  made  to  embrace  the 
limb  pretty  tightly  and  then  the  free  end  of  the  tube  is  folded 
so  as  thoroughly  to  close  it  in,  and  the  whole  affair  secured  in 
position  by  a  large  bandage  made  of  the  same  antiseptic  gauze 
as  the  dressing,  which  should  be  carried  up  as  a  spica  bandage 
to  take  at  least  two  or  three  turns  round  the  pelvis. 

We  have  now  briefly  discussed  the  principles  and  the  method 
in  which  carbolic  acid  is  used.  A  word  may  be  due  here  to 
other  antiseptic  agents  which  may  possibly  take  the  place  of  or 
supplement  carbolic  acid ;  these  are  chloride  of  zinc,  boric  acid, 
salicylic  acid. 

Chloride  of  Zinc. — Chloride  of  zinc,  a  powerful  escharotic, 
irritant,  astringent,  deodorizer  or  disinfectant,  according  to  the 
strength  and  method  in  which  it  is  used,  is  a  useful  agent  in 
antiseptic  surgery.  Well  known  to  surgeons  since  Mr.  Camp- 
bell de  Morgan's  interesting  paper  on  the  use  of  chloride  of  zinc 
in  surgical  operations  and  injuries,  it  is  used  not  only  in  the 
hope  of  destroying  germs  of  cancer  possibly  latent  in  the  vicinity 

^  The  use  of  these  may  be  best  explained  in  a  note.  The  oilsilk  protective  is 
put  along  the  edge  of  the  wound  to  prevent  the  irritating  effect  of  the  carbolic 
gauze  on  the  cut  surface  itself.  The  deep  dressing  of  dipped  gauze  is  merely  a 
strip  of  gauze  previously  soaked  in  carbolic  lotion,  so  as  at  once  to  destroy  and 
neutralize  any  germs  which  may  have  rested  in  the  protective  or  dressing.  That 
such  precautions  are  necessary  illustrates  both  the  complexity  and  difficulty  of 
the  whole  question, 


1875.]  Present  Position  of  Antiseptic  Surgery.  ^&t 

of  an  operation  undertaken  for  the  removal  of  the  original  growth, 
but  also  because  it  has  an  excellent  effect  in  preventing,  or 
perhaps  rather  postponing,  putrefactive  changes  in  granulating 
or  recent  wounds. 

In  superficial  cancerous  sores  it  is  an  excellent  escharotic 
and  at  the  same  time  so  far  an  antiseptic,  that  beneath  its 
scab  formed  over  the  sore,  healing  may  take  place  absolutely 
free  from  odour  or  contraction.  Mr.  Lister  has  pointed  out 
that  its  use  after  Mr.  de  Morgan's  method  after  excisions  of 
maxillary  bones  or  other  operations  about  the  face  greatly 
diminishes  or  prevents  the  subsequent  foetor  which  is  so  often 
communicated  to  the  breath  and  which  doubtless  has  in  it  an 
element  of  danger  by  possible  blood-poisoning.  Used  after 
excision  of  ^lamma,  we  have  sometimes  seen  it  followed  by  rapid 
healing,  if  free  exit  be  given  by  drainage  tube  or  otherwise  to 
the  large  amount  of  salmon-coloured  discharge  which  follows 
its  use  ;  in  other  cases,  again,  differing  in  no  very  marked 
way,  union  has  been  delayed  and  attended  by  excessive  sup- 
puration. 

Lister,  at  one  time,  seems  to  have  used  chloride  of  zinc  in 
solution  (40  grains  to  an  ounce  of  water)  as  an  application  to 
putrid  sinuses  (by  injection),  but  finding  that  if  used  too  strongly 
and  becoming  diffused  into  the  cellular  tissue  it  caused  slough- 
ing he  seems  now  to  have  given  up  its  use.^ 

Though  from  its  want  of  volatility  chloride  of  zinc  will  not 
do  as  a  permanent  antiseptic  dressing,  still  its  power  of  pre- 
venting suppuration  or  putrefaction  for  some  days  after  a  single 
application  to  a  cut  surface  renders  it  of  great  value  as  an  anti- 
septic in  many  operations,  as  it  gives  time  for  granulations  to 
form. 

Boracic  or  boric  acid  is  another  antiseptic  recently  introduced 
into  surgical  practice  in  this  country  by  Professor  Lister.  A  full 
account  of  his  obtaining  the  knowledge  of  its  virtues  from  Dr. 
Stang,  of  Sorweg,  in  Norway,  and  of  the  experiments  he  made 
with  it  will  be  found  in  his  lecture  on  improvements  in  the 
details  of  antiseptic  surgery  in  the  '  Lancet '  for  May  1,  1875. 

He  had  been  suffering  from  an  onychia  of  the  little  finger, 
and  found,  as  patients  not  unfrequently  do,  that  a  weak  watery 
solution  of  carbolic  acid  caused  almost  intolerable  pain,  and  yet 
did  not  destroy  the  pungent  ammoniacal  odour.  The  Swedish 
amykoSy  the  active  principle  of  which  is  boric  acid,  was  abso- 
lutely painless  and  yet  perfectly  removed  the  odour.  This  was 
the  starting-point  of  a  series  of  experiments  with  it  which  have 
proved  not  only  in  Mr.  Lister's  hands,  but  in  those  of  many 

1  '  Lancet,'  March  20th,  1875,  p.  401. 


268  Reviews.  [Oct., 

other  surgeons,  that  boric  acid  has  certain  valuable  qualities  as  a 
dressing. 

In  prurigo  ani  and  eczema  of  the  legs  it  is  sometimes  of 
great  value.  Stored  up  in  lint  in  very  considerable  quantity  it 
makes  an  excellent  mild,  comparatively  unirritating  antiseptic 
application  for  fetid  ulcers.  Such  storing  up  is  easily  managed, 
for  the  acid  is  dissolved  very  freely  in  boiling  water  and  very 
sparingly  in  cold  ;  so  that  lint  dipped  in  a  saturated  solution 
at  or  near  boiling  point  and  allowed  to  dry  will  be  found  to  have 
absorbed  a  very  large  amount  of  the  acid,  and  as  the  crystals 
are  soft  and  unctuous,  such  lint  makes  an  agreeable  dressing  as 
well  as  one  which  will  act  as  an  antiseptic  for  a  considerable 
time  even  in  cases  where  discharge  is  profuse. 

In  the  *  Edinburgh  Medical  Journal^  for  Sept.,  1874,  a  very  full 
account  is  found  of  the  method  of  using  the  acid  in  granulating 
wounds  by  Professor  Lister,  and  in  the  discussion  which  followed 
Mr.  Lister's  statement  Dr,  Chiene  stated  that  he  had  used 
boracic  acid  in  ointment  and  powder  in  eczematous  ulcers  so 
long  ago  as  1872. 

Salicylic  Acid. — Professor  Thiersch,  who  has  for  some  time 
been  using  Lister's  mode  of  dressing  wounds  antiseptically,  has, 
within  the  last  year,  been  using  salicylic  acid,  which  in  March, 
1874,  was  put  at  his  disposal  by  Professor  Kolbe. 

This  substance  has  been  for  some  time  known  to  chemists  as 
a  constituent  of  the  oil  of  winter-green  (^Gaultlieriaprocumbens), 
and  of  the  essential  oil  of  Monotropa  Hypopithys,  &c. 

It  may  be  made  from  dry  powder  of  sodium-phenol,  by  con- 
ducting into  it  dry  carbonic  anhydride  at  170°  C.  Salicylate 
of  soda  is  formed,  and  this  is  decomposed  by  hydrochloric  acid 
into  sodium  chloride  and  salicylic  acid,  which  is  precipitated. 
A  good  account  of  it  is  given  by  Dr.  Squibb,  in  a  paper  read 
by  him  before  the  New  York  Academy  of  Medicine,  and  subse- 
quently published  in  pamphlet  form.  The  acid,  bleached  or 
unbleached,  occurs  in  minute  broken  acicular  crystals,  giving 
it  the  appearance  of  a  granular  powder,  which  is  odourless  and 
nearly  tasteless,  but  leaves  a  sweetish  astringent  after-taste. 
It  is  very  slightly  soluble  in  cold  water,  but  very  soluble  in 
hot.  The  presence  of  neutral  salts,  as  of  sodium  phosphate,  has 
the  power  of  increasing  its  solubility  in  water,  three  parts  of 
the  latter  salt  causing  the  solution  of  one  part  of  the  acid  in 
fifty  parts  of  water.  It  is  much  more  soluble  in  alcohol  and 
ether  than  in  water.  It  melts  at  125°  C,  and  sublimes  at 
200°  C. 

Dr.  R.  GodefFroy  has  an  interesting  paper  on  the  subject  of 
this  acid,  in  the  Zeitschrift  des  allgemeinen  osterreichischen 
Apothekcr-  Vereines,  April,  1875.     He  states  that  salicylic  acid 


1875.]  Present  Position  of  Antiseptic  Surgery.  26^ 

may  be  obtained  in  various  ways  besides  by  tbe  metbod  which 
we  have  detailed  above.  It  may  be  prepared  by  the  oxidation 
of  salicin,  a  glucoside  contained  in  the  barks  of  some  species  of 
salix.  It  may  also  be  got  by  the  oxidation  of  saligenin,  by 
heating  oil  of  gaultheria  with  potassium-hydrate,  and  by  de- 
composing potassium-salicylate  by  hydrochloric  acid.  Salicylic 
acid  may  be  considered  to  be  an  oxidation  product  of  benzoic 
acid,  since  it  contains  one  atom  more  of  oxygen,  thus :  C^HgOa 
=  benzoic  acid,  and  0-11603  =  salicylic  acid.  It  differs  from  its 
isomers,  oxybenzoic  acid  and  paraoxybenzoic  acid,  by  giving  a 
beautiful  violet  colour  with  solution  of  ferric  chloride. — 'Edin. 
Med.  Journ.,'  July,  1875. 

The  preparations  used  by  Professor  Thiersch  are : 

1.  Salicylic  water,  a  solution  containing  one  part  of  the  acid 
in  300  of  water ;  or  about  as  much  as  distilled  water  at  the 
ordinary  temperature  of  a  hospital  ward  is  able  to  take  up. 

S.  Salicylic  cotton  of  two  degrees  of  saturation,  3  per  cent,  and 
10  per  cent. 

3.  Salicylic  jute,  admirably  soft,  a  powerful  absorbent  and  a 
cheap  and  satisfactory  disinfectant. 

The  manner  in  which  these  are  prepared  is  thus  described  in 
the  '  London  Medical  Record  '  for  June  2,  1875. 

For  3  per  cent,  salicylic  cotton,  750  grammes  are  dissolved  in 
750  grammes  of  spirit  of  specific  gravity  0*830,  the  solution  is 
then  diluted  with  150  litres  of  water  at  a  temperature  from 
156°  to  176°  Fah.,  and  the  mixture  is  used  to  saturate  25  kilo- 
grammes of  cotton-wadding  freed  from  fatty  matter;  different 
proportions  of  same  ingredients  are  used  for  the  10  per  cent, 
saturation.  The  saturation  of  the  cotton  is  best  done  in  a  large 
shallow  tub,  and  it  is  best  to  use  only  a  small  quantity  of  cotton 
wool  at  a  time  to  allow  of  an  equal  distribution  of  the  acid. 
After  saturation  of  the  cotton  in  successive  layers,  the  salicylic 
acid  crystallizes  in  the  progress  of  cooling,  and  it  is  then  care- 
fully dried. 

Jute  dressing  is  prepared  by  3  or  4  per  cent,  saturation  with 
the  addition  of  20  per  cent,  of  glycerine  to  prevent  the  acid 
being  given  off  too  freely  in  the  form  of  dust.  The  jute  dress- 
ing is  most  suitable  for  suppurating  wounds  in  consequence  of 
its  being  able  readily  to  absorb  fluids,  in  which  process  the 
cotton  is  comparatively  deficient. 

Salicylic  acid  has  some  advantages  over  carbolic  acid  if  it  can 
be  found  to  be  equally  efficacious  as  an  antiseptic.  It  is  much 
less  irritating  ;  it  is  inodorous,  and  it  is  non-volatile,  so  that  it 
can  be  trusted  for  a  longer  time. 

As  it  is  less  irritating,  it  in  some  measure  may  be  expected 
to  involve  less  complicated  dressings  and  manoeuvres.     So  that 

112— Lvi.  18 


Mo  Reviews,  [Oct., 

ill  its  use,  in  many  cases,  the  oilsilk  protective  may  be  dis- 
pensed with,  and  perhaps  even  the  macintosh  v^^hich  Lister 
puts  between  his  outer  layer  and  the  one  next  it.  On  the  other 
hand,  salicylic  acid  provokes  coughing  and  sneezing,  both  as  a 
dry  dressing  and  when  used  as  spray. 

One  advantage  of  immense  importance  it  possesses  over 
carbolic  acid, — that  it  seems  to  be  much  less  poisonous.  The 
frequency  of  fatal  poisoning  by  misadventure  by  carbolic  acid 
has,  of  late  years,  been  most  striking  and  alarming. 

As  is  the  case  in  carbolic  acid  irrigation,  salicylic  acid  will 
after  some  time  be  found  in  the  urine ;  it  indicates  its  presence 
by  an  olive-green  colouring. 

As  to  results  Professor  Thiersch  prefers  it  to  carbolic  acid, 
and  in  his  hand  it  has  entirely  superseded  the  use  of  the  latter. 
The  statistics  he  gives,  as  quoted  in  '  Medical  Record '  for  May 
26,  1875,  are  by  no  means  striking  or  encouraging. 

Of  twenty-two  cases  reported  four  were  amputations  of  the 
thigh  with  fatal  results ;  and  in  two  cases  of  amputation  of  the 
forearm,  three  of  amputation  of  the  leg,  four  of  the  hand,  and 
six  of  the  artery,  the  course  was  not  remarkable — three  suc- 
cessful amputations  of  the  thigh  and  leg  occurred  in  children. 
Dr.  Thiersch  has  arrived  at  the  conclusion  (we  fear,  perhaps,  on 
rather  insufficient  data) ,  from  a  consideration  of  the  unsuccessful 
cases,  that,  although  salicylic  acid  may  not  prevent  all  decom- 
position, and  although  offensively  smelling  products  of  decom- 
position may  be  found,  it  prevents  that  form  of  decomposition 
which  leads  to  pygemia. 

Lister,  while  he  does  not  believe  that  salicylic  acid  will  take 
the  place  of  carbolic,  finds  salicylic  acid  useful  in  preventing 
decomposition  in  cases  where  the  bandage  has  to  be  left  on  a 
considerable  time,  say  a  week.^ 

Risks  and  Objections. 

We  can  take  these  in  no  regular  order,  but  just  as  we  find 
them  cropping  up  as  we  watch  the  treatment  or  in  the  writings 
of  unbelievers  and  critics. 

Risks. — Every  remedy  which  has  potency  for  good  has  also 
when  misapplied  or  abused  an  equally  power  to  hurt.     Car 
bolic  acid  is  no  exception  to  this  rule.     One  of  the  saddest] 
results  of  the  great  frequency  of  its  use,  as  an  antiseptic,  as 
lotion,  or  a  deodorizer,  is  the  alarming  frequency  of  cases  ol 
poisoning  by  accidental  swallowing  of  this  too  potent  external] 
remedy. 

Even  in  the  surgeon's  hands,  however,  sad  results  have  fol- 

1  *  Edin.  Med.  JOurn.'  for  July,  1875,  p.  95. 


1875.]  Present  Position  of  Antiseptic  Burgery.  27l 

lowed  its  rash  and  indiscriminate  application.  On  its  first 
introduction  a  zealous  house-surgeon  after  injecting  a  compound 
fracture  with  the  strongest  obtainable  solutions  of  the  glacial 
acid  kept  pledgets  of  lint  soaked  in  the  same  solution  applied 
to  the  limb,  causing  a  most  distinct  and  rapid  caustic  action 
which  necessitated  amputation.  Too  energetic  injections  of 
cellular  tissue  with  a  strong  syringe  loaded  with  a  strong  solution 
have  produced  similar  unfortunate  results. 

Apart  from  these  results,  which  may  be  put  down  to  abuse  of 
the  remedy,  in  certain  constitutions  and  in  certain  states  of 
system,  very  marked  effects  followed  the  use  of  the  drug  even  in 
careful  hands.  For  example,  in  many  patients,  the  opening  of 
an  abscess  with  the  antiseptic  precautions  described  above,  which 
includes  the  washing  out  of  the  abscess  cavity  with  one  or  more 
syringefuls  of  a  1 — 40  solution,  is  followed  within  a  few  hours 
by  the  passing  of  urine  which  immediately  on  exposure  to  air 
assumes  the  characteristic  smoky  tint  seen  after  the  internal 
use  of  carbolic  acid. 

In  one  case  under  the  writer's  observation  this  persisted  for 
weeks,  even  when  the  strength  of  the  antiseptic  injection  was 
much  reduced,  and  the  urine  at  times  contained  broken-down 
blood-discs  indicating  considerable  renal  congestion. 

Still  more  dangerous  and  more  marked  are  the  distinct  symp- 
toms of  general  carbolic-acid  poisoning  of  the  system  which 
have  been  observed  to  occur  after  the  use  of  antiseptic  dressings 
for  extensive  abrasions  or  destructions  of  the  skin,  as  after  a 
severe  burn.  Valuable  as  the  gains  in  the  subsequent  treatment 
are  of  having  a  large  burn  rendered  antiseptic  we  believe  that 
carbolic  acid  is  not  an  agent  which  can  be  invariably  or  indeed 
frequently  used  for  this  purpose  with  safety.  For  such  cases, 
sulphurous,  boracic,  or  perhaps  salicylic  acid  will  be  found 
safer  means  of  obtaining  the  desired  results. 

While  thus  acting  the  unpleasant  role  of  advocatus  diaholi, 
and  stating  some  of  the  risks  attending  the  use  of  this  valuable 
drug,  we  must  not  forget  a  not  unfrequent  troublesome  though 
not  dangerous  symptom,  which  we  have  frequently  observed  in 
cases  (for  example)  of  excisions  of  the  mamma  under  antiseptic 
precautions.  The  irritation  of  the  gauze  sets  up  a  form  of  cu- 
taneous erythema,  eczema,  or  even  impetigo  of  a  most  trouble- 
some kind,  which  goes  on  increasing  so  long  as  the  dressing  is 
kept  on  and  does  not  disappear  even  for  many  days  after  it  is 
removed. 

It  cannot  be  predicted  or  prophesied  in  any  given  case  whether 
this  will  be  the  result  or  not ;  it  occurs  in  otherwise  healthy 
people  and  does  not  imply  any  previous  tendency  to  skin  erup- 


i7i  Reviews,  [Oct., 

tions,  nor  is  it  more  frequently  observed  in  scrofulous  or 
syphilitic  cases  than  in  unimpeachable  constitutions. 

0}i  Granulating  Wounds. — On  a  granulating  surface  the 
action  of  a  carbolic- acid  dressing  is  rarely  beneficial.  If  it  is 
in  immediate  contact  with  the  granulations,  it  almost  invariably 
acts  as  an  irritant,  delaying  cicatrization,  by  causing  the  for- 
mation of  a  peculiar  yellowish  layer  apparently  of  coagulated 
serum  and  pus  resembling  a  diphtheritic  pellicle.  This  remains 
for  days  unchanged,  and  the  wound  beneath  it,  though  painless 
and  inodorous,  makes  no  progress  whatever.  In  fact,  once  a 
wound  or  ulcer  has  assumed  a  granulating  surface,  and  deep 
parts  are  consolidated,  the  period  at  which  carbolic- acid  dress- 
ings are  useful  seems  for  that  wound  to  be  past,  and  boracic  or 
salicylic  acid  may  be  used  if  antiseptics  are  to  be  continued  at 
all,  or  very  frequently  water  dressing  may  be  substituted  with 
advantage. 

N.B. — This  applies  only  to  superficial  wounds,as  after  excision 
of  tumours  with  loss  of  substance,  ulcers,  &c.,  not  to  cases  in 
which  deep  abscesses  have  been  opened  with  antiseptic  precau- 
tions. In  these  cases  at  the  risk  of  irritating  granulations,  full 
antiseptic  precautions  must  be  maintained  with  the  utmost  care 
and  accuracy  till  the  wound  is  absolutely  healed  from  the  bottom 
and  not  a  drop  of  discharge  is  either  retained  or  escapes.  This 
is  specially  the  case  when  the  abscess  has  depended  on,  or  is 
connected  with,  the  presence  of  dead  or  diseased  bone,  as  in 
psoas,  lumbar,  or  joint  abscesses. 

While  for  exposed  granulations  carbolic  acid  even  with  all 
possible  precautions  of  protective  oilsilk,  &c.,  does  not  seem 
useful,  it  is  far  otherwise  when  the  surgeon  has  to  deal  with  a 
blood-clot  effused  between  the  lips  of  an  incision  as  in  an  ampu- 
tation, or  in  removal  of  a  superficial  tumour.  If  the  antiseptic 
method  be  successfully  carried  out,  the  remarkable  sight  is 
witnessed  of  the  clot  not  only  not  suppurating^  but  of  its 
actually  becoming  organized,  and  being  utilised  to  fill  up  a  gap, 
or  supply  deficiency  of  material,  under  the  protection  of  the 
antiseptic  dressing.  Those  who  have  used  it  often  are  familiar 
now  with  the  changes  on  the  blood-clot,  its  partial  contraction, 
its  vascularisation  in  the  first  six  or  eight  days,  and  its  gradual 
approach  in  appearance  and  usefulness  to  the  character  of 
normal  cutis. 

A  very  interesting  case  of  the  using  of  a  blood-clot  with  the 
intention  from  the  first  of  filling  a  gap  and  preventing  contrac- 
tion we  quote  from  a  recent  number  of  the  ^  Edinburgh  Medical 
Journal  : ' 

^^  Mr.  Ghiene  showed  a  patient  to  tlie  Medico- Chirugical  Society  of 
Edinburgh,  suffering  from  a  simple  malady,  but  whose  case  illustrated 


m 


'5."]  Present  Position  of  Antiseptic  Surgery,  273 


the  organization  of  a  blood-clot  in  an  open  cavity.  He  believed  that 
this  was  the  first  systematic  attempt  to  fill  a  cavity  with  a  blood-clot. 
The  patient  sufiered  from  a  horn  on  the  heel,  which  he  had  removed 
along  with  a  triangular  piece  of  skin,  each  side  of  the  triangle  being 
1|-  inches  long.  He  had  then  cleared  out  all  the  tissues  down  to  the 
OS  calcis,  thus  making  a  cavity  half  an  inch  deep.  He  next  applied 
protective  and  a  gauze  dressing  before  removing  the  tourniquet,  in  the 
hope  that  blood  would  ooze  from  the  sides  and  fill  the  cavity  with  a 
blood-clot.  This  operation  was  performed  on  the  18th  of  April.  Six 
days  after,  the  cavity  was  filled  with  a  dark  jelly-like  substance.  On 
the  twelfth  day  this  clot  was  of  the  same  colour,  but  firmer  in 
consistence.  On  the  sixteenth  day  it  bled  when  scratched.  On  the 
twenty-sixth  it  was  evidently  organized  and  red  in  colour.  Epider- 
mis began  to  cover  it  on  the  thirtieth  day  ;  and  on  the  thirty-fourth 
it  was  completely  covered  and  entirely  healed,  without  any  contrac- 
tion. This  organized  blood-clot  was  therefore  half  an  inch  deep,  and 
like  an  equilateral  triangle,  each  side  being  an  inch  and  a  quarter  in 
length.  It  was  still  a  point  of  clinical  interest  whether  the  contrac- 
tion would  ultimately  take  place.  On  this  point  he  would  satisfy 
the  Society  by  showing  the  patient  in  July.  He  only  wished  furthier 
to  state,  that  no  retentive  apparatus  had  been  employed,  as  he  had 
no  proof  when  he  operated  that  there  would  be  contraction.*' 

Another  from  Mr.  Lister's  own  practice :  ^ 

"  The  next  case  is  one  of  ununited  fracture  in  the  lower  part  of  the 
femur  of  a  year's  standing,  in  a  man  36  years  of  age.  Twelve  days 
ago,  I  cut  down  on  the  outer  side  of  the  limb,  a  very  long  incision 
being  required.  Einding  the  fragments  overlapping  about  an  inch, 
I  removed  portions  with  the  gouge  and  hammer  from  the  posterior 
surface  of  the  upper  fragment  and  the  opposing  part  on  the  anterior 
surface  of  the  lower  one,  so  as  to  leave  two  fresh  osseous  surfaces  in 
apposition.  Without  antiseptic  treatment,  this  would  have  been  a 
very  dangerous  operation.  The  risk  of  pyaemia  would  have  been  so 
great  that,  in  common  with  most  surgeons,  I  should  have  regarded 
such  interference  as  unjustifiable  ;  but  I  think  we  may  venture  to 
say  that,  with  antiseptic  treatment  in  its  present  form,  all  such  risk 
may  be  certainly  avoided.  It  is  now  twelve  days  since  the  opera- 
tion. Eor  the  first  few  days  blood  and  serum  were  effused  very 
copiously,  and  we  had  an  arrangement  by  means  of  which  a  large 
mass  of  gauze  could  be  applied  in  considerable  extent  under  the 
limb.  But  the  time  has  come  when  it  might  be  put  up  in  a  more 
permanent  form.  This  plaster-of- Paris  arrangement  was  applied 
yesterday,  while  the  limb  was  kept  well  extended  by  the  pulleys,  the 
patient  being  under  chloroform.  I  have  here  a  limited  space  for  the 
dressing,  and  therefore  use  a  correspondingly  thick  mass  of  gauze. 
This  you  will  find  often  a  matter  of  importance,  as  in  operating  for 
strangulated  hernia,  where  you  have  not  much  space  between  the 
wound  and  sources  of  putrefaction  in  the  perineum.     And  so  in  the 

1  '  Edin.  Medical  Journal,'  Sept.  1875,  p.  203 


274  Reviews.  [Oct., 

present  case,  the  window  left  in  the  plaster-of-Paris  is  occupied  by 
a  very  substantial  mass  of  gauze.  The  discharge  of  the  last  twenty- 
four  hours  has  caused,  you  see,  merely  a  small  brownish  stain  upon 
the  gauze,  the  result  of  a  slight  amount  of  serum,  tinged  with  the 
colouring  matter  of  the  blood.  The  ends  of  the  wound  were  stitched 
up  for  about  three  inches  at  each  side ;  those  parts  united  by  first 
intention,  and  are  completely  healed.  The  central  part  of  the 
wound  was  left  open  for  the  orifices  of  three  large  drainage-tubes. 
And  herein  we  see  the  persistent  blood-clot.  Two  days  ago,  I  took 
out  for  the  first  time  the  drainage-tubes,  and  they  were,  just  as  in 
the  case  you  last  saw,  lying  in  tubular  moulds  in  the  coagulum. 
One  of  them  was  permanently  removed ;  the  other  two  were  re-intro- 
duced after  being  considerably  shortened  by  cutting  portions  off 
from  the  deeper  ends.  In  taking  out  drainage-tubes  you  must  be 
particularly  careful  to  have  the  spray  properly  directed.  For  as  the 
drainage-tube  comes  out,  air  must  enter  to  take  its  place,  and  this  air  ~ 
will  be  septic  or  not  as  the  spray  is  not  or  is  over  the  wound.  Here 
we  see  the  orifices  of  the  two  drainage-tubes,  one  of  which  may  pro- 
bably now  be  dispensed  with  altogether.  As  I  remove  them,  you 
observe  the  tubular  beds  in  which  they  lay.  And  here,  as  in  the  last 
case,  we  have  as  yet  no  suppuration  whatever  from  the  open  wound." 

Effect  on  Hospital  Mortality  and  on  the  Health  of  Wards,    _ 

Here  we  approach  the  very  key  of  the  position,  and  as  yet,^ 
we  regret  to  say,  that  really  valuable  comparative  statistics  are 
few  and  far  between.     We  have  abundance  of  general  impres- 
sions— vague  splendid  generalities.     Some  few  continental  au- 
thorities will  be  quoted  immediately. 

What  we  want  are  series  of  statistics  or  observations  of  two 
kinds.  (1.)  Alist  of  operations,  amputations,  herniotomies,  ovari- 
otomies, &c.,  sufficiently  large  to  be  compared  on  the  one  hand 
with  similar  sets  of  cases  in  other  places,  or  on  the  other  with  sets 
of  cases  under  similar  conditions  except  no  antiseptic  precau- 
tions. Materials  for  such  a  comparison  surely  cannot  be  want- 
ing, and  we  would  like  to  see  an  equal  number  of  Lister's  cases 
compared  with  Mr.  Callender's  magnificent  results  in  St. 
Bartholomew's  with  his  special  mode  of  dressing  stumps,  or  with 
the  very  carefully  prepared  tables  of  splendid  successes  in  am- 
putation by  Professor  Spence  in  neighbouring  wards  of  the 
same  hospital  in  which  Mr.  Lister  works — these  last  obtained 
without  any  antiseptic  precautions.  (2.)  Much  would  be  learned 
from  a  series  of  careful  observations  of  pulse  and  temperature 
of  cases  treated  antiseptically.  So  far  as  we  can  discover,  the 
only  really  precise  thermometric  observations  by  which  septic 
and  antiseptic  cases  under  similar  conditions  can  be  contrasted 
and  compared  are  those  by  Joseph  Bell,^  of  Edinburgh,  who  in 

1  '  Edin.  Med.  Journ.'  for  August,  1873. 


1875.]  Present  Position  of  Antiseptic  Surgery,  275 

the  same  hospital  as  Lister,  follows  out,  we  believe,  the  anti- 
septic system. 

He  has  given  charts  of  temperature  in  twenty-five  cases,  too 
small  a  number  to  found  much  on,  but  he  seems  to  have  assured 
himself  of  the  truth  of — and  to  be  on  familiar  terms  with — the 
following  axioms  or  ideas. 

''  1.  Suppuration^  even  very  profuse,  does  not  necessarily  imply 
any  great  rise  in  temperature,  so  long  as  it  is  not  putrid. 

"  2.  Foetor  or  putrefaction  of  suppuration  always  induces  a  rise 
in  temperature. 

"  3.  A  high  temperature,  lasting  for  more  than  three  or  four  days 
after  the  injury  or  operation,  indicates  mischief  impending,  such  as 
sloughing  or  abscess. 

"  4.  The  temperature  generally  gives  warning  a  day,  or  even  two 
days,  before  the  pulse. 

To  illustrate  these  points,  he  has  divided  his  cases  into  three 
sets : — 

"1.  Cases  of  recovery  from  operation  or  injury  without  pu- 
trefaction of  suppuration 13 

"2.  Cases  where  temperature  warned  of  the  approach  of  mis- 
chief       .         .         .         . 8 

"3.  Cases  of  fatal  issue  with  high  temperature     ...      4 

His  cases  are  briefly  recorded,  but  some  of  these  are  very 
remarkable,  especially  the  following  : — 

"  3.  Excision  of  Breast  and  Glands. — J.  Gr.,  aet.  40.  Extensive 
scirrhus  of  right  mamma  and  axillary  glands.  I  removed  the  breast, 
and  dissected  out  axilla  with  great  care.  She  made  a  very  rapid 
recovery ;  discharge  abundant,  but  quite  sweet ;  and.  except  the 
day  of  the  operation,  her  temperature  did  not  exceed  99*6°,  and  her 
pulse  kept  under  78.  This  was  a  remarkable  case,  from  the  extent 
of  surface  involved. 

*'  7.  Excision  of  Knee- Joint. — Mrs.  P.,  set.  26,  had  a  very  bad 
knee-joint,  with  abscesses  and  great  destruction  of  bones.  She 
was  losing  ground.  I  excised  the  knee-joint  during  a  very  feverish 
condition  from  pain,  and  the  relief  was  so  great  that  both  pulse  and 
temperature  fell  the  very  day  of  the  operation.  She  made  a  good 
recovery,  and  her  chart  shows  a  very  rapid  return  to  her  normal 
standard,  both  of  temperature  and  pulse.  Discharge  in  her  case 
was  profuse,  but  antiseptic. 

"  8.  R.,  set.  16,  was  also  a  case  of  excision  of  knee-joint,  in  which 
recovery  was  exceptionally  rapid  and  perfect.  I  reiter  to  his  case 
only  to  show  how  uneventful  is  the  chart  of  his  pulse  and  tem- 
perature. For  about  five  days  he  suff*ered  a  good  deal  of  pain  in 
the  leg,  after  which  he  could  hardly  be  called  a  patient  at  all,  as 
he  ate  and  slept  perfectly." 

This  surgeon  also  published  in  the  same  journal^  a  series  of 
cases  illustrative  of  the  antiseptic  use  of  carbolic  acid. 
1  *  Edin.  Med.  Journ.,'  May,  1869. 


276  Reviews.  [Oct., 

While  in  his  account  of  each  case  there  is  a  want  of  rigorous 
scientific  accuracy  of  description,  and  perhaps  a  suspicion  of 
youthful  enthusiasm,  some  of  the  cases  are  very  remarkable, 
especially  two  cases  of  wounds  of  knee-joint  recovering  without 
suppuration,  and  a  case  of  compound  dislocation  of  the  elbow- 
joint. 

In  summing  up  the  results,  he  gives  in  a  few  words  the  ex- 
pectations he  had  been  led  to  form  from  the  antiseptic  method  : 

"  I  trust,  however,  that  the  cases  I  have  mentioned  will  prove  to 
the  Society  that  we  are  warranted  in  believing  that  in  the  antiseptic 
principle,  explain  it  as  you  will,  and  simplify  it  as  I  hope  we  may, 
we  have  a  very  great  addition  to  our  means  of  combating  disease. 

Even  if  on  theoretical  grounds  surgeons  may  deny  the  possibiHty 
of  preventing  suppuration,  and  ignore  our  facts,  still  if  it  be  granted 
that  by  this  method  we  can  diminish  the  amount  and  destroy  the 
foetor  of  pus,  we  have  done  much  to  improve  the  sanitary  condition, 
and  diminish  the  fatality,  of  our  great  hospitals." 

Mr.  Annandale,  another  surgeon  in  the  same  school,  seems  to 
have  faith  in  antiseptics  ;  and  in  an  interesting  paper  published 
in  the  Edinburgh  Medical  Journal  of  January,  1875,  he  advo- 
cates the  use  of  special  exploratory  incisions  with  careful 
antiseptic  precautions  in  cases  of  doubtful  diagnosis.  Several 
classes  of  such  cases  are  described.  Two  of  early  suppuration 
of  hip  and  knee-joint  afford  good  examples  of  the  boldness  and 
success  with  which  surgeons  who  have  learned  to  trust  anti- 
septics cut  into  important  joints  and  obtain  cures  without  sup- 
puration or  anchylosis.  Readers  of  this  and  other  similar 
papers  by  the  surgeons  of  the  northern  school  who  believe  in 
antiseptics  will  be  struck  by  the  confident  manner  in  which 
they  speak  of  the  result  of  cases  if  they  can  only  he  kept  sweet, 
and  the  freedom  with  which  they  cut  into  joints,  expecting 
that  even  after  such  interference  mobility  of  the  joint  will 
result. 

In  Hospital  practice  we  have  not  only  the  patient's  own 
welfare  to  seek  and  strive  for — and  we  think  that  some  cases 
nearly  prove  that  a  patient  whose  discharge  is  sweet  runs  less 
risk  than  if  it  were  putrid  or  offensive — ^but  we  must  remember 
that  each  patient  has  an  effect  for  good  or  evil  (generally  the 
latter)  on  the  ward  and  his  neighbours  in  its  beds.  Every  foetid 
ulcer,  every  putrid  amputation  or  excision,  adds  its  quota  of 
filth — call  it  germs,  call  it  bad  air  or  what  you  like — to  the  atmo- 
sphere of  a  room  which  can  hardly  hold  its  own  against  the 
respiratory  and  secretory  emanations  of  twenty  sick  men,  and 
any  mode  of  treatment  which  will  diminish  such  foetor  is  of  in- 
calculable value  to  the  ward  and  its  occupants.  In  watching 
practice  in  Edinburgh  we  have  often  geen  cases  putrid  from  the 


1875.]  Present  Position  of  Antiseptic  Surgery,  277 

first,  patiently  dressed  with  many  layers  of  gauze,  which  have 
prevented  any  odour  from  the  case,  and  even  sometimes  by 
time  and  patience  the  once  putrid  sore  has  been  rendered  anti- 
septic. 

Another  most  important  question  in  reference  to  the  value  of 
antiseptic  dressings  in  hospital  practice  is,  as  to  the  power  of 
preventing  erysipelas — pyaemia  and  hospital  gangrene. 

On  this  subject  we  have  many  fine  vague  generalities. 

Gumming  has  no  misgivings.     He  writes  : 

"  A  relationship  between  pyaemia,  hospital  gangrene,  and  erysipelas 
(the  dreaded  scourges  of  our  large  hospitals)  may  be  traced  from 
the  fact  of  their  disappearance — -coincident  with  the  introduction  of 
antiseptic  surgery."^ 

Brave  words  indeed ! 

Lister's  own  views  on  this  subject  may  be  given  in  his  own 
words : 

"  And  the  effects  of  this  rigid  antiseptic  management  upon  the 
hospital  atmosphere  forms  one  of  the  most  important  features  of 
the  treatment.  Last  evening  I  learnt  from  one  of  the  surgeons  of 
a  large  Liverpool  hospital  the  gratifying  news  that  pyaemia  has 
almost,  if  not  entirely,  left  wards  that  were  very  subject  to  it 
before  ;  and  this,  as  far  as  can  be  ascertained  by  the  surgeons,  from 
no  other  cause  than  the  careful  carrying  out  of  antiseptic  treatment. 
The  results  of  my  own  experience  in  this  matter  in  Glasgow  were 
published  nearly  two  years  ago  ;  and  I  may  repeat  now  what  I  then 
said,  that  wards  once  among  the  most  unhealthy  in  the  kingdom 
were  converted  into  models  of  healthiness,  simply  as  the  result  of 
antiseptic  treatment.  A  year  ago  I  published  equally  satisfactory 
evidence  regarding  my  practice  in  the  Edinburgh  Infirmary  for 
nearly  a  year.  Another  year  has  since  elapsed,  and  during  the 
whole  of  my  Edinburgh  period — now  almost  two  years — in  wards 
containing  nearly  sixty  beds,  we  have  not  had  a  solitary  case  of 
pyaemia,  whilst  we  are  also  entirely  free  from  hospital  gangrene  and 
from  erysipelas.  Yet  in  those  wards  the  beds  are  placed  much 
closer  than  is  in  accordance  with  modern  notions.  At  first  I  had 
them  thinned  ;  but  learning  that  patients  were  placed  on  *'  shake- 
downs "  for  the  night,  and  finding  that,  in  spite  of  this  arrangement, 
which  of  course  was  the  same  in  efi'ect  as  if  all  had  beds,  the  wards 
remained  perfectly  healthy,  I  had  the  number  restored  to  its  original 
figure.  Now  I  was  myself  at  one  time  house-surgeon  in  those  same 
wards  for  a  year  and  a  quarter,  and  I  need  hardly  say  that  the 
surgeon  under  whose  care  they  used  to  be  was  a  man  under  W'hom 
things  were  managed  as  well  as  they  could  be  with  the  means  then 
at  a  surgeon's  disposal — I  allude  to  Mr.  Syme ;  yet  I  may  safely 
say  that  such  complete  immunity  from  hospital-diseases  never  existed 
in  those  wards  before  the  antiseptic  system  was  introduced. 

1  Op.  cit.,  p.  58, 


278  Reviews.  [Oct., 

"  Nor  has  such  testimony  been  borne  by  myself  alone.  Professor 
Saxtorph  of  Copenhagen,  in  a  letter  which  I  communicated  to  the 
'  Lancet '  a  year  since,  published  most  striking  information  as  to  a 
very  large  hospital  previously  extremely  liable  to  pyaemia,  so  that 
the  smallest  wounds  often  gave  rise  to  it,  yet  remaining  for  a  year 
absolutely  free  from  the  disease,  and,  so  far  as  he  could  judge,  from 
no  other  circumstance  than  the  rigorous  adoption  of  the  antiseptic 
system.  Equally  satisfactory  evidence  regarding  the  healthiness  of 
hospital  wards  brought  about  by  this  means  has  been  given  in  one 
of  the  Blue  Books  of  the  navy  by  Dr.  Bernard  of  the  Naval 
Hospital  here."— ^  Brit.  Med.  Journ.,'  Aug.  26th,  1871. 

Berlin. — At  the  Charite  Hospital,  Professor  Bardeleben  uses 
Lister's  treatment  carefully  and  with  excellent  results.  He 
opens  abscesses  under  spray  and  attends  to  all  the  minutiae, 
making  free  use  of  drainage  tubes  and  carbolized  sponges.  An 
eye-witness  reports^  some  interesting  cases  in  which  serious 
wounds  healed  without  suppuration.  Langenbeck  lately  per- 
formed an  operation  in  Professor  Lister's  presence  with  anti- 
septic precautions  for  the  first  time.  It  is  not  often  that  a  man 
so  distinguished  and  at  an  advanced  age  is  ready  to  try  new 
ways.  Nussbaum  at  Munich  has  found,  after  the  use  of  anti- 
septic methods,  a  great  decrease  in  the  amount  of  pysemia  and 
hospital  gangrene. 

On  the  other  hand,  we  have  conflicting  opinion  as  to  the 
power  of  antiseptic  dressings  in  preventing  erysipelas. 

Thiersch  finds  no  benefit  from  its  use. 

"  Erysipelas  has  occurred  sometimes  more,  sometimes  less  severely. 
In  1873,  there  were  seventy-five  cases  among  1902  patients;  in 
1874,  among  1921  patients  the  number  of  cases  of  erysipelas  was 
distinctly  less.  In  both  years  antiseptic  treatment  made  no  difter- 
ence.  As  has  been  recognised  on  all  sides,  antiseptic  treatment  has 
no  power  to  prevent  the  occurrence  of  erysipelas ;  it  occurs  under 
the  use  both  of  carbolic  and  salicylic  acid,  sometimes  frequently, 
sometimes  rarely,  sometimes  in  a  severe  and  sometimes  in  a  mild 
form."2 

BelP  records  two  cases  of  erysipelas,  both  fatal,  coming  on 
during  the  progress  of  antiseptically  managed  wounds.  Our 
own  experience  of  the  gauze  as  a  dressing  would  rather  lead  to 
the  conclusion,  that  in  certain  skins  the  constant  application  of 
the  irritant  carbolic  acid  produces  a  sort  of  erythema,  which 
may  pass  into  a  distinct  attack  of  erysipelas,  in  others  may 
cause  a  species  of  eczema,  which,  if  the  dressing  be  continued, 
as  remarked  above,  will  pass  into  impetigo. 

1  '  Lancet/  June  19th,  1875. 

2  *  Medical  Record,'  June  2nd,  1875. 

3  Op.  cit.     •  Edin.  Med.  Journ.,'  August,  1873. 


t 


^^w^. 


]  Present  Position  of  Antiseptic  Surgery.  279 

Objections. — 1.  From  the  point  of  view  of  the  Hospital 
Committee. — It  is  expensive ;  at  first  very  expensive,  and  even 
now  certainly  it  is  dearer,  that  is,  surgical  dressings  now  cost 
much  more  than  thej'  did  prior  to  the  coming  into  use  of  anti- 
septics in  the  Edinburgh  Infirmary. 

We  have  obtained  the  following  from  a  friend  in  Edinburgh. 

In  the  Infirmary  there,  where  only  three  out  of  the  five  sur- 
geons use  antiseptic  dressings,  in  1874  there  was  used  44,930 
yards  of  gauze  at  an  expense  of  nearly  £600,  if  the  macintosh 
cloth  and  oil-silk  be  also  added ;  while  there  is  no  equivalent 
diminution  in  the  expense  for  lint  bandages,  &c. 

Well,  be  it  so,  this  is  not  a  valid  or  even  an  important  objec- 
tion if  only  the  results  to  limb  and  life  are  better  than  those 
obtained  under  the  old  or  other  systems  of  treatment.  Really 
good  devoted  nursing  is  also  much  more  expensive  than  the  old 
Mrs.  Gamp  style  ;  palatial  wards,  pleasant  couches,  and  high 
feeding  are  all  expensive ;  yet  no  one  doubts  that  the  expense 
is  not  only  justifiable  but  unavoidable.  Perhaps  antiseptic 
dressings  will  yet  justify  their  expensiveness. 

2.  From  the  surgeon's  point  of  view. — Such  minutiae  in 
dressing  are  tedious,  it  takes  up  my  time ;  it  is  troublesome, 
and  requires  to  be  watched ;  consequently  I  must  myself  dress 
or  watch  the  dressing  of  every  case.  I  cannot  leave  it  to  house- 
surgeon  or  dresser. 

This  is  quite  true  so  far,  that  certainly  each  patient's  every 
dressing  will  take  longer  time  than  it  does  under  the  old  system. 
Yet,  perhaps,  in  the  end  time  may  be  saved ;  for  once  the  case 
is  fairly  antiseptic,  it  need  be  dressed  so  seldom — once  in  three 
or  four  days  instead  of  every  day  ;  and  few  will  deny  that  in 
the  end  it  is  for  the  patient's  advantage  at  least  that  the  surgeon 
himself  should  see  his  wound  every  time  it  is  dressed ;  and  for 
the  students  who  visit  the  hospital,  the  oftener  the  surgeon  sees 
his  cases  the  better.  We  are  rather  disposed  to  believe  that  it 
is  one  of  the  chief  advantages  of  the  antiseptic  system  that  it 
demands  a  very  special  individual  watchfulness  over  each 
patient,  if  it  is  to  succeed. 

But,  alas !  not  only  must  the  patient  be  watched,  but  the  most 
unremitting  attention  must  be  paid  to  every  action  during  the 
period  the  wound  is  exposed  to  view.  Is  a  friendly  surgeon 
going  round  your  ward  ? — a  touch  of  his  finger  if  unprotected  by 
washing  in  carbolic  acid  may  ruin  the  case.  Does  an  instrument 
fall  to  the  ground  or  even  lie  for  a  second  on  the  table  ? — to  in- 
troduce it  into  the  wound  again  unless  dipped  is  theoretically 
destruction  to  your  hopes.  Is  it  a  warm  day,  and  are  you 
liable  to  sweat  ? — a  drop  falling  into  the  wound  or  on  the  dressing 


280  Reviews.  [Oct., 

will  be  fatal  to  its  success.^  Such  being  the  case,  it  is  not  wonder- 
ful that  in  the  practice  of  many  who  honestly  aim  at  following 
out  antiseptic  treatment  and  believe  they  succeed,  the  results 
have  not  always  been  equal  to  expectation. 

Another  objection,  theoretical  perhaps,  but  still  very  hard  to 
answer,  meets  the  advocates  of  antiseptic  surgery  at  the  very 
threshold  of  their  innermost  defence.  Let  us  grant,  they  say, 
the  existence  of  germs,  also  that  their  presence  is  as  dangerous 
and  their  absence  as  delightful  as  you  say  it  is,  how  are  we  to 
know  that  these  precautions  of  yours  are  sufficient  to  destroy 
these  germs,  which  are,  you  tell  us,  so  indestructible  ?  Will 
one  dip  of  the  knife  do  for  the  ones  on  it  ?  Will  your  spray,  fine 
as  it  is,  suffice  to  destroy  those  floating  about  in  the  ward  atmo- 
sphere ? 

This  difficulty  cannot  be  put  aside  or  ignored.  Possibly  an 
answer  may  be  found  in  experiment  of  Demarquay,^  who 
found  germs  still  present,  though  apparently  innocuous,  in  the 
serum  from  perfectly  sweet  wounds,  as  if  the  antiseptic  had  been 
enough,  without  actually  destroying  the  germs,  to  so  far  remove 
any  dangerous  results  from  their  presence. 

Will  antiseptic  surgery,  in  its  present  form,  ever  make  its 
way  into  private  practice  of  surgery  in  the  hands  of  the  gene- 
ral practitioner  in  the  towns,  or  of  the  country  surgeon  ? 

Not  to  any  great  extent  unless  the  procedure  is  very 
much  simplified.  The  surgeon  cannot  be  expected  to  lug 
about  with  him  a  steam  engine,  which  requires  twenty  minutes 
to  get  up  its  steam,  or  an  assistant  to  work  a  hand-spray 
every  time  he  wants  to  dress  an  abscess  or  an  ulcer.  Nor 
can  a  parochial  board  be  expected  to  furnish  antiseptic  gauze, 
protective,  macintosh,  and  bandages  out  of  the  rates. 

Fortunately  in  the  ordinary  routine  of  country  or  general 
practice  of  surgery  antiseptics  are  not  needed.  Mother 
Nature  may  be  trusted  to  heal  most  wounds  if  she  is  only 
let  alone,  and  every  surgeon  who  has  really  seen  much  good 
work  in  private  has  many  a  case  to  tell  of,  equally  remark- 
able in  rapidity  of  healing,  and  uneventfulness  with  those 
that  are  vaunted  as  antiseptic  miracles. 

Cases  there  are,  however,  which,  even  in  the  purest  air 
and  under  the  most  wholesome  conditions,  will  be  treated 
more  safely,   rapidly,  and  fortunately  by    the   adoption  in  all 

1  Pi'ofessor  Eberth's,  of  Zuricli,  researches  on  sweat  are  in  this  point  of  view 
most  interesting.  He  finds  in  the  axilla,  breast  and  inner  side  of  thigh  of  persons 
in  a  state  of  perspiration,  an  enormous  number  of  bacteria.  In  most  cases  they 
originate  from  minute  bodies  found  upon  the  hairs  in  these  regions.  The}'  rapidly 
increase  in  number  and  are  nearly  indifferent  to  reagents — concentrated  acids, 
alkalies,  ether  and  chloroform  ! ! !     In  '  Virchow's  Archiv  '  for  February,  1875. 

r  *  Gazette  Medicale  de  Paris,'  August  29th,  1874. 


lB75.]  Recent  Researches  in  Nerve  Pathology,  Ssl 

its  strictness  of  antiseptic  treatment.  Chief  among  those  are 
all  abscesses  connected  with  or  dependent  on  the  presence  of 
diseased  bone,  lumbar,  psoas,  joint,  «&:c.,  all  cases  of  com- 
pound fracture  except  the  very  simplest,  and  some  cases  of  liga- 
ture of  great  vessels. 

With  regard  to  these  last,  however,  those  who  advocate 
antiseptics  will  find  it  difficult  to  answer  those  who  may  say 
to  them.  Do  not  preach  on  the  blessings  of  antiseptics  till  you 
can  show  us  a  series,  like  Syme's,  of  thirty-seven  cases  of 
ligature  of  the  femoral  for  aneurism  without  a  single  death. 

Great  men  lived  before  Agammemnon,  and  we  all  have  read 
in  the  classics  of  surgery  of  statistics  of  amputations,  which 
will  be  hard  to  beat.  Still  progress  ought  to  be  our  aim,  and  a 
science  which  stands  still  is  going  back. 

In  closing  this  brief,  imperfect,  and  (from  the  very  nature 
of  the  subject  and  state  of  the  question)  unsatisfactory  notice 
of  antiseptic  surgery,  we  must  say  that,  in  common  with  many 
others  who  have  visited  Edinburgh  to  watch  the  system  in 
operation,  we  have  been  deeply  impressed  by  the  zeal  and 
simplicity,  the  patience  and  scientific  method,  brought  to  bear 
on  the  subject  by  its  inventor. 


II. — Recent  Researches  in  Nerve  Pathology.' 

Paralysis  Agitans  and  Insular  Sclerosis. — The  two  diseases 
which  are  here  considered  together  have  very  close  affinities  in 
many  important  particulars.  Alike  in  the  obscurity  of  their 
causation,  alike  in  their  morbid  anatomy,  alike  in  their  clinical 
features,  their  resemblance  is  still  further  increased  by  the 
slowness  with  which  each  has  gained  a  footing  amongst  recog* 
nised  diseases  in  this  country. 

Although  paralysis  agitans  was  described  as  long  ago  as  181T 
by  our  countryman  Parkinson,  and  although  it  has  been  elabo- 
rately treated  of  by  Dr.  Sanders  in  'Reynolds'  System,'  the 
number  of  complete  cases  published  in  England  may  be  counted 
on  the  fingers  of  one  hand  ;  and  as  to  insular  sclerosis,  so  little 
attention  has  it  attracted  that  a  learned  French  author  can 

^  1.  Leqons  sur  les  Maladies  du  Systeme  Nerveux  faites  a  la  Salpitriere.  Par 
J.  M.  Chaecot,  Professeur  a  la  Faculte  de  Medecine  de  Paris,  &c.,  &c. 

2.  mgJd  Cases  of  Insular  Sclerosis  of  the  Brain  and  Spinal  Cord.  By  W. 
MoxON,  M.D.,  *  Guy's  Hospital  Reports,'  vol.  xx,  1875. 

3.  On  the  Morbid  Histologif  of  the  Spinal  Cord.  By  W.  B.  Kbstevbn, 
F.R.C.S.,  '  St.  Bartholomew's  Hospital  Reports,'  vol.  viii,  1872. 

4.  Miliary  Sclerosis ;  its  Pathological  Significance.  By  W.  B.  Kesteveit, 
P.R.C.S.,  •  British  and  Foreign  Medico-Chirurgical  Review,'  July,  1874, 


^8:4  Reviews.  [Oct., 

express  a  doubt  as  to  whether  the  disease  is  even  known  on  this 
side  of  the  Channel. 

The  most  complete  description  of  these  maladies  is  contained 
in  Prof.  Charcot's  admirable  '  Lectures  on  the  Diseases  of  the 
Nervous  System;'  a  work  which  we  commend  to  our  readers 
as  containing  on  many  subjects,  and  especially  on  the  diseases 
of  the  spinal  cord,  the  most  recent,  exact  and  comprehensive 
knowledge  obtainable,  related  with  all  the  national  precision  of 
idea  and  of  diction,  and  with  an  infusion  of  interest,  sometimes 
amounting  to  enthusiasm,  which  is  peculiar  to  the  author.  So 
accurate  have  become  the  observations  in  the  clinic,  and  so 
definite  the  morbid  changes  discovered  by  new  methods  of  ex- 
amination, that  Prof.  Charcot  is  able  to  map  out  the  cord  into 
pathological  regions  and  to  say  with  precision  what  symptoms 
shall  follow  from  disease  of  each  one,  and,  conversely,  -what 
regions  shall  be  found  diseased  when  such  and  such  symptoms 
are  presented.  When  it  is  remembered  how  short  a  time  it  is 
since  locomotor  ataxy  was  definitely  located  as  disease  of  the 
posterior  columns,  and  wh6n  it  is  considered  that  a  standard 
text-book  still  in  use  can  describe  multitudinous  nervous  dis- 
orders, amongst  others  chorea  and  epilepsy,  as  symptoms  of  a 
disease  called  "  spinal  irritation,"  it  will  be  seen  how  vast  is 
the  advance  which  these  lessons  indicate. 

Doubtless  Prof  Charcot's  work  is  not  free  from  the  defect, 
inseparable  from  the  method  pursued,  of  sometimes  drawing  a 
sharp  distinction  between  things  which  in  nature  merge  into  one 
another,  thus  rendering  it  difficult  for  others  to  obtain  the 
same  definite  results  that  he  does.  To  instances  of  this  kind,  we 
shall  subsequently  direct  the  reader^s  attention  ;  but  so  slight  a 
drawback  may  be  readily  pardoned  in  view  of  his  very  success- 
ful attempt  to  reduce  the  chaos  of  spinal  disorders  into  some 
definite  order. 

Dr.  Moxon's  report  of  the  eight  cases  under  his  care  is  the 
only  account  of  insular  sclerosis  in  the  language,  and  his  cases 
were  the  first  in  this  country  in  which  the  disease  was  diagnosed 
and  the  diagnosis  verified.  His  readers  are  greatly  indebted  to 
him  for  the  acumen  with  which  he  has  separated  the  essential 
symptoms  from  the  non-essential,  and  presented  a  most  concise 
description  of  the  usual  features. 

Mr.  Kesteven  is  well  known  for  his  laborious  and  very  valu- 
able researches  into  the  morbid  histology  of  the  spinal  cord ; 
and  his  name  is  especially  associated  with  a  change  known  as 
miliary  sclerosis,  which  must  be  carefully  distinguished  from 
that  called  insular  sclerosis,  which  we  are  about  to  consider. 
The  one  is  a  change  invariably  associated  with  a  definite  group 
of   symptoms ;    the  other,  although  a  gross   and    destructive 


1875.]  Recent  Researches  in  Nerve  Pathology,  2S^ 

change,  is  common  to  a  great  number  of  diseases  most  diverse 
in  their  manifestations. 

It  will,  perhaps,  give  the  reader  the  best  warrant  of  the  com- 
pleteness of  the  lectures,  and  at  the  same  time  the  most  vivid 
idea  of  the  diseases,  if  we  relate  an  imaginary  case  of  each 
compiled  from  Prof.  Charcot's  account,  checking  it  where 
desirable  by  comparison  with  the  other  works. 

Taking  first  paralysis  agitans,  we  find  that  the  patient  may 
be  of  either  sex,  and  of  any  profession  or  station  in  life ;  he  is 
more  than  forty  years  old;  he  has,  perhaps,  lived  in  a  cold 
damp  place,  and  has  suffered  much  mental  distress.  For  some 
time  before  he  comes  under  care  he  has  suffered  from  a  sense  of 
great  fatigue,  or  it  may  be  from  rheumatic  or  neuralgic  pains  in 
the  limb  which  is  about  to  be  attacked  by  tremor.  Gradually 
the  agitation  from  which  the  disorder  takes  its  name  begins  to 
affect,  say,  the  forefinger  and  thumb  of  the  right  hand.  These 
digits  are  perpetually  quivering  and  striking  together  as  if  the 
patient  were  taking  pinches  of  snuff  or  rolling  pellets  of  paper. 
Little  by  little  the  tremor  affects  the  other  fingers,  then  the 
hand ;  and  to  this  it  may  remain  restricted  for  a  long  while, 
even  for  years.  Eventually,  however,  it  spreads  up  the  right 
arm,  and  at  the  same  time  the  right  foot  becomes  involved;  and 
after  a  while  the  left  hand  and  left  foot  follow  the  same  course. 

The  muscles  of  the  face  do  not  become  tremulous.  On  the 
contrary,  they  become  unusually  immobile,  and  give  the  face  a 
remarkable  fixed,  sad,  dogged  expression,  which  of  itself  is 
almost  diagnostic  of  the  disease.  This  fixity  of  the  face  is  but 
part  of  a  general  rigidity  which  at  a  later  period  affects  the 
muscles  of  the  neck,  trunk,  and  some  at  least  of  those  of  the 
extremities.  The  effect  of  this  rigidity  is  to  impose  on  the 
patient  a  most  remarkable  attitude  and  gait.  The  head  is 
strongly  inclined  forwards,  and  the  body  also  leans  in  this 
direction ;  the  elbows  are  a  little  away  from  the  sides,  the  fore- 
arms flexed  on  the  arms,  the  hands  flexed  at  the  wrists  and 
resting  on  the  waist,  while  the  fingers  maintain  their  constant 
oscillations.  If  the  patient  be  told  to  walk,  he  rises  slowly  and 
with  difficulty  from  his  seat,  hesitates  for  some  seconds,  and 
then  starts  into  a  rapid  shuffling  trot, ''  as  if,"  says  Prof.  Charcot, 
"  he  were  running  after  his  centre  of  gravity,  which  still  escaped 
him."  Or,  instead  of  this,  he  may  have  a  tendency  to  go 
backwards. 

It  is  to  be  remarked  that  the  patient  has  no  nystagmus,  nor 
is  his  articulation  affected  as  it  is  in  Sclerosis,  unless  indeed  the 
agitation  of  the  body  be  so  great  that  it  communicates  an  inter- 
ruption to  the  voice  like  that  which  affects  a  novice  in  equitation 
when  his  horse  begins  to  trot.     As  a  rule,  however,  the  voice. 


§^4  Reviews.  [Oct., 

far  from  being  tremulous,  has  a  monotony  of  expression  similar 
to  that  of  the  face.  The  patient  speaks  abruptly  in  mono- 
syllables or  short  sentences,  and  uses  no  cadence,  but  maintains 
his  voice  at  one  invariable  pitch  from  the  beginning  to  the  end 
of  his  sentence,  a  peculiarity  which  renders  his  tone  very 
striking. 

Besides  these  motor  troubles,  the  patient  has  affections  of 
sensation,  which,  though'they  cannot  be  called  painful,  are  some- 
times sufficiently  severe  to  render  his  life  quite  burdensome. 
There  is  a  constant  feeling  of  tension  in  the  muscles,  a  sense  of 
fatigue,  and  an  indefinable  uneasiness  which  urges  him  to 
incessantly  change  his  position.  Besides  this,  there  is  a  feeling 
of  excessive  heat  which  compels  him  even  in  the  depth  of 
winter  to  toss  off  all  his  clothes.  In  spite  of  this,  however, 
the  temperature  is  not  raised,  and  this  is  in  accordance  with 
the  rule  which  Prof.  Charcot  and  Dr.  Bouchard  have  enunciated, 
that  in  static  contraction  of  muscles,  or  that  contraction  whicli 
is  chiefly  tonic,  the  temperature  is  raised,  while  in  dynamic 
contractions,  or  those  which  are  chiefly  clonic,  the  temperature 
remains  normal.  This  is  what  we  should  a  priori  be  led  to 
expect,  since  in  the  former  case  the  work  done  is  wholly  out  of 
proportion  to  the  vigour  of  the  contraction,  and  we  should 
therefore  expect  a  production  of  heat  in  lieu  of  the  arrested 
mechanical  motion,  while  in  the  latter  case,  since  the  limbs 
are  moved,  work  is  done,  and,  the  greater  part  of  the  force  being 
expended  in  mechanical  motion,  there  is  but  little  to  be  con- 
verted into  heat. 

We  have  related  these  symptoms  as  occurring  continuously, 
but  the  reader  must  understand  that  they  are  spread  over  a  very 
long  time,  ten,  twenty,  or  even  thirty  years  elapsing  before 
the  terminal  period  arrives.  Sooner^  or  later,  however,  the 
motor  trouble  increases  to  such  an  extent  that  the  patient  is 
obliged  to  remain  in  his  chair  all  day,  and  at  last  is  confined 
to  bed.  Then  his  nutrition  suffers,  his  intellect  becomes  obscured, 
he  gets  more  and  more  prostrate,  at  last  bed-sores  appear  on 
his  sacrum,  and  he  dies  from  gradual  exhaustion ;  the  charac- 
teristic tremor  having  much  diminished  and  perhaps  altogether 
ceased  during  this  terminal  period. 

Such  is  the  general  course  of  a  typical  case  of  paralysis 
agitans,  but  of  course  there  are  many  variations  in  the  severity 
of  the  different  symptoms,  and  it  is  comparatively  rare  to  meet 
with  a  case  which  presents  them  quite  like,  the  foregoing.  Prof. 
Charcot  states  that  there  are  rare  cases  in  which  the  muscular 
rigidity  is  one  of  the  earliest  symptoms,  so  that  before  the 
tremor  has  appeared,  or  when  it  is  but  very  slight,  the  attitude 
and  gait  are  already  very  pronounced.     We  believe  that  it  is 


1875.]  Recent  Researches  in  Nerve  Pathology.  285 

not  uncommon  for  the  fixed  expressionless  face,  the  peculiar 
voice  and  the  characteristic  attitude  to  exist  early  in  the 
disease,  when  tremor  must  be  narrowly  looked  for  to  be  detected 
at  all.  The  agitation  is  not,  as  the  nomenclature  implies,  the 
most  characteristic  symptom.  The  termination,  too,  is  more 
often  brought  about  by  some  intercurrent  affection,  by  pneumonia 
for  instance,  than  by  the  course  of  the  disease  itself. 

There  is  a  certain  satiric  humour  in  Prof.  Charcot's  notice  of 
the  morbid  anatomy  of  paralysis  agitans.  He  divides  the 
autopsies  hitherto  made  into  three  groups.  In  the  first  group 
nothing  at  all  was  found.  The  second  group  comprises  cases  of 
supposed  paralysis  agitans,  which  Prof.  Charcot  considers  were 
in  reality  sclerosis ;  and  the  third  group  contains  the  case  of 
Parkinson  subsequently  mentioned,  and  a  similar  case  by 
Oppolzer  which  is  treated  with  similar  distrust.  There  are, 
however,  other  cases  on  record  which  give  much  more  satisfactory 
results.  Leyden  has  reported  one  in  which  the  agitation  was 
limited  to  the  right  arm,  and  a  sarcoma  the  size  of  a  large  nut 
was  found  in  the  optic  thalamus  of  the  opposite  side.  Murchi- 
son  and  Cayley  have  reported  a  case  in  which  very  definite 
changes,  partly  of  sclerosis  and  partly  of  cell  growth,  were 
found  in  the  cord ;  but  as  in  this  case  the  symptoms  are  described 
but  very  briefly,  it  is  possible  that  Prof.  Charcot  would  place  it 
in  his  second  group.  Joffroy,  however,  took  especial  care  to 
investigate  this  point,  as  to  whether  the  cases  were  really 
paralysis  agitans  or  insular  sclerosis,  and  he  states  that  two  out 
of  his  three  cases  were  clearly  paralysis  agitans.  In  these  two 
there  was  exuberant  growth  of  the  epithelium  of  the  central 
canal  and  of  the  nuclei  around.  In  the  third  case,  which 
seems  not  to  have  been  a  very  doubtful  one,  there  was  in  addition 
a  sclerosed  patch  in  the  medulla. 

In  the  brief  historical  introduction  to  insular  sclerosis  Prof. 
Charcot  notices  the  total  absence  of  all  mention  of  this  disease 
from  the  standard  works  of  this  country,  and  says  that  even 
to  this  day  he  does  not  believe  we  have  heard  of  it.  It  is  im- 
possible not  to  admit  the  justice  of  the  implied  reproach,  al- 
though had  Prof.  Charcot  paid  a  visit  to  the  wards  of  our 
hospitals  he  would  have  found  that  the  disease  is  by  no  means 
so  unknown  as  its  absence  from  our  literature  would  seem  to 
indicate.     Nevertheless,  it  must,  as  Dr.  Moxon  says, 

"  appear  strange  that  the  singular  and  definite  disease  .  .  .  has  not 
yet  been  admitted  by  the  profession  in  this  country,  when  we 
know  that  it  not  only  has  constant  and  characteristic  symptoms, 
but  also  a  quite  peculiar  and  very  remarkable  morbid  anatomy." 

When  it  is  considered  that  in  insular  sclerosis  there  is  a  gross 

112— LYI.  19 


286  tleviem.  [Oct., 

change  which  may  affect  any  part  or  any  combination  of  parts 
of  the  cerebro-spinal  axis,  it  will  be  readily  understood  that 
the  symptoms  to  which  this  change  may  give  rise  will  differ 
very  widely  with  the  part  of  the  nervous  centre  involved  ;  and 
when  it  happens  to  involve  a  part  which  is  a  common  seat  of 
other  changes,  the  symptoms  of  sclerosis  will  closely  simulate 
those  of  other  diseases.  Apropos  of  this  peculiarity  Prof.  Char- 
cot relates  how  a  distinguished  physician,  who,  however,  was 
not  familiar  with  the  symptoms  of  sclerosis,  paid  a  visit  to  the 
hospital  where  it  abounded.  Prof.  Charcot's  colleague  showed 
him  a  case  of  the  new  disease ;  it  was  a  beautiful  specimen  of 
the  cerebro-spinal  form.  The  patient  left  his  bed  and  made  a 
few  steps  down  the  ward.  "  He  is  an  ataxic,"  said  the  visitor. 
"  Perhaps,'^  replied  the  host ;  "  but  what  do  you  think  of  these 
rhythmic  movements  with  which  the  head  and  upper  extremities 
are  affected  ?"  "  1"  see,"  replied  the  visitor,  "  he  has  chorea 
besides,  or  perhaps  paralysis  agitans."  The  patient  was  then 
interrogated,  and  replied  with  a  peculiar  defect  of  articulation, 
and  often  with  slight  tremor  of  the  lips.  "  I  find,"  said  the 
physician,  "  you  wish  to  puzzle  me  by  showing  me  a  case  of 
extreme  complexity.  Here  are  now  the  symptoms  of  general 
paralysis.  We  will  go  no  further;  your  patient  unites,  perhaps, 
in  himself  the  whole  pathology  of  the  nervous  system." 

In  spite  of  this,  however,  it  is  by  no  means  difficult,  at  any 
rate  in  an  advanced  case,  to  diagnose  the  disease,  which  we 
shall  now  proceed  to  describe  in  the  same  manner  as  the  last. 

When  the  malady  first  appears  the  patient  is  a  young  adult. 
The  first  symptom  noticed  by  her  (for  it  is  more  common,  accord- 
ing to  Prof.  Charcot,  in  women  than  in  men)  is  a  gradually 
increasing  enfeeblement  of  the  lower  limbs — a  symptom  common 
enough,  but  which  excites  suspicion  of  sclerosis  if  there  is  no 
accompanying  disturbance  of  sensibility,  no  atrophy  of  the 
muscles,  no  bladder  or  rectum  trouble,  and  particularly  if  there 
are  intermissions  in  its  course.  This  may  remain  the  sole 
symptom  for  months  or  even  for  years  before  the  advent  of  the 
characteristic  tremor  places  the  diagnosis  beyond  a  doubt. 

The  tremor  of  insular  sclerosis  is  quite  peculiar,  and  by  the 
exercise  of  ordinary  care  may  be  easily  distinguished  from  other 
forms  which  at  first  sight  resemble  it  closely.  When  the  patient 
is  in  the  recumbent  posture,  abandoned  to  complete  repose,  there 
is  no  trace  of  tremor  in  any  part  of  the  body.  When  she  is 
seated  there  is  no  tremor  in  the  extremities,  which  are  at  rest,  but 
the  head  and  trunk,  which  are  sustained  by  muscular  action, 
are  agitated  by  a  slight  trembling  motion.  Now,  if  she  be  told 
to  carry  a  glass  of  water  to  her  mouth,  immediately  the  arm 
begins  to  move  tremor  is  developed,  and  the  more  prolonged 


-1875.] 


Recent  Researches  in  Nerve  Pathology.  387 


and  extensive  the  movement  the  greater  become  the  excursions 
of  the  tremor.  When  first  she  grasps  the  glass  the  tremor  is 
scarcely  noticeable,  but  as  she  continues  the  movement  the 
agitation  becomes  more  and  more  severe  until  when  it  reaches 
the  mouth  the  glass  is  clattered  against  the  teeth  and  the  water 
is  spilt.  Similarly,  when  first  she  begins  to  walk  the  tremor 
does  not  interfere  greatly  with  her  progress,  but  at  each  step  she 
staggers  more  and  more  until  it  is  necessary  to  support  her  in 
order  to  save  her  from  falling.  Let  her  now  be  placed  on  her 
bed  and  immediately  all  tremor  ceases. 

The  tremor  of  paralysis  agitans,  with  which,  no  doubt,  insular 
sclerosis  has  often  been  confounded,  unites  with  great  general 
similarity  several  points  of  marked  difference. 

In  the  first  place,  the  tremor  of  paralysis  agitans  exists  just  as 
much  during  repose  as  during  exertion,  and  never  departs  except 
under  the  influence  of  slumber.  Dr.  Moxon  says  that  "in  para- 
lysis agitans  the  patient  is  much  less  disturbed  by  it  [the  tremor], 
and  there  is  not  that  extreme,  almost  idiotic  helplessness  of  man- 
ner which  characterizes  sclerosis,  due  doubtless  to  the  extensive 
destruction  of  brain,"  &c.  It  is  evident  that  this  applies  to 
those  cases  only  in  which  the  brain  is  involved  as  well  as  the 
cord.  Again,  while  the  head,  and  particularly  the  lips,  are 
greatly  agitated  in  sclerosis,  in  paralysis  agitans  they  are  remark- 
ably fixed.  Then,  too,  in  the  latter  affection  the  shocks  of  the 
tremor  have  less  excursion,  are  more  regular,  more  rapid,  more 
crowded  together,  as  it  were,  than  they  are  in  sclerosis,  in  which 
the  oscillations  are  more  ample  and  more  approach  the  gesticu- 
lations of  chorea. 

It  is  always  easy,  however,  to  distinguish  the  disorderly  and 
hizarre  movements  of  chorea  from  the  rhythmic  oscillations  of 
sclerosis  ;  indeed.  Dr.  Moxon  says  that  the  latter  are  not  in  the 
least  like  chorea,  and  that  he  will  not  waste  time  in  giving  differ- 
ences. It  is  only  necessary  to  notice  that  in  sclerosis  the  general 
direction  of  a  movement,  as  for  instance  that  of  carrying  the 
hand  to  the  mouth,  persists  in  spite  of  the  tremor,  while  in 
chorea  the  act  is  interefered  with  by  absolutely  contradictory 
movements. 

Then  also  in  locomotor  ataxy,  although  there  are  abrupt  dis- 
orderly gestures,  there  is  no  true  tremor,  no  rhythmic  succession 
of  shocks,  as  there  is  in  sclerosis ;  and  in  the  latter  malady 
closure  of  the  eyes  has  no  effect  on  the  movements. 

In  mercurial  poisoning  tremor  occurs  which  is  wholly  indis- 
tinguishable from  that  of  sclerosis,  but  in  which,  according 
to  Dr.  Moxon,  there  is  not  the  embarrassed  helplessness  of 
sclerosis. 

This  gradual  enfeeblement  with  the  accompanying  tremor,  the 


1^88  Reviews,  [Oct., 

most  striking  as  it  is  the  most  characteristic  symptom  of  sclerosis, 
spreads  at  length  to  the  upper  extren)ities  ;  and  when  these  the 
spinal  symptoms  are  well  developed,  a  new  set  of  symptoms 
dependent  on  affection  of  the  intracranial  ganglia  become  super- 
added to  them.  This  group  of  symptoms  comprises  certain  af- 
fections of  the  eyes,  of  the  articulation,  and  of  the  intelligence. 

The  patient  may  have  diplopia,  but  it  will  be  only  a  passing 
symptom ;  and  she  will  be  likely  to  have  amblyopia  with  or 
without  optic  atrophy  ;  but  the  most  remarkable  symptom  which 
appears  about  this  period  is  the  peculiar  movement  called  nys- 
tagmus— a  rapid  simultaneous  oscillation  of  the  two  globes  from 
right  to  left  and  from  left  to  right,  sometimes  disappearing 
when  the  eyes  are  at  rest,  but  instantly  called  into  play  by  fixing 
the  gaze  on  an  object. 

The  defect  of  articulation  is  very  like  that  of  general  paralysis  ; 
the  same  tremor  of  the  lips,  the  same  drawling  utterance,  the 
syllables  being  prolonged  and  broken  into  a  bleat,  and  the 
same  difficulty  with  certain  consonants,  particularly  h,  p, 
and  g. 

The  defect  of  intelligence  is  of  the  nature  more  of  a  general 
enfeeblement  of  mind  than  of  any  special  defect.  The  patient 
laughs  and  cries  with  unusual  facility,  is  hopeful  or  depressed 
without  reason,  and  loses  to  a  considerable  extent  her  memory, 
but  there  is  seldom  any  actual  alienation.  Dr.  Moxon  says  of 
one  of  his  patients — 

"  Her  intellect  was  narrowed  without  unclearness,  so  that  on  the 
daily  course  of  things  before  her  eyes  she  replied  tolerably  well,  but 
could  not  go  much  beyond  this.  There  was  no  delusion,  and  her 
conduct  and  demeanor  were  always  as  right  as  the  .  .  .  disabilities 
allowed." 

The  complete  development  of  the  foregoing  symptoms  indicates 
the  approaching  termination  of  the  first  stage  of  the  malady — a 
stage  which  dates  from  the  first  appearance  of  the  symptoms  to 
the  time  when  the  tremulous  mobility  of  the  limbs  gives  place  to 
a  spasmodic  rigidity,  and  which  may  last  for  two,  four,  or  even 
six  years. 

The  rigidity  characteristic  of  the  second  stage  begins  by  slight 
isolated  attacks,  which  gradually  increase  in  length^and  severity 
until  the  members  are  reduced  to  a  condition  of  permanent 
immobility  by  the  spasmodic  contraction  of  their  muscles.  At 
this  period  the  lower  limbs  take  the  following  position  : — The 
thighs  are  extended  on  the  pelvis,  the  legs  on  the  thighs,  and 
the  feet  are  in  the  position  of  talipes  varo-equinus.  The  knees 
are  generally  so  closely  applied  to  one  another  that  they  can  only 
be  separated  by  using  considerable  force.  If  the  extremity  of 
one  foot  be  taken  in  the  hand  and  briskly  extended,  the  whole 


1875.]  Recent  Researches  in  Nerve  Pathology,  289 

of  the  corresponding  member  is  seized  with  a  convulsive  tremor 
which  reminds  us  of  that  produced  by  strychnia  poisoning. 
This  tremor,  which  may  even  extend  to  the  opposite  limb,  and 
which  will  continue  for  several  minutes  if  left  alone,  may  be 
immediately  arrested  by  sharply  and  forcibly  flexing  one  of  the 
great  toes.  The  same  tremor  may  be  caused  by  various  kinds 
of  irritation,  and  sometimes  develops  spontaneously  or  on  at- 
tempts at  voluntary  movement.  The  complete  accuracy  of 
Prof.  Charcot's  description  will  be  at  once  acknowledged  by 
those  who  have  clinically  studied  this  curious  phenomenon, 
which,  as  Prof.  Charcot  observes,  is  identical  with  the  spinal 
epilepsy  of  Brown-Sequard.  It  is,  however,  remarkable  that  with 
such  complete  loss  of  power,  dependent  on  a  spinal  lesion,  there 
is  no  diminition  of  electric  irritability  in  the  affected  muscles. 
Before  the  spasmodic  rigidity  appears  the  irritability  is  certainly 
normal,  and  after  the  accession  of  the  rigidity  the  reflex  ex- 
citibility  is  so  great  as  to  render  observation  exceedingly 
difficult. 

There  is  one  other  symptom  which  the  patient  is  most 
likely  to  exhibit  at  this  stage  of  the  malady ;  this  is  the 
occurrence  of  epileptiform  or  apoplectiform  attacks,  further 
developments,  no  doubt,  of  the  vertigo  which  occurs  as  one  of 
the  earlier  symptoms.  These  attacks  may  be  slight  or  they 
may  be  very  severe,  even  so  as  to  be  the  immediate  cause  of 
death. 

With  all  this  motor  disturbance  there  is  no  anaesthesia,  no 
loss  of  cutaneous  sensibility  ;  and  Dr.  Moxon  remarks  that  the 
rule  in  all  organic  spinal  palsies  is  that  the  motor  power  is  lost 
much  more  quickly,*  certainly,  and  entirely  than  the  sensory 
power.     On  this  point,  indeed,  all  observers  are  agreed. 

After  a  period  of  several  months  or  years  the  commencement 
of  the  third  stage  is  indicated  by  a  general  impairment  of  the 
vital  function.  Habitual  want  of  appetite  and  diarrhoea  bring 
on  progressive  emaciation ;  the  sphincters  lose  their  power ; 
the  mucous  membrane  of  the  bladder  becomes  inflamed  and 
ulcerated,*  bedsores  appear  on  the  sacrum  and  on  every 
point  exposed  to  pressure,  and  rapidly  increase  until  they  attain 
enormous  dimensions.  At  the  same  time  the  original  symptoms 
become  exaggerated,  the  obscuration  of  the  intellect  increases 
to  actual  dementia,  and  the  defect  of  articulation  becomes  such 
that  the  patient  can  only  express  himself  by  an  unintelligible 
growl.  When  matters  have  arrived  at  this  pitch  death  is  not 
far  off,  and  may  be  brought  about  by  the  continuance  of  the 
foregoing  symptoms  or  by  some  intercurrent  pulmonary  or 
intestinal  affection. 

Such  is  the  course  of  a  complete  case  of  disseminated  cerebro- 


290  Reviews.  [Oct., 

spinal  sclerosis,  but  the  reader  will  understand,  as  before,  that 
these  symptoms  may  be  met  with  in  very  various  combinations, 
according  to  the  parts  of  the  central  nervous  system  involved 
in  the  disease.  Sometimes  the  disease  is  limited  to  the  cord, 
and  the  symptoms  are  correspondingly  incomplete;  in  other 
cases  the  brain  only  is  involved,  and  then  the  converse  obtains  ; 
yet  a  third  class  of  cases  have  in  addition  an  unusually  com- 
plete involvement  of  the  posterior  columns,  and  then  the  sym- 
ptoms of  locomotor  ataxy  will  be  superadded  to  those  of  scle- 
rosis. There  is  a  fourth  variety  which,  although  very  uncom- 
mon, is  sufficiently  important  to  deserve  separate  mention.  In 
some  cases  the  patients  are  suddenly  seized  with  the  symptoms 
of  bulbar  paralysis,  better  known  in  this  country  as  glosso- 
labio-laryngeal  paralysis,  to  which  they  rapidly  succumb,  the 
autopsy  displaying  the  cause  of  death  in  a  recent  patch  of 
sclerosis  in  the  medulla  oblongata. 

The  main  symptom  displayed  by  the  two  diseases  here  con- 
sidered, the  symptom  which  groups  them  together  and  separates 
them  widely  from  almost  all  other  diseases,  in  which  are  to  be 
found  their  closest  resemblance  and  their  clearest  difference,  is 
tremor.  This  symptom  has  at  present  attracted  little  attention, 
and  remains  wholly  unexplained  except  by  such  solutions  as 
are  offered  by  Jaccoud,  who  says — '*  L'affaiblissement  de  I'inner- 
vation  de  stabilite  est  la  condition  pathogenique  du  tremble- 
ment ;"  and  Charcot,  who  says — "  The  transmission  of  voluntary 
impulses  still  takes  place  through  the  denuded  axis-cylinders, 
but  it  takes  place  in  an  irregular,  jerky  fashion,  and  thus  is  pro- 
duced the  tremor  which  embarrasses  the  execution  of  voluntary 
movements."  Tremor  appears  to  us  a  phenomenon  of  such 
importance,  as  well  on  account  of  its  physiological  bearings  as 
from  its  diagnostic  value,  that  we  propose  to  examine  it  in 
some  detail. 

In  a  discussion  on  ^*  tremor  in  general"  which  introduces  the 
chapters  on  paralysis  agitans  and  insular  sclerosis  Prof. 
Charcot  insists  that  a  sharp  distinction  should  be  drawn  be- 
twixt two  varieties  of  tremor.  The  first  variety  affects  the 
patients  only  when  they  perform  voluntary  movements  ;  while 
they  are  at  rest  their  limbs  are  perfectly  still.  The  second 
variety  is  continuous.  Whether  they  are  in  action  or  in  repose, 
whether  sitting,  standing,  or  lying,  the  limbs  of  these  patients 
are  agitated  by  a  ceaseless  trembling  which  leaves  them  only  on 
the  advent  of  sleep.  Prof.  Charcot  claims,  not  only  that  this 
is  a  most  important  clinical  division,  which  it  undoubtedly  is, 
but  even  that  the  two  varieties  are  physiologically  distinct,  and 
he  quotes  with  approbation  Van  Swieten's  classification  into 
tremor  coactus  and  tremor  a  debilitate.     Although  it  is  with 


1876.]  Recent  Researches  in  Nerve  Pathology.  291 

diffidence  that  we  place  ourselves  at  variance  with  Prof. 
Charcot  on  a  subject  which  he  has  made  so  peculiarly  his  own, 
it  appears  to  us  that  in  this  instance  he  has  allowed  his  desire 
for  extreme  clearness  to  induce  him  to  make  a  separation  in 
kind  where  in  nature  there  is  only  a  difference  in  degree. 

The  continuous  action  of  the  muscles  in  health,  the  unsteadi- 
ness of  fatigue^  the  intermittent  tremor  of  sclerosis,  the  per- 
petual agitation  of  paralysis  agitans,  and  the  rhythmic  action  of 
the  heart,  appear  to  us  only  degrees  of  the  same  phenomenon. 

The  sustained  contraction  of  a  voluntary  muscle  has  been 
shown  by  well-known  experiments  to  be  the  result  of  innumer- 
able separate  contractions  of  the  muscle  repeated  at  extremely 
small  intervals  of  time,  thus  becoming  confluent  and  producing 
a  uniform  effect ;  in  the  same  way  that,  if  the  edge  of  a  card 
be  pressed  against  a  revolving  cog-wheel,  we  hear,  not  the 
separate  taps  of  the  cogs  against  the  card,  but  a  continuous 
musical  note.  If  the  wheel  be  made  to  revolve  more  and  more 
slowly,  the  pitch  of  the  note  becomes  lower  and  lower  until  at 
last  the  sounds  become  discrete  and  we  distinctly  hear  each 
separate  tap  as  each  cog  strikes  the  card.  .It  is  the  same  with 
the  muscular  contraction.  If  the  interval  of  time  between  each 
two  successive  shocks  become  greater  and  greater,  the  relaxa- 
tion which  takes  place  after  each  one  has  time  to  become  more 
and  more  complete,  until  the  continuous  contraction  becomes 
first  remittent  and  then  intermittent.  Hence  the  sole  difference 
between  the  rhythmic  action  of  the  heart  and  the  continuous 
action  of  the  voluntary  muscles  is  that  in  the  former  the  long 
interval  between  each  shock  and  its  successor  allows  of  com- 
plete relaxation,  while  in  the  latter  no  sooner  has  the  relaxation 
begun  than  a  new  shock  catches  the  muscle  and  recontracts  it 
before  the  relaxation  is  considerable  enough  to  be  appreciated 
except  by  the  most  delicate  instruments.  Similarly,  the  differ- 
ence between  the  same  continuous  action  and  the  remittent 
action  in  sclerosis  is  that  the  minute  interval  of  the  former 
becomes  in  the  latter  great  enough  to  be  appreciated  by  the 
unaided  senses. 

The  question  of  course  arises,  what  is  the  cause  of  this 
lengthening  of  the  interval  ?  which  involves  the  question,  why 
is  there  an  intermittent  action  at  all — why  is  it  not  continuous  ? 
The  answer  is  easy.  Not,  only  as  in  the  foregoing  cases,  may 
an  intermittent  cause  produce  a  continuous  effect,  but  conversely 
a  continuous  cause  may  produce  under  certain  circumstances 
an  intermittent  effect.  The  most  obvious  illustration  is  sup- 
plied by  physics.  When  the  disc  of  an  electrical  machine  is 
turned,  electric  tension  increases  continuously  on  the  prime 
conduct  or  until  it  exceeds  the  resistance  of  the  air,  and  then  » 


292  Reviews.  [Oct., 

sudden  discharge  takes  place,  which  is  repeated  again  and  again 
at  successive  intervals  whenever  the  tension  is  brought  up  to 
the  proper  pitch,  the  rate  of  production  of  the  electricity  re- 
maining constant.  Here,  then,  is  an  intermittent  effect  produced 
by  the  continuous  accumulation  of  a  force  opposed  to  a  constant 
resistance.  More  than  this,  it  is  found  that  by  increasing  the 
resistance,  say  by  lengthening  the  distance  the  spark  has  to 
travel,  the  tension  necessary  to  overcome  the  resistance  is  in- 
creased, and  therefore  also  the  time  during  which  the  tension 
must  accumulate,  in  other  words  the  interval  between  two  suc- 
cessive shocks.  Similarly,  by  diminishing  the  resistance  we 
may  render  the  shocks  more  rapid.  As  a  corollary  from  this 
we  have  the  necessary  result  that  the  longer  the  interval  be- 
tween two  successive  shocks,  that  is,  the  slower  the  shocks,  the 
more  powerful  are  they  when  they  do  occur.  Since  it  seems  to 
be  an  established  doctrine  that  the  function  of  nerve-cells  is  to 
store  up  and  expend  force,  the  application  of  these  principles  to 
nerve-muscle  phenomena  seems  quite  allowable.  The  dis- 
charge of  force  from  the  nervous  centre  to  the  cardiac  muscles 
takes  place  at  considerable  intervals  of  time ;  the  effect  of  each 
discharge  is  therefore  great,  and  we  have  no  doubt  the  reason 
is  that  the  resistance  is  great  also.  The  normal  discharge  to 
the  voluntary  muscles  takes  place,  we  suppose,  under  extremely 
low  resistance ;  the  discharges  therefore  follow  one  another 
with  extreme  rapidity,  and  the  effect  of  each  one  is  exceedingly 
small,  the  visible  effect  being  that  of  the  aggregate  of  a  great 
number. 

Now  let  us  suppose  that  this  resistance  is  increased,  by 
which,  of  course,  we  mean  the  resistance  to  be  overcome  by  the 
nerve-current  descending  from  the  nerve-centre  to  the  muscles, 
resistance  analogous  to  that  expressed  by  (R)  in  Ohm's  law. 
The  necessary  consequence  will  be  that  the  discharges  will  be 
slower  and  stronger ;  and  instead  of  the  fine  remission  of 
normal  contraction  is  produced  a  coarser  remission  which 
breaks  the  continuity  of  the  normal  action  into  a  fine  tremor. 
If,  therefore,  we  can  show  that  in  paralysis  agitans  and  sclerosis 
the  resistance  to  the  passage  of  the  current  along  the  nerve- 
fibres  is  increased,  the  tremor  is  completely  explained  on  purely 
physical  grounds.  In  the  description  of  the  minute  anatomy 
we  shall  show  that  the  nerve-fibres  are  deprived  of  their  insu- 
lating material,  that  they  are  strangled  by  the  contraction  of  a 
fibroid  growth,  by  which  they  are  warped  and  wrung  out  of 
their  normal  positions,  and  that  their  diameter  is  very  greatly 
diminished.  There  is  no  doubt  that  these  conditions  do  mate- 
rially diminish  the  conducting  power  of  the  fibres ;  that  is,  they 
increase  the  resistance. 


1875.]  Recent  Researches  in  Nerve  Pathology.  293 

Whether  the  tremor  of  fatigue  be  flue  to  increased  resistance 
or  to  diminished  rapidity  of  accumulation  in  the  centre  is  not 
material  to  the  argument,  but  the  fact  that  fatigue  does  cause 
tremor  in  healthy  subjects,  tremor  which  first  shows  itself  on 
movement  only,  and,  if  the  fatigue  be  greater,  at  rest  also, 
proves  that  the  two  varieties  of  tremor  are  not  radically 
distinct. 

The  description  of  the  morbid  anatomy  of  sclerosis  shows  that 
Prof.  Charcot  carries  into  the  post-mortem  room  and  the  labora- 
tory the  laborious  observation  and  the  same  minute  attention  to 
accuracy  which  render  him  so  excellent  a  guide  in  the  clinic. 
Taking  first  the  macroscopic  appearances,  he  describes  the  mor- 
bid change  as  consisting  in  a  number  of  grey  patches,  irregular 
in  shape  but  of  definite  and  clearly  marked  outline,  scattered 
over  the  whole  length  of  the  cord  and  extending  up  to  the 
medulla,  the  pons,  the  cerebellum,  even' invading  parts  of  the 
cerebrum  itself  and  the  central  ends  of  cerebral  and  spinal 
nerves.  On  making  a  section  across  one  of  these  patches  it  is 
found  that  they  extend  to  variable  depths  and  in  the  most 
irregular  manner  into  the  substance  of  brain  and  cord,  so  that 
the  surface  markings  afford  no  reliable  criterion  of  the  extent  of 
tissue  affected.  The  patches  have  a  firm  consistence,  a  clean 
section,  and  their  colour  is  a  rosy  grey. 

When  a  low  power  of  the  microscope  is  brought  to  bear 
on  a  thin  section  of  the  cord  it  is  found  that  the  sharp  separa- 
tion between  the  healthy  and  the  diseased  parts  is  only  apparent, 
and  that  really  they  merge  into  one  another  by  insensible  gra- 
dations. Directing  our  attention  first  to  the  healthy  portion  of 
a  transverse  section,  Prof.  Charcot  describes  the  well-known 
appearance  of  the  white  substance,  the  numerous  discs  formed  by 
the  cut  ends  of  nerve-fibres,  each  with  its  central  axis -cylinder 
and  its  sheath  of  myeline.  Between  the  fibres  appears  the 
much-discussed  connective  substance,  neuroglia  or  reticulum, 
to  which,  as  the  seat  of  the  principal  and  probably  the  primary 
change  in  sclerosis.  Prof.  Charcot  devotes  great  attention.  He 
adopts  the  view  that  the  neuroglia  is  a  true  lymphoid  connective 
tissue,  composed  of  nucleated  stellate  cells,  by  the  union  of 
whose  processes  the  reticulum  is  formed.  Although,  however, 
he  states  some  of  the  objections  to  this  view,  he  does  not  men- 
tion those  which  appear  to  be  the  most  powerful — the  argument 
of  Robin  that,  whereas  all  the  other  connective  tissue  is  developed 
from  the  mesoplast,  the  nervous  centres  are  developed  wholly 
from  the  epiplast;  and  the  observations  of  Henle  and  Meckel  that 
the  chemical  reactions  of  the  neuroglia  are  the  inverse  of  those 
of  ordinary  connective  tissue.  However,  as  Jaccoud  truly  says, 
the  difference  is  merely  whether  we  term  the  morbid  change  i; 


294  Reviews^,  [Oct.,1 

hyperplasia  of  a  tissue  pre-existing  or  a  neoplasia,  and  the  dif- 
ference makes  not  the  slightest  alteration  in  the  clinical  signi- 
ficance  of  the  change. 

Passing  from  the  normal  cord  into  the  peripheral  zone  of  a 
patch  of  sclerosis,  it  is  noticed  that  the  trabeculse  of  the  reticulum 
are  notably  thickened,  having  sometimes  double  their  nor- 
mal diameter.  At  the  same  time  the  nuclei  which  occupy 
the  intersections  of  the  reticulum  have  increased  in  size  and 
number.  Jaccoud,  following  Rindfleisch  and  Frommann,  lays 
great  stress  on  the  accumulation  of  the  nuclei,  which  he  re- 
presents as  being  very  abundant,  but  Prof.  Charcot  relegates 
this  change  into  a  subordinate  position.  The  nerve-fibres  ap- 
pear more  distant  from  one  another  ;  in  reality  they  are  di- 
minished in  volume,  the  decrease  being  due  solely  to  loss  of  the 
myeline  sheath,  the  axis-cylinder  remaining  normal  or  becomiug 
slightly  hypertrophied. 

Taking  a  part  nearer  to  the  centre  of  the  patch  (zone  of  transi- 
tion), the  nerve-fibres  are  seen  to  be  still  further  diminished. 
Many  of  them  seem  to  have  disappeared;  in  reality  they  have  been 
deprived  of  their  sheath  of  myeline,  and  are  represented  only  by 
their  axis-cylinders,  which  have  acquired,  according  to  Prof» 
Charcot,  ^^  colossal "  dimensions.  The  trabeculae  of  the  reticulum 
have  become  more  transparent,  their  outlines  are  less  definite, 
and  in  certain  parts  they  are  replaced  by  long  and  fine  fibrillse 
like  those  of  ordinary  connective  tissue. 

In  the  central  region  of  a  sclerotic  patch  the  change  has 
become  extreme.  The  fibrillated  connective  tissue  is  now  very 
greatly  developed  at  the  expense  of  all  the  other  elements. 
The  fibroid  reticulum  has  disappeared ;  the  nuclei  have  di- 
minished in  size  and  number;  the  myeline  has  vanished.  Still 
a  certain  number  of  axis-cylinders  remain  intermixed  with  the 
fibrillse,  but  they  have  no  longer  the  dimensions  that  they  had 
in  an  earlier  stage ;  most  of  them,  indeed,  are  diminished  in 
size  so  that  they  can  with  difficulty  be  distinguished  from  the 
connective-tissue  fibrils.  The  persistence  of  a  certain  number 
of  axis- cylinders  is  a  constant  occurrence  in  insular  sclerosis, 
but  probably  the  majority  undergo  the  change,  described  by 
Frommann,  of  first  showing  a  longitudinal  striation,  these  strise 
then  breaking  up  into  granules  which  disappear  by  absorption. 
Besides  these  changes  in  the  normal  constituents  of  the  cord, 
there  appears  another  element  which  is  not  found  except  in 
disease.  Among  the  nerve-fibres  are  found  bodies  of  irregular 
rounded  outline,  having  the  double  contour  and  the  other  physi- 
cal properties  of  myehne.  Existing  in  the  peripheral  zone  in 
large  isolated  masses,  they  become  smaller  and  more  numerous 
as  the  change  advances,  until  they  are  at  last  represented  by 


1875.]  Recent  Researches  in  Nerve  Pathology,  995 

minute  granules  Avhich  have  all  the  appearance  of  fat.  These 
granules  are  not  found  in  the  centre  of  the  patch,  but  only  in 
the  peripheral  and  transition  zones  ;  and,  as  they  are  there  found 
in  great  abundance  around  the  vessels  and  in  their  lymphatic 
sheaths,  it  is  probable  that  they  are  thus  absorbed. 

Having  studied  the  successive  appearances  presented  by  a 
patch  of  sclerosis  when  examined  from  the  periphery  towards 
the  centre,  that  is,  from  the  most  recent  changes  to  the  most 
advanced,  we  are  in  a  condition  to  consider  what  is  the  sequence 
of  the  appearances  we  have  witnessed,  which  are  primary,  and 
which  are  merely  subsidiary.  On  this  head  Prof.  Charcot  has 
no  doubt.  Incontestably,  he  says,  the  multiplication  of  the 
nuclei  and  the  hyperplasia  of  the  reticulate  fibres  of  the 
neuroglia  are  the  initial  fundamental  fact,  the  necessary  ante- 
cedent. The  degenerative  atrophy  of  the  nervous  elements  is 
secondary.  Dr.  Moxon,  too,  says  that  the  minute  anatomy  is 
evidently  that  of  chronic  inflammation,  and  describes  it  as  be- 
ginning in  the  medullary  rays  of  the  connective  tissue,  involving 
the  nerve-fibres  secondarily.  Jaccoud  also  speaks  of  sclerosis 
as  constituted  by  two  acts  of  the  connective  tissue — first  abnor- 
mal development  or  proliferation,  and  then  contraction  and 
compression.  Rindfleisch  is  of  the  same  opinion.  So  that  there 
can  be  little  doubt  that  sclerosis  of  cord  is  strictly  analogous  to 
those  changes  which  have  so  long  been  known  to  take  place  in 
other  organs,  in  which  the  same  sequence  of  proliferation  and 
contraction  of  connective  tissue  leads  to  the  same  disastrous 
effects  on  the  structure  and  function  of  the  organ. 

The  cause  of  the  peculiar  distribution  of  the  patches  of 
sclerosis  is  at  present  unknown.  Prof.  Charcot  does  not  hazard 
any  hypothesis.  He  states  that  Rindfleisch  has  brought  for- 
ward the  notion  that  the  point  of  departure  is  in  the  vascular 
system — that  inflammation  of  the  walls  of  the  small  vessels  is 
the  first  change,  and  that  from  these,  as  from  centres,  it  is 
propagated.  Rindfleisch,  however,  clearly  distinguishes  two 
kinds  of  sclerosis.  In  one  form  there  is  invariably  a  thickened 
vessel  in  the  centre  of  the  patch ;  in  the  second,  besides  other 
differences,  he  distinctly  states  that  the  behaviour  of  the  vessels 
is  of  subordinate  significance.  The  fact  that  he  limits  the  term 
sclerosis  to  the  first  variety,  and  calls  the  other  grey  degenera- 
tion, has  probably  given  rise  to  Prof.  Charcot's  error.  A  second 
hypothesis  brought  forward  by  Dr.  Moxon  deserves  attentive 
consideration,  both  from  its  novelty  and  from  the  connection  it 
would  establish  between  disorders  at  first  sight  widely  different. 
The  supposition  is  that  there  is  reason  to  regard  insular  sclerosis 
as  eruptive — to  look  upon  the  phenomenon  of  eruption  as  by  no 
means  confined  to  the  skin,  but  producing  characteristic  ap- 


296  Reviews.  [Oct., 

pearances  in  many  other  organs.  In  smallpox  the  mucous 
membranes,  the  inward  reflexions  of  the  tegument,  show  the 
characteristic  eruptions.  In  syphilis  the  same  kind  of  action  is 
found  in  muscles,  bones,  &c.,  in  the  form  of  gummata.  But 
the  closest  resemblance  to  sclerosis  is  found  in  the  subacute 
arteritis  occurring  in  patches,  which  Dr.  Moxon  has  described 
as  inflammatory  mollities.  The  fibroid  substances  in  brain  and 
artery  resemble  each  other  very  closely,  and  the  form  of  distri- 
bution of  the  charge — round  blotches — is  the  same  in  both.  In 
either  case  we  meet  with  a  disease  of  unknown  origin,  which 
presents  itself  as  an  eruptive  outburst  of  more  or  less  circular 
foci  of  subinflammatory  action.  In  neither  case  is  there  any 
correspondence  of  the  figure  of  the  patch  with  any  structural 
component  of  the  texture.  Dr.  Moxon  believes  that  both 
maladies  have  an  essentially  eruptive  nature,  by  which  he 
means  that  the  local  disease  is  set  up  by  some  agency  which  is 
of  specific  kind  and  not  native  in  the  part  in  which  the  change 
is  seen.  It  is  to  be  hoped  that  Dr.  Moxon  will  further  elaborate 
an  idea  of  such  fruitful  promise — an  idea  which,  if  really 
established,  will  give  us  a  far  clearer  insight  into  a  class  of  ob- 
scure diseases,  and  furnish  very  valuable  indications  for  pre- 
ventive and  curative  treatment. 

It  remains  now  to  consider  what  is  the  connection  of  the 
symptoms  of  the  disease  with  the  peculiar  change  in  the  nervous 
centres,  and  here,  again,  the  deficiency  of  our  knowledge  is  con- 
spicuous. The  uniform  coexistence  of  the  morbid  change  with 
the  peculiar  group  of  symptoms  described  leaves  no  more  doubt 
of  its  causal  relation  to  them  than  of  the  causal  relation  of 
sclerosis  of  the  posterior  columns  to  the  staggering  gait  and 
electric  pains  of  locomotive  ataxy ;  and  this  is  further  confirmed 
by  the  fact  that  in  other  diseases  (cerebral  change  with  descend- 
ing wasting,  pachymeningitis,  primitive  symmetrical  sclerosis, 
&c.)  damaging  the  antero-lateral  columns  there  occur  paralysis 
and  spasmodic  rigidity.  But  in  what  way  it  is  that  change  in 
this  region  gives  rise  to  these  symptoms  is  at  present  unex- 
plained. We  have  endeavoured  to  show  that  tremor  may  be  ra- 
tionally accounted  for  by  the  existence  of  such  a  condition  in 
the  nerve-centres,  but  to  discuss  the  dependence  of  the  other 
symptoms  on  the  anatomical  condition  would,  in  the  present 
state  of  our  knowledge  of  the  functions  of  the  different  regions 
of  the  cord,  merely  lead  us  into  idle  speculation. 

Our  knowledge  of  the  etiology  of  these,  as  of  most  other 
nervous  diseases,  is  still  in  a  very  unsatisfactory  condition.  It 
is  indeed  gratifying  that  the  three  things  which  have  so  long 
been  credited  with  the  parentage  of  every  kind  of  nervous 
disorder — syphilis,  masturbation    and  sexual  c:jvcess — seem  at 


1875.]  Recent  Researches  in  Nerve  Pathology,  297 

length  to  be  losing  their  time-honoured  reputation.  None  of 
these  is  mentioned  by  Prof.  Charcot.  The  imaginations  of 
pathologists  on  this  subject  have  been  much  like  that  of  the 
celebrated  sailor  to  whom  was  granted  the  fairy  privilege  of 
having  three  wishes  fulfilled.  After  he  had  secured  all  the  rum 
in  the  world  and  all  the  tobacco  in  the  world  by  his  first  two 
wishes,  he  could  think  of  nothing  further  to  wish  for  than  a 
little  more  rum.  After  crediting  all  nervous  disorders  to  sexual 
excess  and  syphilis,  pathologists  have  no  explanation  of  a  new 
disease  but  a  little  more  sexual  excess. 

It  is  interesting  to  note  the  contrary  results  to  which  two 
excellent  observers  are  led  by  reasoning  from  insufficient  data. 
Jaccoud  finds  that  sclerosis  attacks  young  or  adult  individuals 
without  distinction  of  sex  up  to  the  age  of  forty-five  years,  and 
he  has  known  two  cases  over  fifty.  Prof.  Charcot  considers  it 
established  that  the  malady  is  much  more  common  in  females 
than  in  males — that  it  rarely  appears  after  thirty,  and  never 
after  forty.  Jaccoud  finds  that  of  eighteen  cases  ten  are  male 
and  eight  female.  Prof.  Charcot,  out  of  thirty-four  cases,  finds 
nine  male  and  twenty-five  female.  Both  observers  agree,  how- 
ever, in  recognising  the  powerful  influence  of  moist  cold  in 
causing  both  paralysis  agitans  and  insular  sclerosis,  and  the 
latter  adds  vivid  emotions  as  another  fruitful  cause.  In  this, 
as  in  all  similar  cases  where  such  very  common  conditions  are 
arraigned  as  causes  of  such  rare  diseases,  it  is  evident  that  they 
cannot  be  the  sole  nor  even  the  principal  causal  conditions,  or 
the  diseases  would  be  far  more  common.  If,  as  Prof.  Charcot 
states,  the  anxiety  caused,  for  example,  by  an  illicit  pregnancy 
can  give  rise  to  sclerosis,  the  disease  would  scarcely  have 
remained  so  long  unrecognised  on  account  of  its  rarity. 

Much  more  importance  must  be  attached  to  a  fact  noticed  by 
Dr.  Bourneville,  that  the  appearance  of  the  symptoms  of  sclerosis 
is  often  preceded  by  some  acute  illness.  It  is  possible  that  a 
damaged  cord,  which  was  able  to  perform  its  functions  without 
great  defect  so  long  as  the  general  health  was  good,  gave  way 
suddenly  when  the  vital  condition  was  lowered.  This,  at  least, 
was  suggested  as  being  the  case  in  a  patient  whom  we  recently 
saw  with  an  able  pathologist  and  physician.  A  woman  had  cen- 
tripetal paralysis  of  all  four  extremities  with  muscular  atrophy, 
and  she  dated  these  symptoms  from  her  confinement  two  months 
before.  The  view  of  the  case,  founded  on  a  general  examination 
of  her  system,  was  that  she  had  had  disease  in  her  cord  for  a 
very  long  period  before  the  symptoms  showed  themselves,  and 
that  the  confinement  had  brought  them  out  in  some  such  way 
as  this.  Suppose  a  fibroid  thickening  of  the  vessels  of  the  cord 
such  as,  judging  from  her  clinical  history,  there  was  no  doubt 


298  Revieivs.  [Oct., 

she  had  in  other  organs,  so  long  as  the  heart  retained  its  full 
power,  the  vis  a  tergo  would  be  competent  to  force  the  plasma 
through  the  thickened  walls  of  the  vessels  in  sufficient  quantity 
to  sustain  the  nourishment  of  the  cord  nearly  up  to  the  normal 
standard ;  but  when  the  heart's  power  was  suddenly  much 
diminished  the  cord  would  be  very  insufficiently  nourished, 
and  its  function  would  rapidly  fail.  In  view  of  these  circum- 
stances a  very  favorable  prognosis  was  given,  it  being  believed 
that  as  the  heart  regained  power  the  cord  would  regain  its 
function  ;  and  this  was  fully  justified  by  the  event.  The  patient 
recovered.  The  case,  however,  is  not  decisive,  for  she  took 
iodide  of  potassium. 

Keeping  in  mind  the  profound  alteration  of  structure  on 
which  the  symptoms  undoubtedly  depend,  we  should  antici- 
pate that  drugs  would  be  useless  in  the  treatment  of  this 
disease.  What  drug  could  restore  the  lost  myeline  to  the 
nerves,  or  reconvert  the  dense  fibrillar  connective  tissue  into 
cobweb-like  neuroglia?  We  are  prepared  to  hear,  there- 
fore, that  the  whole  catalogue  of  so-called  nervines — chloride  of 
gold,  phosphate  of  zinc,  nitrate  of  silver,  bromide  of  potassium, 
arsenic,  belladonna,  strychnine,  ergot  of  rye,  and  the  rest — have 
one  and  all  failed  to  benefit  the  patients,  although  several  of 
them  have  appeared  to  exaggerate  the  symptoms.  Rather, 
we  should  imagine,  by  careful  abstinence  from  fatigue  and 
anxiety,  by  rigorous- dietetic  and  hygienic  rules,  by  the  removal 
of  any  concomitant  maladies  or  sources  of  weakness,  should  the 
general  standard  of  nutrition  be  raised  to  the  highest  possible 
pitch ;  so  that  although  we  cannot  renew  the  damaged  patches 
in  the  cord,  yet  by  ensuring  them  a  copious  supply  of  pure, 
rich,  well-oxygenated  blood  sent  by  a  powerful  heart,  we  place 
those  elements  that  yet  remain  under  the  most  favorable  con- 
ditions possible  for  retaining  and  improving  their  function. 


III. — Paget's  Clinical  Lectures  and  Essays.^ 

Some  of  the  most  useful  teaching  of  men  of  large  experience 
and  wide  scope  of  mind  is  that  which  may  be  gathered  from 
the  casual  reflections  and  remarks  which  are  called  forth  by  par- 
ticular subjects  under  investigation.  Herein  the  teacher  is  not 
hampered  by  the  necessity  of  reducing  his  thoughts  to  a  sys- 
tematic form ;    he  can  throw  out  hints  and  state  impressions 

1  Clinical  Lectures  and  Ussays.     By  Sir  James  Paget,  Bart,  F.R.S.,  D.C.L. 
Oxon.,  LL.D.  Cantab.     Edited  by  Howaed  Maesh,  F.R.C.S. 


1875.] 


I^AGET^s  Clinical  Lectures  and  Essays.  SSQ' 


which  would  be  out  of  place  in  a  formal  treatise ;  and  his  ob- 
servations have  the  additional  interest  which  is  always  given  by 
an  immediate  application.  In  this  way  also  the  listener's  intel- 
lect is  stimulated  to  the  filling  up  of  suggestive  outlines,  or  the 
pursuit  of  indicated  paths  of  inquiry.  This  it  is  which  gives  so 
great  a  value  to  the  conversation  of  men  of  learning  and  wide 
observation,  some  of  whose  best  thoughts  have  been  thus  trans- 
mitted. Unfortunately  the  pace  of  our  present  mode  of  life 
gives  but  little  opportunity  for  sustained  rational  conversation. 
People  in  the  present  day  have  not  time  for  the  "  talk  "  whereby 
men  such  as  Johnson  or  Coleridge  used  to  recreate  and  improve 
themselves  and  others.  The  result  of  this  has  been  an  increase 
of  periodical  literature,  containing  short  essays  and  papers,  cor- 
responding in  style  very  much  to  the  conversation  of  former 
days.  It  is  well  for  us,  then,  when  one  having  such  excep- 
tional materials  for  and  such  unexampled  powers  of  teaching, 
as  distinguish  Sir  James  Paget,  gives  to  us  in  a  collected  form, 
some  of  his  occasional  and  less  systematic  lessons,  and  thus 
enlarges,  as  it  were,  the  circle  of  his  pupils.  The  volume  of 
'  Clinical  Lectures  and  Essays '  which  Sir  James  Paget  has 
recently  published  is  modestly  prefaced  by  the  statement,  that 
it  is  not  intended  for  ^^  those  who  are  in  large  surgical  practice 
or  familiar  with  surgical  literature.  Its  chief  purpose  will  be 
attained  if  it  be  useful  to  students  and  to  those  who  have  too 
few  opportunities  of  studying  surgery  in  either  large  practice  or 
large  books."  But  we  think  there  are  few  in  the  profession 
who  will  not  be  glad  to  profit  by  the  sagacious  reflections  and 
mature  advice  contained  in  the  book,  and  to  possess,  in  a  con- 
venient form,  the  valuable  essays  which  are  therein  gathered 
from  many  scattered  sources. 

These  essays  also  have  a  high  value  as  models  of  method  and 
style.  A  man  of  high  scientific  attainments  recently  expressed 
to  the  present  writer  his  opinion  that  the  members  of  the  medical 
profession  excelled  chiefly  in  their  powers  of  immediate  deduc- 
tion, but  were,  as  a  rule,  not  skilful  in  carrying  on  sustained 
chains  of  reasoning.  This  we  believe  is,  generally  speaking, 
true ;  but  Sir  James  Paget  has  given  many  evidences  of  the 
possession  of  very  high  reasoning  powers,  and  the  student  may 
gather  from  his  writings  numerous  examples  of  cautious  and 
well-sustained  argument,  as  well  as  of  subtle  analysis  and  accu- 
rate deduction.  Moreover,  it  may  be  noticed  with  what  modest 
reticence  he  abstains  from  attempting  explanations  when  the 
facts  are  insuflicient — an  example  too  little  followed  by  many 
medical  writers ;  and  the  style  has,  besides  the  clearness  which 
belongs  to  a  thorough  comprehension  of  the  subject-matter,  a 
classic  eloquence  which  makes  it  most  attractive  reading. 


800  Reviews,  [Oct., 

Mr.  Marsh,  besides  having  edited  tlie  volume,  has  added 
some  valuable  notes,  which  we  shall  notice  in  their  place. 

The  first  essay  is  on  the  various  risks  of  operations,  and  gives 
us  many  useful  notes  whereby  we  may  distinguish  those  patients 
which  are,  from  those  which  are  not,  favorable  subjects  for  opera- 
tions. Those  who  recover  best  from  operations  are  not  they  who 
are  most  healthy  for  active  life,  but  boys  between  the  ages  of 
twelve  and  sixteen  years,  and  chronic  invalids  who  have  lived 
carefully  and  temperately,  and  ^'  to  whom  an  operation  brings 
no  great  change  of  habits."  The  boys,  we  presume,  owe  their 
good  recovery  very  much  to  the  soundness  of  their  bodies, 
which  have  not  yet  been  exposed  to  much  damage  by  wear  or 
dissipation ;  the  chronic  invalids  to  their  careful  living  and  the 
little  change  of  habits  involved  by  an  operation. 

Children  are  likewise,  in  many  respects,  free  from  dangers 
which  beset  their  seniors,  and  are  in  danger  chiefly  from  the 
shock  of  an  operation.  They  bear  pain  ill,  and,  as  Mr.  Marsh 
points  out  in  a  note,^  may  be  reduced,  by  a  few  hours  of  acute 
pain,  to  a  state  of  dangerous  collapse.  Mr.  Marsh  very  properly, 
therefore,  advises  the  free  use  of  anaesthetics  and  of  opium — 
advice  which  we  would  earnestly  endorse. 

Children  take  anaesthetics  very  well,  and  we  possess  in  ether 
one  which  not  only  has  the  advantage  of  producing  insensibility 
to  pain,  but  which  also,  by  its  stimulant  effects,  acts  as  an  an- 
tagonist to  shock.  We  think  that  the  value  of  opium  in  the 
traumatic  fever  and  nervous  irritability,  following  operations 
in  children,  is  by  no  means  sufficiently  appreciated.  The  effect 
upon  them  of  small  and  frequently  repeated  doses  is  most  ex- 
cellent, and  we  quite  agree  with  Mr.  Marsh,  that  "  it  is,  per- 
haps, the  most  valuable  medicine  that  children  ever  take." 
Mr.  Marsh  also  questions  the  accuracy  of  the  opinion  that  chil- 
dren bear  the  loss  of  blood  badly.  We  consider  that  their  large 
reparative  power  enables  them  rapidly  to  make  up  the  loss ;  but 
we  think  also  that  they  are  in  graver  danger  at  the  time  of  the 
haemorrhage,  than  adults  would  be  from  a  proportionate  bleeding, 
on  account  of  the  profounder  impression  made  upon  the  ner- 
vous system.  It  is  quite  true,  as  Mr.  Marsh  says,  that  convul- 
sions do  not  often  follow  large  haemorrhages  in  children ;  but 
coma  does,  as  we  have  several  times  seen,  after  not  very  copious 
bleeding. 

The  author  remarks  that  children  are  much  less  liable  than 
adults  to  pyaemia  after  operation,  and  the  editor  adds  that  they 
more  often  recover  when  it  does  occur.  This  should  encourage 
us  to  operate  on  children  in  the  early  stage  of  pyaemia,  when 

1  P.  399. 


n 


875.]  Paget's  Clinical  Lectures  and  Essays,  301 


y  so  doing  we  can  remove  the  source  of  the  blood-poisoning. 
Wc  have  ourselves  seen  a  child,  who  was  unquestionably  suffer- 
ing  from  pyrcmia,  make  a  rapid  recovery  from  the  time  when  a 
diseased  limb  was  amputated.  The  tuberculosis  which  some- 
times seems  to  be  set  up  by  an  operation  may,  we  think,  be 
occasionally  due  to  the  interference  with  old  caseous  material 
which  the  operation  often  involves. 

Age  is,  of  course,  a  source  of  danger  to  the  subjects  of  opera- 
tions, and  the  author  wisely  reminds  us  that  we  must  judge  of 
age,  not  by  years,  but  by  the  amount  of  degeneration  present. 
Old  persons  bear  the  loss  of  blood  badly,  and  we  are  warned 
against  keeping  them  long  recumbent,  or  over-feeding  them. 
"  They  that  are  fat  and  bloated,  pale,  with  soft  textures,  flabby, 
torpid,  wheezy,  incapable  of  exercise,  looking  older  than  their 
years,"  are  characterised  as  "very  bad"  subjects  for  operations. 
The  scrofulous  are  said  to  exhibit,  in  reference  to  operations, 
chiefly  want  of  healing  power.  This  is  no  doubt  true,  and  the 
rapid  recovery  which  follows  the  removal  of  the  majority  of 
joints  affected  by  chronic  disease,  is  evidence  that  many  of  such 
cases  are  miscalled  "  scrofulous."  The  syphilitic  and  the  gouty 
do  not  seem  to  incur  any  special  risk  from  operations,  excepting 
in  so  far  as  the  latter  are  liable  to  have  granular  kidneys  or 
other  degenerations ;  neither  do  the  cancerous  nor  the  plethoric. 
The  very  fat,  especially  those  who  overeat  and  drink,  and  have 
pendulous  bellies  and  defective  portal  circulation,  are  referred 
to  as  a  very  bad  class  for  operations.  Here  the  author  gives  a 
wise  warning  concerning  the  prevalence  of  habitual  soaking, 
and  the  fatal  harm  that  many  persons,  who  pass  for  highly 
respectable  people,  thereby  do  themselves. 

Dyspepsia  is  spoken  of  as  increasing  the  risk  of  chloroform  or 
ether  sickness.  This  may,  perhaps,  be  so ;  but  we  think  that 
renal  disease  is  by  far  the  most  common  cause  of  the  after- 
sickness  from  anaesthetics.  We  not  only  agree  with  the  author 
that  constipation  for  a  few  days  after  an  operation  is  harmless, 
but  would  go  further,  and  say  that  it  is  very  often  beneficial  to 
prevent  the  disturbance  accompanying  an  action  of  the  bowels, 
and  that  after  an  operation  for  strangulated  hernia  it  is  desirable 
to  give  opium  for  this  purpose. 

We  think  that  Sir  James  Paget  rather  over-estimates  the 
danger  of  operating  on  those  with  amyloid  enlargement  of  the 
liver,  which,  when  coincident  with  long-continued  suppuration, 
may  be  even  an  additional  reason  for  removing  by  operation, 
the  disease  which  may  be  its  cause. 

We  are  surprised,  moreover,  to  see  that  he  is  rather  in  favour 
of  operating  for  fistula  in  phthisical  patients;  and  we  question, 
indeed,   whether  many  persons  in  ill  health,  even  when  not 

112— LYI.  20 


302  Reviews.  [Oct., 

phthisical,  are  not  more  harmed  than  benefited  by  the  "  free 
incisions  "  which  are  usually  thought  applicable  to  sinuses  and 
abscess  about  the  anus. 

The  danger  of  operating  on  the  subjects  of  albuminuria  is 
alluded  to,  and  there  is  a  useful  warning  against  incautious 
catheterism,  which,  with  some  remarks  on  operating  upon  the 
insane,  the  pregnant,  and  the  suckling,  bring  this  subject  to  a 
close.  Then  follows  a  chapter  on  "  The  Calamities  of  Surgery," 
which,  it  is  shown,  are  sometimes  to  be  averted  by  careful  atten- 
tion to  details,  but  are  sometimes  by  no  skill  to  be  avoided. 
The  author  justly  says  that  a  man  who  is  to  be  submitted  to  an 
operation  ought  at  least  to  be  inspected  with  a  care  equal  to 
that  expended  upon  a  candidate  for  life  insurance,  and  he 
recommends  for  guidance  the  questions  which  an  insurance  office 
requires  to  be  answered. 

There  is  a  great  element  of  safety  in  the  consultations,  usually 
held  in  hospital  practice,  upon  all  cases  in  which  an  operation 
is  proposed. 

We  regret  to  notice  that  Sir  James  Paget  still  speaks  some- 
what doubtfully  of  the  advantages  of  ether  over  chloroform, 
although,  in  a  note,  he  states  that  '^  for  the  last  two  years  I  have 
used  only  sulphuric  ether,  or,  for  short  operations,  nitrous 
oxide  gas  or  ether-spray."  Certainly,  deaths  from  anaesthetics 
are  among  those  calamities  of  surgery  which  may  be  notably 
reduced  by  the  careful  selection  of  the  safest  available  agent. 
Nothing  can  be  better  than  nitrous  oxide  for  short  operations, 
and  it  might  be  much  more  frequently  used  for  such  than  it  is 
at  present ;  but  for  operations  of  longer  duration,  it  has  been 
abundantly  shown  that  ether  is  by  far  the  safest  anaesthetic 
which  we  at  present  possess,  and  that  it  can  be  given  as  easily 
and  conveniently  as  chloroform.  Moreover,  it  is  less  liable 
than  chloroform  to  produce  after-sickness,  and  is,  by  its  stimu- 
lant effect,  antagonistic  to  the  shock  of  an  operation.  Examples 
are  given  of  the  value  of  attention  to  small  things  in  surgery, 
and  of  the  lessons  that  may  be  learned  from  failures  and  mis- 
takes. "  But  there  are  some  people  who  seem  to  have  a  happy 
art  of  forgetting  all  their  failures,  and  remembering  nothing  but 
their  successes,  and,  as  I  have  watched  such  men  in  professional 
life,  years  have  always  made  them  worse  instead  of  better  sur- 
geons. They  seem  to  have  a  faculty  of  reckoning  all  failures 
as  little,  and  all  successes  as  big  ;  they  make  their  brains  like 
sieves,  and  they  run  all  the  little  things  through,  and  retain  all 
the  big  ones  which  they. suppose  to  be  their  successes;  and  a 
very  mischievous  heap  of  rubbish  it  is  that  they  retain.'' 

The  short  essay  on  "  Stammering  with  other  Organs  than 
those  of  Speech"  gives  the  key  to  understanding  a  class  of  cases, 


'^R. 


]  Paget's  Clinical  Lectures  and  Essays.  303 


til 

I 


that  without  it,  would  often  be  puzzling.  This  is  the  note  of 
these  cases : — "  Stammering,  in  whatever  organs,  appears  due 
to  a  want  of  concord  between  certain  muscles  that  must  con- 
tract for  the  expulsion  of  something,  and  others  that  must  at 
the  same  time  relax  to  permit  the  thing  to  be  expelled."  In- 
ances  of  this  discord  or  stammering  are  given,  affecting  the 
inary  organs,  the  oesophagus,  and  the  rectum. 

The  next  lecture  is  on  "  Cases  that  Bone-setters  Cure." 
ome  of  the  most  successful  of  such  cures  are  due  to  the  rup- 
ture of  adhesions  between  the  joint-surfaces,  others  to  the  more 
gradual  lengthening  of  shortened  structures  outside  the  joints. 
The  author  gives  some  useful  guides  towards  the  discernment 
of  the  cases  that  are  suited  to  such  treatment.  For  it  m^ist  be 
remembered  that  although  the  public  hear  but  little  of  the 
failures  and  injuries  done  by  the  **  bone-setters,"  yet  such 
treatment  is  sometimes  followed  by  the  gravest  mischief.  We 
doubt  whether  adhesion  or  ulceration  takes  place  in  joints  as 
the  result  of  mere  immobility,  though  the  surrounding  soft 
parts  may  become  contracted  or  wasted ;  and  we  think,  there- 
fore, a  careful  inquiry  should  be  made  in  all  cases  of  stiff  joints 
for  the  occurrence  of  even  the  slightest  inflammatory  attack, 
and  that  this  should  very  much  influence  us  as  to  whether  the 
joint  should  be  suddenly,  or  gradually  moved.  The  gradual 
stretching  of  an  adhesion,  as  a  rule,  does  harm,  whereas  its 
rupture  is  often  at  once  curative ;  but  when  the  stiffness  of  a 
joint  depends  upon  the  structures  around,  and  not  within  it, 
the  slower  method  of  rubbing  and  exercise  is  much  more  suc- 
cessful than  any  sudden  and  extended  movement,  which,  indeed, 
may  do  much  harm.  Sir  James  Paget  refers  to  a  case,  related 
by  Mr.  Butlin,  of  ankylosis  of  a  knee-joint  which  was  long 
kept  straight  for  the  treatment  of  a  fractured  femur;  but  the 
case  is  not  a  conclusive  one,  for  there  had  been  a  recent  frac- 
ture of  the  lower  end  of  the  femur,  when  the  knee-joint  might 
possibly  have  been  injured ;  these  were  ulcers  of  the  articular 
cartilage  which  were  surrounded  by  vascular  patches,  and  the 
bone  was  somewhat  softened.  Moreover,  Dr.  Reyber  has  shown 
that  absorption  of  the  cartilage  of  a  fixed  joint  takes  place 
when  the  parts  are  not  in  contact,  and  not  where  they  are  in 
apposition,  so  that  the  wasting  of  the  cartilage  is  due  rather 
to  loss  of  function  than  to  pressure. 

The  lectures  on  "  Strangulated  Hernia"  are  full  of  valuable  ex- 
perience gathered  from  the  author's  notes  of  his  cases,  but  con- 
tain less  of  novelty  than  the  rest  of  the  book.  Among  the  signs 
of  strangulation  commanding  the  operation  for  hernia,  the  most 
reliable  is  said  to  be  vomiting,  the  importance  of  which,  we 
believe,  cannot  be  too  much  insisted  upon. 


304  Ueviews.  [Oct., 

With  regard  to  the  peritonitis  occurring  in  connection  with 
strangulated  hernia,  Mr.  Marsh,  in  a  note,  alludes  to  Mr. 
Hutchinson's  opinion  that  peritonitis  very  rarely  occurs  before 
the  operation,  unless  there  be  perforation,  and  that  when  it 
occurs  after  the  operation  it  is  chiefly  caused  by  the  return  of 
inflamed  intestine  and  flakes  of  lymph,  and  by  the  injury 
inflicted  by  fingers,  &c.,  introduced  into  the  sac.  We  admit 
the  rarity  of  peritonitis  before  the  operation,  unless  there  be 
perforation ;  and  we  believe  that  by  far  the  most  common  cause 
of  its  occurrence  after  the  operation,  is  the  return  of  inflam- 
matory products  into  the  peritoneal  cavity. 

Recent  experiments  have  shown  the  intense  and  rapid  inflam- 
mation that  may  thus  be  set  up,  and  we  think  this  is  one  of  the 
strongest  arguments  for  opening  the  sac  in  the  majority  of 
operations  for  strangulated  hernia.  If  the  hernia  has  been  long 
strangulated,  inflammatory  products  are  almost  certainly  found 
in  the  sac,  and,  moreover,  the  condition  of  the  intestine  must  be 
the  more  doubtful ;  and  if  an  operation  is  called  for  after  a  very 
short  time  of  strangulation,  the  case  is  probably  an  acute  one, 
and  inflammatory  exudation  is  again  probable.  To  this  lecture 
Mr.  Marsh  appends  an  excellent  note  on  the  ^'  aspiration"  of 
strangulated  hernia,  and  gives,  we  think,  a  very  just  estimate  of 
the  value  of  that  method  of  treatment.  The  paper  on  "  Chronic 
Pya3mia"  describes  several  cases  of  that  disease,  one  of  which 
extended  over  three  years.  Its  frequent  association  with  acute 
necrosis  is  pointed  out.  "  The  frequency  of  death  from  acute 
pyaemia  in  this  disease  is  well  known,  yet  I  think  there  are  no 
cases  of  pyaemia  in  which  death  is  more  often  escaped." 

Perhaps  the  most  interesting  and  valuable  lectures  in  the 
volume,  are  those  on  "  Nervous  Mimicry  ;"  they  notably  display 
the  sagacity  of  the  author.  Herein  we  are  warned  against  the 
common  error  that  neuromimesis  "is  to  be  found  only  or  chiefly 
in  the  silly,  selfish  girls  among  whom  it  is  commonly  supposed 
that  hysteria  is  rife  or  an  almost  natural  state."  Rather  are 
we  to  look  for  it  in  those  of  unusual  mental  or  emotional 
character,  and  to  remember  that  "1  cannot,"  though  it  often  looks 
like  "  I  will  not,"  really  may  be  '*  I  cannot  will."  Very  impor- 
tant in  aid  of  diagnosis  is  the  family  history,  which  often  gives 
evidence  of  ancestral  or  consanguineous  insanity,  and  the 
author  justly  lays  great  stress  upon  the  hyperneurotic  diathesis 
of  these  patients,  and  the  fallacy  of  supposing  "  that  nervous 
mimicry  or  hysteria,  or  any  of  the  allied  forms  of  disease,  can 
be  referred  to  any  malady  of  any  other  part  than  the  nervous 
system."  But  it  must  also  be  remembered  that  there  are  nume- 
rous cases  of  trivial  disease  or  injury,  made  to  seem  severe  by 
hysteria  or  other  nervous  fault."     Excellent  advice  is  given  foi 


1875.]  Paget's  Clinical  Lectures  and  Essays.  305 

the  diagnosis  of  the  real  from  the  mimic  disease,  and  there  is  a 
description  of  a  nervous  dihitation  of  arteries  simulating  aneurism, 
of  which  we  have  seen  several  examples,  but  of  which  we  have 
not  elsewhere  met  with  a  description. 

The  lecture  on  "  Carbuncle"  asserts  the  uselessness  of  the  cut- 
ting, stimulating,  and  feeding  which  used  to  be  thought  necessary; 
|and  the  value   of  fresh  air  and  careful   dressing  of  the  wound. 

ur  experience  is  quite  confirmatory  of  this,  and  we  think 
hat,  thanks  to  Sir  James  Paget's  teaching,  the  more  rational 
reatment  he  advises  is  gaining  ground.  The  mortality  of  the 
disease  has  been  much  over-estimated,  and  in  Sir  J.  Paget's 
opinion  "  there  is  no  other  disease  of  the  same  extent  and 
general  severity  which  is  attended  with  so  little  risk  to  life." 

This  statement  refers,  of  course,  to  uncomplicated  carbuncle, 
for,  like  any  other  extensive  suppuration,  it  may  be  the  fatal 
addition  to  existing  disease,  as,  for  instance,  it  not  unfre- 
quently  is  to  diabetes.  The  fatal  affection  called  "facial  car- 
buncle" was,  when  the  lecture  was  first  given,  considered  by  the 
author  as  a  separate  disease,  but  he  now  ^^  feels  nearly  sure  that 
the  disease  of  the  lip  is  true  carbuncle  which,  because  of  some 
peculiarity  in  the  textures  of  the  lip,  especially  in  young  per- 
sons, is  peculiarly  apt  to  infect  the  blood  and  generate  acute 
pyaemia."  To  the  remarks  on  dressing  carbuncles,  we  would 
add  that  nothing  has  seemed  to  us  so  efficient,  both  for  comfort 
and  progress,  as  the  application  of  the  oakum  now  used  for 
dressing  wounds. 

There  then  follows  a  most  admirable  chapter  on  what  the 
author  has  well  named  "  sexual  liypochondriasis."  It  seems  to 
us  a  model  of  the  method  in  which  such  subjects  should  be 
treated,  namely,  by  straightforward,  conscientious,  plain-speak- 
ing. It  will  be  very  helpful  to  many  of  less  authority,  to  be 
able  to  quote  Sir  James  Paget's  denunciation  of  the  false 
teaching  of  Lallemand  and  his  followers;  and,  we  doubt  not, 
that  many  wrong  and  harmful  opinions  will  be  neutralised  by 
the  excellently  wise  words  in  which  Sir  James  treats  of  some  of 
the  difficult  questions  connected  with  this  subject, 

A  paper  on  "  Gouty  Phlebitis"  is  founded  upon  several  inter- 
esting cases  which  are  related.  Among  other  results  of  this 
affection,  one  not  commonly  known,  is  the  hypertrophy  of  the 
muscles  of  the  limb  to  which  the  author  calls  attention. 

The  essay  on  "  Residual  Abscesses"  describes  a  class  of  cases 
frequently  seen,  but  often  misinterpreted,  and  gives,  we  believe 
for  the  first  time,  the  real  explanation  of  their  nature.  "  Under 
the  name  of  residual  abscesses"  are  included  "  all  abscesses 
formed  in  or  about  the  residues  of  former  inflammations.  Most 
of  them  are  formed  where  pus,  produced  long  previously,  has 


306  Reviews.  [Oct.^ 

been  wholly  or  in  part  retained  and  become  dry,  or  in  some 
form  obsolete  ;  but  some  of  them,  it  is  probable,  are  found  in 
the  thickenings,  adhesions,  or  other  slowly  organised  products 
of  inflammation  long  past.''  These  abscesses  remind  us  of 
what  we  think  is  too  often  forgotten — that  the  effects  of  disease 
frequently  remain  when  the  disease  itself  has  been  long  at  an  end. 
We  think  that  this  is  the  explanation  of  some  of  the  cases 
spoken  of  by  Sir  J.  Paget  in  a  subsequent  chapter  as  "  senile 
scrofula,^'  in  which,  because  of  advancing  years  or  broken 
health,  some  of  the  latent  products  of  old  inflammation  are  the 
seat  of  fresh  suppuration.  We  cannot  but  think  that  John 
Hunter  was  right  in  regarding  scrofula  as  a  disease  of  youth. 

The  paper  on  '^  Dissection  Poisons"  is  a  description  with 
commentary,  of  the  illness  from  which  its  author  suffered,  in 
consequence  of  poisoning  during  a  post-mortem  examination  of 
a  patient  dead  of  pyaemia.  Sir  James  points  out  the  curious 
but  indubitable  fact  that  immunity  from  this  kind  of  poison  is 
acquired  from  constant  contact  with  it,  and  that  such  immunity 
may  be  both  local  and  general,  also  that  after  a  time  this  immu- 
nity is  lost.  Most  of  those  much  engaged  in  morbid  anatomy 
can  confirm  this.  In  speaking  of  his  own  liability  to  pneu- 
monia the  author  usefully  reminds  us  ''  that  there  is  no  disease 
so  specific  but  that  its  signs  may  be  confused  or  complicated 
with  the  things  that  are  peculiar  to  the  patient."  Thus  are 
explained  the  various  eruptions  and  other  troubles  sometimes 
educed  by,  and  bringing  discredit  upon,  vaccination ;  "  they 
come  out  from  the  personal  constitutions  of  the  several 
patients,  which  are  disturbed  by  the  vaccination,  as  they  might 
have  been  by  anything  else  producing  some  slight  fever. 

A  short  paper  on  "  Quiet  ^jecrosis"  (we  cannot  help  a  passing 
expression  of  our  admiration  for  the  happy  titles  which  Sir  J. 
Paget  gives  to  his  essays),  describes  the  exfoliation  of  bone 
and  cartilage  which  sometimes  occurs  "  without  any  of  the 
attendant  phenomena  of  either  inflammation  or  fever." 

The  essay  on  "Scarlet  Fever  after  Operations"  draws  attention 
to  the  fact  that ''  there  is  something  in  the  consequences  of  sur- 
gical operations  which  makes  the  patients  peculiarly  susceptible  of 
the  influence  of  the  scarlet  fever  poison."  The  disease  in  these 
cases  is  variously  modified,  but  in  all  of  them  the  period  of 
incubation  is  unusually  short.  In  a  note  on  this  subject  Mr. 
Marsh  gives  some  striking  facts  collected  from  the  records  of  the 
Hospital  for  Sick  Children.  We  think  he  clearly  shows  that 
the  disease  is  really  scarlet  fever,  and  that  "  both  the  explana- 
tions of  Sir  James  Paget  are  correct,  though  of  course  in  dif- 
ferent cases."  These  explanations  are  as  follows  :  "  Either  the 
condition  induced  in  a  patient  by  a  surgical  operation  is  one 


1(, 


875.]  Medical  Missions,  307 


hat  gives  a  peculiar  liability  to  the  reception  of  an  epidemic  or 
contagious  poison,  and  any  one  of  these,  being  imbibed  imme- 
diately after  the  operation,  produces  its  specific  effect  in  much 
less  than  the  usual  period  of  incubation ;  or  else  those  who 
suffer  with  scarlatina  within   a  few  days  after  operation,  had 
^T)reviously  imbibed  the  poison,  but  would  not  have  manifested 
^Hts  effects  so  soon,  if  at  all,  unless  their  health  had  been  ex- 
^^pausted  or  disturbed."  These  facts  have  a  great  practical  import- 
^Hince  for  those  engaged  in  operative  surgery,  and  should  be  espe- 
^Hially  remembered  in  connection  with  plastic  operations,  wherein 
^Rmmediate  union  is  essential  to  success.     We  have  certainly 
^Heen  a  considerable  number  of  such  operations  fail  from  the 
^■occurrence  of  scarlet  fever  immediately  after  the  operation.  The 
remainder  of  the  volume  consists  of  "  Notes  for  the  Study  of 
some  Constitutional  Diseases."    These  notes  are  extremely  sug- 
gestive,  and  will    furnish   the    thoughtful    reader    with    rich 
material  for  reflexion  and  investigation.     They  do  not  profess 
to  be  more  than  "  fragments,"  but  they  display  in  a  notable 
degree  that  sagacity  and  exact  observation — that  ayxivoia  and 
ciKpi^eia — which  give  so  great  a  value  to  all  the  writings  of  their 
author,  and  which  make  these  *^  fragments"  of  more  worth  than 
many  a  bulky  tome. 

We  resist  the  temptation  to  quote  any  part  of  these  notes, 
but  would  point  out  as  especially  interesting  and  suggestive, 
the  remarks  on  ^^  the  variation  of  constitutional  diseases  in 
hereditary  transmission"  and  those  on  "  the  evolution  of 
diseases." 

We  recommend  our  readers  not  to  lose  the  pleasure  and 
instruction  to  be  derived  from  a  perusal  of  this  book,  which  we 
consider  one  of  the  most  valuable  recent  additions  to  surgical 
literature.  Mr.  Howard  Marsh,  besides  editing  the  work,  has 
increased  its  value  by  the  admirable  notes  to  which  we  have 
alluded,  and  by  a  copious  index ;  he  also  gives  some  useful 
references  to  the  literature  of  some  of  the  subjects  treated. 


IV. — Medical  Missions. 

Some  of  our  readers  may   ask.  What  is  a  medical  mission  ? 
It  is  well,  therefore,  that  we  should  at  the  outset  explain  the 

^  1.  The  Quarterly  Paper  of  the  I^dinhurgh  Medical  Missionary  Society. 

2.  The  Medical    Missionary   Journal.      Published   monthly   by    Dr.    Buens 
Thomson. 

3.  Memorials  of  James  Henderson,  M.D.,  F.R.C.S.  JEd.,  Medical  Missionary  to 
Chitia,  1872. 

4.  Seedtime  in  Kashmir;    a  Memoir  of  W.  J.  Elmslie,  M.D.,  F.R.C.S.  Fd., 
Medical  Missionary  in  Kashmir, 


308  Reviews.  [Oct., 

meaning  and' scope  of  the  term.  A  medical  mission  is  an  agency 
for  niiuistering  to  the  sick  ;  and^  while  their  minds  are  softened 
and  touched  by  kindness,  or  by  the  physical  relief  they  have 
experienced,  taking  the  opportunity  to  inculcate  tlie  first  princi- 
ples of  Christianity.  A  medical  mission  has  thus  a  twofold 
aspect.  It  addresses  itself  to  the  cure  of  the  body  and  at  the 
same  time  to  the  enlightenment  of  the  mind.  But  this  is  not 
the  place  to  dwell  upon  the  religious  aspect  of  the  subject. 
However  scriptural  and  reasonable  such  a  mode  of  extending 
the  limits  of  Christendom  may  be,  a  medical  review  is  not  the 
fittest  place  for  enlarging  upon  it.  We  shall,  therefore,  confine 
ourselves  to  speaking  of  medical  missions  as  they  aim  at  the 
relief  of  sickness  and  disease.  This  will  afford  us  a  sufficiently 
wide  scope  and  a  sufiaciently  varied  field  of  observation.  It 
will  carry  us  back  from  our  own  days  to  the  commencement  of 
the  Christian  era  j  it  will  transport  us  from  the  large  cities  of 
our  own  country  far  off"  to  China  and  Japan ;  and  from  the 
aggregated  masses  of  our  own  crowded  courts  to  the  secluded 
Zenanas  of  Hindostan. 

In  dealing  with  the  subject  we  shall  give,  first,  a  slight  sketch 
of  the  history  and  progress  of  medical  missions,  and  then  we 
shall  speak  more  in  detail  of  their  rapid  development  during 
the  last  thirty  years.  For  it  is  their  recent  development,  and 
the  variety  of  forms  in  which  they  are  now  advancing,  that 
gives  to  medical  missions  their  present  interest,  and  makes  them 
a  suitable  subject  for  consideration  by  such  a  review  as  this. 

We  have  said  that  our  subject  carries  us  back  to  the  earliest 
days  of  Christianity.  We  need  but  remind  our  readers  how 
the  Divine  Founder  of  our  religion  *'  spake  of  the  kingdom  of 
God,  and  healed  them  that  had  need  of  healing;"  and,  furtlier, 
that  He  enjoined  upon  His  disciples  *^  to  preach  the  kingdom 
of  God  and  to  heal  the  sick." 

In  the  third  and  fourth  centuries  many  instances  are  re- 
corded of  Christians  Avho  devoted  themselves  with  the  utmost 
assiduity  to  the  relief  of  suff'erers  from  the  plague  and  other 
epidemic  diseases ;  amongst  these  may  be  mentioned  Columba, 
the  noted  apostle  of  the  Picts  and  Scots,  whose  skill  and  success 
was  so  remarkable  as  to  make  many  regard  his  cures  as 
miracles — a  thing  which  has  often  occurred  to  medical  mission- 
aries from  his  time  to  the  present. 

Later  on  in  the  middle  ages  many  societies  of  monks  were 
instituted  to  provide  physical  and  spiritual  relief  for  the  sick 
and  the  ignorant.  Thus  one  order  was  founded  in  France  to 
furnish  nurses  for  persons  attacked  by  St.  Anthony's  fire,  as 
erysipelas  was  then  called.  This  disease  was  in  those  days  a 
far  greater  scourge  than  it  now  is,  and  caused  a  terrible  mortality 


Medical  Missions.  309 

"iTiroughoat  Europe  Others,  both  male  and  female,  devoted 
themselves  to  tlie  care  of  lepers,  and  founded  large  establishments 
in  which  to  receive  and  nurse  their  patients.  Jacob  of  Vitry 
says  of  such,  '^  For  Christ's  sake  they  bring  themselves  to 
endure,  amidst  filth  and  disgusting  scents — -by  driving  them- 
selves up  to  it — such  intolerable  hardships  that  it  would  seem 
as  if  no  sort  of  penitential  exercise  which  man  imposes  on 
himself  deserved  a  moment  to  be  compared  with  this  holy 
martyrdom."  Tlic  Jesuits  also,  following  the  example  of  Loyola, 
have  always  paid  especial  attention  to  the  care  of  the  sick  in 
their  foreign  missions;  and  to  this,  no  doubt,  a  part  of  their 
success  may  be  traced. 

It  must  be  borne  in  mind  that  in  the  middle  ages  learning, 
in  all  its  branches,  was  in  the  hands  of  the  ecclesiastics.  Hence 
it  was  almost  a  necessity  that  all  measures  for  the  relief  of  the 
sick  should  emanate  from  them ;  and  that  every  one  who  was 
attracted  by  the  study  of  medicine,  or  who  had  a  natural  apti- 
tude for  nursing;,  should  join  himself  to  one  of  the  religious 
orders,  and  exercise  his  vocation  under  the  protection  of  the 
church.  But  though  some  of  these  orders  doubtless  owed  their 
origin  to  a  genuine  religious  zeal  in  their  founders,  yet  in  course 
of  time  they  so  far  degenerated  that  even  Papal  edicts  were  issued 
against  the  fraudulent  tricks  of  the  monks  who  went  about 
collecting  for  the  ^^spittals"  large  sums  of  money,  of  which 
but  a  small  portion  was  ever  expended  upon  them. 

The  history  of  British  medical  missions  may  be  traced  back 
to  the  year  1701.  -The  earliest  effort  in  this  direction  was  due  to 
General  Codrington,  an  English  officer,  who  was  the  possessor 
of  estates  in  the  West  Indies.  A  portion  of  these  he  left  to  the 
Society  for  the  Propagation  of  the  Gospel  in  Foreign  Parts  in  the 
following  terms  : — 

"  General  Codrington  gives  and  bequeathes  his  two  plantations  in 
the  island  of  Barbadoes,  and  part  of  his  island  of  Barbuda,  to  the 
Society  for  the  Propagation  of  the  Christian  religion  in  foreign  parts, 
created  and  established  by  his  good  master  King  William  the  Third  ; 
and  desires  that  the  plantations  should  continue  entire,  and  300 
negroes,  at  least,  be  always  kept  thereon,  and  a  convenient  number  of 
professors  and  scholars  maintained  there,  who  are  to  be  obliged  to 
study  and  practise  physic  and  chirurgery  as  well  as  divinity,  that  bv 
the  apparent  usefulness  of  the  former  to  ail  mankind  they  may  both 
endear  themselves  to  the  people,  and  have  the  better  opportunity  of 
doing  good  to  men's  souls  while  they  are  taking  care  of  their  bodies  ; 
but  the  particulars  of  the  constitution  he  leaves  to  the  Society  com- 
posed of  wise  and  good  men." 

Many  difficulties  attended   the   carrying  out  of  this  will,  but 
finally  an  establishment  was  formed  f^ud  supported  out  of  these 


310  Reviews.  [Oct., 

estates  consisting  of  a  President  and  twelve  scholars,  and  allow- 
ances were  made  to  those  who  wished  to  prosecute  their  studies 
in  England.  The  annual  value  of  the  property  so  bequeathed 
is  said  to  have  amounted  to  £2000,  a  larger  sum  of  money  than 
has  ever  been  devoted  to  medical  missions  by  any  single  indi- 
vidual before  or  since. 

A  little  later  in  the  eighteenth  century  two  medical  men, 
Dr.  Hocker  and  Mr.  RuefTer,  were  sent  by  the  Moravians  to 
Persia.  They  might  have  settled  at  Ispahan  with  every  pro- 
spect of  advantage  to  themselves,  as  the  Persians  set  a  high  value 
upon  the  skill  of  European  physicians,  but,  as  they  found  no 
scope  for  missionary  exertions,  they  fell  back  upon  Cairo.  Mr. 
Rueffer  died  before  reaching  that  city  in  consequence  of  the 
hardships  which  they  underwent,  while  Hocker  continued 
the  practice  of  his  profession  in  Egypt  for  thirty  years. 

In  1787  Mr.  John  Thomas,  surgeon  to  the  "  Oxford,"  East 
Indiaman,  who  had  made  several  voyages  to  Calcutta  and 
become  deeply  interested  in  the  miserable  condition  of  the 
Hindoos,  resolved  to  remain  in  Bengal,  and  labour  among  the 
natives.  He  was  a  most  devoted  missionary,  and  his  surgical 
skill  gave  him  great  influence.  Multitudes  flocked  to  him  for 
advice,  many  from  distant  parts,  and  when  he  travelled 
through  the  country  his  progress  was  often  hindered  by  the 
crowds  who  came  to  him  to  be  treated  ;  and  in  consequence  of 
the  interest  in  Christianity  which  his  words,  no  less  than  his 
benevolent  work,  had  created,  the  well-known  Dr.  Carey  was 
sent  out  by  the  Baptist  Missionary  Society  in  1793. 

A  few  years  later  Dr.  Vanderkemp  was  sent  to  South  Africa 
by  the  LondonMissionary  Society.  He  laboured  among  the  Caffirs 
with  the  utmost  zeal,  and  his  medical  skill  won  for  him  a  high 
place  in  their  affections.  The  strong  footing  which  Christanity 
has  since  obtained  in  South  Africa  is  probably  in  no  small 
measure  due  to  the  influence  of  this  medical  missionary. 

The  first  effort  in  this  direction  made  in  China  was  in  1819, 
when  Dr.  Livingstone,  a  surgeon  of  the  East  India  Company, 
called  the  attention  of  the  Rev.  Dr.  Morrison,  an  agent  of  the 
London  Missionary  Society,  to  the  Chinese  system  of  medicine. 
He  was  struck  by  the  number  of  medicinal  plants  which  were 
exposed  for  sale  in  the  markets,  and  which  were  not  known  to 
the  European  pharmacopoeia.  Dr.  Morrison  took  up  the  subject 
warmly,  and  appears  to  have  seen  how  much  it  might  assist  him 
in  gaining  the  confidence  of  the  Chinese  if  he  took  some  steps 
to  relieve  their  bodily  sufferings.  He,  therefore,  purchased  a 
complete  Chinese  medical  library  with  an  adequate  assortment 
of  Chinese  medicines ;  he  engaged  the  services  of  a  Chinese 
physician  and  apothecary,  as  well  as  a  herbalist,  whose  entire 


1875.]  ■    Medical  Missions.  311 

stock  he  purchased  for  Dr.  Livingstone's  examination.  He  then 
opened  a  dispensary  at  which  he  himself  endeavoured  to  be 
present  two  or  three  hours  daily,  and  Dr.  Livingstone  also 
frequently  gave  the  patients  the  benefit  of  his  services.  This 
effort  appears  to  have  originated  chiefly  in  the  desire  to  ascer- 
tain what  value  there  might  be  in  the  Chinese  medical  system, 
and  how  far  it  might  be  advantageously  studied  by  a  European 
surgeon.  It  was  at  least  a  matter  of  curiosity  to  see  whether 
their  medical  system  was  worthy  of  the  name,  and  whether  it  was 
possible  that  their  materia  medica  might  contain  some  articles  of 
real  value.  The  conclusion  arrived  at  was  that  2000  years  ago 
the  Chinese  were  greater  proficients  in  medicine  than  any  of 
the  nations  of  the  West ;  but  that  since  that  time  few  improve- 
ments have  been  introduced,  whilst  an  abundant  crop  of  errors 
has  sprung  up  in  every  department  of  practice. 

In  1827  Dr.  Colledge  opened  an  eye  infirmary  at  Macao. 
Eight  years  later  a  similar  institution  was  commenced  at 
Canton  by  Dr.  Peter  Parker,  an  agent  of  the  American  Board 
of  Missions.  The  success  of  his  treatment  produced  a  great 
sensation,  and  patients  of  all  ranks  flocked  to  the  hospital 
from  all  parts  of  the  empire.  In  the  course  of  two  years  4575 
persons  passed  under  his  care.  Reports  of  the  cases  were 
published  quarterly  in  the  '  Chinese  Repository,'  which  con- 
tain many  interesting  particulars  relative  to  the  diseases  of 
the  eye,  which  are  so  common  in  the  "  celestial  empire."  He 
did  not,  however,  confine  his  attention  altogether  to  ophthalmic 
practice.  Indeed  his  success  in  all  branches  of  surgery  was  so 
great  that  we  cannot  be  surprised  at  the  esteem  in  which  he 
was  held  by  the  Chinese.  The  following  extracts  from  his 
reports  will  show  both  the  importance  of  the  operations  which 
he  sometimes  had  to  undertake  and  the  mode  in  which  the 
natives  expressed  their  gratitude.  *'  They  were  much  struck," 
he  writes,  "  by  the  case  of  a  beggar  from  Macao,  who  had  a 
tumour  of  extraordinary  magnitude  upon  the  side  of  his  face 
and  head.  When  it  became  so  large  as  to  disable  him  from 
labour,  he  had  no  resource  but  that  of  begging.  This  burden, 
though  one  that  would  weary  a  man  to  bear  an  hour,  he 
could  not  put  ofl"  for  a  moment  day  or  night.  He  had  lono- 
been  a  loathsome  and  pitiable  object  to  the  citizens,  and  when 
I  was  at  Macao,  as  I  passed  him  in  the  streets,  he  pre- 
sented written  appeals,  from  unknown  authors,  to  my  sym- 
pathy, and  requests  that  he  might  be  relieved  of  his  burden. 
The  tumour,  measuring  2  feet  6  inches  in  circumference, 
and  weighing  a  few  ounces  short  of  nine  pounds,  was  lately 
removed.  The  man  quite  recovered  in  three  weeks.  He  is  now 
porter   to  the  hospital,  where  he   acquits   himself  well.     The 


312  -  Reviews.  [Oct., 

magnitude  of  the  operation,  the  elliptical  incisions  being  about 
eighteen  inches  in  length,  and  the  adhesion  of  the  base  over  tlio 
carotid  artery  and  the  parotid  gland  being  deep  and  stron'j-, 
rendered  it  impossible  it  should  be  performed  without  solicitude." 

The  following  is  a  specimen  of  one  of  the  scrolls  of  gratitude 
%vhich  were  not  unfrequently  presented  to  the  doctor  by  pa- 
tients who  had  been  cured  by  him.     Dr.  Parker  writes  : — 

*'  February  26,  1849,  Chusher,  a  manchu,  set.  54,  had  a  fun- 
goid  tumour  of  the  size  of  an  orange  situated  upon  the  back 
and  spine.  The  tumour  was  readily  and  successfully  removed. 
Before  leaving  the  hospital  the  patient  made  repeated  solicita- 
tions to  be  allowed  to  send  an  artist  to  take  the  portrait  of  the 
surgeon.  His  importunity  was  at  length  acceded  to,  and  soon 
there  was  presented  a  portrait,  taken  in  water  coloiirs,  by  the 
side  of  which,  on  the  same  canvas,  was  the  following  inscription 
in  poetry,  and  an  account  of  his  case,  and  what  he  had  seen  in 
the  ht)spital : — 

"  "What  man  is  that  ?  America's  noble  and  disinterested  man, 
who  does  to  others  as  he  would  that  others  should  do  to  him.  His 
country  is  different  from  ours,  his  feelings  are  the  same.  In  all 
distresses  and  diseases  he  feels  the  sorrows  and  joys  of  others  as 
though  they  were  his  own.  Those  cases  w^hich  require  the  use  of 
instruments,  and  which  are  difficult  to  others,  are  easy  to  him.  He 
cherishes  a  mind  that  is  divine,  and  bears  the  visage  of  Budha ;  a 
full  halo  of  glory  surrounds  his  deeds,  and  he  deserves  immeasurable 
longevity.  Parker's  meritorious  virtues  are  as  numerous  as  the 
sands  of  the  ever-flowing  river.  I  denominate  him  as  Ye- Sir. 
"What  say  you,  yes  or  no  ?  " 

-  Indeed,  China  has  always  been  a  favorite  field  for  the  work 
of  the  medical  missionary.  The  people  are  so  opinionated,  and 
so  proud  of  their  semi-civilisation,  that  it  is  difl[icult  to  get  them 
to  give  a  fair  hearing  to  the  religion  of  Christendom,  but  they 
can  at  once  perceive  the  value  of  the  science  which  the  medical 
missionary  brings  along  with  him.  In  1838  a  local  medical 
missionary  society  was  formed — *'  The  Medical  Missionary 
Society  in  China" — of  which  Dr.  Colledge  was  (and  still  is)  the 
president.  The  thirty-sixth  Annual  Report,  which  has  just  reached 
us,  is  a  most  interesting  pamphlet.  With  its  details  of  work 
done  at  the  various  dispensaries  and  hospitals  in  connection 
with  the  Society,  its  Chinese  woodcuts  of  remarkable  cases, 
with  their  explanations  in  Chinese  characters,  and  its  allusions 
to  the  peculiarities  of  the  natives,  it  gives  in  a  brief  space  a  vivid 
picture  of  what  medical  missions  are  doing  in  a  far  distant 
field. 

In  1839  the  London  Missionary  Society  sent  out  Lockhart 
and  Hobson.      The  former,  who  has  now  returned  to  this  couu- 


1875.]  Medical  Missions.  313 

try,  laboured  at  Shanghai  for  nearly  twenty  years.  Mr.  Hobson 
settled  at  Canton,  and  opened  a  hospital  there  in  a  good  situa- 
tion, easy  of  access  both  by  road  and  water.  There  was  a  good 
dispensary  with  separate  entrances  for  men  and  women,  and 
there  were  twelve  rooms  on  the  ground  floor,  capable  of  con- 
taining 45  beds,  besides  extra  accommodation  for  a  hundred 
more  patients,  if  at  any  time  it  should  be  needed.  This  hos- 
pital was  resorted  to  by  about  20,000  patients  annually.  Mr. 
Hobson  paid  particular  attention  to  the  education  of  Chinese 
youths  in  the  principles  of  European  medicine,  aud  for  this 
purpose  published  several  small  works  in  Chinese  on  anatomy, 
surgery,  medicine,  midwifery,  comparative  physiology,  &c. 

He  also  trained  several  young  Chinese  in  the  science  and 
practice  of  medicine,  and  they  afterwards  became  his  assistants. 

In  1840  Dr.  Parker  visited  this  country.  Articles  which  had 
appeared  in  newspapers  on  the  subject  of  the  medical  work 
going  on  in  China  had  attracted  the  notice  of  several  members 
of  our  profession,  and  had  prepared  them  to  take  an  interest  in 
the  matter.  Dr.  Parker  had  interviews  with  most  of  the  lead- 
ing medical  men  of  the  metropolis,  and  one  result  was  that  the 
Royal  College  of  Surgeons  undertook  to  educate,  free  of  ex- 
pense, such  Chinese  youths  as  might  be  sent  to  this  country  for 
medical  training,  and  three  scholarships  were  founded  at  King's 
College  for  the  education  of  medical  missionaries. 

The  most  notable  result,  however,  of  Dr.  Parker's  visit  to 
this  country  was  the  formation  of  the  Edinburgh  Medical  Mis- 
sionary Society,  which  was  founded  in  1841,  partly  to  assist  the 
Chinese  missions,  and  partly  to  aid  the  Syrian  Medical  Associa- 
tion. This  brings  us  to  what  may  be  considered  the  modern 
development  of  medical  missions,  for  to  the  Edinburgh  Society 
may  be  traced  almost  all  the  w^ork  which  has  been  done  in  this 
direction  by  this  country  during  the  last  thirty  years.  The  first 
President  was  the  late  Dr.  Abercrombie,  who  took  a  lively  interest 
in  its  proceedings  and  frequently  attended  its  meetings.  But 
Dr.  Abercrombie  was  not  the  only  distinguished  medical  man 
who  actively  supported  the  infant  society.  Among  those  who 
have  been  its  friends,  and  who  have  passed  away,  we  may  men- 
tion Dr.  Alison,  Dr.  Coldstream,  Professor  George  Wilson, 
Professor  James  Miller,  and  Sir  James  Simpson.  While  a 
glance  at  the  present  list  of  directors  shows  that  many  of 
the  most  eminent  men  in  Edinburgh  take  an.  active  part  in 
its  promotion,  it  has  at  various  times  arranged  for  the  delivery 
of  lectures  and  addresses  to  students  on  medical  missions,  and 
it  publishes  a  Quarterhj  Pa/?<?r  giving  current  information  upon 
the  subject.  To  these  sources  we  are  indebted  for  many  of  the 
details  contained  in  this  article.      The  Society  maintains  a  mis- 


314  Reviews,  [Oct., 

sionary  dispensary  in  the  Cowgate,  and  also  a  training  institu- 
tion in  George  Square.  There  are  now  in  this  institution  fifteen 
students,  who  are  prosecuting  their  studies  at  the  University  or 
at  the  College  of  Surgeons,,  with  the  view  of  becoming  medical 
missionaries.  The  Society  also  maintains  at  the  present  time 
three  medical  missionaries  abroad — Dr.  Elder,  at  Madras,  Dr. 
Palm,  in  Japan,  and  Dr.  Vartan,  at  Nazareth.  Indeed,  the 
operations  of  the  Society  in  all  its  branches  have  been  so  steadily 
increasing  that  the  need  of  larger  and  more  convenient  premises 
has  been  much  felt,  and  an  effort  is  now  being  made  to  raise 
£10,000  in  order  to  erect  a  suitable  building  to  embrace  both 
the  dispensary  and  the  training  institution,  and  this  new  build- 
ing it  is  proposed  to  associate  with  the  name  of  David  Living- 
stone, the  great  African  explorer  and  medical  missionary. 

To  those  who  have  followed  the  course  of  medical  missions 
during  their  recent  development  there  is  no  name  more  familiar 
than  that  of  Dr.  Burns  Thomson.  For  many  years  he  was  the 
superintendent  of  the  work  of  the  Society  in  Edinburgh.  He 
had  been  one  of  their  earliest  students,  he  "wrote  a  prize  essay 
on  the  subject,  and  his  devotion  to  the  cause  and  his  energy  of 
character  led  to  his  appointment  to  this  important  post.  Under 
his  guidance  the  Society  made  rapid  advances  both  at  home  and 
abroad.  Though  he  is  no  longer  connected  with  it  he  still 
devotes  himself  to  medical  missionary  work,  and  carries  on  a 
dispensary  of  his  own  and  a  convalescent  home.  He  moreover 
supports  three  agents  abroad — two  medical  men  and  one  trained 
nurse  in  Madagascar.  He  publishes  monthly  the  '  Medical 
Missionary  Journal,'  which  was  the  first  serial  devoted  to  this 
subject,  and  much  of  the  information  contained  in  this  article 
has  been  gleaned  from  its  pages. 

So  early  as  the  year  1824  the  attention  of  the  London  Society 
for  Promoting  Christianity  among  the  Jews  was  directed  to  the 
importance  of  establishing  a  medical  mission.  In  that  year  they 
sent  Dr.  Dalton  to  Jerusalem  with  this  object;  but  in  1826  he 
died,  and  the  plan  appears  to  have  remained  in  abeyance  for 
some  years.  In  1842  Dr.  Macgowan  was  sent  out  as  the  Society's 
medical  agent,  and  in  1844  a  hospital  containing  25  beds  was 
opened.  From  that  time  to  the  present  it  has  been  actively 
carried  on.  It  is  now  under  the  medical  charge  of  Dr.  Chaplin, 
and  last  year  he  and  his  qualified  assistant  saw  7771  out-patients, 
besides  making  11,445  visits  to  sick  Jews  at  their  own  houses. 
During  certain  seasons  Dr.  Chaplin  makes  a  tour  of  Palestine, 
halting  for  a  short  time  at  each  of  the  towns  where  the  Jews 
chiefly  congregate. 

It  may  be  well  here  to  explain  the  way  in  which  the  work  of 
the  missionary  dispensary  is  carried  on  in  Edinburgh,  as  it  is  the 


1875.]  Medical  Missions.  31 5 

model  upon  which  other  institutions  of  the  same  kind  have  been 
framed,  both  at  home  and  abroad.  The  accommodation  pro- 
vided is  much  the  same  as  that  of  ordinary  dispensaries,  and 
consists  of  a  waiting-room,  a  consulting-room  and  a  pharmacy. 
The  patients  assemble  as  usual  in  the  waiting-room,  and  at  a 
fixed  hour  a  passage  of  Scripture  is  read  and  explained  in  a 
simple  manner.  A  short  prayer  concludes  the  brief  service; 
and  then  the  patients  are  seen  separately  in  the  consulting-room, 
and  prescribed  for.  Besides  receiving  patients  at  the  dispensary, 
the  medical  man  and  his  assistants  visit  the  sick  at  their  own 
houses,  which  indeed  constitutes  a  most  important  part  of  the 
work  of  all  ordinary  dispensaries.  These  various  opportunities 
of  seeing  the  patients  give  the  medical  missionary  the  means  of 
becoming  intimately  acquainted  with  their  moral  condition,  and 
he  is  able  to  graft  upon  the  dispensary  different  classes,  meet- 
ings, &c.,  for  elevating  and  Christianising  the  population  among 
whom  he  labours.  In  those  foreign  stations  where  the  dispensary 
has  grown  into  a  hospital  the  work  is  carried  on  in  substan- 
tially the  same  manner,  though  it  will  easily  be  believed  that 
the  hospital  is  found  a  more  efficient  basis  ;  and  in  many  cases 
the  ministerial  duties  are  conducted  by  a  clerical  missionary, 
who  acts  somewhat  in  the  capacity  of  chaplain  to  the  institu- 
tion. Dr.  Burns  Thomson  has  very  properly  laid  great  stress 
upon  the  importance  of  training  missionary  nurses,  and  this  is 
now  being  done  not  only  in  Edinburgh  but  also  at  several  of 
the  foreign  stations. 

To  many  persons  it  has  appeared  desirable  that  the  general 
treatment  of  the  sick  poor  should  be  carried  on  by  means  of 
medical  missions,  and  that  direct  moral  and  religious  influences 
should  accompany  the  practice  of  medicine  and  surgery  among 
the  ignorant  and  degraded  classes  of  society.  This  has  led  to 
the  establishment  of  medical  missionary  dispensaries  and  hospi- 
tals in  many  of  the  large  cities  of  the  kingdom.  Starting  from 
Edinburgh  as  a  centre,  they  are  now  to  be  found  in  Aberdeen, 
Glasgow,  Liverpool,  Manchester,  Bristol  and  London ;  while  if 
we  cross  the  channel  we  hear  of  them  in  several  of  the  populous 
towns  of  Europe,  and,  if  we  travel  yet  further  eastward,  we 
meet  with  them  in  Syria,  in  Madagascar,  in  India,  in  China, 
and  in  various  other  places. 

We  have  named  at  the  head  of  this  article  the  two  serials 
which  are  devoted  to  the  spread  of  information  upon  the  subject 
of  medical  missions,  and  also  the  memoirs  of  two  medical  mis- 
sionaries who  have  lately  passed  away  while  they  were  still 
actively  engaged  in  their  self-denying  labours.  It  is  not  possible 
for  us  to  do  more  than  to  touch  upon  a  few  of  the  salient  points 
of  our  subject.  But  if  any  one  wishes  to  obtain  a  comprehensive 


316  Revieivs.  [Oct., 

view  of  what  medical  missions  are  doing  he  should  study  these 
periodicals,  and  if  he  desires  to  see  how  they  are  carried  out  in 
detail  he  should  read  these  biographies.  The  men  whom  they 
pourtray  were  both  of  them  remarkable,  and  their  lives  were 
full  of  interest,  apart  altogether  from  their  bearing  upon  our 
present  subject. 

Dr.  Henderson  was  the  son  of  a  poor  labouring  man  in  the 
Highlands  of  Scotland.  His  mother  was  left  a  widow  when  he 
was  scarcely  three  years  old,  and  his  early  years  were  spent  in 
much  poverty.  His  mother  taught  him  to  read,  but  this  was 
all  the  instruction  he  had.  As  a  young  boy  he  was  employed 
by  a  farmer  to  herd  cattle.  A  little  later  he  was  engaged  by  a 
country  doctor  as  groom.  At  this  time  he  began  to  have  an 
earnest  longing  for  more  information,  and  subsequently,  Avhen 
he  had  obtained  the  situation  of  footman  in  a  gentleman's 
household,  he  set  to  work  in  the  most  diligent  and  self-denying 
manner  to  educate  himself.  The  butler,  who  had  himself  been 
trained  for  a  higher  position,  was  a  kind  friend  to  him,  and  ren- 
dered him  great  assistance.  It  was  at  this  time  that  he  first 
entertained  the  idea  of  aspiring  to  a  University  training  to  lit 
himself  for  the  ministry.  He  had,  however,  no  friends  to  aid 
him,  and  he  was  discouraged  from  the  attempt  by  all  whom  he 
consulted.  But  he  adopted  as  his  principle,  "  There  is  nothing 
that  has  ever  been  accomplished  by  man  in  past  times  which  I, 
as  an  individual,  may  not  accomplish,  provided  that  other  things 
are  equal  ;"  and  having  by  the  most  rigid  economy  laid  by  a 
small  sum  of  money,  he  gave  up  his  place,  and  took  lodgings  in 
which  he  shut  himself  up  all  day,  and  worked  and  studied  in- 
cessantly from  early  morning  till  past  midnight.  He  lived  in 
the  most  frugal  manner,  spending  for  his  board  and  lodging  no 
more  than  4s.  6d.  a  week.  After  five  months  he  decided  on 
going  to  Edinburgh,  and  there  he  was  fortunate  in  obtaining  a 
situation  as  footman  to  a  lady  who  paid  him  good  wages,  while 
she  left  him  a  great  deal  of  time  at  his  own  disposal.  This 
leisure  he  employed  in  study,  and  he  engaged  the  assistance  of 
first-rate  masters  in  Latin,  Greek,  and  mathematics.  In  this 
way  he  prepared  himself  for  college,  and  saved  sufficient  money 
to  pay  his  fees.  He  was  now  25  years  of  age.  He  had  received 
no  encouragement  to  enter  the  ministry,  while  his  attention  had 
often  been  drawn,  amid  his  humbler  friends  and  acquaintances, 
to  the  beneficent  aspect  of  our  profession.  He  felt  that  it  aff'orded 
opportunities  for  doing  good  quite  unknown  in  any  other  calling ; 
and  it  became  the  object  of  his  ambition  to  qualify  himself  for 
it.  In  1855  he  entered  himself  at  Surgeon's  Hall,  gave  up 
domestic  service,  and  studied  with  his  wonted  assiduity 
throughout  the  whole  of  his  course,  and  acquitted  himself  most 


Medical  Mission^.  317 

editably.  When  he  received  his  diploma  he  was  offered  a 
practice  that  woiikl  have  yiehled  liim  £700  a  year.  But  he  had 
ah-eady  made  up  his  mind  to  be  a  medical  missionary,  and,  after 
a  very  short  delay,  he  was  engaged  by  the  London  Missionary 
Society  to  proceed  to  China.  When  he  presented  himself  before 
the  Board  in  London  his  self-possessed  manner,  gentlemanly 
bearing,  and  frank  answers,  excited  special  interest  in  him, 
while  his  manifest  intelligence  and  proved  energy  of  character 
secured  his  immediate  nomination.  His  destination  was  Shang- 
hai, where  he  succeeded  to  the  work  of  Dr.  Hobson,  and  his 
time  was  soon  fully  occupied  by  the  numerous  patients  who 
Hocked  around  him.  During  the  first  year  he  prescribed  for 
more  than  16,000  persons,  whilst  169  patients  were  treated  in 
the  wards  of  the  hospital.  He  was  assisted  by  Chin  Foo,  a 
native  apothecary  and  house  surgeon,  of  whom  he  wrote  : — 

"  He  has  been  in  the  hospital  now  about  eight  years,  and  assisted 
Drs.  Lockhart  and  Hobson.  He  is  attentive  to  all  his  duties,  very 
intelligent,  and  kind  to  the  patients,  has  carefully  read  all  Dr. 
Hobson' s  medical  works  in  Chinese,  and,  were  it  not  that  he  wants 
practical  anatomy,  he  would  be  a  good  surgeon  ;  but,  owing  to  the 
stupid  prejudices  of  the  Chinese,  he  has  never  even  seen  the  interior 
of  a  dead  body.  I  have  tried  to  teach  him  from  anatomical  plates, 
but  these  are  not  sufficient.  He  can,  however,  perform  the  minor 
operations  well,  under  my  direction." 

After  about  two  years'  residence  in  Shanghai  Dr.  Henderson 
returned  to  this  country  to  be  married.  But  he  remained  here 
a  very  short  time,  and  was  back  again  at  his  post  in  eight 
months.  From  this  time  till  the  date  of  his  death  in  1865  he 
continued  his  work  at  the  medical  missionary  hospital.  His 
popularity  among  the  Chinese  was  great,  and  the  number  of  his 
patients  steadily  increased.  In  1864  he  was  made  F.R.C.S.  Ed., 
on  account  of  his  scientific  acquirements  and  of  his  researches 
as  vice-president  of  the  Chinese  Branch  of  the  Royal  Asiatic 
Society. 

Dr.  Elmslie's  career  was  in  some  respects  not  unlike  that  of 
Dr.  Henderson. 

He  was  born  in  Aberdeen  in  1832.  His  father  was  a  shoe- 
maker, and,  as  soon  as  his  son  was  old  enough  to  help  in  the 
work,  he  insisted  on  his  beginning  to  learn  his  trade.  He  would 
not  hear  of  his  being  sent  to  school.  If  it  had  not  been  for  the 
encouragement  of  his  mother,  and  his  own  energy,  he  would 
have  remained  ignorant  even  of  the  rudiments  of  learning.  She 
did  all  she  could  to  help  him,  and  in  the  evenings  after  work 
his  young  friends  often  taught  him  something  that  they  had 
just  learnt  at  school.  He  himself  was  eager  for  instruction, 
and  used  frequently  to  fix  a  book  in  front  of  him  and  study 

H2--LYI.  21 


318  Heviews,  [Oct., 

while  he  was  at  work.  He  became  very  skilful  in  his  trade, 
and  thus  earned  money  which  enabled  him  at  the  age  of  sixteen 
to  enrol  himself  as  a  pupil  in  the  grammar  school  of  Aberdeen. 
Eut  still  during  his  spare  hours  he  was  obliged  to  work  as  a 
boot-closer.  Notwithstanding  these  disadvantages,  in  his  second 
year  he  gained  a  bursary  by  competition,  and  at  the  end  of  the 
next  session  he  carried  off  the  first  Greek  prize.  In  1853 
Elmslie  passed  from  school  to  college.  His  father's  failing  health 
now  made  him  more  than  ever  dependent  upon  his  son's  exer- 
tions. He,  therefore,  undertook  an  engagement  to  teach  in  a 
school  in  Aberdeen,  and  he  had  also  several  private  pupils. 
Being  a  first-rate  student,  and  of  gentlemanly  manners,  he  had 
no  difficulty  in  getting  as  much  employment  as  he  wished. 
After  he  had  taken  his  degree  in  arts  he  gained  another  bursary 
by  competition,  and  entered  the  Free  Church  Divinity  College 
in  1858  with  a  view  to  becoming  a  minister.  But  about  this 
time  his  attention  was  directed  to  medical  missions,  and  he 
resolved  to  qualify  himself  to  take  part  in  them.  To  a  man 
who  had  no  resources  and  no  friends  the  four  additional  years 
of  study,  which  were  requisite,  were  a  serious  matter.  But  he 
braced  himself  for  the  struggle.  Again  he  taught  in  the  academy, 
received  private  pupils,  stitched  the  "  uppers  "  of  boots  and 
shoes,  and  pored  over  his  books.  In  July,  1862,  he  passed  his 
second  professional  examination  with  much  credit.  At  an  early 
stage  of  his  studies  he  had  heard  of  the  Edinburgh  Medical 
Missionary  Society,  and  it  would  have  been  a  great  advantage 
to  him  if  he  could  have  joined  their  institution,  and  thus  obtained 
his  education  free  of  expense ;  but  his  family  circumstances 
tied  him  to  Aberdeen.  He  was  quite  alive  to  the  benefit  which 
he  would  derive  from  studying — if  it  were  only  for  a  time — 
under  such  men  as  Syme,  Simpson,  and  Miller.  He,  there- 
fore, determined  to  go  up  to  Edinburgh  for  the  last  year  of  his 
course ;  and  in  1862  he  became  an  inmate  of  the  Medical  Mis- 
sionary Dispensary.  He  distinguished  himself  greatly  in  his 
classes ;  but,  notwithstanding,  when  he  returned  to  Aberdeen  to 
take  his  degree,  he  was  plucked  in  those  very  subjects  for  which 
in  Edinburgh  he  had  received  a  gold  medal  and  a  certificate  of 
merit.  Judging  —  and  perhaps  not  incorrectly  —  that  the 
authorities  at  Aberdeen  looked  with  disapproval  on  his  removal 
to  Edinburgh,  he  decided  on  leaving  altogether  the  former 
university  and  graduating  at  the  latter.  But  this  involved  an 
extra  year  of  study,  and  again  threw  him  upon  his  own  resources ; 
for  he  honorably  declined  to  allow  the  expense  incurred  by  his 
failure  to  fall  upon  the  Medical  Missionary  Society.  This  year 
was  the  time  of  his  hardest  struggle,  for  he  had  to  earn  his  own 
living  at  the  time  when  he  was  reading   more  diligently  than 


'     1875.]  Medical  Missions.  319 

^^^er.  But  he  was  rewarded  with  success ;  and  he  finally  re- 
^H^ved  his  degree  in  1864,  his  examiners  being  abundantly 
^Htisfied  with  the  excellence  of  his  papers. 

A  few  months  previously  he  had  accepted  the  post  of  medical 
missionary  in  Kashmir  under  the  Church  Missionary  Society ; 
and  he  sailed  for  India  in  September  of  the  same  year.  The 
first  winter  was  spent  at  Lahore,  where  he  worked  hard  at  the 
language,  and  spent  three  or  four  hours  daily  in  the  government 
hospital  in  order  to  become  familiar  with  Indian  complaints. 
He  reached  Kashmir  early  in  the  following  May,  and  opened 
his  dispensary  a  few  days  after  his  arrival.  Before  the  close  of 
the  first  month  he  had  as  many  as  fifty  patients  a  day,  and  had 
performed  several  important  operations.  The  number  of 
his  patients  steadily  increased,  but  in  September  he  was  obliged 
to  leave  the  valley,  in  accordance  with  the  rule  which  was  then 
in  force,  that  no  European  should  remain  in  Kashmir  during 
the  winter  months.  This  law  continued  in  operation  during 
the  seven  years  of  Dr.  Elmslie^s  missionary  life.  He  returned 
to  his  post  in  the  spring,  and  left  again  every  autumn,  spending 
the  winters,  for  the  most  part,  in  similar  work  at  Umritsar. 
His  work  increased  upon  him  till  at  length  there  were  often  as 
many  as  170  patients  in  a  day.  When  it  is  remembered  that 
he  had  no  qualified  assistant,  and  that  even  when  performing 
operations  and  administering  ansesthetics  he  could  only  have 
such  help  as  a  young  native,  whom  he  was  training,  could  give 
him,  the  arduous  nature  of  his  duties  may  be  appreciated. 
The  native  doctors,  even  if  they  had  been  ready  to  co-operate 
with  him,  could  have  afforded  no  assistance.  They  are  utterly 
unacquainted  with  anatomy ;  the  superstition  of  the  country 
forbidding  all  post-mortem  examinations.  An  idea  may  be 
formed  of  their  ignorance  by  the  following  incident.  "  The 
Maharajah's  native  doctor  being  annoyed  that  most  of  his  pa- 
tients were  leaving  him  for  the  mission  dispensary  on  account 
of  the  superior  surgery,  in  an  evil  hour  for  himself  and  his 
patient  thought  he  would  try  his  hand  at  surgery.  He  pro- 
ceeded to  open  a  boil  in  the  groin  of  a  sepoy  :  in  doing  so  he 
cut  into  the  femoral  artery,  and  his  unfortunate  patient  bled  to 
death."  More  than  once  during  Dr.  Elmslie^s  residence  in 
Kashmir  the  valley  was  visited  by  the  cholera.  The  poverty, 
filth,  and  immorality  which  abound  there  were  favorable  to  its 
development,  and  its  ravages  were  fearful.  Dr.  Elmslie  was 
indefatigable  in  his  labours,  going  in  and  out  amongst  the 
people,  and  visiting  from  twenty-five  to  thirty  cholera  cases  a 
day.  In  this  emergency  he  was  even  admitted  to  see  the  women. 
Formerly,  when  in  rare  cases  he  had  been  called  upon  to  give 
advice  to  native  ladies,  he  was  obliged  to  form  his  diagnosis  with  a 


320  t^eview^.  [Oct., 

thick  veil  between  him  and  his  patient,  through  a  hole  in  which 
he  examined  the  tongue.  Now,  in  their  dire  extremity,  this 
custom  of  the  country  was  not  enforced.  The  hakims  confessed 
that  they  were  powerless,  and  the  chief  confidence  of  the 
people,  from  the  Rajah  downwards,  was  placed  in  the  wearing 
of  amulets  and  charms. 

After  he  had  spent  five  years  in  his  medical  mission  work 
Dr.  Elmslie  returned  to  this  country.     During  his  residence  in 
Kashmir  he  had,  besides  his  professional  labours,  endeavoured 
to  reduce  the  language  to  writing — a  thing  which  had  never 
before    been  attempted,  and    his  chief  employment  whilst  at 
home  was  passing  through  the  press  a  Kasmiri  vocabulary  and 
dictionary.     He  worked  so  hard  at  this  self-imposed  task  that 
he  brought  on  an  illness  from  the  effects  of  w^hich  he  never  en- 
tirely recovered.     The  work  was   not  out  of  the  hands  of  the 
publishers  till  Dr.  Elmslie  had  returned  to  India  ;  and  a  com- 
pleted copy,  intended  for  him,  reached  Umritsar  the  day  after 
his  death.     Whilst  at  home  several  appointments  of  value  -were 
offered  to  him,  but  he  declined  them  all  to  return  to  his  mission 
work.     On  the  S3rd  of  February,  1872,  he  was  married,  and 
on  the  5th  of  March  he  and  his  bride  left  Edinburgh  for  India. 
The  succeeding  summer,  which  he   spent  in  Kashmir,  was  a 
particularly   trying  one.     At  the  end  of  the  first  month  it  is 
noted,  "  he  has  just  had  to-day  his  eleven  hundredth  patient 
and  finished  his  seventieth  operation  in  a  month."     There  also 
occurred,  in  August  of  this  year,  one  of  those  inundations  which 
are  frequent  in  the  valley.     There  was  a  great  deal  of  general 
sickness  at  the  time,   and    an  epidemic  of  cholera  followed. 
Besides  the  'cases  seen  at  the  dispensary  382  cholera  patients 
were  visited  in  their  own  homes.     It  is  no  wonder,  then,  that 
the  close  of  the  season  found  Dr.  Elmslie  quite  exhausted  from 
overwork,  and  more  fit  for  repose  than  for  an  arduous  journey 
across  the  passes  of  the  Himalayas.     Repeated  requests  were 
made,   both  to    the  Maharajah   and  to    the   Governor  of  the 
Punjab,  that  he  might  be  allowed,  at  least,  to  delay  his  journey. 
A  special  application  was  also  forwarded  to  the  Supreme  Govern- 
ment at  Calcutta,  and  the  request  that  he  might  be  permitted 
to  winter  in  Kashmir  was  at  last  granted.     But  the  necessary 
permit  only  reached  Mrs.  Elmslie   the  day  after  her  husband's 
death.     He  left  Kashmir   the  last  week  in  September.     The 
journey  across  the  snowy  mountains,  at  a  height  of  11,900  feet, 
was  one  of  fearful  suffering  to  a  man  Avhose  heart  and  lungs 
were  both  seriously  affected  ;  the  rough  jolting  of  the  "  dandy" 
by  day  and  the  imperfect  shelter  at  night  aggravated  his  suffer- 
ings.    He  had  no  companion   but  his  young  wife,  who  was 
nearly  exhausted  by  fatigue  and  want  of  sleep.     His  symptoms 


1875.] 


Medical  Missions,  321 


became  more  and  more  urgent,  and  just  as  they  had  arrived  at 
Goojerat,  and  were  within  reach  of  friends  and  medical  assist- 
ance, he  died. 

Thus  was  a  valuable  life  sacrificed  to  an  absurd  rule,  which 
has  now  happily  been  abolished.  The  mission,  however,  has 
not  been  given  up.  It  is  now  conducted  by  Dr.  Theodore 
Maxwell.  Tlie  Maharajah  has  built  a  hospital,  and  it  is  hoped 
tliat  the  work  will  in  future  be  carried  on  throughout  the  year 
without  interruption. 

The  Society  for  the  Propagation  of  the  Gospel  in  Foreign 
Parts  carries  on  a  college  in  the  West  Indies  in  conformity  with 
the  terms  of  General  Codrington's  bequest,  to  which  we  have 
already  alluded  ,•  but  the  medical  training  given  to  the  students 
seems  to  be  altogether  subordinated  to  the  teaching  in  divinity. 
Indeed  this  society  has  done  but  little  in  the  way  of  employ- 
ing medical  missionaries.  It  can  point  to  two  bishops — Dr. 
McDougall,  late  of  Labuan,  and  Dr.  Callaway,  of  Kaffr aria — 
who  were  both  actively  engaged  as  medical  practitioners  before 
they  became  clergymen,  and  who  have  found  their  medical 
knowledge  of  no  small  use  to  them  in  their  distant  dioceses. 
Mr.  Strachan,  of  Madras,  who  is  an  agent  of  this  Society,  is  also 
a  qualified  medical  man.  But  with  these  exceptions  it  can 
scarcely  be  said  that  the  Propagation  Society  has  taken  any  part 
in  the  recent  development  of  medical  missions  which  forms  the 
subject  of  this  paper. 

The  Church  Missionary  Society  maintains  an  opium  refuge 
at  Hangchow,  of  which  Dr.  Gait  is  the  medical  superintendent. 
Dr.  Theodore  Maxwell,  of  Kashmir,  is  an  agent  of  the  same 
Society;  and  it  has  just  sent  out  Mr.  E.  "SV.  Forster  to  Fast 
Africa.  The  Rev.  W.  H.  Collins,  of  Peking,  is  also  a  member 
of  the  Royal  College  of  Surgeons. 

The  London  Missionary  Society  has  made  more  use  of  our 
profession  than  any  other.  It  supports  at  present  Dr.  Dudgeon 
at  Peking  ;  Mr.  Kenneth  McKenzie  at  Hankow  ;  Mr.  G.  W, 
Parker  at  Fianarantsoa,  Madagascar;  Dr.  T.  S.  Thomson  at 
Neyoor,  Travancore ;  and  Dr.  G.  A.  Turner  at  Upolu,  Samoa, 
South  Seas. 

The  various  Presbyterian  churches,  both  north  and  south  of 
the  Tweed,  have  shown  that  the  same  zeal  which  led,  in  the 
first  instance,  to  the  formation  of  the  medical  missionary  dis- 
pensaries in  Edinburgh,  leads  them  also  to  send  medical  mis- 
sionaries abroad.  At  their  foreign  stations  there  are  something 
like  a  dozen  fully  qualified  medical  men. 

It  has  been  a  common  practice  with  all  the  missionary  socie- 
ties to  encourage  their  clerical  agents  to  acquire  such  medical 
knowledge  as  they  can  pick  up  by  the  way.     Thus^  the  studeritg 


322  Reviews,  [Oct., 

of  St.  Augustine's  College,  Canterbury,  attend  the  hospital  regu- 
larly during  their  last  year  of  training,  and  receive  instruction 
from  one  of  the  physicians.  Moreover,  the  societies  have  often 
established  dispensaries  and  hospitals  at  their  foreign  stations, 
and  engaged  some  local  practitioner  to  attend  to  the  patients. 
This  is  all  very  well,  and  these  plans  have,  no  doubt,  been  the 
means  of  alleviating  a  great  deal  of  distress,  and  introducing 
among  the  natives  more  correct  ideas  with  regard  to  the  care 
and  the  nursing  of  the  sick ;  but  neither  of  these  methods  of 
proceeding  fall  within  the  scope  of  our  present  paper.  We  con- 
fine ourselves  to  medical  missions  as  they  are  carried  out  by 
those  who  devote  their  whole  time  and  energies  to  them,  and 
who  bring  to  the  work  all  the  knowledge  and  skill  of  highly 
educated  and  fully  qualified  practitioners. 

If  it  is  allowed  that  we  confer  a  great  boon  by  carrying  the 
advantages  of  European  medical  knowledge  to  those  nations 
that  have  no  medical  system  at  all,  or  only  one  which  is  worse 
than  useless,  a  little  reflection  will  show  that  it  is  not  enough 
to  send  medical  men  to  India  and  the  East.     This  would  but 
half  supply  the  need.     It  must  be  remembered  that  there  the 
women  and  children  are  secluded  in  the  Zenanas,  and  that  even 
the  native  hakims  are  seldom  admitted  to  see  them  unless  the 
patient  is  in  extremis.     The   treatment  of  the  native  doctors  is 
not  only  ignorant,  but  also   excessively  meddlesome,  and  calcu- 
lated to  do  irretrievable  mischief,  when  they  are  called  in  ;  but 
as  a  rule  the  females  of  India  ara  in  their  times  of  sickness 
given  over  to  the  care  of  native  nurses  whose  practice  is  even 
more  harmful  than  that  of  the  doctors.     Very  sad  effects  often 
follow  from   their  gross  ignorance  and  unlimited  meddlesome- 
ness.    The  death-rate  among  Indian  women  and  children  is 
enormous,  quite  out  of  due  proportion.     Dr.  Elmslie  says,  *'on 
account  of  the  social  habits  of  the  people  medical  aid,  to  be 
extensively  accepted,  must  be  given  by   women.     They  alone, 
whether  they   be  natives  or  Europeans,  have  free  access  to  the 
Zenanas.     Native  gentlemen  would  only  be  too  glad  to  call  ixi 
even  a  European  missionary  lady,  possessed  of  the  necessary 
medical  knowledge,  to  see  a  beloved  wife  in  the   hour  of  her 
trial,  or  a  darling  sick  child,  the  pride  and  hope  of  their  home. 
....  Western  medical  and  surgical  skill  is  esteemed  everywhere, 
is  everywhere  greatly  needed,  and,  we  believe,  would  be  every- 
where readily  and  thankfully  received  by  the  women  of  India, 
if  offered  to  them  in  a  manner  harmonising  with  the  social  cus- 
toms of  their  country."     Such  considerations  as  these  have  led 
to  the  employment    of   missionary   nurses  by    several  of   our 
societies — such   nurses    have  generally   received   more    or  less 
training  in  medicine,  more    particularly  in  midwifery.      For 


1875.]  Medical  Missions,  323 

instance,  in  Delhi  there  has  been  for  eight  \ears  past  a  mis- 
sionary accoucheuse,  supported  by  the  Delhi  Female  Medical 
Mission,  who  was  trained  in  Europe,  and  who  worked  in  con- 
nection with  the  Society  for  the  Propagation  of  the  Gospel. 
Her  services  have  been  so  much  appreciated  that  the  work  has 
extended.  A  dispensary  for  women  and  children  has  been 
opened,  which  is  at  present  presided  over  by  a  Kaiserwerth 
deacon ness,  who  not  only  attends  to  the  patients,  but  is  also 
training  a  class  of  seventeen  native  nurses.  The  benefit  thus  con- 
ferred upon  the  women  of  India  has  been  recognised  by  the 
municipality  of  Delhi,  a  body  largely  composed  of  Mahomedan 
and  Hindoo  gentlemen,  which  grants  £90  a  year  in  scholarships 
to  the  native  women  who  are  thus  trained  ;  while  the  Punjab 
government  contributes  410  rupees  a  year  for  medicine.  This 
is  a  specimen  of  what  is  being  done  in  different  parts  of  India 
by  our  own  country  women,  while  the  Americans  have  gone  a 
step  further,  having  sent  out  fully  qualified  medical  ladies  to 
act  as  missionaries.  One  such  is  stationed  at  Bareilly,  another 
at  Umritsar,  and  others  elsewhere.  These  ladies  not  only  train 
nurses  to  act  under  them,  but  are  endeavouring  also  to  raise  up 
a  class  of  native  female  practitioners.  Whatever  may  be  the 
feeling  with  regard  to  such  practitioners  in  this  country,  there 
can  scarcely  be  a  difference  of  opinion  as  to  the  advisability  of 
encouraging  such  a  class  to  meet  the  wants  of  the  female  part 
of  the  population  of  our  Indian  empire.  To  the  missionary 
societies  is  due  the  credit  of  having  taken  the  first  steps  in  this 
direction,  and  thus  giving  the  earliest  impulse  to  a  movement 
which  must  have  a  most  important  bearing  upon  the  sanitary 
condition  and  domestic  management  of  the  people ;  while  at 
the  same  time  it  cannot  fail  to  raise  the  social  status  of  Indian 
women,  and  to  emancipate  them  from  the  thraldom  in  which 
they  are  -now  kept.  We  were  glad  to  observe  in  the  Madras 
Mail,  of  the  11th  of  March,  that  the  attention  of  Government 
has  been  given  to  the  same  subject.  It  is  desirous  of  affording 
every  encouragement  to  ladies  to  study  for  a  degree  in  medicine. 
It  has  been  decided  that  in  order  to  do  so  they  must  attend  the 
full  curriculum  of  prescribed  studies,  with  certain  specified 
exceptions,  these  exceptions  being  midwifery,  surgery,  and  one 
or  two  lectures  in  anatomy  and  physiology.  For  instructing 
them  in  these  subjects  special  arrangements  have  been  made; 
and  as  a  further  encouragement  it  has  been  determined  that, 
for  the  present,  no  fees  shall  be  required  from  lady  students. 

The  amount  of  work,  in  a  single  department  of  practice, 
which  the  medical  men  attached  to  foreign  missionary  stations 
may  have  to  perform  is  well  illustrated  by  the  following  brief 
extract  from  the  last  report  of  the  Medical  Missionary  Society 


334  Reviews.  [Oct., 

in  China  (1874) — a  report  to  which  we  have  already  referred, 
and  which  is  in  every  way  most  creditable.  We  there  read  that 
at  Canton,  and  the  five  affiliated  dispensaries 

"  There  were  thirty-eight  operations  for  stone  by  lithotomy,  with 
four  deaths,  and  eight  by  lithotrity,  all  which  were  successful. 
Three  operations  for  elephantiasis  of  the  scrotum  were  performed 
with  successful  results.  Extraction  of  the  crystalline  lens  for  cataract 
has  been  performed  fifty-three  times,  and  with  restoration  of  sight 
in  all  but  four  cases.  In  addition  to  the  above,  other  operations, 
amounting  in  numbers  to  more  than  a  thousand,  have  been  performed, 
giving  partial  or  temporary  relief  to  some,  and  efi'ecting  permanent 
cures  in  many.  Altogether  the  year's  work  may  be  considered  satis- 
factory." 

In  the  same  Report  Mr.  J.  Vacken,  who  has  a  dispensary  at 
Fuk-wing,  says : 

"  I  beg  to  oft'er  my  acknowledgments  to  Mr.  Kofi'er,  of  the  Medical 
Hall,  Hong  Kong,  for  the  gratuitous  supply  of  one  lb.  of  the  root 
of  a  Siamese  plant,  the  name  of  which  seems  not  yet  to  be  known. 
The  extract  of  this  root  yields  a  specific  remedy  for  the  cure  of  ring- 
worm, which  disease  is  very  prevalent  here.  This  medicine  lias 
proved  unfailing  in  all  cases,  and  therefore  this  root  ought  to  become 
more  generally  known,  and  to  find  its  deserved  place  in  modern 
pharmacy." 

Is  this  plant  known  to  our  dermatologists  ?  If  not,  it  would  be 
worth  while  to  inquire  what  it  is,  for  the  introduction  of  new 
medicines  is  one  of  the  benefits  which  we  may  expect  from  the 
enterprise  of  medical  missionaries. 

It  would  be  easy  to  multiply  quotations  from  the  reports  of 
the  different  missions,  giving  particulars  most  interesting  in  a 
medical  point  of  view — for  example,  of  leprosy  and  its  treatment ; 
of  opium  smoking  and  its  eff'ects;  of  poisoning  from  eating  the 
roe  of  the  torpedo ;  of  alcoholism  in  Mongolia,  from  the  use  of 
arak  made  from  mares'  milk  ;  of  a  peculiar  form  of  epithelioma 
met  with  in  Kashmir,  depending  upon  the  habits  of  the  people  ; 
of  the  successful  introduction  of  vaccination  in  various  remote 
regions ;  as  well  as  of  many  other  remarkable  medical  and 
surgical  cases.  But  space  forbids.  We  can,  however,  assure 
our  readers  that  if  they  refer  to  the  reports  themselves,  they 
will  find  a  mass  of  interesting  medical  and  surgical  details 
which  will  well  repay  perusal. 

The  medical  missionary  societies  are  Avell  aware  of  the  fact, 
that  if  a  country  is  to  be  properly  supplied  with  doctors,  it  can 
only  be  by  training  natives.  Their  attention  is,  therefore,  always 
more  or  less  directed  to  this  object. 

There  cannot  be  a  better  example  of  what  may  be  effected 
by  medical  missions  in  developing  a  native  school  of  medicine^ 


1875.] 


Medical  Missions.  325 


and  substituting  an  enlightened  system  of  treatment  for  the 
absurd  and  often  harmful  practices  of  the  ignorant  medicine- 
men of  heathen  countries,  than  what  has  occurred  in  Madagascar 
Avithin  the  hist  fifteen  years.  Dr.  Andrew  Davidson,  a  pupil  of 
Dr.  Burns  Th.omson's,  was  sent  to  Antananarivo,  the  capital  of 
that  island,  by  the  London  Missionary  Society  in  186^.  He 
opened  a  dispensary  the  first  week  of  his  arrival.  His  patients 
during  the  first  year  amounted  to  between  5000  and  6000. 
His  successful  treatment  of  the  native  prime  minister,  who  had 
been  a  martyr  to  gout  for  nine  years,  procured  him  the  favour 
of  that  officer,  who  built  a  house  for  the  doctor,  and  granted 
him  premises  for  a  larger  dispensary.  He  was  shortly  after- 
wards chosen  Court  physician,  and  received  the  medal  of  the 
order  of  Radama  for  his  successful  treatment  of  the  king's 
son.  During  the  political  troubles  through  which  the  island 
soon  afterwards  passed  the  French  physicians  were  obliged  to 
leave,  and  Dr.  Davidson  remained  alone,  the  one  European 
medical  man  in  an  island  with  a  population  of  fully  7,000,000. 
This  gave  him  great  opportunities,  and  he  was  not  slow  to 
avail  himself  of  them.  In  January  1864  the  foundations  of  a 
hospital  were  laid.  The  people  entered  heartily  into  the  work. 
The  nobles  contributed  largely  to  the  expenses  of  the  building. 
The  Queen  sent  officers,  with  music,  Slc,  to  represent  her  on 
the  occasion  of  laying  the  foundation  stone,  and  expressed  her 
sense  of  the  value  of  the  institution  by  desiring  that  it  should 
be  called  the  "Royal  Hospital."  Dr.  Davidson's  next  step 
was  to  start  a  medical  school  in  connection  with  the  hospital, 
and  Dr.  Mackie  was  sent  out  to  assist  him.  These  two  set 
themselves  diligently  to  prepare  text-books  for  the  use  of  the 
students,  feeling  that  if  any  good  was  to  be  done  of  a  permanent 
and  widespread  character  it  must  be  by  training  native  doctors. 
They  appear  to  liave  found  them  apt  students,  and  several  are 
already  taking  the  charge  of  outlying  missionary  dispensaries. 
A  trained  nurse  was  some  years  ago  sent  out  to  the  "  R-oyal 
Hospital,"  and  she  has  a  large  class  of  native  women  under  her 
instructions.  From  such  a  nucleus  as  this  how  much  may  be 
expected  in  the. future  for  the  amelioration  of  the  physical  con- 
dition of  the  Malagasy  !  Dr.  Davidson  is  literally  introducing 
to  a  whole  kingdom  and  nation  the  blessings  of  European 
medical  know^lege  in  the  place  of  the  grossest  and  most  super- 
stitious practice  ;  and  his  training  college  bids  fair  to  be  not 
merely  a  medical  school,  but  also  the  first  step  towards  a  na- 
tional university.  This  is  the  medical  mission  which  derives 
its  pecuniary  support  chiefly  through  Dr.  Burns  Thomson. 

The  space  at  our  disposal  will  not  allow  us  to  enlarge  upon 
what  has   been   done   by  the   medical   missionaries   of    othcv 


336  Reviews.  [Oct., 

countries.  We  have  been  obliged  to  confine  our  attention 
almost  entirely  to  the  work  which  has  been  accomplished  by- 
men  sent  out  from  this  country.  We  must,  however,  remark,  in 
passing,  that  the  American  Board  of  Missions  have  shown  them- 
selves fully  alive  to  the  value  of  this  agency,  and  have  sent  out 
many  most  useful  medical  missionaries.  Among  the  most 
remarkable  of  these  was  Dr.  Asahel  Grant,  who  laboured  chiefly 
among  the  Nestorians  of  Persia  (1836),  and  who,  at  a  time  when 
the  life  of  a  foreigner  was  scarcely  safe  in  that  country,  traversed 
its  mountain  passes  in  perfect  security,  his  only  weapon  being 
the  cataract  needle  ;  such  was  the  reputation  that  he  had  gained 
by  the  successful  use  of  this  little  instrument.  In  reading  the 
reports  of  our  own  medical  missionaries,  especially  those  in 
India  and  China,  we  come  across  frequent  mention  of  American 
medical  missionaries  who  are  carrying  on  the  same  work  in 
adjacent  stations.  And,  as  we  might  expect  from  the  greater 
prominence  which  has  been  given  in  the  United  States  to  the 
medical  education  of  women,  we  find  that  they  have  not  only 
sent  out  nurses,  but  also,  as  we  have  already  mentioned,  they 
have  been  the  first  to  send  out  fully  qualified  lady  doctors,  to 
extend  to  the  secluded  inmates  of  Eastern  Zenanas  the  benefits 
of  a  rational  system  of  medical  treatment. 

To  some  of  our  readers  the  subject  of  medical  missions  may 
be  altogether  new  ;  while  others  may,  perhaps,  derive  from  this 
paper  a  clearer  and  more  systematic  idea  of  their  scope  than 
they  have  previously  had.  But  to  all  alike  it  must,  we  think, 
be  obvious  that  they  are  rapidly  gaining  in  public  opinion. 
They  are  in  accordance  with  the  spirit  of  the  age,  inasmuch  as 
they  are  an  attempt  to  spread  to  other  nations  some  of  the 
benefits  of  European  civilisation,  and  we  have  no  doubt  that  in 
years  to  come  we  shall  hear  more  and  more  of  their  progress. 
Such  has  been  their  development  in  our  own  day,  so  numerous 
are  the  lines  upon  which  they  are  advancing,  so  various  are 
their  adaptation  to  the  diverse  needs  of  humanity,  that,  having 
once  made  a  fair  start,  they  can  hardly  fail  to  win  a  large 
measure  of  public  support  and  to  advance  with  accelerated 
speed.  Already  the  demand  for  suitable  and  well-qualified  men 
is  greater  than  the  supply.  At  the  present  time  the  Edinburgh 
Society  has  before  it  ten  applications  which  it  is  unable  to  meet. 
A  new  call  is  being  made  upon  our  profession.  New  paths  are 
opening  up  before  our  students — paths  which,  if  they  do  not 
lead  to  worldly  advantages,  are  yet  replete  with  scientific 
interest,  and  are  particularly  fitted  to  inspire  the  ardour  of  high- 
minded  and  generous  men. 


1875.]  The  Teaching  of  Histology.  327 


v.— The  Teaching  of  Histology.^ 

For  some  years  past  there  has  been  a  cry  for  ''  practical 
instruction  "  in  all  departments  of  medical  study.  This  cry  is 
not  of  yesterday,  though  it  is  louder  now  than  it  has  been  for  a 
generation.  There  was  a  time  when  systematic  lectures  formed 
the  only  recognised  channel  by  which  anatomy,  chemistry, 
nay,  even  medicine  and  surgery,  found  their  way  to  the  average 
practitioner  during  his  student-days.  Steadily,  and  not  very 
slowly,  when  the  obstacles  to  such  reform  are  taken  into  account, 
the  lecture  system  in  all  these  branches  of  the  medical  curri- 
culum has  been  supplemented,  first  by  an  organised  system  of 
demonstrations,  secondly  by  measures  to  enable  each  individual 
learner  to  acquire  an  immediate  personal  familiarity  with  a  part 
or  the  whole  of  every  subject  taught.  Physiology  has  been  the 
last  to  yield  to  the  stream  of  change ;  but  it  too  has  yielded, 
and  a  course  of  "  experimental  demonstrations,"  with  a  class  of 
"  practical  physiology/'  now  figure  in  the  prospectus  of  every 
medical  school  which  wishes  itself  to  be  thought  on  a  level  with 
the  demands  of  the  age.  The  recent  regulations  of  the  licens  - 
ing  bodies,  making  some  such  instruction  compulsory  on  all 
candidates  presenting  themselves  for  examination,  have  power- 
fully contributed  to  hasten  the  progress  of  this  fundamental 
change.  In  its  latest  phase  the  movement  is  no  less  than 
revolutionary  j  some  of  the  advocates  of  "  practical  instruction'^ 
desiring  to  see  lectures  wholly  abolished,  as  a  mere  waste  of 
time.  The  text-book  is  to  supersede  the  professor,  and  the 
student  is  to  give  up  all  his  hours  to  the  dissecting-room,  the 
laboratory,  and  the  hospital  ward. 

It  may  be  worth  while  briefly  to  consider  the  logical  issue  of 
this  tendency  in  its  more  general  relations,  before  proceeding  to 
discuss  its  bearing  on  the  teaching  of  histology.  It  should  be 
clearly  understood  that  the  change  from  simple  lecturing  to 
lecturing  with  demonstration,  is  different  in  kind  from  that  in- 
volved in  the  substitution  of  "  practical  instruction  '^  for  profes- 
sorial teaching.  The  former  is  the  legitimate  development  of  a 
method  consecrated  by  long  usage;  the  latter  is  a  revolution. 
Whether  a  teacher  appeal  solely  to  the  ear,  as  in  lecturing,  or 
to  the  eye  together  with  the  ear,  as  in  demonstrating,  he  is  still 
putting  the  stamp  of  his  individuality  upon  a  material  more  or 

^  1.  The  Histology  and  Sisto- Chemistry  of  Man.  By  Prof.  Heineich  Feet. 
Translated  from  the  fourth  German  edition  by  Asthtjb  E.  J.  Baekeb,  Surgeon 
to  the  City  of  Dublin  Hospital.     London,  1874. 

2.  Sandhooh  for  the  Physiological  Laboratory.  Edited  bj'  Dr.  Btjedon 
Sandeeson.  Part  I. — Histology,  by  Dr.  E.  Klein,  Assistant  Professor  at  the 
Brown  Institution.    London,  1873. 


328  Reviews.  [Oct., 

less  plastic;  the  student  still  receives  what  the  teacher  has  to 
give.  But  the  scheme  favoured  by  the  most  advanced  school 
of  reformers  tends  to  substitute  personal  initiative  for  passive 
receptivity  as  a  means  of  acquiring  knowledge.  The  student  is 
to  teach  himself;  he  is  to  be  provided  with  all  needful  books 
and  appliances  and  left  to  make  his  own  way,  the  office  of  the 
teacher  sinking  to  that  of  a  convenient  dictionary  to  be  consulted 
at  the  learner's  option. 

This  is  not  the  place  for  a  discussion  of  the  absolute  merits  or 
defects  of  a  proposal  which  we  have  designedly  sketched  out 
in  its  most  extreme  form.  There  is  much  to  be  said  in  its  favour, 
when  the  end  in  view  is  to  produce  original  investigators  of  a 
high  order.  Granted  exceptional  capacity,  unlimited  time,  a 
limited  sphere  of  effort,  and  an  intention  to  penetrate  into  the 
domain  of  the  unknown, — the  best  results  might  fairly  be  anti- 
cipated from  a  scheme  under  which  no  germ  of  latent  power  could 
fail  of  finding  its  appropriate  soil  and  the  requisite  medium  for 
its  expansion.  But  are  these  preliminary  conditions  fulfilled  in 
the  case  with  which  we  are  now  concerned  ?  It  is  sufficiently 
obvious  that  they  are  not.  Ardent  reformers  in  this  department 
do  not  always  appear  to  realise  the  immense  extent  of  the  field 
over  which  the  mind  of  the  medical  student  is  expected  to  range 
during  the  four,  or  at  most  five,  years  of  his  pupilage.  No 
other  profession  makes  anything  like  the  same  demand  upon 
the  brain.  The  haughty  boast,  "  I  have  taken  all  knowledge 
to  be  my  province,"  becomes  little  more  than  a  statement  of 
fact  in  the  mouth  of  a  candidate  for  the  London  University 
degree.  Now,  an  encyclopaedic  training  of  this  sort  can  only  be 
carried  out  in  a  limited  time,  on  the  condition  that  whatever 
independent  powers  the  learner  may  possess  shall  be  husbanded 
with  the  utmost  economy,  and  turned  into  the  narrow  channel 
of  strictly  technical  acquirement.  They  must  be  concentrated 
on  medicine,  surgery,  and  obstetrics,  where  every  detail  is  of 
immediate  value,  and  where  the  question  of  time  occupies  a 
relatively  subordinate  position,  since  the  whole  of  the  student's 
after-life  is  given  up  to  these  subjects.  As  regards  the  vast 
substructure  of  the  physical  sciences,  it  should  be  clearly  ad- 
mitted that  an  understanding  of  their  leading  principles  is  all 
that  can  be  expected  or  desired,  and  that  the  greatest  saving 
of  time  and  labour  may  be  achieved  by  allowing  the  student  lo 
remain  a  passive  recipient.  Systematic  lectures  and  demonstra- 
tions must  occupy  the  foremost  place  ;  they  may  be  supplemented 
by  "  practical  instruction,"  strictly  limited  to  such  points  as  are 
of  intrinsic  utility,  or  lend  vividness  and  interest  to  the  theore- 
tical teaching. 

In  illustration  of  these  principles  we  may  take  anatomy  and 


1875.] 


The  Teachwg  of  Histology^ 


32^ 


chemistry,  two  subjects  in  which  the  "  practical"  metliod  has 
been  followed  for  some  considerable  time.  In  the  case  of  the 
former,  besides  attending  lectures  and  demonstrations,  the 
student  has  to  dissect.  Dissection — individual  research — is  an 
indispensable  feature  of  anatomical  instruction  for  two  reasons  : 
first,  because  it  forms  the  only  introduction  to  operative  surgery  ; 
secondly,  because  without  it  the  multitudinous  facts  of  descrip- 
tive anatomy,  appealing  almost  exclusively  to  the  memory  and 
hardly  at  all  to  the  reasoning  faculties,  could  not  be  adequately 
imprinted  on  the  learner's  mind.  The  same  method  is  followed 
in  the  teaching  of  chemistry,  but  no  longer  under  the  same 
conditions.  The  theoretic  foundations  of  this  science  are  not 
only  capable  of  being  taught  in  systematic  lectures,  but  they 
can  hardly  be  taught  in  any  other  way.  The  experimental  facts 
on  which  the  laws  of  chemistry  are  based  can  be  demonstrated 
by  a  skilful  teacher  to  a  large  class  of  students,  while  any 
attempt  to  make  the  student  work  them  out  for  himself  would 
prove  futile.  Scientific  chemistry  rests  on  quantitative  analysis. 
The  course  of  '^  practical  chemistry  "  attended  by  medical  stu- 
dents consists  chiefly,  if  not  entirely,  of  qualitative  analysis; 
and  there  is  no  prospect  of  immediate  usefulness  to  set  against 
this  theoretical  deficiency.  Chemical  analysis  stands  in  no  such 
intimate  relation  to  any  branch  of  medical  practice  as  that  which 
subsists  between  practical  anatomy  and  operative  surgery.  The 
simple  processes  employed  by  the  physician  in  examining 
urine,  &c.,  might  easily  be  learned  at  a  subsequent  stage  of  the 
student's  career,  without  any  of  the  elaborate  machinery  which 
has  to  be  set  in  motion  under  .the  existing  system,  and,  in  point 
of  fiict,  they  are  thus  learned.  The  reductio  ad  absurdum  of  the 
present  arrangements  is  to  be  found  in  the  frequent  inability  of 
a  student,  who  has  gone  through  a  course  of  practical  chemistry, 
to  ascertain  the  presence  of  chlorides  in  urine.  The  truth  is 
that,  notwithstanding  the  excellent  method  which  is  now 
pursued,  and  the  conscientious  zeal  of  very  able  teachers,  the 
average  student  fails  to  carry  away  or  to  retain  any  real  fami- 
liarity with  even  the  commonest  processes  of  analysis.  He 
has  wasted  a  ^ood  deal  of  time,  and  a  quantity  of  expensive 
reagents  ;  and  the  result — except  in  a  few  cases — is  ridiculously 
out  of  proportion  to  the  means  employed. 

If  we  look  at  the  teaching  of  histology  from  the  same  point  of 
view,  we  cannot  but  perceive  that  the  students  of  this  subject 
fall  naturally  under  two  distinct  categories.  It  may  be  difficult, 
or  even  impossible,  to  distinguish  at  first  between  the  indi- 
viduals belonging  to  the  one  and  those  belonging  to  the  other. 
The  majority,  in  any  class  of  medical  students,  purpose  to  devote 
their  lives  to  practice;  for  them  the  results  of  histological  re-< 


330  Meviews.  ^Oct.> 

search,  in  their  bearing  upon  general  anatomy  and  pathology, 
are  the  main  desideratum ;  they  want  results,  not  methods  ;  or 
only  so  much  of  method  as  shall  give  a  certain  life  and  reality 
to  the  study  of  results.  A  minority,  on  the  other  hand,  and  in 
our  English  schools  a  very  small  minority,  consists  of  men  who 
will  devote  themselves  to  the  prosecution  of  research.  It  is 
clear  that  for  the  former  and  larger  group,  who  desire  to  obtain 
a  maximum  of  information  in  a  minimum  of  time,  a  dogmatic 
method  and  systematic  completeness  of  exposition  are  required ; 
the  subject  should  be  treated  as  a  whole,  and  with  a  nice  dis- 
crimination of  the  relative  importance  of  its  parts.  Vexed 
questions,  problems  awaiting  a  solution,  should  be  left,  as  much 
as  possible,  on  one  side.  For  the  smaller  number,  an  opposite 
mode  of  instruction  is  more  profitable ;  their  attention  ought  to 
be  turned  to  the  doubtful  and  uncertain  borderland  in  which 
adventure  may  be  crowned  with  discovery.  For  them  it  is  an 
intellectual  hindrance  to  view  the  subject  as  complete. 

In  our  medical  schools,  at  least  for  the  present,  the  interests 
of  the  minority  must  be  postponed  to  those  of  the  majority. 
The  minority  must  seek  what  it  requires  in  private  laboratories 
or  abroad.  We  have  to  deal  with  a  class  of  learners  for  whom 
systematic  method  is  the  prime  requisite,  both  as  a  surer  basis 
for  the  superstructure  of  professional  attainment,  and  because 
it  effects  the  greatest  saving  of  time  and  labour.  It  behoves  us, 
therefore,  to  consider  in  limine  what  it  is  that  we  desire  to  teach 
under  the  name  of  Histology. 

The  attempts  of  such  men  as  Leeuwenhoek  and  Ruysch  to 
unravel  the  minutiae  of  structure,  though  productive  of  much 
valuable  knowledge  on  special  points,  failed  to  impress  any  dis- 
tinctive tendency  on  scientific  thought.  The  true  foundations 
of  histology  were  laid  by  Bichat's  great  work  on  general 
anatomy,  at  the  beginning  of  this  century.  They  were  laid, 
singularly  enough,  with  hardly  any  reference  to  structural 
details  beyond  the  range  of  the  unaided  eye.  It  was  not  until 
the  cell-theory,  in  the  original  form  given  to  it  by  Schwann,  had 
furnished  a  scheme  capable  of  embracing  and  co-ordinating  the 
multitude  of  isolated  facts  which  came  pouring  in  from  all 
quarters,  that  histology,  in  the  sense  in  which  we  now  under- 
stand the  word,  was  definitely  constituted.  Our  conceptions  of 
the  cell-theory  have  been  greatly  modified  during  the  last  thirty 
years ;  but  it  still  remains  the  only  framework  by  which  the 
countless  facts  of  tissue-structure,  whether  normal  or  morbid, 
are  held  together  and  rendered  capable  of  being  assimilated  by 
the  mind. 

The  word  histology  is  constantly  used  to  denote  two  perfectly 
^distinct  conceptions,  and  this  loose  and  ambiguous  employment 


1875.]  The  Teaching  of  Histology,  331 

of  the  term  breeds  endless  confusion.  On  the  one  hand,  its 
etymology  would  naturally  incline  us  to  apply  it  to  that 
branch  of  science  which  concerns  itself  with  those  simpler 
elements  of  which  the  more  complex  organs  of  the  body  are 
built  up ;  on  the  other  hand,  the  services  rendered  to  that 
branch  of  science  by  the  microscope  are  so  many  and  so 
great,  that  the  means  have  almost  come  to  overshadow  the 
end,  and  a  term  primarily  suited  to  denote  an  intellectual 
conception  has  come  to  be  frequently  applied  to  a  method  of 
research.  In  other  words,  histology  is  sometimes  made  sy- 
nonymous with  general  anatomy,  and  sometimes  with  micro- 
scopic anatomy.  Now,  the  former  is  an  abstract  conception, 
and  was  arrived  at,  as  we  have  akeady  noticed,  without  the 
aid  of  the  microscope  ;  the  latter  is  not  a  branch  of  science,  but 
the  fruit  of  an  artifice  by  which  our  field  of  vision  is  enlarged. 
General  anatomy  stands  in  much  the  same  relation  to  descrip- 
tive anatomy,  as  mathematical  astronomy  to  the  simple  observa- 
tion of  the  heavenly  bodies  ;  the  former  is  not  necessarily  more 
dependent  on  the  microscope  than  the  latter  is  upon  the  tele- 
scope, though  these  instruments  are  indispensable  for  their 
prosecution ;  and  any  confusion  of  histology  with  microscopy, 
any  attempt  to  place  the  method  of  observation  on  a  par  with 
the  science  to  which  it  happens  to  be  auxiliary,  ought  to  appear 
as  unphilosophical  to  the  histologist  as  corresponding  language 
in  reference  to  the  telescope  would  appear  to  the  astronomer. 
It  follows,  moreover,  that  we  ought  not  to  fall  into  the  mistake 
of  looking  to  a  more  minute  analysis  of  structure  as  the  road  to 
progress  in  histology.  Supposing  it  were  possible — a  possibility 
nothing  less  than  chimerical — to  push  our  magnifying  powers 
so  far  as  to  enable  us  to  discern  the  chemical  structure  of  the 
matter  subjected  to  our  instruments,  to  see  the  molecules  in 
their  rhythmic  dance  with  the  bodily  eye,  as  we  now  see  them 
with  the  eye  of  the  imagination,  we  should  not  thereby  enlarge 
the  boundaries  of  general  anatomy  ;  we  should  simply  penetrate 
by  a  new  path  into  the  domain  of  physics  or  of  chemistry.  The 
r scientific  completion  of  general  anatomy  must  be  worked  out  by 
*^he  study  of  development.  When  once  we  are  able  to  trace  all 
the  steps  by  which  a  particle  of  bioplasm  is  multiplied  and 
lifferentiated  into  the  complex  variety  of  parts  of  which  the 
idult  organism  is  made  up,  we  shall  have  done  enough  for  our 
mrpose.  All  questions  as  to  the  nature  of  bioplasm  and  the 
)urce  of  its  singular  endowments,  lie  outside  the  limits  of  mor- 
phology, and  must  be  investigated  by  way  of  experiment,  not  by 
"lat  of  observation  alone. 

Histology  admits  of  being  taught  in  a  course  of  systematic 
[ectures  illustrateil  by  diagrams  a^d  specimens,  both  naked-eye 


B3^  Heview^.  [Oct.^, 

and  microscopic.  Strictly  speaking,  it  ought  not  to  be  separated 
from  anatomy,  normal  or  morbid,  of  which  it  forms  a  part ;  it  is 
only  by  accident  that  it  has  come  to  be  associated  with  physio- 
logy, and  the  connection  has  not  been  a  happy  one  for  the  latter 
subject.  For  many  years,  indeed,  the  teaching  of  physiology 
in  our  medical  schools  was  fairly  crushed  by  the  unnatural 
usurpations  of  its  yoke-fellow. 

The  course  of  '^  practical  instruction  "  which  is  now  all  but 
universally  added  to  lectures  on  histology,  includes  many. things 
which  do  not  properly  belong  to  that  science.  It  might,  with 
greater  justice,  be  termed  a  course  of  instruction  in  the  use  of  the 
microscope  for  purposes  of  anatomical  and  physiological  research. 
The  two  books  whose  titles  head  the  present  article  illustrate 
the  "  systematic ''  and  the  "  practical  "  modes  of  approaching 
the  subject  respectively.  One  appeals  primarily  to  the  larger 
group  of  students  referred  to  above,  the  other  to  the  smaller 
one.  Neither  of  them  is  absolutely  limited  to  histology,  strictly 
so  called,  for  Professor  Frey  devotes  sixty-two  pages  to  an  ac- 
count of  the  chemical  composition  of  the  tissues  before  pro- 
ceeding to  describe  their  structure,  while  Dr.  Klein  includes 
an  account  of  various  applications  of  the  microscope  to  physio- 
logical experimentation. 

Frey's  work  may  be  regarded  as  the  legitimate  successor  of 
KoUiker's  *  Manual  of  Human  Microscopic  Anatomy,'  which 
it  very  much  resembles  in  scope.  Compared  with  the  latest 
edition  of  KoUiker's  manual,  however  (that  published  in  1860), 
it  presents  two  obvious  advantages.  In  the  first  place,  it  has 
been  rendered  into  clear  and  readable  English;  in  the  second, 
it  avoids  any  elaborate  discussion  of  those  questions  on  which 
the  most  eminent  European  histologists,  for  the  present,  agree 
to  differ ;  questions  interesting  to  the  specialist,  but  which  leave 
the  ordinary  student  utterly  bewildered — in  that  state  of  mind 
which  was  humorously  alluded  to  some  years  ago  by  Professor 
Huxley,  when  he  said  that  among  the  candidates  in  physiology 
at  the  University  of  London  he  found  men  disposed,  when 
asked  whether  the  blood  circulates,  to  answer  that  "  Professor 
Langkopf  was  of  opinion  that  it  did,  while  Professor  Breitkopf 
believed  that  it  did  not." 

The  first  part  of  Frey's  manual  is  devoted,  as  already  stated, 
to  an  account  of  the  ''elements  of  composition"  of  the  body — 
in  other  words,  to  a  brief  sketch  of  its  proximate  chemical  con- 
stituents. This  is  done  simply,  and  without  that  display  of 
graphic  formulse  which  meets  the  student  in  some  modern  text- 
books. The  next  part  contains  a  full  description  of  the  simple 
and  compound  tissues ;  while  in  the  third,  the  circulatory, 
respiratory,   digestive,    urinary,    generative,    bony,     muscular, 


1875.]  The  Teaching  of  Histology.  B33 

nervous,  and  sensory  organs  are  dealt  with  seriatim.  The 
whole  is  abundantly  illustrated  by  upwards  of  six  hundred 
woodcuts,  many  of  which  are  decidedly  coarse,  but  their  num- 
ber may  be  allowed  to  compensate  for  any  shortcomings  of 
artistic  quality.  The  entire  work  is  characterised  by  a  tone 
of  robust  and  orderly  common  sense,  and  no  part  of  it  is 
allowed  to  usurp  an  undue  predominance  over  the  rest.  In 
these  points  it  is  a  model  of  what  a  student's  text-book  ought 
to  be. 

Of  the  changes  which  have  been  wrought  in  pure  histology 
during  the  last  fifteen  years,  and  which  render  a  new  text-book 
indispensable,  some  idea  may  be  formed  by  comparing  Prey's 
chapters  on  the  lymphatic  system,  and  on  the  minute  structure 
of  the  great  nerve-centres,  with  those  in  Kolliker's  manual. 
The  progress  has  been  essentially  due  to  the  employment  of 
new  methods^of  preparation. 

As  regards  the  lymphatic  system,  it  may  be  truly  said  that 
we  were  ignorant  alike  of  its  glandular  and  of  its  canalicular 
portion.  The  labours  of  Frey  and  Teichmann,  of  Recklinghausen 
and  His,  of  Ludwig  and  his  pupils,  of  Sanderson  and  Klein, 
have  cleared  up  most  of  the  difficulties  by  which  the  subject 
was  surrounded,  and  furnished  a  secure  basis  for  inquiring  into 
its  functional  and  pathological  relations.  Injection  by  simple 
puncture  (Hyrtl's  method)  has  proved  to  be  an  easy  and 
effectual  way  of  eluding  the  opposition  of  the  valves  by  which 
the  larger  lymphatic  channels  are  guarded,  and  of  determining 
their  general  arrangement  and  distribution  in  the  various  organs 
of  the  body.  In  many  instances,  the  result  of  such  injections 
might  remain  ambiguous,  but  for  the  aid  of  the  silvering  process. 
The  demonstration  of  a  limiting  layer  of  condensed  connective 
tissue  forming  the  proper  wall  of  every  channel,  and  capable  of 
being  resolved  into  a  mosaic  of  nucleated  area?,  suffices  to  meet 
the  argument  that  the  injected  liquid  has  simply  forced  its  way 
along  interstitial  crevices  and  fissures.  The  endothelial  mark- 
ings are  so  easily  defined  by  the  nitrate  of  silver,  and  so  charac- 
teristic, that  there  is  no  longer  any  difficulty  in  tracing  the  most 
minute  lymphatic  canaliculi  even  without  the  aid  of  injections. 
The  continuity  of  the  great  serous  cavities  of  the  thorax  and  ab- 
domen with  the  lymphatic  system  by  means  of  distinct  stomata, 
(a  continuity  originally  foreseen  by  Mascagni,)  has  also  been 
established  within  the  last  few  years,  and  will  prove  fertile  in 
consequences.  It  is  especially  satisfactory,  moreover,  that  the 
methods  by  which  these  facts  have  been  ascertained  are  so 
simple  and  so  constant  in  the  results  they  yield,  that  they  can 
be  successfully  employed  even  by  beginners  in  the  art  of  micro- 

Kopic  research. 
r 


334  .  Reviews.  [Oct., 

The  anatomical  study  of  the  cerebro -spinal  axis  is  a  much 
more  intricate  matter.  Here,  too^  the  progress  which  has  been 
made  is  due,  in  the  main,  to  the  means  we  now  possess  of 
obtaining  large  sections  in  which  the  mutual  relations  of  the 
elementary  parts  are  preserved.  To  make  a  sufficiently  thin 
section  of  the  cortex  cerebri,  or  spinal  marrow,  without  dislocation, 
it  is  necessary  to  harden  the  pulpy  tissues  ;  but  hardening  in- 
volves opacity.  This  difficulty  is  now  easily  overcome ;  we 
know  several  agents  by  which  tissues  hardened  in  chromic  acid, 
bichromate  of  potash,  &c.,  can  be  rendered  perfectly  transparent ; 
those  most  commonly  employed  being  turpentine  and  oil  of 
cloves.  Sections  treated  in  this  way,  and  mounted  in  dammar 
or  Canada  balsam,  are  quite  transparent,  and  show  all  the 
tissue-elements  in  situ.  By  plunging  them  into  various  staining 
fluids  before  they  are  mounted,  a  still  more  complete  differentiation 
of  elementary  parts  may  be  obtained,  and  the  structure  of  the 
nervous  centres  becomes  as  demonstrable  as  that  of  the  kidney 
or  of  bone.  Moreover,  by  substituting  the  microtome  for  the 
ordinary  razor  or  Valentin's  knife  it  becomes  easy  to  make  any 
number  of  successive  sections  in  parallel  planes,  so  that  a  given 
portion  of  the  spinal  cord  may  be  thoroughly  explored  without 
any  breach  of  continuity.  Finally,  by  means  of  the  freezing 
microtome,  we  are  able  to  make  trustworthy  sections  of  almost 
any  organ  without  the  expenditure  of  time  and  labour  required 
for  hardening,  &c.  By  methods  such  as  these,  our  knowledge 
of  the  intimate  structure  of  the  great  nerve-centres,  both  in 
health  and  disease,  has  been  rendered  as  precise  as  that  which 
we  possess  concerning  the  remaining  organs  of  the  body.  Lock- 
hart  Clarke,  Luys,  Meynert,  and  others,  have  succeeded  in 
demonstrating  the  invariable  association  of  definite  and  localised 
lesions  of  nerve-centres  with  some  of  the  most  obscure  diseases 
of  the  nervous  system,  thus  redeeming  one  of  the  waste- lands 
of  pathology  from  the  neglect  to  which  its  apparent  inaccessi- 
bility had  long  condemned  it. 

Dr.  Klein's  part  of  the  '  Handbook  for  the  Physiological 
Laboratory '  differs  widely  from  Frey's  manual  both  in  its 
merits  and  defects.  Every  scrap  of  information  as  to  the  methods 
employed  in  histological  research  has  its  value  when  coming 
from  an  acknowledged  master  in  the  art  of  technical  manipula- 
tion ;  and  there  is  hardly  a  sentence  which  does  not  carry  intrinsic 
evidence  of  its  source  in  personal  observation  and  experiment. 
Though  professing  to  deal  only  with  methods  of  investigation, 
the  work  contains  much  teaching  of  a  dogmatic  kind.  The 
student  is  told  what  he  will  see  as  well  as  how  he  should  set 
about  seeing  it.  The  number  of  engravings,  too,  is  far  greater 
than  is  strictly  needed  for  the  purpose  of  illustrating  methods 


i 


t 


1875.]  The  Teaching  of  Histology.  395 

These  engravings  stand  on  quite  a  different  level  from  those  in 
Frey's  book.  They  are  all  of  them  original,  and  are  meant,  not 
as  semi-diagrammatic  sketches  to  elucidate  the  statements  in  the 
text,  but  as  faithful  representations  of  particular  objects.  Some 
of  them  are  very  beautiful,  and  reflect  the  highest  credit  both 
on  draughtsman  and  engraver.  Indeed,  if  we  put  aside  the 
exquisite  woodcuts  which  adorn  many  of  Dr.  Beale's  books  and 
monographs,  we  have  not  much  to  be  compared  with  them  in 
our  micrographic  literature.  It  may  almost  be  said  that  they 
are  too  good  for  the  purpose  for  which  they  are  intended. 
Minute  fidelity  in  the  representation  of  microscopic  objects  is 
perhaps  of  less  importance  to  the  beginner  than  it  may  seem, 
at  first  sight,  to  be.  If  the  alternative  lie  between  a  small 
number  of  accurate  and  highly  finished  drawings  of  particular 
specimens,  and  an  abundance  of  rough  woodcuts  which,  without 
actually  misrepresenting  anything,  omit  many  of  the  finer 
minutiae  of  structure,  the  latter  ought  certainly  to  be  preferred  in 
an  elementary  text-book.  It  should  be  borne  in  mind  that  a 
drawing,  however  accurate,  represents  not  so  much  the  actual 
specimen  under  observation  as  the  inference  drawn  from  it  by 
a  skilled  observer.  The  impression  conveyed  to  the  mind  of  an 
histologist  by  certain  appearances  is  a  complex  product,  resulting 
from  the  inspection  of  lines  and  points  in  a  series  of  horizontal 
planes,  and  from  the  comparison  of  a  great  number  of  similar 
specimens.  It  is  this  impression  which  is  really  embodied  in  a 
drawing.  Those  who  have  had  occasion  to  employ  a  skilled 
draughtsman,  unaccustomed  to  the  microscope,  in  delineating 
an  object  under  a  moderately  high  power,  will  have  been  struck 
with  the  difficulty  he  finds  in  seeing  what  appear  to  be  most 
obvious  features.  He  draws  what  he  sees ;  and  he  sees  only 
those  lines  and  points  which  are  in  focus  at  the  moment.  For 
a  like  reason  photography  is  never  likely  to  prove  an  efficient 
substitute  for  drawing  in  microscopic  work.  The  camera  is  un- 
biassed and  draws  no  inferences ;  for  that  very  reason  it  yields 
information  of  scanty  value.  Hence,  too,  the  most  perfect 
drawings  can  never  quite  take  the  place  of  personal  observation  in 
the  teaching  of  histology ;  some  practical  work  is  indispensable, 
even  for  medical  students.  Diagrams  or  rough  sketches  are 
sometimes  better  than  true  pictures  for  elementary  instruction, 
the  absence  of  detail  enabling  the  main  features  to  be  more 
readily  seized  by  the  pupil,  while  he  is  never  allowed  to  fall  into 
the  error  of  supposing  that  he  has  found  a  substitute  for  the 
labour  of  studying  the  objects  themselves. 

There  are  some  positive  defects  in  Dr.  Klein's  work  to  which 
it  is  worth  while   to  draw   attention,  since  they   are  of  a  kind 
"  at  may  be  remedied  in  future  editions.     These  defects  are 


ievtews. 


[6ct., 


particularly  objectionable  in  a  laboratory  handbook,  intended 
for  reference  during  the  press  of  actual  work,  rather  than  for 
methodical  perusal  in  the  study.  They  may,  for  the  most  part, 
be  attributed  to  carelessness  or  haste.  It  is  by  no  means  easy 
to  find  what  one  wants  without  a  long  and  vexatious  search,  in 
which  the  general  index  aifords  but  little  help,  while  the  ar- 
rangement of  the  sections  in  each  chapter  is,  to  say  the  least  of 
it,  arbitrary.  To  add  to  the  reader's  perplexity,  the  numbering 
of  the  sections,  adopted  throughout  the  remaining  divisions  of 
the  handbook,  is  unaccountably  omitted  in  this  part  of  it. 
Moreover,  the  connection  of  the  text  with  the  engravings  is  often 
left  to  the  reader^s  ingenuity ;  the  latter  (issued  in  a  separate 
volume  or  atlas)  are  sometimes  unprovided  with  any  reference 
to  the  letter-press,  or  provided  with  a  reference  not  specific 
enough  to  be  of  much  service.  The  text  ignores  the  illustrations 
even  more  than  the  illustrations  ignore  the  text.  Considering 
their  rare  excellence,  it  is  somewhat  annoying  to  find  that  out 
of  188  engravings  only  30  are  referred  to  in  the  body  of  the 
work.  Had  the  text  been  produced  by  one  author  and  the 
illustrations  by  another,  their  mutual  independence  could 
scarcely  have  been  more  vigorously  asserted  than  it  is.  It  is 
further  to  be  regretted  that  the  excellent  plan  recommended 
and  invariably  adhered  to  by  Dr.  Beale,  of  adding  to  each 
drawing  the  magnifying  power  in  diameters,  should  not  have 
found  favour  with  Dr.  Klein.  The  prevalent  Continental  custom 
of  stating  that  a  particular  object  was  drawn  under  "  Hart- 
nack's  oe.  4,  obj.  7,  tube  half  drawn  out,"  is  not  only  wanting 
in  scientific  .  precision,  but  is  highly  inconvenient,  especially 
as  the  magnifying  power  of  the  various  combinations  of  Hart- 
nack's  lenses  is  nowhere  given,  and  their  use,  at  any  rate  in 
this  country,  is  far  from  being  universal. 

In  its  present  state,  therefore,  this  portion  of  the  handbook 
is  better  suited  to  the  wants  of  the  advanced  student  and  the 
original  worker,  than  to  those  of  the  beginner.  AVhere  the  end 
in  view  is  to  enable  a  number  of  medical  students,  of  various 
degrees  of  ability  and  industry,  to  obtain  ocular  demonstration 
of  facts  which  have  been  communicated  to  them  by  systematic 
lectures  and  text-books,  clearness  and  simplicity  of  arrangement 
are  of  the  first  importance.  Any  obscurity  of  exposition,  any 
disproportion  between  the  amount  of  time  and  labour  given  to 
a  particular  question  and  the  importance  of  that  question  rela- 
tively to  the  entire  science,  is  sure  to  make  itself  disastrously 
felt  in  the  confused  and  blundering  impressions  left  on  the  mind 
of  the  average  learner.  The  only  scheme,  so  far  as  we  are 
aware,  under  which  an  ordinary  class  can  be  guided  through 
the  entire  subject  during  the  limited  time  available  for  the  pur- 


1875.]  The  Teaching  of  Histology.  3Ji7 

pose,  is  that  which  was  followed  hy  Professor  Rutherford  during 
his  tenure  of  office  at  King's  College.^ 

The  following  quotations  embody  the  leading  features  of  his 
plan,  and  exhibit  its  eminently  practical  character: 

"  It  is  not  advisable  to  teach  more  than  five-and-twentj,  or,  at  the 
outside,  thirty  students  at  a  time ;  to  teach  even  this  number  satis- 
factorily requires  three  skilled  assistants — senior  students  who  have 
been  through  the  course  and  can  assist  the  uninitiated.  The  whole 
of  histology  may  be  gone  through  in  twenty-four  lessons,  each  lesson 
lasting  from  an  hour  and  a  half  to  two  hours. 

"  The  plan  I  now  adopt  on  all  occasions  is  to  treat  my  class  like  a 
regiment  of  soldiers,  making  every  one  do  the  same  thing  at  the 
same  time.     The  interest  is  thoroughly  kept  up  by  making  the  class 
a  sort  of    debating  society.     While  every  one  looks  at   the  same 
objects,  I  ask  one  student  after  another  to  describe  what  he  sees. 
The  observations  of  one  student  are  in  this  way  checked  by  the 
observations  of  another.     The  class  resembles  a  little  army  of  in- 
vestigators ;  it  is,  in  fact,  a  miniature  of  the  histological  world.     The 
power  that  every  student  has  of  criticising  the  observations  of  his 
fellows  makes,  as  might  be  supposed,  every  one  exceedingly  careful. 
A  simple  object  like  yeast  is  taken  first.     I  give  no  description  of 
the  torula,  but  I  ask  the  student  to  describe  and  then  to  draw  what 
he  sees.     Any  one  may  be  called  on  to  do  this.     Any  one  who  dis- 
agrees with  any  statement  is  asked  to  do  so,  and  to  give  a  demon- 
stration in  support  of  his  opinion.     To  facilitate  such  descriptions 
every  student  has  a  card  on  which  are  printed  the  following  points : — 
1,    shape ;    2,  edge ;    3,  colour ;    4,  transparency ;   5,  contents ;    6, 
size ;  7,  effects  of  reagents.     The  card  prevents  the  student  from 
getting  bewildered,  and  teaches  him  method  and  thoroughness.  Care 
is  taken  that  no  one  ever  becomes  idle.     If  his  preparation  is  made, 
and  he  be  waiting  on  his  neighbours,  he  occupies  his  time  in  drawing. 
When  we  come  to  complex  structures,  such  as  bone,  I  give  a  brief 
preliminary  account  of  the  subject,  in  order  that  every  one  may 
understand  what  he  sees.     By  questioning  the  student  as  the  demon- 
stration goes  on  it  is  easily  ascertained  if  he  knows  what  he  is  about. 
On  all  occasions,  however,  I  make  the  student  describe  what  he  sees. 
This  method  really  educates  him  in  a  way  such  as  no  other  method, 
in  my  opinion,  can.     When  necessary  I  show  preparations  which 
have  been  previously  made. 

"  At  the  beginning  of  the  course  a  general  account  is  given  of  the 
microscope  and  accessory  apparatus.  The  student  is  instructed  how 
to  clean  the  instrument,  how  to  measure  its  magnifying  power,  how 
to  measure  the  size  of  an  object,  and  how  to  draw.  After  this  every 
student  is  provided  with  his  microscope,  and  the  regular  work  of 
demonstration  begins.  From  time  to  time,  as  the  course  advances, 
short  accounts  are  given  of  the  preparation  of  objects,  &c.  These 
are  not  entered  into,  however,  until  the  student  has  had  a  little  ex- 
perience of  the  effects  of  agents  upon  torulse,  blood-corpuscles,  &c." 

^  PabUshecl  in  the  '  Quarterly  Journal  of  Microscopical  Science,'  Jan.,  X872. 


338  Reviews.  [Oct., 

The  arrangement  of  Dr.  Klein^s  manual  conforms  more 
closely  to  that  followed  in  systematic  works  on  histology  than 
would  perhaps  be  found  convenient  in  teaching  a  class.  Of  its 
two  principal  divisions,  one  is  concerned  with  the  preparation 
of  the  simple,  the  other  with  that  of  the  compound  tissues. 
The  first  chapter  is  devoted  to  the  blood-corpuscles.  The  mode 
of  observing  the  amoeboid  movements  of  the  leucocytes  in  the 
blood  of  homoeothermic  and  poBcilotiiermic  animals  respectively 
is  fully  described,  as  also  the  effect  of  gases,  liquid  reagents, 
electricity,  heat,  and  moisture,  on  both  red  and  colourless  ele- 
ments. The  next  chapter  gives  an  account  of  epithelium  and 
endothelium,  including  the  study  of  ciliary  motion  and  the 
employment  of  nitrate  of  silver.  The  third  chapter  describes 
the  methods  of  preparing  and  examining  the  various  connective 
tissues  (fibrous,  elastic,  and  areolar  tissue,  the  cornea,  different 
kinds  of  cartilage  and  bone).  The  fourth  deals  with  striped 
and  unstriped  muscle,  including  Briicke's  method  of  investi- 
gating the  former  by  means  of  polarised  light.  In  the  fifth 
chapter  we  have  an  account  of  nerve-cells,  nerve-fibres,  and 
their  terminal  distribution.  The  second  part  opens  with  a 
description  of  various  modes  of  cutting  sections,  hardening  the 
compound  tissues,  embedding,  staining,  and  mounting  them. 
The  different  processes  for  injecting  the  circulatory  system  are 
then  discussed,  the  discussion  leading  up  to  an  account  of  the 
structure  of  blood-vessels,  and  the  way  to  observe  the  circula- 
tion in  the  living  organism.  The  next  chapter  is  devoted  to 
the  lymphatic  apparatus,  and  includes  a  description  of  the 
methods  adopted  in  an  investigation  whose  results  have  re- 
cently been  published  in  the  form  of  a  monograph.  This  part 
is  more  lavishly  illustrated  than  any  of  the  others.  The  organs 
of  respiration  and  digestion  are  dismissed  in  two  relatively 
brief  chapters,  followed  by  an  account  of  the  skin  and  the 
genito-urinary  apparatus.  The  organs  of  special  sense  come 
next  in  order.  Lastly,  we  have  a  chapter  on  embryology  which 
is  too  diificult  of  comprehension  for  the  beginner,  while  it  is  too 
concise  for  the  wants  of  the  advanced  student.  Now  that  we 
are  in  possession  of  the  admirable  monograph  by  Foster  and 
Balfour,  this  chapter  may  be  regarded  as  superfluous.  A  short 
appendix  gives  some  of  the  methods  of  studying  the  process  of 
inflammation  in  epithelial  structures,  cartilage,  the  cornea  and 
tongue  of  the  frog,  &c.,  methods  which  have  been  so  fertile  in 
valuable  results  during  the  last  few  years,  but  which  belong 
rather  to  pathology  than  to  normal  histology. 

Briefly  to  recapitulate.  The  teaching  of  histology  to  a  class 
of  medical  students  should,  under  existing  circumstances,  be 
rigidly  systematised,  and  connected  as  closely  as  possible  with 


1875.]         Chambers  on  Diet  in  Health  and  Disease »  339 

that  of  anatomy.  Frey's  manual  is  probably  the  best  guide  we 
have  for  this  part  of  the  course.  The  "  practical  instruction" 
by  which  lectures  ought,  in  all  cases,  to  be  supplemented,  must 
not  be  suffered  to  usurp  their  place,  but  should  be  carefully 
subordinated  to  them.  Its  principal  requirements  are  order 
and  method,  if  the  interests  of  the  majority  of  students  are  to 
be  preferred  to  those  of  a  small  minority.  Dr.  Klein's  treatise, 
in  its  present  form,  is  better  suited  to  the  wants  of  the  private 
student  than  to  those  of  a  mixed  class ;  it  contains,  however,  a 
mass  of  exceedingly  valuable  material  which  might  easily  be 
modelled,  by  a  practised  teacher,  into  a  thoroughly  workable 
scheme. 


VI. — Diet  in  Health  and  Disease.^ 

What  to  eat,  drink,  and  avoid,  is  a  branch  of  knowledge  of 
no  mean  importance  to  our  bodily  and  mental  welfare.  It  is 
one,  indeed,  more  or  less  cultivated,  and  yet  most  grievously 
neglected,  by  mortals  generally.  It  is  a  constant  subject  of 
conversation  and  a  matter  upon  which  every  individual  considers 
himself  more  or  less  an  authority,  and  upon  which  also  he  is 
most  ready  to  give  instruction  to  others.  It  is,  moreover,  a 
subject  whereon  each  individual  is  apt  to  regard  himself  as  the 
best  judge  relatively  to  himself,  and  yet  is  one  about  which  the 
self-taught  and  self-satisfied  individual  is  most  prone  to  make  a 
mistake,  or  to  meddle  with  to  his  own  detriment.  Lastly,  it  is  a 
branch  of  knowledge  on  which  many  books  have  been  written ; 
some  of  these  have  rather  darkened  knowledge,  whilst  others 
have  embarrassed  their  readers  by  overmuch  philosophy,borrowed 
from  the  chemist  and  physiologist,  or  have  harassed  them  by 
one-sided  theories  of  nutrition  and  impracticable  rules  of  diet. 

Nothing  can  be  more  foolish,  and  too  often  mischievous  also, 
than  the  conceits  and  notions  respecting  diet  prevailing  among 
the  public.  Doctors  are  ever  at  work  correcting  those  notions 
and  counteracting  their  consequences,  but  their  labour  is  too 
much  like  that  of  Sisyphus.  There  is  a  downward  gravitation 
to  folly  and  self-indulgence  frustrating  all  their  efforts.  Their 
disciples  are  often  prejudiced,  and  oftener  unwilling,  learners. 
They  have  to  encounter  a  giant  enemy  to  their  dietetic  rules  in 
the  shape  of  idiosyncrasy,  a  shadowy  form,  in  truth,  in  many 
instances,  but  sufficiently  formidable  to  effect  their  frequent 
discomfiture.  And  what  is  more  inimical  to  their  efforts,  the 
doctors  are  much  divided  among  themselves ;  they  have  favourite 

^  A  Manual  of  Diet  in  Sealth  and  Disease.  By  Thomas  King  Chambees, 
M.D.,  &c.     London,  1875. 


840  Reviews.  [Oct., 

crotchets,  pet  axioms,  phantom  fears ;  they  follow  fashion,  or 
court  singularity  by  opposing  it;  they  lend  themselves  to 
extravagant  doctrines  and  swear  by  stimulants  or  by  teeto- 
talism. 

These  remarks  would  seem  tantamount  to  saying  that  the 
principles  of  dietetics  imbibed  by  medical  men  are  uncertain 
and  without  influence  among  them.  In  some  degree  this  may 
be  true,  but  it  is  not  the  whole  truth.  There  are  principles, 
based  on  well-determined  truths  in  chemistry  and  physiology, 
and  held  in  common  by  all  instructed  medical  men ;  but  there 
is  likewise  a  mass  of  knowledge  concerning  food  and  drinks 
never  systematically  placed  before  medical  men  during  their 
career  as  students.  They  pick  up  incidentally,  here  and  there, 
maxims  of  living,  as  chance  directs^  wholesome  or  vapid,  which 
cleave  to  them  as  long  as  they  practise,  with  small  modification. 
They  adopt  the  current  opinions  of  their  time  with  reference  to 
most  points,  and  they  find  it  hard  to  decide,  particularly  when 
called  on  to  determine  the  dietary  of  disease,  between  the 
doctrines  held  by  rival  teachers. 

It  is  with  regard  to  the  '*  dietetics  of  sickness  "  that  concur- 
rence of  medical  opinion  is  most  called  for,  as  well  in  the 
interests  of  the  profession  as  of  the  public.  It  is  a  matter  upon 
which  the  public  look  for  general  agreement ;  and  it  is,  more- 
over, one  regarding  which  we  ought  to  be  enabled  to  arrive  at 
definite  and  established  principles,  inasmuch  as  it  falls  within 
the  limits  of  experimental  science.  Unfortunately,  however, 
experiment  is  little  resorted  to  with  regard  to  diet  compared  with 
-what  it  is  with  reference  to  drugs,  although  diet  is  frequently 
as  important  as  the  latter.  Whilst  this  great  question  is,  there- 
fore, undecided  among  the  doctors,  to  whose  particular  pro- 
vince it  appertains,  no  marvel  is  it  to  find  a  host  of  contradictory 
notions  prevalent  among  their  clients. 

Agreeing  as  we  do  with  Dr.  Chambers  that  man  is  an  omni- 
vorous animal,  small  astonishment  need  be  expressed  at  the 
diversities  of  opinion  among  mankind  respecting  the  whole- 
someness  of  various  sorts  of  food.  The  normal  people  are  those 
who  know  not  they  have  stomachs  ;  when  the  discovery  is  made 
much  of  their  happiness  is  lost,  and  the  question  of  diet  crops 
up  for  solution,  and  their  eyes  are  opened  to  the  difference 
between  good  and  bad.  These  normal  people  would  abound  on 
the  earth,  were  not  the  conditions  of  healthy  animal  existence 
deranged  and  overturned  by  the  habits,  the  fashions,  and  the 
exigencies  of  civilised  life.  From  these  the  ills  of  the  stomach 
originate,  and  each  conscious  possessor  of  that  organ  has  ever 
before  him  the  problem  of  what  to  eat,  drink,  and  avoid,  and 
among  the  multitude  of  edibles  before  him  each  man  in  the  exer- 


1875.] 


Chambers  on  Diet  in  Health  and  Disease.  3  11 


cise  of  free  choice,  though  hampered  by  prejudices  and  fashion, 
selects  those  most  pleasing  to  him,  and  which,  too,  he  is  prone 
to  regard  as  also  superior  in  digestibility  and  nutritive  qualities 
to  those  approved  by  his  neighbour. 

It  is  well  when  he  is  content  with  the  contemplation  of 
his  own  discernment  and  does  not  wish  to  enforce  his  dietary 
upon  his  neighbour.  It  is  well  when  charity  aboundeth  between 
him  who  eateth  herbs  and  him  who  eateth  meat,  between  the 
drinker  of  wine  and  the  abstainer  from  it.  Unhappily,  as  daily 
observation  exhibits,  such  charity  is  largely  displaced  by  intole- 
rance, whilst  liberty  is  denounced  and  its  destruction  demanded. 

Any  book  that  can  correct  popular  misapprehensions  about 
diet,  that  can  set  forth  in  plain  language  the  accepted  principles 
of  dietetics,  and  expand  our  notions  with  reference  to  them  and 
their  application,  and  that  can  withal  do  this  from  a  liberal 
point  of  view,  untrammeled  by  party  cries,  and  can  for  its 
groundwork  appeal  to  ample  experience  and  observation,  is  one 
that  must  be  welcome  to  the  masses  to  whom  we  have  referred 
as  so  much  in  need  of  instruction.  We  have  carefully  examined 
the  treatise  before  us,  and  can  confidently  recommend  it  as  a  book 
of  the  sort. 

The  author.  Dr.  King  Chambers,  is  well  known  to  the  pro- 
fession by  previous  publications  of  great  value,  particularly  by 
their  truly  practical  character.  His  volume  of  clinical  lectures 
admirably  illustrates  the  cogency  and  clearness  both  of  his 
teaching  and  of  his  literary  style.  And  the  subject  of  his 
present  book  is  one  by  no  means  newly  taken  in  hand.  In  the 
volume  of  lectures  already  referred  to,  the  dietetics  of  sickness 
occupied  no  mean  space ;  whilst  in  his  treatise  on  "  the  Indi- 
gestions "  diet,  as  a  matter  of  course,  constituted  a  special  topic 
for  consideration.  We  may  consequently  say  that  the  subject 
of  diet  is  one  he  has  peculiarly  made  his  own,  and  the  profession 
will  on  this  account,  even  apart  from  his  known  high  position 
as  a  metropolitan  hospital  physician  and  teacher,  receive  with 
much  confidence  this  his  latest  production,  'A  Manual  of  Diet 
in  Health  and  Disease.' 

But  itis  time  to  give  some  particulars  of  the  contents  of  thebook, 
although  we  do  not  propose  to  review  them  at  great  length:  not 
but  that  he  has  supplied  material  available  for  the  exercise  of  the 
critic's  art,  particularly  in  doctrines  and  statements  respecting 
matters  somewhat  outside  the  subject,  to  discuss  which,  however, 
we  do  not  esteem  it  our  present  business.  For  instance,  we 
cannot  concur  in  all  the  opinions  conveyed  in  his  chapter  on 
"noxious  trades,"  or  in  that  on  *' athletic  training."  We  are 
not  so  impressed  with  the  demonstration  of  the  harmlessness  of 
boat-racing  attempted  by  Dr,  Morgan,  as  Dr.  Chamber?  appears 


342  Reviews.  [Oct., 

to  be ;  nor  can  we  accept  it  as  sound  general  doctrine  that  there 
is  no  actual  increase  of  muscular  tissue  in  a  limb  actively  used, 
or,  to  use  the  author's  words,  "  that  they  [the  muscles]  become 
larger  is  extremely  problematical ;"  nor  admit  "  that,  if  muscles 
did  by  training  grow  bigger,  as  reckoned  in  a  state  of  repose,  it 
were  a  result  not  at  all  to  be  desired  ;"  nor,  again,  the  assertion 
that  hypertrophied  muscular  organs  lose  their  shape  and  power ; 
for  the  examples  he  quotes  in  illustration  of  it  are  taken  from 
morbid  states,,  and  will  not  on  examination  bear  out  the  dictum. 

As  just  now  remarked,  such  matters  are  somewhat  outside  the 
special  subject  of  his  treatise,  and  a  captious  critic  could  point 
to  many  paragraphs  in  respect  of  which  exception  might  be 
taken  as  not  sufficiently  cognate  with  the  subject-matter  in  hand. 
In  short,  the  teacher  of  the  practice  of  medicine  and  of  pathology 
is  here  and  there  too  prominent.  His  utterances  are  good,  but 
do  not  truly  belong  to  the  subject  of  diet. 

The  work  is  divided  into  three  parts — general  dietetics, 
special  dietetics  of  health,  and  dietetics  in  sickness.  The 
first  includes  chapters  on  the  theories  of  dietetics,  on  the 
choice  of  food,  on  the  preparation  of  food,  on  digestion,  and 
on  nutrition.  The  chapter  on  the  theories  of  dietetics  is 
marked  by  much  moderation  in  chemical  and  physiological 
detail,  yet  withal  conveys  a  large  amount  of  information  re- 
specting the  essential  characters  and  the  purposes  of  food.  This 
moderation  in  detail  will  be  thankfully  accepted  by  most  of  his 
readers,  who,  wanting  to  be  instructed  in  dietetics,  do  not  require 
a  dissertation  on  the  anatomy  and  physiology  of  the  stomach, 
or  on  the  chemistry  of  food  in  general.  For,  so  far  as  medical 
men  are  concerned, — and  to  them  such  works  as  the  one  under 
notice  are  especially  addressed, — it  may  be  assumed  that 
they  possess  a  fair  knowledge  of  the  stomach  and  its  functions, 
and  of  the  chemistry  of  articles  of  diet  in  common  use.  Yet 
what  is  more  common  in  medical  literature  than  to  find  in 
special  treatises,  preliminary  disquisitions  on  the  anatomy  and 
physiology  of  the  organ  or  organs  treated  of  pathologically  ?  as 
though  their  medical  readers  had  for  the  first  time  to  be  in- 
structed in  those  matters.  Such  dissertations  belong  to  the  sort 
of  literary  lumber  called  "  padding  ;'^  they  are  a  nuisance  to  the 
reader  seeking  for  enlightenment  on  questions  important  to  him 
as  a  practitioner,  and  professional  opinion  should  be  pronounced 
against  the  practice  of  introducing  them. 

Treating  on  the  ^'  choice  of  food/'  Dr.  Chambers  notices 
seriatim  the  principal  articles  of  consumption,  including  wines, 
making  excellent  practical  remarks  on  their  value  as  food,  on 
their  character  when  wholesome  and  genuine,  and  on  the  adul- 
terations practised  with  regard  to  them.      He  discourses  on  the 


i 


1875.]         Chambers  on  Diet  in  Health  and  Disease,  343 

ocular  and  tactile  qualities  of  flesh,  fish,  and  fowl  like  a  well- 
instiucted  housekeeper,  imparting  lessons  which  it  would  be 
well  that  every  housekeeper  might  obtain. 

Wines  he  reduces  to  seven  classes,  viz. — 1,  strong  dry  wines; 
2,  strong  sweet  wines ;  3,  aromatic  wines ;  4,  acid  wines ; 
5,  sparkling  wines ;  6,  perfect  wines;  and  7,  rough  wines.  Of 
these  several  sorts  the  reader  will  like  best  to  know  what  are 
"  perfect  wines."     These  are  defined  to  be — 

'*  such  as  possess  the  virtues  derived  from,  the  presence  of  alcohol, 
of  water,  of  sugar,  of  etherial  flavours,  of  fruity  extractive,  and  of  acids, 
without  any  of  them  being  so  predominant  as  to  mask  the  others,  or  to 
require  artificial  additions  for  the  preservation  of  soundness  and 
flavour." 

The  example  of  such  perfection  is  found  in  "  claret" — not,  in- 
deed, in  the  fine-named  varieties,  such  as  Chateau  Lafitte  or 
Chateau  Latour,  but  in  the  unnamed  sorts  known  in  the  wine 
trade  as  "  first,  second,,  and  third  quality  clarets  " — the  genuine 
fermented  juice  of  the  grape  without  admixture  for  the  sake  of 
special  flavours,  or,  what  is  more  objectionable,  for  the  purpose 
of  fortifying  with  spirit  what  is  damaged  or  imperfect  of  its  kind. 

"  Against  the  adulteration  of  claret  [he  adds]  which  does  not  pre- 
tend to  be  anything  else  than*  first,'  '  second,'  or  *  third  '  quality,  we  have 
the  valuable  safeguard  of  the  enormous  quantity  that  is  made,  and  the 
small  profits  which  could  be  got  out  of  the  labour  and  risk  of  adulte- 
rating it." 

Much  truth  undoubtedly  exists  in  these  remarks.  They  con- 
vey a  wholesome  lesson  to  the  buyers  of  the  fine-named  wines  so 
forcibly  and  persistently  pressed  upon  us  by  interested  adver- 
tising dealers,  who  seem  of  late  years  to  have  multiplied  like 
locusts,  and  are  well-nigh  as  unmitigated  plagues.  At  the 
same  time  we  should  not  entertain  an  equal  feeling  of  security 
with  Dr.  Chambers  against  adulteration,  if  content  to  purchase 
nameless  clarets  on  the  ground  that  adulteration  of  such  would 
not  pay,  for  both  in  the  country  of  their  growth  as  well  as  in 
England  it  has  been  our  lot  to  meet  with  vile  stuff  sold  as 
claret  without  name,  and  beyond  question  sophisticated  in  no 
slight  degree. 

The  author  proceeds  to  observe  that  "  the  common  Burgun- 
dies and  the  red  Rhine  wines  run  our  claret  very  hard  in  the 
race  for  perfection ;  they  err  in  containing  too  much  fruity  ex- 
tractive, which,  except  the  wine  happens  to  be  very  strong  in 
alcohol,  causes  decomposition."  Beaujolais  when  good  receives 
commendation,  but  the  Hungarian  wines  are  "  damned  with 
faint  praise." 

"  On  the  preparation  of  food  "  the  information  conveyed  has 


34 1<  Reviews.  [Oct., 

the  same  practical  and  precise  character  as  that  respecting  the 
choice  of  food.  Dr.  Chambers  discourses  on  cookery  with 
the  air  of  a  professor ;  likewise,  when  we  reach  the  following 
chapter  on  digestion  his  teachings  lose  little  of  that  decided 
and  unhesitating  or  dogmatic  character  with  which  the  previous 
pages  of  his  treatise  have  made  us  familiar.  This  feature  we 
notice,  though  not  as  a  fault.  On  the  contrary,  it  is  a  merit 
in  a  teacher  who  has  got  distinct  opinions,  based  on  study  and 
experience,  to  offer,  and  a  fortunate  circumstance  for  his  pupils. 
It  is  for  the  latter  to  sit  at  the  feet  of  their  master,  to  receive, 
but  presently  to  "  prove  all  things  and  hold  fast  that  which  is 
good." 

Opinion  has  differed,  and  even  still  differs,  respecting  the 
desirability  of  an  after-dinner  nap.  It  is  a  matter,  however,  on 
which  the  author  has  made  up  his  mind.  Instinct,  he  admits, 
tells  us  to  take  rest  after  meals,  but  the  rest  must  not  be  in 
excess,  and  '^  sleep,  for  example,  after  dinner  retards  digestion, 
and  allows  the  distended  stomach  to  act  injuriously  on  the  cir- 
culation of  the  brain.  It  is  proper  only  for  very  aged  persons 
or  invalids."  For  though  instinct  prescribes  rest.  Dr.  Chambers 
would  not  have  us  take  for  example  "  dogs  and  other  carnivorous 
animals  who  betake  themselves  to  sleep  after  a  repast ;"  because, 
in  his  view,  this  instinct  is  a  vicious  one  consequent  on  the  bad 
habit  such  animals  are  apt  to  follow  of  unduly  gorging  them- 
selves with  food,  especially  when  living  in  a  wild  state.  For, 
as  he  further  asserts,  ''  dogs  which  live  in  the  company  of  men, 
and  feed  on  the  mixed  and  cooked  diet  of  their  masters,  usually 
give  up  the  practice  of  sleeping  after  their  meals  along  with 
their  gluttony,"  and,  as  a  reward  of  merit,  suffer  less  from 
indigestion  than  their  wild  companions. 

This  teaching  is  admirably  distinct  and  decided ;  but,  we  con- 
sider, it  is  to  be  received  with  modifications  and  exceptions. 
The  old  argument  by  analogy  from  the  lower  animals  does  not, 
we  conceive,  lose  much  of  the  validity  it  has  been  thought  to 
possess  by  the  objections  urged  against  it;  nor  can  the  physio- 
logical arguments  used  against  sleep  be  accepted  in  their 
entirety,  or  as  so  universally  true  as  Dr.  Chambers  would  have 
us  believe.  It  may  be  difficult  to  prove,  as  the  author  remarks, 
that  the  wdld  animals  who  sleep  after  a  feast  have  their  lives 
prolonged  thereby,  but  the  proof  that  they  are  the  worse  for  the 
sleep  is  equally  not  forthcoming.  People  wdio  sleep  after  food  are 
not  in  the  habit  of  so  doing  except  after  their  principal  meal ;  and 
when  that  meal  has  been  duly  earned  by  labour,  it  will  need 
some  distinct  evidence,  something  more  than  general  physio- 
logical dicta,  to  convince  us  that  a  short  siesta  is  detrimental  to 
health,     We  have  in  view,  not  the  lethq,rgic  sleep  of  pampered 


I 


75.]         Chambers  on  Diet  in  Itealth  and  Disease,  345 

and  lazy  people,  but   the   apparently  instinctive   sleep  of  the 
labourer  when  time  and  opportunity  are  afforded  him. 

Part  II  of  the  volume  is  devoted  to  the  *^  Special  Dietetics  of 
Health,"  and  the  instruction  it  contains  is  marked  by  the  same 
good  sense  as  other  portions.  It  is  also  interspersed  with 
incidental  literary  remarks  and  allusions,  as  elsewhere  met  with 
throughout  the  treatise,  which  render  its  perusal  a  pleasure  as 
well  as  a  profit.  But  there  is  little  to  detain  us  in  its  several 
chapters  until  we  reach  the  last,  viz.  that  on  alcohol.  To  this 
article  of  diet  and  medicine  Dr.  Chambers  has  given  very  full 
consideration,  and  his  observations  on  this  ^inflammatory'  matter 
are  distinguished  by  moderation  and  judgment.  In  his  chapter 
on  the  dietetics  of  literary  life  he  has  well  summarised  the  pro- 
perties of  alcohol  as  a  restorative,  when  taken  with  food,  of 
nerve-power. 

"  The  physiology  of  the  action  of  alcohol  [he  writes]  has  a  very 
practical  bearing  on  the  physical  regimen  of  the  mental  functions. 
Alcohol  has  the  power  of  curbing,  arresting,  and  suspending  all  the 
phenomena  connected  with  the  nervous  system.  We  feel  its  influence 
on  our  thoughts  as  soon  as  on  any  other  part  of  the  man.  Sometimes 
it  brings  them  more  completely  under  our  command,  controls  and 
steadies  them  ;  sometimes  it  confuses  and  disconcerts  them,  thea 
breaks  off  our  power  and  the  action  of  the  senses  altogether.  The  first 
effect  is  desirable,  the  others  to  be  avoided.  When  a  man  has  tired 
himself  with  intellectual  exertion,  a  moderate  quantity  of  alcohol  taken 
with  food  acts  as  an  anaesthetic,  stays  the  wear  of  the  system  wliich  is 
going  on,  and  allows  the  nervous  force  to  be  diverted  to  the  due  diges- 
tion of  the  meal.  But  it  must  be  followed  by  rest  from  mental  labour, 
and  is,  in  fact,  a  part  of  the  same  regimen  which  enforces  rest — it  is  an 
artificial  rest.  To  continue  to  labour  and  at  the  same  time  to  take  the 
anaesthetic  is  an  inconsistency.  It  merely  blunts  the  painful  feeling 
of  weariness,  and  prevents  it  from  acting  as  a  warning." 

The  popular  notion,  fostered  by  many  a  bacchanalian  song, 
that  wit  and  humour  are  evoked  by  alcoholic  drinks,  receives 
no  encouragement  from  Dr.  Chambers.  "  An  abstainer  [he 
says]  in  a  party  of  even  moderate  topers  finds  their  jokes  dull 
and  their  anecdotes  pointless,  and  his  principal  amusement  con- 
sists in  his  observation  of  their  curious  bluntness  to  the  absur- 
dity of  their  merriment."  But  so  far  as  this  statement  is  worth 
anything,  the  topers  might  find  another  interpretation,  and 
assert  that  the  abstainer's  wits  are  too  dull  to  understand  or 
appreciate  their  jokes  and  anecdotes,  and  need  to  be  sharpened 
by  good  liquor.  However  this  may  be,  we  are  not  disposed  to 
subscribe  to  the  general  denial  of  the  quickening  or  brightening 
influence  of  alcohol  on  the  mental  powers.  Observation  both 
in  olden  and  modern  times  is  opposed  to  it. 


346  Reviews.  [Oct., 

To  turn,  however,  to  the  special  chapter  on  alcohol  (one  of 
the  longest  in  the  book),  we  find  Dr.  Chambers  in  the  character 
of  an  original  experimenter  on  the  physical  effects  of  that  sub- 
stance. His  first  experiment  was  made  on  a  healthy  man, 
from  three  to  six  ounces  of  brandy  being  given  daily  in  portions 
with  the  four  meals;  the  second,  made  on  the  same  indivi- 
dual, consisted  in  giving  six  ounces  in  doses  of  half  an  ounce 
every  hour ;  the  third  was  carried  out  on  a  man  used  to  more 
full  living  than  the  previous  one,  the  brandy  being  an  addi- 
tion to  his  usual  allowance  of  stimulants  in  the  shape  of  from 
five  to  seven  glasses  of  port  or  sherry.  To  these  experi- 
ments is  appended  an  observation  made  in  the  case  of  a  young 
woman  who  had  fallen  into  liabits  of  excess.  The  conclusions 
gathered  from  the  first  experiment  were,  that  alcohol  is  not  a 
diuretic,  but  that  it  increases  the  formation  of  urea,  and  con- 
sequently provokes  a  more  active  destructive  assimilation  and 
a  more  active  reconstruction  of  the  nitrogenous  elements  of  the 
tissues,  and  that  accompanying  this  interstitial  growth  is  a 
temporary  rise  of  the  digestive  powers  of  the  stomach ;  further, 
that  the  excretion  of  phosphorus  is  decreased,  a  circumstance 
arguing  diminished  chemical  changes  in  the  brain  and  nerves, 
with  consequent  lessened  and  blunted  function,  and  lessened 
general  vitality,  as  exhibited  by  decreased  ability  to  generate 
heat. 

Where  food,  he  argues,  is  keenly  enjoyed  without  recourse  to 
stimulants,  "their  consumption  is  certainly  useless,  and  possibly 
injurious.  So  long  as  alcohol,  in  the  indirect  mode  mentioned, 
augments  vital  metamorphosis,  it  ministers  to  the  force  of  the 
body.  But  it  is  not  a  source  of  force,  and  its  direct  action  is 
an  arrest  of  vitality."  On  the  other  hand,  where  the  intellec- 
tual or  muscular  energy  is  borne  down  by  pressure  of  work, 
there  a  fair  ration  of  beer  or  wine  at  their  evening  meal  is  of 
material  service.  Most  wisely  and  energetically  does  Dr. 
Chambers  warn  his  readers  against  the  drinking  of  spirituous 
liquors  in  the  morning,  and  equally  wisely  and  well  docs  he 
pronounce  against  taking  stimulants  between  meals. 

His  second  experiment  comes  in  support  of  these  protests, 
by  proving  that  alcohol,  in  small  divided  doses  and  between 
meals,  "  deranges  the  metamorphosis  of  the  tissues,  and  in  the 
direction  of  arrest ;  and  persistence  in  the  habit  must  lead  in 
the  end  to  permanently  diminished  organisation,  degeneration, 
atrophy." 

It  were  well  could  these  doctrines  be  instilled  into  the  rising 
generation  of  our  commercial  towns.     We  are  pained  to  see  , 
our  young  men  resorting  to  luncheon  bars  and   taverns  at  all  j 
hours  of  the  dav  between  meals,  to  drink  a  glass  of  bitter  beer. 


1875.]         Chambers  on  Diet  in  Health  and  Disease,  ^4^ 

or,  not  unfrequently,  some  liqueur.  It  is  a  growing  vice,  fruit- 
ful of  evil,  physical  and  moral — one  that  has  been  much 
encouraged  by  the  comparatively  modern  institution,  the 
"  luncheon  bar." 

Towards  the  close  of  the  chapter  the  author  sums  up,  under 
thirteen  heads,  his  conclusions  relative  to  the  influence  of 
alcohol  upon  a  healthy  man,  and  deduces  therefrom  four  rules 
and  many  corollaries  as  to  the  virtues  and  uses  of  that  agent. 
We  should  be  pleased  to  reproduce  them  here,  but  they  are  too 
long  to  be  transferred  to  our  waning  space. 

He  looks  for  reformation  in  the  abuse  of  alcoholic  drinks 
to  the  habits  and  silent  pressure  of  amended  social  life.  Pro- 
gressive improvement  in  our  habits  and  customs  must,  he  affirms, 
avail  more  than  all  repressive  legislation  ;  and  to  forward  such 
improvement  he  holds  to  be  a  special  duty  of  medical  men. 
Special  legislation  in  behalf  of  dipsomaniacs  receives  small  en- 
couragement. 

"  There  is  [says  Dr.  Chambers]  a  difficulty  in  sending  a  drunkard 
to  an  asylum,  but  he  is  easily  sent  to  '  Coventry '  and  made  to  feel  a 
degraded  animal.  There  may  possibly  be  some  rare  cases  to  be  found 
of  true  '  dipsomania,'  where,  without  any  other  mental  disease,  the 
patients  are  carried  off  by  an  uncontrollable  impulse  to  drink ;  but 
they  certainly  are  very  rare  indeed,  and  every  alleged  instance  that  I 
have  investigated  has  always  exhibited  also  some  other  form  of  in- 
sanity sufficient  to  justify  the  imposition  of  restraint,  or  else  proved 
to  be  using  the  cant  of  the  day  as  an  excuse  for  self-indulgence.  The 
exceptional  cases  may  be  separately  dealt  with  when  they  occur; 
but  as  a  rule  I  think  it  better  to  give  men  the  education  of  being 
their  own  gaolers  than  to  let  them  lean  on  the  weak  crutch  of  State 
inebriate  asylums." 

The  third  and  last  part  of  the  book  is  occupied  with  ''Diete- 
tics in  Sickness  ;" —  including  acute  fevers,  inflammatory  states, 
weak  digestion,  gout  and  rheumatism,  gravel,  stone,  diabetes 
and  albuminuria,  deficient  evacuation,  nerve  disorders,  scrofula, 
rickets  and  consumption,  and  disease  of  heart  and  arteries. 
To  the  medical  man  this  section  of  the  treatise  will  possess  a 
special  interest ;  it  exhibits  within  a  very  brief  compass  the 
lessons  gathered  from  a  very  long  and  large  experience. 
However,  as  much  of  the  teaching  has  heretofore  appeared  in 
other  works  of  the  same  author  with  which  the  profession  is 
familiar,  it  is  not  here  necessary  to  produce  it.  It  is,  in  our 
opinion, very  sound  and  safe  teaching — curt,  decisive,  and  easily 
remembered,  and  presented  in  a  clear  and  engaging  manner. 
A  companion  portion  is  attached  to  several  chapters,  setting 
forth  "  recipes  "  for  various  articles  of  diet  suitable  to  the  sick, 
and  some  useful  supplementary  information  is  supplied  with 


348  neviews.  [Oct., 

regard  to  change  of  climate,  particularly  in  the  case  of  gout 
and  rheumatism. 

From  the  preceding  remarks  a  fair  notion  may  be  gained  of 
the  matter  and  manner  of  this  most  recent  EngUsh  book  on 
diet.  A  review  of  the  whole  work  justifies  us  in  strongly 
commending  its  perusal  to  all  our  readers. 


VII. — Microscopic  Organisms  in  Health  and  Disease.^ 

The  series  of  memoirs  whose  titles  we  have  enumerated 
below  are  all  the  fruit  of  the  well-directed  energies  of  the 
Sanitary  Commission  of  the  Government  of  India,  and  reflect 
as  much  credit  on  that  organization,  as  do  the  valuable  researches 
issued  under  Mr.  Simon's  direction,  on  our  own  Privy  Council 
Medical  Department.  The  subjects  have  been  well  selected, 
the  researches  ingenious  and  exhaustive ;  and  success,  which 
does  not  always  wait  upon  experiment,  has  crowned  the  labours 
of  the  indefatigable  investigators. 

The  inquiries  with  which  we  are  now  concerned  have,  in 
spite  of  their  variety,  a  certain  unity  of  aim,  being  all  directed 
to  investigate  the  influence  of  organized  beings,  animal  or 
vegetable,  on  human  life ;  and,  as  regards  the  vegetable  organ- 
isms, with  a  special  view  to  detect  any  influence  of  such  organ- 
isms on  cholera.  It  may  not  be  superfluous  to  point  out  that 
Drs.  Lewis  and  Cunningham  are  peculiarly  fitted  to  pass  a 
judgment  on  these  points,  since,  besides  their  medical  and  biologi- 
cal training,  they  have  worked  under  the  great  fungologist,  De 
Bary,  with  the  special  object  of  becoming  acquainted  with 
microscopic  vegetation.  We  may,  therefore,  conclude  that  they 
know,  as  far  as  may  be  known,  what  is  and  what  is  not  a 
vegetable  organism,  which  could  hardly  be  asserted  of  all  inves- 
tigators who  have  attacked  this  diflicult  theme. 

Their  researches  fall  under  three  heads,  which  we  will 
consider  separately: — 1.  The  microscopic  examination  of  air. 

^  1.  Microscopic  Examinations  of  Air.  By  P.  Douglas  Cunningham,  M.B., 
attached  to  Sanitary  Commissioner  with  Government  of  India.     (Not  dated.) 

2.  Report  of  Microscopical  and  Physiological  Researches  into  the  Nature  of 
the  Agent  or  Agents  producing  Cholera.  By  T.  E..  Lewis,  M.B.,  and  P.  D. 
Cunningham,  jM.B.     Calcutta,  1872. 

3.  Report  on  Cholera.  (Second  Series.)    By  the  same  authors.    Calcutta,  1874. 

4.  On  a  Rcematozoon  inhabiting  Human  Blood,  and  its  Relatioti  to  Chyluria 
and  other  Diseases.  By  T.  R.  Lewis,  M.B.,  Assistant- SurgeoH,  attached  to  Sani- 
tary Commissioner  with  Government  of  India.     Calcutta,  1872. 

5.  The  Pathological  Significance  of  Nematode  Hcematozoa.  By  T.  R.  Lewis, 
M.B.     Calcutta,  1874. 


18^5.]     Microscopic  Organisms  in  Health  and  Disease.      349 

2.  Direct  investigations  on  cholera.     3.  Researches  on  entozoa, 
which  are  not  immediately  connected  with  the  other  topics. 

I. — Microscopic  Examination  of  Air. 

Dr.  Cunningham  has  contributed  some  important  observations 
on  atmospheric  micrography,  as  it  may  be  called,  which  are  of 
importance,  negatively,  in  the  question  as  to  the  presence  of 
germs  of  disease  in  the  air.  He  first  gives  a  review  of  the  lite- 
rature of  the  subject,  which  is  very  full  and  careful.  The 
results  of  previous  observers  are  characterized  with  justice  as 
extremely  contradictory,  some  affirming,  others  denying,  the 
presence  of  organized  bodies  or  their  germs  in  the  atmosphere. 
But,  as  it  seems  to  us,  the  preponderance  of  number  and 
authority  is  on  the  side  of  those  observers  who  have  found  in 
very  many  cases  the  germs  of  fungi  in  dust  or  suspended  in  the 
atmosphere. 

Dr.  Cunningham's  observations  were  made  with  the  view  of 
determining,  if  possible,  whether  there  were  any  connection 
traceable  between  the  prevalence  of  special  bodies  in  the  atmo- 
sphere and  the  occurrence  of  particular  forms  of  disease.  With 
this  object  the  air  of  two  large  jails  at  Calcutta  was  examined 
on  fifty-nine  occasions  by  an  apparatus  used  by  Dr.  Maddox  in 
similar  experiments,  consisting  of  a  sort  of  funnel,  the  open  end 
of  which  was  kept  always  exposed  to  the  prevailing  current  of 
wind,  by  freely  rotating  on  a  spindle,  and  having  a  broad  vane 
at  the  other  end.  The  current  of  air  was  made  to  impinge  upon 
a  cover-glass  smeared  with  glycerine,  by  which  all  dust  was 
retained.  The  glass  was  allowed  to  remain  for  twenty-four 
hours,  and  then  transferred  to  the  stage  of  the  microscope.  The 
apparatus  was  placed  about  five  feet  from  the  ground  on  an 
open  space  of  grass. 

The  solid  matters  thus  collected  aie  classified  as  follows  : 

1.  Particles  of  siliceous  matter. 

2.  Particles  of  carbonaceous  matter. 

o.  Fragments  of  hair  and  other  animal  substances. 

4.  Fragments  of  cellular  tissue  of  plants.  Starch-corpuscles 
nearly  always. 

5.  Pollen-grains,  amongst  which  those  of  several  common 
grasses  could  be  easily  recognised,  and  a  few  belonging  to  plants 
of  other  natural  orders. 

6.  Alga?,  but  not  in  great  numbers.  Among  these  were  frag- 
ments of  Oscillatorise,  Desmidiacese,  &c.,  with  some  lower 
genera. 

7.  Sporidia  of  lichens  were  frequent. 

8.  Spores  and  sporidia  of  fungi,  often  at  once  referable  to 
their  proper  genera,  formed,  in  fact,  by  far  the  greater  part  of 

112.— LYI.  23 


350  Ueviews.  [Oct., 

the  bodies  found.  The  most  common  forms  were  sporidia  of 
Sphceriacea,  frequently  in  a  state  of  germination,  but  names  of 
numerous  other  families  are  given  by  Dr.  Cunningham.  He 
does  not  himself  venture  to  affix  generic  names  i  but  this  has 
been  done  to  a  considerable  extent  by  the  Rev.  J.  M.  Berkeley, 
in  an  article  in  the  '  Quarterly  Journal  of  Microscopical  Science' 
for  April,  1874,  which  we  have  made  use  of  in  estimating  the 
value  of  Dr.  Cunningham's  researches.  The  judgment  of  this 
eminent  botanist  must  be  regarded  as  decisive  of  the  true  nature 
of  the  organisms.  He  observes  that  the  extraordinary  quantity 
of  fungus-spores  carried  about  by  the  air  is  very  remarkable,  and 
refers  to  the  observations  of  Ehrenberg  on  the  existence  of 
fungus-spores  in  the  dust  of  the  trade-winds,  thousands  of  miles 
from  land  (Ehrenberg,  however,  found  in  ordinary  dust  vegetable 
much  less  numerous  than  animal  organisms,  such  as  infusoria). 
Such  observations  obviously  supply  a  perfectly  adequate  expla- 
nation of  the  apparently  spontaneous  growth  of  fungi  when 
moisture  and  other  circumstances  are  favorable. 

Some  miscellaneous  observations,  in  addition  to  this  regular 
series,  remain  to  be  considered.  A  certain  number  of  specimens 
were  collected  specially  with  the  view  of  ascertaining  whether 
bodies  definitely  recognisable  as  bacteria  occurred  constantly  or 
frequently  in  the  air.  In  these  observations  there  was  a  general 
absence  of  distinct  bacteria,  but,  "  as  is  almost  always  the  case 
in  atmospheric  dust,  a  general  diffusion  of  minute  particles 
resembling  those  included  by  Robin  under  the  term  micro- 
coccus," with  respect  to  which  "  it  is  impossible  to  deny  that 
many  of  them  may  be  of  a  bacterial  nature."  Bacteria  were, 
however,  developed  in  abundance  from  dry  dust,  collected  from 
various  localities,  such  as  the  leaves  of  trees,  even  in  the  hottest 
and  driest  seasons  of  the  year  at  Calcutta,  when  this  was  added 
to  suitable  fluids,  such  as  urine,  though  the  same  fluid  remained 
quite  free  from  bacteria  when  no  dust  was  added.  Similar 
observations  have,  of  course,  been  repeatedly  made. 

With  respect  to  the  composition  of  dust  as  commonly  occur- 
ring in  Calcutta,  one  interesting  point  brought  out  by  numerous 
observations  was  the  almost  entire,  if  not  entire,  absence  of 
infusoria,  their  cysts  or  ova  ;  though  they  have  been  repeatedly 
observed  {e,  g.  by  Ehrenberg)  as  occurring  in  abundance.  Per- 
haps the  scorching  heat  and  dryness  of  th'e  Calcutta  climate 
may  explain  this. 

A  series  of  observations  was  also  made  on  the  organisms  in 
rainwater,  intended  chiefly  to  throw  light  on  the  question  of 
the  existence  and  difl'usion  of  bacteria  in  the  air.  The  result 
was  that  specimens  of  rainwater  in  Calcutta,  collected  with 
every  precaution  to  ensure  their  freedom    from    contact-con- 


1875.]     Microscopic  Organisms  in  Health  and  Disease,      35 1 

tamination,  frequently  show  sooner  or  later  the  presence  of 
spores,  mycelium,  zoospores,  monads,  bacterioid  bodies,  and 
distinct  bacteria.  The  zoospores  are  demonstrably  derived  from 
the  mycelium,  arising  from  common  atmospheric  spores ;  and 
there  is  every  probability  that  the  monads  and  bacteria  have  a 
similar  origin.  Thus,  while  Dr.  Cunningham  expresses  no 
opinion  on  the  question  of  the  ultimate  origin  of  bacteria, 
whether  by  heterogenesis  or  the  contrary,  his  conclusions  are  to 
a  certain  extent  at  variance  with  those  of  Dr.  Burdon  Sander- 
son, who  has  been  led  to  deny  the  transmission  of  bacteria  or 
their  germs  through  the  air.  As  a  rule,  none  of  the  higher 
forms  of  infusoria  were  present,  a  result  as  much  at  variance 
with  the  statements  of  Ehrenberg  as  were  those  of  the  observa- 
tions on  atmospheric  dust. 

A  final  series  of  observations  was  undertaken  on  the  air  of 
sewers,  care  being  taken  that  the  air  should  be  really  within 
and  not  merely  in  the  neighbourhood  of  the  mouths  of  the  drains. 
Comparing  the  solid  particles  found  in  the  air  thus  obtained 
with  those  of  other  localities,  the  principal  points  of  difference 
were — 

"  The  comparatively  small  quantity  of  the  common  coarser  constituents 
of  dust  in  the  form  of  silica,  &c. ;  the  presence  of  oily  matter  in  consider 
able  quantity  in  several  of  the  preparations  ;  the  existence  of  distinct 
bacteria  in  four  out  of  the  eight  specimens  ;  the  constancy  of  the  presence 
of  greenish  cellules,  apparently  the  spores  of  aspergillus ;  and  the 
prominent  feature  imparted  by  the  relative  abundance  of  fine  molecular 
matter." 

The  presence  of  bacteria  is  very  noticeable  and 
"Accords  with  Cohn's  observations  on  their  conveyance  by  watery 
vapour,  and  suggests  that  their  apparent  absence  in  ordinary  atmo- 
pheric  air  is  due,  not  to  their  not  entering  it  in  large  quantities,  but  to 
the  fact  that,  unless  the  amount  of  watery  vapour  present  is  very  great, 
they  lose  their  characteristic  appearance  by  which,  in  default  of  move- 
ment, they  can  alone  be  recognised." 

These  observations  again  conflict  with  the  exclusive  reference 
of  bacteria  to  contact-inoculatioYi  which  Dr.  Burdon  Sanderson 
has  deduced  from  his  experiments. 

Since  the  connection,  if  any,  of  such  atmospheric  germs  with 
disease  was  the  chief  aim  of  the  researches,  statistics  of  the 
prevalence  of  five  special  diseases  were  kept  during  the  period 
that  the  atmospheric  observations  were  made.  The  diseases 
selected  were  diarrhoea,  dysentery,  cholera,  ague,  dengue,  four 
of  which  were  among  the  most  prevalent  forms  of  disease  during 
the  period  of  observation,  though  the  fifth,  cholera,  could 
scarcely  be  said  to  be  prevalent  at  the  time.  The  statistics 
extend  over  not  only  the  day  of  the  microscopic  observations/ 


352  Review^.  [Oct.^ 

but  also  three  days  before  and  three  days  after,  and  the  results 
are  given  in  elaborate  diagrams.  The  only  conclusion  was  that 
no  connection  Avhatever  could  be  traced  between  the  numbers 
of  atmospheric  cells  and  the  prevalence  of  any  of  the  observed 
diseases,  there  being  no  constant  coincidence  either  of  agree- 
ment or  discord.  Nor,  again,  was  the  presence  of  any  special 
form  of  cell  at  all  connected  with  the  prevalence  of  these  dis- 
eases. 

These  conclusions,  though  negative,  must  be  considered  as 
the  most  important  reached  by  Dr.  Cunningham's  researches. 
They  show  that,  whatever  the  physical  contagium  of  epidemic 
diseases  may  be,  it  is  not  among  the  solid  impurities  yet  detected 
in  air,  and  supply  a  much-needed  commentary  on  the  facile 
generalizations  respecting  *'  Dust  and  Disease  "  which  have  been 
made  popular  at  the  Royal  Institution..  The  motto  of  Dr. 
Cunningham's  work  would  surely  be  "  Dust  and  no  Disease." 

On  the  other  hand,  very  important  "concomitant  variations" 
are  brought  to  light  on  comparing  the  amount  of  atmospheric 
dust  with  physical  conditions.  So  that  Dr.  Cunningham  is 
able  absolutely  to  state — ► 

"The  amount  of  inorganic  and  amorphous  particles  and  other 
debris  suspended  in  the  atmosphere  is  directly  dependent  on  conditions 
of  moisture  and  of  velocity  of  wind." 

We  should  add  that  the  memoir  is  illustrated  by  fourteen 
well-executed  plates,  containing  a  vast  number  of  figures,  suffi- 
ciently minute  to  enable  a  botanist  like  Mr.  Berkeley  to  recog- 
nise distinct  organic  forms,  and  that  every  page  of  the  report 
is^  to  use  Mr.  Berkeley's  words,  worthy  of  careful  study. 

II. — Reseakches    on    the   Agent    or   Agents   PRODUciNa 

Cholera. 

The  researches  on  cholera,  conducted  by  Dr.  Lewis  and  Dr. 
Cunningham  jointly,  must,  of  course,  be  regarded  as  the  most 
important  of  all,  as  being,  in  fact,  the  pivot  upon  which  the 
others  turn.  We  have  to  notice  two  reports  of  these,  one  dated 
1872,  the  other  1874.  Each  is  divided  into  three  heads,  viz, 
(1)  The  microscopic  examination  of  blood,  (2)  Experiments 
on  the  introduction  of  choleraic  and  other  organic  fluids  into  the 
system,  and  (3)  Experiments  on  the  section  of  the  splanchnic 
and  mesenteric  nerves.  It  will  be  best  to  take  together  the 
observations  under  each  head  contained  in  both  reports. 

1.  Microscopic  examination  of  blood. — The  observations  under 
this  head  are  of  a  very  fundamental  character,  and  do  not  refer 
to  cholera  alone.  The  necessity  of  this  extension  of  the  field  of 
research  is  shown  in  the  following  sentence  : 


1875.]     Microscopic  Organisms  in  Health  and  Disease.     353 

**In  the  instructions  issued  by  the  Army  Sanitary  Commissioners  for 
the  conduct  of  this  inquiry  particular  stress  is  laid  on  the  importance 
of  accepting  no  statement  bearing  on  the  question  of  the  mode  of 
origin  and  diffusion  of  cholera  as  proven,  no  matter  how  distinguished 
the  authority  on  which  it  may  have  been  made,  until  an  opportunity 
occuried  for  verifying  it  for  ourselves.'* 

The  authors  have  frankly  accepted  the  arduous  task  thus  im- 
posed, and  begun  with  the  study  of  the  microscopic  appearances 
of  normal  blood.  Their  methods  of  examination  were  two — 
first,  to  expose  a  small  drop  of  blood  on  glass  to  the  fumes  of  a 
two-per-cent.  solution  of  osmic  acid,  and  then  mount  the  speci- 
men in  a  solution  of  acetate  of  potash ;  secondly,  to  subject 
the  blood  to  continuous  observation  in  wax  cells  for  periods 
varying  from  one  day  to  nearly  three  months,  the  object  of  the 
latter  method  being  to  watch  the  changes  which  a  small  portion 
of  blood  undergoes  when  secluded  from  the  external  atmosphere, 
but  in  presence  of  an  adequate  amount  of  air  and  moisture.  The 
advantage  of  these  continuous  observations  may  not  at  once  be 
obvious  to  all  readers,  but  they  supply,  in  fact,  a  particular 
kind  of  information  which  cannot  be  obtained  in  any  other  way. 
It  is  desirable  to  ascertain  not  only  whether  any  or  what  organic 
particles  may  be  present  in  a  specimen  of  blood,  but  of  what, 
if  of  any,  the  germs  may  be  present.  By  such  observations  it 
has  been  attempted  to  show  the  presence  of  sarcinse  in  normal 
blood,  and  to  establish  the  existence  of  peculiar  corpuscles 
characteristic  of  syphilis,  the  phenomena  being  in  both  cases 
apparent  only  in  blood  which  has  been  carefully  preserved  and 
subject  to  continuous  observation  during  a  certain  time.  The 
same  method  is  adopted  to  show  the  development  in  some 
specimens  of  blood  of  bacteria  not  observed  in  it  when  fresh,  and 
proceeding,  in  all  probability,  from  some  germs  not  visible  or  not 
recognizable  with  our  optical  resources.  Moreover,  the  changes 
which  the  elements  of  the  blood  themselves  undergo  are  subject 
to  variation,  and  have  been  thought  to  be  significant.  The 
results  arrived  at  in  the  first  series  of  observations  have  lost 
some  of  their  importance  in  consequence  of  the  numerous  re- 
searches which  have  been  made  of  late  years  by  other  observers, 
but  the  comparative  observations  made  on  healthy  blood  and  on 
blood  from  cholera  patients  are  interesting  and  valuable. 
Cholera  blood  exhibited  at  first  nothing  abnormal.  The  num- 
ber of  white  corpuscles  at  first  visible  was  small  and  not  note- 
worthy. Coagulation  took  place  in  the  ordinary  manner,  a  ring 
of  clear  serum  being  formed  round  the  contracting  clot ; 

"  But  with  the  formation  of  the  ring  of  clear  serum  a  series  of 
most  remarkable  phenomena  constantly  presented  itself.  Normal- 
sized  white  corpuscles  began  to  migrate  into  the  fluid,  hut  in  additioi} 


354  Reviews,  [Oct., 

to  these,  and  in  far  greater  numbers  and  activity,  were  larger  and  more 
delicate  bioplastic  bodies  ;  cells  they  were  not,  for  they  had  not  at  this 
time  the  faintest  differentiation  of  walls,  contents,  or  nucleus.  They 
were  simply  masses  of  fluid  bioplasm,  so  fluid  and  diluted  as  to  be 
scarcely  distinguishable  by  refraction  from  the  surrounding  medium." 

Gradually  these  masses  became  more  distinct,  and  showed 
both  changes  of  form  and  movements  of  progression.  We  can- 
not follow  their  fortunes  minutely.  Suffice  it  to  say  that,  after 
subdividing  and  breaking  up  into  a  second  generation  of  bio- 
plasts, they  became  motionless,  presenting  the  appearance  of 
aggregations  of  pus-like  cells,  ultimately  either  breaking  down 
into  monad-like  colonies  or  forming  something  more  resembling 
nucleated  cells.  The  active  stage  of  the  bioplasts,  in  sealed 
preparations,  was  not  usually  more  than  twenty-four  hours,  but 
in  the  motionless  condition  they  sometimes  remained  unchanged 
for  many  days.  The  most  important  result  of  these  observa- 
tions on  the  blood  is  undoubtedly  the  explanation  they  are 
capable  of  affording  of  the  bioplastic  bodies  and  cells  so  abund- 
ant in,  and  characteristic  of,  the  evacuations  passed  in  cholera, 
to  which  the  bioplasts  of  the  blood  bear  the  most  marked  re- 
semblance, if  they  are  not  identical  with  them.  The  same 
is  true  of  certain  "  hyaline-cells  "  found  equally  in  the  blood 
and  in  the  evacuations,  which  appear  to  be  modified  bioplasts. 
It  would  seem,  then,  that  the  cellular  elements  found  in  the 
intestinal  discharges  are  derived  from  the  blood,  and  that  in 
both  situations  they  are  modified  elements  of  the  body  itself, 
not  extraneous  organisms.  In  fact,  the  blood  of  cholera  patients 
was  found,  as  an  almost  invariable  rule,  free  from  bacteria  or 
other  foreign  organisms,  either  actual  or  potential — that  is  to 
say,  they  were  neither  present  at  the  moment  of  examination 
nor  seen  to  be  evolved  when  the  specimen  was  subjected  to 
continuous  observation. 

These  phenomena  are  not  (and  the  authors  draw  attention 
to  this  point)  wholly  without  precedent  in  the  case  of  normal 
blood.  In  a  certain  number  of  normal  specimens  examined  in 
the  manner  above  described  amoeboid  corpuscles,  similar  to 
those  seen  in  cholera  blood,  were  seen  creeping  out  of  the  clot 
after  coagulation,  and  went  through  similar  metamorphoses. 
The  difference  consists  in  the  far  greater  number  of  such  cor- 
puscles seen  in  the  cholera  specimens,  and  in  their  greater 
permanence,  the  bioplasts  in  normal-blood  specimens  rapidly 
becoming  disintegrated.  Still  the  authors  believe  that  they 
could  always  distinguish  a  specimen  of  choleraic  from  one  of 
normal  blood  on  the  second  day  of  observation,  even  though 
they  might  appear  indistinguishable  when  first  examined  with 
the  microscope.     This  is  certainly  a  solid  result,  if  confirmed 


1875.]     Microscopic  Organisms  in  Health  and  Disease.      355 

by  subsequent  observation,  and  we  must  admit  that  the  authors 
have  discovered  a  property y  if  not  a  criterion j  of  the  blood  in 
cholera. 

Other  interesting  observations,  which  we  must  pass  over,  were 
made  on  specimens  of  normal  blood,  especially  in  relation  to  the 
occurrence  under  ordinary  conditions  of  monads  or  bacteria, 
which  were  found  to  be  present  only  in  a  very  few  cases  either 
of  healthy  or  diseased  blood,  even  when  observed  continuously 
for  a  considerable  time.  For  these  and  other  reasons,  the 
authors  express  somewhat  strongly  the  opinion  that  there  is  no 
evidence  in  favour  of  attributing  any  diseased  conditions  to  the 
causative  action  of  bacteria  or  similar  organisms,  even  when  they 
are  proved  to  exist ;  but  we  hardly  think  they  have  always  done 
justice  to  the  evidence  which  has  been  furnished.  For  instance, 
to  say  that  the  bacteridia  of  Davaine,  found  in  the  blood  in 
cases  of  splenic  apoplexy  of  sheep,  and  malignant  pustule  in 
man,  are  nothing  more  than  coagulated  fibrine  filaments, 
appears  to  us  to  be  nothing  more  than  a  conjecture  ;  again,  the 
authors  appear  to  us  greatly  to  exaggerate  the  difficulty  of 
distinguishing  minute  particles  of  an  undetermined  nature, 
which  may  have  some  mechanically  produced  movements,  from 
bacteria,  and  it  seems  hardly  worth  while  to  quote  such  a  writer 
as  Bechamp.  Thatthis  is  difficult  or  sometimes  impossible  in  blood 
preparations  must  be  granted,  because  it  is  difficult  to  apply  the 
crucial  test  of  solubility  in  strong  solution  of  potash.  That 
bacteria,  properly  so  called,  are  not  dissolved  by  this  reagent, 
while  particles  of  albuminous  and  fatty  nature  are  so,  cannot 
admit  of  doubt ;  nor  that  collections  of  particles  insoluble  in 
potash  are  found  in  the  solid  tissues  of  patients  dying  of  certain 
diseases.  Neither  does  it  appear  to  us  at  all  decisive,  or  even 
very  important,  that  such  bodies  should  not  be  found  in  speci- 
mens of  blood  taken  during  life.  Very  few  may  be  passing 
through  the  blood  at  the.  same  time,  and  the  distribution  of 
these  may  be  extremely  irregular.  The  presence  of  such  bodies 
in  the  tissues  in  certain  diseases  we  regard  as  indisputable, 
though  the  question  will  still  arise,  what  relation  they  bear  to 
the  disease,  and  Messrs.  Lewis  and  Cunningham  may  be  quite 
right  in  supposing  that  the  explanation  of  cholera  is  not  to  be 
found  in  this  direction. 

Again,  we  quite  adopt  the  explanation  indicated  by  the 
authors  in  their  second  report  on  cholera  (p.  32,  1875),  that  the 
occurrence  of  bacteria  of  ordinary  putrefaction  may  be  the  ex- 
pression of  the  fact  that  changes  usually  observed  after  the  death 
of  the  organism  have  taken  place  in  certain  diseased  fluids  and 
tissues  before  death.  Such  cases,  e.  g.,  gangrene,  urinous  infil- 
tration, &c.,  are,  we  think,  distinguishable  without  difficulty 


356  Reviews.  [Oct., 

from  cases  of  pysemia  or  certain  specific  diseases  where  bacteria 
not  resembling  those  of  ordinary  putrefaction  occur  in  the  blood 
during  life  or  the  tissues  after  death.  One  suggestive  observa- 
tion is  recorded  in  the  second  report,  viz.  that  leucocytosis, 
or  an  abundance  of  white  corpuscles  in  the  blood,  appears  to  be 
inconsistent  wdth  the  coexistence  or  development  of  bacteria. 
The  latter,  if  introduced  into  the  circulation,  disappear,  being 
apparently  worsted  in  the  struggle  for  existence,  so  long  as  the 
leucocytes  are  in  a  state  of  activity.  In  vaccinia  produced  by 
inoculation  and  in  syphilis  the  authors  found  bacteria  to  be  as 
little  constantly  present  as  in  cholera. 

2.  Introduction  of  choleraic  and  other  fluids  into  the  system. — 
The  experiments  on  the  introduction  of  choleraic  and  other 
fluids  into  the  system  form  two  important  series.  In  both  series 
dogs  were  the  animals  chiefly  experimented  upon,  at  least  in 
those  experiments  which  are  recorded,  it  being  found  that  great 
fallacies  attend  the  performance  of  such  experiments  upon 
smaller  and  more  delicate  animals,  such  as  the  rodents. 

In  the  first  series  seventy-nine  such  experiments  are  recorded,  in 
which  the  matter  of  choleraic  dejections,  or  a  solution  of  it,  or  in 
some  instances  other  organic  fluids,  such  as  blood,  either  fresh  or 
kept  for  some  days,  were  injected  into  the  veins  of  dogs,  being 
also  in  some  experiments  introduced  into  the  peritoneal 
cavity.  Ansesthetics  were  used  in  the  most  careful  and  com- 
plete manner,  so  as  to  spare  all  pain  to  the  animals,  and  besides 
thorough  post-mortem  examinations  the  blood  was  in  most 
instances  examined  with  the  microscope. 

The  general  results  of  this  first  series  of  experiments  were  as 
follows  : — The  injection  of  choleraic  material  into  the  veins 
proved  fatal  in  about  forty  per  cent,  of  the  cases,  and  excluding 
cases  where  death  appeared  to  be  due  to  the  operation  the  rest 
of  the  cases  recovered.  The  mortality  was  less  when  the 
material  was  much  diluted,  but  it  was  greater  when  the  mate- 
rial had  been  kept  some  days  than  when  it  was  fresh.  The 
injection  of  ordinary  faecal  matter  -was  fatal  in  a  certain  num- 
ber of  cases,  the  average  mortality  being  about  thirty  per  cent, 
instead  of  forty,  a  difference  which  does  not  seem  clearly  to  show 
any  specific  lethal  property  in  the  choleraic  matter.  The  chief 
peculiarity  noticed  at  the  post-mortem  examination  w^as  tliat 
great  disorganization,  or  at  least  congestion  with  other  compli- 
cations, affected  the  whole  of  the  small  intestifies  with  the 
exception  of  a  portion  extending  one  or  two  feet  above  the 
ileocecal  valve.  The  authors  cannot  in  any  way  account  for 
this  special  distribution  of  morbid  change  or  reconcile  it  witli 
any  known  facts  of  anatomical  structure.  No  similar  limitation 
is  seen  in  cholera.     No  special  affection  of  the  intestinal  glands 


1875.1      Microscopic  Organisms  in  Health  and  Disease.     357 

"was  in  any  instance  observed,  and  the  stomach  and  large  intes- 
tine were  always  healthy. 

In  three  cases  large  numbers  of  vibriones  or  actively  moving 
filaments  were  observed  on  the  mucous  surface  of  the  intestines 
and  detected  further  in  the  mesenteric  glands,  but  not  in  the 
blood — a  condition  which  the  authors  compare  to  what  is  called 
mycosis  intestinalis  ;  but  with  this  exception  no  relation  to 
vibriones  or  bacteria  was  made  out.  It  is  a  little  singular 
that  the  same  materials  injected  into  the  peritoneum  pro- 
duced a  somewhat  different  series  of  morbid  changes.  Peri- 
tonitis of  course  resulted,  and  in  a  considerable  number  of 
cases  pericarditis;  but  in  the  intestines  no  disorganization  of 
the  mucous  membrane  was  observed,  great  congestion  and  a 
sort  of  sanguineous  exudation  being  alone  remarked. 

This  series  of  experiments,  then,  failed  to  induce  lesions  or 
phenomena  identical  in  nature  with  those  of  cholera,  nor  did 
"  it  afford  any  evidence  in  favour  of  the  existence  of  a  specific 
poison  contained  in  choleraic  excreta  peculiar  to  them  alone, 
and  giving  rise  to  special  phenomena."  It  clearly  points, 
however,  to  the  influence  of  decomposing  animal  matter,  even 
when  not  extremely  foetid,  in  producing  intestinal  disease. 

The  number  of  these  experiments  did  not  appear  sufficient 
to  warrant  any  inference  as  to  any  difference  in  degree  between 
the  toxic  effect  of  choleraic  and  other  alvine  discharges,  nor  did 
it  appear  to  the  authors  that  a  sufficient  number  of  experiments 
had  been  made  with  perfectly  fresh  choleraic  material.  To 
supply  these  differences  was  partly  the  object  of  the  second  series 
of  experiments,  but  they  were  also  intended  '^  to  test  to  the 
utmost  the  influence  of  bacteria  in  these  processes,"  and,  lastly, 
"  to  ascertain  whether  the  product  resulting  from  lesions  thus 
produced  invariably  possesses  the  property  of  reproducing  the 
phenomena  in  a  more  marked  or  even  equal  degree." 

The  general  result  of  the  two  series  of  experiments  was  that, 
while  both  choleraic  dejections  and  those  from  persons  in  health 
may  when  injected  into  the  veins  produce  intestinal  affections, 
this  result  was  produced  much  more  frequently  by  the  choleraic 
material.  Fresh  cholera  material  appeared  to  be  undoubtedly 
more  poisonous  than  that  which  had  become  putrid ;  and  what  is 
a  very  important  fact,  heating  the  material  to  boiling  did  not  in 
the  slightest  degree  diminish  its  poisonous  effect.  Almost  the 
same  was  true  of  the  toxic  properties  of  ordinary  alvine  evacu- 
ations, so  that  the  authors  draw  the  unhesitating  conclusion  that 
the  cholera  poison  cannot  be  a  living  substance,  no  such  sub- 
stance, they  think,  having  been  proved  capable  of  surviving 
exposure  to  a  temperature  of  212°  in  fluid. 

It  is  noteworthy  that  the  authors  could  not  confirm  in  any 


358  Reviews.  [Oct., 

way  the  fact  recorded  by  so  many  experimenters  with  respect  to 
artificial  septicaemia,  namely,  the  increase  in  intensity  of  the 
virulent  properties  of  inflammatory  products  caused  by  their 
transference  from  one  animal  to  another.  In  fact,  solutions  of 
excrementitious  matters  introduced  directly  into  the  peritoneum 
were  more  poisonous  than  the  fluids  resulting  from  the  inflam- 
mation thus  caused — a  result  at  variance  with  those  of  Burdon 
Sanderson  and  Klein,  and  of  the  French  experimenters.  In 
only  two  instances  were  they  able  to  transfer  the  morbid  action 
more  than  twice.  The  only  conclusion  we  can  draw  from  this 
fact  is  that  it  suggests  a  multiplicity  of  poisons,  some,  perhaps, 
being  more  capable  of  rapid  increase  than  others. 

It  is  fair  to  give  the  final  conclusion  in  the  authors'  own 
words : 

"  Something  is  present  [in  choleraic  matter]  which  is  capable  of  exer- 
cising a  singularly  pernicious  eff'eet  on  animal  life,  the  most  prominent 
local  manifestation  of  its  action  being  observed  in  the  intestinal 
canal. 

"  What  is  this  something  ?    Is  it  visible  ?  Is  it  a  living  substance  ? 

*'  With  regard  to  the  first  question,  we  should  not  presume  to  speak 
decisively,  though  we  have  ourselves  searched  for  it  in  vain  with  lenses 
which  have  the  reputation  of  being  the  best  yet  constructed,  and  have 
been  uniformly  unsuccessful  in  associating  it  with  any  constant 
visible  phenomena. 

With  regard  to  the  second  question,  the  authors  think  that — 
**  Until  it  be  proved  that  living  substances  can  withstand  immersion 
in  a  fluid  at  a  temperature  of  212*^  F.  of  some  minutes'  duration,  we 
have  no  hesitation  in  stating  that  the  morbid  phenomena  which  we 
have  observed  to  follow  the  introduction  into  the  animal  economy  of 
strained  solutions  of  choleraic  and  normal  alvine  discharges,  and  of 
other  decomposing  animal  substances,  are  not  the  result  of  infection 
with  a  material  the  poisonous  properties  of  which  are  dependent  on 
its  possessing  vitality." 

3.  Section  of  intestinal  nerves. — Before  leaving  the  subject 
of  cholera,  we  must  refer  to  the  experiments  on  the  section 
of  the  nerves  distributed  to  the  intestines,  first  performed 
by  Moreau.  This  experimicnter  found  that,  when  the  branch  of 
the  mesenteric  nerve  distributed  to  a  loop  of  intestine  was 
divided,  the  paralysis  thus  produced  was  accompanied  by  a 
copious  secretion  of  watery  fluid  from  the  mucous  membrane. 
Now,  comparing  the  results  of  the  experiments  just  detailed,  in 
which  choleraic  or  other  animal  matters  were  introduced  into 
the  circulation,  with  the  phenomena  of  actual  cholera,  one  of  the 
most  striking  differences  is  the  absence,  in  experimental  condi- 
tions, of  that  increased  secretion  of  fluid  which  is  so  charac- 
teristic of  the  disease.     The   authors  therefore  hoped  that,  if 


1875.]      Microscopic  Organisms  in  Health  and  Disease,      359 

they  could  in  any  way  induce  a  greatly  increased  secretion,  they 
might  assimilate  the  morbid  phenomena  of  experiment  some- 
what more  closely  to  those  of  disease.  Hence  they  determined 
to  repeat  Moreau's  experiments,  but  first  attempted  to  ascertain 
whether  by  section  of  the  splanchnic  nerve  the  whole  of  the 
intestine  simultaneously  could  be  affected,  and  not  merely  one 
or  two  loops  as  in  the  method  of  the  French  experimenter. 
The  result  of  two  series  of  experiments  was,  however,  to  show 
that  section  of  the  greater  splanchnic  nerve  on  one  or  both  sides,' 
even  when  combined  with  excision  of  the  semilunar  ganglion, 
had  no  effect  whatever  on  causing  exudation  or  other  change 
on  the  intestine.  By  section  of  the  mesenteric  nerves,  on  the 
other  hand,  they  confirmed  in  a  great  number  of  instances  the 
results  of  Moreau,  the  contrary  instances  being  apparently  due 
to  imperfection  in  the  experiment.  The  almost  invariable  result 
was  a  copious  secretion  of  fluid,  entirely  independent  of  the 
detachment  of  the  epithelial  covering,  but  sometimes  associated 
with  an  exudation  of  bioplasts  upon  the  surface.  Similar  con- 
firmation has,  we  may  say,  been  given  to  Moreau's  statements 
by  Dr.  Lauder  Brunton,  and  the  subject  is  now  under  investi- 
gation by  a  committee  of  the  British  Association. 

Let  us  hope  that  Drs.  Lewis  and  Cunningham,  having  already 
reproduced,  in  some  degree,  two  of  the  chief  morbid  phenomena 
of  cholera,  may  be  ultimately  able  to  effect  the  synthesis  of  the 
whole,  and  thus  explain,  in  the  only  really  satisfactory  way,  the 
whole  morbid  process. 

IV. — Researches  on  Entozoa. 

Dr.  Lewis's  investigation  of  the  disease  known  as  chyluria 
has  led  to  very  interesting  results,  some  of  which  may  be  now 
pretty  widely  known ;  but  as  others  have  scarcely  received  due 
attention,  it  will  be  worth  while  to  give  a  brief  resume  of  the 
whole  subject.  In  the  year  1870  Dr.  Lewis  first  observed  in 
the  milky  urine  of  a  patient  suffering  from  *^  chyluria,"  numer- 
ous specimens  of  a  small  nematoid  worm,  which,  being  con- 
stantly found  and  evidently  not  accidentally  present,  was  re- 
ferred to  as  the  probable  cause  of  the  disease.  Some  fifteen  or 
twenty  cases  subsequently  examined  fully  confirmed  the 
hypothesis,  filarise  being  present  on  every  occasion.  At  this 
time  the  parasite  was  not  detected  in  the  blood,  but  about  two 
years  afterwards,  when  examining  the  blood  of  a  patient  with 
diarrhoea.  Dr.  Lewis  observed  nine  minute  nematoid  worms  on 
a  single  slide.  The  investigations  to  which  this  incident  gave 
rise  have  now  satisfactorily  established  the  presence  of  the 
parasite  in  the  blood  as  well  as  in  the  urine  in  all  such  cases ; 
and  the  name  Filaria  sanguinis  hominis  given  to  the  parasite 


330  •  Reviews.  [Oct., 

has  been  shown  to  be  well  deserved.  So  numerous  are  the 
parasites  that  they  may  always  be  seen  in  a  minute  drop  of 
blood  taken  from  any  part  of  the  body  ;  and  supposing  them 
to  be  uniformly  distributed,  Dr.  Lewis  calculates  that  there 
may  be,  on  a  moderate  estimate,  140,000  in  the  body  at  once. 
In  one  case  the  patient  aifected  with  chyluria  suffered  from  a 
chronic  "inflammation'^  of  the  conjunctivae,  and  milky  fluid 
was  constantly  welling  from  the  corners  of  the  eyes,  which,  on 
examination,  was  found  also  to  contain  the  parasite.  Although 
the  body  is  so  universally  affected,  nevertheless  no  characteristic 
post-mortem  appearances  were  recorded  in  the  few  cases  where 
an  autopsy  was  obtained. 

"  Not  the  remotest  clue  is  afforded  as  to  the  nature  or  as  to  the 
cause  of  the  disease  by  the  pout -mortem  appearances  visible  to  the 
naked  eye  ;  nor  is  there  any  sufficiently-marked  lesion  to  account  for 
the  condition  of  the  urine  during  life,  nor  for  the  rapid  manner  in 
which  the  patient  (in  one  case)  ultimately  succumbed." 

The  microscopic  examination  of  the  kidneys,  however,  showed 
that  numerous  minute  filarise  were  contained  in  every  part  of 
them. 

The  constancy  of  these  results  was  of  itself  quite  sufficient  to 
establish  the  fact  of  the  association  of  the  parasite  with  the  dis- 
ease, its  habitat  in  the  blood,  and  its  elimination  by  the  kidneys. 
It  still  appeared  strange  that  the  constant  infection  of  the  blood 
should  have  been  overlooked  in  the  earlier  instances  where  the 
chylous  urine  was  found  to  contain  parasites,  and  a  remarkable 
coincidence  enabled  Dr.  Lewis  to  supply  this  omission.  It  hap- 
pened that  a  compositor  in  the  Government  printing-office,  who 
was  actually  engaged  in  setting  up  this  very  essay,  was  the 
identical  patient  in  whose  urine  two  years  before  filarise  were 
first  detected,  and  whom  Dr.  Lewis  had  vainly  endeavoured  to 
find  for  the  purpose  of  further  examination.  No  difficulty  was 
found  on  this  occasion  in  obtaining  numerous  filarise  from  a  few 
drops  of  his  blood.  The  man  had  been  engaged  in  his  occupa- 
tion without  suffering  inconvenience  from  his  complaint,  and 
indeed  in  many  instances  the  disease  appears  to  have  been  ex- 
tremely slight,  so  that  the  patients  refused  to  remain  in  hospital 
to  be  treated,  or  even  concealed  their  condition.  The  incident 
illustrates  also  the  length  of  time  (two  years  and  a  half)  for 
which  filariae  can  remain  in  the  body  without  giving  any  evi- 
dence of  a  tendency  to  undergo  further  development.  In  fact, 
as  Dr.  Lewis  says — 

"  For  aught  we  know  to  the  contrary,  these  filariee  may  live  for 
many  years,  and  thus  at  any  moment,  no  matter  how  long  after  a 
previous  attack,  nor  in  what  country  the  person  may  reside,  he  may  he 


I 


1875.1      Microscopic  Organisms  in  Health  and  Disease.       36l 

surprised  by  the  sudden  accession  of  chyluria,  or  any  other  obscure 
disease,  such  as  will  be  readily  understood  by  the  physician  when  he 
becomes  aware  of  the  state  of  the  blood." 

We  cannot  dwell  upon  the  anatomy  or  the  life-history  of  the 
hsematozoon.  It'^  is  a  worm-like  animal,  the  average  diameter 
of  the  body  being  about  that  of  a  red  blood-corpuscle,  and  its 
average  length  about  forty-six  times  its  greatest  diameter ;  that 
is  to  say,  its  greatest  transverse  diameter  is  about  -jtoit  of  an 
inch,  and  its  length  about  yV  of  an  inch.  When  seen  on  the 
stage  of  the  microscope  it  is  extremely  active  in  its  movements 
and  difficult  to  observe,  but  the  body  is  evidently  contained  in 
a  transparent,  elastic,  tubular  sheath,  closed  at  both  ends,  which 
is  capable  of  elongation  or  shortening.  This  seems  to  show, 
Dr.  Lewis  thinks,  that  in  the  present  stage  of  its  existence  the 
home  of  the  parasite  is  in  the  blood,  as  it  has  no  visible  means 
of  perforating  the  tissues,  and  does  not  show  any  tendency  to 
migration.  There  is  evidence,  however,  that  it  may  also  pene- 
trate the  minute  channels  of  the  lymphatic  system.  From  what 
we  know  of  the  life-history  of  parasites  it  is  clear  that  that  of 
the  hsematozoon,  thus  far  known,  is  quite  incomplete.  This  is 
an  embryonic  form  which  must  have  other  stages  and  trans- 
formations, though  these  are  at  present  quite  unknown.  Dr. 
Lewis  conjectures  merely  that  the  parasite  will  ultimately  be 
traced  to  the  tank,  either  to  its  water  or  its  fish. 

In  the  second  report  on  this  subject  another  formidable  dis- 
ease is  referred,  with  great  probability,  to  the  action  of  the  same 
parasite,  viz.  an  elephantoid  condition  of  the  scrotum,  and  also 
in  one  instance  of  the  foot.  We  do  not  gather  that  Dr.  Lewis 
attributes  all  the  monstrous  tumours  known  as  elephantiasis  to 
this  cause,  but  in  the  cases  recorded  there  w^as  infiltration  of 
subcutaneous  tissue  with  fluid,  and  hypertrophy  of  the  sur- 
rounding parts,  so  as  to  produce  a  large  tumour,  which  in  one 
case  was  of  the  size  of  a  man^s  head. 

Although,  as  we  have  said,  the  life-history  of  the  Filaria 
sa7igumis  Jiominis  is  quite  incomplete,  and  even  its  transmission 
through  the  body  imperfectly  understood,  much  fuller  informa- 
tion has  been  obtained  on  both  these  points  with  respect  to 
an  allied  form  of  nematode  haematozoon  from  the  dog,  which 
forms  the  chief  subject  of  Dr.  Lewis's  second  memoir.  The 
parasite  there  described  appears  to  be  quite  distinct  from  the 
blood-parasites  which  have  already  been  found  in  the  dog  by 
different  observers,  and  enumerated  by  Dr.  Lewis  in  an  historical 
sketch,  which  we  have  not  space  to  notice.  It  has  been  found 
in  two  stages — the  embryonic  and  the  mature.  The  embryo 
bears  a  close  resemblance  to  the  human  hsematozoon  spoken  of 
above,  and,  like  that,  lives  in  the  blood.     The  mature  form  (or 


362  Reviews.  [Oct., 

what  is  believed  to  be  so)  is  a  nematode  worm  from  one  to  three 
inches  in  length,  corresponding  very  nearly,  though  not  pre- 
cisely, to  the  Filaria  sanguinolenta  of  Rudolphi ;  it  is  found  in 
solid  fibrous  tumours  along  the  aorta  and  oesophagus.  Dr. 
Lewis's  belief  is  that  the  mature  worm  is  produced  from  an  im- 
mature larval  form,  which  is  swallowed  by  the  dog,  and  attaches 
itself  to  the  mucous  lining  of  the  oesophagus,  then  working  its 
way  through  the  tissues  till  it  reaches  the  thoracic  aorta  where 
the  worm  lives  coiled  up  in  a  small  nodular  elevation  on  the 
inner  surface  of  the  vessel.  Here  it  enlarges;  ultimately  ad- 
jacent worms  migrate  into  each  other's  abodes,  and  a  tumour 
the  size  of  a  filbert  or  larger  may  be  formed,  which,  when  cut 
into,  contains  a  little  colony  of  mature  pinkish  worms,  the  male 
being  from  one  to  two  inches  long,  the  female  from  two  to  three 
and  a  half.  The  females  become  impregnated  and  produce  innu- 
merable ova,  which  are  imbedded  in  a  thick,  yellow,  gelatinous 
fluid,  and  pass  through  an  orifice  in  the  tumour,  either  into  the 
blood  on  the  aortic  side  or  into  the  alimentary  canal  on  the 
oesophageal.  The  ova  develop  into  embryonic  worms,  which  are 
the  hsematozoa  already  described,  and  these  appear  to  undergo 
no  further  transformation  in  the  blood.  Of  this  history  there 
is,  as  Dr.  Lewis  confesses,  no  direct  proof,  but  we  must  allow  it 
a  very  high  degree  of  probability.  The  human  hsematozoon 
(though  a  distinct  species)  must  almost  certainly  have  a  similar 
history,  and  hence,  to  understand  its  development,  we  should 
have  to  find  a  filaria  somewhere  in  the  solid  tissues  of  the 
body.  We  may  only  point  out  that  the  hcematozoic  stage  can 
hardly  be  a  normal  stage  in  the  metamorphosis  of  either  species. 
The  embryos  which  find  their  way  into  the  intestinal  canal  and 
escape  must  be  those  which  propagate  the  canine  species,  though 
in  the  Filaria  sanguinis  hominis  the  immature  form  ejected  in 
urine  or  lymphoid  discharge  may  undergo  further  transforma- 
tions in  some  appropriate  field.  Those  that  remain  in  the  blood 
stop  at  the  same  immature  stage  of  development. 

The  whole  of  the  two  reports  on  hsematozoa,  which  we  have 
been  obliged  to  notice  very  imperfectly,  will  well  repay  perusal,^ 
and  are,  like  the  others,  admirably  illustrated. 

^  An  abstract  of  the  second  report,  with  figures,  will  be  found  in  the  '  Quar- 
terly Journal  of  Microscopical  Science '  for  July,  1875. 


1875.]  On  tnter-Marriage,  363 

VIII. — On  Inter-Marriage.^ 

Marriages  of  kinsfolk  must  have  been  coeval  with  creation. 
Whether  the  race  originated  in  one  pair,  or  in  pairs  corre- 
sponding in  number  to  its  varieties,  such  unions  in  primeval 
times  were  inevitable.  Moreover,  wherever  communities  or 
colonies  were  founded  or  formed  by  a  few  individuals,  or  wher- 
ever such  associations  were  or  are  isolated  geographically,  or 
by  race  or  social  conditions,  the  same  course  must  have  been, 
and  must  still  be,  pursued;  or  where  the  proportion  between 
the  two  sexes  is  destroyed  by  the  infanticide  of  female  infants 
or  otherwise.  It  would  be  premature  to  inquire  whether  such 
arrangements  were  beneficent  or  pregnant  with  evil,  as,  under 
the  circumstances,  their  consequences  could  neither  be  known, 
nor  dreaded,  nor  escaped  from.  But,  independently  of  the 
limitation  of  choice,  other  influences  may  have  contributed  to 
multiply  such  alliances.  It  can  be  readily  conceived  that  early 
associations,  the  affections,  the  friendship  subsisting  between 
relations,  the  strong  sympathies  created  by  an  identity  of 
language  and  interests,  by  a  similarity  in  habits,  pursuits,  pre- 
dilections, may  have  brought  about,  under  the  agency  of  freewill 
and  preference,  by  the  very  attractions  between  the  sexes  which 
have  guided  men  in  all  ages,  those  consanguine  connections 
which,  under  certain  circumstances,  seem  to  have  been  more  the 
result  of  the  tyranny  of  position  than  of  the  promptings  of  in- 
stinct, for  that  dissociation  or  divarication  between  members  of 
families,  now  so  glaring,  must  have  occurred  in  comparatively 
modern  times.  In  the  daylight,  as  well  as  in  the  dawn,  of 
civilisation,  even  now,  there  are  families  who  consciously  and 
advisedly  shrink  from  the  formation  of  new  connections,  marry 
within  the  bounds  of  consanguinity,  and  have  hence  been  called 
cousin-families.  Even  in  our  own  country,  amongst  the  remain- 
ing representatives  of  the  Celtic  race,  within  a  short  period,  and 
in  other  countries  at  the  present  time,  clanship  has  been  main- 
tained by  cousinship,  and  the  pride  of  pure  blood  was  as  indo- 
mitable in  the  vassal  as  in  his  liege  lord — in  the  serf,  who  could 
scarcely  trace  his  genealogy,  as  in  his  chief. 

The  Bible,  taken  strictly  as  a  biographical  record,  and  under 
this  aspect  it  has  never  been  assailed  by  sceptics,  reveals  the 

1  1.  The  Marriage  of  Near  Kin,  considered  with  respect  to  the  Laws  of  NationSt 
the  Results  of  Experience  and  the  Teachings  of  Biology.  By  Henry  Htjth. 
London,  1875.     Pp.  426. 

2.  Marriages  between  Cousins  in  England  and  their  Effects.  By  Geobge  H. 
Daewin,  M.A.,  Fellow  of  Trinity  College,  Cambridge.     1875.     Pp.  29. 

3.  Medical  Frohlenis  of  the  Bay.  The  Annual  Discourse  before  the  Massa- 
chusetts Medical  Society,  June  3,  1874.  By  Nathan  Allen,  M.D.,  LL.D* 
Lowell,  Mass.    Boston,  1874.     Pp.  92. 


364  keviews,  [Oct., 

course  which  must  have  been  long  followed  by  primitive  peo- 
ples. Brothers  must  have  formed  unions  with  sisters,  and  so  on, 
even  if  nearer  ties  were  not  occasionally  created  ;  and  even  in 
what  may  be  called  the  mediaeval  period  of  Jewish  history,  when 
the  exigencies  of  a  sparse  population  had  disappeared,  we  find 
that  even  leaders  and  lawgivers  sanctioned  connections  between 
blood  relations ;  and  even  after  legal  restrictions  upon  such  had 
been  imposed  there  remained  a  national  prejudice  against  mar- 
riage with  aliens.  Wherever  the  genesis  of  human  association 
has  to  be  recommenced,  or  wherever  small  communities  are 
shut  out  from  surrounding  peoples  by  accident,  as  in  the  case 
of  the  mutineers  of  the  Bounty, — by  design,  as  in  that  of  the 
Vaqueros  of  the  Pyrenees,  and  the  voluntary  recluses  of  St.  Kilda 
— or  by  compulsion,  as  in  isolated  tribes  in  Iceland,  Westmannoe, 
&c.  &c. —  similar  institutions  have  prevailed.  Motives  of  a 
higher  or  lower  character,  as  they  may  be  variously  estimated, 
have  induced  and  justified  the  same  relation  between  the  sexes. 
The  Ptolemy  rulers  of  Egypt,  either  in  obedience  to  an 
ancient  custom  or  to  guard  against  the  pollution  of  the  royal 
blood  and  caste  by  admixture  with  subject  or  servile,  and  there- 
fore impure,  streams,  habitually  married  sisters,  nieces,  and 
cousins.  This  incestuous  intercourse  prevailed  during  thirteen 
reigns  at  least.  Impelled  by  similar  incentives,  the  Peruvians 
and  Persians  are  proved — and  the  inhabitants  of  a  large  portion 
of  the  world,  designated  by  the  Greeks,  barbarian,  including 
India,  Mesopotamia,  Parthia,  Assyria,  all  the  north  of  Africa, 
are  asserted — upon  good  authority,  to  have  chosen  their  mothers, 
daughters,  or  sisters,  as  wives.  In  fact,  it  would  be  difficult  to 
point  out  any  region  in  which,  anciently,  this  custom  did  not 
prevail,  especially  among  the  dominant  and  privileged  classes  ; 
and  even  our  own  ancestors,  while  in  a  semi-savage  condition, 
imitated  their  more  civilised  contemporaries.  But  whole  tribes 
of  men,  not  actuated  by  the  desire  to  transmit  an  uninterrupted 
and  uncontaminated  lineage  of  princes  and  rulers,  but  by  the 
wider  conservative  principle  of  keeping  their  people  free  from 
all  foreign  ties  and  influences,  have  encouraged  marriage  be- 
tween members  of  the  same  sept  or  tribe.  The  Arabs,  before 
their  conversion  to  Mohammedanism,  practised  incest  in  its 
grossest  form,  and  the  Bedouins  are  still  so  proud  of  their  race 
that  they  will  not  marry  an  alien,  or  even  a  female  of  different 
descent,  and  are  as  rigid  in  carrying  out  this  rule  as  they 
are  in  preserving  pure  the  pedigree  of  their  horses.  The  Affghans 
and  natives  of  Beloochistan,  all  presenting  a  magnificent  physi- 
cal development,  are  so  proud  of  their  lineage,  and  so  exclusive 
in  guarding  it,  that  recognition  of  incorporation  is  never  ob- 
tained until  six  descents  can  be  proved,  and  they,  accordingly, 


i 


1875.]  On  Liter- Marriage.  365 

never  ally  themselves  with  even  neighbouring,  and,  perhaps, 
congeneric  clans.  The  Parsecs,  or  Guebres,  are  as  scrupulous 
and  exacting  as  to  genealogy,  although  religious  as  well  as 
tribal  scruples  may  regulate  their  conduct.  The  Gypsies  of  the 
same  region  live  almost  promiscuously,  the  children  belonging 
to  the  horde,  and  not  to  particular  parents,  as  is  affirmed  to 
have  been  the  rule  formerly  in  China,  where  even  mothers  re- 
mained members  of  their  sons'  harem  ;  and  the  Mingrelese  on 
the  Black  Sea,  handsome  and  beautiful  in  person,  associate 
nearly  in  the  same  degraded  manner,  but  whether  from  selfish, 
territorial,  or  patriotic  motives  has  not  been  ascertained.  But 
in  Hindostan  there  is  an  imperium  in  imperio — a  separation  of  a 
vast  population,  which  must  have  had  a  common  birth,  into  sects 
and  castes;  first,  into  four  great  divisions,  which  are  again 
differentiated  into  more  than  a  hundred  others,  by  descent,  by 
occupation,  and  by  moral  antipathies.  They  will  not  inter- 
marry, they  will  not  help,  tolerate,  touch,  each  other,  so  that 
Brahmins  are  united  to  Brahmins,  and  Sudras  are  united  to 
Sudras,  through  successive  generations,  and,  unless  where  the 
written  or  traditional  custom  is  violated,  and  the  distinctions  of 
society  outraged,  the  connections  between  blood  relations  in 
given  localities  must  be  intimate  and  intricate.  The  Ceylonese 
acknowledge  the  same  tyrannous  prohibition  against  the  mar- 
riage of  the  high  and  the  low,  and  the  rich  and  the  poor,  and 
incest,  polygamy,  and  polyandry  are  the  natural  concomitant,  if 
not  direct  results.  The  latter  revolting  tie  exists  in  Thibet  as 
it  anciently  did  in  Sparta,  as  well  as  in  Central  Africa,  but 
under  very  different  domestic  and  social  regulations,  and  upon 
what  pretext  is  not  well  ascertained.  Where  polygamy  is 
allowed  or  enjoined  by  law,  as  among  the  Mongols,  a  man  may 
marry  three  sisters  at  once,  and  two  families  may  intermarry 
for  centuries.  Creed,  superstition,  sectarianism,  even  politics, 
which  lead  so  largely  to  the  segregation  of  communities,  are  as 
fertile  in  bringing  together  in  closer  and  nearer  affinities  the 
individuals  composing  the  sections  separated.  Marriage  within 
the  pale  was,  at  one  time,  a  cardinal  virtue  and  an  omnipotent 
rule.  Even  in  the  very  remote  and  pleasant  land  of  Polynesia 
the  royal  race  contracted  marriages  with  blood  relations,  and 
"  Taniehandra  married  a  relation,  while  his  son  married  a 
sister,  and,  from  love  to  his  father,  one  of  the  latter's  widows.^' 
The  marital  affinities  in  these  islands,  where  all  save  the  human 
soul  is  beautiful  and  divine,  are  of  the  most  lax  and  indefinite 
character,  and  are  determined  rather  by  passion,  temperament, 
or  abundance  of  food,  than  by  any  of  the  factors  previously 
enumerated.  It  should  be  here  noted  that  the  Circassians, 
consisting  of  several  fraternities,  never  marry  within  their 
112-Lvi.  24 


366  Ueviem.  [Oct., 

limits,  that  the  Kalmucks  have  a  great  abhorrence  of  marriages 
between  near  kin,  that  the  Tartars  do  not  seek  wives  within 
their  own  clan,  that  the  Dyaks,  among  whom  the  decapitated 
head  of  a  foe  is  the  most  acceptable  gift  to  an  affiancee  or  bride, 
are  interdicted  from  marrying  first  cousins,  in  order  to  place 
prominently  the  proposition  that  such  repugnance  must  depend 
upon  individual,  or  national,  or  climatic  differences  and  mutual 
constitution,  as  the  majority  of  mankind  have  at  one  stage  of 
progress  or  another  followed  an  opposite  course. 

At  certain  periods  of  advancement  almost  all  nations  have 
instituted  prohibitions  against  consanguine  unions.  The  rea- 
sons for  such  a  step,  the  grades  of  relationship  embraced  in  the 
law,  and  the  extent  and  modification  of  the  restrictions,  differ 
widely  in  different  races.  Sometimes  the  interdict  is  connected 
with  the  inheritance  of  property,  sometimes  with  asceticism,  but 
rarely  with  any  perception  of  the  laws  of  health  or  with  the 
evils  supposed  to  arise  from  the  violation  of  these.  -In  fact,  it  is 
most  probable  that  the  belief  in  the  existence  of  deterioration 
has  been  suggested  by  such  enactments  and  by  the  rigidity  with 
which,  both  in  heathen  and  Christian  lands,  they  were  enforced. 
Had  degeneracy  been  palpable  and  clamant,  it  must  have 
appealed  so  constantly  and  clamorously  to  the  hearts  and  con- 
sciences of  families  and  sodalities  that  no  police,  or  penal,  or 
priestly  interference  would  have  been  required,  and  it  may  be 
argued  that,  had  the  infirmities  of  body  and  mind  now  traced 
to  this  source  been  multiplied  in  proportion  to  the  frequency  of 
the  practice,  the  blood-corruption  must  have  been  so  universal 
and  so  appalling  that  it  could  not  have  failed  to  attract  the 
notice  and  excite  the  fears  of  the  most  ignorant  and  stolid  of 
the  governed  as  well  as  of  the  governing  body.  To  the  Israel- 
ites a  code  of  regulations  as  to  marriage  was  promulgated 
between  1571  and  1620  B.C.,  when  the  circumstances  deter- 
mining the  earlier  post-diluvial  marriages  had  ceased  to  press. 
By  this  code,  tantamount  to  the  condemnation  of  previous  con- 
nections, a  Jew  was  not  permitted  to  marry  his  mother,  sister, 
step-mother,  and  other  degrees  within  blood-kinship.  A 
slight  amount  of  restraint  was  created  in  Egypt  by  considera- 
tions of  rank,  riches,  and  the  sacredness  of  caste ;  but  there 
was,  besides,  no  union  permitted  in  the  direct  ascending  line, 
nor  collaterally  with  a  sister.  A  check  is  said  to  have  been 
given  by  Alexander  the  Great  to  the  incestuous  intercourse 
between  members  of  sovereign  Persian  families.  The  Greeks 
were,  like  other  nations,  surrounded  by  barbarians,  endogamous, 
and  their  proliferation  by  emigrant  colonies  was  the  result  of  the 
exclusion  of  children  of  mixed  descent  from  citizenship,  and  it 
is  presumable  that  the  disposition  to  breed  in  and  in  was  not 


1875.] 


On  inter- Marriage,  367 


effectually  counteracted  until  tlie  effect  of  Christianity  claimed 
the  supremacy  over  the  selfish  impulses^  although  the  same 
limitations  prevailed  as  in  Egypt.  Rome,  in  its  rise  as  well  as 
in  its  decline,  seems  to  have  equalled  less  powerful  and  less 
polished  communities  in  the  contraction  of  blood-marriages, 
although  perhaps  the  most  flagrant  and  frequent  instances  are 
to  be  found  in  its  lusty  youth.  Such  ties  seem  to  have  been 
dictated  by  pride,  patricianism,  and  the  transmission  of  property. 
The  Tarquins  were  but  examples  of  the  practice  among  the 
nobles;  all  ranks  recoiled  from  espousal  with  a  foreigner;  the 
equestrian  disdained  a  plebeian  connection ;  heiresses  were  bound 
to  marry  kinsmen.  The  union  of  uncle  and  niece  was  permitted. 
Mohammed  originated  wide  and  strict  prohibitions,  but  he  him- 
self married  his  first  cousin  and  a  daughter-in-law ;  but  Con- 
stantino and  Constantius  attached  the  penalty  of  death  to  such 
marriages,  and  Theodosius  introduced  a  law  against  the  mar- 
riage of  cousins.  Many  fluctuations  of  opinion  and  legislation 
may  be  detected,  even  after  Italy  and  other  parts  of  the  Western 
Empire  had  been  converted  to  Christianity,  and  no  fixity  or 
permanency  was  imparted  to  the  extent  of  prohibition  until  the 
time  of  Gregory  I,  a.d.  550,  who  denounced  the  union  of  third 
cousins,  although  he  had  been  anticipated  by  the  Ostrogoths, 
who  interdicted  marriage  within  the  fifth  and  sixth  degrees, 
while  Gregory  III,  a.d.  731,  extended  this  restriction  to  the 
sixth  or  seventh  degree,  or  between  sixth  cousins.  It  would  be 
profitless  to  prosecute  further  research  during  the  Christian  era, 
as  the  canonical  laws  above  alluded  to  have  been  observed  with 
greater  or  less  fidelity  ever  since  among  the  lower  orders,  over 
whom  the  priesthood  exercised,  and  still  exercises,  great,  if  not 
supreme,  authority.  But  among  the  royal  and  princely  families 
of  Europe  the  dispensing  power  of  the  Church  has  so  broken 
down  these  bonds  and  barriers  that  even  heralds  have  a  difli- 
culty  in  unravelling  the  tangled  web  of  propinquity  produced  ; 
and  had  vengeance,  under  the  guise  of  morbidity  and  mor- 
tality, really  pursued  the  offenders  against  a  sanitary  as 
well  as  a  sacred  law,  no  representative  of  imperial  or  feudal 
lords  could  now  exist.  Nor  has  the  shadow  of  such  ecclesias- 
tical absolution  from  the  impediments  of  canonical  law  altogether 
passed  away.  The  modern  histories  of  Spain  and  Portugal 
'afford  many  illustrations  of  this,  and  thus  in  1826  a  Papal  bull 
would  have  set  aside  the  prohibition  of  marriage  between  an 
uncle  and  a  niece  in  the  case  of  Donna  Maria  da  Gloria  and 
Don  Miguel,  but  was  nullified  by  the  treachery  of  the  latter ; 
and  even  the  plebeian  mountain  shepherds  called  Vaqueros, 
who  will  not  marry  out  of  their  tribe,  still  pay  more  money 
for   dispensations   than    the   whole  province   of  the  Asturias. 


368  Reviews.  [Oct.^ 

Royal  edicts  have  in  like  manner  set  the  canonical  laws  as  to  con- 
sanguinity at  defiance,  and  within  a  short  period  such  a  relaxation 
was  passed  in  Sweden  permitting  the  marriage  of  first  cousins, 
and  in  the  same  country  a  man  may  marry  his  sister-in-law  by  the 
king's  authority.  It  may  be  inferred  from  what  has  been 
stated  that  there  was  no  inherent  dislike  or  indisposition  on  the 
part  of  relatives  to  marriage ;  that,  on  the  contrary,  there  existed 
many  inducements  to  such  connections,  and  that,  although  a 
different  doctrine  has  been  propounded,  to  the  effect  that  an 
identity  of  sentiment  and  impulse,  even  in  widely  separated 
peoples,  may  have  led  to  the  establishment  of  similar  customs, 
the  only  natural  impediment  is  in  the  age  of  the  parties.  It  is  well 
known  that,  whatever  the  views  of  the  early  Jewish  Lawgiver, 
whether  dictated  by  inspiration  or  religions  policy,  those  have, 
for  better  or  worse,  guided  civilised  nations  since  the  epoch 
when  they  were  delivered.  Gregory  is  said  to  have  reproduced 
them,  and  the  Church  of  which  he  was  a  Saint  is  conceived  to 
have  injured  the  world  by  placing  limits  upon  the  increase  of 
population,  while  it  marvellously  raised  the  standard  and  sway 
of  morality  by  placing  woman  in  a  new  and  purer  and  more  dig- 
nified relation  to  the  other  sex.  The  conventual  life,  the  with- 
drawal of  large  numbers  by  celibacy  from  the  reproductive 
classes,  must  have  tended  to  disturb  the  equilibrium  between 
the  sexes  as  to  marriage,  and  must  have  served  as  an  indirect 
check  upon  fertility.  It  has  been  afliirmed  that  the  cloister  was 
resorted  to  as  a  sanctuary  from  unholy  unions  and  from  the 
curse  which  was  conceived  to  impend  over  the  fruit  of  those 
who  eat  of  the  forbidden  tree.  What,  then,  was  this  curse  ?  Did 
it  bear  the  fruit  of  mere  moral  and  ultimate  retribution — was  it 
wreaked  in  physical  disease,  deformity,  decrepitude,  in  sterility, 
impaired  fecundity,  idiocy,  paralysis,  and  all  the  ills  that  flesh 
is  heir  to,  culminating  in  early  or  premature  death  ?  In  contem- 
plating this  sad'picture  of  the  future  of  humanity  we  have  often  been 
struck  by  the  habit  of  intelligent  and  laborious  advocates  of  tlie 
hypothesis  of  the  pernicious  and  fatal  effects  of  consanguine  mar- 
riages in  overlooking  the  cosmic  custom  which  seems  tobe  an  intui- 
tive refutation  of  such  hypothesis ;  in  nibbling  over  the  two  or  one 
and  a  half  per  cent,  which  may  distinguish  the  condition  of  the 
children  of  those  conjectured  to  be  unhealthy  from  those  of 
parents  conjectured  to  be  healthy.  It  is  at  the  same  time  astound-* 
ing  that  these  inquirers  should  concentrate  their  attention  upon 
consanguinity  alone  as  the  origin  of  physical  and  psychical 
degeneracy,  even  of  certain  forms  of  moral  turpitude  in  small 
communities  or  circumscribed  localities,  to  the  exclusion  of  all 
the  other  known  factors  of  such  afflictions  which  must  be  con- 
temporaneously at  work,  and  which  are  confessedly  productive 


1875.] 


Oti  Inter 'Marriage,  369 


of  similar  results,  and  this  while  the  more  candid  of  the  number 
admit  that  the  data  obtained  are  defective  and  often  selected ; 
that  such  data  "  do  not  speak,  strongly  against  a  blood-rela- 
tionship of  parents  "  that  this  influence,  whatever  it  may  be, 
is  "  unsteady,"  and  that  they  have  been  disappointed  as  to  its 
uniformity,  extent,  &c.  Two  methods  have  been  followed  in 
the  attempt  to  answer  the  vexed  question  as  to  the  effects  of 
blood-relationship  on  off*spring.  The  first  of  them  has  consisted 
in  selecting  an  isolated  village  or  tribe,  in  ascertaining  the 
number  of  marriages,  sanguine  and  non-sanguine,  among  the 
inhabitants,  the  number  of  children  in  these  unions  respectively, 
then  in  comparing  the  health,  strength,  survivorship  of  these, 
and  in  concluding,  from  the  proportionate  value  of  these  ele- 
ments, the  influence  of  relationship,  but,  as  we  have  just  said, 
without  any  due  consideration  or  estimate  of  the  other  causes, 
such  as  heredity,  race,  food,  habits,  moral  and  religious  training, 
which  must  affect  this  proportion.  The  second  method  consists 
in  taking  similar  steps  and  in  making  similar  deductions  with- 
out making  due  allowance  for  the  circumstances  which  may 
prevent,  or  modify,  or  destroy,  whatever  occult  influence  may 
be  associated  with  close  and  long-continued  intermarriage. 

The  objects  of  the  work  of  Huth  now  before  us  are  professed  to 
be  "  to  put  in  a  collected  form  all  that  has  been  written  on  the 
marriage  of  near  kin,^'  and  ^^  that  it  may  serve  as  a  handbook 
to  the  literature  of  the  subject."  These  expressions  are  too 
modest,  and  are  calculated  to  mislead  as  to  the  amount  of 
copious,  patient,  and  exhaustive  research  displayed,  as  to  the 
clear  and,  we  conceive,  candid  exposition  of  a  controversy  of 
great  width  and  vast  importance,  and  as  near  an  approach  to  a 
settlement  of  the  dispute  as  can  at  present  be  expected. 

The  first  portion  of  the  volume  is  dedicated  to  a  sweeping 
survey  of  marital  usages  in  almost  all  lands  and  ages,  and  de- 
monstrates that,  however  irreconcilable  the  conjugal  connections 
narrated  were  with  current  opinions,  they  could  not  have  en- 
tailed disastrous  consequences  ;  that,  even  where  the  kindred  of 
the  parties  was  close  and  long  continued,  the  issue  was  robust 
and  beautiful,  as  exemplified  in  the  Lacedemonian  women;  and 
that  the  descendants  of  the  Jews,  even  at  present,  are  in  favor- 
able surroundings,  equal  in  many  respects  to  the  Circassians, 
who  are  rapidly  increasing  in  numbers,  and  present  a  smaller 
infant  mortality  by  one  third  or  one  half  than  among  the  Chris- 
tians. The  same  remark  applies  to  periods  when  females  were 
bought,  sold,  and  treated,  though  with  less  solicitude  and 
science,  like  our  cattle, 

Tlie  following  portion  on  asceticism  shows  that,  although 
ecclesiasticallftws  may  frustrate  or  limit,  fanaticism  may  foster, 


370  Reviews,  [Oct., 

promiscuous  and  profligate  intermarriage,  and  that  sects  at 
present  exist  in  which  incest  is  an  institution,  equally  as  in  the 
days  of  the  Magians  when  such  corruptions  are  said  to  have 
arisen  as  to  countenance  the  axiom  that  the  offspring  of  a  son 
and  a  mother  was  the  best  calculated  for  the  office  of  a  priest.  The 
succeeding  chapters  are  on  the  varied  origin  of  prohibited  degrees 
among  savages,  and  on  the  absence  of  all  instinctive  antipathy 
to  consanguine  union,  wherein  it  is  stated  that  Burton,  in  his 
'  Anatomy  of  Melancholy,'  is  the  first  author  who  "  considers 
that  the  offspring  are  hurt  by  these  marriages ;"  and  when  the 
weight  of  evidence  gathered  from  a  large  catena  of  recorded 
observations  is  in  their  favour  we  reach  the  crucial  argument 
in  the  investigation  derived  from  isolated  communities  who  have 
constantly  married  among  themselves.  Among  such  are  enu- 
merated the  descendants  of  the  mutineers  of  the  "  Bounty," 
who  were  finely  formed,  strong,  and  of  tall  stature.  A  tribe  at 
Surabaya,  Java,  1200  in  number,  occupying  forty  villages,  are  so 
proud  of  their  institutions  as  never  to  admit  female  strangers 
within  their  pale,  and  are  frugal,  happy,  bigger  and  stronger 
than  any  neighbouring  race.  The  same  amount  of  vigorous 
life  and  of  longevity  has  been  noticed  among  the  natives  of  vil- 
lages in  Cornwall,  where  exogamous  marriages  are,  from  situa- 
tion, difficult ;  among  the  Stuarts  of  Glenfinlas,  where  clanship 
determined  marriage.  In  Burnmouth  and  Ross,  Berwickshire, 
where  position  and  contraband  trade  long  confined  matrimony 
within  narrow  limits,  though  it  be  affirmed  that  there  is  a  larger 
amount  of  "  unsoundness  "  than  in  the  average  population  of 
Scotland,  the  inhabitants  are  said  to  be  healthy,  strong,  indus- 
trious, and  respectable ;  as  in  Eyemouth,  in  the  same  county, 
which  has  a  similar  site  in  history ;  in  St.  Kilda,  where  a  small 
group  of  individuals  is  gradually  verging  towards  extinction, 
partly  from  insufficient  or  inappropriate  nourishment,  but  chiefly 
from  trismus  nascentium,  where  unions  within  the  interdicted 
degrees  have  been  inevitable  for  centuries.  Iceland,  where  a 
population  of  about  58,000,  practically  shut  out  from  other 
parts  of  Europe,  is  and  has  been  compelled  to  marry  in  and  in, 
although  sometimes  decimated  by  epidemics  and  subjected  to 
frightful  hardships,  presents  a  greater  number  of  births,  less 
deformity,  less  insanity,  than  in  Denmark  ;  although  the  per- 
centage of  idiocy  is  greater,  it  is  wonderful,  when  the  somewhat 
dissolute  manners,  the  intemperance,  and  the  extreme  destitu- 
tion of  the  majority  of  the  parents  are  considered,  that  it  is  so 
small.  In  the  Scilly  Islands  the  inhabitants  are  described  by 
one  narrator  as  dwarfish,  by  another  as  possessing  proportions 
which  *^  give  the  lie  to  the  current  notion  that  men  and  quadru- 
peds must  degenerate  in  small  islands/'  and  here  the  boundaries 


1875.]  On  Inter-Marriage,  371 

drawn  by  degrees  of  affinity  must  be  constantly  overstepped. 
Passing  the  channel,  we  find  in  Asprieres  a  population  of  1700, 
with  only  two  deaf-mutes  springing  from  unrelated  parents.  In 
Baty,  according  to  Voisin,  there  is  a  population  of  3300, 
separated  from  and  having  little  communication  with  the  main- 
land, simple,  intelligent,  reserved  in  character,  presenting  no 
instance  of  malformation,  or  any  disease  of  the  mind,  or  of 
deaf-mutism,  albinoism,  blindness,  or  retinitis  pigmentosa,  and 
free  from  the  stains  of  prostitution,  drunkenness,  and  other 
immorality,  although  marrying  amongst  each  other  from  time 
immemorial.  In  the  nominal  republic  of  Andorra,  Pyrenees,  the 
citizens,  amounting  to  7000  or  8000,  living  as  their  fathers  lived 
in  great  simplicity,  never  unite  themselves  to  foreigners,  nor  to 
any  one  unequal  in  rank,  and  consequently  choose  their  help- 
mates from  their  own  family  and  such  as  participate  in  their 
fortunes.  This  unchanged  and  unchanging  people  are  described 
as  a  strong  and  well-proportioned  race,  among  whom  mental 
disease  and  vice  are  almost  unknown. 

We  have  intentionally  omitted  a  large  number  of  interesting 
and  pertinent  illustrations  from  this  catalogue,  most  of  which 
militate  against  the  notion  that  marriages  of  kin  entail  evil,  some 
support  it,  and  lastly  that  derived  from  the  present  condition  of 
the  Jewish  race,  especially  in  relation  to  deaf-mutism,  because 
the  information  on  the  subject  is  conflicting.  This  has  been  done, 
not  merely  to  economise  space,  but  because  we  object  to  skeletonic 
and  microscopic  statistics,  and,  in  the  words  of  Huth,  because 
"  we  have  absolutely  no  basis  or  very  imperfect  estimates  indeed" 
in  the  face  of  world-long  history  and  experience  with  which  the 
great  mass  of  mankind  rest  perfectly  satisfied.  Another  series 
of  facts  can  only  be  very  cursorily  adverted  to ;  such  are  the 
connection  between  idiocy,  microcephalism,  deformed  and 
dwarfed  stature,  with  the  soil  and  surroundings,  as  seen  in  the 
Cretins  of  Alpine  regions  ;  the  direct  or  immediate  connection 
between  idiocy  and  alienation  with  intemperate  habits,  as 
proved  by  the  increase  of  idiocy  150  per  cent.,  and  insanity  50 
percent.,  on  the  removal  of  the  spirit  duty  in  Norway;  the 
fluctuations  of  intemperance  from  social  habits,  and  in  particular 
classes,  independently  altogether  of  family  relations;  the 
absence  of  consumption  from  communities  where  frequent  con- 
sanguine marriages  are  unavoidable,  as  in  Iceland  and  in  our 
own  Western  Islands,  from  which  evidence  has  been  drawn  to 
prove  that  idiocy,  &c.,  can  be  traced  to  this  source ;  ^  the  argu- 
ments of  Chateauneuf,  who  concludes  that  "  seven  or  eight 
consecutive  generations,  lasting  about  three  centuries,  is  the 
average  life  of  a  nobleman's  family  in  France  and  that,  so  far 


Dr.  Mitchell  *  On  Blood-Relationship  in  Marriage/  p.  442  et  seq. 


372  Reviews.  [Oct., 

from  being  less  prolific,  they  are  perhaps  even  more  prolific  than 
ordinary  families ; ""  the  etiology  of  scrofula  from  every  en- 
feebling and  exhausting  origin  in  no  way  connected  with  con- 
sanguinity ;  the  theories  that  anaemia  in  the  parents  may 
explain  all  the  phenomena  under  discussion,  and  that  crosses 
are  positively,  as  well  as  potentially,  injurious  by  spreading  and 
multiplying  defects  in  the  type,  as  seen  in  the  deterioration 
of  mixed  races  and  half-castes,  which  unite  the  vices  and  defects 
of  both  parents. 

The  experience  afforded  by  the  breeding  of  the  lower  animals 
is  valuable.  The  great  preponderance  of  opinion  of  those  who, 
experimentally  or  for  gain,  have  engaged  in  this  inquiry  is  that 
consanguine  connections  afford  a  direct  means  of  improving  the 
breed;  either  as  to  a  part  or  the  whole  of  the  body.  This  im- 
provement consists,  not  merely  in  increasing  the  quantity  or 
quality  of  fat,  fiesh,  wool — saleable  commodities  which  are,  how- 
ever, the  products  of  diseased  action  in  the  animal — but  of 
beauty  of  form,  accelerated  speed,  and  high  development  of  some 
of  the  external  senses.  In  fact,  the  great  cardinal  point  seems 
to  be  that,  provided  the  parents  are  healthy,  their  progeny  will 
be  so,  will  represent  the  desirable  features  of  the  type,  and  that 
these,  under  judicious  management,  will  be  intensified  and  per- 
petrated by  long-continued  breeding  in  and  in.  The  racehorse 
of  England,  the  Arab  horses  of  the  desert,  can  all  be  traced  back 
to  the  same  famous  stock  in  one  or  more  lines,  by  repeated  and 
the  closest  interconnections,  with  the  qualities  for  which  they 
are  prized  either  perfectly  preserved  or  enhanced.  In  the 
thirteenth  century  sheep  were  imported  from  England  by  the 
Spaniards,  who  have  excluded  all  foreign  blood  from  the  stock, 
which  has  been  bred  in  and  in  since  that  time,  and  the  animals 
are  still  free  from  all  blemish  or  impairment  of  those  qualities 
for  which  they  have  been  prized.  In  France  the  Naz  Flock 
has  had  no  addition  from  without  for  sixty  years,  and  gives  no 
indication  of  degeneracy.  The  best  breed  now  scattered  over 
all  the  states  of  the  American  Union  is  descended  from  one  Ewe, 
and  have  preserved  her  characteristics  by  constant  in-breeding 
and  without  admixture.  The  wild  as  well  as  the  park  deer  in 
Great  Britain  are  free  from  all  blight  and  blemish,  although 
crossing  is  not  within  their  reach ;  but  the  innumerable  troops 
of  wild  cattle  and  horses  which  now  cover  the  plains  in  South 
America,  the  Falkland  Islands,  &c.,  which  must  have  proceeded 
from  common  parents,  and  could  have  had  no  access  to  other 
flocks,  afford  extraordinary  instances  of  undiminished  prolificness 
and  of  the  possession  of  some  of  the  most  highly  valued  qualities 
of  their  species.  But  a  wider  survey  of  all  the  living  creatures 
peopling  the  globe,  and  which  must  have  multiplied  at  certain 


1875.] 


On  Inter 'Marriage.  373 


times,  and  must  still  in  many  localities  multiply,  by  incessant 
interunion,  teaches  the  same  lessons  and  more  impressively. 
That  evil  results  may  follow  the  mingling  of  kindred  blood 
cannot  be  denied,  but  that  in  drawing  deductions  from  such 
cases  the  collateral  influences  should  be  embraced  is  well 
shown  by  the  experiment  of  M.  Legrain,  wlio  treated  two  series 
of  rabbits,  originating  in  a  common  stock,  in  a  different  manner, 
brothers  being  coupled  with  sisters  during  five  generations. 
One  series  was  kept  in  the  dark,  with  unwholesome  surround- 
ings ;  one  in  light,  with  abundance  of  air,  food,  &c.  The  former, 
in  the  third  generation,  had  diminished  in  prolificness  and 
viability,  while  the  latter,  in  the  fifth  generation,  remained  pro- 
lific and  undegenerate  in  health. 

We  shall  not  analyse  the  concluding  chapters  on  the  question, 
"  Why  are  there  two  sexes  ? " — hermaphroditism,  &c., — but 
would  strongly  recommend  the  perusal  of  the  appendices  as 
containing,  in  addition  to  the  references  in  the  body  of  the 
volume,  a  large  collection  of  condensed  cases  bearing  upon  the 
matters  discussed,  drawn  from  a  multitude  of  sources,  and  which 
present  a  sort  of  vidimus  of  the  literature  bearing  upon  con- 
sanguine marriages. 

On  opening  Mr.  Darwin's  pamphlet  on  '  Marriages  between 
First  Cousins  in  England,  and  their  Effects,'  we  were  at  first 
impressed  with  the  suspicion  that  it  was  a  humorous  exercita- 
tion  or  philosophical  conundrum,  as  in  his  third  paragraph  he 
writes,  "  In  looking  through  the  marriages  announced  in  the 
'  Pall  Mall  Gazette  '  I  noticed  one  between  persons  of  the  same 
surname.  Now,  as  the  number  of  surnames  in  England  is  very 
large,  it  occurred  to  me  that  the  number  of  such  marriages 
would  afford  a  clue  to  the  number  of  first-cousin  marriages  ;" 
but,  on  discovering  that  this  method,  which  many  will  stigma- 
tise as  novel  and  rude,  was  designed  to  supply  that  information 
sought  for  by  the  motion  of  Sir  J.  Lubbock,  that  a  question  as 
to  the  frequency  of  cousin-marriages  in  England  should  be  in- 
serted in  the  Census  Act  of  1871,  we  bestowed  graver  considera- 
tion upon  his  labours.  These  labours  have  led  the  author  to 
the  sound  conclusion  that  consanguine  marriages  are  innocuous, 
although  the  route  by  which  he  arrives  at  this  opinion  is  some- 
what adventurous  and  circuitous.  By  consulting  the  *  Registrar- 
General's  Report  for  1873'  Mr.  Darwin  finds  that  275,450 
persons  are  named,  that  of  these  the  number  of  persons  to  one 
surname  is  84.  His  next  step  was  to  count  the  number  of 
marriages  in  that  redoubtable  chronicle,  the  '  Pall  Mall  Gazette,' 
from  1869  to  1873,  amounting  to  18,528,  of  which  125  were 
same-name  marriages.  This  curious  calculation  shows  that 
every  seventy-third  person  i§  a  Smith,  every   seventy-sixth  a 


374  Reviews,  [Oct., 

Jones,  every  115th  a  Williams,  every  148th  a  Taylor,  and  soon. 
Next  it  appears  that  in  one  marriage  in  seventy-three  one  of 
the  parties  will  be  a  Smith,  and  if  there  were  no  cause  which 
tended  to  make  persons  of  the  same  surname  marry  there  would 
be  one  in  seventy- three,  or  5329  marriages  in  which  both  parties 
were   Smiths.     Therefore   the    probability   of  a    Smith-Smith 
marriage  due  to  mere  chance  is  -yt^-q,  and  so  proportionally  with 
the  other  surnames.     Mr.  Darwin  next  examines  700  pages  of 
Burke's   ^Landed   Gentry,'   marking    every   case    where    the 
marriage  was  same  name,  and  endeavoured  to  ascertain  from 
the  Pedigree  all  instances  in  which  marriages  of  persons  of  the 
same  name  were  between  first  cousins.     This    search  proved 
that  of  9549  seventy-two  were  same-name  first-cousin  marriages, 
and  seventy-two  were  same-name  marriages  not  between  first 
cousins,  all  precautions  being  taken  to  exclude  double  returns. 
This  gives  the  percentage  of  same-name  marriages  as  I'b.    When 
all  authorities  as  to  the  English  and  Irish  peerage  and  gentry 
are  consulted  there  appear  to  be  ninety  out  of  11,538  or  0*78 
per  cent,   of  same-name   first-cousin   marriages.     In   reply  to 
circulars  addressed  to  the  upper  middle  and  upper  classes,  it 
appears  that  of  3663  marriages  there  were  of  first-cousin  mar- 
riages 125,  the  percentage  of  first-cousin  marriages  being  3*41, 
and  of  same-name  marriages,  whether  cousin  or  not,  1*38      It 
is  necessary  to  note  that  only  181   of  800  applications   were 
responded  to.     We  do  not  enter  upon  the  statistics  of  the  pro- 
portions between  same-name  cousin  marriages  and  not  same- 
name  cousin  marriages,  as  the  author  confesses  that  his  sources 
of  information  were  inadequate,  but  he  conjectures  that  same- 
name  first-cousin  marriages  are    to  different-name  first-cousin 
marriages  as  one   to  four.     Candidly   enough   he   applies  the 
terms  "  perplexing,"  "  discrepant,"  and  "  beyond  his  powers," 
to  his  arithmetical  calculations,  but  seems  somewhat  confident 
that  in  London  they  are  1^  per  cent.,  in  urban  districts   2  per 
cent.,  in  rural  districts  2J  per  cent.,  in  the  middle  and  upper 
classes  34  per  cent.     It  does  not  seem  necessary  to  explain  at 
length  the  process  by  which  the  author  measures  and  weighs 
the  fifty  and  150  commonest  names  inscribed  upon  cardboard, 
or  arrives  at  the  conclusion  "  that  in  England  and  Wales  about 
one  marriage  in  a  thousand  takes  place  in  which  the  parties  are 
of  the  same  surname   and  have  been  uninfluenced  by  any  rela- 
tionship between  them  bringing   them   together."     His   next 
advance  is  to  apply  to  the  superintendents  of  nineteen  asylums 
as  to  the  cousinship  of  the  parents  of  the  insane  under  their 
charge.     The  results  were  that  of  18,000  inmates,  as  to  whose 
antecedents  some  information  could  be  obtained,  about  181  were 
reported  to  have  been  the  issue  of  cousin  marriages  -,  but  it  is 


1875.]  On  Inter-Marriage,  375 

almost  needless  to  state  that  the  returns  were  defective,  or,  where 
complete,  utterly  worthless.  His  researches  as  to  the  consan- 
guinity of  patients  in  hospitals  for  other  diseases,  and  labouring 
under  blindness,  deaf-mutism,  &c.,  were  equally  unproductive 
of  reliable  facts ;  and  when  treating  of  the  literature  of  the 
subject,  and  quoting  the  observations  of  Professor  Mantegazza 
on  sterility  as  a  consequence  of  marriages  between  kindred,  he 
argues  that  this  author  was  not  entitled  to  infer  the  infertility 
of  such  connections,  as  we  are  ignorant  of  the  proportion  of 
barren  marriages  to  the  general  population.  We  admire  the 
ingenuity  and  industry  of  Mr.  Darwin,  and  the  great  honesty 
which  pervades  his  researches,  but  cannot  accept  these  as  im- 
portant contributions  to  our  knowledge,  except  in  so  far  that 
the  weight  of  his  opinion  swells  the  general  concensus  as  to  the 
innocuousness  of  consanguine  marriages.  This  is  the  appro- 
priate place  to  remark  that  a  similar  attempt  has  been  made  in 
France  to  determine  the  proportion  of  marriages  between  cousins 
from  official  documents,  and  that  rn  seven  years,  1853 — 1859, 
of  2,020,224  marriages  17,872  were  in  this  degree  of  relation- 
ship, but  that  the  accuracy  of  this  estimate  has  been  impugned, 
if  not  altogether  invalidated. 

At  so  many  points  do  the  observations  of  Dr.  Nathan  Allen 
touch  this  subject,  that  this  appears  the  proper  stage  for  their 
consideration.  They  are  worthy  of  investigation  upon  other 
grounds.  They  embrace  what  the  statisticians  have  unwittingly 
omitted  or  purposely  ignored  ;  they  describe  many  of  the  causes 
and  circumstances  which  must,  in  a  greater  degree  than  mere 
relationship,  influence  fecundity,  sterility,  and  the  production 
of  healthy  offspring,  without  which,  in  fact,  no  exhaustive  or 
comprehensive  estimate  of  the  factors  of  degeneracy  can  be  ob- 
tained ;  and  they  supply  a  practical  illustration  of  the  specula- 
tions as  to  the  perpetuation  of  races  from  an  unexpected  quarter. 
The  attention  of  the  author  has  been  directed  to  this  inquiry  by 
the  rapid  decrease  of  the  inhabitants  of  New  England,  which, 
should  it  proceed  at  the  same  rate  for  another  hundred  years, 
will  in  all  probability  extinguish  the  descendants  of  the  sturdy 
and  stalwart  pilgrim  fathers.  But  while  the  representatives  of 
the  original  settlers  are  disappearing,  their  places  are  occupied 
by  German,  Irish,  Canadian  emigrants,  or  their  descendants, 
so  that  the  gross  population  suffers  no  diminution.  The 
loss  sustained  is,  consequently,  in  the  quality  or  character, 
rather  than  in  the  numbers,  of  the  present  occupants  of  the  soil. 
The  early  public  records  show  that  the  first  settlers  had  families 
of  seven  to  nine  individuals,  but  this  prolificness  has  gradually 
declined,  and  the  equipoise  in  the  population  has  been  main- 
tained by  the  fertility  of  other  classes  more  recently  added  to 


376  Reviews.  [Oct., 

the  community.  At  present  it  is  calculated  that  the  families  of 
the  genuine  New  Englander  do  not  exceed  four,  and  may  not 
be  much  over  three,  in  number ;  and  although  sources  of  error 
may  arise  in  some  of  the  census  returns,  including  all  inhabi- 
tants without  distinction ;  in  certain  places  where  the  native  has 
been  separated  from  the  foreign  element,  it  would  appear  that 
during  the  last  century  the  birth-rate  and  death-rate  have  been 
gradually  approximating  among  the  pure  American  race,  and 
that  in  certain  towns,  peopled  almost  exclusively  by  this  class, 
the  latter  exceeds  the  former.  This  discouraging  fact  is  not 
altogether  explicable  by  any  special  law  of  unproductiveness,  or 
by  the  practice  of  abortion  known  to  exist  to  a  certain  extent, 
and  suspected  to  be  resorted  to  for  the  very  purpose  of  restrict- 
ing the  number  of  children,  and  thus  diminishing  the  cares  and 
toil  of  maternity,  and  an  elucidation  of  the  difficulty  must  be 
sought  for  in  the  constitution,  the  habits,  the  education,  or  the 
lack  of  physical  education  of  the  infertile  classes.  That  a 
different  rate  of  propagation  is  characteristic  of  different  races, 
or  of  the  same  race  living  under  different  circumstances,  has 
been  demonstrated.  That  luxury,  licentiousness,  intemperance, 
and  the  antagonistic  conditions  of  frugality,  virtue,  and  asceti- 
cism, exercise,  or  may  exercise,  an  important  influence  over  the 
rate  of  fecundity,  has  been  admitted ;  but  in  all  such  investiga- 
tions the  state  of  the  organization  and  of  the  functions  of  the 
parents  have  been  singularly  overlooked,  and  information  sought 
for  from  remote  or  collateral  sources.  The  author  conceives, 
and  rightly  conceives,  that  the  health  of  the  progenitors  deter- 
mines, more  than  any  other  circumstance,  the  numbers,  the 
viability,  and  the  state  and  strength  of  the  organs  and  all  the 
functions,  mental  and  physical,  of  the  issue.  This  truth,  or 
law  of  propagation,  as  he  styles  it,  he  formulises  in  the  words, 
"a  perfect  standard  of  organization,"  or  "perfectionism  of 
structure  and  harmony  of  function,"  or,  in  other  words,  that 
each  organ  in  the  human  body  should  be  perfect  in  structure, 
and  that  each  should  perform  its  legitimate  functions  in  harmony 
with  others.  It  would  be  difficult  to  define  or  to  describe  this 
standard  or  maximum  health  point,  or  to  discover  examples 
of  such  "  perfectionism,"  even  amongst  the  most  finely  formed 
and  robustly  developed  members  of  rural  and  unvitiated  com- 
munities, or  amongst  those  who  have  passed  the  rubicon  created 
by  insurance  companies,  military  boards,  or  wherever  inquisition 
is  instituted  as  to  "  good  lives."  It  is  perfectly  clear  that  a  mature 
and  undiseased  stock  is  required  for  the  production  of  healthy 
descendants.  In  this  sense  the  effect  of  hereditary  tendencies 
may  be  admitted,  as,  while  we  may  refuse  to  believe  in  the 
transmission  of  a  specific  taint,  it  is  obvious  that  the  feeble,  the 


1875.] 


On  Inter-Mairiage.  37? 


exhausted,  the  consumptive,  the  syphilitic,  must  be  less  capable 
of  procreating  at  all,  and  of  producing  strong  and  uninfected 
progeny,  than  the  virile  and  vigorous.  In  a  similar  acceptation 
propinquity  may  be  held  to  act  by  intensifying  whatever  may 
be  most  prominent  or  potent  for  good  or  for  evil  in  the  constitu- 
tion of  the  ascendants,  and  barrenness  may  thus  depend,  not 
upon  impotence  created  by  kinship,  but  by  weakness  and  disease. 
It  would  appear  that  states  of  the  system  much  less  important 
than  positive  or  structural  diseases,  whether  innate  or  communi- 
cated, affect  or  limit  reproduction,  as,  for  instance,  changes  in 
the  balance  of  nutrition,  as  in  corpulency — the  relative  activity 
of  different  organs,  as  where  intelligence  is  highly  cultivated  by 
intense  study,  where  the  imagination  and  emotions  are  excited 
by  literature  and  refinement  at  the  expense  of  muscular  and 
digestive  power,  and  where  all  the  appliances  of  modern  civi- 
lisation are  employed  in  stimulating  and  thus  exhausting  the 
nervous  system.  As  a  corollary  to  this  proposition  it  may  be 
mentioned  that  giants  and  dwarfs  are  unprolific,  and  that  per- 
sons of  expanded  or  contracted  mind  have  few  descendants. 
Excess  in  the  gratification  of  the  propensities  is  visited  by  a  simi- 
lar retribution,  and  the  vicious,  the  dissolute,  the  intemperate, 
are  generally  the  last  of  their  line.  Such  results,  as  well  as 
the  deterioration  and  waning  proportions  of  the  original  Ame- 
rican race,  may  ensue  from  adventitious  circumstances,  or  others 

not  included  in  the  copious  catalogue  supplied  by  De  A , 

who,  while  defending  his  countrywomen  from  the  imputation 
that  they  are  indisposed  to  nurse  their  children  and  to  under- 
take the  attendant  fatigues  and  responsibility,  acknowledges,  in 
the  first  place,  that  not  more  than  one  half  of  these  mothers  are 
supposed  to  be  able  to  act  in  this  capacity,  or  to  furnish  nour- 
ishment to  their  infants,  and,  in  the  second  place,  that  this 
inability  depends  upon  the  imperfect  development  '^  of  the 
lymphatic  and  sanguine  temperament "  and  of  the  mammary 
glands.  This  defect  he  attributes  to  modes  of  dressing,  tight- 
lacing,  to  the  neglect  of  physical  training  and  exercise,  and 
generally  to  the  influence  of  a  vicious  education  and  of  an 
artificial  state  of  society.  He  holds  that  a  decided  change  has 
taken  place  in  the  organization  of  the  female  sex  in  New  Eng- 
land during  the  past  century.  Formerly  there  was  more  muscle, 
a  larger  frame,  greater  fulness  of  form,  and  a  better  development 
of  all  those  organs  that  are  "classed  under  the  sanguine  and 
lymphatic  temperaments.*'  Contemporaneously  there  was  less 
predominance  of  the  brain,  and  the  nervous  system  was  less  ex- 
cited and  over-  taxed.  This  picture  now  represents  the  German, 
English,  and  Irish  intruders,  but  not  the  descendants  of  the 
original  colonists  of  New  England.     In  addition  to  such  direct 


378  Reviews.  [Oct., 

agency,  the  recourse  to  artificial  food,  the  disregard  of  all  phy- 
siological experience  as  to  clothing,  ventilation.  Sec,  must  lead 
to  a  large  increase  in  the  mortality  of  the  young,  and  may,  so 
far,  explain  the  startling  announcement  that  one  third  of  all 
children  in  this  portion  of  the  United  States  die  before  they 
reach  five  years  of  age.  It  is  marvellous  that  either  by  acci- 
dent or  design  the  natural  prevention  or  remedy  for  such  dis- 
astrous social  evils  should  not  have  been  found  in  the  admix- 
ture of  the  two  sections  of  the  inhabitants,  of  those  who  destroy 
and  those  who  perpetuate  their  kind,  of  the  bold  and  brawny 
adventurer  with  his  feeble  and  exhausted  predecessors ;  but  it 
can  be  easily  understood  that,  even  in  a  country  where  there  is 
a  dead  level  of  rank,,  and  where  the  acquisition  of  wealth  gives 
a  patent  of  nobility,  great  gulfs  may  separate  the  old  peoples 
from  the  new,  the  rising  from  those  who  have  risen,  the  lords 
of  the  soil  from  the  sons  of  toil,  even  those  of  higher  physical 
organization  from  those  of  weaker  or  worn-out  powers.  It  was 
said  by  a  great  statesman,  of  the  English,  that  were  not  the 
nobility  to  marry  their  cook  or  laundress  in  every  second  or 
third  generation  the  aristocracy  would  die  out.  We  would  dis- 
pute the  inference,  but  commend  the  practice.  Such  crossings 
are  calculated  to  break  down  that  innateness  of  type  which 
imparts  sameness  or  similarity  of  qualities  to  families,  and,  if 
the  selection  be  judicious,  they  would  secure  a  transfusion  of 
new  moral  pabulum,  an  interchange  of  important  faculties  in 
which  the  respective  parties  may  be  deficient,  of  new  habits  of 
thought,  feeling,  action,  and  if,  as  some  theorists  assert,  the 
brain  and  nervous  system  of  one  parent  and  the  nutritive  and 
muscular  organs  of  the  other  be  reproduced,  the  foundation  of 
a  new  and  more  perfect  race  may  be  begun.  When  physiology 
is  universally  understood  and  applied,  and  when  medical  men 
become,  as  Dr.  A.llen  thinks  they  should,  the  guides  in  all  the 
social  relations  of  life,  they  may  assume  the  function  of  regu- 
lating such  selections,  of  assorting  such  unions  in  accordance 
with  the  destinies  of  successive  generations  as  well  as  of 
individuals,  and  of  presiding  over  a  new  human  evolution ! 


IX. — Veterinary  Sanitary  Science.^ 
Mr.  Fleming's  two  volumes  fill  a  void  long  felt  in  veterinary 
literature.  The  subjects  discussed  in  them  are  of  the  greatest  import- 
ance to  the  health,  the  wealth,  and  in  a  great  measure  to  the  prosperity, 
of  our  country.      Unfortunately  veterinary  sanitary  science  is  in  its 

1  A  Manual  of  Veterinary  Sanitary  Science  and  Police.   By  Geoegb  FLEMING. 
Two  vols 


1875.]  Veterinary  Sanitary  Science.  37^ 

infancy  in  England,  no  veterinary  medical  department  for  the  sup- 
pression of  contagious  diseases  having  been  instituted  previously  to 
1865  ;  and  it  was  only  when  the  cattle  plague  raged  that  our  Govern- 
ment proceeded  to  form  such  a  service.  It  is  a  department  which  might 
be  of  incalculable  benefit  in  the  hands  of  an  efficient  and  energetic 
administration.  The  many  papers  which  have  been  written  upon 
this  subject^  by  being  scattered  throughout  numerous  periodicals  and 
pamphlets,  are  consequently  difficult  of  access,  so  that  the  author 
has  done  good  service  for  his  fellow-practitioners  in  issuing  this  the 
first  complete  work  in  the  English  language  which  fully  describes 
this  important  branch  of  veterinary  medicine.  He  has  shown  con- 
,  siderable  industry  in  collecting  and  arranging  the  results  of  the  most 
recent  labours  of  the  best  Continental  veterinary  authorities,  and 
has  spared  no  trouble  in  laying  before  us  in  a  very  clear  manner  the 
scientific  aspect  of  veterinary  medicine,  viz.  the  nature  and  prevention 
of  sporadic,  enzootic,  and  epizootic  maladies,  and  their  close  relation 
to  the  diseases  of  the  human  subject.  To  the  medical  practitioner 
the  most  interesting  part  of  the  work,  and  by  far  the  most  important, 
is  that  treating  of  the  transmission  of  contagious  diseases  from  the 
lower  animals  to  man,  by  contact,  by  inoculation,  and  by  means  of 
diseased  meat  and  milk. 

These  volumes  strengthen  us  in  the  belief,  which  we  have  long  had, 
that  the  diseases  of  man  and  of  the  lower  animals  are  much  more 
intimately  connected  than  many  authorities  seem  to  suppose.  There 
is  every  opportunity  of  thoroughly  investigating  by  numerous  and 
varied  experiments  the  diseases  'of  the  lower  animals ;  and  in  the 
case  of  epizootics,  by  such  a  course  we  are  confident  that,  with  such 
workers  as  Chauveau,  Sanderson,  and  Klein,  much  light  will  be 
thrown  upon  the  nature  of  epidemics. 

In  considering  the  history  of  the  importation  of  foreign  stock 
into  England  we  find  that  the  prices  of  home  stock  remained  unal- 
tered ;  that  there  was  no  direct  advantage  to  the  public ;  and  that  ever 
since  1839  we  have  had  outbreak  after  outbreak  of  contagious  dis- 
eases which  have  destroyed  our  prime  herds  and  flocks.  The  result 
of  this  is  being  felt  in  the  present  high  price  of  butchers'  meat.  In 
fact,  the  introduction  of  foreign  stock  has  introduced  foreign  dis- 
eases, which  have  destroyed  more  of  our  home  stock  than  the  actual 
value  of  all  the  wretched  foreign  animals  imported  into  the  country. 
Mr.  Clare  Sewell  Eead,  M.P.,  stated  in  the  House  of  Commons 
that,  according  to  the  official  returns  of  the  Board  of  Trade,  the  total 
home  supply  in  towns  for  1867,  ^68,  ^69,  and^70,  of  butchers'  meat 
was  9I5  per  cent.,  as  against  4^  per  cent,  live  animals  and  44  per 
cent,  of  dead  meat  from  foreign  countries.  If  we  take  into  consi- 
deration the  amount  of  butchers'  meat  consumed  in  the  agricultural 
districts,  it  will  increase  our  home  percentage  considerably.  Erom  a 
consideration  of  the  foregoing  it  appears  very  unjust  that  the  British 


3  so  Reviews.  [Oct., 

farmer  should  risk  92  per  cent,  of  his  prime  stock  for  the  alleged  benefit 
of  receiving  4  per  cent,  of  scurvy  foreigners  teeming  with  transmis- 
sible diseases.  So  that  what  the  public  gain  in  butchers'  meat  by 
foreign  importation  is  represented  by  a  cypher,  and  what  the  pubhc 
do  purchase  of  home-fed  stock  is  increased  fourpence  per  pound. 
We  are  not  protectionists;  we  do  not  object  to  the  introduction  of 
foreign  animals  to  provide  food  for  the  rapidly  increasing  population, 
but  we  most  decidedly  object  to  the  importation  of  diseases  that  are 
detrimental  to  the  interests  of  the  country.  Surely  the  public 
should  be  protected  in  this  matter.  Pree  trade  in  disease  cannot 
bring  anything  but  ruin  to  health  and  prosperity.  In  order  to  give 
some  idea  of  this  pecuniary  sacrifice  we  quote  the  following  state- 
ment from  Mr.  Fleming's  first  volume  (pages  14  and  15)  : 

"  Up  to  1869,  for  the  thirty  years  that  had  elapsed  since  the  intro- 
duction of  the  two  contagious  maladies — foot-and-mouth  disease  and 
bovine  pleuro-pneumonia — it  was  estimated  that  the  loss  from  these 
alone  amounted  to  5,549,780  head  of  cattle,  roughly  valued  at 
5683,616,854.  This  is,  of  course,  irrespective  of  the  losses  from  cattle 
plague.  There  cannot  be  a  doubt  that  the  same  rate  of  loss  has  con- 
tinued, if  it  has  not  largely  increased,  since  that  period.  In  1872,  for 
instance  from  one  malady  only — foot-and-mouth  disease — it  is 
calculated  that  the  money  loss  in  Britain  must  have  amounted  to 
£13,000,000;  but  some  authorities  are  of  opinion  that  this  is  even 
under-estimated.  In  Ireland,  for  the  same  year,  229,570  cattle  were 
reported  by  the  police  as  affected  with  the  disease,  but  this  is  undoubtedly 
only  a  tithe  of  the  actual  number,  as  a  declaration  of  its  existence  is 
the  exception,  not  the  rule.  Nevertheless,  if  we  estimate  the  loss  on 
each  animal  reported  at  £2  (though  it  may  be  nearer  ^64),  we  have 
£441,140  to  be  added  to  the  above  sum  as  the  pecuniary  loss  incurred 
in  the  three  kingdoms  from  the  existence  of  one  preventible  malady 
only.  The  damage  inflicted  by  contagious  pleuro-pneumonia  is  pro- 
bably not  much  less,  as  it  is  always  prevalent,  whereas  the  other  is 
more  diffused  at  some  seasons  than  others." 

The  loss  by  cattle  plague  amounted  to  about  £8,000,000. 

According  to  our  own  investigations  into  the  loss  of  stock  by 
preventible  diseases  of  foreign  origin  it  amounts  to  £11,904  per  day, 
and  as  nearly  as  possible  to  £4,000,000  a  year,  so  that  in  our  opinion 
Mr.  Fleming's  statistics  are  most  decidedly  below  the  mark. 

This  is  not  as  it  should  be.  Owing  to  our  insular  position^  there 
should  be  no  difficulty  in  preventing  the  introduction  of  diseases 
indigenous  to  foreign  soils.  We  hope  the  time  is  not  far  distant 
when  State  medicine  will  fully  reahse  the  importance  of  veterinary 
sanitary  science,  and  assist  in  preventing  the  transmission  of  deadly 
plagues  from  the  lower  animals  to  already  sufficiently  afflicted 
humanity. 

Mr.  Fleming's  work  is  divided  into  four  parts.   The  first  section  em- 


1875.]  Velerinary  Sanitary  Science.  88l 

braces  a  consideration  of  the  nature  and  causes  of  sporadic,  enzootic, 
and  epizootic  diseases,  and  the  influence  of  traffic  on  animal  plagues. 
The  causes  are  treated  in  a  very  exhaustive  manner.  The  chapters 
on  the  "  effects  of  locality "  and  the  ''  influence  of  food  "  in  the 
production  of  disease  will  be  found  most  interesting,  and  will  repay 
careful  perusal.  Those  treating  of  infection  and  contagion  contain 
the  latest  views  upon  this  important  subject,  the  labours  of  Chau- 
veau,  Sanderson,  Budd,  Beale,  and  Eichardson  being  clearly  dis- 
cussed. 

The  results  of  experiments  on  the  "infection  radius,''  a  most 
important  subject  for  veterinarians,  are  given.  The  "elaboration 
of  disease  germs,"  the  "mode  of  access  of  disease  germs,'^  and 
the  "  vitality  of  disease  germs,"  are  all  ably  dealt  with  in  distinct 
sections.  An  epitome  of  the  researches  of  Davaine,  Chauveau,  and 
others  on  "  septic  infection/'  cannot  fail  to  be  interesting  to  the 
profession. 

In  part  second  is  discussed  the  prevention  and  suppression  of 
epizootic  and  contagious  diseases.  The  value  of  veterinary  sanitary 
science  is  fully  set  forth  by  the  author ;  and  it  may  be  as  well  to 
give  an  extract  showing  the  utility  of  such  a  science.     He  says — 

*'  It  must  be  remembered  that  the  majority  of  the  maladies  which 
come  under  the  cognizance  of  veterinary  sanitary  science  more  or 
less  directly  affect  every  branch  of  agriculture,  and  that  the  damage 
they  cause  is  not  limited  to  the  immediate  pecuniary  loss  and  incon- 
venience attending  the  inefficiency  or  death  of  those  affected,  but  ex- 
tends to  the  breeding  and  multiplication  of  animals,  embarrasses  one 
or  more  departments  of  commerce,  and  generally  injures,  to  a  more  or 
less  considerable  extent,  the  well-being  of  mankind.  Not  only  are 
such  diseases  formidable  by  the  damage  they  inflict,  but  some  of  them 
are  most  serious  from  the  pernicious  influence  they  may  exercise  on  the 
public  health,  either  by  their  transmission  to  mankind  by  contact  or 
accidental  inoculation,  or  by  the  use  of  the  flesh  or  products  of  the 
diseased  animals  as  food.  Some  of  the  most  dreadful  and  fatal  mala- 
dies are  thus  occasioned." 

'*  The  maxim  that  *  prevention  is  a  thousand  times  better  than  cure  * 
is  founded  on  the  experience — some  of  it  of  a  very  painful  kind — of 
many  years  ;  indeed,  its  truthfulness  appears  to  have  been  recognised 
from  the  very  earliest  times,  though  the  lesson  it  inculcates  has  only 
too  frequently  been  forgotten.  Many  of  the  spreading  diseases  of 
animals  are  not  amenable  to  medical  treatment,  so  that  the  expense  and 
trouble  incurred  are  completely  thrown  away.  Meanwhile  the  con- 
tagia  may  be  so  virulent  and  subtile  that  they  are  continually  and 
widely  spread  through  attempts  to  cure,  and,  if  the  diseases  are  very 
fatal,  the  loss  incurred  may  be  enormous  and  distressing.  We  have 
but  to  remember  what  happened  in  Britain  during  the  reign  of  the 
cattle  plague,  in  1865  and  1866.  And  even  if  easily  remedied  and  not 
very  fatal,  but  yet  highly  contagious,  their  treatment  must  be  attended 

112— Lvi.  25 


382  Reviews,  [Oct., 

with  expense  and  inconvenience  ;  while  their  widespread  existence, 
and  the  loss  of  service,  condition,  and  productiveness  of  the  animals 
(to  say  nothing  of  the  suffering  they  experience)  may  render  an  easily- 
preventible  disease  a  heavy  calamity.  We  need  but  instance  the  so- 
called  "  foot-and-mouth  "  disease.  This  is,  therefore,  neither  a  scientific, 
a  rational,  nor  a  profitable  occupation  ;  and  Science  is  unworthy  of  the 
name  if  it  neglects  preventive  measures,  even  in  ordinary  cases  of  dis- 
ease, and  bungles  over  a  useless  remedy,  or  consumes  half  the  value  of 
the  creature  it  attempts  to  cure,  when  it  might  at  scarcely  if  at  any 
cost  have  maintained  it  in  health." 

"  Deeply  impressed  with  these  facts,  the  governments  of  almost  every 
European  country  pretending  to  any  degree  of  civilisation  have  for 
years  been  wisely  and  carefully  studying  the  subject  of  these  diseases, 
with  a  view  to  their  prevention  and  suppression.  By  several  of  them 
laws  have  been  judiciously  framed,  a  veterinary  sanitary  department  of 
service  under  government  auspices  and  control  has  been  organized,  and 
carrying  out  of  the  preventive  measures  has  been  committed  to  its  care  ; 
the  whole  scheme  of  organization  being  chiefly  founded  on  the  assist- 
ance to  be  derived  from  the  well-educated  and  thoroughly  trained 
veterinarians,  on  whom  must  always  devolve  the  most  important  and 
responsible  share  of  the  duty  in  preventing  or  arresting  the  spread  of 
destructive  diseases.  A  word  from  this  department,  and  the  machinery 
of  a  vigilant  government,  careful  in  protecting  its  subjects  from  loss, 
is  immediately  put  in  movement;  and  in  this  way  disastrous  conse- 
quences are  averted,  almost  without  eff'ort,  and  at  a  minimum  cost. 
Not  only  is  this  organization  invaluable  in  this  direction,  but  it  is  found 
to  be  equally  valuable  in  other  ways — such  as  maintaining  the  neces- 
sary inspection  of  slaughter-houses ;  ensuring  that  the  supply  of  animal 
food  is  of  healthy  and  proper  quality ;  keeping  a  watch  on  the  move- 
ments of  animals  throughout  the  country  with  regard  to  their  sanitary 
condition,  and  particularly  with  regard  to  the  existence  of  contagious 
diseases  ;  aff'ording  instruction  in  contagious  diseases,  hygiene,  &c.,  to 
agriculturists  and  others ;  and  the  drawing  up  of  reports  on  the  health  of 
animals,  in  which  are  contained  suggestions  for  their  improvement  and 
better  management." 

The  general  and  suppressive  measures  advocated  by  the  author 
are  most  excellent.  They  have  the  merit  of  being  thorough ;  but, 
unfortunately,  they  are  too  Continental,  or,  if  we  may  use  the  term, 
un-English — being  so  stringent,  smelling  strongly  of  the  lands  of 
conscription,  that  they  would  not  be  tolerated  for  a  day  by  English- 
men, and,  in  our  opinion,  must  therefore  remain  a  dead  letter. 
But  what  Mr.  Eleraing  recommends  is  not  lost  upon  us,  as  he  has 
set  forth  the  most  successful  Continental  systems  of  suppressing 
contagious  and  infectious  maladies ;  and  from  it  we  may  select  a 
more  simple  system  which  might  be  enforced  in  this  country,  and  in 
a  few  years  would  completely  eradicate  such  diseases  from  our  land. 
We  must  strike  at  the  root  of  the  evil  by  preventing  the  introduc- 
tion of  foreign  diseases.  This  can  be  done  in  one  of  two  ways— 
either  stop  the  importation  of  all  live  stock  into  this  country  and 


1875.]  Veterinary  Sanitary  Science.  38^' 

let  it  be  sent  as  dead  meat,  which  plan  is  adopted  at  present  with 
the  prime  Scotch  beef  from  Aberdeenshire  to  the  London  markets ; 
or,  kill  all  animals  at  the  port  of  debarkation.  This  last  plan  would 
not  be  so  thorough  as  the  former,  but  either  course  would  prevent 
the  continued  introduction  of  the  virus  and  the  diseases  would 
naturally  die  out.  In  the  case  of  isolated  outbreaks  fine  or  im- 
prisonment should  be  the  penalty  for  knowingly  keeping  an  animal 
suffering  from  an  infectious  or  contagious  disease.  Inspectors  should 
be  appointed  to  different  districts  with  full  power  to  kill,  and  isolate, 
the  apparently  healthy  stock,  and  disinfect  premises,  as  circum- 
stances may  require.  Inspectors  should  be  independent  of  private 
practice.  In  the  case  of  pleuro-pneumonia  they  should  have  power 
to  inoculate  all  cattle  that  have  been  near  the  affected  herd.  Com- 
pensation to  the  extent  of  three  fourths  should  be  allowed.  If 
these  means  were  carried  out  promptly  and  thoroughly  it  would  soon 
put  a  stop  to  such  diseases,  provided  the  importation  of  the  fresh 
virus  be  prevented. 

A  word  about  the  inspection  of  stock  at  public  markets,  in  steam- 
boats, &c.  We  are  compelled  to  say,  from  our  experience  of  such 
duties,  that  it  is  of  doubtful  utility,  as  inspectors  cannot  possibly 
recognise  disease  during  its  incubative  stages ;  for  instance  in  the  case 
of  pleuro-pneumonia  the  period  is  forty  days ;  in  cattle  plague  six 
dajs,  and  in  epizootic  aphtha  from  three  to  five  days.  All  that  the 
inspector  can  do  is  to  reject  the  number  of  animals  actually  showing 
the  disease  ;  but  it  is  evident  that  the  pet  system  of  the  Privy  Council 
Office  (veterinary)  can  be  no  protection  to  our  home  stocks. 

In  the  chapters  on  ''  disinfection  and  disinfectants  ^'  veterinarians 
will  find  all  that  is  necessary  for  their  guidance. 

Part  third,  the  special  contagious  diseases  are  discussed,  such  as 
cattle  plague,  contagious  pleuro-pneumonia  in  cattle,  epizootic  aphtha 
(foot-and-mouth  disease),  glanders,  farcy,  strongles,  influenza, 
variolous  fevers,  anthrax  and  anthracoid  diseases,  splenic  or  Texas 
fever  in  cattle,  fowl  cholera,  rabies,  distemper  in  dogs,  venereal 
diseases  of  solipeds,  tuberculosis  of  cattle,  and  other  important  con- 
tagious diseases.  In  our  humble  opinion  this  is  by  far  the  best 
portion  of  the  work.  The  author  gives  a  full  description  of  their 
history,  causes,  symptoms,  terminations,  and  treatment.  The  patho- 
logical anatomy  is  also  admirably  described,  and  can  be  fully  de- 
pended upon — which  is  unlike  most  veterinary  works,  as  they  are 
at  least  thirty  years  behind  in  this  important  branch  of  science. 
In  the  article  on  contagious  pleuro-pneumonia  inoculation  as  a 
preventive  is  fully  discussed,  and  we  would  urge  veterinarians 
to  study  and  practise  the  hints  thrown  out.  The  chapter  on  epi- 
zootic aphtha  (foot-and-mouth  disease)  is  important  to  medical 
practitioners,  as  it  is  a  disease  that  is  very  frequently  transmitted  to 
the  human  subject.     We  have  long  been  convinced  from  our  obser- 


384  Hevietos.  [Oct., 

vations  that  during  an  extensive  outbreak  of  this  disease  (provided 
the  cow's  udder  be  affected)  it  spreads  to  mankind  through  tlie  milk, 
although  it  may  be  and  is  transmitted  in  other  ways.  Cow's  milk 
is  now  more  used  than  ever  in  the  alimentation  of  infants,  and  we  are 
assured  that  it  becomes  an  important  factor  in  the  production  of 
intestinal  and  eruptive  diseases  in  children.  This  poison,  if  once  in- 
troduced into  the  body,  has,  without  doubt,  a  tendency  to  a  fatal 
termination  in  all  young  animals.  The  bad  effects  of  such  milk  upon 
man  have  been  observed  by  Hartwig,  Yillian,  Gamgee,  Gilmot, 
Watson,  Dr.  Hislop,  Dr.  Thom,  and  Dr.  Nichol,  Boston,  U.S.,  and 
many  others  wt  could  mention.  As  the  disease  is  at  present  spreading 
over  the  length  and  breadth  of  the  country,  we  trust,  should  cases 
occur,  medical  men  will  report  them  to  the  medical  pa])ers. 

Glanders,  another  most  terrible  disease  an,d  one  easily  com- 
municable to  man,  is  discussed.  An  idea  of  our  danger  from  this 
source  mav  be  gleaned  from  the  fact  that  the  annual  loss  is  esti- 
mated to  be  over  £20,000. 

Tuberculosis  in  cattle  is  the  subject  of  a  suggestive  paper.  Un- 
fortunately this  has  become  a  very  common  disease  among  dairy 
cows.  One  extract  will  indicate  the  drift  of  the  paper.  "  Gerlach 
and  others  have  demonstrated  that  the  milk  of  tuberculous  cattle 
will  produce  phthisis  in  creatures  fed  wdth  it.'' 

Part  fourth  embraces  a  consideration  of  the  inspection  of 
slaughter-houses,  meat,  milk,  and  knackers'  yards.  This  part  of 
the  work  will  be  found  most  useful  to  officers  of  health,  as  the 
hints  given  may  assist  them  in  their  important  duties. 

The  merits  of  this  excellent  work  are  so  unquestionable  that  we 
have  little  hesitation  in  pointing  out  what  we  suppose  might  be  im- 
provements. It  is  to  be  regretted  that  the  anther  did  not  issue  the 
work  in  two  separate  books,  the  first  on  veterinary  sanitary  science 
and  police  proper,  the  other  as  a  treatise  on  the  diseases  of  the  lower 
animals  communicable  to  mankind.  As  a  text-book  for  veterinary 
students  and  agriculturists  the  work  would  admit  of  condensation, 
and  would  be  improved  by  the  absence  of  such  technicalities  as 
occision  (page  249),  pro  drome  (page  325),  bossilated,  and  others 
of  a  like  nature.  The  absence  of  many  of  the  woodcuts  would  be 
no  great  loss  to  the  work,  as  some  of  them  are  really  bad.  The 
effects  of  sudden  change  of  food  should  be  treated  at  greater  length, 
as  it  is  one  of  the  most  prohfic  causes  of  blood  disorders  in  this 
country.  The  same  remarks  apply  to  the  '^  effects  of  pastures." 
A  chapter  on  the  effects  of  immature  food  is  much  wanted,  as  it 
frequently  gives  rise  to  intestinal  disorders  and  even  symptoms  of 
poisoning. 

In  conclusion  we  have  no  hesitation  in  saying  that  Mr.  Fleming's 
book  is  one  of  the  best  works  on  veterinary  medicine  in  the  English 
language. 


I 


1875,] 


Clay^s  Obstetric  Surgenj,  38.' 


X. — Clay's  Obstetric  Surgery .1 

We  may  credit  the  statement  of  the  author  in  the  commencement 
of  the  preface — "  The  fact  that  a  third  edition  of  this  '  Manual  of 
Obstetric  Surgery'  has  been  called  for  is  sufficient  proof  of  its 
general  utility/^  The  present  volume,  he  asserts,  has  been  care- 
fully revised,  considerably  enlarged,  and  contains  additional  illus- 
trations. We  may  add  further  that  it  is  printed  in  a  clear,  readable 
type ;  is  of  a  handy  size,  not  too  large  for  the  pocket ;  and  that  the 
illustrations  are  neat,  though  not  very  numerous. 

In  dealing  with  the  subject  of  operation  the  author  includes  not 
only  those  cases  where  the  surgeon's  knife,  ligature,  or  caustic  are  the 
chief  agents,  but  also  those  which  require  mechanical  and  manual  aid, 
as  versions  and  operations  with  the  forceps,  vectis,  blunt  hook,  &c. 

The  value  of  the  book  when  it  originally  appeared  was  doubtless 
great,  and  possibly  has  done  much  to  allay  the  anxiety  of  many 
a  young  practitioner  who  had  treated  the  subject  of  midwifery  with 
far  too  much  indifference  when  walking  the  hospitals,  or  had  enjoyed 
little  opportunity  of  learning  it  practically. 

What  we  shall  principally  endeavour  to  examine  in  the  present 
notice  will  be  the  question  of  whether  the  work  has  kept  pace  with 
the  times — whether,  in  fact,  the  information  and  instructions  are 
"  up  to  date.''  On  turning  to  the  subject  of  (induction  of)  abortion, 
the  author  states  he  has  no  confidence  in  medicines  to  procure 
abortion.  "  The  only  certain  means  is  by  mechanically  rupturing 
the  membranes,  and  then  directly  destroying  the  vitality  of  the  em- 
bryo in  utero  "  (p.  14). 

As  a  natural  sequence  to  this  we  are  quite  prepared  to  read  further 
on,  p.  16 — ^^  There  are  dangers  to  be  feared  arising  from  the 
operations  of  a  highly  responsible  and  not  unfrequently  fatal  charac- 
ter, such  as  haemorrhage,  metritis,  and  peritonitis." 

Need  we  say  that  in  the  early  months  of  utero- gestation,  the 
cervix  being  closed  and  the  membranes  high  up,  it  must  be  difficult 
to  puncture  these  latter  without  a  risk  of  interfering  with  the  integrity 
of  the  cervix,  and  of  thus  setting  up  serious  or  even  fatal  mischief,  as 
so  frequently  happens  in  cases  of  criminal  abortion  ?  This  plan  of 
rupturing  the  membranes,  excepting  in  special  cases  of  hsemorrhage, 
is  condemned  by  nearly  all  modern  writers  on  the  subject,  as  being 
unscientific  in  theory  and  dangerous  in  practice.  It  is  not  inducing 
the  uterus  to  throw  off  its  contents,  but  aggravating  it,  so  to  speak, 
into  open  hostility.  It  is  compelling  the  uterus  to  expel  the  ovum 
in  a  directly  inverse  method  to  that  adopted  by  nature. 

1  The  Complete  HandhooJc  of  Obstetric  Surgery.      By  Chaei,bs  Clay,  M.D. 
Tliird  edition.     1871 


386  Reviews.  [Oct., 

The  plan  suggested  by  Barnes,  and  now  very  generally  practised, 
of  inducing  premature  labour  or  abortion  is,  by  passing  a  bougie  or 
catheter,  and  allowing  it  to  remain  between  the  membranes  and  the 
interior  of  the  uterus,  accelerating  by  dilating  the  cervix,  and  not 
puncturing  the  membranes,  until  the  os  is  sufficiently  dilated  to  allow 
of  the  passage  of  the  ovum,  and  not  even  then  unless  requisite. 
The  author  has,  of  course,  a  perfect  right  to  his  own  opinion ;  but 
it  would  have  been  better  had  the  more  modern  method  been  men- 
tioned as  well,  together  with  the  diminution  of  risk,  and  if  he  had 
not  confined  himself  to  the  statement, — "The  only  certain  means 
is  by  mechanically  rupturing  the  membranes." 

In  speaking  of  Caesarean  section  the  author  asserts  that  it  may 
be  done  *'  a  full  hour  after  the  death  of  the  parent  with  a  chance  of 
success,"  p.  45.  Although  we  do  not  doubt  this  may  have  happened, 
it  is  more  than  probable  that  ''  dead  more  than  hour,"  owing  to 
the  unintentional  exaggeration  of  the  friends,  would  more  correctly 
have  been  stated  at  half  if  not  a  third  of  that  period.  In  any  case^  if 
the  doctor  be  present,  we  would  advise  his  operating  at  once  if  he 
intends  to  do  so  at  all. 

The  details  of  the  operation  are  clearly  given,  and  evidently  are 
the  result  of  practical  experience. 

Puerperal  convulsions  are  probably  the  most  trying  complication 
of  labour  that  a  young  practitioner  can  encounter ;  but  even  this  fact 
will  scarcely  warrant  the  indiscriminate  use  of  the  lancet.  "  Bleed 
freely  to  thirty  or  forty  ounces,"  p.  12,  is  generally  at  the  present 
time  commuted  to  the  prescription  to  administer  chloroform  or 
exhibit  chloral ;  and  as  to  shaving  the  head,  unless  in  very  exceptional 
cases,  we  doubt,  if  the  patient  recovered,  whether  she  would  ever 
forgive  the  doctor.  After  some  considerable  experience  in  these 
cases,  we  do  not  hesitate  to  say  that  shaving  the  head  and  bleeding 
to  thirty  or  forty  ounces  are  expedients  now  very  seldom  requisite. 

The  experience  of  Charpentier  (and  many  others)  goes  far  to 
prove  the  great  value  of  chloral  and  chloroform  in  these  cases. 
'*The  mortality  in  cases  treated  by  bleeding  was  thirty-five  per 
cent.,  whereas  that  where  ansesthetics  were  used  was  eleven  per 
cent.,"  are  the  statistics  given  in  his  late  thesis. 

Lancing  the  gums  is  hardly  an  obstetric  operation,  however 
necessary  it  may  be  for  the  student  to  know  when  to  do  it,  and 
what  to  expect  from  it.  Eespecting  embryotomy,  the  rule  laid 
down  is,  that  "  it  is  justifiable  when  there  has  been  strong  labour 
for  some  hours  (about  five  or  six)  and  no  advance;"  it  is  also 
admittedly  justifiable  as  soon  as  ever  the  uterus  is  sufficiently  dilated 
to  allow  of  the  passage  of  the  foetus,  provided  the  capacity  of  the 
pelvis  is  such  that  it  is  impossible  for  a  living  child  to  be  extruded. 

''  The  perforator  and  crotchet  are  the  only  instruments  necessary," 
so  says  Mr.  Clay ;  we  beg  to  differ  very  materially.     The  cephalotribe 


1875.]  Clay's  Obstetric  Surgery,  387 

or  craniotomy  forceps  are  absolutely  necessary  to  effect  delivery  with 
safety  to  the  mother,  where  the  brim  is  so  contracted,  or  the  capacity 
of  the  pelvis  so  interfered  with  by  tumour,  as  to  preclude  the  passage 
of  a  living  child.  The  risk  is  considerably  less  than  where  extraction 
is  attempted  by  the  crotchet  alone. 

We  had  thought  that  the  days  of  pewter  syringes  had  long  past, 
yet  we  find  them  recommended  by  Dr.  Clay,  as  if  the  modern  im- 
provements in  vulcanized  india  rubber,  which  in  every  respect  are 
far  better,  did  not  exist.  The  form  of  syringe  figured  p.  78  is  the 
one  best  adapted  to  produce  cramp  in  the  hand ;  the  oval  shape  is 
far  better. 

On  "  evolution — expulsion  spontaneous  -J' — "  When  the  body  of 
the  child  is  fairly  engaged  in  the  pelvis  and  the  arm  presenting,'''  wait 
for  natural  efforts ;  and  after  watching  these  closely,  "  if  for  some 
time  no  advance  is  observed  I  advise  traction.''  ''  Turning  and 
evisceration  are  altogether  discountenanced."  Can  anything  be 
plainer  than  this?  We  quote  the  ipsissima  verba  that  we  may 
not  be  taxed  with  misrepresentation. 

Further  on  in  the  work,  under  arm  presentation,  the  author  tells 
us  spontaneous  evolution  before  the  child  is  engaged  in  the  brim  is 
hardly  possible ;  after  that,  impossible. 

The  chapter  containing  the  former  instruction  and  opinions  needs 
re-writing ;  it  is  difficult  to  reconcile  the  two  statements.  In  pro- 
lapsus of  the  cord  nothing  is  said  of  the  postural  treatment,  a  very 
important  omission. 

Progressive  shortening  of  the  cervix  uteri  in  advancing  pregnancy 
is  figured  and  described  according  to  the  old  views,  and  the  results 
of  modern  observation  left  unnoticed. 

In  ulceration  of  the  os  or  cervix  uteri  the  method  suggested  of 
squirting  injections  into  the  uterus  with  a  small  glass  syringe,  without 
the  aid  of  a  speculum,  is,  to  say  the  least,  injurious,  if  not 
dangerous. 

In  speaking  of  fistulse—vesico- vaginal — the  author  talks  of  "  in- 
curable cases,"  "  surgery  yet  at  fault,"  and  '^  great  room  left  for 
improvement."  Surely  these  remarks  must  have  been  written  many 
years  ago,  and  are  not  intended  to  apply  to  the  experience  of  to-day. 
Thomas,  in  his  excellent  treatise  on  diseases  of  women,  endorses 
the  opinion  of  Marion  Sims,  that  "  every  case  is  curable  when  the 
operation  is  practicable."  "  Success  is  the  rule,  failure  the  exception." 

The  indications  for  the  employment  of  forceps  are  thus  sum- 
marised : 

"If  twenty-four  hours  after  rupture  of  membranes  no  advance 
has  been  made  for  the  last  four  hours ;  if  exhaustion  manifested  by 
quick  pulse ;  cessation  of  pains ;  greenish  discharges ;  unpleasant 
smell ;  anxiety  of  countenance ;  hurried  breathing ;  tongue  coated ; 
vomiting ;  shivering ;  coldness ;    and  muttering  delirium ;  then  la- 


888  Reviews.  [Oct., 

lour  must  be  terminated^'  The  italics  are  our  own.  The  student 
who  relies  upon  this  advice,  who  waits  till  then,  and  only  then 
thinks  artificial  assistance  requisite,  will,  we  fear, — to  say  the  least, — 
have  small  success  in  practice. 

Speaking  generally,  we  would  say,  if  an  hour  after  rupture  of  the 
membranes — not  twenty-four — no  advance  has  been  made,  forceps 
or  other  assistance  should  at  once  be  resorted  to.  There  is  no 
object  in  waiting  for  hours,  and  often,  as  we  have  seen,  whole  nights 
and  days,  watching  a  patient  uselessly  expending  her  strength,  en- 
deavouring to  propel  her  offspring  through  an  aperture  too  small  to 
allow  of  its  passing,  or  with  force  too  feeble  to  accomplish  the 
object.  Modern  midwifery  prides  itself  upon  timely  assistance. 
Dr.  Hamilton,  of  Ealkirk,  has  proved  that  the  danger  of  forceps 
consists  only  in  delaying  their  application,  not  in  their  employment ; 
and  we  can  thoroughly  endorse  his  views.  How  many  cases  of 
pelvic  '^  cellulitis,"  vesico-vaginal  fistulse,  and  pelvic  peritonitis  are 
due  to  this  inane  inactivity  !  and  when  the  would-be  teachers  of  our 
youth  advise  us  thus  to  wait,  who  can  wonder  at  the  distressing  revela- 
tions of  the  coroners'  court  that  from  time  to  time  are  made  to  us,  or 
wonder  that  the  public  proceed  against  practitioners  for  mal praxis  ! 

The  author  started  with  the  promise  of  ^'  saying  all  that  is  really 
necessary, but  no  more;"  nevertheless  hegives  us  no  less  than  five- and- 
twenty  pages  on  the  subject  of  gestation,  entering  fully  into  details 
of  the  time  taken  by  rabbits  and  mares,  sows  and  cows,  details  which, 
though  doubtless  interesting,  are  quite  out  of  place  in  the  present 
handbook.  The  gist  of  the  whole  matter  seems  to  be  that  the  duration 
of  pregnancy  is  materially  influenced  by  the  respective  ages  of  the 
parents. 

Concerning  haemorrhage  with  hydatids,  we  differ  entirely  from  the 
author  as  to  manual  help  not  being  necessary  before  the  seventh 
month.  If  the  case  be  proved  to  be  one  of  hydatidiform  degenera- 
tion of  the  villi  of  the  chorion,  whether  it  be  at  the  fourth  or  fifth 
month,  the  sooner  the  uterus  is  emptied  of  its  contents  the  better. 

As  to  accidental  haemorrhage,  few  will  now  be  found  who  bleed  as 
suggested,  or  who  give  acetate  of  lead  and  opium. 

In  placenta  praevia,  in  place  of  turning  and  delivering  as  soon  as 
the  OS  will  permit  (p.  152),  or  detaching  the  placenta  entirely,  most 
authorities  now  content  themselves  wuth  rupturing  the  membranes, 
peeling  the  placenta  partially ,  not  entirely,  in  concentric  rings, 
from  the  cervix,  applying  the  tampon,  if  necessary,  and  waiting  on 
nature  for  further  indications. 

No  mention  is  made  of  the  injection  of  the  solution  of  perchloride 
of  iron  in  cases  of  post-partum  haemorrhage;  it  should  at  least 
have  been  referred  to,  even  if  the  author  does  not  agree  with  its 
employment. 

In  cases  of  retained  placeijta,  "if  the  haemorrhage  be  trifling. 


I 


1875.]  Clay's  Obstetric  Surgery.  389 

delay  extraction."  This  we  are  told  in  one  sentence,  and  yet  further 
on  we  find  it  stated  that  "  the  patient  is  not  safe  until  it  is  removed," 
and  that  "delay  gives  rise  to  apprehension  and  involves  the  charac- 
ter of  the  attendant." 

In  hour-glass  contraction  with  retained  placenta,  "  if  the  sym- 
ptoms are  not  urgent,  give  an  anodyne  and  wait."  A  little  gentle 
pressure  externally  with  tlie  finger,  introduced  in  form  of  a  cone, 
and  the  placenta  extracted,  will  generally  overcome  the  irregular 
contraction  at  once  without  any  need  of  opium. 

The  practical  reference  table  for  treatment  of  hsemorrhage  is  very 
clearly  drawn  up,  but  "  lead  and  opium  '^  would  be  as  well  ex- 
punged. 

lu  the  treatment  of  haemorrhoids  after  labour  the  plan  of  dilating 
the  sphincter  ani  forcibly  immediately  after  the  expulsion  of  the 
child,  while  the  patient  is  still  under  the  influence  of  chloroform, 
and  returning  the  piles,  is  not  alluded  to.  This  is  a  very  successful 
expedient. 

Tor  harelip  he  suggests  waiting  until  the  second  or  third  i/ear 
of  life  before  operating ;  most  modern  authorities  resort  to  it  when 
the  child  is  four  to  six  weeks  old — an  important  difference. 

*In  tedious  or  difficult  labour>  "  where  inertia  of  the  uterus  or 
deficient  contraction  attends  delicate,  exhausted  primiparse,"  he 
believes  the  great  remedy  to  be  opium — a  pill  of  two,  or  two  and 
a  half  grains,  or  one  drachm  of  tincture,  so  as  at  once  to  suspend 
uterine  action  and  obtain  sleep.  Chloroform  is  very  properly  sug- 
gested, ergot  not  being  forgotten,  but  we  should  prefer  seeing 
advised  an  earlier  resort  to  the  employment  of  forceps.  Venesection 
is  still  "  the  only  remedy  "  for  rigidity  of  the  os ; — "  avoid  artificial 
dilatation  " — "propriety  of  incision  of  os  very  questionable;"  such 
are  his  views.  We  beg  to  differ ;  incision  is  a  very  valuable  resource 
in  properly  selected  cases,  dilatation,  artificially,  being  also  very 
useful. 

For  extra-uterine  pregnancy  the  "  treatment  is  pretty  nearly  the 
same  in  all  the  forms"  (p.  244).  "The  rupture  of  the  cyst 
should  be  retarded  as  long  as  possible."  Xo  reference  is  made  to 
electrolysis,  performed  per  vaginam,  as  advocated  by  Thomas,  or 
to  gastrotomy,  if  this  be  impracticable. 

In  speaking  of  version,  cephalic  and  podalic,  the  ordinary  internal 
method  is  given,  and  Wigand's  plan  of  external  abdominal  manipu- 
lations alluded  to  ;  but  no  mention  is  made  of  the  method  adopted 
by  Dr.  Braxton  Hicks  of  conjoined  manipulation,  which  is  by  far 
the  better  one. 

The  time  has  come  to  speak  plainly ;  and  with  no  personal  feel- 
ing whatever,  but  merely  on  principle,  we  feel  bound  to  advocate  a 
more  rational  system  of  obstetric  surgery  than  that  suggested  by  the 
handbook  now  under  review,     The  author  has  scarcely  fulfilled  the 


890  Reviews,  [Oct., 

promise  of  his  preface  in  making  the  work  a  trustworthy  guide  to 
young  practitioners. 

Coming  as  it  does  with  the  weight  of  Dr.  Clay^s  authority,  it  is 
all  the  more  important  that  the  information  should  be  sound,  and  in 
accordance  with  the  recognised  views  of  our  chief  professors  and 
teachers.  We  have  no  hesitation  in  saying  this  is  not  the  case, 
andj  with  every  respect  for  the  author,  we  suggest  a  reconsideration 
of  some  of  the  important  points  we  have  above  referred  to.  Tor 
the  sake  of  his  own  reputation,  for  that  of  his  readers  who  may  be 
guided  by  the  practice  recommended  in  its  pages,  and  for  that  of 
the  well-being  of  parturient  women,  it  is  incumbent  on  Dr.  Clay  to 
revise  the  '  careful  revision '  of  his  matter,  for  which  he  has  taken 
credit  in  the  preface  to  the  present  treatise  on  obstetric  surgery.  It 
is  doubtless  a  legitimate  satisfaction  to  an  author  to  have  a  third 
edition  of  his  work  called  for ;  but  it  is,  at  the  same  time,  fraught 
with  the  danger  of  intermitting  the  care  and  diligence  which  have 
in  the  first  instance  won  for  it  success. 


1875.]  391 


asibliosrapftual  ^aeroiti. 


Contributions  to  the  Mechanism  of  Natural  and  Morbid  Partu- 
rition.i — In  this  volume  Dr.  Matthews  Duncan  presents  in  a  col- 
lected form  many  of  the  contributions  whereby  he  has  enriched  the 
literature  of  scientific  obstetrics,  and  especially  that  portion  which 
deals  with  the  mechanism  of  parturition,  a  subject  second  to  none 
in  the  science  of  obstetrics,  and  upon  which  Dr.  Matthews  Duncan^s 
writings  stand  in  the  very  foremost  rank. 

Dr.  Duncan  does  not  profess  to  give  us  much  that  is  new  in  this 
volume,  but  by  publishing  his  contributions  in  a  compact  and  con- 
nected form  he  has  laid  all  who  desire  the  progress  of  medicine, 
and  especially  of  the  obstetric  branch,  under  obligation.  Yet 
though  there  is  but  little  that  is  new  quoad  the  author ;  there  is 
a  great  deal  of  solid  scientific  material  which  it  becomes  a  duty 
incumbent  on'  all  who  practise,  and  pre-eminently  those  who  are 
privileged  to  teach,  midwifery  to  make  themselves  acquainted  with. 
In  Germany  the  subjects  considered  in  this  volume  have  long 
attracted  more  attention,  and  have  been  more  written  upon,  than  in 
this  country,  but  the  able  writings  of  our  own  countrymen,  in- 
cluding the  author.  Dr.  Barnes,  Dr.  Leishman,  and  others,  are  in  no 
degree  inferior,  to  say  the  very  least,  to  those  of  our  German  con- 
freres. There  is  no  necessity  to  go  to  a  foreign  source  for  informa- 
tion and  instruction  while  we  have  such  able  productions  in  EngHsh 
as  those  of  the  writers  just  alluded  to. 

Unfortunately  the  length  of  the  course  allotted  to  midwifery  in 
the  curriculum  of  our  schools  is  much  too  brief  to  enable  the  lecturer 
to  enter  upon  a  sufficient  exposition  of  the  principles  of  the 
mechanism  of  parturition.  The  course  is  so  crowded  that  he  must 
hurry  on  to  other  subjects  more  urgently  demanded  by  the  examining 
boards.  Hence  the  principles  on  which  the  science  of  midwifery  is 
founded  are  but  imperfectly,  if  at  all,  comprehended  by  the  majority 
of  students. 

We  will  endeavour  to  give  a  critical  sketch  of  the  present  volume, 

^  Contributions  to  the  Mechanism  of  Natural  and  Morbid  Parturition.     By  J. 
Matthews  Duncan,  M.D.,  &c.    Edinburgh,  1875. 


392  Bibliographical  Record,  [Oct., 

from  which  we  trust  our  readers  will  gather  a  not  inaccurate  idea  of 
the  value  of  Dr.  Duncan^s  contributions. 

The  first  chapter  of  the  book  is  appropriately  dedicated  to  a  con- 
sideration of  •"  The  Mode  of  Progress  of  the  Science  of  Natural 
Parturition.'^ 

Herein  Dr.  Duncan  seeks  to  direct  attention  to  the  mode  in  which 
increasing  knowledge  of  the  function  of  natural  parturition  has 
been  ripened  into  a  science  of  this  department  of  medicine.  As 
natural  parturition  is  more  common,  so,  says  Dr.  Duncan,  is  this 
department  of  science  more  important  than  that  of  morbid  labour. 
To  the  modern  tendency  to  strain  after  utility  or  practical  results 
Dr.  Duncan  gives  a  philosophical  caution.  We  should  rely,  he 
argues,  on  practical  good  coming  out  of  honest  scientific  labours 
without  always  having  before  us  the  immediate  attainment  of  so- 
called  practical  results.  We  should  not  set  about  the  search  for 
gold  by  digging  in  the  nearest  field,  but  by  the  study  of  geology. 
He  sneers  rather  at  what  he  'calls  "  7nere  practitioners  ''  who  have, 
he  says,  "  flourished  since  the  world  began,  but  have  done  very 
little  progressive  work  for  the  benefit  of  the  race.  That  has  to  be 
slowly  elaborated  by  an  humbler  sort,  the  men  of  science." 

Of  science  Dr.  Duncan  truly  says — "  Its  achievements  are  cer- 
tain, secure,  beneficent.  They  may  be  diffused  over  the  world 
without  being  thereby  diluted.  They  are  capable  of  being  expressed 
in  written  language,  and  handed  down  to  every  coming  age.'' 

After  a  severe  satire  on  the  tendency  to  run  after  new  "practices," 
the  author  points  out  that  William  Hunter  was  the  first  who  satis- 
factorily completed,  to  a  large  extent,  the  science  of  parturition  in 
his  great  work  published  in  1774.  "This  grand  foundation-stone 
of  obstetrical  science,"  says  Dr.  Duncan,  "  still  remains  securely 
fixed,  unsurpassed  in  perfection  of  elaboration,  and  more  admired 
than  when  it  left  his  hands." 

The  great  French  writer,  Levret,  comes  in  for  a  due  meed  of 
praise,  and  Dr.  Duncan  remarks  that  every  day  shows  more  and  more 
the  correctness  of  Levret's  assertion  that  parturition  is  a  "  natural 
operation,  truly  mechanical,  susceptible  of  geometrical  demonstra- 
tion." 

The  first  great  advance  in  scientific  midwifery,  consisting  in  a 
knowledge  of  topography,  measurements,  shapes,  axes,  being  achieved, 
the  second  great  stage,  the  discovery  of  the  manner  in  which  the 
foetus  traverses  the  maternal  passages,  and  the  alterations  in  form 
thereby  produced,  remains  still  incomplete,  though  much  has  been 
done  towards  it. 

The  third  great  department  of  scientific  midwifery  is  engaged 
with  the  forces  employed  to  do  the  work.  This  involves  problems 
of  much  higher  complexity  thaii  the  other  two.     Here  the  amount 


I 


1^75.]      Mechanism  of  Natural  and  Morbid  Parturition.     393 

of  labour  required  is  enormous,  and  the  author  wisely  enjoins  all  who 
are  ambitious  of  contributing  to  the  elucidation  of  the  problems 
involved  to  "  learn  to  do  a  small  thing  well  before  they  try  high 
tasks/' 

This  chapter  concludes  with  a  fine  peroration  on  the  simplicity  of 
great  discoveries  when  once  they  see  the  light,  and  on  the  great 
obscurity  in  which  they  were  previously  enshrouded. 

The  next  chapter  is  on  '^Long  Delay  of  Labour  after  Discharge 
of  the  Liquor  Amnii/'  That  this  accident  may  occur  and  the  preg- 
nancy continue  for  some  weeks  Dr.  Duncan  distinctly  avers,  and  he 
gives  illustrations  of  it.  It  is  also  proved  by  the  continuance  of  a 
pregnancy  in  which  the  uterus  was  tapped  by  mistake  for  an  ovariaii 
cyst.  The  sufficiency  of  the  explanation  of  the  continuance  of  preg- 
nancy depending  upon  the  situation  of  the  rupture  being  high  up 
is  not  admitted  by  Dr.  Duncan. 

^'  The  Curves  of  the  Developed  Genital  Passage '"'  is  the  subject 
dealt  with  in  the  next  chapter.  The  points  of  special  interest  in 
respect  of  these  are  very  ably  discussed.  A  sufficient  analysis  of  this 
chapter  would  occuj)y  too  much  space,  but  we  would  recommend  all 
who  profess  to  undertake  the  management  of  labour  to  study  the 
subject  by  the  light  here  offered.  There  is  one  very  important 
point,  however,  which  we  cannot  forbear  dwelling  upon ;  it  has 
reference  to  the  dilatation  of  the  soft  parts  which  form  so  large 
a  portion  of  the  third  or  greatest  curve  of  the  genital  passage. 
On  this  Dr.  Duncan  says,  *'  There  is  to  be  noted,  also,  in  con- 
nection with  this  curve,  the  inevitable  tendency  of  the  force  of 
labour,  not  merely  to  distend  the  perineum,  but  also  to  rupture 
it  centrally,  to  force  the  presenting  part  through  it — a  ten- 
dency, the  study  of  which,  apart  from  other  considerations,  leaves 
no  possible  doubt  as  to  the  expediency  of  the  practice  of  supporting 
the  perineum ;  a  practice  which  can  be  demonstrated  to  favour  the 
maintenance  of  its  entirety."  This  we  take  to  be  a  distinct  protest 
that  the  modern  practice  of  abandoning  the  support  of  the  perineum 
is  wrong.  While  decidedly  of  opinion  that  fussy  and  unintermittent 
support  of  the  perineum  is  objectionable,  we  agree  with  Dr.  Duncan 
that,  properly  applied,  the  practice  is  one  of  extreme  value. 

Chapter  IV  is  devoted  to  a  consideration  of  "  The  Power  Exerted 
in  Ordinary  Labours.'^  This,  the  author  thinks,  may  be  measured 
by  discovering  the  tensile  strength  of  the  membranes,  and  many 
experiments  with  that  object  are  detailed.  No  very  practical  or 
reliable  result  appears  to  have  been  obtained. 

We  next  meet  wdth  a  chapter  (Chapter  V)  dealing  with  "  The 
Greatest  Power  of  Labour  exerted  in  Difficult  Cases,'^  which  Dr. 
Duncan  points  out  may  in  a  number  of  cases  be  to  some  extent 
ascertained  by  measuring  the  power  exerted  by  the  forceps.  Instru- 
ments for  this  purpose  have  been  devised  by  Joulin,  Kristeller,  and 


394  Bibliographical  R'ecord.  [Octj 

others.  No  very  satisfactory  conclusions  appear  to  have  been  arrived 
at  at  present,  and  the  subject  awaits  further  investigation. 

Next  we  have  a  chapter  (VI)  ''  On  the  Power  of  the  Uterus  to 
resist  a  Bursting  Pressure.'^  This  has  obviously  an  important 
bearing  on  the  subject  of  rupture  of  the  uterus. 

The  enormous  strength  of  the  uterus  was  fully  demonstrated  in 
the  experiments  made ;  and  this  very  important  conclusion  naturally 
follows — that  the  uterus  is  never  spontaneously  ruptured  when  it  is 
healthy.  This  has  long  been  our  own  opinion,  and  it  is  one  the 
importance  of  which  is  singularly  great  at  the  present  time  owing 
to  the  prosecution  of  accoucheurs  who  have  had  the  misfortune 
to  be  in  attendance  upon  women  to  whom  this  calamity  has 
occurred. 

*'The  Efficient  Powers  of  Parturition^'  are  next  considered. 

Dr.  Duncan  concludes  that  very  few  of  the  most  powerful  labours 
exert  a  force  of  fifty  pounds ;  this  he  arrives  at  by  measuring  the 
amount  of  force  required  to  keep  back  a  head  just  emerging  from 
the  vulva.  He  is  here  in  conflict  with  the  Rev.  Dr.  Haughton,  who, 
by  measuring  the  bulk  and  extent  of  the  voluntary  and  involuntary 
muscles  employed  in  parturition,  arrives  at  the  conclusion  that  ''  on 
an  emergency  somewhat  more  than  a  quarter  of  a  ton  pressure  can 
be  brought  to  bear  upon  a  refractory  child  that  refuses  to  come  into 
the  world  in  the  usual  manner.''"'  Dr.  Haughton  regards  the  volun- 
tary muscles  as  supplying  the  greater  part  of  this  power,  crediting 
them  with  523  lbs.  and  the  uterus  itself  with  54. 

Dr.  Duncan,  on  the  other  hand,  concludes  that  the  comparatively 
small  figure  of  80  lbs.  gives  the  highest  power  of  labour,  voluntary 
and  involuntary  effort  together.  The  pressure  of  a  quarter  of  a 
ton  would  suffice,  says  Dr.  Duncan,  to  bray  the  child  to  pieces, 
and  would,  "if  appropriately  applied,  not  only  expel  the  child  but 
also  lift  up  the  mother,  the  accoucheur,  and  the  monthly  nurse,  all 
at  once.'' 

Chapter  YIII  is  '^  On  the  Chief  Directions  and  Extents  of  Uterine 
Shrinking ;  specially  at  the  time  of  the  complete  Expulsion  of  the 
Contents  of  the  Gravid  Uterus."  Dr  Duncan's  method  of  obser- 
vation on  these  points  consists  in  noting  the  rugae,  ridges  or 
wrinkles,  and  the  sulci,  furrows,  or  grooves  occasionally  found 
on  the  peritoneal  surface  of  the  contracted  uterus  and  likewise  the 
cracks  or  fissures  encountered  on  the  same  membrane.  No  satis- 
factory results,  however,  are  apparent. 

"  The  Tensile  Strength  of  the  Fresh  Adult  Eoetus  "  is  next  in 
order.  In  some  interesting  experiments  made  on  fresh  foetuses,  the 
author  found  that  an  average  weight  of  120  lbs.  caused  decapitation. 
Before  this  occurred,  however,  the  spinal  cord  was  injured,  the 
cervical  vertebra  giving  way. 

In  the  following  Chapter  (X)  Dr.  Duncan  enters  into  an  elaborate 


1875.]     Mechanism  of  Natural  and  Morbid  Parturition^     395 

and  instructive  discussion  '^  On  the  Pelvic  Joints  in  Parturition/' 
He  distinctly  states  that  there  is  an  appreciable  amount  of  normal 
mobility  in  them  in  parturient  women,  and  he  demonstrates  the 
mechanism  of  this.  He  says,  ^'  The  movements  which  occur  may  be 
described  as  consisting  in  the  elevation  and  depression  of  the  sym- 
pliysis  pubis,  the  ilia  moving  upon  the  sacrum ;  or  if  the  sacrum 
be  regarded  as  the  moving  bone,  it  describes  a  nutatory  motion  upon 
an  imaginary  transverse  line  passing  through  the  second  bone,''  and 
a  diagrammatic  representation  is  given  in  illustration  of  this  move- 
ment. 

There  is,  too,  slight  mobility  of  the  pubic  symphysis.  A  propos 
of  this  subject  Dr.  Duncan  remarks  that,  in  his  opinion  the  Sigaul- 
tian  operation  (symphyseotomy)  has  been  too  readily  abandoned. 

"  The  Obliquity  or  Lateral  Flexion  of  the  Foetal  Head  "  is  con- 
sidered in  Chapter  XI.  '^  The  object  of  this  paper,  is,"  says  Dr. 
Duncan,  ^'  to  show  that  the  obhquity,  or  lateral  obliquity,  of  the  foetal 
head  when  passing  through  the  brim  of  the  pelvis,  described  by 
Naegele,  by  some  of  his  predecessors,  and  by  his  followers  down  to 
the  latest  authors,  does  not  exist  in  natural  parturition  ;  and  that 
obliquity,  or  lateral  obhquity,  of  the  foetal  head  when  passing  through 
the  outlet  of  the  pelvis,  not  described  by  Naegele  and  his  followers, 
does  occur  in  natural  parturition."  With  a  slight  qualification  this 
position  is  supported  by  another  very  able  writer  on  the  mechanism 
of  parturition,  Dr.  Leishman.  The  arguments  adduced  certainly 
appear  to  invalidate  Naegele's  statements. 

"  Obliquity  or  Lateral  Flexion  at  the  Outlet"  (Chapter  XII),  on 
the  contrary,  is  believed  to  occur  both  by  Duncan  and  Leishman,  and 
its  mechanism  is  explained  in  this  chapter. 

The  next  Chapter  (XIII)  is  "  On  the  Synclitic  Motion  of  the 
Foetal  Head" — a  condition  described  by  Kiincke.  The  account 
given  hardly  admits  of  a  critical  analysis  consistent  with  the  space 
at  our  disposal. 

Chapter  XIV,  "On  the  Production  of  Presentation  of  the 
Face,"  is  of  considerable  interest.  Dr.  Duncan  does  not  admit  that 
the  dolichocephalous  form  of  head  exerts  that  amount  of  influence  in 
the  production  of  face  presentation  attributed  to  it  by  Heck€r,  of 
Munich ;  he  explains  this  occurrence  otherwise,  as  we  shall  presently 
see,  but  he  acknowledges  that  dolichocephaly  may  be  an  important 
factor  in  the  mechanism  as  he  apprehends  it.  Lateral  uterine  obliquity 
and  the  second  position  he  regards  as  the  chief  factors. 

The  next  chapter  (XV)  need  not  detain  us  :  it  is  "  On  the  Caput 
Succedaneum,  the  presentation,  and  their  relation  in  cases  where  the 
head  comes  first."  The  following  one,  however,  calls  for  more 
attention ;  it  is  on  '^  The  Expulsion  of  the  Placenta "  (Chapter 
XVI).  Dr.  Duncan  first  shows  the  astonishingly  erroneous 
conclusions  arrived  at  by  most  authors  who  regard  the  expulsion 


B96  Bihliographical  Record.  [Oct.^ 

of  the  placenta  as  occurring  in  an  "  inverted  umbrella  "  fasliion  : 
an  error  of  observation  which  Duncan  clearly  points  out,  while 
he  shows  the  true  mechanism  of  the  normal  expulsion  of  this 
body.  Our  own  close  observation  of  this  subject  enables  us  to 
confirm  the  statements  made  by  Dr.  Duncan,  that  the  pla- 
centa presents  by  its  edge,  and  that  it  is  folded  on  itself  longitu- 
dinally. 

Chapter  XVII  is  devoted  to  an  allied  subject :  '^  The  size  of 
Aperture  necessary  for  the  passage  of  the  Placenta,  and  for  the  pas- 
sage of  the  Accoucheur's  Hand.''  This  is  of  interest  specially  in 
relation  to  the  treatment  of  placenta  praevia.  From  experiments 
made  Dr.  Duncan  found  that  an  aperture  fully  two  inches  in  diameter 
was  required  for  the  transmission  of  the  uninjured  mature  placenta. 
The  hand  can  be  passed  through  an  aperture  from  2  J  to  3  inches  in 
diameter.  "  It  may,  therefore,  says  Dr.  Duncan,  "be  safely  asserted 
that,  in  the  very  great  majority  of  cases  of  placenta  prsevia,  the 
hand  may  be  passed  into  the  uterus  if  the  placenta  can  be  extracted 
from  it  in  a  satisfactory  manner  without  disruption.'' 

Akin  to  the  foregoing  subject  is  that  discussed  in  the  next  (XVIII) 
chapter,  "  On  the  Changes  undergone  by  the  Cervix  Uteri  during 
Labour.''  During  pregnancy  the  cervix  undergoes  hypertrophy  or 
enlargement  in  every  direction,  but  until  shortly  before  labour  sets 
in  it  usually  forms  no  part  of  the  cavity  containing  the  ovum. 
After  delivery  the  cervix  is  elongated,  thinned,  and  softened,  being  in 
great  contrast  with  the  body  of  the  uterus,  which  is  shortened, 
thickened,  and  hardened.  The  influence  of  this  condition  on  lacera- 
tions of  the  vagina  is  briefly  considered.  We  next  have  a  chapter 
(XIX)  on  "  Increased  Length  of  the  Cervix  Uteri  after  Labour." 
This  is  stated  to  be  considerable,  so  much  so  as  to  lead  some  to  be- 
lieve they  have  to  do  with  a  case  of  hour-glass  contraction,  when  in 
truth  the  narrowed  point  is  but  the  normal  contraction  of  the  tissues 
at  the  junction  of  the  cervix  with  the  body  of  the  uterus.  It  is  right 
to  say  that  the  conclusions  of  this  chapter  are  questioned  by 
Professor  Isaac  E.  Taylor,  of  New  York,  in  the  '  American  Journal 
of  Obstetrics'  for  May,  1874. 

"  The  Production  of  Inverted  Uterus  "  is  the  subject  discussed  in 
Chapter  XX.  Dr.  Duncan  enters  into  an  elaborate  disquisition  on 
the  manner  in  which  this  accident  is  produced.  He  maintains  that 
there  must  be  paralysis  of  the  whole  or  a  part  of  the  body  of  the 
uterus  before  inversion  can  be  begun.  This  view  Dr.  Duncan  shows 
is  not  altogether  a  new  one,  and  of  its  truth  there  can  be  but  little 
doubt.  The  placental  site  being  so  commonly  the  seat  of  the  par- 
tial form  of  paralysis,  it  seems  to  us  that  a  very  important  point  of 
practice  flows  from  this,  viz.  the  desirability  of  speedy  separation  of 
the  placenta.  AYe  are  of  opinion  that  there  is  very  commonly  too 
great  delay  in  the  removal  of  the  after-birth,  and  would  say — If  the 


1875.]     Mechanism  of  Natural  and  Morbid  Parturition,     397 

placenta  be  separate,  remove  it ;  if  it  be  adherent,  separate  it — both 
without  delay. 

Chapter  XXI  is  devoted  to  '^  Hseinorrhage  during  Pregnancy  in 
Cases  of  Placenta  Prsevia."  This  the  author  states  may  be  caused 
in  four  ways : 

1.  By  rupture  of  a  utero-placental  vessel  at  or  above  the  internal 
OS  uteri. 

2.  By  rupture  of  a  marginal  utero-placental  sinus  witliin  the  area 
of  spontaneous  premature  detachment 

8.  By  partial  separation  of  the  placenta  from  accidental  causes, 
such  as  a  jerk  or  fall. 

4.  By  partial  separation  of  the  placenta,  the  consequence  of 
uterine  pains,  producing  a  small  amount  of  dilatation  of  the  internal 
OS 

In  haemorrhage  from  the  two  first  sources  there  need  be  no  subse- 
quent morbid  alteration  of  the  cotyledon  or  cotyledons ;  whereas  in 
the  two  latter  there  will,  if  the  pregnancy  last  long  enough,  be  well- 
known  pathological  changes — thrombosis  and  decolorisation,  and 
ultimately  atrophy.  The  author's  discussion  of  the  various  theories 
advanced  on  this  subject  is  too  diffuse  for  condensation,  and  any 
analytical  criticism  worthy  of  his  high  reputation  would  occupy 
much  more  space  than  we  could  accord  to  it.  We  may  say,  how- 
ever, that  he  refutes  the  ordinarily  accepted  doctrines,  and  thinks 
that  much  harm  has  arisen  from  authors  treating  unavoidable  as 
quite  distinct  from  accidental  hsemorrhage ;  the  fact  being  that  their 
whole  pathology,  thougli  not  identical,  is  nearly  so. 

Allied  to  the  foregoing  is  the  subject  dealt  with  in  the  next 
chapter  (XXII),  viz.  ^The  Spontaneous  Separation  of  the  Placenta 
when  it  is  Prsevia.^'  Duncan's  contention,  illustrated  by  a  variety 
of  arguments,  is  that  the  placenta  is  not  attached  to  the  cervical 
portion  of  the  uterus,  the  cervix  forming  no  part  of  the  ovum-con- 
taining cavity  ;  that,  in  fact,  "  a  placenta  prsevia  is  attached  to  the 
body  of  the  uterus  above  the  cervix,  and  may  cover  its  internal  os." 
Here  he  is  in  direct  conflict  with  other  distinguished  authors.  In 
Dr.  Duncan's  view  separation  of  the  placenta,  when  it  is  prsevia,  is 
due  to  expansion  of  its  seat  of  attachment  to  the  uterus,  and  not  to 
contraction  thereof.  '^  Expansion  of  the  placental  insertion,"  says 
he,  "  in  the  first  stage  of  labour  is  the  distinguishing  specialty  of 
placenta  prsevia,  and  has  detachment  as  its  distinguishingly  peculiar 
result." 

Chapter  XXIII,  *'  On  the  Causes  of  Unavoidable  Haemorrhage 
during  Miscarriage  or  Labour  when  the  Placenta  is  Praevia,"  is  a 
continuation  of  the  important  subject  of  Placenta  Prsevia.  Dr. 
Duncan  does  not  hesitate  to  say  that  "  when  the  placenta  is  truly 
prsevia — that  is,  attached  when  labour  begins  to  the  area  of  spon- 
taneous premature  detachment — haemorrhage  is  unavoidable."     A 

112— ivi.  26 


398  bibliographical  Record.  [Oct., 

laboured  discussion  of  the  subject  follows,  which  we  do  not  propose 
to  enter  upon. 

Chapter  XXIY  continues  the  further  discussion  of  this  question  ;  it 
is  "On the  Sources  of  Hsemorrhage  during  Miscarriage  or  Labour  at 
Pull  Term  in  cases  of  Placenta  Praevia."  This  very  interesting  subject 
appears  to  be  still  surrounded  with  considerable  obscurity.  Dr. 
Duncan  somewhat  favours  the  view  that  the  circular  sinus  of  the 
placenta  is  a  frequent  source. 

Chapter  XXV  deals  likewise  with  placenta  prsevia.  It  is  "On 
the  Mechanism  of  Arrestment  of  Haemorrhage  in  cases  of  Placenta 
Prsevia."  This  is  pretty  fully  discussed,  but  we  do  not  think  we 
can  profitably  dwell  upon  it. 

We  next  come  to  the  appendix  of  the  book,  which  comprises  Dr. 
Duncan's  address  in  obstetric  medicine  at  the  Norwich  meeting  of 
the  British  Medical  Association  in  1874.  Beginning  with  an  able 
plea  for  the  division  of  labour,  the  author  next  goes  on  to  enforce 
the  importance  of  method.  He  then  directs  attention  to  the  im- 
portance of  mechanism,  the  scientific  value  of  which  he  rightly 
proclaims.  Important  as  a  knowledge  of  the  mechanism  of  normal 
parturition  is,  the  writer  admits  that  a  knowledge  of  that  of  mor- 
bid parturition  is  more  eagerly  sought  after  by  the  bulk  of  practi- 
tioners, but  he  laments  the  absence  of  secure  guidance  in  this 
matter.  Notwithstanding  all  the  able  writings  and  teachings  on 
this  important  subject  we  are  still,  he  says,  without  the  knowledge 
we  require.  Still  more  difficult  than  the  foregoing  are  natural  and 
morbid  childbirth. 

Dr.  Duncan's  address  has  been  so  recenUi  given  to  the  world, 
and  doubtless  has  been  so  widely  read,  tnat  we  content  ourselves 
with  this  brief  mention  of  it. 

In  conclusion  we  may  say  that  this  volume  of  collected  papers 
confirms  the  general  belief  that  Dr.  Duncan  deservedly  stands  in  the 
foremost  rank  of  past  or  present  scientific  obstetricians. 

Steiner  on  Children's  Diseases. i — Fifteen  years  of  uninterrupted 
activity  in  the  Children's  Hospital  at  Prague  have  encouraged  and 
given  some  claim  to  the  author  to  write  this  treatise.  It  professes 
to  be  a  compendium  of  children's  diseases,  a  trustworthy  guide  to 
the  student  as  well  as  the  practitioner. 

The  mere  fact  of  a  second  edition  of  the  work  having  been  called 
for  within  three  years  of  its  first  appearance  is  a  sufficient  guaran- 
tee of  its  appreciation  by  the  profession  in  Germany,  and  has  doubt- 
less influenced  the  translator   in   selecting  it  as  worthy  of  being 

1  Compendium  of  Children's  Diseases  :  a  JffandhooJc  for  Practitioners  and 
Students.  By  Dr.  JoHANN  Steinee.  Translated  from  the  second  German  edition. 
By  Lawson  Tait,  F.R.C.S.     London,  1874. 


1875.]  Steiner  on  Children's  Diseases,  399 

presented  to  the  profession  in  England  in  the  language  best  suited 
to  the  wants  of  practitioners, 

The  author  has  arranged  his  subject  under  nine  divisions  :  the 
first  comprising  the  Investigation  of  Disease;  the  second,  Diseases 
of  the  Nervous  System ;  the  third,  Diseases  of  the  Organs  of  Ee- 
spiration ;  the  fourth,  Diseases  of  the  Organs  of  Circulation  and  of 
the  Lymphatic  System ;  the  fifth,  Diseases  of  the  Organs  of  Diges- 
tion; the  sixth.  Diseases  of  the  Urinary  and  Sexual  Organs;  the 
seventh,  General  Diseases  of  Nutrition ;  the  eighth.  Zymotic  Diseases  ; 
the  ninth,  Diseases  of  the  Skin. 

Under  the  first  heading,  the  Investigation  of  Disease,  the  author 
very  rightly  observes  that  "  the  absence  of  speech,  the  uncertainty 
of  the  communications  concerning  the  subjective  disturbances  of  the 
conditions  of  health,  the  wilfulness,  dislikes,  fear,  and  agitation  of  the 
child,  make  an  inquiry  difficult  or  even  impossible;  and  this  is  so  much 
the  more  if  the  practitioner  does  not  understand  how  to  win  for 
himself  the  confidence  of  the  patient." 

Under  "Diseases  of  the  Nervous  System"  are  included  Dis- 
eases of  the  Brain  and  its  Membranes,  and  of  the  Spinal  Cord  and 
its  Membranes.  The  subject  is  treated  very  exhaustively,  all  the 
known  varieties  of  nervous  disorders  being  briefly  referred  to,  and 
the  researches  of  those  who  have  directed  attention  to  the  pathology 
of  special  lesions  being  incorporated  in  the  text  so  as  to  bring  the 
subject  quite  up  to  date. 

Epilepsy  is  grouped  among  Diseases  of  the  Spinal  Cord  and  its 
Membranes,  though  the  author  in  treating  of  the  subject  remarks 
that  "post-mortem  examinations  have  revealed  so  many  various 
essential  alterations  that  the  conclusion  has  been  arrived  at  that 
there  has  been  no  specific  lesion  by  which  the  disease  can  be  accounted 
for.^'  He  regards  epilepsy  as  a  common  disease  of  childhood.  In 
speaking  of  treatment,  no  mention  is  made  of  what  measures  should 
be  adopted  during  a  fit,  nor  any  restrictions  given  as  to  diet,  exercise, 
&c.  We  fear  the  practitioner  would  be  somewhat  disappointed 
when  referring  to  this  chapter  for  any  hints  or  indications  for  treat- 
ment ;  indeed,  the  whole  subject  is  very  cursorily  treated. 

In  the  chapter  devoted  to  Diseases  of  the  Organs  of  Eespiration 
the  various  conditions  met  with  are  duly  given.  In  speaking  of 
catarrh  in  early  life  sufficient  importance  is  scarcely  accorded  to  the 
syphilitic  coryza  so  often  met  with,  and  which  is  too  frequently  mis- 
taken by  the  unwary  for  a  mere  cold  in  the  head.  The  advantage 
of  administering  mercury  through  the  mother's  milk  is  not  alluded 
to,  and  the  propriety  of  abstaining  from  baths  in  the  case  of  infants, 
merely  because  they  have  idiopathic  nasal  catarrh,  is,  in  our  judg- 
ment, of  doubtful  expediency.  The  description  of  croup  is  evidently 
drawn  from  frequent  observation  of  this  distressing  malady,  and  is 
given  with  clear,  minute,  and  circumstantial  detail.     The  author 


406  bibliographical  Record,  [Oct., 

does  not  agree  with  those  who  regard  ordinary  inflammatory  croup 
as  infections,  though  he  believes  there  can  be  no  doubt  that  the 
diphtheritic  variety  is  eminently  contagious.  He  states  that  34*6 
per  cent,  of  the  cases  in  the  Children's  Hospital  at  Prague  have  been 
saved  by  the  operation  of  tracheotomy. 

He  depends  chiefly  on  inhalations  and  emetics,  the  most  useful  of 
the  former  in  his  experience  being  lime-water,  and  ipecacuanha  for 
the  latter.  Tracheotomy,  he  observes,  constitutes  of  itself  no 
remedy  against  the  croup,  but  by  giving  nature  time  to  bring  about 
more  favorable  conditions  it  is  often  of  great  importance. 

The  translator  has  supplemented  a  manifest  defect  in  dealing  with 
this  subject,  by  giving  an  account  of  the  after-treatment  required ; 
and,  as  we  should  have  expected,  it  is  practical  and  thorough.  We 
regret  he  has  not  made  the  chapter  complete  by  giving  the  details 
of  the  operation  itself,  for  we  feel  confident  it  would  have  been 
much  valued  by  many  a  young  practitioner. 

The  subject  of  foreign  bodies  in  the  air-passages  is  somewhat 
summarily  dismissed ;  considering  the  frequency  and  danger  of  this 
accident,  a  more  detailed  account  would  have  been  acceptable. 

Hooping-cough  is  described  at  some  length.  He  regards  it  as  an 
epidemic,  neurotic  contagious  bronchial  catarrh,  accompanied  by 
spasmodic  attacks  of  coughing.  Belladonna  is  recommended  as 
the  drug  most  likely  to  be  of  service.  No  notice  is  given  of 
chloral,  which  in  severe  cases  has  been  proved  to  check  the  severity 
and  lessen  the  frequency  of  the  paroxysms  of  coughing,  as  also  to 
induce  sleep  and  allay  the  distressing  vomiting  so  frequently  met 
with  in  this  disorder. 

In  speaking  of  phthisis,  the  author  supports  the  tubercular, 
pneumonic,  and  bronchitic  origin  of  this  malady. 

In  pleurisy,  '^when  symptoms  of  sufl'ocation  occur  from  the 
extreme  amount  of  effusion,  the  chest  must  be  tapped  without  loss 
of  time,^'  remarks  the  author ;  though,  "  if  the  pleurisy  should 
become  purulent  and  the  symptoms  become  unfavorable,  thora- 
centesis must  be  performed;  though  very  frequently  the  natural 
eff'orts  will  create  an  exit"  (pp.  173-4).  An  earlier  resort  to  thora- 
centesis, as  advocated  by  Bowditch,  Play  fair,  and  others,  together  with 
the  plan  of  subaqueous  drainage,  seem  justified  by  recent  experience, 
and  are  points  of  great  importance  in  the  management  of  these 
troublesome  cases. 

In  speaking  also  of  pericarditis  with  efi'usion,  "  the  operation  of 
tapping  the  pericardium  has  not  been  largely  adopted"  (p.  163)  is 
all  that  is  said  ;  no  mention  is  m^ade  of  paracentesis  as  practised  by 
Aran,  as  also  by  Sibson  and  numerous  others,  successfully.  From 
the  very  nature  of  the  operation,  its  difficulties  and  dangers, 
and  the  responsibility  attached  to  its  performance,  it  is  not  very 
likely  "  to  be  largely  adopted  /'  still,  in  many  cases,  it  is  of  extreme 


1675.]  Steinbr  on  Children's  Diseases.  401 

value,  not  only  in  relieving  most  urgent  distress,  but  also  in  saving 
many  a  life  tliat  otherwise  would  inevitably  be  lost. 

The  preliminary  observations  on  the  nourishment  of  children  are 
well  worthy  of  perusal  and  evidence  much  practical  knowledge,  though 
it  is  a  question  whether  "  sickly  and  rachitic  children  require  to  be 
kept  longer  at  the  breast  than  those  which  are  healthy'''  (p.  196). 
It  frequently  happens  that  the  children  are  sickly  or  rachitic  because 
the  maternal  milk  is  not  sufficiently  nourishing,  and  a  change  to 
good  healthy  cow^s  milk  often  works  wonders. 

The  remarks  on  cleft  palate  will  scarcely  meet  with  the  approval 
of  the  rising  surgeons  of  the  present  generation.  The  translator  even 
appends  a  foot-note,  entering  a  protest  against  the  author's  conclusions. 
Diphtheria  is  evidently  a  subject  the  author  has  seen  much  of;  he 
writes  currente  calamo. 

Lime-water,  either  as  inhalation  by  means  of  a  spray -producer, 
or  locally  applied,  is,  according  to  the  author's  experience,  the  best 
remedy  for  cutting  short  the  exudation  and  the  necrobiosis,  and  pre- 
venting the  absorption  of  the  poisonous  matter. 

The  recent  controversy  in  the  medical  journals  respecting  diph- 
theria and  croup  seems  unnecessary,  if  we  can  rely  on  the  differential 
diagnosis  given  by  the  author  : — "  True  croupous  exudation  is  free 
and  membranous,  whilst  the  diphtheritic  is  parenchymatous  with 
necrobiosis."" 

Gangrenous  stomatitis,  described  by  the  author  as  norma,  seems 
to  be  more  frequent  abroad  than  at  home,  if  we  may  judge  from 
the  fact  of  no  less  than  102  cases  having  been  observed,  only  four 
of  which  recovered.  Stomatomykosis  is  the  name  suggested  for 
the  ordinary  parasitic  aphthae  affecting  the  mouth  of  infants  ;  lime- 
water  and  borax  are  the  remedies  relied  upon.  The  remarks  on 
dentition  and  its  dangers  are  practical.  No  mention  is  made  of  the 
employment  of  chloral,  which  in  many  of  the  distressing  nervous 
symptoms  due  to  the  irruption  of  the  teeth  is  invaluable,  and  far 
to  be  preferred  to  any  preparations  of  opium.  In  treating  of  in- 
vagination, or  intussusception,  "  gastrotomy  as  a  last  resource  may- 
be entertained ;''  but  distension  of  the  bowel  by  air  or  fluids  with 
the  prospect  of  relieving  the  obstruction  is  not  referred  to — rather 
an  important  omission,  judged  by  the  standard  of  recent  experience. 

In  speaking  of  parenchymatous  nephritis,  the  author  says,  "  The 
presence  of  hyaline  casts  must  be  proved  ere  the  diagnosis  can  be 
made  with  certainty  (p.  276.)  The  importance  of  producing  diapho- 
resis by  means  of  vapour  baths  is  not  insisted  upon  with  sufficient 
force.  The  employment  of  chalybeates  in  the  later  stage  of  con- 
valescence is  not  even  alluded  to. 

The  author  has  evidently  not  seen  the  cases  published  by  Mr. 
John  Wood  of  successful  operation  for  the  cure  of  ectopia  vesicae, 


403  Bihliographical  Record.  {Oct., 

or  he  would  not  assert  that  "  a  radical  cure  of  this  deformity  is 
hardly  possible^'  (p.  283). 

We  are  glad  to  find  Dr.  Steiner  has  not  shirked  the  duty  of 
alluding  to  a  very  distressing  practice  indulged  in  by  even  very 
young  children  of  both  sexes,  viz.  masturbation.  This  is  far  more 
frequent  than  many  have  any  idea  of,  and  exerts  an  influence  upon 
the  growing  child  very  prejudicial  to  its  future  well-being,  intel- 
lectually, morally  and  physically. 

"The  use  of  sewing-machines,  which  has  become  of  late  so  preva- 
lent, has  an  evil  influence  in  this  direction,"  he  thinks,  "  especially 
for  young  girls ;  and  he  has  heard  several  times  from  women  ex- 
pressions of  opinion  in  this  direction.'^  The  employment  of  bHs- 
tering,  repeated  from  time  to  time,  one  of  the  most  efficacious 
means  of  dealing  with  this  habit,  is  not  sufficiently  insisted  on. 

The  subject  here  briefly  touched  upon,  although  one  of  vital  im- 
portance, is  generally  remitted  to  the  domain  of  neutral  territory. 
In  no  work  that  we  are  familiar  with  on  children's  diseases,  Dr. 
Steiner's  excepted,  is  the  question  discussed;  the  general  treatises 
on  medicine  seldom  even  allude  to  it,  and  only  when  the  final  stage, 
dementia,  is  attained  do  we  find  it  figuring  in  the  reports  of  our 
asylums  as  a  probable  cause  of  mental  defect.  It  is  doubtless  a 
difficult  question  to  handle,  but  that  is  no  reason  for  deterring  us 
from  making  the  attempt  to  rescue  it  from  the  hands  of  quacks 
and  unprincipled  adventurers  who  trade  upon  the  baser  passions  of 
our  nature. 

Parents  have  no  suspicion  in  many  instances  why  a  child  is  so 
listless  and  apathetic,  so  disinclined  for  exertion  and  so  easily  tired ; 
the  medical  man  is  consulted,  but  from  the  difficulty  of  getting  any 
facts  and  from  a  wish  to  avoid  injuring  the  feelings  of  the  parents, 
few  inquiries  are  made ;  and  whatever  may  be  his  suspicions,  no- 
thing is  said,  a  tonic  is  prescribed,  and  the  boy  drifts  on  into  con- 
firmed onanism,  becoming  weak  and  vacillating,  an  easy  prey  to  the 
advertising  quacks. 

Under  the  heading.  General  Diseases  of  Nutrition,  a  full  descrip- 
tion is  given  of  rickets,  scrofula,  tuberculosis,  purpura,  and  rheu- 
matism. 

Syphilis,  which  by  nearly  every  authority  is  grouped  among  the 
general  or  diathetic  diseases,  is  here  classed  with  the  zymotic  dis- 
eases, along  with  the  exanthemata,  cholera,  &c.  Dr.  Steiner  affirms 
that  rickety  children  often  have  a  precocious  mental  development, 
and  are  restless,  irritable,,  and  easily  excited  (p.  309).  Respecting 
the  latter  clause,  doubtless,  it  is  correct ;  but,  as  a  general  rule,  the 
rickety  child  is  far  below  the  average  in  mental  capacity,  though 
there  may  be  no  symptoms  of  idiocy. 

The  author  refers  to  the  influence  of  syphilis,  struma,  unhealthy 
occupations,  and  sexual  excesses  in  the  parents,  as  forming  a  very 


1875.]  Stein ER  on  Children's  Diseases.  403 

important  cause  in  the  production  of  rickets  among  children,  more 
especially  when  the  mother  lias  been  subject  to  their  influence. 

The  method  adopted  in  speaking  of  scrofula  will  approve  itself 
to  the  student,  the  subject  being  treated  of  seriatim  under  the 
different  organs  affected,  as  lymphatic  glands,  skin,  mucous  mem- 
brane, bones,  joints,  &c. 

The  relation  of  tubercle  to  scrofula  he  regards  as  still  far  from 
being  definitely  determined.  If  not  identical,  they  are  diseases 
which  are  very  closely  related  in  their  causes,  in  their  pathology, 
and  in  their  clinical  history ;  and,  though  they  often  occur  coinci- 
dently  or  in  sequence,  it  is  not  a  matter  of  necessity  that  they 
should  do  so. 

A  combination  of  the  tubercular  and  syphiHtic  diatheses  in  the 
parents  he  regards  as  strongly  favouring  a  tendency  to  scrofula,  and 
the  too  early  employment  of  starchy  food,  or  too  great  excess  of  it 
in  the  dietary,  is  doubtless  sufficient  to  explain  a  large  number  of 
cases. 

The  treatment  suggested,  both  general  and  local,  is  clear  and  com- 
prehensive. "For  the  affections  of  bones  and  joints  some  special 
surgical  treatise  had  better  be  consulted/^  (p.  325). 

The  most  important  factor  in  the  production  of  tuberculosis  the 
author  regards  as  hereditary  tendency ;  but  the  disease  may  be 
developed  independently  by  bad  sanitary  conditions,  and  also  by  the 
emboHc  impaction  (Einschwemmung)  of  purulent  and  cheesy  matter. 
The  various  theories  with  regard  to  this  interesting  subject  of  Buhl, 
Virchow,  Waldenburg,  Cohnheim,  Frankel,  Klebs,  Villemin,  Nie- 
meyer,  and  Schiippel,  are  briefly  referred  to. 

The  bronchial  glands  were  found  to  be  affected  in  275,  the  lungs 
in  175  only  of  the  cases  observed  by  the  author.  The  main  points 
in  the  treatment  are  briefly  glanced  at.  "  Cod-liver  oil,  when  it 
can  be  borne,  and  the  whey  treatment,  are  our  most  efficient  methods 
of  cure,  but  unfortunately  they  very  seldom  effect  it  '^  (p.  330). 

Purpura  is  classed  among  the  general  diseases  of  nutrition,  and 
very  rightly  so,  for  we  generally  find  a  history  of  "  insufficient  and 
improper  food,  together  with  residence  in  cold,  damp,  and  badly 
ventilated  dwellings,"  which  unquestionably  exert  a  considerable  in- 
fluence in  the  production  of  purpura,  though  it  may  be  also  secondary 
to  some  other  disease,  as  the  author  points  out.  A  special  form  of 
this  dyscrasia,  indicated  by  Schdnlein — peliosis  rheumatica — is  here 
referred  to.  The  symptoms  are  lassitude  and  pain  in  the  joints, 
these  latter  being  swollen  and  very  painful,  especially  on  being 
moved,  and  they  present  all  the  appearance  of  joints  affected  by 
acute  articular  rheumatism.  These  symptoms  last  from  two  to 
four  days,  and  are  then  followed  by  the  appearance  of  a  petechial 
eruption. 

The  section  on  zymotic  diseases  is  clearly  and  concisely  written, 


404  Biblioffraphical  Record.  [Oct., 

though  we  miss  many  useful  suggestions  as  regards  the  treatment  of 
complications.  In  scarlatina,  e.(/.  "if  uvsemic  symptoms  appear, 
quinine  in  large  doses  and  cold  packing  will  be  found  of  service/' 
No  reference  is  made  to  vapour  baths,  diaphoretics,  or  cathartics. 
Quinine,  digitalis,  and  the  mineral  acids  are  the  remedies  chiefly 
rehed  upon  in  reducing  the  temperature  in  the  exanthemata. 

Of  420  children  suffering  from  smallpox,  315  had  not  been 
vaccinated,  and  208  died,  or  66  per  cent. ;  whilst  of  the  1 05  vac- 
cinated only  14  died,  or  13  per  cent.  Of  12,000  vaccinations  per- 
formed in  the  Prague  Hospital  no  case  of  communication  of  other 
diseases  by  the  agency  of  the  vaccine  virus  is  known.  These 
statistics  will  doubtless  be  interesting  to  the  anti-vaccinationists. 

The  section  devoted  to  diseases  of  the  skin  is  scarcely  so  compre- 
hensive as  we  should  have  expected,  though  the  more  important  and 
most  frequent  of  these  diseases  are  mentioned,  and  the  general  indi- 
cations for  treatment  given.  The  author  puts  forth  a  fact  worthy 
of  notice  in  speaking  of  eczema.  More  than  a  thousand  cases  having 
come  under  his  observation,  local  treatment,  without  respect  to  their 
duration  or  extent,  was  almost  always  resorted  to,  and  he  is  not  aware 
of  any  fatal  case  having  occurred  during  or  after  such  treatment.  He 
does  not  agree  with  those  who  recommend  abstention  from  local 
treatment,  lest  the  curing  of  the  rash  induce  mischief  of  a  more 
serious  kind,  as  meningitis,  hydrocephalus,  &c. 

A  few  words  as  to  the  manner  in  which  the  translator  has  accom- 
plished his  task  are  all  that  is  necessary.  On  comparison  with  the 
German  the  translator  will  be  found  to  be  as  literal  as  the  different 
construction  of  the  two  languages  would  admit  of;  the  sense  or 
meaning  of  the  original  being  invariably  given,  even  when  some 
transposition  was  necessary  to  suit  the  English  idiom. 

'^  All  thermometric  observations  have  been  rendered  in  the  centi- 
grade scale,  and  all  measurements  in  centi-  and  millimetres.'^  This 
will  possibly  prove  a  little  confusing  at  present  to  the  English 
reader,  who  will  be  at  a  loss  to  understand  how  long  a  child  who 
measures  forty-nine  centimetres  really  is,  no  table  showing  the  re- 
lation between  the  two  measurements  being  given-^a  decided  want. 
Again,  "the  weight  of  the  body  of  a  new-born  child  averages  from 3 
to  4000  grammes  "  (p.  2)  is  a  statement  that  will  puzzle  many. 

It  would  have  been  well  also  to  have  anglicised  some  of  the  ex- 
pressions employed,  e.^.  if  retraction  of  one  lower  extremity  occur, 
"then  gonitis,  coxitis,  or  psoitis  may  be  suspected"  (p.  3). 

In  all  material  points,  however,  the  English  version  loses  nothing 
from  its  translation,  and  gains  much  by  a  few  judicious  interpolations. 

In  many  respects  the  book  is  one  that  the  student  and  junior 
practitioner  will  be  glad  to  refer  to,  but  more  as  a  classical  than  as 
a  clinical  memoir.  We  miss  the  details  regarding  treatment  that 
we  are  familiar  with  in  West  and  Tanner.     The  indications  are  too 


1875.]  Materia  Medica  and  Therapeutics.  405 

vague  to  satisfy  the  wants  of  most  students  or  young  practi- 
tioners. There  is  no  appendix  of  forinula3,  and  very  few  instructions 
as  to  what  combination  of  drugs  or  what  doses  are  requisite.  We 
have  given  a  sufficient  account  to  enable  the  reader  to  form  a  fair  idea 
of  the  value  of  the  work.  It  is  printed  in  a  clear  readable  type, 
and  in  every  respect  does  credit  to  its  well-known  publishers. 

Materia   Medica   and     Therapeutics — Vegetable   Kingdom.^— 

The  work  which  now  lies  before  us  is  one  with  which  it  is  not  easy 
to  deal.  It  contains  much  which  is  new  and  has  been  highly  com- 
mended, but  the  greater  part  of  the  new  material  is  of  the  most 
questionable  character,  whilst  we  make  bold  to  say  that  the  majority 
of  those  who  have  commended  the  work  have  hardly  been  in  a 
position  to  do  so  from  a  thorough  knowledge  of  the  subject.  The 
newer  matter,  indeed,  is  almost  wholly  taken  from  two  sources,  the 
later  German  researches  and  homoeopathic  literature.  The  oppor- 
tunity of  bringing  much  interesting  matter  from  the  German  before 
the  British  profession  depends  in  great  measure  on  the  remissness  of 
former  writers  in  the  same  field ;  even  the  author  himself  seems 
ignorant  that  very  much  of  the  material  available  in  the  Brothers 
Husemann  Pflanzen-Stofle,  which  he  uses  so  extensively,  is  to  be 
found  in  a  work  which  he  does  not  refer  to  once,  viz.  the  same 
brothers^  edition  of  Van  Hassetl's  toxicology,  now  nearly  twenty 
years  before  the  world. 

As  to  the  rest  of  this  new  matter,  it  is  neither  more  nor  less  than 
pure  homoeopathy  preached  in  the  ordinary  bungling  homoeopathic 
manner,  and  this  we  are  prepared  to  show.  The  source  of  this 
knowledge  is  not  far  to  seek.  Dr.  PhiUips  was  long  known  as 
a  prominent  homoeopathic  practitioner,  but  by  degrees  he  became 
more  and  more  separated  from  the  homoeopaths,  until  at  last  he  was 
formally  reconciled  to  old  physic  by  being  admitted  a  member  of 
the  Clinical  Society.  Such  being  the  case,  there  are  good  grounds 
for  animadversion  on  the  part  of  homoeopaths,  who  most  justly  say, 
here  is  a  man  preaching  pure  homoeopathy,  and  yet  his  teachings  are 
accepted  with  something  approaching  to  admiration  by  the  body  of 
the  profession.  We  confess  we  here  hold  with  the  complainants, 
for  this  is  certain ;  either  Dr.  Phillips's  teaching  must  be  rejected,  or 
homoeopathy  and  old  physic  become  one  and  the  same ;  the  only  dis- 
tinction of  any  importance  left  is  the  dose,  in  which  again  the  two 
opposing  bodies  are  rapidly  converging.  But  there  is  one  charac- 
teristic of  the  educated  men  of  our  section  of  the  profession,  a 
characteristic  which,  we  trust,  will  ever  steadily  continue,  and  this 
assuredly  tends  to  separate  them  from  ordinary  homoeopaths.  To  us 
is  given  a  pathology  which  we  seek  after  more  and  more  as  a  basis 

1  Materia  Medica  and  Therapeutics — Vegetable  Kingdom.  By  CHAUIiBS  D.  F. 
PpiLUPS,  M.D.,  F.R.CS.Ii;.    London.    Pp.  584. 


406  BibliograpJiical  Record.  [Oct., 

whereupon  to  work  ;  to  the  homcEopath  but  a  bundle  of  symptoms ; 
and  this  we  hope  to  make  abundantly  apparent  from  the  present 
treatise. 

These  charges,  therefore,  we  make  bold  to  bring  against  Dr.  Phil- 
lips^s  work,  that  it  displays  a  profound  contempt  for  ordinary  patho- 
logy, and  that  it  teaches  the  system  of  treating  a  malady  by  sym- 
ptoms alone.  We  put  it  therefore  to  the  public  if  this  is  a  book  to  be 
received  as  a  recognised  authority  on  the  treatment  of  disease  ? 
Let  us  turn  for  the  proof  of  our  assertions  to  the  book  itself. 

Dr.  Phillips^s  work  on  Materia  Medica  and  Therapeutics  as  far 
as  yet  published  deals  only  with  the  vegetable  kingdom ;  the  other 
articles  of  the  materia  medica  are  left  to  be  dealt  with  hereafter. 
He  classifies  the  various  agents  in  their  botanical  orders,  but  groups 
the  orders  somewhat  diff'erently  from  the  system  usually  adopted.  In 
speaking  of  a  plant,  first  are  given  its  botanical  descriptions ;  secondly, 
and  in  a  certain  fashion,  its  chemical  characteristics ;  thirdly,  its 
physiological  efi'ects  ;  fourthly,  and  as  a  rule  more  fully,  its  thera- 
peutical eff'ects;  and  fifthly,  its  pharmacopoeial  preparations  are  briefly 
disposed  of.  What  can  have  induced  the  author  to  adopt  such  a 
scheme  we  know  not ;  we  can  understand  a  regular  treatise  dealing 
with  the  botany  of  the  plant  under  consideration,  but  in  such  a  treatise 
as  the  present  a  section  on  the  subject,  especially  such  as  the  sections 
here  given,  are  but  repertories  of  useless  lore,  giving  bulk  to  a  book 
which  might  have  been  much  smaller  and  certainly  none  the  worse 
for  much  excision. 

The  first  group  of  plants  discussed  is  the  Eanunculacese,  com- 
prehending in  it,  however,  several  plants  not  unusually  employed 
m  ordinary  medicine.  The  first  and  the  most  important  plant  dis- 
cussed  is — Aconite.  This  powerful  drug  has  long  been  in  the  hands 
of  homoeopaths,  whilst  foolishly  rejected  by  many  regular  practitioners, 
and  consequently  we  might  hope  to  learn  something  from  the  notice 
here  given,  but  there  is  not  much.  In  the  first  place,  the  account 
given  of  its  physiological  action  is  meagre  in  the  extreme,  and  is 
mainly  quoted  from  authors  of  little  authority  nowadays.  As  to  its 
therapeutical  value  it  is  now  generally  conceded  that  in  the  early 
and  acute  stages  of  many  maladies  of  the  so-called  inflammatory 
kind  aconite  does  good  if  anywhere,  but  this  is  not  everything.  Thus 
it  does  good  in  pneumonia,  but  only  in  the  early  stage ;  it  does  not 
afi'ect  condensation,  and  it  is  only  fair  to  mention  the  fact  that  Dr. 
Phillips  recognises  their  tendency  to  spontaneous  defervescence  at 
certain  periods  in  pneumonia  which  render  all  statistics  connected 
with  the  disease  more  or  less  fallible.  Our  experience  is  that  in  some 
cases  it  may  do  good,  but  is  altogether  unreliable.  So  of  acute 
rheumatism,  this  drug  has  been  frequently  used  in  that  disease  and 
as  frequently  lauded  or  despised.  Dr.  Phillips  says  he  has  never 
known  heart  disease  occur  if  aconite  was  given  from  the  beginning ; 


1875.]  Materia  Medica  and  Therapeutics.  ^  407 

the  same  may  be  said  of  many  other  drugs,  the  truth  being  that  the 
great  risk  of  heart  mischief  is  in  the  beginning  ;  or  again,  should  the 
disease  recandesce,  not  in  the  ordinary  course  of  the  disease.  Our 
own  experience  is  that  it  is  of  little  or  no  use ;  nor  do  the  objections 
raised  by  the  author  apply  to  such  experience  as  regards  the 
inefficiency  of  the  drug,  for  the  aconite  was  given  in  small  and 
frequent  doses,  and  was  active  enough  when  used  for  other 
purposes. 

In  some  places  Dr.  Phillips'  homoeopathic  training  crops  out  un- 
pleasantly, especially  as  regards  symptomatology.  Thus  we  find 
under  aconite  a  paragraph  as  follows  : — "  Palpitation  :  aconite  is 
also  of  great  use  in  those  cases  of  palpitation  of  the  heart  which 
depend  upon  simple  hypertrophy  of  the  left  ventricle.  On  the 
other  hand,  in  hypertrophy  of  the  left  side  of  the  heart,  with 
diseased  valves  admitting  of  regurgitation,  aconite  is  dangerous.^' 

Is  there  such  a  thing  as  simple  hypertrophy  of  the  left  heart  ?  if 
so,  what  is  it  due  to  ?  The  only  form  with  which  we  are  familiarly 
acquainted  is  associated  with  contracted  kidney,  and  is  therefore  not 
simple,  or  to  contracted  aortic  opening,  which  is  still  less  so.  Mark, 
again,  the  signs  and  effects  of  regurgitation  by  the  two  orifices  are 
different.     This  is  homoeopathic  pathology. 

With  Pulsatilla  begins  a  small  group  of  substances,  including 
bryonia  and  actsea,  almost  exclusively  used  by  homoeopaths ;  conse- 
quently here  we  find  the  information  is  almost  purely  from  homoeo- 
pathic sources ;  their  authority  cannot  be  quoted,  though  their  state- 
ments are  used,  and  hence  the  astounding  statements  stand  -wholly 
on  Dr.  PhilHps'  responsibility.  This  authority  may  be  good  or  bad, 
but  we  question  if  ophthalmic  surgeons  would  care  to  trust  to 
Pulsatilla  internally  and  externally  in  purulent  ophthalmia  of  children, 
or  even  to  gonorrhoeal  ophthalmia,  as  w^e  are  here  advised. 

We  have  accused  Dr.  Phillips  of  the  direct  teaching  of  homoeo- 
pathy after  their  own  fashion  of  symptoms  only.  We  may  select  this 
as  a  sample. 

Dyspepsia. — Pulsatilla  is  a  good  medicine  in  many  of  those  cases  of 
dyspepsia  or  of  subacute  gastritis  met  with  in  phlegmatic  tempera- 
ments, where  we  find  some  or  all  of  the  following  symptoms  present, 
namely,  depression  of  the  nervous  system  with  fear  of  death  j  loss  of 
appetite ;  white  and  thickly  coated  tongue  ;  httle  or  no  taste,  or  if 
taste  be  present  a  sensation  in  the  palate  of  greasiness;  sensation  of 
mucus  about  the  mouth  and  gums ;  nausea  with  an  inclination  or  wish 
to  vomit;  flatulency  ;  heartburn  ;  occasional  pains  and  flatulent  colic 
in  the  epigastrium ;  sick  headache ;  dry  cough  ;  coldness  and 
clamminess  of  the  extremities  and  often  likewise  of  the  entire  sur- 
face of  the  body,  generally  accompanied  by  constipation  or  by 
diarrhoea.  When  the  diarrhoea  is  attended  by  mucous  discharges 
or  by  active  piles,  the  pulsatilla  quickly  removes  them.     Now,  what 


408  Bibliof/rapJdcal  Record.  [Oct., 

means  this  farrago  of  symptoms?  where  do  we  find  anything  like  it 
save  in  homoeopathic  works  ?  But  the  truth  is  that  in  the  whole  of  this 
section  the  authorities  are  homoeopaths  or  eclectics,  but  as  their  names 
cannot  be  taken  from  Husemann  they  are  silently  passed  by.  There 
is  no  necessity  for  any  one  who  understands  homoeopathy  to  go 
beyond  the  various  articles  included  under  the  natural  order  Eanun- 
culacse,  especially  Pulsatilla,  hydrastris  and  actaea,  to  be  convinced 
of  the  character  and  the  sources  of  the  work. 

If  we  go  further  on  tlirough  the  book  the  same  unsatisfactory 
features  are  notable ;  there  are  few  indeed  of  the  articles  which  could 
pass  without  question.  As,  however,  there  is  a  certain  recognised 
basis  to  go  upon,  the  information  is  not  in  most  cases  wholly 
homoeopathic.  When,  however,  w^e  arrive  at  such  articles  as  cocculus 
indicus,  sanguinaria,  bryonia,  arnica,  &c.,  we  cannot  fail  to  be 
struck  with  the  characters  of  the  sections ;  they  sound  almost  Hke 
hydrastis  or  actsea  over  again  ;  and,  like  most  homoeopathic  litera- 
ture, amount  to  neither  more  nor  less  than  sheer  nonsense.  It  is 
no  part  of  our  purpose  to  be  unfair  to  the  book ;  we  are  quite  free 
to  admit  that  there  are  some  good  articles  in  it.  But  there  is  far 
too  much  trash  in  it ;  its  materials  have  not,  as  a  rule,  been  sought 
from  original  sources ;  there  is  an  air  of  learning  about  it  which  is 
hollow ;  men  of  all  values  are  quoted  save  the  author^s  old  homoeo- 
pathic friends,  and  poor  authorities  often  take  the  place  of  good 
ones ;  moreover,  the  book  is  cumbered  with  a  good  deal  of  useless 
rubbish.  It  is  quite  certain  that  this  last  statement  is  true  of  most 
books  of  materia  medica  and  therapeutics,  but  here  a  considerable 
proportion  of  this  kind  of  stufP  is  voluntarily  introduced.  In  short, 
were  the  book  cleared  of  superfluities,  it  might  be  reduced  to  a 
much  smaller  size  and  a  less  pretentious  character.  Our  main  pur- 
pose in  writing  this  notice  of  the  book  was  and  is  to  direct  attention 
to  its  dangerous  character  as  a  work  of  unreliable  authority,  and 
we  conceive  that  what  we  have  already  said  and  quoted  will  suffice 
for  this  purpose.  Were  it  necessary  we  could  multiply  these  illus- 
trations indefinitely,  but  we  think  we  have  done  enough.  We  are 
quite  unacquainted  with  the  author  save  by  his  book,  and  our 
observations  have  been  made  in  no  hostile  spirit  to  himself;  but  we 
conceive  it  to  be  our  duty  to  make  known  to  the  public  the  character 
of  certain  passages  in  the  work  which  essentially  mar  the  whole. 

Wanklyn's  Tea,  Coffee,  and  Cocoa.^ — Had  a  little  more  time  and 
labour  been  bestowed  upon  the  preparation  of  this  pamphlet  it  would 
have  proved  serviceable  to  many  public  analysts.  The  author 
acknowledges  in  his  preface  that  he  has  done  little  more  than  collect 

'  A  Practical  Treatise  on  the  Analysis  of  Tea,  Coffee,  and  Cocoa.  By  J.  A. 
Wanklyn.     Pp.  viii  anci  59.     London,  1874, 


18/5.]  "Watts    Dictwuary  of  Chemistry.  409 

the  material  which  had  been  accumulated  by  the  numerous  chemists 
who  have  examined  tea,  coffee,  and  cocoa.  His  own  additions  to 
our  knowledge  are  very  small,  and  from  imperfect  acquaintance  with 
the  chemical  literature  of  food  analysis,  he  too  often  claims,  as 
original,  methods  and  facts  long  previousl}'  known.  Witness  his 
announcement  as  a  new  process  of  the  taking  of  five  grams  of  milk 
for  determining  the  residue  left  on  its  evaporation — the  very  quantity 
recommended  by  M.  Doyere  so  long  ago  as  1851.  His  discovery  of 
manganese  in  beech  leaves,  given  to  the  public  last  year  as  a  novelty, 
had  been  similarly  anticipated  by  many  years. 

A  good  manual  of  food  analysis  is  really  much  needed.  It  would 
not  be  a  bulky  volume  even  were  it  to  include  all  the  necessary 
processes  for  the  examination,  not  only  of  tea,  cocoa,  coffee,  milk, 
and  other  articles  of  food  in  daily  use,  but  of  water  also.  At  present, 
when  any  kind  of  material  used  as  food  has  not  been  the  subject  of 
frequent  analysis,  the  chemist  to  whom  it  happens  to  be  sent 
may  never  have  submitted  it  to  examination  before.  He  is  probably 
ignorant,  not  only  of  the  standard  of  average  composition  with  which 
the  sample  if  genuine  should  agree,  but  of  the  tests,  qualitative  and 
quantitative,  which  are  best  adapted  to  reveal  its  character.  Such 
information  as  exists  in  reference  to  the  chemistry  of  the  material 
under  examination  is  not  only  scattered  in  isolated  papers  contained 
in  scientific  journals,  chiefly  foreign,  but  it  requires  adaptation  and 
further  work  before  it  can  be  made  to  answer  the  end  in  view.  Some 
adequate  steps  should  be  taken  at  once  to  supply  the  deficiency  here 
pointed  out.  Surely  the  Chemical  Society,  the  British  Association, 
and  the  Society  of  Public  Analysts  might  between'them  decide  upon 
a  plan  for  providing  a  really  standard  book  on  food  analysis.  A 
committee  should  be  appointed  to  whose  several  members  might  be 
assigned  the  duty  of  writing  the  different  chapters  of  the  proposed 
volume,  a  responsible  editor  revising  the  whole  work. 

Watts'  Dictionary  of  Chemistry,  2nd  Supplement.^— Nothing  is 
more  difficult  to  review  than  a  dictionary.  We  have  little  to  say  concern- 
ing the  present  volume,  having  already  given  our  estimate  of  the  great 
value  of  the  five  volumes  of  the  dictionary  itself  and  of  the  first 
supplement.  Two  only  of  the  contributors  to  the  preceding  volumes 
have  written  in  this  second  supplement,  and  their  articles  are  not 
purely  chemical,  relating  as  they  do  to  magnetism  and  light.  Three 
new  contributors  were,  however,  secured  by  Mr.  Watts,  namely.  Dr. 
Armstrong,  of  the  ]jondon  Institution ;  Dr.  IN'ewell  Martin,  Lecturer 
of  Christ's  College,  Cambridge ;  and  Mr.  R.  Warington,  formerly 
assistant  to  Professor  Church  at  the  Agricultural  College,  Cirencester. 

1  A  Dictionary  of  Chemistry.  By  Heney  Watts.  Second  Supplement. 
Loudon,  1875. 


4l0  Bibliographical  Record.  [Oct., 

The  first  of  these  three  chemists  has  written  a  couple  of  articles,  one 
being  on  isomeric  phenols,  and  the  other  on  the  chlorides  of  sulphur. 
Dr.  Newell  Martin  has  contributed  some  seven  pages  on  subjects 
connected  with  the  physiological  chemistry  of  man ;  these  articles 
are  clearly  written,  but  they  give  a  very  inadequate  idea  of  the  vast 
amount  of  good  work  which  has  been  lately  accomplished  in  this 
most  important  department  of  inquiry.  Mr.  Warington's  contri- 
butions relate  to  agricultural  chemistry,  and  seem  to  have  been  com- 
piled with  great  care;  they  take  up  such  subjects  as  malt,  fodder, 
manure,  and  root-crops.  In  the  paragraph  on  malt  we  notice,  how- 
ever, a  serious  error,  for  which  it  is  difficult  to  account.  Malt-dust, 
which  is  removed  by  screening  germinated  and  dried  barley,  is  said 
to  consist  of  the  radicle  and  plumule  of  the  grain.  So  far  from 
this  ever  being  the  case,  the  quality  of  malt  may  always  be  judged 
of  to  a  certain  extent  by  the  length  of  the  plumule,  which  remains 
firmly  attached  to  the  finished  malt,  and,  so  far  from  being  removed 
or  even  removable,  can  only  be  seen  by  raising  the  coverings  of  the 
grain.  But  such  mistakes  as  this  are  quite  exceptional,  so  that  we 
may  fairly  regard  these  papers  on  agricultural  chemistry  as  fairly 
supplementing  in  some  degree  the  deficiencies  of  the  original 
dictionary  in  this  particular. 

Of  the  1215  pages  which  the  present  supplement  contains,  by  far 
the  larger  number  are  the  work  of  the  indefatigable  editor,  Mr. 
Watts.  He  has  executed  his  task  of  collecting  and  condensing  the 
results  of  recent  chemical  research  (to  the  end  of  1872  mainly)  with 
skill  and  success.  Now  and  then,  of  course,  some  new  announcement 
of  an  old  fact  or  an  old  process  is  given  as  if  it  were  really  a  new 
discovery  worthy  of  record  as  such.  This  is  almost  the  only  kind  of 
defect  in  the  present  volume  of  which  we  feel  inclined  to  complain. 
Eeferring,  for  example,  to  the  article  on  milk  (pp.  811 — 813),  we  find 
nothing  of  that  which  is  new  in  it  worth  preserving,  while  the  re- 
maining statements  in  it,  if  announced  as  new  discoveries,  have  in 
reality  been  familiar  to  some  chemists  for  years.  The  well-known 
plan  of  testing  milk  by  taking  the  specific  gravity,  not  of  the  milk 
itself,  but  of  the  whey  or  serum  which  it  yields  on  artificial  curdling, 
is  cited  on  the  authority  of  a  recent  writer  in  the  ^  Chemical  News.' 
"VYe  notice  the  same  tendency  to  give  as  new  many  facts  which  are 
not  merely  old,  but  have  acquired  an  almost  antiquarian  interest,  in 
other  works  besides  that  under  review.  Such  a  tendency  is  common 
in  compilers  of  popular  scientific  works,  but  it  is  disappointing  to 
meet  with  it  in  the  otherwise  invaluable  abstracts  published  in  the 
'  Monthly  Journal  of  the  Chemical  Society.'  These  abstracts  have 
been  largely  drawn  upon  by  Mr.  Watts,  and  it  is  probably  in  this 
way  that  the  hypertrophy  of  the  present  book  may,  in  some  measure, 
be  explained. 


1875.1         Forces  which  carry  on  Circulation  of  Blood.        411 

Forces  which  carry  on  the  Circulation  of  the  Blood.^ — In  this 
little  brochure  Dr.  Buchanan  seeks  to  demonstrate  the  influence  the 
pneumatic  forces  exert  in  aiding  the  heart  to  maintain  the  circu- 
lation of  the  blood.  Most  physiologists,  trusting  the  reasoning 
advanced  by  Dr.  Arnott,  consider  these  forces,  if  they  have  influence 
at  all,  to  be  quite  subsidiary  to  the  cardiac  contraction,  but  Dr. 
Buchanan  by  a  very  logically  maintained  argument  establishes  their 
importance,  and  suggests  various  experiments  by  which  it  may  be 
proved. 

The  course  of  his  argument  renders  it  necessary  that  the  actual 
force  exerted  by  the  heart  should  in  the  first  instance  be  determined, 
and  he  proceeds  to  point  out  the  cause  of  the  strikingly  discrepant 
results  obtained  by  Borelli,  Hales,  and  Kiel,  viz.  that  these  observers 
proposed  different  problems  to  themselves,  the  first  seeking  to  de- 
termine the  absolute  force  of. the  heart ;  the  second,  the  absolute  force 
of  the  fibres  of  the  left  ventricle  as  combined  and  operating  in  the 
mechanism  of  the  heart ;  and  the  third,  the  effective  force  of  the 
heart  in  carrying  on  the  circulation  of  the  blood,  or  in  other  words, 
the  work  done  by  the  heart.     Dr.  Buchanan  takes  up  the  last  pro- 
blem, and  shows  that,  to  calculate  the  effective  force  of  the  heart,  it  is 
necessary  to  know  the  mass  of  blood  to  be  moved,  the  velocity  with 
which  it  moves,  and  the  obstacles  which  oppose  its  progress.     In 
pursuing  this  inquiry  he  estimates  the  number  of  contractions  of  the 
heart  per  minute  at   73,  the  primary  sectional  area  of  the  blood- 
vessels at  '^IST    of  a  square  inch,  and  the  quantity  of  blood  dis- 
charged at  each  stroke  two  ounces,  propelled  into  a  tube  already 
full  of  blood,  and  having  a  height  of  eighty-seven  inches ;  such  a 
column  weighs  twenty-two  ounces.     He  further  estimates  that  the 
velocity  of  the  blood  issuing  from  the  heart  is  ten  inches  per  second, 
which  is  certainly  below  the  truth ;  "  the  heart,  therefore,  at  each 
contraction,  exerts  a  force  which  would  be  in  equilibrium  if  counter- 
balanced by  a  weight  of  22  oz.  +129  grs. ;   and  that  the  mode  in 
which  this  force  is  expended  is  most  easily  understood  by  supposing 
that  we  have  a  tube  87  inches  in  height,  and  '4187  of  an  inch  in 
base,  that  this  tube  is  exactly  filled  with  blood,  and  that  at  each 
contraction  of  the  heart  two  additional  ounces  of  blood  are  forced 
into  it  at  the  lower  end,  lifting  the  whole  column  over  a  space  of 
8  inches,  and  causing  an  equal  overflow  at  the  top.    This  represents 
accurately  the  labour  of  the  human  heart,  and  supplies  us  with  two 
numbers  to  express  it :  the  one,  22  oz.,  being  the  weight  of  the 
column  of  blood,  and  the  other,  8  inches,  the  space  over  which  the 
column  is  lifted.     The  former  of  these  numbers  denotes  the  resist- 
ance that  has  to  be  overcome  in  forcing  2  oz.  of  blood  into  the  aorta 

'  The  Forces  which  carry  on  the  Circulation  of  the  Blood.  By  Andrew 
Buchanan,  M.D.,  Professor  of  Physiology  in  the  University  of  Glasgow.  Second 
edition.     London,  1874. 


412  Bibliographical  Record.  [Oct.^ 

and  pushing  before  it  the  whole  mass  of  blood  in  the  blood-vessels; 
the  latter,  again,  denotes  the  velocity  with  which  the  blood  issues 
from  the  heart.  Multiplying  those  two  numbers  together  we  obtain 
the  momentum  wliich  the  heart  communicates  to  the  blood,  220  oz. 
moving  with  a  velocity  of  8  inches  during  the  period  of  a  pulsation, 
or  of  10  inches  per  second,  or  50  feet  per  minute.  This  is  equiva- 
lent to  176  oz.  (22  X  8)  lifted  one  inch,  or  14*66  oz.  lifted  one 
foot,  during  the  period  of  a  pulsation,  or  of  65'9  foot-pounds  in  a 
minute,  or  42'3  foot-tons  in  twenty-four  hours. ''^  Dr.  Buchanan 
then  shows  the  errors  that  underlie  Hales'  application  of  the 
hydrostatic  paradox  to  the  action  of  the  heart,  and  of  his  system 
of  measurement  of  its  internal  superficies. 

These  are  essentially,  he  thinks,  that  the  heart  differs  from  the 
experimental  demonstration  of  the  hydrostatic  paradox  in  having  an 
aperture  of  •4187-inch  diameter  which  permits  the  escape  of  fluid  as 
soon  as  the  heart  begins  to  contract,  as  indeed  is  demonstrated  by 
the  fact  that  the  hseniostatic  column  only  rises  to  its  full  height  at 
the  commencement  of  the  contraction  of  the  ventricles,  and  then 
begins  immediately  to  subside,  so  that  it  is  obvious  that  the  blood 
escaping  along  the  aorta  must  gradually  diminish  the  tension  on  the 
walls  of  the  ventricle.  The  second  fallacy  in  Hales'  argument  is, 
that  whatever  may  be  the  force  exerted  by  muscular  fibre  at  the  com- 
mencement of  contraction,  it  gradually  diminishes  as  contraction 
proceeds.  The  correction  requisite  for  these  two  errors  in  calcula- 
tion Dr.  Buchanan  considers  to  be  that  the  mean  force  of  the  mus- 
cular fibres  as  arranged  in  the  human  heart  is  no  more  than  one 
eighth  of  their  original  force,  whilst  the  mean  size  of  the  ventricular 
surface  must  be  reduced  to  one  fourth..  ^^  Combining  these  two 
ratios  we  have  a  total  medium  estimate  of  one  thirty-second.  Now 
if  we  multiply,"  he  goes  on  to  say,  "  22  oz.  by  32  oz.,  the  result  is 
44  lbs.,  which  would  be  very  nearly  the  initiatory  power  of  the  heart 
if  we  assume  the  size  of  the  ventricular  surface  as  18"3984  square 
inches.  The  conclusion,  therefore,  is  that  there  is  no  difi*erence 
between  the  effective  force  of  the  heart  estimated  at  22  oz.  and  the 
mean  absolute  force  =  14  lb.  or  704  oz.  divided  by  32  =  22  oz." 

Having  thus  determined  the  absolute  efiective  force  of  the  heart. 
Dr.  Buchanan  proceeds  to  consider  what  other  forces  aid  in  carry- 
ing on  the  circulation  of  the  blood.  These  are  the  muscular  con- 
tractility of  the  blood-vessels,  which  is  very  small;  and  secondly,  a 
central  pneumatic  force  or  the  atmospheric  pressure  towards  the 
chest  and  heart  rendered  effective  by  a  central  dilative  force.  This 
last  he  considers  to  be  much  more  effective  than  is  generally  ad- 
mitted, and  he  opposes  Dr.  Arnott's  objection  that  any  aspirative 
action  can  be  exerted  on  thin-walled  vessels  like  the  veins  on  ac- 
count of  their  tendency  to  collapse,  by  pointing  out  that  the  pres- 
sure of  the  blood  would  keep  them  constantly  full.     He  crilicises 


1875.]  d?i  Tuberculous  Arthritis.  413 

with  much  force  Dr.  Arnott's  "  bloodless  experiment  "  intended  to* 
disprove  the  suction  action,  in  which  a  syringe  terminates  in  two 
nozzles,  one  dipping  into  water  whilst  the  other  preserves  free  commu- 
nication with  air.  In  this  experiment,  as  might  be  expected,  as  long 
as  the  air  enters  freely,  the  water  rises  to  a  very  small  height  only. 
Dr.  Buchanan  modifies  this  typical  respiratory  apparatus  by  intro- 
ducing a  sac  into  the  syringe  with  an  exterior  opening  through  which 
the  air  rushes  and  distends  the  sac  on  raising  the  piston.  This,  it 
must  be  acknowledged,  fairly  represents  the  action  of  the  diaphragm 
and  chest  in  respiration,  and  proves  that  a  considerable  force  is  in 
constant  operation. 

Dr.  Buchanan  considers  that  asphyxia  is  the  experimentum  crucis 
of  the  doctrine  of  the  pneumatic  agency  of  the  chest.  When  the 
act  of  breathing  ceases  the  heart  is  deprived  of  all  assistance  from 
the  pneumatic  force  of  the  chest ;  it  has  to  contend  single-handed 
against  all  the  resistances  which  oppose  the  onward  movement  of  the 
blood — a  task  for  which  its  utmost  efforts  are  ineffectual ;  it  labours 
and  palpitates  in  vain ;  the  blood  accumulates  in  the  capillary  vessels 
of  the  system  and  more  effectually  oppresses  the  brain,  which  it  does 
the  more  readily  that  it  is  now  no  longer  as  oxygenated  blood,  but  as 
black  or  venous  blood,  that  it  stagnates  in  the  cerebral  vessels;  loss  of 
consciousness  of  sensibility  and  of  all  other  forms  of  nervous  energy 
speedily  ensue,  and  these  are  the  forerunners  of  the  extinction  of  life. 

The  phenomena  of  the  foetal  circulation  are  impressed  by  Dr. 
Buchanan  as  supporting  this  conclusion;  and  he  maintains  that 
the  foramen  ovale  is  simply  a  means  of  allowing  the  right  heart  to 
aid  the  left  in  carrying  on  the  circulation.  Immediately  after  birth 
the  pneumatic  forces  come  into  play  and  the  foramen  ovale  closes 
up.  The  pneumatic  forces  are  consequently  about  equivalent  to 
the  force  exerted  by  the  right  heart. 

The  phenomena  resulting  from  the  opening  of  a  vein  even  at  some 
distance  from  the  heart  lend  considerable  support  to  Dr.  Buchanan''s 
explanation;  still  he  does  not  appear  to  us  quite  to  meet  the 
difficulty  experienced  by  Poissenille  of  obtaining  evidence  of  a 
suction  power  in  veins  more  remotely  situated,  and  he  seems  also 
to  overlook  the  very  decided  reflux  that  may  be  observed  to  occur 
during  expiration  in  the  great  veins  of  the  neck,  and  which  is  op- 
posed to  his  view,  that  no  fluid  escapes  from  the  chest  at  this  period. 
The  subject  is  one  that  possesses  much  interest  from  a  practical 
as  well  as  a  theoretical  point  of  view,  and  Dr.  Buchanan  deserves 
great  credit  for  his  attempts  to  elucidate  a  confessedly  difficult  bit 
of  physiology. 

On  Tuberculous  Arthritis.^— Dr.  Roux  professes  himself  to  be  a 

1  JDe  VArthrite  Tuherculeuse,  Demonstration  de  I' Existence  de  cette  Affection 
par  Inoculation  de  produits  synoviaux.     Mtude  accompagnee  d' Observations  re- 
112— LVi.  27 


414  V  Bibliographical  Record.  [Oct., 

believer  in  the  inoculation  of  tubercle,  although  he  does  not  bring 
forward  any  very  strong  arguments  or  facts  in  support  of  this  view. 
The  practical  part  of  his  work  seems  to  aim  at  distinguishing  the 
different   kinds  of  tubercular  arthritis,   and  he  divides  them  into 
two  categories — one  in  which  a  pulmonary  lesion  is  anterior  to  the 
articular,  and   another  in  which  the  articular  disease  is  first  de- 
veloped  and   precedes   the    visceral  affection   by  several   months. 
The  cases  falling  within  the  second  division  are  much  more  frequent 
than  the  others,  and  Dr.  Eoux  refers  to  the  numerous  instances 
where  patients  suffer  for  several  months  or  even  years  with  white 
swelling,  and  are  then  attacked  with  intercurrent  phthisis,  which 
sometimes  becomes  the  predominant  affection,  sometimes  is    only 
obscurely  developed,  and  sometimes  is  discovered  only  after  death. 
With  regard  to  treatment,  he  advocates  the  use  of  the  knife  as 
being  the  best  means  of  arresting  the  disease  when  the  lungs  are 
not  yet  positively  affected,  and  he  gives  two  cases  in  illustration,  in 
one  of  which  the  leg  was  amputated  for  a  white  swelling  of  the 
knee,  and  in  the  other  a  resection  of  the  elbow  was  performed  for 
tubercular  disease  of  that  joint ;  in  both  these  cases  complete  re- 
covery took  place,  although  there  had  been  previously  threatenings 
of  pulmonary  mischief.     The  question  of  amputation  or  resection 
is  regarded  somewhat  differently  in   England  and  in  Erance,  for 
whereas  in  the  former  country,  according  to  Dr.  Eoux,  resection  is 
performed  on  all  kinds  of  joints  and  sometimes  for  comparatively 
slight  affections,  in  France,  on  the  other  hand,  resection  is  never 
performed  on  the  lower  limbs,  except  sometimes  on  the  foot.     The 
reasons  given  for  the  abandonment  by  the  French  surgeons  of  re- 
section of  the  knee  and  the  hip  are  stated  by  Dr.  Eoux  to  be  the 
great  mortality  attending  the  operation,  and  the  want  of  sufficient 
repairing  power  in  the  joint,  and  the  difficulty  of  procuring  perfect 
anchylosis. 

Stille's  Therapeutics  and  Materia  Medica.^ — It  is  unnecessary  to 
do  much  more  than  to  announce  the  appearance  of  the  fourth  edition 
of  this  well-known  and  excellent  work.  We  are  informed  in  the 
preface,  however,  that  for  two  years  it  has  been  out  of  print,  and 
that  the  unavoidable  delay  in  preparing  the  new  edition  has  given 
opportunities  to  the  author  to  revise  the  whole  work  and  to  add 

cueillies  a  V Hotel- Dieu  de  Lyon.  Par  le  Dr.  J.  RoTJX,  Ancien  Interne  des 
H6pitaux  de  Lyon. 

On  Tuberculous  Arthritis,  a  Demonstration  of  the  Existence  of  this  Affection 
hy  Inoculation  of  Synovial  Products.  A  Study,  accompanied  by  Observations 
collected  at  the  Kotel-Dieu  of  Lyons.  By  Dr.  J.  Eoux,  formerly  House-Surgeon 
at  the  Lyons  Hospitals. 

^  Therapetdics  and  Materia  Medica :  a  Systematic  Treatise  on  the  Action  and 
Uses  of  Medicinal  Agents,  including  their  Description  a}id  History.  By  Alfeed 
Stille,  M.D.,  Professor  of  the  Theory  and  Practice  of  Medicine  and  of  Clinical 
Medicine  in  the  University  of  Pennsylvania,  &c.  Fourth  edition,  thoroughly 
revised  and  enlarged.    In  two  volumes.     Philadelphia,  1874. 


1875.]  Roy  on  Burdwar  Fever.  415 

about  250  pages  of  new  matter.  Several  new  articles  have  been 
introduced,  the  chapter  on  electricity  has  been  almost  entirely  re- 
written by  Dr.  Mathew  J.  Grier,  and  the  nomenclature  throughout 
has  been  made  to  conform  to  the  last  edition  of  the  (United  States) 
^  Pharmacopoeia.''  The  book  is  arranged  according  to  the  thera- 
peutical action  of  the  respective  drugs,  and  Dr.  Stille  states  that 
continued  study,  observation,  and  reflection  have  tended  to  strengthen 
his  conviction  that  it  is  a  mischievous  error  to  deduce  the  thera- 
peutical uses  of  medicines  from  their  physiological  action,  and  that 
clinical  experience  alone  is  the  true  and  safe  test  of  the  virtues  of 
medicinal  agents. 

Commentary  on  the  British  Pharmacopceia.i — Notwithstanding 
the  great  number  of  books  already  published  in  explanation  of  the 
drugs  and  preparations  in  the  British  Pharmacopoeia,  Dr.  Walter 
Smith's  volume  will,  we  think,  be  found  a  welcome  addition  to  the 
list.  It  difiers  from  other  class-books  on  Materia  Medica  in  not 
reprinting  the  text  of  the  Pharmacopoeia,  so  that  its  size  is  propor- 
tionally reduced  and  needless  repetition  is  avoided.  We  cannot  too 
strongly  urge  the  necessity  of  every  medical  practitioner  possessing 
a  copy  of  the  official  publication,  and,  if  so,  then  the  commentary 
need  not  embody  all  the  descriptions  and  formulae  over  again.  Those 
who  only  wish  to  know  how  to  prescribe  with  accuracy  and  safety 
will  be  satisfied  with  the  '  British  Pharmacopoeia '  itself,  but  the  great 
majority  of  practitioners  and  all  students  must  wish  for  much  more, 
and  works  like  this  before  us  will  supply  the  deficiency.  It  is  of 
course  quite  impossible  to  enter  into  detail  as  to  the  manner  in  which 
Dr.  Walter  Smith  has  executed  his  task,  but  we  must  remark  that 
the  book  is  very  well  and  clearly  printed,  and  the  descriptions  are 
very  good.  The  new  notation  in  chemistry  being  now  very  gene- 
rally understood,  it  is  adopted  in  the  chemical  sections.  The 
natural  history  of  the  animal  and  vegetable  substances  is  briefly 
described,  but  details  are  given  of  such  plants  as  are  indigenous  to 
Great  Britain  and  Ireland, or  are  commonly  cultivated  in  those 
countries.  Another  feature  in  this  work  is  that  the  recently  pub- 
lished '  Additions  to  the  British  Pharmacopoeia '  are  incorporated  in 
the  text  in  their  alphabetical  order,  and  some  brief  notices  are  also 
given  of  some  non-officinal  drugs  which  are  at  present  most  in 
demand  or  which  promise  to  become  permanent  additions  to  our 
stock  of  remedies. 

Roy  on  Burdwar  Fever.^— The  author,  a  native  of  India,  who 

1  Commentary  on  the  British  Pharmacopoeia.  By  Walteb  G.  Smith,  M.D. 
Dublin.     Pp.  766.     London,  1875. 

2  Essay  on  the  Causes,  Symptoms^  and  Treatment  of  JBurdtoar  Fever,  or  the 
Epidemic  Fever  of  Lower  Bengal.  By  G.  C.  RoT,  M.D.,  F.R.C.S.,  Surgeon, 
Bengal  Establishment,  &c.     Calcutta,  1874  (pp.  92). 


416  Bibliograp Ideal  Record.  [Oct.i 

seems  to  have  studied  in  this  country,  is  Inspector  of  Dispensaries 
in  Burdwar.  After  nearly  two  years'  experience  there  he  embodied 
his  views  as  to  the  causes  of  the  fever  which  has  prevailed  in  that 
and  the  neighbouring  districts  of  Lower  Bengal  for  a  considerable 
period  in  a  paper  which  was  submitted  for  competition  for  the 
prize  offered  by  the  Viceroy  of  India  for  the  best  essay  on  that 
subject.  Though  not  the  successful  competitor,  he  has  since  en- 
larged the  original  paper  by  the  addition  of  much  new  matter,  and 
it  is  in  this  form  w-e  have  to  deal  with  it. 

The  cultivation  of  rice  has  long  been  one  of  the  chief  occupations 
in  many  parts  of  the  delta  of  the  Ganges  and  Brahmaputra,  and  the 
increasing  demand  for  this  article  of  late  years,  both  for  home  con- 
sumption and  export,  has  led  to  an  enlarged  area  being  brought 
under  crop,  not  only  in  the  delta  itself,  but  in  the  low  alluvial  dis- 
tricts to  the  west  of  it,  the  rivers  of  which  rise  in  the  high  land  of 
Cheta  Nagpore  and  flow  into  the  Hughly.  Rice  requires  much 
water  while  growing,  and  the  cultivators  are  accustomed  to  ensure 
the  necessary  supply  of  this  by  raising  small  dams  round  their 
fields,  which  retain  enough  of  the  rainfall  to  afford  the  moisture 
required  for  bringing  the  crop  to  maturity.  A  low,  flat,  alluvial 
district,  subject  to  the  flooding  caused  by  tropical  rains,  is  always 
subject  to  fever  as  the  waters  subside,  but  the  evil  is  aggravated  to 
no  inconsiderable  degree  by  the  conditions  under  which  rice  cultiva- 
tion is  carried  on,  and,  accordingly,  the  older  rice  districts  in  the 
centre  and  eastern  parts  of  the  delta  have  been  long  characterised 
by  the  frequency  and  severity  of  the  malarial  fevers  in  them.  It 
was  only  within  the  last  twenty  years,  according  to  our  author,  that 
fever  became  prevalent  in  some  of  the  western  parts  of  the  delta, 
or,  more  probably,  the  unusual  prevalence  of  the  disease  in  these 
districts  has  only  attracted  attention  within  that  period.  Be  this 
as  it  may,  however,  every  few  years  it  has  been  extending  itself 
westward  over  fresh  country,  and  by  1869  it  had  involved  Burdwar, 
Bancoorali,  and  Midnapoor.  The  progress  of  the  disease  in  a 
village  is  thus  described  : 

"  The  fiirst  year  of  the  invasion  is  characterised  by  an  increase  of 
ordinary  fever  cases,  but  it  subsides  completely  wath  the  advance  of 
the  season  ;  the  second  year  counts  more  victims  and  the  duration  of 
the  disease  becomes  longer.  With  the  prolonged  suffering  the  com- 
plications begin  to  appear.  A  little  respite  is  enjoyed  in  summer 
by  those  who  are  free  of  complications,  but  only  to  suffer  again  in 
the  ensuing  rains.  In  the  third  year  more  mortality  takes  place 
from  primary  attacks  and  secondary  complications,  as  it  finds  the 
system  so  reduced  from  constant  suffering  that  it  is  ill  fitted  to 
sustain  an  assault.  Enlargement  of  the  spleen  and  the  liver, 
anasarca,  anaemia,  ascites,  cancrum  oris,  now  become  common  sights. 
In  summer,  instead  of  improving,  the  suffering  continues.     In  the 


1875.]  Roy  on  Bardwar  Fevei\  417 

fourth  year  a  slight  abatement  of  its  severity  is  observed,  but  fatal 
cases  occur  among  chronic  patients,  who  succumb  under  slight 
causes  of  exhaustion.  In  the  fifth  year  improvement  is  more 
manifest,  and  temporary  abeyance  in  summer  shows  itself.  In  the 
sixth  year  the  majority  recover,  gaining  in  flesh  and  strength, 
but  a  permanently  enlarged  spleen  is  left  behind."     (P.  46-7.) 

Though  the  fever  is  clearly  malarial,  it  has  been  supposed  that 
an  element  of  contagion,  having  been  added  in  some  way  to  the 
original  disease,  causes  it  to  spread  from  village  to  village  through 
human  agency.  The  author,  however,  states  he  had  been  able  to 
watch  numerous  cases  of  the  worst  type  in  individuals,  in  the  early 
and  later  parts  of  the  season,  who  did  not  impart  the  disease  to  their 
attendants,  while,  during  the  height  of  the  rains,  it  became  general 
and  widespread,  as  is  common  with  fevers  depending  on  endemic 
causes.  As  to  type,  he  points  out  the  frequent  combination  of 
continued  remittent  and  intermittent  fevers  in  the  same  case,  the 
one  merging  into  the  other  in  various  ways  as  the  disease  runs  its 
course,  a  peculiarity  every  one  who  has  observed  fever  closely  in 
malarious  localities  must  have  recognised.  He  also  mentions  one 
variety  in  which,  instead  of  convalescence  being  established  in  eight 
or  nine  days,  the  disease  goes  on  and  assumes  the  typhoid  type,  a 
combination  we  believe  is  not  unfrequent  when  the  ordinary  cause 
of  enteric  fever  exists  in  any  locality  at  the  same  time  with  malaria. 
In  his  descriptions,  too,  of  a  fatal  termination  from  cerebral  compli- 
cations on  the  fourth  or  fifth  days  of  the  fever,  from  exhaustion  in 
the  second  week,  whether  arising  from  deficient  nourishment  or 
accelerated  by  too  few  evacuations,  and  from  pulmonary  congestion 
in  the  third  or  fourth  week  or  later,  old  tropical  practitioners  will 
recognise  phases  of  disease  they  must  frequently  have  encountered, 
and  which,  until  they  became  familiar  with  them,  were  always 
sources  of  serious  anxiety  and  doubt.  One  complication  noticed, 
cancrum  oris,  is  not  common  elsewhere  in  fevers  of  this  description, 
though  sometimes  met  with ;  it  mostly  occurred  in  boys  under 
fifteen,  and  "  generally  towards  the  end  of  winter  or  beginning  of 
summer,  when,  after  prolonged  and  continuous  suffering,  vitality  is 
reduced  to  its  lowest  ebb.^' 

Various  causes  have  been  assigned  by  different  writers  for  the 
greater  frequency  and  severity  of  this  fever  of  late  years.  Of  these 
the  principal  are — the  gradually  increasing  imperfection  of  the 
drainage  consequent  on  the  deposition  of  alluvial  matter  in  the 
channels  of  the  delta,  the  impediment  offered  to  the  free  escape  of 
surface  water  by  railway  works,  the  numerous  pools  required  for  the 
cultivation  of  rice,  the  increase  of  jungle  in  the  neighbourhood  of 
many  villages,  and,  lastly,  bad  water  for  domestic  use.  Now,  as  the 
author  points  out,  all  these  have  been  in  operation  for  a  very  long 
period,  except  the  interference  with  the  surface  drainage  caused  bv 


418  Bibliographical  Record.  [Oct., 

the  railway  works,  which  is  not  material  in  amount,,  and  applies  but 
to  a  very  limited  portion  of  the  districts  affected ;  and  though  he 
thinks  each  has  contributed  to  the  development  of  the  fever  at 
various  points,  yet  the  disease  was  by  no  means  so  generally 
diffused  as  the  existence  of  these  conditions  would  lead  us  to  expect, 
and  it  presented  a  varying  intensity,  recurring  in  greater  force  every 
few  years,  and  then  manifesting  a  disposition  to  spread  into  dis- 
tricts previously  comparatively  exempt.  To  explain  these  apparent 
anomalies  the  author  observes,  every  poison  requires  a  favorable 
soil  to  become  endemic  in  a  country,  and  it  is  the  addition  of  a  fer- 
ment in  the  air  that  gives  it  an  increased  potency,  and  thus  converts 
it  into  an  epidemic  agency.  The  ferment,  he  considers,  is  generated 
by  the  long-continued  action  of  accumulating  filth,  and  it  is  com- 
municated to  contiguous  places,  spreading  devastation  from  village 
to  village  in  a  series  of  years.  We  fear  this  theory  will  not  prove 
satisfactory  to  those  who  submit  it  to  a  critical  examination,  and 
compare  it  with  what  is  known  of  the  manifestations  of  fever  else- 
where in  India,  or  in  other  countries.  That  there  are  many  sources 
of  malaria  in  operation  in  the  districts  in  which  this  fever  has  pre- 
vailed there  can  be  no  doubt ;  that  fevers  have  become  more  frequent 
in  them  from  time  to  time  under  the  operation  of  these  causes, 
which,  for  want  of  a  specific  knowledge  of  their  nature,  we  have 
hitherto  included  under  the  term  '^  epidemic  influence,^''  is  equally 
clear;  but  the  particular  cause  which  has  led  to  the  remarkable 
prevalence  and  severity  of  the  disease,  in  a  comparatively  limited 
though  gradually  extending  area,  has  still  to  be  indicated.  We 
hope  Dr.  Roy  will  continue  to  apply  the  powers  of  observation  of 
which  his  essay  affords  evidence  to  the  investigation  of  the  facts 
which  come  under  his  notice,  with  the  view  of  eliciting  more  precise 
information  on  this  very  interesting  question. 

Hamilton  on  Syphilitic  Osteitis.^ — Mr.  Hamilton's  lectures,  though 
not  containing  anything  new,  will  furnish  the  student  with  a  clear 
and  terse  description  of  syphilitic  bone  disease,  and  with  some  useful 
practical  hints  for  diagnosis  and  treatment. 

The  subject  is  treated  under  three  heads — periostitis,  the  bony 
node,  and  the  soft  node — and  is  illustrated  by  the  relation  of 
numerous  cases. 

Although  periostitis  is  spoken  of  separately,  Mr.  Hamilton  justly 
remarks  that  clinically  we  find  that  even  shght  cases  of  periostitis 
involve  changes  in  the  surface  of  the  bone  also.  A  good  descrip- 
tion with  an  illustrative  photograph  is  given  of  the  hard  or  bony 
node,  which,  though  most  often  found  among  the  late  manifestations 

1  Lectures  on  Syphilitic  Osteitis  and  Periostitis.  By  John  HAMILTON,  Surgeon 
to  the  Riclimond  Hospital  in  London  and  Dublin.     1874. 


1875.]  Hamilton  on  Stjphilitic  Osteitis.  419 

of  the  disease,  is  sometimes  also  seen  as  an  early  symptom,  accom- 
panied by  sore  throat  and  rashes  upon  the  skin. 

An  interesting  case  is  related  wherein  a  node  upon  the  fifth  rib 
closely  simulated  a  mammary  tumour.  "  Osteitis  and  periostitis  of 
the  spine  of  the  vertebrae  are  so  like  spinal  irritation  and  neuralgia 
that  it  is  only  by  much  care  in  the  examination  of  the  local  derange- 
ment and  the  concomitant  symptoms  with  the  history  that  accurate 
induction  is  obtained.  A  still  more  important  and  interesting 
locality  is  where  the  bodies  of  the  vertebrae  in  the  pharynx  are  the 
seats  of  osteitis  and  periostitis.  Another  situation  which  is  not 
unusual,  and  where  it  might  lead  to  mistake,  is  the  trochanter 
major  of  the  femur.'^  Cases  exhibiting  various  paralytic  symptoms 
depending  upon  syphilitic  disease  of  the  vertebrae  and  cranium  are 
given,  and  also  of  epilepsy  due  to  thickening  of  the  skull  and 
cerebral  membranes. 

The  most  valuable  lecture  is  that  on  syphilitic  disease  of  the 
bones  of  the  orbit.  The  resemblance  which  these  cases  bear  to 
malignant  disease  is  well  described,  and  is  a  matter  that  the  student 
cannot  have  impressed  too  vividly  upon  his  mind.  Most  surgeons 
must  have  seen  cases  in  which  protrusion  of  the  eyeball  by  soft 
orbital  tumours  has  led  to  their  being  condemned  as  malignant,  but 
which  have  rapidly  recovered  under  anti- syphilitic  remedies. 

The  soft  node  is  described  as  "  the  product  of  syphilitic  inflam- 
mation of  the  bone  and  periosteum  in  strumous  and  broken-down 
constitutions  ;'^  but  we  think  it  is  by  no  means  confined  to  such 
persons.  The  resolution  of  these  nodes  often  gives  rise  to  the 
depressions  on  the  surface  of  a  bone  which  are  valuable  evidences 
of  past  syphilis.  The  danger  of  operative  interference  with  necrosed 
cranial  bones  is  spoken  of,  and  the  treatment  by  sulphuric  acid 
introduced  by  Mr.  G.  Pollock  is  alluded  to. 

We  think  it  a  pity  that  Mr.  Hamilton  should  apply  to  the  syphi- 
litic gummata  the  name  of  "  yellow  tubercle,"  a  description  which 
can  only  add  to  the  confusion  already  existing  with  regard  to  the 
signification  of  the  word  "  tubercle ;"  and  we  see  no  reason  for 
separating  those  cases  of  periostitis  in  which  the  inflammatory  pro- 
ducts undergo  caseous  degenerations  from  the  other  instances  of 
periosteal  nodes. 

In  the  lecture  on  treatment  we  are  glad  to  see  Mr.  Hamilton 
speaking  decidedly  upon  the  necessity  for  mercury.  ^'  There  are 
some  members  of  the  profession,  I  am  aware,  who  believe  that  not 
only  is  mercury  objectionable  when  the  bones  are  diseased,  but  that 
their  diseased  condition  is  the  result  of  the  previous  use  of  mercury. 
I  have  sufficiently  shown  by  my  recommendation  that  I  do  not 
agree  with  this  opinion,  A  style  of  reasoning  has  been  adopted 
(unsupported  by  facts)  that,  when  mercury  has   been  previously 


420  Bibliographical  Record.  [Oct., 

given^  the  diseases  of  the  bones  which  may  afterwards  appear  are 
caused  by  it.  On  the  same  principle  the  deaths  from  phthisis  might 
be  attributed  to  cod-Hver  oil,  for  how  few  die  of  that  fatal  disease 
who  have  not  previously  taken  cod-liver  oil !  I  have  notes  of  cases 
where  well-marked  nodes,  with  other  secondary  symptoms,  occurred 
where  no  mercury  at  all  had  been  given  for  the  primary  chancre. 
I  have  met  with  many  cases  of  tertiary  osteitis  and  periostitis,  par- 
ticularly of  the  cranium,  where  no  mercury  had  been  used  for 
primaries  or  secondaries.^' 

A  useful  guide  as  to  the  effect  of  mercury  is  to  have  the  patient 
periodically  weighed.  Mercurial  inunction  is  recommended,  but 
we  are  surprised  to  see  no  allusion  to  the  mercurial  vapour  bath. 
The  great  value  of  iodide  of  potassium  in  the  later  cases  is  pointed 
out,  and  some  cases  related  showing  how  amenable  to  treatment 
many  of  the  syphilitic  bone  diseases  are. 

Taylor  on  Syphilitic  Diseases  in  Children.^ — This  is  a  careful  and 
elaborate  treatise  upon  a  subject  to  which  the  author  has  given  much 
attention.  It  is  based  partly  upon  the  observations  of  others  and 
partly  upon  a  series  of  cases  recorded  with  great  care  by  Dr.  Taylor 
himself,  and  may  be  recommended  as  an  excellent  account  of  a  class 
of  cases  the  nature  of  which  has  been  often  mistaken,  and  which  even 
now  are  frequently  not  recognised  as  syphilitic.  Doubtless  Dr. 
Taylor  is  correct  in  saying  that  many  of  the  syphilitic  lesions  of 
the  osseous  system  in  infants  have  been  regarded  as  evidences  of 
rickets  or  scrofula ;  and  altliough  instances  of  syphilitic  bone  disease 
in  infants  had  been  accurately  described  by  Yalleix  in  1834,  and  by 
Ranvier  in  1864,  no  systematic  account  of  the  affection  had 
appeared  until  Dr.  Wagner,  of  Berlin,  published  in  1870  a  paper 
minutely  describing  the  bone  lesions  in  twelve  syphilitic  children, 
and  showed  that  the  pathological  processes  were  sui  generis.  These 
observations  were  confirmed  and  added  to  by  Professors  Waldeyer  and 
Kobner;  and  in  1872  an  excellent  clinical  description  of  the  cases 
was  published  by  M.  Parrot  in  Paris.  Dr.  Taylor  has  collected 
all  the  published  cases,  and  has  added  twelve  of  his  own,  described 
wqth  a  care  that  makes  them  a  very  valuable  record.  These  are 
followed  by  a  minute  description  of  the  pathology  of  the  affection, 
and  by  sections  upon  diagnosis  and  treatment.  The  most  common 
form  of  osseous  lesion  in  syphilitic  infants  is  an  enlargement  of  the 
shaft  of  the  long  bones,  due  to  an  inflammatory  affection  of  the 
lower  part  of  the  shaft,  and  of  the  ossifying  layer  of  the  epiphysial 
cartilage,  whereby  the  epiphysis  is  often  separated  from  the 
diaphysis.     The  ends  of  the  bones  become  thickened  externally  and 

1  Syphilitic  Lesions  of  the  Osseous  System  in  Infants  and  Young  Children. 
By  R.  W.  Tayloe,  M.D.    New  York,  1875, 


1875.]  Taylor  on  Syphilitic  Diseases  of  Bones  in  Children,   421 

softened  within,  and  may  bo  eventually  destroyed  by  a  purulent 
infiltration  leading  to  destruction  of  the  lamellae  and  the  forma- 
tion of  cavities.  The  joint  is  not  usually  involved.  A  similar 
disease  less  frequently  attacks  the  short  bones,  giving  rise  to  nodu- 
lar swellings  upon  their  surface.  Dr.  Taylor  divides  these  cases 
into  two  classes — '^a  first  in  which  the  morbid  processes,  as 
evidenced  by  swellings,  undergo  resolution,  without  perceptible  im- 
pairment of  the  structure  of  the  bones,  of  the  parts  around  and 
above  them,  or  of  the  function  of  the  member  of  which  they  form  a 
part  j  and  a  second  in  which  resolution  does  not  take  place,  but  in 
which  degenerative  changes  are  observed.  These  degenerative 
changes  may  be  limited  simply  to  a  destruction  of  the  superficial 
portions  of  the  swellings  in  greater  or  less  extent,  or  they  may  be 
so  severe  as  to  involve  the  whole  diameter  of  the  swelling  in  de- 
struction or  liquefaction,  in  which  event  the  epiphyses  become 
separated  from  the  diaphyses.^' 

In  describing  the  affection  as  it  occurs  in  the  upper  extremity  it 
is  pointed  out  that  the  swellings  are  usually,  though  not  invariably, 
symmetrical,  and  are  more  often  developed  at  the  internal  condyle 
of  the  humerus  than  elsewhere.  The  ribs  are  less  often  affected 
than  the  other  long  bones,  and  usually  only  a  few  ribs  are  involved. 
It  is  necessary  to  distinguish  this  disease  from  the  enlargement  of 
the  end  of  the  ribs  due  to  rickets.  The  diagnosis  will  be  assisted 
by  the  concomitant  symptoms,  by  the  early  development  of  the 
syphilitic  swelhngs  and  the  absence  of  a  prodromal  stage,  by  the 
limited  number  of  ribs  affected  in  syphilis,  the  less  symmetrical 
character  of  the  syphilitic  disease,  and  the  state  of  the  fontanelle, 
the  closing  of  which  is  not  delayed  by  syphilis.  The  affection  of  the 
other  long  bones  is  described  with  a  good  deal  of  needless  repetition, 
and  an  elaborate  description  is  given  of  the  so-called  "  dactylitis 
syphilitica.^'  We  do  not  think  this  last  disease  is  clearly  proved  to 
be  syphilitic.  It  presents  several  obvious  differences  from  the  epi- 
physial disease  described  above,  and  Dr.  Taylor  admits  (p.  149) 
that  in  many  of  these  cases  of  dactylitis  "  the  concatenation  of 
lesions  and  symptoms  which  is  called  scrofula  was  present,''  that  in 
many  of  them  there  was  no  history  or  symptom  of  syphihs,  and  that 
"  after  careful  comparative  study  of  these  cases "  (syphilitic  and 
non-syphilitic)  he  must  confess  ''that  there  are  almost  no  dis- 
tinguishing points."  We  think  that  the  character  of  the  swelling, 
affecting,  as  it  does,  the  whole  phalanx,  and  not  its  epiphysis  or  shaft- 
end  merely,  points  to  a  scrofulous  rather  than  to  a  syphilitic  origin. 

The  cranial  bones  of  children  who  inherit  syphilis  sometimes 
present  nodes  very  much  resembling  those  so  commonly  seen  in  the 
acquired  disease.  These  are  among  the  less  frequent  of  the  bone 
affections  of  syphilitic  children,  although,  we  think,  not  so  rarely  seen 
as  Dr.   Tavlor   supposes.      The  frontal  bone  is  the   most  often 


422  Bibliographical  Record,  [Oct., 

attacked.  These  nodes  are  prone  to  undergo  rapid  degeneration, 
and  to  lead  to  the  formation  of  extensive  ulcers,  and  even  when  re- 
solution takes  place  depressions  are  often  left  in  the  surface  of  the 
affected  bone.  It  is  to  be  remembered  also  that  the  inner  surface  of  the 
cranial  bones  has  been  found  diseased  in  syphilitic  infants.  With  regard 
to  the  other  irregular  bones,  such  as  the  scapula  or  ihum,  the  chief 
point  to  be  noticed  is  that  the  syphilitic  swellings  are  chiefly  found 
"  wherever  the  body  of  a  bone  is  continuous  with  an  epiphysis.'' 

These  bone  affections  are  usually  developed  within  a  period  averag- 
ing between  two  and  six  weeks ;  a  number  of  bones  are  usually 
affected  at  the  same  time,  and  the  swellings  are  often  symmetrically 
distributed.  The  integument  is  not  usually  involved,  though  in 
severe  cases  it  may  become  secondarily  inflamed,  and  the  joints  most 
often  escape.  There  is  not  generally  much  pain,  except  upon 
movement  of  the  affected  limb;  motion  is,  however,  much  restricted, 
so  that  the  limbs  often  appears  paralysed,  a  peculiarity  which  has 
led  to  the  name  "  pseudo-paralysis "  being  applied  to  the  disease. 
The  local  changes  are  unattended  by  any  marked  fever.  It  is  clearly 
proved  that  the  bones  may  be  affected  by  syphilis  during  intra- 
uterine life,  and  when  the  disease  is  developed  after  birth  the 
symptoms  generally  show  themselves  during  the  first  six  weeks  of 
infancy. 

A  very  important  fact  insisted  on  by  Dr.  Taylor  is,  that  the 
changes  w^e  have  now  referred  to  may  occur  iu  acquired  infantile 
syphilis.  This  is  proved  by  Dr.  Taylor's  eighth  case,  in  which  a 
previously  healthy  child  acquired  a  syphilitic  ulcer  on  the  hp  from 
an  infant  with  inherited  syphilis.  The  patient  subsequently  suffered 
from  well-marked  syphihtic  symptoms,  including  the  characteristic 
swellings  upon  several  of  the  long  bones.  The  author  calls  attention  to 
the  activity  and  extent  of  the  morphological  changes  going  on  in  the 
osseous  system  of  growing  children,  and  points  out  that  the  patho- 
logical changes  due  to  syphilis  may  be  engrafted  upon  the  physiolo- 
gical processes  during  any  part  of  the  period  of  development.  Dr. 
Taylor  also  alludes  to  the  similarity  of  many  of  the  symptoms  of 
acquired  and  inherited  syphilis  as  exemphfied  in  several  of  his  cases, 
and  agrees  with  Mr.  Hutchinson  that  periostitis  is  a  frequent 
manifestation  of  inherited  syphilis.  The  treatment  advocated  by 
Dr.  Taylor  is  the  administration  by  the  stomach  of  bichloride  of 
mercury  and  iodide  of  potassium,  and  he  justly  condemns  the 
hypodermic  injection  of  these  remedies.  "We  do  not  agree,  however, 
with  his  objections  to  mercurial  inunction,  which  we  have  often 
seen  act  as  admirably  in  inherited  as  in  acquired  syphilis,  and  we 
may  add  that  we  have  seen  epiphysial  swellings  disappear  rapidly 
and  completely  under  the  influence  of  grey  powder  without  the 
addition  of  iodide  of  potassium. 


1875.]  CarteIi  on  Leprosy  and  Elephantiasis,  423 

Carter  on  Leprosy  and  Elephantiasis. i— The  issue  of  this  hand- 
some volume  reflects  much  credit  on  the  Indian  Office.  An 
opportunity  has  been  aff'orded  to  Dr.  Carter  to  bring  together  an 
immense  amount  of  information  respecting  the  disease  he  has  so 
patiently  and  carefully  studied.  The  volume  indeed  is,  as  the 
author  states,  mainly  a  compilation.  The  chief  element  of  it  is  to 
be  found  in  the  various  papers  and  reports  which  in  a  series  of  years 
have  been  produced  by  the  author  himself,  whether  as  the  result  of 
what  he  has  seen  in  India  or  in  ISTorway.  A  considerable  portion 
is  also  devoted  to  the  labours  of  Norwegian  observers,  which  are 
brought  very  prominently  forward,  and  the  notes  contain  much  of 
w^iat  has  been  written  in  India  and  other  parts  of  the  world  of  late 
years  on  this  very  complicated  malady.  We  have  recently  devoted 
so  much  of  our  space  to  the  consideration  of  this  disease  (see  April, 
July,  and  October  numbers  of  1874)  that  we  shall  for  the  present 
defer  any  minute  examination  of  its  contents.  It  is  probable  that 
the  results  of  the  inquiry  concerning  skin  diseases  in  India  which  was 
suggested  to  Government  by  Drs.  Tilbury  Fox  and  Farquhar  will 
ere  long  be  given  to  the  world  ;  indeed  we  find  that  the  portion  which 
relates  to  Medus  has  already  been  printed  in  the  East.  The  Indian 
Government  is  commencing  a  fresh  inquiry  into  the  nature  and  dif- 
fusion of  the  disease.  We  also  expect  soon  to  see  what  impression 
his  more  recent  investigations  on  his  way  back  to  Bombay  have 
made  on  Dr.  Carter.  Possibly  also  the  Colonial  Office  may  elicit 
some  fresh  information  respecting  the  Australian  colonies  and  some 
of  the  South  Sea  islands  ;  from  all  these  sources  fresh  material  may 
be  expected  which  will  help  us  to  a  fuller  consideration  of  the  sub- 
ject at  a  later  period. 

Meantime  we  would  say  that  the  chief  novelty  in  this  volume  is 
the  prominence  given  to  febrile  symptoms  as  one  of  the  prodromata 
of  the  disease.  And  to  the  various  forms  of  cutaneous  aff'ections 
which  may  accompany  it,  or  are  thought  to  be  characteristic  of  it, 
of  w^hich  our  author  has  been  able  to  gain  some  illustrations  from 
his  own  sketches  as  well  as  from  those  of  Danielson^s  great  work. 
But  perhaps  chief  among  the  novelties  of  the  work  are  the  views 
respecting  the  essential  nature  of  leprosy  which  Dr.  Carter  appears 
to  be  gradually  adopting.  He  now  regards  it  less  as  a  dyscrasy,  as 
it  has  been  most  frequently  considered  to  be,  and  attributes  to  it, 
like  his  Norwegian  friends,  a  chronic-infection  character. 

He  thus  expresses  himself : — "  As  far  as  the  order  and  course  of 
phenomena  and  their  probable  cause  are  concerned,  the  hypothesis 


1  On  Leprosy  and  JElephantiasis.  With  Plates.  By  H.  Vandyke  Caetee, 
M.D.  Lond.,  H.M.  Indian  Medical  Service.  Published  under  sanction  of  the 
Secretary  of  State  for  India.     London,  1874.     4to,  pp.  246. 


424  Bibliographical  Record,  [Oct., 

of  a  nature  in  leprosy  like  to  that  of  scrofula,  syphilis,  and  I  had 
almost  added  pyaemia,  smallpox,  &c.,  seems  to  offer  by  far  the 
best  clue  to  their  comprehension.  Perhaps  the  vehicle  of  infec^ 
tion  is  essentially  of  the  same  order.  Meantime  I  am  aware  of  the 
consequence  of  these  admissions ;  the  hereditary  nature  of  leprosy 
must  be  limited  to  an  innate  proclivity  or  predisposition  to  disease." 
He  almost  unreservedly  adopts  Hansen^s  theory  that  "  the  leprous 
disease  is  essentially  an  implanted  one,  and  derived  from  without ; 
its  structural  elements  are  first  located  in  the  skin  and  adjoining 
surfaces,  and  afterwards  reach  the  blood  or  system.  Here,  in  fact,  is  a 
specific  malady  which,  though  of  chronic  character,  is  yet  of  parasitic 
nature,  and  it  is  almost  a  necessary  corollary  that  it  should  be  of 
infectious  nature.^' 

It  is  not  surprising  that,  thus  following  in  the  wake  of  Hansen, 
Dr.  Carter  now  is  inclined  to  admit  the  contagion  of  leprosy,  and 
also  to  attribute  a  much  less  important  share  in  the  production  of 
disease  to  hereditary  transmissions  than  he  himself  and  most 
observers  formerly  did.  He  practically  returns  to  the  old  received 
opinion,  that  leprosy,  like  phthisis,  was  infectious. 

The  great  question  to  which  all  this  points  is  this,  whether 
leprosy  should  again  be  treated,  as  of  old,  as  a  highly  contagious 
disease.  Is  the  treatment  in  the  Sandwich  Islands  or  in  Crete  by 
entire  isolation  necessary  or  justifiable,  especially  if  the  main  reason 
assigned  for  isolation,  the  propagation  of  the  disease  by  heredity, 
is  now  considered  doubtful  ?  Is  there,  or  is  there  not,  risk  in 
treating  leprous  patients  in  the  same  hospital  with  other  invalids  ? 

There  are  two  particular  facts  of  which  surely  it  would  be 
possible  to  ascertain  the  reality  or  otherwise.  Is  it  an  undoubted 
fact  that  leprosy  was  introduced  into  Honolulu  by  the  Chinese,  and 
that  in  the  course  of  about  fifteen  years  the  cases  of  leprosy  have 
increased  from  60  to  800  in  a  population  of  only  40,000  ?  Then,  is 
it  true,  as  most  Indian  writers  say,  that  leprosy  is  rare  in  Burmah  at 
the  present  day,  while  authors  within  the  present  century  have 
described  it  as  very  common,  and  as  being  treated  by  the  Govern- 
ment by  strict  isolation?  It  would  be  most  important  to  know 
whether  the  disease  had  diminished,  and  whether  its  diminution  can 
be  regarded  as  the  consequence  of  this  isolation. 

While  we  agree  with  Dr.  Carter  on  many,  points,  and  consider 
that  he  is  quite  right  in  following  what  is  now  the  usual  practice  in 
dropping  the  name  of  elephantiasis  for  that  of  leprosy,  we  cannot 
help  expressing  our  regret  that  his  style  is  not  more  natural. 

When  we  come  on  the  heading  of  a  chapter,  "  Prevalence  in  Time 
and  Space,"  we  begin  to  wonder  whether  we  are  reading  a  medical 
or  a  metaphysical  description. 

We  wish  Dr.  Carter  every  success  in  the  investigation  of  the 
interesting  subject  to  which  he  has  so  long  devoted  his  abihties. 


1875.]      LoNGMORii's  Insiructions  to  Army  Surgeon^,  425 

Longmore's  Instructions  for  Army  Surgeons.^ — The  substitution 
of  the  rifle  for  the  smooth-bore  musket  in  the  army  naturally  led  to 
endeavours  to  utilise  to  the  utmost  the  increased  powers  of  range 
and  precision  of  fire  which  the  new  arms  possessed,  and  the  efforts 
made  to  accomplish  this  soon  brought  to  light  many  defects  of 
vision  in  the  men  who  were  required  to  use  it  which  had  not  forced 
themselves  on  the  notice  of  the  military  or  medical  authorities  pre- 
viously. About  fifteen  years  ago  this  question  had  become  so 
pressing  that  Sir  James  Gibson,  then  Director- General  of  the  Army 
Medical  Department,  requested  Mr.  Longmore,  professor  of  military 
surgery  in  the  Army  Medical  School,  to  prepare  concise  and  simple 
instructions  for  the  practical  examination  o£  the  vision  of  recruits  and 
soldiers,  for  the  guidance  of  medical  officers  in  this  new  but  essential 
part  of  their  duty.  The  result  was  the  first  edition  of  the  '  Manual,' 
which  appeared  in  1863.  That  has  been  out  of  print  now  for  about  seven 
years,  and  the  author,  notwithstanding  many  applications  to  bricg  out 
a  new  edition,  has  hitherto,  in  presence  of  the  works  of  Donders  and 
others,  hesitated  to  undertake  it.  The  importance  of  providing  the 
candidates  for  the  army  and  navy  medical  services,  while  prosecuting 
their  studies  at  Netley,  with  the  necessary  information  as  to  the 
defects  of  vision  they  may  subsequently  require  to  deal  with,  in  a 
concise  form,  has  at  last  led  him  to  revise  and  extend  the  former 
edition,  without,  however, his  wishing  the  one  now  under  consideration 
to  be  considered  as  more  than  an  aid  to  the  memory,  and  not  as  in  any 
way  obviating  the  necessity  for  the  study  of  the  larger  works  of  the 
leading  ophthalmologists  by  those  who  wish  to  become  thoroughly 
proficient  in  the  subject. 

The  manual  is  divided  into  two  parts,  the  first  of  which  contains 
five  chapters.  Of  these  the  first,  after  explaining  the  terms  in  ordi- 
nary use,  points  out  the  various  descriptions  of  lenses  with  their 
properties.  Here  there  is  an  absence  of  illustrative  diagrams.  We 
quite  understand  the  author's  anxiety  to  compress  his  work  as  much 
as  possible,  as  well  to  retain  it  within  small  compass  so  as  to  keep  it 
moderate  in  price;  and,  so  far  as  those  who  have  had  the  advantage 
of  attending  his  lectures  are  concerned,  the  absence  of  diagrams  may 
be  of  little  consequence,  as  no  doubt  such  aids  are  freely  used  to 
demonstrate  everything  capable  of  being  more  forcibly  conveyed 
through  the  eye  than  by  mere  description ;  but  at  a  distance,  and 
for  those  who  are  imperfectly  acquainted  with  the  effects  of  convex 
and  concave  lenses,  a  few  simple  diagrams  showing  the  influence  of 
a  refracting  medium  in  the  course  of  a  ray  of  light,  and  how  the  dif- 


^  Manual  of  Instruction  for  the  Guidance  of  Army  Surgeons  in  Testing  the 
Range  and  Quality  of  Vision  of  Recruits,  and  in  Distinguishing  the  Cause  of 
Defective  Vision  in  Soldiers.  By  Surgeon- General  T.  Lokgmoee,  C.B.  2nd  ed, 
London,  1875  (pp.  131). 


426  Bibliographical  Record,  [Oct., 

ferent  manner  in  which  the  medium  is  presented  to  the  incident  ray 
in  these,  respectively,  produces  such  a  different  result,  would  render 
this  question,  which  is  so  intimately  connected  with  all  that  follows, 
far  clearer  to  the  reader,  and  enable  him  to  grasp  the  principle 
concerned  at  the  outset. 

In  the  second  chapter  the  character  of  natural  vision  is  defined, 
and  the  deviations  from  it,  owing  to  the  excess  or  deficiency  of  the 
refractive  powers  of  the  eye,  pointed  out,  with  their  causes  and  the 
mode  of  distinguishing  them  and  of  determining  their  degree.  The 
accommodating  function  of  the  healthy  eye  to  distinct  vision  of 
objects  at  different  distances  is  also  treated  of,  and  the  influence  of 
age  and  other  causes  in  limiting  its  range  clearly  indicated. 

The  third  chapter  contains  remarks  on  the  acuteness  of  vision, 
with  notices  of  the  means  ordinarily  employed  for  determining  its 
degree,  and  the  nature  and  extent  of  the  various  deviations  from  it. 
In  each  instance,  after  a  short  definition  of  the  nature  of  the  parti- 
cular form,  its  causes  are  pointed  out,  and  the  symptoms  and 
diagnosis  follow.  The  fourth  chapter  is  occupied  with  a  description 
of  the  test  dots  employed  for  determining  the  visual  powers  of 
recruits,  and  the  principles  on  which  they  are  based;  and  in  the 
fifth  the  mode  of  conducting  the  examination  is  indicated,  and  the 
details  in  the  previous  chapters  applied. 

The  second  part  is  devoted  to  the  ophthalmoscope  and  its  uses, 
and  contains  three  chapters.  Of  these  the  first  embraces  a  descrip- 
tion of  the  instrument,  and  the  various  details  to  be  observed  in 
employing  it ;  the  second  gives  a  short  sketch  of  the  natural  appear- 
ance of  the  various  parts  of  the  interior  of  the  eye  as  seen  with  the 
assistance  of  the  ophthalmoscope ;  and  the  third  treats  of  the  lesions 
of  those  parts  discernible  by  the  ophthalmoscope,  and  the  means  of 
distinguishing  them.  The  manual  ends  with  a  copious  index,  which 
enables  the  reader  to  refer  to  any  subject  in  the  text  with  ease  and 
readiness. 

Though  written  with  an  especial  reference  to  the  requirements  of 
medical  officers  of  the  army  and  navy,  Mr.  Longm ore's  manual,  care- 
fully prepared  as  it  has  been,  and  presenting  in  a  compendious  form 
much  information  that  is  diffused  through  many  bulky  treatises,  is 
calculated  to  be  of  much  service  to  medical  men  in  civil  life  who  may 
have  to  deal  with  affections  of  vision  in  the  course  of  ordinary  prac- 
tice, but  whose  avocations  do  not  leave  them  sufficient  leisure  to 
study  the  subject  at  length  in  the  systematic  works  of  original 
investigators. 

Archives  of  Electrology.i — This  journal,  edited   by  the  inde- 

1  Archives  of  Electrology  and  Neurology.  Edited  by  G.  Beaed,  M.D.  Vol.  5, 
No.  2,  1874.    New  York, 


1875.] 


Beard  oti  Archives  of  Electrology .  247 


fatigable  Dr.  Beard,  appears  twice  a  year,  in  May  and  November, 
and  in  the  present  active  state  of  neurology  materials  ought  to 
accumulate  rapidly  enough  for  two  parts  per  annum.  At  the  same 
time  we  think  it  is  unwise  in  an  editor  to  tie  his  hands,  and  to 
oblige  himself  to  bring  out  the  parts  of  a  serial  at  a  given  date 
whether  he  has  good  matter  or  not. 

It  is  better  to  issue  the  parts  at  irregular  intervals  as  material 
accumulates.     In  these  days  the  multiplication  of  serials  is  a  great 
hindrance  to  the  inquirer,  and  to  add  to  the  bulk  and  dispersion  of 
good  matter  by  padding  is  too  vexatious.     Much  of  the  present 
volume  is  padding  of  an  indefensible  kind,  which  must  so  far  keep 
down  the  character  of  the  publication.     The  editor  himself,  who 
gives  due  time  and  care  to  an  article  on  chronic  alcoholism  which 
is  well  worth  printing  and  reading,  is  obhged  to  eke  out  his  space 
by  some  very  flimsy  "  Letters  to  Inquiring  Practitioners.^''     Hungry 
practitioners  surely  may  master  rather  stronger  meat  than  this. 
The  first  place  in  the  number  is  given  to  an  article  by  Dr.  Tripier, 
to  which  we  take  objections  of  a  wholly  different  kind.     He  largely 
undertakes  the  treatment  of  uterine  disturbances  by  Taradism,   a 
process  which  requires  the  application  of  an  electrode  to  the  inner 
generative  organs  of  women  daily,  or  at  least  on  alternate  days,  for 
weeks  together.     He  also  proposes  to  insert  his  electrodes  into  the 
bladder  or  rectum  of  maiden  ladies,  in  whom  daily  vaginal  explo- 
rations might  have  inconveniences.     Now,  from  beginning  to  end 
of  this  article  it  seems  never  to  enter  this  person''s  mind  that  such 
proceedings  are  only  to  be  justified  on  the  grounds  of  absolute 
necessity — on  the  grounds,  that  is,  that  this  treatment  has  a  value 
as  far  transcendent  as  its  meddlesomeness  is  excessive.     We  need 
scarcely  say  that  he  shows  nothing  of  the  kind,  nor  is  alive  in  any 
degree  to  the  consequent  gross  impropriety  of  his  proceedings.     It 
is  time  that  the  profession  should  say  plainly  that  this  fashionable 
trifling  with  womanly  delicacy  is  going  too  far — that  too  many 
physicians  of  late  have  been  tempted  to  forget  what  is  due  to  their 
own  honour  and  to  the  proper  reticence  of  their  patients.     Suave 
compliance  on  the  one  hand,  and  half-concealed  pruriency  on  the 
other,  may  in  time  become  too  plain  in  both  doctor  and  patient  if 
the  thing  is  not  sharply  checked  by  public  opinion.     Of  late  mur- 
murings  of  no  uncertain  kind  have  been  making  themselves  heard 
in  many  places.     Of  the  rest  of  the  number  we  can  speak  with  more 
satisfaction.     Dr.  Munson  takes  up  a  subject  on  which  we  are  far 
too  ignorant,  namely,  the  effects  of  lightning  upon  the  nervous 
system.      Dr.   Frank    deals   with    the    electrolytic    treatment    of 
hydrocele.     Dr.  Seeley  writes  on  galvanism  in  ocular  and   aural 
affections ;  and  Dr.  Bulkley  takes  up  the  relations  of  the  nervous 
system  to  diseases  of  the  skin.     This  opens  up  a  very  promising 
field,  a  far  more  promising  one  than  the  view  which  attributed  many 


4^8  BibUograplncal  Record,  [Oct., 

such  lesions  necessarily  to  the  blood  because  they  are  symmetrical ! 
Tlie  number  ends  with  editorial  gleanings  and  notices  of  books. 
We  heartily  welcome  the  ^  Archives/  and  wish  them  something  more 
than  a  succes  d'estime. 

Leroy-Dupre  on  Hydropathy^ — In  this  pamphlet  Dr.  Leroy- 
Dupre  has  laid  before  his  readers  a  short  account  of  the  principles 
and  practice  of  hydrotherapeutics.  He  commences  with  a  descrip- 
tion of  the  various  methods  in  more  common  use,  and  of  the 
apparatus  necessary  for  the  purpose ;  he  next  discusses  the  action 
of  cold  water  upon  the  organism,  and  this  is  followed  by  an  enumera- 
tion of  the  conditions  the  observance  of  which  will  result  in  a  good 
reaction.  Indeed,  in  the  production  of  this  reaction,  due  to  the 
dilatation  of  small  arteries  which  have  contracted  upon  the  applica- 
tion of  cold,  appears  to  lie  nearly  the  whole  secret  of  hydropathy ; 
and  with  its  production  at  the  right  time  and  in  the  right  place  the 
author  is  engaged  in  the  succeeding  sections  on  the  therapeutical 
indications  for  its  use  and  on  the  diseases  requiring  it. 

Chapters  on  the  contra-indications,  and  on  its  employment  in 
private,  conclude  the  treatise. 

On  the  whole  it  presents  a  fairly  comprehensive  account  of  the 
methods  and  objects  of  hydropathy,  which  may  be  of  service  to 
those  who  wish  to  have  more  information  on  its  practice  than  can 
be  found  in  our  works  on  medicine  and  therapeutics. 

Milton  on  Vapour  Baths.2— The  main  object  of  this  small  treatise 
is  to  introduce  to  notice  a  portable  apparatus  to  administer  vapour 
baths  and  modified  Turkish  or  hot-air  baths,  invented  by  the  author. 
Judging  from  the  diagrams,  it  appears  a  sufficient,  simple,  and 
effective  apparatus  for  the  purpose  intended ;  but  we  cannot  quite 
free  our  mind  from  the  impression  that  the  individual  employing  it 
runs  some  risk  of  being  enveloped  not  only  in  vapour  but  in  flame, 
particularly  if  the  Eussian  lamp  happened  to  be  overcharged  or  by 
some  mischance  upset.  But  such  things  are  not  intended  for 
clumsy  people. 

The  first  section  of  the  book  is  occupied  by  a  short  narration  of 
cases  for  which  the  vapour  and  Turkish  baths  have  proved  especially 
useful.  In  lepra  and  eczema  vapour  baths  have  proved  in  the 
author's  hands  most  beneficial.  In  prurigo  Turkish  baths  have 
succeeded  better,  but  neither  form  of  bath  is  entirely  to  be  relied 
upon  in  ichthyosis  and  sclerema.  In  gout  and  subacute  rheumatism 
compHcating  skin  diseases,  both  forms  of  bath  are  of  great  value. 
Neuralgic  complications  may  be  also  expected  to  get  relief. 

1  Des  Indications  et  des  Contre-indications  de  VHydr other apie.  Per  M.  le 
Dr.  Leeoy-Dupbe. 

-  On  the  Modified  Turkish  and  Vapour  Bath,  and  its  Value  in  certain  Diseases 
of  the  Skin.    By  J.  L.  Milton.    London,  1875. 


1875.] 


Journal  of  the  Chemical  Society,  429 


The  medical  practitioner  in  search  of  bath-apparatus  for  domestic 
use  will  do  well  to  read  the  account  of  Mr.  Milton's  invention. 
The  few  cases  of  skin  diseases  recorded  in  this  small  volume  treated 
bj  baths  will  also  encourage  him  to  essay  their  employment. 

Nomenclature  of  Diseased — This  is  an  American  issue  of  the 
'  Provisional  Nomenclature  '  of  the  Royal  College  of  Physicians 
of  this  country.  It  is  most  gratifying  as  well  as  complimentary  to 
the  English  compilers  of  the  nomenclature  to  find  it  thus  adopted 
officially  by  an  important  branch  of  the  public  medical  service  of 
the  United  States,  viz.  the  Marine  Hospital  Service.  Its  adoption 
is  to  be  credited  to  Mr.  Woodworth,  the  energetic  supervising  sur- 
geon of  the  department,  to  whom  we  have  been  indebted  for  copies, 
from  time  to  time,  of  the  interesting  medical  reports  of  the  Marine 
Hospital  Service. 

We  learn  from  a  prefatory  note  to  this  volume  that,  previously  to 
this  its  first  official  adoption,  the  classification  of  diseases  in  the 
statistics  of  mortahty  for  the  Ninth  Census  of  the  United  States 
was  made,  in  all  essential  particulars,  in  accordance  with  it ;  that  it  is 
practically  adopted  by  the  Medical  Department  of  the  United  States 
Army,  and  has  been  generally  sanctioned  by  the  profession  in  the 
States.  "  From  the  foregoing  [remarks  Mr.  Woodworth]  it  will  be 
seen  that  its  promise  to  become  the  common  nomenclature  and 
classification  for  at  least  all  English-speaking  peoples  is  in  a  fair 
way  to  be  realised^' — a  consummation  much  to  be  desired  hi  the 
interests  of  medicine,  both  as  an  art  and  a  science. 

Journal  of  the  Chemical  Society.^ — Some  quarter  of  a  century  ago 
the  physiological  and  pathological  branches  of  chemistry  numbered 
among  their  most  ardent  votaries  some  prominent  British  chemists. 
For  various  reasons  other  branches  of  the  science  of  chemistry  have 
since  presented  superior  attractions,  and  medical  chemistry  has  been 
in  disfavour.  It  is,  then,  scarcely  to  the  pages  of  the  journal  of  our 
Chemical  Society  of  London  that  we  should  turn  expecting  to  find  a 
full  record  of  chemistry  in  its  relations  to  medicine.  But  though 
our  Continental  confreres  have  been  of  late  the  chief  workers  in  the 
fields  of  physiological  and  pathological  chemistry,  no  completer 
record  of  the  new  discoveries  in  those  departments,  and  indeed  in 
every  other  branch  of  the  science,  will  be  found  than  in  the  pages  of 
the  '  Journal  of  the  Chemical  Society  of  London.'  Up  to  the  end  of 
the  year  1870  the  journal  contained  only  such  papers  as  had  been  read 

^  Nomenclature  of  Disease  prepared  for  the  Use  of  the  Medical  Officers  of  the 
United  States  Marine- Hospital  Service.  By  the  Supervising  Surgeon,  Jonx  M. 
Woodworth,  M.D.    Washington,  1874. 

^  Journal  of  the  Chemical  Society,  1871-4.     London. 

112— LVI.  28 


430  Mhlio graphical  Record.  [Oct., 

before  the  society,  either  in  extenso  or  in  abstract ;  but  with  the  com- 
mencement of  the  year  1871  the  journal  entered  upon  a  new  career 
of  usefuhiess.  Tlie  happy  idea  was  conceived  of  supplementing  the 
proceedings  of  the  society  by  full  and  carefully  prepared  abstracts  of 
all  the  current  foreign  literature  of  chemistry.  How  well  this  has 
been  done  can  be  seen  by  a  reference  to  the  journal  itself^  which 
appears  every  month  under  the  able  editorship  of  Mr.  Henry  Watts, 
aided  by  a  large  staff  of  abstract-makers,  whose  names  are  a 
guarantee  that  the  work  will  be  thorough,  and  who  are  supported 
by  an  energetic  publishing  committee. 

It  is  not  too  much  to  say  that  in  the  volumes  of  the  journal  the 
physiologist,  the  chemist,  and  the  physician  will  find  a  faithful 
record  of  all  that  is  going  on  in  this  country  and  abroad  that  is  of 
interest  in  the  chemical  world.  Unimportant  memoirs  are  briefly 
summarised,  whilst  those  which  are  of  greater  interest  are  presented 
with  some  amount  of  detail.  In  all  cases  the  length  of  the  paper  is 
noted,  and  accurate  references  given  to  the  original  sources.  Erench, 
German,  Italian,  Russian,  American,  and  English  chemical  literature 
is  thus  laid  under  contribution  for  the  benefit  of  English  chemists. 

Wisely,  as  we  think,  the  council  of  the  society  has  resolved  to 
bring  their  now  very  useful  journal  within  the  reach  of  all.  Although 
the  monthly  numbers  are  not  sold  separately,  the  journal  is  supplied 
to  any  one  on  payment  of  a  small  annual  subscription.  We  advise 
all  our  readers  who  are  interested  in  scientific  medicine  to  become 
subscribers ;  and  certainly  no  scientific  or  medical  library  can  be 
considered  complete  without  the  admirable  '  Journal  of  the  Chemical 
Society  of  London.' 

Ziemssen's  Medical  Cyclopeedia.i — It  was  only  in  the  number  of 
this  Review  for  April  last  that  we  noticed  at  some  length  the 
German  edition  of  this  very  comprehensive  'Cyclopaedia  of  Medicine,' 
as  far  as  it  w^as  then  published.  We  have  now  before  us  three 
bulky  volumes  containing  the  articles  then  reviewed  rendered  into 
English  by  several  American  physicians,  some  of  whom  are  well 
known  in  this  country  both  by  their  position  in  the  profession  and 
by  their  contributions  to  medicine.  All  that  remains  us  as  necessary 
on  the  present  occasion  is  to  signify  our  opinion  of  the  manner  in 
which  the  translators  have  performed  their  work,  and  on  this 
matter  we  have  to  pronounce  a  very  favorable  opinion.  There  is 
certainly  an  inequality  of  performance,  the  English  idiom  being 
much  better  conveyed  by  some  of  the  translators  than  by  others. 
Indeed,  it  strikes  us  that  some  few  of  the  number  have  been  selected 
for  the  work  on  account  of  their  exact  knowledge  of  German,  but 
who,  haling  from  "  the  Eatherland,'"*  have  not  hitherto  acquired  the 

1  CyclopfBdia  of  Medicine.  Edited  by  Dr.  H.  VON  ZiEMSSEN.  Vols,  i,  ii,  and 
iii.     London,  1875. 


1875.]  Agricultural  Report  of  Victoria,  43l 

English  idiom.  The  prospectus  issued  in  this  country  gives  a  list 
of  "  gentlemen  who  have  agreed  to  talce  part  in  the  international 
work  of  translation/''  and  who  are  more  or  less  known  to  us  as 
fellow-countrymen  in  practice  in  Great  Britain  and  in  Ireland. 
But  so  far  as  the  volumes  as  yet  issued  are  concerned^  these  trans- 
lators on  this  side  the  Atlantic  have  not  put  in  an  appearance.  All 
those  whose  names  are  appended  to  the  articles  now  before  us  are 
physicians  residing  in  the  tJnited  States. 

In  fact,  the  pubKcation  is  an  American  enterprise,  of  which  the 
London  house  of  Messrs.  Sampson  Low  and  Co.  make  themselves  the 
medium  to  place  before  the  profession  in  England.  The  production 
of  a  cyclopsedia  on  the  scale  on  which  this  present  one  is  projected 
indicates  a  strong  conviction  on  the  part  of  the  American  editor. 
Dr."  A.  H.  Buck,  of  New  York,  and  his  collaborateurs  and  pub- 
lishers, of  the  value  of  the  work  and  of  the  desire  of  the  profession 
to  possess  themselves  of  so  complete  a  survey  of  German  pathology 
and  practice.  In  this  country  it  has  a  worthy  competitor  in 
'Eeynolds's  System  of  Medicine/  and  will  find  it  no  easy  task 
to  make  its  way  into  the  libraries  of  English  practitioners,  and 
especially  of  such  among  them  as  have  a  strong  prepossession 
in  favour  of  English  '^  practice." 

The  pubHshers  refer  to  it  as  an  "  internationar'  work,  but  we 
do  not  quite  recognise  this  to  be  its  character,  seeing  that  it  is 
wholly  a  production  of  Germany.  But,  being  now  translated  into 
English,  it  so  far  becomes  international  that  it  conveys  the  teach- 
ing of  Germany  to  the  many  peoples  to  whom  English  is  the  native 
tongue,  and  nothing  can  more  conduce  to  the  advancement  of 
medical  science  than  the  diffusion  among  different  nations  of  the 
principles  and  practice  prevaihng  among  them  individually.  An 
intercourse  of  opinions  is  as  advantageous  in  medicine  as  in  social 
science,  by  dispelling  narrowness  of  views  and  overturning  self- 
opinion  and  self-conceit. 

Those  who  possess  themselves  of  these   volumes  may  be  con- 
gratulated on  obtaining  most  painstaking,  scientific,  and  complete 
articles  on  the  subjects  treated  of  in  them.     The  type  is  large  and  • 
clear,  highly  commendable  to  eyes  past  their  prime,  and  the  general 
"  get  up  "  of  the  volumes  is  most  excellent. 

Agricultural  Report  of  Victoria.^ — We  have  been  favoured  with 
a  copy  of  the  report  of  the  Secretary  for  Agriculture  in  Yictoria, 
which  may  be  commended  to  all  intending  emigrants  to  that  colony, 
to  those  interested  in  the  history  and  progress  of  our  great  English 
colonies,  to  our  naturalists,  and  even  to  our  agriculturists,  who  may 
get  a  wrinkle  on  farming  matters  from  their  fellow-workers  in  the 

1  Second  Annual  Report  of  the  Secretary  for  Agriculture,  Department  of  Lands 
and  Agriculture,  Victoria.     Melbourne,  1874. 


432  Bibliographical  Record.  [Oct., 

antipodes.  The  naturalist  will  find  a  very  good  account,  with  ex- 
cellent figures,  of  some  Victorian  and  other  Australian  grasses,  by 
Mr.  Bacchus ;  and  also  a  description  of  some  Australian  wood-boring 
beetles,  also  illustrated.  The  meteorologist  has  presented  to  him  a 
report  on  the  meteorology  of  Victoria,  with  numerous  tables  to 
gladden  his  heart,  setting  forth  from  day  to  day  the  state  of  the 
barometer,  of  temperature,  of  dew-points  and  humidity,  the  pre- 
vailing direction  of  the  wind,  and  the  amount  of  rainfall,  accom- 
panied by  various  notes  and  comments  from  the  able  observations  of 
the  Government  Astronomer,  Mr.  Ellery,  F.E/.S. 

Intending  emigrants  who  patronise  beer  and  wine  will  be 
gratified  to  learn  that  both  hops  and  the  vine  are  extensively  culti- 
vated in  Victoria ;  the  latter  important  plant  occupying  a  surfjice 
of  200  acres,  and  promising  to  become  a  source  of  much  wealth 
to  its  cultivators. 

Another  important  industry  has  been  introduced  into  the  colony 
since  1873,  viz.  "  Sericulture,^'  or  the  growth  of  silk.  As  a  matter 
of  course  it  is  yet  in  its  very  infancy,  but  the  silk  exhibited  at  the 
Vienna  Exhibition  was  pronounced  equal  to  the  best  Itahan.  The  cul- 
tivation of  flax  has  also  been  attempted,  but  climatic  conditions 
are  unfavorable  to  it.  Nevertheless  there  is  a  earnest  endeavour 
to  overcome  difficulties  and  to  win  success.  The  volume  also  con- 
tains several  papers  of  interest  to  farmers  and  horticulturists ;  and 
it  will  hereafter,  apart  from  its  present  intrinsic  value,  be  of  much 
importance  in  tracing  the  industrial  history  and  progress  of  this  most 
enterprising  and  successful  colony  of  Victoria. 

Salt  on  Electrical  Apparatus.^ — This  small  book  is  no  superfluous 
addition  to  our  stock  of  treatises  on  medical  electricity.  It  supposes 
the  reader  to  know  the  principles  of  the  application  of  electricity  in 
the  treatment  of  disease,  but  not  to  be  equally  familiar  with  the 
results  of  the  inventive  faculties  of  mechanicians  ever  seeking  after 
perfection  in  the  construction  of  instruments.  And  as  no  one  can 
be  presumed  to  be  better  acquainted  with  the  mode  of  dealing  with 
their  instruments  than  the  makers  of  them  themselves,  the  profession 
is  indebted  to  the  well-known  instrument  makers  of  Birmingham, 
the  Messrs.  Salt,  for  the  publication  of  the  brief  volume  under 
notice. 

The  meaning  of  the  printed  text  is  greatly  elucidated  by  numerous 
excellent  engravings  of  apparatus  and  of  portions  of  apparatus. 
The  book  is  well  printed,  and  at  the  moderate  price  put  upon  it 
may  be  secured  by  every  practitioner  of  medicine  who  does  not 
consider  himself  an  expert  in  the  use  and  management  of  electric 
and  galvanic  batteries. 

^  A  Practical  Description  of  every  Form  of  Medico- Electric  Apparatus  in 
Modern  Use,  with  Plain  Directions  for  Mounting ,  Charging,  and  Working. 
Illustrated  by  carefully  drawn  Engravings.  By  Salt  and  Son,  of  Birmingham. 
London,  1875. 


1875.]  433 


©rismal    CommiutiratiansJ* 


I. — On  Lung-Disease  from  Inhalation  of  Dust. — By  John  T. 
Arlidge,  M.D.,  A.B.  Lond.,  E.U.C.P.  Lond.,  Physician  to 
the  North  Staffordshire  Infirmary,  Stoke-upon-Trent,  &c. 

Additional  evidence  is  constantly  accruing  to  prove  that  dust  may 
be  inhaled,,  that  it  may  penetrate  to  the  lung-cells,  and  that  its 
presence  within  the  pulmonary  tissue  is  a  cause  of  serious  organic 
disease.     The  older  medical  writers  have  recorded  not  a  few  cases 
illustrative  of  these  facts,  and  it  remained  for  the  physicians  of  the 
generation  now  passing  away,  and  of  the  present  one,  to  cast  serious 
doubts  upon  them,  and  even  to  deny  the  possibility  of  minute  particles 
of  foreign  matters  making  their  way  within  the  lungs  by  inhalation. 
This  denial  had  a  physiological  basis,  viz.  : — that  the  air- passages  had 
ciliated  epithelium,  and  that  the  action  of  the  cilia  thrust  forward  and 
outward  any  particles  entering  within  those  passages,  and  thereby 
prevented  their  further  penetration  towards  the  pulmonary  tissue. 
It  likewise  rested  on  the  assumptions,  that  ciliary  action  must  always 
be  in  the  same  direction ;  that  it,  so  to  speak,  could  not  be  wearied 
by  long- continued  and  persistent  inhalation  ;    that  it  could  not  be 
enfeebled  by  habits   of  life  and  other  causes  destructive  of  vital 
power ;  that  its  resistance  could  not  be  overcome  by  violent  in- 
spiratory acts  involved  by  exertion  or  coughing ;  and  that  inhaled- 
particles  could  enter  the  lung-tissue  only  by  a  progressive  passage 
through  the  repeatedly  branching  bronchi. 

The  physiological  doctrine  of  the  impeding  action  of  the  cilia  to 
the  entrance  of  foreign  particles  into  the  lung-cells  is  undeniable; 
but  experiment  and  observation  prove  it  not  always  and  under  all 
circumstances  efi'ectual.  Direct  experiments  upon  animals,  made  by 
Lewin^  and  others,  demonstrate  this  inefficiency;  and  the  records 
to  be  met  with,  in  works  on  forensic  medicine,  of  deaths  consequent 
on   suffocation  in  an  atmosphere  laden  with  particles   of  carbon, 

1  '  Die  lulmlations  Tberapie.'    Berlin,  1865,  p.  87  et  spq. 


434  Original  Communications.  [Oct., 

equally  prove  that  the  resistance  of  the  cilia  can  be  overcome.  The 
several  assumptions  mentioned  are  equally  disposed  of  by  more 
minute  observation  and  reflection.  Physiologists  have  shown  that 
the  direction  of  ciliary  action  admits  of  variation,  that  its  activity 
and  power  are  in  direct  relation  to  tissue-integrity  and  to  vital 
energy,  and  that  the  simple  onward  course  through  the  tubes  to  the 
alveoli  is  not  the  only  way  that  foreign  particles  can  penetrate  the 
tissue,  but  that  they  may  enter  by  medium  of  the  mucus-corpuscles 
which  invest  them,  and  may  likewise  find  their  way  into  the  lympha- 
tics; lastly,  and  without  contention,  that  foreign  matters  in  very 
tangible  quantities  are  found  in  the  bodies  of  individuals  exposed  to 
the  inhalation  of  dust,  and  that  the  quantity  discovered  exists  in  a 
far  higher  proportion  among  those  so  exposed  especially  than  among 
other  persons.  The  disbelief  in  the  interpenetration  of  lung-tissue 
by  inhaled  dust  prevailed  principally  among  those  less  familiar  with 
occupations  highly  productive  of  dust.  For  instance,  it  obtained 
chiefly  in  the  German  and  French  schools  ;  in  the  former  under  the 
influence,  of  late  years,  of  that  most  distinguished  pathologist. 
Professor  Virchow.  The  French  objectors  were  also  ably  led  by 
Andral  and  Trousseau.  In  England,  on  the  contrary,  the  special 
region  of  coal-mines  and  of  manufacture,  the  inhalation  of  dust,  and 
the  production  of  lung-disease  thereby,  has  been  always  generally 
held  as  an  established  fact. 

The  opponents  of  the  doctrine,  however,  did  good  service  by 
showing  that  black  discoloration  of  the  pulmonary  tissue,  with  and 
without  induration,  enlargement  and  blackening  of  the  bronchial 
glands,  and  nodules  of  apparent  gritty  or  sandy  matter,  may  have 
their  origin  in  morbid  changes  quite  independently  of  inhaled  matter. 
Heusinger  and  Becker  attribute  the  black  staining  or  granular 
masses  they  encountered  to  defective  elimination  in  the  tissues  of 
carbon  and  carbonic  acid,  and  to  a  sort  of  precipitation  of  carbon 
within  them  ;  whilst  Hasse  thought  the  black  infiltration  to  be,  on 
the  one  hand,  associated  with  a  process  of  healing  in  lung-lesion,  as 
for  example  tubercle,  or,  on  the  other,  to  be  connected  with  changes 
incident  on  age,  as  illustrated  in  senile  atrophy  of  the  lungs.  Yir- 
chow,  again,  sought  an  explanation  of  it  in  the  hypothesis  that  its 
origin  was  in  the  altered  colouring  matters  of  the  blood ;  and  in 
evidence  referred  to  cases  of  hypersemia  of  the  lungs  consequent  on 
heart-disease,  accompanied  by  diffused  extravasions  varying  in  hue 
from  red  to  black.  In  such  lesions  the  altered  coloured  matter  is, 
for  a  time  at  least,  included  within  cells,  but  these  disappear,  and  the 
pigment  may  be  set  free,  and  be  then  encountered  in  the  interstices 
of  connective  tissue  in  the  form  of  black  granules,  and  more  rarely 
of  crystals.  He  further  assumed  it  as  probable  that  the  production 
of  certain  coloured  matters  in  particular  tissues  might  be  influenced 
by  some  special  nutritive  qualities  of  those  tissues,  or  by  individual 


1875.  [        On  Lung 'Disease  from  Inhalation  of  Bust.  435 

peculiarities,  just  as  seems  to  happen  in  the  coloration  of  the  hair 
and  of  the  dermis. 

On  the  part  of  French  physicians,  Trousseau  and  Leblanc  enter- 
tained similar  views  with  Virchow. 

The  interpretation  supported  by  the  foregoing  eminent  pathologists 
is  doubtless  right  enough  with  regard  to  many  examples  of  blackened 
lung-tissue.  Wherein  they  erred  was  in  making  that  interpretation 
exclusive.  Their  experience  apparently  never  brought  them  into 
contact  with  cases, — common  enough  in  some  manufacturing  and 
coal-getting  districts,  to  which  their  explanation  would  not  apply, 
and  which,  both  by  histological  appearances  and  by  chemical  analysis, 
would  have  demonstrated  to  them  the  presence  of  inhaled  foreign 
particles,  and  not  only  altered  and  disintegrated  blood  effused  within 
the  lung-parenchyma  as  a  consequence  of  disease. 

A  case  decisive  of  the  fact  that  foreign  solid  matters  may  enter 
within  the  lung-tissue  by  breathing  occurred  to  Traube  in  1860, 
and  is  appealed  to  by  German  authors  as  the  first  placed  on  record 
so  demonstrative.  However,  it  is  quite  certain  that  many  English 
physicians  had  convinced  themselves  of  the  occurrence,  long 
previously,  by  post-mortem  examinations ;  nevertheless  Traube''s  case 
is  highly  valuable  by  reason  of  the  minuteness  with  which  it  was 
examined,  and  the  care  and  fulness  with  which  it  is  reported.  A 
serous  black  fluid,  staining  the  fingers,  could  be  squeezed  from  the 
affected  lungs,  which,  on  microscopical  examination,  presented 
granules  precisely  resembling  those  of  charcoal- dust,  in  which  the 
patient  had  for  many  years  worked.  Moreover,  small  pieces  of 
dust  were  found  at  different  depths  in  the  epithelium,  some  of  which 
stuck  in  like  arrows,  whilst  others  had  entirely  penetrated,  and 
others  again  had  transfixed  the  cells  and  were  advancing  into 
adjoining  cells.  Nay,  Rindfleisch,""  who  assisted  in  the  examination 
of  Traube^s  case,  assures  us  that  he  found  in  the  juice  squeezed 
from  the  parenchyma  of  the  lung  "  one  of  the  dotted  cells  of  coni- 
ferous wood  entirely  carbonized,  but  in  which  I  w^as  enabled  to 
count  seven  pores  close  together.  This  particle  of  charcoal- dust 
equalled  half  the  diameter  of  an  alveolus.^' 

That  dust  may  enter,  in  the  act  of  breathing,  into  the  bronchi, 
the  alveoli,  and  the  parenchyma  of  the  lungs,  must  therefore  be 
accepted  as  an  estabhshed  fact.  Whilst  lodged  within  the 
bronchial  tubes,  the  atoms  of  dust  are,  however,  liable  to  be 
propelled  outwards  by  the  cilia,  and  to  be  ultimately  expectorated. 
But  those  that  escape  this  salutary  action  penetrate  into  the 
alveolar  parenchyma,  where  they  are  no  longer  exposed  to  dis- 
turbance from  the  cilia,  but  now  follow,  as  Rindfleisch  describes,  ^^  the 
general  current  of  the  extra-vascular  nutrient  fluid,  together  with 

1  •  Pathological  Histology,'  Syd.  Soc.  edition,  vol.  ii,  p.  52. 


436  Original  Communications.  [Oct., 

which  they  tend  ultimately  to  reach  the  lymphatic  vessels.  Oq 
their  way  they  must  occasionally  meet  with  corpuscular  elements 
which  have  the  power  of  permanently  adopting  small  solid  particles 
into  their  protoplasm.  Foremost  among  such  elements  are  the 
stellate  corpuscles  of  the  connective  tissue ;  next,  the  migratory 
amoeboid  cells  v^hich  are  found  in  the  connective  tissue  of  the  lungs 
as  well  as  elsewhere,  and  which  carry  the  black  pigment  with  them 
wherever  they  go.  The  residual  portion,  that  which  escapes  being 
arrested  by  cells  on  its  way  to  lymphatics,  is  carried  to  the  root  of 
the  lung  and  enters  the  lymphatic  glands  of  the  m^ediastinum,  and 
here  the  granules  meet  with  an  insuperable  obstacle  to  their 
further  progress,  for  the  countless  lymph-corpuscles  with  which  the 
glands  are  stored  are  ready  to  take  up  as  many  of  the  charcoal- 
particles  as  can,  by  any  possibility,  be  accommodated  in  their  pro- 
toplasm"'^ (op.  cit.,  p.  51). 

From  the  preceding  observations  it  appears  that  the  lungs  may 
be  discoloured,  and  seriously  embarrassed  and  injured  in  structure  and 
functions,  by  inhaled  particles ;  and  further,  that  they  may  be  some- 
what similarly  discoloured  by  altered  blood-matters,  the  resultants 
of  disease  within  the  pulmonary  tissue  itself,  and  which,  in  their 
turn,  may  be  associated  with,  or  act  as  the  effectual  causes  of,  other 
disease.  The  term  melanotic  lung  has  been  loosely  applied  to  both 
forms  of  discoloration ;  it  would  be  well  if  disused  altogether,  for 
it  seems  to  imply  a  certain  substantive  morbid  condition  of  lung 
characterised  by  a  black  colour,  whereas  ij;  is  evident  that  colour  is 
an  accidental  feature  dependent  on  differing  causes. 

There  is  not  much  danger  of  the  two  primary  varieties  of  dis- 
coloured lung  being  confounded  either  during  life  or  after  death ; 
their  history  so  widely  differs,  as  does  also,  I  may  add,  generally 
their  pathological  appearances.     Of  this  more  hereafter. 

The  motes  in  the  sunbeam  have  made  man  in  all  ages  cognisant 
of  the  diffusion  of  minute  particles  at  all  times  in  the  air  we  breathe ; 
but  the  enormous  extent  of  their  diffusion  has  been  much  more 
vividly  brought  home  to  our  minds  by  the  admirable  experiments  of 
Prof.  Tyndall ;  and  what  is  more,  these  experiments  exhibited  the 
constituent  parts  of  the  atmospheric  dust,  showing  that  some  portion 
of  it  was  composed  of  organic,  the  rest  of  inorganic  matters.  Any 
one  who  realises  the  fact  of  the  enormous  diffusion  of  dust  in  the 
air  will  less  marvel  at  the  fact  that  chemical  analysis  has  shown  the 
presence  of  mineral  matter  in  the  lungs  of  children  within  three  or 
four  years  after  birth,  and,  cceteris  paribus,  the  progressive  accumu- 
lation of  such  material  in  the  lungs  with  advancing  age.  It  is  in 
the  form  of  silica  that  the  mineral  dust  has  been  sought  after  by 
analysis.  In  illustration  I  may  quote  the  results  obtained,  very 
recently,  by  Riegel  in  conjunction  with  his  colleague  Dr.  Hauser 
(op.  cit.,  p.  2^2).     The  lungs  analysed  were  those  of  individuals  not 


1875.]        On  Lu7ig 'Disease  from  Inhalation  of  Dust.  437 

subjected  to  conditions  of  life  and  labour  involving  exposure  to  more 
dust  than  common.  The  lungs  of  a  child^  four  weeks  old,  furnished 
the  first  example.  In  them  no  silica  was  found.  In  those  of  a 
boy,  set.  4,  silica  constituted  2'44  per  cent,  of  the  ash  left  after 
incineration.  In  those  of  a  day-labourer,  set.  47,  it  amounted  to 
13*39  per  cent.,  and  in  those,  again,  of  a  woman  cook,  sixty-nine 
years  old,  it  reached  16*69  per  cent. 

Accepting  these  figures  as  accurate,  they  leave  no  doubt  of  pro- 
gressive accumulation  in  proportion  to  age  among  individuals 
similarly  situated.  Common  observation,  moreover,  speaks  to  the 
same  fact,  for  a  blackish  discoloration  of  the  lungs  is  a  feature  which 
arrests  attention,  particularly  in  those  who  are  more  advanced  in  life. 

As  might  well  be  anticipated,  in  various  occupations  in  which  much 
dust  is  produced  and  thrown  off,  its  inhalation  becomes  so  consider- 
able that  sooner  or  later  the  foreign  particles  permeating  the  bron- 
chial tubes  and  lung-tissue  become  a  source  of  sufi'ering  and  disease. 
In  some  departments  of  labour  pulmonary  disease  has  been  so 
distinctly  due  to  the  inhalation  of  a  particular  dust  generated  that  it 
has  received  special  appellations  from  the  occupation  pursued,  such, 
for  example,  as  "miners'  phthisis,"*'  Sheffield  "grinders' rot,"  "potters' 
consumption  and  asthma."  In  some  other  forms  of  labour  the  dust 
by  inhalation  has  long  been  popularly  known  as  a  cause  of  disease  ; 
for  instance,  among  freestone  hewers  and  masons,  among  the 
operatives  in  cotton  and  woollen  mills,  and  among  millers.  In  a 
less  degree  many  other  workmen  engaged  in  other  pursuits  suffer 
from  the  same  morbific  agent.  Lewin  refers  to  charcoal-grinders 
and  carriers;  to  chimney-sweeps,  moulders,  and  iron-polishers; 
to  gas-stokers,  to  smiths,  and  glass-polishers  ;  and  the  list  might  be 
increased  by  quotation  of  smaller  trades,  foremost  among  which  would 
stand  workers  in  mother-of-pearl,the  fatality  amongst  them  from  pul- 
monary disease  being  probably  unequalled  in  any  other  class  of  artisans. 

Now,  a  great  difterence  obtains  in  the  extent  and  severity  of  the 
disease  produced  from  the  character  of  the  dust  inhaled ;  and  it  may 
be  safely  predicated  that  mineral  dust,  as  that  of  freestone,  of  potters' 
clay,  of  coal  and  mother-of-pearl,  is  much  more  destructive  of  lung- 
function  and  tissue  than  is  the  dust  of  organic  origin,  as  that  of  wool, 
or  cotton,  or  flour.  The  amount  of  suffering  will  also  bear  a  direct 
relation  to  the  character  of  the  industrial  processes  pursued,  in  some 
of  which  the  generation  of  dust  is  more  abundant,  and  its  inhalation 
favoured  by  the  circumstances  of  labour.  For  example,  the  heated 
air  of  workshops,  or  difficulties  in  the  way  of  ventilation  imposed 
by  special  conditions  of  labour,  the  association  of  the  dust  with  par- 
ticular vapours  or  gases,  may  be  well  imagined  to  add  to  the  inten- 
sity of  the  evils  of  dust.  To  go  into  particulars  upon  these  points 
would  lead  me  on  to  an  essay  on  noxious  trades.  But  this  much 
it  is  necessary  for  me  to  say,  that  differences  in  the  nature  of  the 


438  Original  Communications »  [Oct., 

dust  inhaled,  and  differences  in  the  circumstances  attending  its  inhala- 
tion_,  serve  to  modify  somewhat  the  symptomatic  features  and  history 
of  the  consequent  disease  during  life,  and  likewise  the  pathological 
appearances  after  death.  But,  granting  such  differences,  I  can  ex- 
press no  admiration  for  the  prolific  word-making  of  some  physicians, 
especially  among  the  Germans,  to  describe  those  different  trade-pro- 
puced  chest- affections.  Thus  pneumonokoniosis  stands  for  diseases 
due  to  the  inhalation  of  dust  in  general ;  anthracosis  for  those  due 
to  coal-dust ;  chalicosis  for  such  as  arise  from  siliceous  stone-dust ; 
siderosis  for  ferruginous  dust-disease.  These,  and  other  like  bar- 
barous words  pointing  to  other  varieties  of  dust,  I  should  be  very 
sorry  to  see  perpetuated ;  and  the  more  so  as  I  hold  that,  whatever 
dust  be  inhaled,  the  pathological  process  set  up  by  it  partakes  of 
the  same  essential  character,  though  differing  in  intensity,  and,  in 
the  case  of  inhaled  organic  particles,  somewhat  modified  as  to  results 
produced.  As  my  experience  of  lung-disease  caused  by  the  inhala- 
tion of  dust  has  almost  entirely  fallen  among  miners  and  potters,  I 
shall  confine  myself  to  the  description  of  the  lesion  met  with  among 
such  workmen.  And  first,  let  me  state  that  lung- disease  is  more 
prevalent  and  more  fatal  among  potters  than  among  miners.  I  con- 
sider the  dust  from  the  clay  and  flint  used  by  the  former  to  be  more 
detrimental  to  pulmonary  tissue  than  coal-dust.  It  is  essentially  a 
siliceous  dust,  and  is  rendered  extremely  fine  by  the  processes  the 
clay  passes  through  in  its  preparation.  Moreover,  it  is  worth 
noting,  that  in  several  processes  in  the  manufacture  of  pottery, 
particularly  in  the  making  of  china,  finely  ground  flint  is  largely 
used,  either  in  a  pure  state  or  mixed  with  china-clays. 

As  a  siHceous  dust,  made  up  of  more  or  less  angular  atoms,  it  is 
naturally  extremely  irritating  to  the  tissues,  and  may  be  supposed 
to  have  more  penetrating  power  than  other  kinds  of  dust,  by  its  hard, 
vitreous  character.  The  German  writers  note  a  diff'erence  in  the 
power  of  penetration  between  charcoal-dust  and  the  dust  of  mineral 
coal,  remarking  that  the  former  makes  its  way  more  readily  into 
the  tissues  than  the  latter,  by  reason  of  its  possessing,  more  or  less, 
the  form  of  spiculse,  or  elongated  sharpened  splinters. 

But,  at  the  same  time,  though  the  clay-dust  may  pierce  the 
epithelial  surface  more  readily  than  the  coal,  it  does  not  exhibit  the 
same  diftusibility ;  perhaps  by  reason  of  its  more  irritating  character 
and  the  consequent  inflammatory  action  provoked.  For,  on  the 
whole,  the  coal-dust  penetrates  the  lungs  and  discolours  them  more 
generally  than  does  the  clay-dust.  At  the  same  time  both  forms 
of  dust  exhibit  a  preference  for  the  upper  and  posterior  portions  of 
the  lungs ;  in  other  words,  the  dust  accumulates  most  in  those  parts 
first  reached  in  the  inspiratory  act.  The  lungs  assume  a  black  or 
grey-black  colour  wherever  the  deposit  takes  place;  and,  as  is 
natural;   the  depth  of  colour  is   greatest  where  coal-dust  is   the 


1875.]        On  Lung 'Disease  from  Inhalation  of  Dust.  439 

substance  inspired.  Generally  speaking,  the  depth  of  colour  is 
greatest  where  most  condensation  of  tissue  is  found ;  where  the 
particles  of  dust  are  more  diffused  the  colour  is  rather  greyish 
black.  The  condensation  of  lung  is  as  remarkable  as  the 
black  colour.  Hardened  masses  occur,  at  times  measuring 
two  inches  and  upwards  in  length  and  width,  and  in  depth  or 
thickness  nearly  as  much.  Sometimes  they  have  a  somewhat 
rounded  configuration,  especially  when  of  smaller  dimensions. 
But  under  no  circumstances  are  they  at  all  separable  from  the  sur- 
rounding tissue  as  distinct  heterologous  tumours.  They  have  no 
defining  line,  but  the  condensation  of  tissue  progressively  lessens 
from  the  centre  of  greatest  density,  the  lung-substance  around 
exhibiting  signs  of  the  spreading  lesion.  A  section  of  the  condensed 
mass  presents  great  resistance  to  the  knife,  cutting  with  a  leathery 
or  cartilaginous  consistence,  and  now  and  then  with  a  gritty  sensa- 
tion. When  first  cut  through  the  colour  is  pretty  uniformly  black, 
but,  after  washing,  the  surfaces  present  lighter  and  darker  specks, 
and,  to  find  a  similitude,  have  a  nutmeg-like  aspect.  No  blood 
exudes  on  its  section,  but  the  pulmonary  tissue  around  is  hypersemic. 
It  is  common  also  to  find  an  emphysematous  state  of  neighbouring 
lobules.  This  condition  is  most  pronounced  along  the  anterior 
edges  of  the  lungs. 

The  indurated  portions  for  the  most  part  reach  the  surface, 
and  are  there  covered  by  a  thickened  pleura,  and  pleuritic  adhesions 
are  usual. 

In  some  cases  softening  in  the  centre  of  the  condensed  tissue  has 
taken  place  and  dusky  pus  or  a  purulent  detritus  is  formed  within  it. 
In  many  instances  tubercular  deposits  are  found  associated  in 
the  same  lungs  with  the  hardened  masses.  I  have  not  observed 
caseous  matter  in  the  condensed  tissue,  but  there  may  be 
caseous  tubercle  in  the  same  lungs,  breaking  down  and  forming 
abscesses  as  in  ordinary  consumption. 

.  Together  with  the  hardened  state  of  the  pulmonary  parenchyma, 
there  is  always  more  or  less  chronic  bronchitis.  The  bronchial 
secretion  is  ordinarily  viscid,  of  a  yellowish  or  yellowish-white 
colour;  but  its  consistence  and  viscidity  vary  according  to  the- 
presence  or  absence  of  activity  in  the  bronchial  infl.ammation  and 
in  the  diseased  parenchyma.  In  the  earher  phases  of  the  lesion, 
and  when  the  men  are  still  pursuing  their  occupation,  more  or  less 
black,  sooty -like  particles  discolour  the  expectoration.  This  black- 
cuing  of  the  sputum  gave  rise  to  the  term  "  black-spit ''  used 
formerly  by  miners  to  designate  the  form  of  bronchitis  that  especially 
attacked  them.  It  is,  indeed,  a  phenomenon  observed  in  a  more  in- 
tense degree  among  miners  than  among  potters,  though  present  in 
each  class  of  workmen.  When  a  miner  or  potter  is  attacked  by 
severe  catarrh  or  bronchitis  the  black  spit  is  particularly  observed 


440  Original  Commu?ncations.  [Oct., 

at  the  beginning  of  his  illness ;  as  his  illness  goes  on  the  discolora- 
tion lessens,  the  collection  of  dust  in  his  bronchial  tubes  having 
been  mostly  got  rid  of. 

Enlargement,  induration,  and  blackening  of  the  bronchial  glands 
about  the  roots  of  the  lungs  is  a  lesion  universally  encountered 
along  with  condensation  of  lung  from  dust-inhalation.  When 
speaking  previously  of  the  course  pursued  by  the  dust  this  glan- 
dular change  was  remarked  on.  There  is  abnormal  growth  of  the 
connective  tissue  both  of  the  glands  and  of  their  capsules,  and  in 
the  end  destruction  of  the  true  glandular  substance. 

The  microscopic  appearances  of  the  indurated  connective  tissue 
and  limited  pneumonic  activity,  with  excessive  growth  of  black 
lung,  bespeak  a  hyperplasia.  The  inhaled  dust  acts  as  a  local  irri- 
tant in  the  parenchyma  of  the  lung,  surrounding  the  alveoli,  and 
likewise  upon  the  lining  membrane  and  walls  of  the  bronchi. 
Lymph-exudation  takes  place;  encroaches  and  presses  upon  the 
air-cells;  develops  partially  into  fibrous  tissue,  whilst  other  por- 
tions do  not  advance  beyond  a  granular  stage.  The  lymph-matter 
contracts  in  the  course  of  its  growth ;  the  alveoli  are  destroyed, 
and  their  vascular  supply  is  cut  off.  The  contraction  of  the  new  tissue 
is  evidenced  to  the  naked  eye  by  the  puckeringsof  the  diseased  mass, 
although  this  is  sometimes  masked  by  the  free  development  of  a 
loose  connective  tissue  around  and  by  pleuritic  thickening. 

The  action  of  acetic  acid  clears  somewhat  the  mass  and  brings 
to  light  in  it — which  may  previously  have  looked  like  a  formless 
granular  mass — some  recognisable  remnants  of  lung-tissue  in  the 
shape  of  elastic  fibre  and  rude  broken  outlines  here  and  there  of 
former  air-cells.  The  black  matter  is  seen  in  the  shape  of  more  or 
less  rounded  specks,  scattered  loosely  or  gathered  in  broken  lines, 
or  collected  into  irregular  heaps  amid  the  fibroid  tissue.  When 
seen  in  lines  these  black  particles  can  generally  be  made  out  to  be 
present  in  the  connective  tissue  around  the  former  alveolar  cavities, 
or  else  spreading  along  in  the  direction  of  lymphatics. 

Judging  from  appearances  in  the  diseased  tissue  after  the  action 
of  acids,  I  infer  that  not  only  is  lymph- matter  thrown  out  in  the 
septa  between  the  alveoK,  but  also  that  it  occupies  the  air-cells,  and 
conspires  with  that  exuded  around  them  in  their  obliteration. 

The  whiter  dots  seen  on  section  of  the  hardened  lung  are 
shown  by  the  microscope  to  be  small  bronchial  tubes;  and  it  is 
noticed  that  the  walls  of  these  tubes  are  greatly  thickened,  and 
that  their  lumen  is  obliterated.  When  nitric  acid  is  applied  to  a 
fragment  of  the  diseased  tissue  it  appears  at  first  to  harden  and 
corrugate  it,  but  its  prolonged  action  induces  softening  and  de- 
struction of  all  structure.  So  soon  as  the  acid  acts  upon  the  tissue 
a  lively  effervescence  ensues  indicative  of  the  presence  of  a  carbonate, 
in  all  probability  carbonate  of  lime,     After  the  acid  has  done  its 


1875.]        071  Lung -Disease  from  Inhalation  of  Dust,  4il 

■work  many  particles  remain,  among  which  are  seen  some  having  the 
appearance  of  minute  splinters  of  silica. 

The  chemical  analysis  of  diseased  lungs  has  not  been  prosecuted 
so  extensively  as  it  should  have  been.  Although  by  no  means 
numerous,  it  would  be  useless  to  give  the  results  of  the  analyses 
published  by  various  experimenters.  Kussmaul  made  special  ex- 
amination respecting  the  inhalation  of  siliceous  sand  by  quarrymen, 
and  the  general  fact  arrived  at  by  him  was,  that  in  that  class  of 
workpeople  the  silica  in  the  lungs  exceeded  by  three  tiuies  the 
amount  in  others  of  like  ages  not  'especially  exposed  to  dust- 
inhalation.  Another  analysis  by  Meinel,  quoted  by  Riegel,  of 
diseased  stonemasons^  lungs  exhibited  a  minimum  of  23*3  per 
cent,  and  a  maximum  of  45"6i  per  cent,  of  siHceous  and  sandy 
matter  in  the  ash  of  the  incinerated  lung.  So  RiegePs  own  analysis 
of  the  lungs  of  a  stonecutter,  whose  case  he  relates,  showed  that 
the  ash  of  the  dried  substance  equalled  3*94  per  cent.,  and  that  the 
proportion  of  silica  in  the  ash  was  41 '3 8  per  cent.  In  another 
similarly  employed  the  ash  amounted  to  5'22  per  cent,  and  the 
silica  of  the  ash  to  3 7 '47.  In  two  other  individuals,  also  stone- 
cutters, these  same  figures  were  respectively  4"58  per  cent,  of  the 
ash  and  38*48  of  silica  in  the  ash,  and  5*57  per  cent,  of  ash  and 
58*3  per  cent,  silica  in  the  ash. 

I  may  now  subjoin  the  analysis  of  a  condensed  piece  of  potter's 
lung,  most  kindly  made  for  me  by  Mr.  A.  H.  Church,  the  Professor 
of  Chemistry  in  the  Eoyal  Agricultural  College,  Cirencester.  He 
found  the  specific  gravity  of  the  mass  to  be  1-06.  It  contained 
76'37  per  cent,  of  water,  20'91  of  organic,  carbonaceous,  or  volatile 
matters,  and  2' 7 2  ash  of  mineral  matters.  In  100  parts  of  the 
mineral  ash  silica  amounted  to  47'78,  alumina  to  18*63,  per- 
oxide of  iron  to  5*55,  and  alkalies  and  undetermined  matters  to 
28-04. 

The  proportion  of  silica  in  this  example  of  lung  exceeded,  there- 
fore, that  found  in  any  previous  analysis  quoted,  except  one  where 
that  substance  is  stated  to  have  reached  58*3  per  cent,  of  the  ash. 
But  this  analysis  of  potter's  lung  stands  alone  in  the  determination 
of  the  alumina  present,  an  ingredient  in  the  clays  used  in  pottery, 
but  not  to  be  looked  for  in  the  lungs  of  workers  in  freestone. 

The  carbonate  of  lime  in  potter's  lung,  as  attested  by  effervescence 
with  acids,  may  be  assumed  to  constitute  no  inconsiderable  portion 
of  the  28*04  per  cent,  of  alkalies  and  undetermined  substances 
noted  in  Prof.  Church's  analysis.  This  carbonate  of  lime  will 
give  increased  consistence  to  the  diseased  tissue,  and,  at  the  same 
time,  add  to  its  opacity  under  the  microscope,  a  circumstance 
attested  by  the  clearing  of  specimens  after  the  action  of  acids.  Its 
origin  is  doubtful,  but  it  may  be  supposed  to  be  derived  from 
tissue-elements  themselves,  carbonate  of  lime  being  a  frequent  con- 


441^  Original  Communications,  [Oct., 

stituent  of  morbid  products,  for  instance,  in  brain-sand,  in  obsolescent 
tubercle,  &c. 

The  clinical  history  of  indurated  lung  produced  by  inhalation  of 
dust  may  be  sufficiently  told  in  a  few  words.  The  disease  is  a  pro- 
gressive one,  although  progress  may  be  materially  retarded  by  with- 
drawal from  the  occupation  involving  the  inspiration  of  dust. 
Nevertheless,  when  once  the  morbid  process  has  been  set  up,  it 
would  seem  to  act,  through  the  affected  portion,  as  a  permanent 
cause  of  irritation ;  so  that  the  lungs  are  prone  to  take  on  inflam- 
matory action  from  the  influence  of  cold  and  depressing  circum- 
stances of  no  great  intensity. 

The  onset  is  not  rapid.  Men  of  fair  constitution  will  work  for 
ten  or  more  years  before  exhibiting  definite  symptoms  of  lung- 
lesion.  Patients  will  state  that  for  one,  two,  three,  or  many  winters 
they  have  had  cough  with  expectoration,  but  that  they  have  re- 
covered on  the  accession  of  warm  weather ;  and  that  each  succeeding 
winter  the  cough  has  grown  more  obstinate  and  has  receded  more 
slowly  with  advancing  summer.  Now  and  then  one  severe  attack 
of  broncliitis  appears  to  establish  permanent  mischief,  and  ever 
afterwards  the  patient  continues  an  invahd.  In  all  the  earlier  stages 
the  symptoms  are  those  of  ordinary  chronic  bronchitis.  The  sputum 
varies  according  to  the  present  condition  of  the  patient,  becoming 
viscid  when  there  is  a  recrudescence  of  inflammatory  action.  At 
times  it  is  very  abundant  and  frothy,  at  others  coughed  up  in 
the  form  of  rather  heavy  pellets,  or  of  irregular  masses  shaping 
themselves  to  the  bronchial  tubes.  A  greyish  and  milky  opacity  is 
common,  and  in  rarer  cases  the  expectoration  is  fetid.  A  purulent 
admixture  is  less  observed  unless  there  be  at  the  same  time  tuber- 
cular disease.  Haemoptysis  is  very  uncommon.  If  met  with  it 
affords  good  reason  for  suspecting  the  presence  of  tubercle. 

A  prominent  symptom  is  the  shortness  of  breath.  Speaking 
generally,  this  symptom  is  out  of  proportion  to  the  bronchitis  pre- 
sent. In  an  ordinary  bronchitic  patient  we  should  not  expect  to  find 
it  of  equal  intensity.  In  advanced  stages  of  the  disease  the  dyspncea 
is  extensive.  The  chest,  nevertheless,  does  not  get  more  rounded  as  it 
does  in  emphysema,  but  suffers  contraction.  The  two  forms  of 
'^  consumption,'-*  however,  are  frequently  united ;  when  this  is  so  we 
have,  as  a  matter  of  course,  the  usual  symptoms  of  pulmonary 
phthisis  with  an  unusual  amount  of  dyspnoea.  Wasting  goes  on  to  a 
very  extreme  degree,  just  as  in  tubercular  consumption,  but  without 
the  same  hectic  and  sweating.  The  aspect  of  the  patient  bears  the 
closest  resemblance  to  that  of  a  phthisical  patient,  and  the  malady 
well  deserves  the  popular  name  of  "  potters'  consumption "  and 
^'potters'  asthma.''  In  fine,  the  distinction  in  many  cases  between 
"  potters'  consumption  "  and  tubercular  consumption  is  difficult  to 
make.     The  dehquescence  or  breaking  down  of  morbid  deposit  in 


1875.1        On  Lung -Disease  from  Inhalation  of  Dust.  44.^ 

the  one  malady  and  in  the  other  is  an  identical  process ;  so  likewise 
in  pneumonic  phthisis  and  in  potters'  phthisis  there  is  alike  a 
lobular  pneumonia,  but  experience  indicates  that  a  suppura- 
tive process  belongs  to  the  former  lesion  rather  than  to  the 
latter 

Erequent  sharp  pains  in  the  chest,  varying  from  time  to  time  in 
position,  are  remarkably  frequent  in  potters'  consumption.  I  have 
already  noted  that  the  indurated  portions  of  lung,  as  a  rule,  reach  the 
surface  and  that  the  pleura  over  them  undergoes  thickening.  Those 
pains,  therefore,  may  be  assumed  to  be  very  often  pleuritic  in 
character. 

On  the  whole  the  temperature  in  potters'  consumption  does  not 
range  so  high  as  in  tubercular  phthisis ;  and,  as  before  remarked, 
sweating  is  of  small  amount  or  absent. 

In  the  matter  of  physical  signs  it  is  worthy  of  notice  that  dulness 
on  percussion  is  not  always  present  where  condensation  of  lung 
exists.  Examination  after  death  has  shown  this  to  be  the  case,  and 
that  an  emphysematous  state  of  surrounding  portions  of  tissue  may 
be  accepted  in  explanation  of  the  fact. 

A  considerable  difference  is  observable  in  the  power  of  resistance 
of  different  individuals  to  the  ill-effects  of  dust  inhalation.  This 
difference  is  attributable  to  various  circumstances  affecting  them  and 
their  surroundings.  Whilst  a  good  constitutional  vigour  may  stand 
in  good  stead  one  artisan,  a  feeble,  delicate  frame,  particularly  if 
there  be  hereditary  lung- weakness — which  is  extremely  common 
among  potters — will  render  another  an  easier  prey  to  the  ill- effects  of 
his  occupation.  But  a  wide  difference  arises,  also,  from  the  work- 
man's surroundings  and  the  division  of  labour  which  he  specially 
follows,  for  some  departments  of  the  trade  are  more  detrimental  to 
health  than  others.  To  go  into  particulars  on  this  head  would  carry 
me  far  beyond  the  limits  of  this  paper.  Other  collateral  conditions, 
entailing  variations  in  proclivity  to  disease,  are  to  be  found  in  the 
hygienic  conditions  of  the  workshops.  In  all  shops  where  the  clay- 
is  moulded  and  pressed  the  temperature  ranges  high,  but  in  the 
worst  of  their  number  not  only  is  there  an  unduly  elevated  tempe- 
rature, but  very  defective  ventilation,  draughts,  and  dampness  of 
floors  and  walls.  In  fact,  in  many  old  manufactories  there  are  work- 
shops totally  unfit  for  occupation  in  a  sanitary  point  of  view. 

But,  unhappily,  in  too  many  cases  the  baneful  effects  of  their  trade, 
and  of  the  conditions  of  its  exercise,  are  aggravated  by  their  own 
folly  and  vice.  There  is  a  large  amount  of  drunkenness,  dissipation, 
and  irregular  living,  sapping  the  health,  and  rendering  their  victims 
an  easy  prey  to  disease,  particularly  to  colds  and  inflammations  of 
the  chest,  which  are  the  invariable  antecedents  of  the  subsequent 
induration  with  its  attendant  asthma  and  wasting.  Much  might  be 
done  to  lessen  the  dust  given  off  in  the  processes  of  manufacture  by 


4li  Original  Communications.  [Oct.* 

sanitary  constructions,  and  the  inhalation  of  dust  might  be,  to  a  very 
large  extent,  avoided  by  the  use  of  simple  respirators.  The  former 
object  will,  it  is  to  be  hoped,  gradually  be  arrived  at  through  the 
intelligence  and  philantliropy  of  employers;  the  latter  is  princi- 
pally in  the  hands  of  the  workpeople,  who  could  readily  adopt  the 
use  of  respirators  did  not  their  stupid  pride  and  weakness  of  resolve, 
their  indifference  or  opposition  to  whatever  is  new  in  their  modes  of 
work,  and  their  ridiculous  sensitiveness  to  personal  appearance  and 
the  possible  ridicule  of  others,  stand  in  the  way,  and  so  make  them 
sacrifice  health  and  life  to  inexorable  trade  usages  and  foolish  senti- 
mentality. The  operation  of  the  Factory  Acts  has  done  a  great  deal 
towards  the  structural  improvement  of  manufactories  ;  has  rendered 
work  more  regular,  particularly  by  the  stoppage  of  night  labour ; 
has  limited  the  hours  of  work,  and  prevented  the  employment  of 
children  too  young  or  too  weak.  But  to  bring  about  all  the  sani- 
tary improvements,  whether  of  manufactories  or  of  those  employed 
within  them,  a  considerable  extension  and  many  amendments  of  the 
sanitary  provisions  of  those  Acts  are  needed. 

The  preventive  measures  of  diseases  arising  from  the  inhalation  of 
dust  would  afford  matter  for  lengthened  discussion,  but  such  a  dis- 
cussion would  be  here  out  of  place.  I  will  therefore  conclude  this 
communication  by  remarking  that  I  have  preferred  setting  forth  my 
own  observations  and  the  results  of  experience  to  writing  a  complete 
disquisition  on  the  subjects  considered,  by  examiiiing  and  discussing 
the  statements  and  opinions  of  many  physicians  who  have  dealt  more 
or  less  fully  with  the  like  topics,  otherwise  it  would  have  been  my 
duty  to  have  referred  to  several  English  authors  who  have  written 
on  the  diseases  of  artisans^  and  especially  to  the  painstaking  and 
extensive  inquiries  of  Dr.  Headlam  Greenhow. 


1875.]  Presence  of  Ah  in  Middle  Ear  Sign  of  Live  Birth.  445 


II.  Memorandum  on  the  Presence  of  Air  in  the  Middle  Ear  as  a 
Sign  of  Live  Birth.     By  P.  Ogston. 

In  the  '  Monatsschrift  fiir  Ohrenheilkunde/  1868,  Dr.  Eobert 
Wreden,  of  St.  Petersburg,  in  a  series  of  articles  on  the  condition  of 
the  ear  at  and  soon  after  birth,  directs  the  attention  of  medical 
jurists  to  the  entrance  of  air  into  the  middle  ear,  and  the  disappear- 
ance of  the  gelatinous  substance  which  fills  the  tympanic  cavity 
prior  and  up  to  the  birth  of  the  child. 

He  states  that  this  substance  disappears  within  twenty- four  hours 
after  birth ;  that  a  twelve  hours'  respiration  is  not  sufficient  to 
effect  its  complete  disappearance  ;  and  concludes  by  suggesting  that 
the  occurrence  of  air  in  this  situation  might  be  of  importance  in  a 
medico-legal  point  of  view,  as  proving  that  respiration  had  taken 
place. 

That  these  statements  have  been  made  without  sufficient  grounds, 
and  that  they  require  considerable  modification,  the  following 
fifteen  cases,  collected  partly  by  Dr.  xilexander  Ogston  and  partly 
by  myself,  seem  to  prove : 


112 — LYi.  29 


446 


Original  Communications, 


[Oct., 


Age  of  child. 

State  of  the  middle 
ears. 

State  of  lungs. 

Cause  of  death. 

Other  facts  to  fix 
term  of  life,  &c. 

1 

14  weeks. 

Filled  with  air. 

Fully  expanded. 

Smothering. 

Bronchitis. 

2 

9  weeks. 

Pilled  with  air. 

do. 

do. 

do. 

3 

2  months. 

Filled  with  fluid. 

do. 

do. 

4 

6  weeks. 

R.   air,   L.  muddy 
fluid. 

do. 

do. 

Bronchitis. 

5 

I  month. 

Filled  with  air. 

do. 

do. 



6 

4  weeks. 

R.  air,  L.  air  and 
fluid. 

do. 

Broncho- 
pneumonia. 

7 

S  days. 

Filled  with  air. 

do. 

Bronchitis. 

Lungs  bulky,em- 
physematous. 

8 

3  days. 

Containing  air. 

do. 

Smothering. 



9 

2  hours. 

Fluid    and   yellow 

Partly  expanded. 

Apoplexia- 

Breathed  feebly 

substance. 

neonatorum. 

about  2  hours. 

10 

N"ew-born. 

Containing  fluid. 

Expanded. 

Smothering. 

Meconium  in 
large  intestine. 

11 

New-born. 

Filled     with      red 
fluid. 

do. 

Fracture       of 
skull. 

do. 

12 

New-born. 

Containing  fluid. 

do. 

Smothering. 

Navel'String  at- 
tached.    Meco- 

13 

New-born. 

Containing        red 
fluid. 

nium  in  large 
intestine. 

Partly  expanded. 

(?) 

Meconium  in 
large  intestine. 

14 

New-born. 

Containing  air. 

Expanded. 

Smothering. 

do. 

15 

New-born. 

Containing  fluid. 

Unexpanded. 

Stillborn. 

"^^ 

I  ought,  perhaps,  to  have  omitted  the  first  six  cases  as  not  bearing 
directly  on  the  subject,  but  I  have  thought  it  better  to  adduce  them, 
as  tliough  most  of  the  ears  contained  air,  yet  some  of  them  con- 
tained fluid  also,  and  in  one  (3)  they  were  filled  with  fluid,  although 
the  child  had  lived  two  months,  and  there  were  no  signs  of  catarrh 
in  the  respiratory  tract  to  account  for  its  presence.  The  fluid  was 
probably  catarrhal ;  but  as  it  was  not  examined  microscopically  I 
cannot  state  positively  that  it  was  so. 

The  last  nine  cases,  on  the  contrary,  are  those  in  which  Dr. 
Wreden's  proposed  test  should  be  expected  to  prove  useful,  but,  as 
we  see  by  the  table,  in  only  three  (6,  7,  and  14)  was  air  found  in 
the  middle  ears,  although  the  lungs  in  all,  with  the  exception  of  a 
stillborn  immature  infant,  contained  sufficient  air  to  float  in  water, 
and  from  all  air  could^be  expressed  when  they  were  held  under 
water. 

The  presence  of  catarrhal  fluid  in  the  middle  ear  might  be  mis- 
leading, but  in  these  cases  more  or  less  air  would  be  found  along 
with  it  which  would  tend  to  prevent  its  being  mistaken  for  the 
gelatinous  matter  found  before  birth, — F.  Ogston,  Jun. 


1875.] 


447 


Chronicle  of  ilelriral  ^titntt. 


EEPORT  ON   MATERIA  MEDICA  AND  THERAPEUTICS. 
By  RoBEET  HrNTEE  Semple,  M.D., 

Fellow  of  the  Royal  College  of  Physicians,  London,  Physician  to  the  Bloomsbury  Dispensary,  London, 


On  the  Action  of  Eserine  (^JPhysostygmin)  on  Chorea.  By  Dr. 
BouciiFT,  of  the  Hopital  des  Enfans  Malades,  Paris. — After  some 
general  observations  on  the  physiological  researches  previously  made 
on  the  active  principle  of  the  Calabar  bean,  Dr.  Bouchut  states,  as  the 
result  of  his  recent  investigations,  that  the  action  of  this  alkaloid  is 
very  different  in  man  from  that  produced  in  dogs.  He  has  employed 
the  sulphate  of  eserine  or  eserine  itself  four  hundred  and  thirty-seven 
times  in  the  human  subject,  but  not,  of  course,  in  poisonous  doses,  al- 
though he  has  carried  it  to  the  extreme  limits  of  tolerance,  in  the  dose 
of  three,  four,  five,  and  six  milligrammes  (a  milligramme  is  the  yoW 
of  about  fifteen  grains),  which  quantity  he  thinks  it  dangerous  to 
exceed.  Hitherto  eserine  has  been  employed  internally  only  in  a  few  cases 
of  tetanus,  but  Dr.  Bouchut  conceived,  judging  from  its  physiological 
action,  that  it  might  be  useful  in  chorea ;  and  of  the  whole  number  of 
his  cases,  205  took  the  medicine  in  the  form  of  pills,  and  the  other 
232  were  treated  by  subcutaneous  injection,  the  dose  of  eserine  being 
the  same  in  all  cases,  namely,  from  two  to  five  miUigrammes.  All  the 
patients  were  children  affected  with  chorea  or  nervous  convulsions,  and 
their  ages  were  from  seven  to  twelve.  Dr.  Bouchut  in  this  elaborate 
paper  shows  in  a  series  of  successive  paragraphs  the  effect  of  subcu-: 
taneous  injections  of  pure  eserine  in  different  doses ;  the  effect  produced 
by  the  subcutaneous  injection  of  sulphate  of  eserine  ;  the  effect  of  the 
sulphate  of  eserine  in  pills,  and  that  of  the  same  substance  taken  in 
solution ;  the  action  of  eserine  on  the  composition  of  the  urine ;  the 
comparative  action  of  eserine  in  man  and  in  the  lower  animals ;  the 
effects  of  the  alkaloid  on  the  contraction  of  the  peripheric  vessels ; 
and,  lastly,  the  therapeutical  effects  of  eserine  and  its  sulphate  in 
chorea  and  other  convulsive  diseases. 

The  injection  of  pure  eserine  in  the  dose  of  five  milligrammes  in 
children  appears  to  be  attended  with  very  striking  and  rather  serious 
consequences ;  for  when  twelve  children,  from  seven  to  twelve  years  old, 
affected  with  chorea,  were  subjected  to  this  treatment,  they  suffered 


4l8  Ohronicle  of  Medical  Science.  [Oct.^ 

severe  epigastric  pain,  nausea,  slim}'  and  scanty  but  painful  vomiting, 
and  more  or  less  well-marked  paralysis  of  the  diaphragm,  which  ren- 
dered the  vomiting  more  difficult.  It  is  remarkable  that  the  pupils 
were  not  strongly  contracted  in  any  of  the  children,  but  in  two  of 
them  they  were  slightly  contracted,  and  in  all  the  rest  they  were 
dilated,  although  at  the  same  time  they  were  contractile. 

The  above  symptoms  lasted  three  hours,  and  during  this  time  the 
choreic  movements  were  arrested,  but  they  returned  progressively  in 
ten  cases  in  proportion  as  the  eserine  lost  its  action.  In  smaller  doses, 
employed  in  injections,  the  symptoms  produced  were  similar  but  of  a 
slighter  character,  and  the  chorea  was  relieved  during  the  whole  time 
of  the  action  of  the  eserine,  with  one  exception,  among  eight  children. 
"When  the  alkaloid  was  administered  in  the  form  of  pills  the  symptoms 
produced  were  less  marked  than  when  the  subcutaneous  injection  was 
employed  ;  so  that  by  the  former  metliod  three  to  five  milligrammes 
might  be  given  with  safety,  while  it  was  dangerous  to  exceed  two  to 
three  milligrammes  by  the  latter.  As  to  the  presence  of  albumen  and 
sugar  in  the  urine  under  the  influence  of  sulphate  of  eserine,  Dr. 
Bouchut  has  never  been  able  to  find  any  such  change  ;  and  although 
he  does  not  dispute  the  fact  that  these  substances  have  been  found  in 
the  lower  animals  treated  by  this  drug,  yet  he  suggests  that  the  action 
is  probably  difi'erent  in  man.  With  regard  to  the  time  when  the 
s\^mptoms  commence.  Dr.  Bouchut  has  found  that  after  injections  the 
eflTects  are  almost  instantaneous,  some  of  the  little  patients  becoming 
pale  and  sick,  spitting  frothy  or  watery  but  scanty  matter  from  the 
mouth,  or  making  attempts  to  vomit  which  are  prevented  by  the 
weakness  of  the  diaphragm.  The  paralysis  of  the  last-named  muscle 
is  the  most  disagreeable  result  which  ensues  after  the  injections  of  large 
doses  of  eserine,  as,  for  instance,  five  milligrammes ;  and  even  asphyxia 
might  ensue,  although  below  three  milligrammes  this  is  not  likely. 
An  unexpected  result  was  observed  by  Dr.  Bouchut,  namely,  that  the 
pupil  remained  tolerably  contractile  to  the  light  and  seemed  a  little 
dilated.  In  232  injections  containing  one  to  five  milligrammes  the 
pupil  was  never  contracted  as  it  is  after  the  direct  instillation  of  eserine 
into  the  eye. 

There  is  an  enormous  difference,  as  Dr.  Bouchut  has  proved,  between 
the  effects  of  eserine  in  man  and  in  the  lower  animals,  the  greater 
part  of  the  symptoms  observed  in  the  latter  not  being  developed  in 
man,  and,  on  other  the  hand,  those  which  are  observed  in  man  are  not 
found  to  exist  in  the  brute  creation. 

With  reference  to  the  practical  question  as  to  the  action  of  eserine 
in  the  treatment  of  chorea  and  convulsive  diseases.  Dr.  Bouchut  shows 
that  in  the  dose  of  three  milligrammes  in  injection,  and  five  to  six 
milligrammes  taken  by  the  stomach,  the  alkaloid  arrests  or  moderates 
the  choreic  movements  during  the  period  of  its  elimination.  This 
effect  is  only  temporary,  but  still,  in  proportion  to  the  diminution  of 
the  movements  in  question,  the  disease  itself  is  relieved  and  finally 
disappears.  The  particulars  of  twenty-four  cases  are  given  by  the 
author,  and  he  shows  that  of  the  cases  treated  by  injection  the  suc- 
cessful result  was  obtained  by  an  average  of  seven  injections,  and,  taking 


1875.]     Report  on  Materia  Medica  and  Therapeutics.  44-9 

the  results  of  injoctioii  and  administration  by  the  mouth  together,  the 
average  duration  of  treatment  was  ten  da3^s. 

The  general  conclusions  drawn  by  Dr.  Bouchut  from  his  observations 
are  the  following  : — Eserine  and  its  sulphate  may  be  employed  either 
in  hypodermic  injections  or  by  the  stomach,  and  they  should  be  ad- 
ministered to  the  patient  fasting ;  the  action  is  most  energetic  when 
injections  are  used.  The  action  of  the  drug  lasts  from  one  to  three 
hours,  and  then  ceases  entirely,  so  that  the  dose  may  be  resumed  to 
the  amount  of  fifteen  to  twenty  milligrammes  given  at  intervals 
during  the  day.  Eserine  usually  causes  paleness  of  the  face  and  con- 
traction of  the  pulse  sometimes  followed  by  retardation,  and  almost  all 
the  patients  experimented  upon  had  uneas}^  feelings,  epigastric  pain, 
nausea,  and  spitting  of  stringy  watery  fluid,  and  sometimes  there  was 
bilious  vomiting.  The  alkaloid  does  not  sensibly  alter  the  temperature, 
and  in  the  doses  above  described  it  does  not  cause  colic  or  diarrhoea  ; 
and  when  given  internally  it  leaves  the  pupil  in  its  natural  state  of 
contractility,  the  dilatation  or  contraction  of  this  aperture  being  only 
exceptional.  When  administered  in  cases  of  chorea  the  disease  is 
gradually  cured  in  about  ten  days,  and  the  method  by  injection  is  more 
certain  in  its  effect  than  the  administration  by  the  stomach.  Dr. 
Bouchut  has  never  seen  tremblings  or  convulsions  caused  by  eserine, 
and  he  thinks  it  probable  that  these  effects  are  only  produced  by  large 
and  poisonous  doses. — Bulletin  GSneral  de  Therapeutique,  April  15th, 
1875. 

On  the  Treatment  of  Malignant  Pustule  ly  Phenic  (Carbolic)  Acid. 
Bj'  Dr.  EsTRADERE,  of  Bagneres  de  Luchon. — For  the  last  three  years 
Dr.  Estrad^re  has  treated  cases  of  malignant  pustule  by  a  method 
which  he  believes  to  be  entirely  novel,  the  chief  remedy  employed 
being  phenic  acid  used  internally  as  well  as  externally.  The  cases  he 
gives  are  eight  in  number,  the  disease  having  been  contracted  in  various 
ways,  sometimes  by  the  contact  of  animals  which  had  died  of  malignant 
pustule,  sometimes  by  the  bites  of  insects.  The  first  case  was  a  fatal 
one,  being  caused  by  stripping  a  heifer,  and  it  is  adduced  to  show  the 
inutility  of  the  ordinary  treatment  by  cauterizations  of  nitrate  of  silver 
and  hot  iron,  and  the  internal  use  of  ammonia,  quinine,  &c.  The  fifth 
case,  which  the  author  considers  the  most  striking  one,  was  that  of  a 
butcher  who  had  stripped  two  cows  which  had  died  of  malignant 
pustule.  The  seat  of  the  patient's  disease  was  the  neck,  and  Dr. 
Estradere  made  a  crucial  incision  of  the  pustule,  and  afterwards  apphed 
the  nitrate  of  silver.  The  disease,  however,  became  worse,  and  the 
cedema  spread  over  the  scalp,  the  forehead,  the  lips,  and  the  chin, 
besides  the  neck  and  the  upper  part  of  the  chest.  The  place  of  the 
original  pustule  was  converted  into  a  black  eschar,  and  two  large  in- 
cisions were  made  over  the  pectoral  muscles  ;  at  the  same  time  the 
phenic  acid  was  prescribed  internally,  and  compresses  of  the  same 
substance  were  applied  over  the  neck  and  over  the  incisions.  From  this 
point  of  the  treatment  the  patient  gradually  improved  ;  the  eschar 
was  at  the  end  of  a  fortnight  separated  and  removed,  the  subjacent 
part  became  of  a  bright  red  colour,  granulations  sprang  up,  and  cicii- 


450  Chronicle  of  Medical  Science,  [Oct., 

trization  was  completely  effected.  Keviewing  the  history  of  his  eight 
cases,  the  author  shows  that  of  two  of  them,  treated  in  the  ordinary 
way,  one  died  and  the  other  recovered  with  difficulty,  but  in  the  cases 
treated  by  the  phenic  acid  the  beneficial  effects  were  observed  in  all 
and  the  treatment  was  uniformly  successful.  Dr.  Estradere  thinks 
he  has  established  the  fact  that  the  phenic  acid,  used  internally  and 
externally,  is  the  best  remedy  for  malignant  pustule  and  that  all 
other  treatment  may  be  abandoned. — Bulletin  GenSral  de  Therapeu- 
ti^ue,  June  15th,  1875. 

On  the  Use  of  Nitrite  of  Amyl  in  various  forms  of  Spasm,  and  on 
its  Value  as  an  aid  to  Diapiosis.  By  Dr.  S.  Weir  Mitchell,  of 
Philadelphia. — Dr.  Mitchell  has  for  some  time  entertained  the  con- 
viction that  nitrite  of  amyl  would  be  a  suitable  remedy  in  epilepsy, 
because  it  rapidly  induces  fulness  of  the  vessels  of  the  whole  head,  and 
thus  would  counteract  the  condition  of  vascular  spasm  which  charac- 
terises the  outset  of  the  epileptic  attack.  The  cases,  however,  are 
rare  in  which  the  remedy  can  be  employed,  because  the  fit  comes  on  so 
suddenly  as  to  prevent  the  due  administration  of  the  nitrite,  but  in 
certain  instances  the  patient  has  a  succession  of  fits  within  a  Hmited 
space  of  time,  and,  being  then  in  bed,  is  so  placed  as  to  admit  of  the 
trial  of  this  plan.  The  first  case  in  which  Dr.  Mitchell  was  able  to 
test  the  value  of  the  remedy  occurred  in  1872  and  the  result  was  quite 
successful.  The  case  was  one  in  which  the  disease  was  caused  by 
sexual  abuse,  and  various  remedies  had  been  employed  in  vain,  but,  as 
a  last  resource,  Dr.  Mitchell  gave  the  patient  three  or  four  drops  of 
nitrite  of  amyl,  and  directed  him  to  inhale  it  by  putting  the  open 
phial  which  contained  it  up  one  nostril  while  he  closed  the  other  nostril 
and  then  made  a  few  full  inspirations.  At  the  second  trial  of  the 
experiment  the  patient  felt  his  face  flush,  the  carotids  beat  violently, 
the  head  felt  full,  and  the  spasm  being  thus  caused  to  cease,  the  im- 
pending attack  was  cut  short  for  the  first  time  in  the  course  of  the 
epileptic  seizures.  On  subsequent  occasions  the  attacks  were  arrested 
in  a  similar  manner,  and  Dr.  Mitchell  reports  that  for  the  last  two 
years  and  a  half  there  have  been  only  seven  fits,  or  rather  only  one, 
for  all  the  rest  have  been  cut  short  by  the  nitrite.  Several  other  cases 
are  given  in  which  the  results  were  the  same,  and  although  Dr.  Mitchell 
does  not  allege  that  the  drug  has  any  power  to  prevent  the  return  of 
the  fits,  he  has  no  doubt  of  its  efficacy  in  arresting  the  actual  con- 
vulsion. In  reference  to  the  aid  given  to  diagnosis  by  the  use  of  the 
nitrite,  Dr.  Mitchell  writes  with  some  hesitation,  but  he  thinks  that  in 
some  doubtful  cases  of  cerebral  disease  the  nitrite  may  help  to  clear 
up  the  difficulty.  When,  for  instance,  the  malady  is  truly  epileptic, 
the  nitrite  of  amyl  may  arrest  the  fit  in  the  manner  already  described  ; 
but  when  the  disorder  is  of  the  congestive  type,  the  drug  maj^  prove 
useful  in  settling  the  question  of  its  nature  by  reproducing  the  train  of 
symptoms  and  thus  showing  its  real  character. — Philadelphia  Medical 
Times,  March  6th,  1875. 

On  the  Therapeutical  Effects  of  Dietetic  Treatment.  By  Dr.  Datj- 
YEKGNE,  Sen.,  Physician  of  the  Manosque  Hospital. — After  quoting  a 


1875.]       Report  on  Materia  Medica  and  Therapeutics,        451 

sentence  formerly  written  by  Prof.  Bouchardat  to  the  effect  "that 
young  physicians,  as  they  advance  in  Hfe,  will  see,  as  he  did,  that  drug 
medication  will  not  keep  all  its  promises,  and  that  they  will  often 
resort  to  the  careful  use  oC  hygienic  measures  in  the  treatment  of 
disease,"  Dr.  Dauvergne  signifies  his  concurrence  in  the  view  ex- 
pressed, and  proceeds  to  give  several  cases  in  illustration  of  its  truth. 
The  first  case  was  that  of  a  lady  who  had  a  swelling  of  an  uncertain 
character  in  the  right  hypochondrium,  attended  with  the  most  alarming 
symptoms  and  acute  pain,  but  which,  after  resisting  the  employment 
of  poultices  of  opium  and  belladonna,  yielded  to  the  application  of 
tepid  water  on  a  napkin  folded  and  laid  over  the  painful  region.  Another 
case  was  that  of  a  boy  twelve  years  old,  who  had  an  induration  of  the 
whole  abdominal  region,  with  hectic  fever,  but  who,  after  trying  various 
remedies,  recovered  entirely  by  being  put  upon  an  exclusive  diet  of 
white  grapes.  A  third  instance  was  afforded  by  a  man  at  the  Manosque 
Hospital  with  an  engorgement  of  the  liver,  with  jaundice,  but  who  was 
eventually  cured  entirely  by  being  placed  upon  a  diet  consisting  of 
water-melons,  white  grapes,  figs,  and  peaches,  without  bread  or  soup. 
Dr.  Dauvergne  states  that  he  has  also  cured  several  cases  of  anasarca 
and  ascites  by  means  of  a  milk  diet ;  and  he  adduces  a  striking  case  in 
which  an  old  gentleman,  nearly  eighty  years  old,  and  who  was  swollen 
all  over  his  body  and  was  daily  expected  to  die,  recovered  under  the 
use  of  milk  and  onion  soup.  But  it  should  be  added  that  purgatives 
and  digitalis  were  also  employed  at  the  same  time.  While  adducing 
these  examples  of  the  good  effects  often  attending  a  judicious  diet,  Dr. 
Dauvergne  notices  other  cases  where  maladies  have  been  aggravated 
and  even  death  caused  by  erroneous  diet.  This  latter  class  of  cases 
chiefly  consisted  of  fevers,  in  which  the  malady  appeared  to  be 
going  on  favorably,  but  in  which  the  symptoms  reappeared  under 
injudicious  alimentation.  Dr.  Dauvergne's  observations,  although  by 
no  means  new,  are  well  worthy  of  attention,  and  his  cases  afford  very 
good  illustrations  of  the  views  he  advances. — Bulletin  General  de 
TherapeutiqiLOy  May  30th,  1875. 

On  the  Use  of  Cold  Baths  in  Cerehral  Rheumatism. — At  a  recent 
meeting  of  the  Societe  des  Hopitaux  in  Paris  the  use  of  cold  baths  in 
cerebral  rheumatism  was  the  subject  of  discussion,  M.  Fereol  intro- 
ducing to  the  members  an  account  of  a  case  so  treated.  The  patient 
was  thirty-four  years  old,  of  quiet  and  temperate  habits,  who  was 
suffering  from  acute  articular  rheumatism.  He  was  treated  at  first 
with  emetics,  sulphate  of  quinine,  and  colchicum,  but  in  five  days  ho 
was  seized  with  delirium,  agitation,  and  dyspnoea,  and  at  the  same 
time  the  pains  in  the  joints  disappeared.  The  temperature  of  the 
body  rose  to  forty  degrees  (Centigrade),  and  leeches,  calomel,  and 
bromide  of  potassium  were  given  without  success.  The  temperature 
rose  further  to  forty-one  degrees,  and  blisters  were  placed  on  the  hairy 
scalp  and  digitalis  was  given.  There  was  then  a  little  more  rest,  but 
the  aspect  was  typhous,  with  stupor  and  continuous  sub-delirium  ; 
sleeplessness,  agitation  of  the  muscles,  subsultus  tendinum,  dry  tongue, 
&c.     After  some  consultation  with  other  physicians  it  was  determined 


452  Chronicle  of  Medical  Science.  [Oct., 

to  try  the  effect  of  cold  baths  as  the  only  remaining  resource.  This 
plan  was  pursued  for  a  whole  week,  the  patient  remaining  under  close 
observation  the  whole  of  the  time,  and  the  thermometer  being  almost 
fixed  under  the  axilla.  As  soon  as  the  temperature  rose  to  39*5°  the 
patient  was  plunged  into  a  cold  bath.  Prom  the  25th  of  February  to 
the  3rd  of  March  sixteen  baths  were  administered  at  a  temperature 
varying  from  twenty-one  to  twenty-five  degrees  (Centigrade),  and  the 
duration  of  each  bath  was  twenty  minutes  on  the  average.  The  patient 
always  raised  the  temperature  of  the  water  from  one  to  two  degrees, 
and,  on  leaving  the  bath,  his  own  temperature  fell  to  thirty-six  degrees. 
After  several  fluctuations  and  much  anxiety  on  the  part  of  the  medical 
attendants,  the  patient  eventually  recovered  completely.  M.  Fereol 
insists  on  the  absolute  necessity  of  constant  and  intelligent  supervision 
during  this  mode  of  treatment,  and  he  states  that  the  life  of  the 
patient  depends  on  such  care  being  unintermittingly  bestowed.  This 
was  the  third  case  of  cerebral  rheumatism  cured  in  France  by 
the  use  of  cold  baths.  Dr.  Dujardin-Beaumetz,  in  making  some 
observations  on  M.  Fereol's  case,  thought  that  it  was  necessary,  before 
laying  down  precise  rules  as  to  the  treatment  of  cerebral  rheumatism 
by  cold  baths,  to  determine  what  was  meant  by  the  disease  in  question. 
He  believed  that  the  treatment  was  inapplicable  to  many  of  the  cases 
of  cerebral  rheumatism  so  called,  and  that  it  was  only  adapted  to  that 
form  of  disease  described  by  Trousseau  as  nevrose  rhumatismale,  and 
by  Wunderlich  as  maladie  rhumatoide  a  forme  nerveuse. — Bulletin 
General  de  Therajpeutique^  March  30th,  1875. 

On  the  Action  of  Various  Drugs  on  the  Biliary  Secretion.  By 
Prof.  EuTHERFORD  and  M.  Viqnal. — At  the  recent  meeting  of  the 
British  Medical  Association  at  Edinburgh,  a  report  was  made  by  Prof. 
Eutherford  on  a  series  of  experiments  made  upon  dogs  to  ascertain  the 
effect  of  various  drugs  in  promoting  the  secretion  of  bile.  It  had  been 
showm  by  Prof.  Hughes  Bennett's  committee  that,  in  dogs  with  per- 
manent biliary  fistulas  and  living  on  a  fixed  diet,  "  spontaneous  diarrhoea, 
dysentery,  and  purgation,  produced  by  blue  pill,  calomel,  corrosive 
sublimate,  and  podophyllin,  always  diminished  the  solid  constituents  of 
the  bile,  and,  with  one  exception,  the  fluid  portions  of  the  bile  also." 
More  recently,  Rohrig  performed  experiments  on  the  action  of  chola- 
gogues  in  fasting  curarized  animals  with  temporary  fistulas,  and  found 
that  large  doses  of  croton  oil  greatly  increased  the  secretion  of  bile, 
and  that  a  similar  effect,  though  to  a  less  extent,  was  produced  by 
colocynth,  jalap,  aloes,  rhubarb,  senna,  and  sulphate  of  magnesia,  the 
relative  power  of  producing  hepatic  stimulation  being  in  the  order  just 
mentioned.  Prof.  Putherford  and  M.  Vignal  have  performed  a  further 
series  of  experiments,  adopting  Kohrig's  method  with  some  modifica- 
tions. Their  conclusions  in  some  respects  confirm  and  in  others  modity 
those  of  the  last-named  observer.  Croton  oil,  although  violently  irri- 
tating to  the  alimentary  canal,  is  shown  by  them  to  have  but  little 
action  on  the  liver.  Podophyllin  was  proved  to  increase  greatly  the 
biliary  secretion,  and  aloes  was  also  shown  to  be  a  powerful  hepatic 
stimulant,  Khubarb  was  proved  to  be  a  more  important  hepatic  stimulant 


1875.]       Keport  on  Materia  Medica  and  Therapeutics,        453 

than  Kohrig  had  stated  it  to  be  ;  the  cholagogue  effect  of  senna  is  less 
than  that  of  rhubarb,  but  colchicum  is  a  very  decided  cholagogue  . 
taraxacum  is  a  cholagogue,  but  not  a  powerful  one,  and  scamraony  has' 
a  slight  cholagogue  action.  In  four  experiments  with  calomel,  the 
secretion  of  bile  was  slightly  increased  in  one,  but  there  was  nothing 
but  diminution  of  the  secretion  in  the  other  three ;  purgative  action, 
however,  was  produced  in  all,  and  the  bile  was  rendered  more  watery. 
The  experiments  on  which  these  statements  are  founded  are  shortly  to 
be  published  in  extenso,  and  the  above  is  only  a  brief  abstract  of  the 
resume  of  Prof.  Kutherford's  report.  —  British  Medical  Journal^ 
Aug.  14th,  1875. 

Or  the  Uses  and  Administration  of  Phosphorus.  By  Dr.  Kirbt 
(Pamphlet). — Dr.  Kirby,  like  most  other  writers  on  the  subject,  regards 
phosphorus  as  a  medicine  especially  calculated  to  supply  or  to  restore 
phosphorus  to  the  system,  and  he  specifies  the  cases  in  which  its  use 
is  indicated.  But,  as  is  well  known,  this  element  is  now  employed  in 
many  maladies  besides  those  in  which  its  chemical  action  is  specifically 
required,  and  including,  for  instance,  neuralgia,  hysteria,  melancholia, 
epilepsy,  &c.  The  mode  of  administering  phosphorus,  however,  so  as 
to  secure  its  beneficial  operation  and  to  avoid  its  poisonous  action,  has 
long  been  and  perhaps  still  is  a  question  requiring  a  definite  solution. 
The  'Additions  to  the  British  Pharmacopoeia'  made  last  year,  give, 
as  is  well  known,  two  directions  for  preparing  phosphorus  lor  medical 
use,  namely,  the  "  Oleum  Phosphoratum  "  and  the  "  Pilula  Phosphori," 
while  Dr.  Ashburton  Thompson,  in  a  work  lately  published  by  him, 
recommends  the  use  of  phosphorus  dissolved  in  cod-liver  oil,  or  com- 
bined with  zinc,  and  others  have  recommended  the  use  of  the  phos- 
phites and  hypophosphites  of  soda,  potat^h,  and  lime,  as  a  means  of  intro- 
ducing phosphorus  into  the  system.  But  Dr.  Kirby  maintains  that 
the  successful  employment  of  phosphorus  depends  entirely  on  its 
administration  in  the  free  state,  that  is,  before  its  conversion  into  phos- 
phoric acid  or  other  phosphorus  compound.  With  this  object  in  view 
he  thinks  it  essential  that  it  should  not  be  exposed  to  oxidation,  nor 
the  digestive  functions  disturbed  or  disordered  by  it  or  by  the  men- 
struum or  vehicle  in  which  it  is  administered.  He  therefore  recommends 
the  use  of  phosphorus  in  a  pill,  which  he  calls  Pilula  Phosphori  Mollis, 
because  it  is  a  soft  and  soluble  pill-mass,  and  to  distinguish  it  from  the 
Pilula  Phosphori  of  the  British  Pharmacopoeia,  which  is  hard  and 
insoluble.  The  pills  recommended  by  Dr.  Kirby  contain  one  grain  of 
phosphorus  in  fifty,  and  therefore  five  grains  contain  one  tenth  of  a 
grain  of  free  phosphorus.  Five  grains  is  the  maximum  dose,  and  half  a 
grain,  which  contains  one  hundredth  of  free  phosphorus,  is  the 
minimum. 

On  the  Action  of  Salicylic  Acid. — Dr.  "Winter,  in  a  recent  number 
of  '  Schmidt's  Jahrbiicher,'  in  recording  the  different  results  obtained 
by  the  use  of  salicylic  acid,  remarks,  in  the  first  place,  that  this  acid 
may  completely  replace  carbolic  acid  as  a  disinfectant  in  recent  and 
chronic  ulcers  when  applied  on  the  bandages.  In  several  cases  of  recent 
superficial  gangrenous,  sores  Dr.  Wagner  applied  a  thin  layer  of  pow- 


454  Chronicle  of  Medical  Science.  [Oct., 

dered  salicylic  acid  on  the  surface  and  placed  over  it  some  wadding. 
Sometimes  the  secretions  of  the  sore  passed  through  the  bandage, 
which,  however,  was  inodorous,  and  then  another  layer  of  wadding 
sprinkled  with  salicylic  acid  was  laid  over  it.  Eor  the  most  part  the 
bandage  might  be  removed  in  a  week,  and  the  healing  of  the  sore  was 
accomplished  ;  and  Dr.  "Wagner,  without  denying  the  efficacy  of  the 
wadded  bandage,  attributes  a  great  part  of  the  successful  result  to  the 
disinfecting  properties  of  the  salicylic  acid.  In  atonic  ulcers  of  the 
foot  an  obvious  acceleration  of  the  granulating  process  was  effected  by 
a  salve  of  salicylic  acid  and  lard.  Dr.  Wagner  has  also  employed  this 
agent  successfully  in  the  form  of  gargle  in  ulcers  of  the  gums, 
stomatitis,  &c.,  and  the  foul  smell  from  the  mouth  has  been  at  the 
same  time  corrected.  The  same  authority  recommends  the  use  of 
salicylic  acid  in  all  maladies  which  take  their  origin  from  minute 
organisms.  In  diphtheria  the  acid  seems  to  display  great  efficacy  and 
to  shorten  the  duration  of  the  disease  very  materially,  and  it  may  be 
given  internally  and  also  be  used  as  a  gargle.  Dr.  Karl  Fontheim 
has  likewise  employed  salicylic  acid  successfully  in  diphtheria,  using  the 
remedy  both  internally  and  as  a  gargle. 

[Salicylic  acid  is  so  called  because  it  was  originally  obtained  by  the 
action  of  potash,  aided  by  heat,  upon  salicine,  the  bitter  principle  of 
the  willow-bark,  the  alkali  being  neutralised  by  hydrochloric  acid  and  the 
salicylic  acid  precipitated.  But  Prof.  Kolbe  has  lately  invented  a  new 
method  of  preparing  salicylic  acid  by  the  action  of  carbonic  acid,  aided 
by  heat,  on  a  solution  of  phenol  in  caustic  soda. — Eepoeter.] — 
ScJtmidfs  Jahrhiicher  der  Gesammten  Medicin,  June  17th,  1875. 

071  the  Internal  Eonployinent  of  Sea-water.  By  Dr.  Lisle,  of 
Arcachon. — Dr.  Lisle  was  induced  to  try  the  effect  of  salt  water  on 
himself  in  consequence  of  hearing  that  some  sailors  at  Marseilles,  being 
in  bad  condition  from  the  want  of  fresh  water,  had  taken  it  into  their 
heads  to  make  some  bread  with  salt  water,  and  had  found  their  strength, 
which  had  been  exhausted  by  privation,  restored  by  eating  it.  He 
caused  some  bread  of  this  kind  to  be  made  by  a  baker  of  the  country, 
who,  after  some  unsuccessful  trials,  managed  to  produce  an  article 
which  was  more  palatable  than  ordinary  bread.  Dr.  Lisle  ate  this 
bread  himself,  and  indeed  tasted  no  other  for  more  than  eight  months, 
and  experienced  the  greatest  possible  benefit  from  the  change.  He 
had  previously  suffered  for  nearly  thirty  years  from  a  nervous  affec- 
tion of  the  stomach,  of  a  somewhat  indefinite  kind,  of  variable 
duration,  frequently  accompanied  by  severe  disturbance  of  the  digestive 
functions  and  more  or  less  complete  loss  of  appetite.  Less  than  a 
fortnight  of  the  new  system  sufficed  to  restore  the  appetite,  to  regu- 
late the  digestive  functions,  to  improve  the  nutrition,  and  to  induce 
deep  sleep  exempt  from  the  nightmare  and  the  frightful  dreams 
by  which  it  w^as  formerly  disturbed.  He  then  recommended  the  sea- 
water  bread  to  all  persons,  whether  ill  or  well,  who  consulted  him  ;  and 
while  none  of  them  suffered  any  ill  effects,  they  all  declared  that  it  was 
more  agreeable  to  the  taste,  kept  fresh  a  longer  time,  and  was  more 
easily  and  rapidly  digested  than  common  bread.     From  the  results  of 


1875.]       Report  on  Materia  Medica  and  Therapeutics.       455 

Dr.  Lisle's  own  observations  and  those  of  a  medical  colleague  at 
Arcachon,  he  was  able  to  arrive  at  the  conclusions  that  the  sea-water 
bread  restores  and  increases  the  appetite,  renders  digestion  more  rapid 
and  easy,  and  actively  stimulates  all  the  nutritive  functions,  and  that 
it  is  the  best  plan  to  use  it  in  order  to  maintain  the  elements  of  the 
blood  in  their  normal  proportions  and  to  reconstitute  this  fluid  when 
it  is  impoverished.  The  experiment  of  using  this  sea- water  bread, 
then,  was  quite  successful ;  but  as  there  are  practical  difficulties  in 
making  it  away  from  the  sea.  Dr.  Lisle  went  a  step  further  and  en- 
deavoured to  find  some  other  method  or  methods  of  administering  the 
sea-water,  and,  therefore,  in  addition  to  the  bread,  for  the  preparation 
and  baking  of  which  he  gives  due  instructions,  he  recommends  the  use 
of  a  syrup  of  sea-water,  made  by  mixing  the  water  with  sugar,  and  an 
elixir  made  with  rum  and  sugar.  Dr.  Lisle  does  not  claim  for  salt- 
water any  specific  property  in  the  cure  of  diseases  such  as  is  possessed 
by  quinine  or  mercury,  but  regards  it  as  a  simple  hygienic  agent,  useful 
only  in  an  indirect  manner  by  its  general  operation  on  the  blood  and 
the  nutritive  functions.  The  sea- water  bread  and  the  thalassic  syrup  and 
elixir  (so  he  names  them)  appear  to  him  to  be  indicated  as  hygienic 
and  preservative  agents  against  disease  in  persons  who  are  healthy  but 
of  delicate  constitution  ;  in  convalescence  from  acute  diseases ;  in  all 
apyretic  derangements  of  the  stomach. and  of  the  digestic  functions  ;  in 
the  neuropathic  disturbances  accompanying  impoverishment  of  the 
blood,  such  as  anaemia,  chlorosis,  hypochondriasis,  asthenic  insanity, 
&c.;  in  the  preservative  and  curative  treatment  of  most  of  the  morbid 
diatheses,  and  especially  the  scrofulous  and  tuberculous  ;  and  in  diabetes 
m  all  the  phases  of  its  development.  Dr.  Lisle  claims  for  sea-water 
all  the  properties  of  a  mineral  water,  and  he  gives  in  a  table  the 
analyses  of  specimens  of  water  taken  from  the  sea  at  Arcachon,  com- 
pared with  those  obtained  from  Nauheim,  Kreuznach,  Hombourg, 
Soden,  and  Balaruc,  showing  the  abundance  in  sea- water  of  the  princi- 
ples to  which  the  usual  mineral  waters  owe  their  efficacy.  The  mine- 
rahsation  of  sea-water  is,  in  fact,  much  superior  to  that  of  any  other 
water  of  the  kind,  and  thus  it  will  be  found,  as  Dr.  Lisle  hopes,  to 
possess  at  least  all  the  hygienic  and  therapeutical  properties  of  the 
class  of  which  it  may  be  considered  the  most  perfect  type. — Bulletin 
General  de  Therapeutique^  Feb.  15th,  1875. 

On  the  Hydrotherapeutic  Treatment  of  Intermittent  Fevers.  By 
Shielet  Deakin,  of  Calcutta. — After  offering  a  few  observations  on 
the  treatment  of  continued  fevers  and  other  affections  of  a  similar 
nature  by  cold  water,  Mr.  Deakin  gives  the  results  o'f  his  own  experi- 
ence in  the  treatment  of  intermittent  and  remittent  fevers  by  this 
method  in  the  Hastings  Coolie  Hospital,  Calcutta,  The  cases  recorded 
are  ten  in  number,  and  they  are  arranged  in  a  tabular  form,  giving  the 
temperature  before  and  after  the  bath,  three  times  a  day,  for  a  varying 
period,  the  longest  being  eight  days.  The  patients  were  mostly  bathed 
in  Mr.  Deakin's  presence,  and  the  time  of  immersion  was  taken  by 
watch.  The  ten  cases  given  in  the  table  were  part  of  twenty  cases, 
which  included  nearly  all  those  of  fever  admitted  during  three  weeks 


456  Chronicle  of  Medical  Science.  [Oct., 

into  the  hospital.  Some  of  tliem  were  mild  cases,  but  in  one  of  them 
the  temperature  rose  to  104°  F.,  in  another  it  twice  reached  105°  F., 
in  a  third  it  reached  1046°,  and  in  a  fourth  it  reached  106°  on  one 
occasion  only.  During  treatment  the  only  drug  given,  except  a  dose 
of  pulv.  jal.  CO.  on  admission,  was  some  camphor  water  as  a  placebo. 
The  temperature  was  invariably  reduced  after  the  bath,  although  the 
mouth  temperature,  as  taken  by  the  thermometer,  did  not  by  any  means 
represent  the  amount  of  heat  abstracted.  The  patients  all  recovered. 
As  a  rule  they  liked  the  baths,  and  were  grateful  for  a  cool  instead  of 
a  burning  skin.  In  none  of  the  cases  was  there  any  enlargement  of 
the  spleen  or  liver  remaining  after  treatment.  The  baths  were  given 
three  times  daily,  at  6  a.m.,  1  p.m.,  and  6  p.m.  After  being 
kept  in  the  bath  half  an  hour,  or  for  twenty  minutes  only  if  the  tem- 
perature was  normal,  the  patient  was  ordered  to  walk  about,  but,  if 
not  strong  enough,  he  was  at  once  wrapped  up  in  a  warm  blanket. 
The  temperatures  were  taken  just  before  immersion  and  about  half  an 
hour  after  the  bath.  Mr.  Deakin  recommends  small  doses  of  quinine 
in  addition  to  the  baths ;  gr.  ij  of  quinine  being  then  as  efficacious  as 
twenty  or  thirty  without  the  bath. — Indian  Medical  Gazette^  Nov.  2nd, 
1874. 

On  tJie  Belative  Strength  of  Chloroform  and  Ether,  and  on  their  Use 
as  AncBsthetics.  By  Dr.  Oscae  H.  Allis,  of  Philadelphia. — Dr. 
Allis  was  first  entrusted  with  the  administration  of  chloroform  in  the 
surgical  clinical  department  of  Jefferson  Medical  College  in  the  j'-ear 
1867,  and  in  that  capacity  assisted  the  Professor  of  Surgery  for  more 
than  two  years.  He  has  devised  some  simple  forms  of  inhaling  ap- 
paratus, which  he  figures  and  describes ;  but  he  remarks  "  that  safety 
in  the  administration  of  chloroform  does  not  lie  in  an  inhaler,  but  in 
him  who  uses  it."  He  thinks  that  it  is  far  safer  to  produce  anaesthesia 
by  an  equal  and  constant  supply  of  chloroform,  namely,  drop  by  drop, 
than  by  pouring  it  on  at  intervals,  even  in  quantities  so  small  as  half  a 
drachm.  AVhen  he  uses  it  he  drops  the  anaesthetic  from  a  graduated 
bottle  containing  three  drachms,  a  drachm  and  a  quarter  of  which  is 
the  quantity  necessary  to  produce  complete  anaesthesia.  His  apparatus 
for  inhaling  ether  is  different  from  that  for  chloroform,  the  former 
requiring  a  larger  evaporating  surface,  by  which  a  more  rapid  evapora- 
tion is  produced  and  consequently  a  more  rapid  anaesthesia,  and  there 
is  also  a  greater  economy  of  ether.  But  he  also  describes  an  extem- 
poraneous inhaler,  which  may  be  constructed  in  a  conical  shape  from  a 
towel  and  a  newspaper.  From  his  practical  experience  Dr.  Allis  lays 
down  certain  rules  for  the  use  of  anaesthetics,  among  which  some  of 
the  most  important  are  that  the  stomach  should  be  nearly  or  entirely 
empty,  and  that  the  reclining  posture  should  always  be  adopted  in 
administering  chloroform.  As  to  the  relative  strength  of  chloroform 
and  ether,  he  has  found  by  experience,  in  giving  chloroform  and  ether 
to  five  persons  under  similar  circumstances,  that  the  former  is  four- 
sixth  times  stronger  than  the  latter ;  and  in  comparing  ten  cases,  as 
nearly  alike  as  possible  in  age,  sex,  and  strength,  he  obtained  a  similar 
result.     He  considers  chloroform  far  more  dangerous  than  ether  when 


1875.]       Report  on  Materia  Medica  and  Therapeutics.       457 

used  as  an  antesthetic,  but  a  combination  of  ether  and  chloroform  has 
been  found  to  be  less  fatal  than  the  latter  used  alone.  In  the  use  of 
ether  he  states  that  safety  may  be  guaranteed  if  ordinary  care  be 
taken  while  chloroform  has  caused  many  sudden  deaths.  Part  of  the 
mortality  from  the  latter  he  attributes,  however,  to  want  of  care  on 
the  part  of  those  who  administer  it. — PMladelfTiia  Medical  Times, 
December  5th,  1874. 

On  tJie  Successful  Use  of  Jahorandi  in  Diabetes  Insipidus  or  Poly- 
dipsia. By  Dr.  Laycock,  of  Edinburgh. — Dr.  Laycock  points  out 
that  both  forms  of  diabetes  as  well  as  certain  kinds  of  Bright's  dis- 
ease are  really  neuroses,  having  their  seat  in  that  part  of  the  encepha- 
lon  which  regulates  the  amount  of  water  in  the  blood,  and  has  there- 
fore both  anatomical  and  functional  relations  with  the  sudoriparous 
glands  and  the  kidneys,  and  with  the  appetite  for  water  and  the  sense 
for  thirst.  He  now  relates  two  cases  of  diabetes  insipidus  or  polydipsia 
in  which  jaborandi  was  given  with  good  effect.  In  the  first  case  the 
quantity  of  urine  passed  was  very  great,  amounting  to  400  and  500 
ounces  per  diem,  and  the  patient  was  compelled  sometimes  to  micturate 
every  half  hour.  The  urine  was  pale,  almost  colourless,  faintly  acid, 
of  sp.  gr.  1005,  with  no  sugar  or  albumen,  and  a  ver}'-  small  amount 
of  the  ordinary  solids.  He  was  under  observation  and  treatment 
from  Dec.  24th,  1874,  to  Feb.  26th,  1875,  when  there  was  still  great 
thirst  and  the  skin  was  dry,  and  the  daily  amount  of  urine  voided  was 
300  ounces.  Jaborandi  was  now  ordered  in  the  form  of  an  infusion 
(one  drachm  of  the  leaves  and  twigs  to  six  ounces  of  water),  and  a 
dessert-spoonful  was  taken  every  four  hours,  this  dose  being  increased 
and  given  at  shorter  intervals  on  succeeding  days.  On  March  5th,  or 
about  a  week  after  the  jaborandi  was  given,  the  skin  of  the  back, 
abdomen,  and  inner  aspect  of  the  thighs  was  found  to  be  perspiring 
pretty  freely,  and  on  the  6th  the  skin  of  the  arms  and  left  palm 
perspired.  On  the  15th  the  quantity  of  urine  had  declined  steadily 
from  300  ounces  to  236 ;  and  on  the  31st,  the  jaborandi  treatment 
having  been  still  continued,  the  quantity  fell  to  180  ounces.  The 
urine  continued  to  diminish  in  amount  till  the  middle  of  May,  when 
it  amounted  to  120  ounces  a  day,  and  the  patient  was  then  discharged 
at  his  own  request.  In  the  second  case  the  daily  quantity  of  urine  passed 
was  128  ounces,  the  sp.  gr.  being  1008,  of  acid  reaction,  and  containing 
some  albumen,  laut  no  sugar.  There  was  great  thirst,  and  in  order  to 
quench  it  the  patient  was  obliged  to  drink  a  large  quantity  of  water 
at  a  time.  This  patient  was  placed  at  once  on  the  jaborandi  treatment, 
one  table-spoonful  of  the  decoction  being  given  thrice  daily.  The 
quantity  of  urine  passed  and  of  fluid  drunk  in  twenty-four  hours  was 
carefully  noted,  and  the  results  were  that  the  amount  of  urine  fell  in 
about  two  months  to  ninety-eight  ounces,  and  that  of  fluid  drunk  fell 
to  100  ounces,  the  amount  at  first  being  186  ounces. — Lancet^ 
Aug.  14th,  1875. 

On  the  Use  of  Iodide  of  Potassium  in  Syphilis.  By  Dr.  Joseph  E. 
Beck,  of  Indiana. — In  this  paper,  which  is,  however,  far  too  dogmatic 
in  its  general  tone,  Dr.  Beck  declares  himself  an  opponent  of  the  use 


458  Chronicle  of  Medical  Science.  [Oct., 

of  mercury  in  any  form  in  the  treatment  of  syphilis,  although  he 
employs  that  mineral  in  other  diseases.  He  admits  that  secondary 
symptoms  are  dissipated  rapidly  under  the  use  of  mercurials,  but  he 
argues  that  in  such  cases  the  disease  is  only  masked,  and  that  tertiary 
manifestations  are  sure  to  ensue.  He  goes  on  to  make  the  following 
strong  assertion,  namely,  "  that  every  case  of  secondary  syphilis  tvhich 
has  been  successfully  {?)  treated  by  mercurials  will,  as  surely  as  the 
sun  rises,  reappear  as  tertiary  syphilis,  if  the  patient  lives  long 
enough^  (The  italics,  &c.,  are  the  author's.)  Dr.  Beck's  treatment, 
which  he  explains  at  length,  consists  in  giving  large  and  increasing 
doses  of  the  iodide  of  potassium,  in  combination,  however,  with  iron  ; 
and  he  also  gives  Fowler's  solution  of  arsenic  at  the  same  time,  and 
if  anaemia  be  present,  which  he  says  is  frequently  the  case,  then  he 
adds  quinine,  gentian,  cod-liver  oil,  and  valerian.  If  any  ulcers  be 
present,  they  are  dressed  with  hydrate  of  chloral  dissolved  in  distilled 
water.  This  constitutes  the  first  step  of  the  treatment,  but  the  subse- 
quent prescriptions  increase  the  doses  of  the  iodide  of  potassium 
and  of  the  Fowler's  solution,  until  iodism  is  established,  when  the 
use  of  the  medicine  is  stopped  for  a  week ;  then  it  is  recommenced, 
and  if  iodism  again  ensues.  Dr.  Beck  says  that  he  "  confidently  dis- 
charges the  patient,  perfectly  and  permanently  cured,  with  the  poison 
of  syphilis  and  that  of  mercury  for  ever  eradicated  from  the  system." 
In  order  to  prove  the  truth  of  the  last  assertion,  he  tests  every  patient, 
about  a  year  after  all  treatment  has  ceased,  with  ten  grain  doses  of 
the  iodide  of  potassium,  and  the  test  has  invariably  produced  profuse 
iodism  before  one  drachm  of  the  drug  has  been  taken.  The  presence 
of  iodism  is  regarded  by  Dr.  Beck  as  the  certain  evidence  of  permanent 
cure.  The  iodide  of  sodium  has  been  in  Dr.  Beck's  hands  negative 
in  its  results. — Philadelphia  Medical  Times,  March  13th,  1875. 


REPORT  ON  PATHOLOGY  AND  THE  PPtACTICE  OF 
MEDICINE. 

By  John  T.  Aelidge,  M.D.,  A.B.  Lond.,  F.E.C.P.  Loud., 

Physician  to  the  North  Staffordshire  lufirmary,  &c. 


The  Pathology  of  Sunstroke. — Dr.  Rudolph  Arndt  gives  the  history 
of  three  cases  of  sunstroke  occurring  in  the  persons  of  three  healthy 
young  soldiers  after  a  long  and  fatiguing  march,  and  follows  the 
account  by  a  review  of  the  pathological  changes  met  with  after 
death. 

There  are  two  features  standing  in  strong  contrast — the  blanching 
of  all  the  organs,  and,  therewith,  the  over-distended  condition  of  all 
their  vessels,  above  a  certain  size  wdth  dark-coloured,  uncoagulated 
blood.  The  skin  and  muscular  tissue  were  bloodless,  but  their  large 
vessels  full  to  bursting,  exuding  large  drops  of  blood  when  wounded. 


1875.]  Report  on  Pathology  and  Medicine,  450 

The  brain  was  in  the  same  anaemic  state  together  with  its  mem- 
branes, whilst  the  large  veins  and  the  sinuses  were  distended  with 
dark,  unclotted  blood.  The  same  condition  obtained  in  the  heart, 
pericardium,  liver,  and  kidneys,  as  well  as  in  the  mucous  membrane 
of  the  intestines  and  bladder.  In  consequence  of  their  extreme 
distension,  the  blood-vessels  were  much  increased  in  size,  and  in 
some  places,  as  beneath  the  endocardium,  the  pericardium,  and  both 
pleursD,  the  overstretching  had  led  to  ecchymoses. 

The  singularly  bloodless  condition  of  the  brain- substance  is  an 
appearance  contradictory  to  the  generally  received  opinion  that 
sunstroke  is  hyperaemia  of  the  brain.  This  notion  must  have  arisen 
from  imperfect  observation,  noting  the  extreme  engorgement  of  the 
larger  vessels,  especially  of  the  veins,  and  confounding  the  escape  of 
blood  from  such  vessels,  and  the  staining  of  the  tissue  thereby,  with 
exudation  from  the  capillary  and  smallest  vessels  of  the  viscus. 
But  the  fact  is,  the  capillaries  and  minute  vessels  are  well-nigh 
empty,  and  in  cases  more  fully  developed  completely  so,  and  their 
walls  collapsed. 

The  cause  of  the  parenchymatous  anaemia  is  apparent.  In  all 
three  cases  the  brain  was  swollen.  It  distended  the  sac  of  the  dura 
mater ;  the  gyri  of  the  hemispheres  were  widened,  flattened  and 
pressed  together,  obliterating  the  interspaces.  In  two  of  the  three 
cases  in  which  the  abdominal  viscera  were  examined  the  liver  and 
kidneys  exhibited  the  same  enlargement,  from  simple  swelling 
of  their  mass.  The  liver  had  acquired  a  more  rounded  form  than 
normal,  and  its  borders  were  thicker.  Its  transverse  diameter 
seemed  most  enlarged.  It  had  a  doughy  feeling,  and  was  readily 
impressed  by  the  fingers,  the  marks  remaining.  Its  acini  were 
distinct.  The  enlarged  kidneys  allowed  of  the  ready  separation  of 
the  capsule.  The  pale  cortical  substance  looked  swollen  and 
widened,  whereas  the  medullary  substance  was  injected  with 
blood,  the  congestion  being  greater  as  the  pelvis  was  approached, 
this  last  part  exhibiting  great  injection  of  its  vessels  with  ecchy- 
moses. 

The  swollen  brain  was  likewise  unusually  wet ;  in  two  cases  there 
was  an  excess  of  serum  in  the  ventricles,  and  in  the  third,  if  not 
actual  excess,  a  considerable  proportion.  On  slicing  it  a  watery 
fluid  escaped,  showing  its  highly  oedematous  condition.  Its  mem- 
branes, which  were  in  places  raised  in  a  bladder-like  fashion,  were 
readily  separable  from  the  subjacent  tissue. 

A  similar,  if  not  identical,  state  of  oedema  existed  in  the  kidneys 
and  liver.  In  the  latter,  indeed,  a  dryness  was  remarked,  but  the 
distinctness  of  its  acini  indicated  the  presence  of  some  interpene- 
trating matter,  which  might  well  seem  to  be  nothing  else  than  the 
serum  of  the  blood.  The  greater  moisture  of  ordinary  liver-tissue 
is  explicable  from  the  fact  of  the  presence  of  blood  throughout  it, 
whereas  in  the  liver  of  those  dead  from  sunstroke  the  hepatic  tissue 
itself  is  bloodless. 

In  the  several  organs  the  capillaries  and  smallest  blood-yessels 


460  Chronicle  of  Medical  Science.  [Oct., 

were  compressed,  and  the  blood  forced  out  of  them  into  the  neigh- 
bouring veins. 

The  heart  was  contracted  in  all  the  cases ;  in  one  the  left  side 
was  more  so  than  the  right.  It  felt  hard,  and  its  naturally  bright 
colour  was  replaced  by  a  dusky  red  or  greyish  brown.  The  tissue 
was  dry  and  fragile,  and  thin  sections  of  it  had  a  lustrous  aspect. 
The  same  phenomena  were  present  in  the  muscles  generally. 

The  dry  condition  of  the  heart-substance  and  of  the  muscular 
tissue  at  large  is  one  contrasting  with  the  oedematous  state  of  the 
brain-matter  ;  and  Arndt,  after  remarking  this  fact,  and  taking 
with  it  the  dry,  though  swollen,  state  of  the  parenchyma  of  the  liver, 
and,  though  in  a  less  degree,  the  like  condition  of  the  cortical  sub- 
stance of  the  kidney,  is  inclined  to  attribute  that  state  to  something 
else  than  simple  oedema,  and  supposes  an  overgrowth  in  size  of  the 
constituent  elements  of  the  tissues,  and  an  excessive  formation  of 
protoplasm  over-rich  in  granules.  After  further  discussion  he  comes 
to  the  conclusion  that  the  essential  nature  of  the  process — as  best 
illustrated  in  the  heart-tissue  and  muscles — is  inflammatory. 
Although  wanting  in  the  usually  recorded  characters  of  encephalitis, 
he  nevertheless  considers  the  lesion  met  with  in  the  brain  to  be  of 
the  nature  of  a  parenchymatous  inflammation,  the  process  being 
modified  by  the  peculiar  circumstances  of  the  attack  and  by  the 
special  nature  of  the  tissue. 

The  history  and  phenomena  of  sunstroke  are  very  fully  entered 
upon  by  Arndt,  as  seen  in  various  stages  and  degrees  of  the  malady. 
He  particularly  insists  on  the  very  high  temperature  of  the  body 
accompanying  it,  and  on  the  consequent  interference  with  all  the  vital 
functions,  particularly  with  the  destructive  metamorphosis  of  tissues, 
and  the  elimination  of  used-up  material.  He  points  out  that  the 
blood  is  loaded  with  excreted  material,  that  it  has  a  black  colour,  does 
not  coagulate,  and  is  rich  in  carbonate  of  ammonia.  The  lungs  are 
congested  in  their  dependent  parts,  and  the  bronchial  mucous  mem- 
brane intensely  injected  and  swollen.  In  the  greatly  elevated 
temperature,  and  the  many  consequences  dependent  upon  it,  Arndt 
finds  an  analogy  with  the  most  marked  septic  diseases. 

Hydrophohia  treated  hy  Chloral. — Dr.  Y.  Grazi  records  a  case  of 
hydrophobia  under  his  care  in  the  Hospital  of  Santa  Maria  Nuova, 
Florence,  in  which  large  doses  of  chloral  were  given  ineflectually. 
The  patient  was  a  woman,  sst.  52,  and  was  bitten  by  a  dog  of  her 
own  on  the  nose.  Her  husband,  a  child,  and  a  servant  of  the 
hospital  were  subsequently  bitten  in  the  hand  by  the  same  dog,  but 
it  is  not  noted  that  any  of  these  suff'ered.  The  period  of  incubation 
was  fifty  days,  during  which  the  woman  appeared  in  perfect  health. 
Her  admission  took  place  on  the  27fch  of  November.  On  the  25th 
her  appetite  failed,  and  she  felt  constriction  of  the  oesophagus  in 
drinking  water,  and  an  aversion  to  drink.  The  following  morning 
she  ate  a  good  breakfast,  but  drank  nothing;  at  dinner-time  she 
could  not  eat,  and  painful  constriction  occurred  on  an  attempt  to 
drink.  When  admitted  her  mind  was  perfectly  clear  and  she  gave  a 
precise  account  of  her  accident  and  symptoms. 


i875.] 


Report  on  Pathology  and  Medicine,  461 


Immediately  after  her  admission  at  noon  a  gramme  (15  grains)  of 
chloral  was  administered.  A  consultation  was  held,  and  it  was  resolved 
to  give  chloral  in  large  doses.  Accordingly  three  grammes  were 
at  once  prescribed,  and  small  pieces  of  ice  ordered  to  be  frequently 
swallowed.  In  the  course  of  the  28tli  she  took  four  grammes.  On 
the  29th,  in  the  morning,  three  grammes  were  given  by  clyster  and 
four  by  the  mouth ;  in  the  evening  of  the  same  day  the  like  doses 
were  repeated  in  the  same  fashion.  The  same  plan  was  pursued  on 
the  following  day,  when  the  oesophageal  pain  disappeared  and  she 
became  tranquil  in  mind  ;  but  on  the  1st  of  December  the  pharyngeal 
constriction  had  increased,  although  the  drug  had  been  persevered 
with.  The  pulse  was  weak,  irregular,  and  120,  respiration  very 
frequent :  the  chloral  was  reduced  to  four  grammes.  The  day 
was  passed  tranquilly,  but  the  signs  of  sinking  continued,  accom- 
panied by  some  slight  involuntary  muscular  contractions,  and  at 
eleven  at  night,  after  speaking  to  a  nurse,  she  suddenly  expired. 

The  body  was  examined  thirty-five  hours  after  death.  The 
cadaveric  rigidity  was  very  great,  particularly  in  the  upper  limbs 
and  face.  On  opening  the  cranium  the  meninges  were  found  much 
injected  with  black  blood.  A  clot  of  blood  existed  under  the 
arachnoid  over  the  pons  Varolii,  and  to  this  is  ascribed  the  sudden 
death.  The  spinal  meninges  were  somewhat  injected,  especially  the 
pia  mater.  The  cord  and  the  spinal  nerves  exhibited  no  change  in 
colour  or  consistence.  The  vessels  generally  were  filled, — the  veins  the 
more  so,  with  intensely  dark  blood,  difiluent  and  nowhere  coagulated, 
and  not  changed  in  colour  by  exposure  to  the  air.  Nothing 
abnormal  was  found  under  the  tongue.  The  pharynx  was  lined  by 
a  false  membrane  extending  downwards  to  the  (Esophagus, 
■attributable  to  the  large  doses  of  chloral  swallowed,  which,  though 
enclosed  in  crumb  of  bread,  escaped  more  or  less  by  reason  of  the 
difficulty  of  deglutition  and  came  into  direct  contact  with  the 
mucous  membrane.  The  lining  membrane  of  the  larynx  preserved 
its  normal  colour  as  low  down  as  the  ventricles,  but  below  this 
point  was  congested ;  the  vascular  injection  being  more  intense 
towards  the  bifurcation  into  the  two  primary  bronchi,  where  a 
tenacious  mucus  covered  the  congested  surface.  The  lungs  were 
gorged,  particularly  behind  and  below.  The  heart  was  hard  and 
contracted,  its  tissue  of  normal  colour :  little  blood  existed  in  its 
cavities.  The  liver,  excepting  being  gorged  with  blood,  appeared 
healthy.  The  gall-bladder  contained  some  bile  of  ordinary  character. 
The  spleen  was  hard  and  small.  The  kidneys  were  slightly  enlarged, 
hard  and  hypersemic.  The  stomach  was  contracted,  and  devoid  of 
alimentary  matters ;  its  membrane  had  at  some  points  a  rosy  hue 
and  was  besmeared  by  abundant  mucus.  The  intestines  contained 
very  little  faecal  matter ;  the  mucous  membrane  showed  some  rosy 
patches,  but  no  structural  alterations  were  visible. 

Dr.  Grrazi  observes  that  he  has  narrated  this  case,  not  because  of 
any  special  features  presented,  but  to  induce  others  to  give  chloral 
in  large  doses,  because  of  the  relief  thereby  afforded  to  the  terribly 
painful  symptoms  of  the  malady.     For  several  days   together   he 

112— Lvi.  30 


462  Chronicle  of  Medical  Science.  [Oct ., 

administered,  in  the  course  of  twenty-four  hours,  as  much  as  fourteen 
grammes  of  that  drug,  without  misgivings,  and  much  to  the  relief  of 
the  suiferer,  who  swallowed  it  willingly,  notwithstanding  the  pain 
accompanying  the  act ;  and  he  considers  the  convulsions,  the  painful 
muscular  contractions,  the  constriction  of  the  gullet,  the  mental 
disturbance  and  delirium,  the  propensity  to  injure  others,  and  all 
the  other  symptoms  of  this  most  terrible  disease,  were  greatly 
lessened  in  intensity.  As  to  the  pathology  of  the  malady  Dr. 
Grazi  has  no  opinion  to  offer. — Lo  Sperimentale,  August,  1875. 

Notes  on  Tetanus. — E.  Hansen  reports  three  cases  of  tetanus, 
exhibiting  similar  features,  but  of  as  many  different  forms  of  origin. 
The  first  case  is  called  one  of  rheumatic  tetanus,  no  other  cause  than 
exposure  to  cold  and  a  chill  being  known.  The  second  is  an 
example  of  traumatic  tetanus,  following  a  wound  of  a  finger,  the 
wound  remaining  open  at  the  time  the  tetanus  appeared.  The  third 
case  was  that  of  a  girl,  SBt.  10,  and  probably  cannot  be  rightly  classed 
with  tetanus,  as  the  symptoms  seemed  attributable  to  spinal  menin- 
gitis or  myelitis,  for  together  with  tetanic  contractions  there  were 
violent  vertebral  pain  and  tenderness  on  pressure.  Nevertheless  no 
fever  presented  itself,  the  pupils  were  not  contracted,  and  paralysis 
never  appeared. 

In  each  case  the  symptoms  followed  generally  this  order : 
muscular  stiffness  of  the  neck,  trismus,  then  violent  epigastric  pains 
due  to  diaphragmatic  contractions,  considerable  difficulty  of  respira- 
tion, and  general  tetanic  contraction,  excepting  in  the  arms,  which 
in  all  instances  remained  free.  In  the  first  case  the  general  con- 
tractions curved  the  body  forward  ;  in  the  second,  backward  ;  and  in 
the  third,  to  one  side.  In  the  last  it  is  worth  noting  that  the  pleuros- 
thotonos,  having  previously  been  on  the  right  side,  became  transferred 
to  the  left  several  hours  before  death.  This  circumstance  indicates 
the  involuntary  nature  of  the  curved  position  assumed,  and  that  the 
position  is  not  of  the  nature  of  a  voluntary  act  intended  to  give  relief. 

The  two  former  cases  got  well,  the  recovery  being  attributed  to 
morphia  injections.  In  the  first  named  these  injections  were  sup- 
plemented by  the  internal  exhibition  of  chloral,  the  morphia  seeming 
not  sufficient  of  itself  to  induce  calm.  In  the  case  of  the  child  the 
morpliia  injections  also  acted  well,  though  inefi'ectual  in  saving 
life.  Injections  of  curare  (woorara)  were  not  only  powerless  for 
good,  but  actually  augmented  the  pain  and  tetanic  paroxysms.  An- 
other noteworthy  fact  is  that,  with  the  two  adult  patients,  passive 
movements  did  not  provoke  convulsions,  whilst  voluntary  motions 
invariably  did  so.  {Dorpat.  Medicin-Zeitungy  Band  v,  p.  230,  and 
Mevue  des  Sciences  Medicales,  July,  1875.) 

Section  (^  Nerves  in  Neuralgia. — MM.  Arloing  and  Tripier  contri- 
buted a  memoir  on  the  division  of  nerves  in  neuralgia  to  the  medical 
section  of  the  French  Association.  The  authors  consider  that  the 
phenomena  of  recurrent  sensibility  have  not  been  sufficiently  kept 
in  view  either  in  human  pathology  or  therapeutics.  By  experiment 
they  have  satisfied  themselves  that  the  property  of  recurrent  sensi- 
bility is  partaken  by  nerves  at  large. 


1875.]  Report  on  Pathology  and  Medicine.  463 

It  is  well  known  that  it  is  rare  in  neuralgia,  especially  the 
functional  varieties,  to  find  the  whole  of  a  nerve-trunk  the  seat  of 
pain ;  were  it  otherwise,  no  spot  on  the  surface  that  received  fibres 
from  any  trunk  would  be  free  from  pain.  As  it  is,  of  the  several 
constituent  fibres  only  some  are  aftected.  Moreover,  neuralgia  does 
not  occupy  the  whole  course  of  nerves  or  of  their  branches.  The 
pain  is  commonly  confined  to  certain  limited  spots,  pressure  upon 
which  will  at  once  induce  it.  As  Yalleix  first  pointed  out,  it  is  the 
most  superficial  nerves  that  are  principally  aff'ected,  and  that  their 
points  of  emergence  on  the  surface  are  the  chief  seats  of  pain.  The 
trifacial  and  thoracic  nerves  constitute  the  greatest  exceptions  to 
these  rules.  The  writers  consider  that  no  adequate  explanation  of 
the  above-named  facts  has  been  offered.  By  tlie  very  simple  experi- 
ment of  pressing  the  ulnar  nerve  at  the  elbows,  they  say,  two  sorts 
of  pain  are  shown  to  exist.  If  gentle  pressure  be  made,  the  pain  is 
felt  exactly  at  the  level  of  the  point  pressed  upon  ;  but  if  the  pressure 
be  more  severe,  the  pain  is  felt  deep  down.  This  fact  stands  in  relation 
and  harmony  with  the  results  they  have  arrived  at  experimentally ; 
viz.  that  all  nerves,  motor,  sensitive,  and  sensory-motor,  possess  re- 
current fibres  ;  that  such  recurrent  fibres  are  more  numerous  on 
a  nerve  as  it  approaches  the  periphery,  and,  per  contra^  decrease  in 
numbers  and  finally  disappear  altogether  at  a  certain  distance  along 
the  trunk.  They  are  special  adjuncts  of  peripheral  nerve-bundles, 
and  are  usually  placed  immediately  beneath  the  neurilemma.  These 
fibres  have  necessarily  some  destination ;  and  as  they  have  never  been 
seen  to  terminate  in  the  thickness  of  the  nerve-bundles,  they  may  be 
assumed,  from  the  characters  noticed,  to  end  at  different  points  in  the 
tissues  adjoining  the  nerve-trunks  or  their  branches.  It  is  these  fibres 
that  transmit  to  the  brain  the  local  sensation  of  pressure  on  the 
ulnar  nerve,  and  that,  in  certain  cases  of  neuralgia,  would  be  affected 
by  morbific  agents ;  whence  an  explanation  is  afi'orded  of  the  iso- 
lated painful  spots  on  the  nerve-trunks  or  on  their  branches.  Another 
argument  in  favour  of  this  hypothesis  is  found  in  the  fact  of  the 
diminution,  or  even  the  total  disappearance,  of  these  fibres  above 
the  points  indicated  by  Valleix  as  the  special  seat  of  neuralgic  pain, 
whether  spontaneous  or  provoked  by  pressure.  At  the  same  time  it 
would  be  an  error  to  assert  that  these  fibres  are  alone  affected  in 
neuralgia;  on  the  contrary,  it  is  probable  that  they  are  not  always 
so ;  yet  it  would  be  equally  far  from  the  truth  to  aver  that  sponta- 
neous neuralgic  pains  followed  the  course  of  the  nerves,  for  usually 
they  break  out  at  several  points  at  one  and  the  same  time,  and  the 
painful  shooting  sensations  at  one  moment  ascend,  at  another  descend, 
and  will  end  at  times  in  a  single  filament.  It  is  the  lines  of  union 
between  these  several  points  that  are  assumed  to  represent  the  course 
of  the  nerves.  But  this  assumption  is  only  imaginary.  Again,  it  is 
supposable  that  the  morbid  agency  acts  at  once  both  on  direct  and 
recurrent  fibres  ;  consequently,  if  we  examine  the  mode  of  extension 
of  neuralgias  from  a  disordered  nerve  to  another  hitherto  sound,  an  ad- 
ditional argument  in  favour  of  the  views  propounded  is  afforded.  It  is 
certain  that  the  extension  very  often  takes  place  by  the  medium  of  the 


464  Chronicle  of  Medical  Science.  [Oct., 

nerve-centres — a  fact  readily  conceivable  when  it  is  considered  that 
neighbouring  peripheral  nerves  have  commonly  also  their  central 
fibres  in  near  apposition  ;  but  in  traumatic  neuralgia  of  a  finger  it  is 
remarkable  to  observe  that,  in  place  of  a  neuralgia  of  the  brachial 
plexus,  there  is  circumscribed  pain  at  the  extremity  of  a  collateral 
and  contiguous  nerve.  The  frequent  coincidence  of  trifacial  neuralgia 
with  pain  of  the  cervical  nerves  may  be  placed  in  the  same 
category.  Lastly,  in  trifacial  neuralgia  it  is  no  uncommon 
thing  for  the  pain  to  glance  from  the  ophthalmic  branch  to 
the  mastoid  process  and  the  upper  portion  of  the  neck. 
Must  it  not,  therefore,  be  admitted  that  the  lesion  in  sensation  may  be 
propagated  as  well  by  the  periphery  as  by  the  centres  themselves  ? 
Still  another  argument  might  be  gathered  from  the  fact,  that  in  old 
cases  of  neuralgia,  without  appreciable  lesion,  section  of  the  nerve 
has  completely  removed  the  pain,  and  that  in  like  maurer  cases  of 
symptomatic  neuralgia  have  been  treated  by  section  of  ihe  nerve 
above  the  lesion  and  have  relapsed. 

Eespecting  the  employment  of  neurotomy,  the  writers  remark 
that  in  neuralgia  symptomatic  of  peripheral  lesions,  these  last  must 
first  of  all  be  healed,  and  that  section  of  the  nerve  must  be  of  later 
consideration,  for  whilst  the  pain  comes  and  goes  the  presence  of 
neuritis  is  probable.  In  so-called  functional  neuralgias,  likewise, 
neuritis  has  also  to  be  borne  in  mind  and  dealt  with. 

We  must  be  guided  in  our  treatment  by  a  consideration  of  the 
modifications  that  supervene  on  pressure  of  the  painful  spot  or  spots. 
Thus,  if  pressure  arrests  pain  on  the  spot,  and,  a  fortiori,  if  it  so 
do  when  the  compression  be  made  higher  up,  we  are  right  in  con- 
cluding that  the  neuralgia  has  its  seat  in  both  the  direct  and  recur- 
rent nerves,  and  that  section  of  both  of  these  is  necessary  to  give 
relief.  Where  the  pain  is  not  stopped  by  pressure,  the  inference  is, 
that  the  lesion  is  situated  exclusively  in  the  recurrent  fibres,  or  else 
in  the  nerve  nearer  the  centre,  or  possibly  in  the  nerve-centre  itself. 
To  determine  if  the  pain  be  in  the  recurrent  branches,  pressure  must 
be  made  over  neighbouring  nerves  to  ascertain  if  the  pain  be 
alleviated.  Supposing  it  not  to  be  so,  we  have  reason  to  suspect 
mischief  higher  up  in  the  trunk  of  the  nerve  or  in  the  nerve-centre 
itself.  Usually  doubt  may  be  cleared  away  by  reference  to  antece- 
dent and  to  concomitant  conditions,  and  in  certain  cases  by  the 
use  of  electricity.  As  a  general  rule,  in  complex  cases,  it  is  well  to 
make  several  associated  and  peripheral  sections,  with  the  object  of 
isolating,  so  to  speak,  the  mesh  of  fibres  on  which  the  morbific 
agent  is  operating.  By  proceedings  of  this  sort  von  Graefe  has  met 
with  great  success  in  dealing  with  some  old  and  rebellious  cases.  In 
the  case  of  a  lady  at  Berlin  he  made  successively  seven  sections  in 
the  orbital  region,  and  efi'ected  a  cure — a  result  attributable  to  the 
interruption  of  all  the  lines  of  communication  with  the  centre. 
{Gazette  SeMomadaire,  August,  1875.) 

Fapular  Erythema  7'elated  to  Rheumatism. — M.  Coulard  singles 
out  this  form  of  skin  eruption  from  among  the  several  noticed  in 
j'heumatism  as  being  pathologically  associated  with  this  malady,  and 


1875.] 


Report  on  Pathology  and  Medicine*  465 


as  an  indication  of  a  rheumatic  diathesis.  Admitting  the  distinction 
between  rheumatic  and  rheumatoid  pains,  those  accompanying  tlie 
erythema  in  question  belong  to  the  former.  Eheumatoid  pains  are 
a  feature  of  hysteria. 

True  rheumatic  pains  do  not  occupy  an  entire  joint,  but  certain 
spaces  only,  which  also  are  especially  painful  on  pressure. 

Hardy  regards  the  connection  of  erythema  and  rheumatism  as 
accidental ;  but  M.  Coulard  opposes  to  this  opinion  his  observation 
of  twenty-one  cases,  in  twelve  of  which  articular  rheumatism  in  an 
acute  form  had  preceded  the  eruption,  and  in  the  other  nine  had 
been  manifested  also  beforehand,  but  with  less  intensity. 

The  eruption,  which  may  be  more  or  less  general,  is  described  as 
occurring  in  patches  of  the  size  of  the  hand,  or  of  a  five-franc  piece, 
separated  by  narrow  strips  of  healthy  skin.  These  patches  are  more 
or  less  inflamed  in  the  centre,  according  to  the  date  of  their  appear- 
ance, the  oldest  being  pale  in  the  middle,  and  surrounded  by  a  wavy 
erythematous  ring  of  a  bright  red  colour  like  that  of  scarlatina. 
Pressure  disperses  the  colour,  but  this  reappears  on  its  withdrawal. 

The  eruption  is  made  up  of  minute  red  points,  uniform  in  colour, 
and  sometimes  accompanied  by  heat  of  skin  or  itching.  Some  of 
the  rings  are  confluent,  and  so  give  rise  to  a  ribbon-like  diffusion. 
Varieties  occur  in  the  shape  of  the  patches,  and  in  their  prominence 
and  colour.  Usually  they  are  not  at  all  elevated.  The  colour 
occasionally  is  more  dusky,  and  even  livid. 

The  eruption  may  occur  either  before,  during,  or  after  a  rheumatic 
attack.  In  the  first  case  its  onset  is  without  prodromata,  its 
average  duration  from  five  to  six  days,  and  its  appearance  accom- 
panied by  heat  and  itching,  but  with  no  fever.  In  the  second  case 
the  general  phenomena  are  mixed  up  with  those  of  the  rheumatic 
fever ;  but  usually  some  special  features  are  noticeable,  such  as  more 
heat  of  skin,  dyspnoea,  acceleration  of  pulse,  &c.  In  no  case  has 
the  eruption  been  attended  by  diminution  of  pain,  but  rather  the 
reverse.  Lastly,  where  it  has  appeared  after  an  acute  attack  there 
have  been  more  or  less  severe  articular  pains.  The  duration  of  the 
eruption  is  so  variable  that  no  rule  can  be  assigned  for  it.  The  only 
general  rule  (but  even  this  is  open  to  exceptions)  is,  that  the 
duration  is  in  direct  relation  to  the  extent  of  the  rash. 

M.  Coulard  will  not  venture  on  the  statistics  of  the  frequency  of 
its  occurrence  in  rheumatic  cases.  He  considers  that  these  cannot 
be  gathered  from  the  recorded  histories  of  cases,  since  those  histories 
are  taken  with  the  view  of  developing  facts  regarding  the  ordinary 
phenomena  of  rheumatic  fever,  among  which  this  form  of  erythema 
has  not  been  reckoned.  Moreover,  he  will  not  undertake  to  decide 
if  this  erythema  be  peculiar  to  rheumatic  subjects,  but  only  go  so 
far  as  to  say  that  its  coexistence  with  rheumatism  is  so  common, 
that  where  it  is  met  with  a  rheumatic  diathesis  may  be  suspected. 

It  is  worthy  of  notice  tlmt  many  years  ago  the  late  Dr.  Begbie, 
of  Edinburgh,  in  his  volume  of  essays,  associated  erythema  nodosum 
with  the  rheumatic  diathesis  (^Beporter).  (ArcJiives  Gencrales  de 
Medegine,  January,  1875.) 


466  Chronicle  of  Medical  Science,  [Oct., 

Presence  of  a  Bruit  of  Fluctuation  and  Metallic  Tinkling  in  Abdo- 
minal Tumours. — M.  Laboulbene,  Physician  of  the  "  Hopital 
Necker,"  records  two  peculiar  cases  of  abdominal  tumour  in  which 
a  bruit  of  "  hydro-aeric  fluctuation  "  was  met  with,  accompanied  with 
metallic  timbre.  The  resume  of  the  first  case  is  as  follows : — A 
woman,  set.  50,  enjoying  habitually  good  health,  and  the  mother 
of  nine  children,  had  noticed  of  late  a  swelling  on  the  left  side  of 
the  abdomen.  When  admitted,  on  the  7th  of  January,  1875,  a 
smooth  tumour,  without  prominences,  was  found  to  occupy  the  left 
flank  in  the  ovarian  region,  having  the  dimensions  of  an  adult  head. 
Pressure  caused  pain.  The  skin  had  its  normal  appearance.  It 
could  be  displaced  by  grasping  with  the  hands  without  difficulty, 
but  no  particular  bruit  was  elicited  by  brusque  movements  from 
right  to  left.  Fluctuation,  without  beiug  well  marked,  could  be 
detected;  percussion  was  dull  over  the  tumour,  and  elsewhere 
resonant.  Fifteen  days  after,  the  tumour  grew  more  prominent,  and 
became  adherent  to  the  skin,  which  was  now  slightly  red  at  the  most 
prominent  point.  Dull  pains  were  complained  of.  Percussion  now 
gave  a  sonorous  note,  and  succussion  made  brusquely,  grasping  the 
tumour  between  the  two  hands,  produced  a  noise  of  fluctuation 
similar  to  that  caused  by  shaking  a  bottle  half  or  three  parts  full  of 
water.  Moreover,  on  rapidly  shaking  the  tumour  three  or  four 
times,  whilst  the  ear  was  applied  over  it,  the  noise  of  fluc- 
tuation was  noticed  to  be  associated  with  a  metallic  timbre.  On 
the  25th  of  the  month  Vienna  paste  was  applied  to  the  skin  where 
it  seemed  thinnest  and  over  the  most  prominent  part  of  the  tumour. 
In  the  evening  of  the  next  day  an  opening  formed,  and  a  large 
glassful  of  purulent,  greenish,  not  thick,  discharge  escaped,  off"ensive 
in  smell,  but  not  putrid,  and  accompanied  with  gas.  G-reat  relief 
followed  the  escape.  The  fluid  on  examination  exhibited  only  the 
leucocytes  of  pus. 

The  treatment  consisted  in  the  application  of  chlorinated  com- 
presses, the  sac  being  allowed  gradually  to  empty  itself;  a  drainage 
tube  was  also  inserted.  On  the  15th  of  February  the  patient  was 
convalescent  and  sitting  up,  the  sero-purulent  discharge  through 
the  tube  having  quite  ceased.  A  weak  injection  of  iodine  was  intro- 
duced into  the  opening,  but  it  immediately  escaped,  thereby 
showing  the  absence  of  any  sac.  On  the  23rd  the  tube  fell  out 
spontaneously.  On  the  2()th  of  March  a  careful  examination 
showed  the  existence  only  of  a  small,  hard  tumour,  of  the  size  of  an 
egg,  and  dull  on  percussion.  Pressure  upon  it  caused  slight  uneasi- 
ness. At  the  end  of  the  month  she  was  discharged  cured,  and  has 
since  continued  well. 

When  first  under  treatment  the  opinion  of  the  case  was  that  it 
was  one  of  ovarian  disease,  but  subsequently  it  was  decided  to 
be  a  cyst  situated  between  the  posterior  aspect  of  the  abdominal 
wall  and  the  coils  of  intestines,  and  in  close  propinquity  to  the  left 
ovary.  The  presence  of  gas  within  it  was  attributed,  not  to  any 
fistulous  communication  between  its  interior  and  the  bowels,  but  to 
its  production  by  decomposition  of  the  contained  purulent  liquid. 


1875.] 


Report  on  Pathology  and  Medicine.  467 


The  second  case  was  that  of  a  woman,  set.  27,  who  had  never  had  a 
child  and  had  enjoyed  good  health.  In  1870  she  perceived  her 
abdomen  enlarge,  but  during  the  two  following  years,  as  she  was  free 
from  suffering,  she  continued  her  employment,  and  it  was  not  until  the 
end  of  1872  that  she  entered  the  hospital  (Hotel-Dieu).  Here  she 
was  punctured  ten  times,  and  on  six  occasions  iodine  injections  were 
resorted  to  after  the  tapping.  The  quantity  withdrawn  varied  from 
one  to  four  litres  on  the  different  occasions.  According  to  the 
patient's  account  the  liquid  was  always  thick,  and  on  the  last 
tapping  was  of  a  dirty-grey  colour.  When  admitted  into  the 
Hopital  St.  Louis  (in  October,  1874)  it  was  with  the  desire  of  having 
the  tumour  removed.  The  tumour  occupied  the  left  side  of  the 
belly,  was  movable  readily,  had  an  irregular  surface,  was  slightly 
painful  on  pressure,  and  obscurely  fluctuated.  The  skin  was  not 
adherent,  but  was  very  movable  over  it.  Percussion  over  the  tumour 
was  dull.  The  uterus  was  small.  The  diagnosis  was  a  multilocular 
ovarian  cyst. 

Succussion  at  first  produced  no  special  bruit ;  but  some  time  after 
her  admission  the  tumour  became  sonorous,  from  the  presence  of 
gas  in  its  interior,  and  the  hydro-aeric  wave,  with  metallic  tinkling, 
manifested  itself.  The  patient  grew  weaker  day  by  day,  and 
ultimately  died  towards  the  end  of  November.  Unfortunately  an 
autopsy  was  interdicted,  but  a  trocar  was  thrust  into  the  tumour 
and  gave  vent  to  excessively  fetid  gas,  to  sero-purulent  fluid,  and  to 
a  grumous,  white  matter. 

With  respect  to  the  production  of  gas  in  closed  sacs,  M.  Herard  had 
previously  noted  three  remarkable  instances  of  such  an  occurrence 
— the  first,  in  a  case  of  empyema  and  pneumothorax  without 
puncture  of  the  lung ;  the  second,  a  case  of  enormous  dilatation  of 
the  left  kidney,  which  contained  pus  and  gas,  and  had  no  communi- 
cation with  the  external  air ;  and  the  third,  an  ovarian  cyst,  which 
suppurated  and  was  occupied  with  pus  and  gas  without  any  external 
communication.  In  this  last  case  the  hydro-aeric  fluctuation  with 
metallic  tinkling  was  observed,  but  it  should  be  noted  that  the  sac  had 
been  punctured  on  three  occasions.  Demarquay,  in  his  work  on 
*'  medical  pneumatology,"  refers  to  other  cases. 

In  conclusion,  M.  Labouib^ne  concurs  with  Herard  that  it  must 
be  admitted,  on  the  direct  evidence  of  facts,  that  the  noise  of 
succussion  in  some  tumours,  and  the  bruit  of  "hydro-aeric" 
fluctuation  with  metallic  tinkling  in  others,  may  be  perceived  in  not 
a  few  abdominal  tumours,  and  .  that  such  phenomena  may  occur 
without  communication  between  their  interior  and  the  external  air. — 
Archives  Generales  de  M6decine,  September,  1875. 

Splenic  Tumour  treated  hy  Injection. — Although  portions  of  the 
spleen  and  also  the  entire  spleen  have  been  successfully  removed 
when  exposed  by  wounds  in  the  side,  it  has  not  so  happened  when 
extirpation  has  been  practised  for  the  removal  of  a  diseased  spleen. 
Of  nine  cases  on  record  the  whole  proved  fatal ;  consequently  the 
removal  of  splenic  tumours  by  operation  can  scarcely  be  held 
justifiable. 


468  Chronicle  of  Medical  Science.  [Oct., 

The  success  which  has  attended  an  injection  of  iodine  in  glandular 
tumours  suggested  to  Professor  Mosler  the  expediency  bf  injecting 
tumours  of  the  spleen,  and  to  test  the  practicability  of  the  process 
he  injected  iodine  into  the  spleen  of  several  dogs  and  rabbits.  He 
succeeded  well  and  found  the  operation  to  be  unattended  by  intense 
peritonitis.  Subsequently  he  has  had  a  case  of  splenic  tumour  in  a 
woman,  into  which  he  injected,  not  iodine,  but  a  weak  solution  of 
carbolic  acid  in  the  first  instance,  and  afterwards  dilute  Fowler's 
solution.  The  patient  was  a  married  woman,  set.  33,  the  mother  of 
two  children,  the  youngest  being  eight  years  old.  Four  years 
before  coming  under  his  care  she  had  intermittent  fever  which  lasted 
a  year  and  a  half,  and  exhibited  much  irregularity  of  character.  Two 
years  previously  she  had  typhoid  fever,  and  had  never  been  well 
since,  suffering  with  swellings  in  various  parts  of  the  body.  A  year 
before  the  dropsical  swelling  extended  to  the  belly,  and  she  became 
quite  invalided  by  various  abdominal  disorders.  She  was  admitted 
into  hospital  on  the  20th  of  January,  1874.  The  abdomen  was 
found  distended,  especially  on  the  left  side,  where  the  spleen  could 
be  readily  felt.  Percussion  showed  it  to  extend  from  above  down- 
wards fifteen  centimetres,  and  transversely  thirteen.  The  liver  was 
also  enlarged,  but  not  to  a  proportionate  extent.  No  glandular 
tumours  detected ;  the  lungs  appeared  healthy  ;  there  was  a  cardiac 
murmur ;  the  urine  normal.  The  blood  showed  no  augmentation  in 
the  proportion  of  the  white  corpuscles. 

The  treatment  consisted  in  the  administration  of  steel,  a  saline 
aperient,  and  the  subcutaneous  injection,  twice  a  day,  of  a  solution 
of  the  amorphous  hydrochlorate  of  quinine  (one  part  to  five  of  water). 
After  each  hypodermic  injection  also  an  ice-bag  was  applied  for  several 
hours  over  the  spot  injected,  whereby  Mosler  considers  inflammatory 
action  to  have  been  prevented.  After  persevering  in  this  course  of 
treatment  for  sixteen  days  a  marked  reduction  of  the  spleen  was 
noticed,  the  two  dimensions  having  fallen  to  eleven  and  eight  centi- 
metres respectively.  Encouraged  by  this,  the  treatment  was  con- 
tinued, and,  in  spite  of  many  uncomfortable  symptoms,  was  carried 
on  until  the  21st  of  March — that  is,  for  the  space  of  three  months — 
when,  finding  no  further  progress,  Mosler  ceased  with  the  quinine 
injections,  and  determined  to  deal  locally  with  the  diseased  viscus. 

"With  a  view  to  this  he  applied  an  ice-bag  over  the  spleen  for 
several  hours,  with  the  object  of  exciting  contraction  of  the  spleen 
and  the  reduction  of  the  blood  in  its  tissue.  This  done,  he  pressed 
the  spleen  as  firmly  as  possible  forwards  against  the  abdominal 
parietes,  and  then  injected  twenty-two  drops  of  a  two-per-cent. 
solution  of  carbolic  acid.  The  greater  resistance  of  the  spleen,  after 
the  piercing  of  the  external  tissues,  was  felt  by  the  instrument,  and 
the  passage  of  the  injection  was  attended  by  violent  pain.  This  last 
occurrence  led  the  operator  to  inject  subcutaneously  in  the  same  spot 
two  centigrammes  of  morphia,  and  to  keep  the  ice-bag  applied  for  the 
next  twenty-four  hours.  No  abdominal  distension  and  no  elevation 
of  temperature  followed,  and  on  the  23rd  of  the  month  the  pain  had 
ceased,  ^nd  the  patient  sat  up  the  whole  day,     She  was  treated  with 


1875.]  Report  on  Pathology  and  Medicine.  469 

iron  and  quinine,  and  in  the  following  month  (April)  was  in 
tolerable  health.  Soon  after  the  injection  Mosler  satisfied  himself 
there  was  some  reduction  in  size  of  the  spleen  ;  but  subsequently 
it  remained  stationary  in  its  dimensions,  and  the  quinine  and  iron 
seemed  to  exert  no  influence  upon  the  malady.  Mosler  therefore 
resolved  again  to  inject  the  spleen,  but  on  this  occasion  to  use  a 
solution  of  arsenic,  employing  one  part  of  Fowler's  solution  to  ten 
of  water.  The  operation  was  conducted  in  the  same  fashion  as 
before,  but  .the  pain  was  less,  and  the  ice-bag  applied  for  only 
tweh^e  hours.  Indeed,  no  reason  against  a  repetition  of  the 
operation  appeared. 

In  the  middle  of  May  the  patient  exhibited  distinct  improvement ; 
the  anaemic  cardiac  murmur  had  disappeared ;  the  spleen  had 
retreated  backwards,  and  now  measured  ten  centimetres  by  five.  In 
June  there  was  a  progressive  improvement  in  health,  coupled  with 
further  reduction  of  the  diseased  organ. 

As  Professor  Mosler  remarks,  the  foregoing  case  proves  the 
feasibility  of  injecting  the  substance  of  the  spleen.  He  would 
enjoin  before  operation  the  use  of  measures  to  reduce  the  blood 
contained  in  the  tissues  of  the  organ,  and  can  advise  nothing  better 
than  quinine,  particularly  when  given  hypodermically,  and  over  a 
considerable  interval.  Several  hours  before  the  operation  the  ice- 
bag  should  be  applied.  The  injection  should  be  attempted  only  in 
those  cases  where  the  spleen  lies  immediately,  or  else  can  be  pressed 
close,  beneath  the  abdominal  parietes.  Hueter's  experiments  induced 
Mosler  to  use  the  dilute  carbolic  acid,  as  they  went  to  show  that 
this  substance  could  be  introdaced.  in  a  very  dilute  form  into  the 
splenic  parenchyma  without  ill-consequences.  He  feared  to  use  a 
solution  of  quinine  on  account  of  the  violent  irritation  of  the  tissues 
caused  by  that  substance.  The  subcutaneous  injection  of  arsenic 
had  been  found  by  himself  useful  in  splenic  tumours,  and  conse- 
quently he  resorted  to  it  in  the  above  case.  Czerny  has  also 
employed  arsenic  successfully  in  the  way  of  injection  into  the  sub- 
stance of  malignant  lymphoma  of  the  glands.  Lastly,  it  may  be 
argued  that  a  further  reduction  in  the  dimensions  of  the  splenic 
tumour  of  the  woman  operated  upon  may  be  attempted  by  future 
operation  ;  and  it  is  very  desirable  that  this  mode  of  treatment  be 
tried  in  suitable  cases  of  such  very  intractable  disease.-— i)ez^^sc7?<?s 
Archiv,  March,  1875. 

Pathology  of  Carcinoma. — Professor  Beneke,  led  to  the  subject 
by  the  well-known  London  discussion,  examines  at  considerable 
length  the  pathology  of  cancer,  and  ranges  himself  among  the  sup- 
porters of  the  doctrine  of  its  constitutional  origin.  What  is  meant 
by  constitutional  tendency  he  considers  to  require  explanation. 
Such  a  tendency  may  originate  in  an  alteration  of  the  fluids  or  of 
the  solids  of  the  body,  or  of  both  together.  The  humoral  pathology 
has  been  most  in  favour,  and  an  hereditary  diseased  material,  or 
otherwise  a  pathological  accumulation  of  excrementitious  matter, 
such  as  uric  or  lactic  acid,  has  been  assumed  to  be  productive  of  the 
Qoustitutional  defect,    The  former  idea  of  hereditary  morbid  material 


470  Chronicle  of  Medical  Science,  [Oct., 

is  entirely  hypothetical;  the  latter  notion,  though  wanting  in 
demonstratioD,  bears  more  the  aspect  of  truth  ;  inasmuch  as  obser- 
vation proves  that  a  constitutional  disorder  may  be  set  up  by  an 
alteration  of  the  nutritive  fluids,  as  happens,  for  instance,  when  the 
relative  proportion  of  the  constituents  of  the  blood  has  suffered  change. 
Analogy  shows  in  the  vegetable  world  how  great  a  difference  in  the 
specific  characters  of  plants,  raised  from  seeds  apparently  precisely 
alike,  originates  from  presumably  a  minute  difference  in  the  proportion 
of  their  elementary  materials.  There  is,  in  Beneke's  opinion,  a  great 
neglect,  on  the  part  of  observers,  of  the  less  prominent  and  apparently 
less  important  constituents  of  the  animal  tissues,  and  too  little 
attention  given  to  the  consequences  of  alterations  in  their  propor- 
tions. Although,  however,  varied  proportion  of  elementary  parts 
has  an  influence  in  determining  a  constitutional  tendency,  it  is  not 
sufficient  to  explain  it.  Associated  with  it  is  the  influence  of  inborn 
or  acquired  departures  from  normal  structure  and  function — an 
influence  beyond  dispute.  As  examples  of  structural  variations 
peculiar  to  individuals  are,  the  greater  or  less  dimensions  of  the 
respiratory  apparatus,  or  of  the  liver,  in  relation  to  the  other 
organs,  and  the  very  considerable  variations  in  the  capacity  of  the 
blood-vessels.  Such  differences,  whether  associated  with  humoral 
changes  or  altered  proportion  of  the  tissue-elements,  are  known  to 
predispose  to  peculiar  diseases,  and  they  are  likewise  conditions 
known  to  be  hereditary. 

Beneke's  next  inquiry  is,  whether  either  or  both  of  the  above 
classes  of  abnormal  phenomena  belong  to  the  history  of  cancer. 
The  first  circumstance  noticeable  in  respect  to  this  inquiry  is,  the 
usually  well-nourished  condition  of  cancer  patients,  when  not  re- 
duced by  the  consequences  of  operation  or  of  exhaustion.  This 
fact  he  adverts  to  as  employed  by  Mr.  Campbell  de  Morgan  as  an 
argument  against  a  constitutional  diathesis,  or  the  presence  of  blood 
disease.  But  he  observes  that  it  by  no  means  indicates  the  absence 
of  blood  changes  of  a  morbid  character.  The  blood  of  such  persons 
may  well  be  considered  absolutely  or  relatively  overcharged  with 
formative  matter;  or  it  may  be  one  or  several  constituents  have 
unduly  augmented,  and  thereby  supply  an  equally  efficient  cause 
of  pathological  changes  as  a  deficiency,  or  an  abnormal  mixture, 
would  do. 

A  second  circumstance  noted  is,  the  higher  or  stronger  develop- 
ment of  the  osseous  system  in  cancer  subjects,  accompanied  with 
(as  Beneke's  own  experiments  show)  an  actually  increased  pro- 
portion of  earthy  phosphates.  AVhatever  may  be  the  case  in  the 
later  stages  of  exhaustion,  there  is  no  excess  in  the  earlier  phases  o£ 
cancer  either  of  oxalates  or  of  phosphates  in  the  urine. 

A  third  feature  is,  that  the  arterial  system  is  more  largely  developed 
in  cancer  patients ;  the  calibre  of  the  arteries  being  greater  than 
usual.  Of  this  fact  Beneke  has  satisfied  himself  by  actual  compara- 
tive measurements  made  in  200  bodies.  In  the  case  of  tubercular 
and  scrofulous  subjects,  on  the  contrary,  a  narrowing  of  the  arteries 
obtains. 


1875.] 


Report  on  Pathology  and  Medicine.  471 


A  fourth  constitutional  factor  to  be  mentioned  is  the  tendency  to 
the  production  of  fat,  either  at  the  commencement  of  the  disease  or 
else  at  an  earlier  period  of  life.  In  connection  with  this  circumstance 
must  be  remembered  the  greater  liability  of  women  to  cancer,  and 
at  the  same  time  their  greater  tendency  to  accumulate  fat.  An 
excessive  development  of  adipose  tissue  is  common  in  mammary 
cancer,  and,  where  the  disease  has  its  seat  in  the  digestive  organs, 
also  in  the  omentum,  the  appendices  epiploicse,  and  the  mesentery. 
In  like  manner  in  hepatic  cancer  an  increased  volume  of  the  liver  is 
observable,  together  with  much  bile,  and  often  likewise  gall-stones — 
conditions  further  indicative  of  a  propensity  to  the  formation  of  fat. 

A  fifth  point  for  remark  is  the  decidedly  hereditary  character  of 
cancer  as  a  sign  of  constitutional  diathesis.  Mr.  Campbell  de  Morgan 
contends,  indeed,  that  this  hereditary  character  offers  no  proof  of 
constitutional  predisposition,  because  we  find,  hereditary  features  in 
a  family  and  other  inherited  peculiarities  which  cannot  be  attributed 
to  blood-taint.  But  in  this  reasoning  Mr.  De  Morgan  is  wrong  ;  he 
argues  against  a  blood-taint  or  a  peccant  matter  as  if  it  were  the 
necessary  element  in  the  production  of  a  constitutional  diathesis, 
and  an  assumed  necessary  entity  on  the  part  o£  his  opponents ; 
whereas  the  latter  recognise  the  necessity  of  no  such  special  materies 
morhi  to  account  for  the  constitutional  diathesis,  but  point  to  altered 
conditions  and  proportions  of  the  humours,  and  to  inherited  or  ac- 
quired changes  of  anatomical  structure  and  function  when  inherited, 
originating  in  all  probability  in  some  almost  inconceivable  changes 
in  the  germinal  matter  of  the  ovum. 

The  apparent  antagonism  of  cancer  to  tuberculosis  and  scrophulosis 
is  a  sixth  argument  in  favour  of  constitutional  proclivity.  A  seventh 
may  be  adduced  from  the  fact  of  the  richness  of  carcinomatous  deposits 
in  the  so-called  myelin  and  cholestearin.  The  abundance  of  these 
materials  is  so  much  the  greater  in  proportion  to  the  softness  and  the 
cellular  consistence  of  the  cancer. 

As  a  further  argument  is  the  especially  significant  fact,  that  the 
inoculation  of  cancer-cells  has  never  succeeded  to  produce  cancer. 
And,  lastly,  cancer  patients  are  peculiar  constitutionally  by  seldom 
possessing  a  nervous  or  sanguine  temperament,  being,  on  the  contrary, 
remarkable  for  a  lymphatic  temperament  and  for  defective  mental 
and  physical  energy. 

Grrouping  these  arguments  together  in  favour  of  the  constitutional 
character  of  carcinoma,  Beneke  concludes  that  they  possess  so  much 
weight  that  the  objections  of  Mr.  De  Morgan  to  the  hypothesis  fail 
to  overturn  them.  At  the  same  time  he  recognises  the  force  of 
the  arguments  against  them,  and  disposes  of  these  in  detail  more  or 
less  completely.  After  so  doing  he  returns  to  the  question  of  the 
nature  of  a  constitutional  defect.  A  constitutional  alteration  is  not, 
he  writes,  as  a  rule,  and  as  commonly  apprehended,  the  result  of  a 
single,  determinate  deviation  from  the  normal  condition,  either  in 
the  composition  of  the  humours,  or  in  the  anatomical  mechanism ; 
and  much  less  is  it  the  consequence  of  an  imaginary  blood-taint. 
On  the  contrary,  it  is,  in  most  instances,  a  consequence  of  the  con- 


472  Chronicle  of  Medical  Science.  [Oct., 

currence  of  variousf  departures  from  the  healthy  standard  ;  aud,  ac- 
cording to  the  manifold  combinations  among  the  various  deviations, 
will  be  the  abnormal  results  in  the  shape  of  various  diseased  condi- 
tions. In  connection  with  this  view  must  be  accorded  a  very  great 
importance  to  the  undoubted  fact  of  the  inconstancy  and  the  differ- 
ence in  intensity  of  the  several  elements  (integrals)  of  constitutional 
anomalies.  It  shows  the  possibility  of  numerous  differences  among 
such  disorders,  the  impossibility  of  the  transformation  of  one  diseased 
state  into  another  ;  the  latent  condition  and  the  temporary  exacer- 
bations ;  the  curability  of  the  malady  in  one  case  and  its  incurability 
in  another.  The  greater  the  abnormality  of  the  anatomical  irregu- 
larities, coupled  with  concurrent  alterations,  the  less  will  be  the 
chance  of  cure. 

It  is  highly  probable  that,  in  respect  of  the  whole  group  of  con- 
stitutional diseases,  e.g.,  carcinoma,  tuberculosis  and  gout,  that  cer- 
tain deviations  from  the  normal  are  characteristic  and  constant, 
whilst  others  are  immaterial  aud  inconstant,  and  that  in  this  way 
modifications  of  the  entire  resultant  lesion  are  brought  about. — JDeut- 
sches  Arcliiv  fur  klin.  Medioin,  July,  1875. 


EEPOET  ON  MIDWIFEEY,    DISEASES  OF  WOMEN, 

AND  DISEASES  OE  CHILDREN. 

By  Alfeed  "Wiltshire,  M.D.,  M.E.C.P.  Lond., 

Joint  Lecturer  on  Midwifery  at  St.  Mary's  Hospital ;  Hon.  Sec.  to  the  Obstet.  Soc.  of  Lond. ; 
formerly  Medical  Inspector  to  Her  Majesty's  Privy  Council. 

MiDWIEEET. 

1.  On  Chloroformization  of  Women  during  Labour,  and  its  Influence 

on  the  Foetus.     By  Dr.  Zweifel  ('  Berliner  Klin.  AVocheu- 
schrift,'  No.  21,  1875). 

2.  On  Temperature  in  Puerperal  Eclampsia,  and  the  Clinical  Indi- 

cations it  furiiishes.     By  Dr.   Boueneville    ('  Archives   de 
Tocologie,'  April,  1875). 

3.  Complete    Inversion   of   the    Uterus  after   Delivery.      By   Dr. 

YoELCKEL  ('  Berl.  Klin.  Wochensch.,'  March  15,  1875). 

4.  Chloral  as  an  Anodyne  in  Labour.  By  Dr.  Chiaeleoni  (*  Gazetta 

Medica  Italiana-Lombardia,'  Eebruary,  1875). 

5.  Pregnancy   and  Labour   in   Epileptic    Women.      By   John   S. 

Paeet,  M.D.  (' Amer.  Journ.  of  Obstetrics,'  August,  1875). 

6.  A  Clinical  Contribution  to  the  Treatment  of  Tubal  Pregnancy .  By 

T.  G-.  Gaillard  Thomas,  M.D.  Q  New  York  Med.  Journ.,' 
June,  1875). 

7.  Cont^Hbutions  to    the   Determination  of  the  Diminution  of  the 

Uterus  after  Delivery.     By  A.  Seedukoff,  M.D.,  of  Moscow 
('Edin.  Med.  Journ.,'  May,  1875). 


1875.J  t^epnri  on  Midwifery,  ^C.  473 

8.  Apparent  Peculiarities  of  Parturition  in  the  Negro  ^ace.     By  J. 

T.  Johnson,  M.D.  ('Amer.Journ.  of  Obstetrics,'  May,  1875). 

9.  On  the  Uterine  Souffle  and  Foetal  Heart.    By  James   Gumming, 

M.D.  ('Edin.  Med.  Journal,'  September,  1875). 

10.  Clinical  Memoir  on  Turning  in  Pelves  narroived  in  the  Conjugate 

Diameter,     By    William    Goodell,   M.D.    (*Amer.  Journ. 
of  Obst.,' August,  1875). 

11.  Puerperal  Fever.     By  Leopold  Putzel,  M.D.  (*  Amer.  Joum. 

of  Obst.,' August,  1875). 

1.  It  has  been  generally  believed  that  chloroform  exhibited  to 
women  during  labour  exercises  no  particular  influence  on  the  foetus 
— an  opinion  which  the  following  recent  observations  of  Dr.  Zweifel 
do  not  confirm.  Zweifel  has  distilled  the  placentae  of  women  who 
have  had  chloroform  during  labour,  and  has  obtained  the  following 
positive  result : — The  placenta  of  a  woman  who  had  chloroform  given 
her  for  twenty  minutes,  one  hour  before  the  birth  of  the  child, 
furnished  characteristic  chemical  indications  of  the  presence  of  chloro- 
form. On  this  question  Dr.  Zweifel  has  also  made  use  of  some  valuable 
observations,  as  yet  unpublished,  of  Dr.  Mering,  made  in  Hoppe- 
Seyler's  laboratory,  which  shows  that  the  urine  of  persons  who  have 
been  chloroformed  contain  a  substance  reducible  by  Pehling's  solu- 
tion, and  turning  to  the  left  under  the  action  of  polarised  light,  but 
incapable  of  undergoing  fermentation.  This  substance  Zweifel  sought 
for  in  the  urine  of  newly  born  children,  with  the  following  results  : 
— In  twenty  five  newly  born  children  whose  mothers  had  not  had 
chloroform  during  labour  he  did  not  find  the  least  trace  of  this  sub- 
stance ;  whilst  in  five  children  whose  mothers  had  had  chloroform 
during  labour  he  did  find  it  in  the  urine.  It  appears,  therefore, 
that  chloroform  may  aff'ect  the  foetus  in  utero. 

2.  Dr.  Bourneville  thus  formulates  the  conclusions  at  which  he 
has  arrived  from  the  careful  observation  of  a  number  of  cases  : 

"  1.  In  the  eclamptic  state  the  temperature  rises  from  the  begin- 
ning to  the  end  of  the  attack. 

"  2.  In  the  intervals  of  accession  the  temperature  maintains  a  high 
figure,  and  at  the  moment  of  convulsions  the  mercurial  column 
registers  a  slight  ascension. 

"  3.  Lastly,  if  the  eclamptic  state  ends  in  death,  the  temperature 
continues  to  rise  and  attains  a  very  high  figure ;  if  on  the  contrary 
the  accessions  disappear,  and  the  coma  diminishes  or  ceases  de- 
finitely, the  temperature  progressively  lowers  and  returns  to  the 
normal  figure." 

Dr.  Bourneville  remarks  also  that,  in  addition  to  the  valuable  in- 
formation aff*orded  by  the  thermometer  in  respect  of  prognosis 
and  treatment,  it  furnishes  valuable  diagnostic  indications.  He  states 
that  in  true  uramia,  whether  it  occur  in  men  or  in  women,  whether  it 
be  caused  by  an  affection  of  the  kidneys  or  by  obliteration  of  the 
ureters,  whether  it  assume  the  comatose  or  convulsive  form,  the 
temperature  is  always  progressively  lowered,  sometimes  falling  very 
low. 


474  Chronicle  of  Medical  Science.  [Oct., 

He  adds — "  Trom  the  first  we  note  a  lowering  of  the  tempera- 
ture iu  TJEiEMiA  and  an  elevation  of  the  temperature  in  Puerperal 
Eclampsia.  In  the  course  of  uraemia  the  temperature  is  pro- 
gressively lowered,  whilst  in  the  course  of  the  eclamptic  state  it  rises 
more  and  more  from  the  onset  of  the  accessions,  and  that  with  great 
rapidity.  These  differences  are  accentuated  at  the  approach,  and 
even  at  the  moment  of  death  :  in  uraemia  the  temperature  descends 
very  low,  even  much  below  the  normal  figure;  in  puerperal  eclampsia, 
on  the  contrary,  it  attains  a  very  high  figure." 

3.  Dr.  Yoelckel  reports  a  case  of  complete  inversion  of  the  uterus 
occurring  fifty -two  hours  after  delivery.  A  primipara,  ast.  32,  was 
seen  thirty- six  hours  after  the  commencement  of  labour  and  ten 
hours  after  the  membranes  had  ruptured.  The  head  presented  in  the 
first  position,  was  impacted,  and  a  large  caput  succedaneum  hadformed. 
The  child  was  delivered  by  forceps.  The  uterus  did  not  contract 
well,  and  the  placenta  was  forced  out  by  Crede's  method.  Severe 
flooding  set  in,  which  was  arrested  with  difficulty  by  cold  water 
injections  and  the  administration  of  ergot.  On  the  morning  of  the 
third  day  severe  afterpain  set  iu,  and  with  an  ardent  desire  to 
micturate ;  hot  fomentations  were  applied.  The  pain  became 
stronger  and  more  frequent  towards  evening.  Suddenlv  with  a 
strong  expulsive  eff'ort  a  globular  body  was  forced  out  of  the  vulva, 
followed  by  a  gush  of  blood,  and  in  a  moment  the  patient  was  dead. 
Dr.  Yoelckel  saw  the  patient  four  hours  after  ;  the  uterus  was  found 
completely  inverted,  lying  outside  the  vulva.  No  necropsy  was 
allowed. 

4.  Dr.  Chiarleoni  confirms  the  statements  made  by  Dr.  Playfair  and 
others  in  this  country  and  abroad  that  chloral  lessens  the  pains  of 
childbirth.  Dr.  Chiarleoni  believes  the  drug  to  promote  uterine 
action.     He  thinks  it  especially  admissible  in  urasmic  convulsions. 

5.  Dr.  Parry's  paper  is  illustrated  by  cases,  and  concludes  as 
follows : 

"  In  regard  to  the  relations  existing  between  pregnancy,  parturi- 
tion, and  epilepsy,  experience  and  the  study  of  the  literature  of  the 
subject  appear  to  warrant  us  in  making  the  following  statements : 

(1.)  Epileptics  rarely  have  convulsions  during  labour.  They  are 
not  more  liable  to  puerperal  convulsions  than  healthy  women. 
Labour  in  them  is,  as  a  rule,  not  more  unfavorable  than  in  healthy 
women. 

(2.)  In  the  exceptional  cases,  in  which  violent  epileptic  convul- 
sions occur  during  labour,  it  is  not  decided  whether  it  is  best  to 
hasten  delivery  or  to  trust  to  nature. 

(3.)  Pregnancy  may  be  the  immediate  cause  of  epilepsy.  In  these 
cases  fits  rarely  occur  during  labour,  and  the  disease  is  immediately 
arrested  by  parturition,  but  it  will  almost  always  reappear  when- 
ever the  v/oman  becomes  pregnant. 

(4.)  Either  form  of  epilepsy  may  result  in  the  death  of  the  foetus, 
but  convulsions  of  this  kind  are  not  as  likely  to  destroy  the  child  as 
are  those  which  may  be  correctly  designated  puerperal.' 

6.  Dr.  Thomas  prefaces  the  subject  matter  of  his  very  interesting 


1875.J 


tteport  on  Midwifery^  ^c.  475 


paper  by  some  suggestive  and  valuable  remarks.  "With  the  courage  of 
a  conscientious  and  experienced  physician  he  honestly  says,  with 
reference  to  the  exact  position  of  extra-uterine  pregnancies,  "  After 
careful  examination  of  every  case  of  extra-uterine  foetation  to  which 
I  have  had  access  I  am  unable  to  substantiate  the  position,  and  yet  I 
am  inclined  to  believe  that,  in  the  commencement  of  its  develop- 
ment, the  impregnated  ovum  never  attaches  itself  to  or  draws  its 
nourisliment  from  any  other  parts  than  those  lined  by  the  mucous 
membrane  of  the  uterus  or  tubes." 

The  case,  briefly  epitomised,  was  as  follows :  A  lady,  set.  32, 
married  six  years,  had  never  had  any  family  when  symptoms  of 
pregnancy  supervened.  All  went  well  for  about  two  and  a  half 
months,  then  after  a  \'qvj  days  uneasiness  and  agonising  pain  sud- 
denly came  on  during  the  night.  The  patient  remained  ill  with 
more  or  less  pain  for  a  fortnight,  when  Dr.  Thomas  was  called  to  see 
her  in  consultation.  Physical  examination  showed  that  the  uterus 
was  somewhat  enlarged,  measuring  three  and  a  half  inches,  and 
slightly  anteverted  obliquely  to  the  right. 

The  vagina  was  soft,  elastic,  and  enlarged,  as  it  is  during  preg- 
nancy. To  the  left  of  the  uterus  was  a  tense  elastic  cyst,  filling  the 
whole  iliac  fossa,  and  extending  downwards  to  the  level  of  the  internal 
OS  uteri.  This  cyst  was  slightly  movable  and  sensitive.  Ballottement 
carefully  practised  revealed  feeble  but  distinct  "  evidence  of  a  very 
light  body  which  was  thrown  upwards  and  fell  upon  the  floor  of  the 
sac."  Dr.  Thomas  from  these  facts  diagnosed  left  tubal  pregnancy 
at  the  end  of  the  third  month  of  development.  Believing  rupture 
to  be  imminent  from  the  nature  of  the  symptoms.  Dr.  Thomas 
urged  immediate  surgical  interference.  This  he  carried  out  in  the 
following  manner,  selecting  elytroraphy  as  the  means  by  which  he 
would  open  the  sac.  To  prevent  undue  haemorrhage  from  the  inci- 
sion into  such  vascular  parts  as  he  was  about  to  deal  with.  Dr. 
Thomas  used  a  platinum  knife  with  the  galvano-caustic  battery.  He 
first  put  the  upper  part  of  the  vagina  over  the  cyst  on  the  stretch,  by 
means  of  tenaculum  fixed  in  the  cervix  uteri  and  vagina,  then,  with 
the  knife  at  a  white  heat,  he  opened  the  cyst,  giving  exit  to  some 
straw-coloured  pinkish  fluid.  Introducing  the  index  finger  a  foetus 
was  found  and  extracted  by  podalic  version  as  far  as  the  head,  which 
became  arrested,  and  was  removed  only  after  the  application  of  a  pair 
of  long-handled  placental  forceps.  Dr.  Thomas  then  attempted  to 
remove  the  placenta  by  gentle  traction  and  detachment.  At  this 
point  the  first  difficulty  which  had  attended  the  operation  showed 
itself.  Not  knowing  the  exact  manner  in  which  the  placenta  is 
attached  in  tubal  pregnancy.  Dr.  Thomas  proceeded  very  cautiously, 
and  when  about  half  the  placenta  was  separated  very  severe  haemor- 
rhage took  place,  so  much  so  that,  tearing  off  the  detached  portion, 
the  operator  at  once  passed  a  gum-elastic  catheter,  and  injected  a 
solution  of  persulphate  of  iron  into  the  sac.  This  instantly  checked 
the  flow  of  blood.  Being  unable  to  make  use  of  a  drainage  tube, 
Dr.  Thomas  inserted  a  long  tent  of  carbolized  cotton,  saturated 
with  a  solution   of  persulphate  of  iron.      Morphia  was   injected 


4?'6  Chrmiicle  of  Medical  Science.  [Oct., 

subcutaneously.  All  went  well  until  the  fourth  day,  when  the  tent 
w^as  removed,  and  symptoms  of  septicaemia  soon  showed  themelves. 
Tliese  yielded  to  constant  injections  of  carbolized  water.  On  the 
fifteenth  day  the  rest  of  the  placenta  came  away  spontaneously. 
In  spite  of  trivial  drawbacks  the  patient  did  very  well,  and  at  the 
end  of  six  weeks  Dr.  Thomas  could  scarcely  find  the  exact  position 
of  the  cicatrix. 

Dr.  Thomas  justly  lays- much  stress  upon  the  value  of  ballottement, 
but  philosophically  adds  that  "  on  no  single  sign,  however,  should 
undue  reliance  be  placed."  He  makes  no  mention  of  purpling  of 
the  vagina,  a  symptom  which  in  our  own  experience  we  have  found  of 
value.  J)r.  Thomas  states  that  during  the  first  sixteen  years  of  his 
practice  he  saw  no  case  of  extra-uterine  pregnancy ;  then  he  saw 
four  in  one  month.  During  the  past  seven  years  he  has  met  with 
nine. 

Dr.  Thomas's  case,  operation,  and  remarks  are  alike  interesting 
and  instructive.  The  all-important  point  in  respect  of  the  operation, 
whether  the  sac  be  opened  through  the  vagina  or  by  gastrotomy,  is,  we 
apprehend,  the  treatment  of  the  placenta.  Shall  this  be  removed 
or  no  ?  Though  Dr.  Thomas's  case  is  encouragiug  in  the  afiirmative, 
there  are  doubtless  very  great  risks  attending  its  removal  on  account 
of  haemorrhage,  while  on  the  other  hand  the  risks  of  septicaemia,  if  it 
be  left  to  disintegrate,  are  by  no  means  slight.  On  the  whole  we 
should,  in  the  light  of  present  experience,  be  disposed  to  follow 
the  latter  practice  ;  always  taking  the  utmost  precaution  to  ensure 
a  suificient  opening  for  the  irrigation  of  the  sac  by  means  of  car- 
bolized, iodized,  or  other  antiseptic  solutions.  But  before  we  can 
be  entitled  to  express  any  very  decided  views  upon  this  point,  we 
must  wait  for  the  light  of  further  knowledge  and  experience.  Dr. 
Thomas  has  added  to  both,  and,  with  Koeberle  and  others,  has  done 
much  to  advance  the  science  of  medicine  in  respect  of  these  serious, 
though  happily  somewhat  rare  cases. 

7.  Dr.  Serdukoff" contributes  an  elaborate  article  on  this  subject, 
based  on  measurements  carefully  made  by  himself  on  150  women. 

The  mode  of  measurement  will  doubtless  be  objected  to  by  some, 
and  it  is  certainly  open  to  criticism,  as  being  inherently  somewhat 
deficient  in  exactness.  Dr.  Serdukofl"  relied  on  external  measure- 
ments, preferring  these,  for  various  reasons,  to  internal  ones.  He 
concludes  from  his  investigations  that  involution  of  the  uterus  is 
not  complete  until  the  lapse  of  from  four  to  six  weeks. 

The  author's  conclusions  are  as  follows :  — 

(1.)  Involution  of  the  uterus  goes  on  more  rapidly  during  the  first 
few  days  of  the  puerperal  period  than  it  subsequently  does. 

(2.)  Involution  of  the  uterus  of  healthy  women  goes  on  well  and 
with  regularity. 

(3.)  Involution,  where  the  uterus  is  the  subject  of  diseases,  such  as 
metritis,  endo-metritis,  or  parametritis,  goes  on  more  slowly,  and 
this  varies  with  the  amount  of  disease. 

(4.)  The  permanent  contraction  which  takes  place  during  the  first 


1875.] 


Report  on  Midwifery,  ^c,  477 


few  hours  after  delivery  is  a  common  occurrence.  "When  it  passes  off 
nn  increase  in  size  begins  to  take  place. 

(5.)  In  women  delivered  at  the  full  time  involution  goes  on  more 
quickly  and  regularly  than  in  those  prematurely  confined. 

((3.)  Length  of  labour  retards  involution. 

(7.)  In  adult  primiparse  involution  of  the  uterus  goes  on  very 
regularly,  but  more  slowly  than  in  young  primipara?.  In  aged  multi- 
parse  involution  does  not  go  on  so  well. 

(8.)  In  women  who  suckle  their  children  involution  during  the 
first  four  days  does  not  go  on  so  quickly  as  in  those  who  do  not 
nurse.  But,  subsequently,  the  involution  is  quicker,  though  less 
regular. 

(9.)  Afterpains  are  not  necessary  for  a  favorable  involution ;  in 
fact,  we  are  as  well  without  them. 

(10.)  In  order  to  determine  the  involution  of  the  uterus,  its  breadth 
only  should  be  measured. 

(11.)  Involution  of  the  uterus  goes  on  proportionally  in  length  as 
well  as  breadth. 

(12.)  Super-involution  and  sub-involution  occur  as  distinct  uncom- 
plicated pathological  conditions. 

8.  Dr.  Johnson  having  at  "Washington  large  opportunities  for  ob- 
serving parturition  in  negresses,  has  here  given  a  comparison  between 
this  function  as  observed  in  negresses  and  in  white  women,  based  on 
two  thousand  cases  of  labour  occurring  in  negro  women.  He  uses 
the  statistics  of  Churchill  as  the  standard  of  comparison  among  white 
women. 

Length  of  Labour. — This  appears  to  be  on  an  average  shorter  in 
negresses  than  in  white  women. 

Presentations. — The  head  appears,  from  the  statements  given,  to 
present  much  more  frequently  in  negresses  than  in  white  women  ; 
abnormal  presentations  are,  therefore,  less  frequent  among  the  blacks. 

Triplets  occurred  once. 

The  'period  of  co7walesence  is  proverbially  short  in  coloured  women. 

Placenta  prcevia  occurred  but  once  in  the  2000  cases. 

Flooding  during  labour  occurred  but  twice. 

Flooding  after  labour  occurred  four  times.  None  of  the  cases 
were  fatal. 

Puerperal  fever  occurred  four  times. 

Operations. — {a)  The  forceps  were  required  but  four  times. 
A  propos  of  this  Dr.  Johnson,  in  some  excellent  remarks,  says  {  "  The 
low  development  of  the  anterior  cerebral  lobes,  and  consequent 
shortening  of  the  fronto- mental  and  occipito-frontal  diameters  of  the 
foetal  head  diminishes  the  suffering  of  the  patient.  The  diameters 
being  shorter  the  resistance  is  less,  and  the  greater  occipital  de- 
velopment is  accommodated  by  the  peculiar  shape  of  the  negro 
pelvis." 

(b)   Version. — This  operation  was  performed  three  times.     *'  Once 

in  the  Preedmen's  Hospital,  when  the  left   hand,  right  foot,  and 

funis  presented,  with  the  head  crowded  down  upon  them  ;  once 

when  rupture  of  the  uterus  occurred,  and  the  child  had  to  be  drawn 

112— LVI.  31 


478  Chronicle  of  Medical  Science.  [Oct., 

back  into  the  uterus  from  the  abdominal  cavity  previous  to  version, 
and  once  in  a  consultation  case,  where  forceps  and  craniotomy  both 
failed,  and  the  child  had  to  be  turned  finally  and  brought  down  by 
the  feet."  In  reference  to  the  last  case  it  is  interesting  to  note 
that  Dr.  Johnson  says  that  this  is  the  only  instance  in  which  he  has 
met  with  deformity  of  the  pelvis  in  anegress.  Here  there  was  con- 
traction of  the  pelvis  antero-posteriorly. 

An  able  and  exhaustive  discussion  upon  the  important  question  of 
racial  peculiarities  of  the  pelvis  is  here  given  by  Dr.  Johnson,  who 
con.cludes  that  there  are  beyond  doubt  "  race  peculiarities  belonging 
to  the  negro  female  pelvis,"  the  chief  point  established  being  "that 
this  antero-posterior  diameter  of  the  inlet  of  the  female  pelvis  in 
the  negro  is  longer  than  in  the  European  female."  This  he  believes 
corresponds  to  the  shape  of  the  average  negro  head. 

Puerperal  Accidents. — Under  this  heading  Dr.  Johnson  states  that 
stillbirths  and  abortions  are  comparatively  rare.  There  were  only 
seven  stillbirths  in  his  2000  cases. 

Umbilical  Cord  around  the  neck  of  the  infant  is  found  to  be  very 
frequent  in  negresses,  occurring  once  in  every  six  cases. 

Mupture  of  the  Uterus  occurred  but  once.  Churchill's  statistics 
give  once  in  every  1318  cases.  In  Dr.  Johnson's  case  the  woman 
recovered  and  subsequently  became  pregnant.  Dr.  Johnson  does 
not  state  the  cause  or  character  of  the  rupture. 

Puerperal  Convulsions  occurred  eight  times  in  Dr.  Johnson's  2000 
cases.  Leishman  gives  the  frequency  as  once  in  every  350  cases  in 
white  women.  Dr.  Johnson  states,  however,  that  his  figures  are 
regarded  as  exceptionally  high  by  other  physicians  who  have  expe- 
rience of  parturition  in  negresses. 

9.  Dr.  Gumming  has  commenced  in  the  September  number  of  the 
*  Edinburgh  Medical  Journal,'  an  essay  on  the  above  subjects. 
Thus  far  he  has  only  dealt  with  the  uterine  soufile ;  the  mode  of 
production  of  which  is  discussed  chiefly  from  the  historical  stand- 
point. The  conclusions  of  Dubois,  Depaul,  Cazeaux,  Kiliau, 
Matthews  Duncan,  Tanner,  Tyler  Smith,  Leishman,  and  Schroeder, 
are  supported.  The  view  maintained  by  the  above-named  authori- 
ties is  doubtless  the  correct  one,  viz.,  that  the  souflle  is  properly 
of  uterine  and  not  of  placental  origin,  and  that  it  is  produced  in 
the  vessels  which  ramify  in  the  uterine  walls. 

10.  Professor  Groodell  contributes  an  excellent  practical  paper  on 
this  subject,  based  on  his  own  experience.  He  relates  several  cases 
in  which  he  resorted  to  version  with  the  best  results.  His  thoughts, 
put  into  a  practical  shape,  are  off'ered  in  the  following  general  pro- 
positions : 

"  (1.)  Turning  should  generally  be  preferred  to  the  lashing  of  the 
forceps  handles. 

**  (2.)  In  pelves  uniformly  contracted  the  forceps  is  the  better 
means  of  delivery. 

"  (3.)  In  pelves  narrowed  in  the  conjugate  diameter  turning  should 
be  resorted  to  whenever  a  half-hour's  faithful  trial  with  the  forceps 
fails  to  make  the  head  engage. 


1875.]  Report  on  Midwifery,  S^c.  479 

"  (4.)  In  pelves  whose  conjugates  range  from  275  to  3*25  inches 
turning  should  be  the  initial  step." 

11.  This  much  discussed  subject  is  dealt  with  by  Dr.  Putzel  in 
a  concise  article  in  which  he  upholds  the  specific  view  or  essential 
nature  of  the  disease.  Dr.  Putzel  speaks  certainly  with  more 
authority  than  most  physicians  can  pretend  to,  since  his  observations 
are  based  on  twenty-two  (22)  post-mortems,  witnessed  by  himself, 
of  patients  several  of  whom  he  had  the  opportunity  of  observing  during 
life.  Dr.  Putzel  maintains  the  view  lately  so  ably  advocated  by 
our  distinguished  confrere  Professor  Fordyce  Barker  during  the  dis- 
cussion of  the  subject  at  the  Obstetrical  Society,  viz.,  that  the 
disease  is  of  a  "  specific  "  or  '*  zymotic  "  nature. 

Diseases  of  Women. 

1.  On  the   Use  of  Chloral  Hydrate  in  Carcinoma   Uteri.     By  Dr. 

Fleischer.  ('  Med.-Chir.  Centralblatt/  ix,  1875). 

2.  On    the  Combination  of  Chlorosis  with  Aplasia  of  the   female 

Sexual  Organs.  By  Dr.  Eenst  Feankel  ('Arch,  fur 
Gyngek.,'  Band  vii.  Heft  3). 

3.  On  Obliteration  of  the   Vagina  for  the   Cure  of  Incontinence  of 

Urine  due  to  great  Destruction  of  the  Vesical  Walls.  By  Dr. 
Herrgott,  of  Nancy  ('  Arch,  de  Tocologie,'  June,  1875). 

4.  The  Mucous  Membrane  of  the  Uterus,  ivith  especial  reference  to 

the  Development  and  Structure  of  the  Decidua.  By  G-.  J. 
Engelmann,  A.m.,  M.D.  ('  Amer.  Journ.  of  Obstetrics,'  May, 
1875). 

5.  Three  Cases  of  Successful  Removal  of  Fibro-Cystic  Tumour  of  the 

Uterus.  By  Thomas  Keith,  M.D.  ('Lancet,'  May  15, 
1875). 

6.  On  the  Arrest  of  Metrorrhagia  by  the  Application  of  Heat  to  the 

Limbar  Region.  By  Dr.  Noel  Gueneatj  de  Mussy  ('  Annales 
de  Gynsecologie/  July,  1875). 

7.  On  Ovariotomy.     By  James  R.  Chadwick,  M.D.,  Boston,  U.S.A. 

(Pamphlet). 

8.  Successful   Ovariotomy  in  a  Case  of  Cyst  of  the  Ovary,  lasting 

Tliirtyfour  Years,  which  had  been  punctured  twenty  four  times. 
By  Dr.  Botjyee  ('  Grazette  Obstetricale,'  June,  1875). 

1.  Dr.  Fleischer  recommends  the  use  of  chloral  hydrate  locally 
in  carcinoma  uteri.  After  thoroughly  washing  out  the  vagina,  he 
passes  up  to  the  cancerous  surface  a  piece  of  cotton  wool  dipped  in 
a  solution  of  chloral  hydrate  (two  drachms  to  three  ounces);  this  is  re- 
peated every  two  hours.  After  two  or  three  applications  the  character 
of  the  pain  is  altered,  and  the  discharge  becomes  less  offensive.  He 
prefers  administering  chloral  as  an  anodyne  by  the  rectum  rather 
than  by  the  mouth  ;  its  effect  can  be  better  regulated,  and  it  does 
not  confine  the  bowels  as  morphia  does. 

2.  Dr.  Ernst  Frankel  concludes  a  paper  on  the  subject  with  the 
following  summary :  That  chlorosis  and  imperfect  development  of 


4^6  chronicle  of  Medical  Science.  [Oct., 

the  genital  organs  are  frequently,  though  not  exclusively,  combined 
with  a  dwarf-like  condition  of  the  heart  and  the  aorta.  The 
influence  which  the  sexual  apparatus  exercises  upon  the  body  may 
also  determine  the  character  of  the  blood,  that  is  to  say,  that  sexual 
aplasia  may  be  the  prime  originator  of  chlorosis.  That  form  of 
chlorosis  which  is  not  associated  with  imperfect  development  of  the 
vascular  system  is  permanently  curable.  The  so-called  menorrhagic 
form  of  chlorosis  is  met  with  as  well  in  deficient  as  with  excessive 
development  of  the  sexual  organs. 

[This  appears  to  accord  with  Yirchow's  well-known  writings  on  the 
subject. — A.  AV.] 

3.  Professor  Herrgott  discusses  this  operation  pretty  fully  in  the 
article  indicated.  He  claims  for  France  the  honour  of  originating 
it ;  the  operation  being  first  practised  by  Yidal  de  Cassis  in  1832. 
Since  then,  however,  the  advances  in  this  departm.ent  of  plastic 
surgery  have  been  very  great ;  valuable  contributions  being  made  by 
surgeons  in  all  parts  of  the  world,  and  especially  by  our  American 
brethren.  Obliteration  of  the  vagina  is  no  doubt  a  most  valuable 
operative  procedure,  and  gives  immense  relief  and  comfort  to  those 
who  are  afflicted  with  the  distressing  lesion  which  calls  for  it. 

4.  In  1872  a  paper  on  this  subject,  based  on  researches  made  by 
Dr.  Engelmann  in  conjunction  with  Dr.  Kundrat,  was  read  by  the 
latter  gentleman  before  the  **  Gesellschaft  der  Aerzte"  of  Vienna, 
and  published  in  Strieker's  '  Medizinische  Jahrbucher '  for  1873. 
Some  of  the  views  stated  in  this  paper  were  developed  after  Dr. 
Engelmann  left  Vienna,  and  as  he  finds  he  cannot  endorse  them  he 
has  published  his  views  in  the  able  paper  now  before  us.  The  wealth  of 
material  available  to  Dr.  Engelmann  both  in  Vienna  and  in  Berlin 
was  very  considerable  and  has  formed  the  basis  of  this  elaborate 
communication,  which  is  largely  illustrated  by  microscopic 
drawings  copied  from  the  original  paper  by  Kundrat  and  Engelmann 
in  Strieker's  '  Jahrbuch.' 

Our  space  will  not  permit  us  to  do  more  than  very  briefly  refer  to 
Dr.  Engelmann' s  researches;  we  must,  therefore,  in  justice  to  the 
author,  ask  those  who  are  interested  in  the  subject  to  follow  the 
whole  of  the  arguments  adduced  in  the  original  paper. 

We  may  say,  however,  that  Dr.  Engelmann  dissents  from  the 
views  ordinarily  accepted  respecting  the  character  and  behaviour  of 
the  uterine  mucous  membrane,  whether  in  the  impregnated  or  un- 
impregnated  state.  He  does  not  agree  with  the  view  that  the 
mucous  membrane  of  the  uterus  is  shed  at  every  menstrual  period  ; 
and  he  asserts  that  the  evidence  we  have  of  the  simultaneous 
occurrence  of  menstruation  and  ovulation  is,  in  his  judgment,  con- 
clusive. "With  respect  to  the  very  important  subject  of  the  forma- 
tion of  the  placenta  Dr.  Engelmann  avers  that  the  uterine,  or 
maternal,  part  of  this  organ  is  formed  '*  only  of  the  most  superficial 
of  the  dense  upper  layers  of  the  serotina  and  in  its  greatest  extent 
of  the  prottiberances  which  spring  from  these  and  envelop  the  rami- 
fications of  the  villi  in  their  growth."  He  denies  that  the  chorion 
villi  dip  into  the  glandular  ducts. 


1875.]  Report  on  Midwifery,  §•<?.  481 

Dr.  Engelmaim's  able  paper  is  deserving  of  careful  study. 

5.  Dr.  Keith  concludes  the  narration  of  these  cases  with  some 
valuable  remarks.  He  states  that  these  are  the  only  instances  in 
which  he  has  interfered  with  uterine  tumours  by  abdominal  section. 
He  generally  declines  to  operate.  These  cases  are,  he  says,  enough 
to  satisfy  him  that  the  removal  of  an  enlarged  uterus  and  ovaries  is 
not  an  operation  to  be  lightly  undertaken.  Haemorrhage  may  be 
severe,  and  the  personal  attendance  necessary  in  each  of  the  three 
cases  was,  Dr.  Keith  remarks,  greater  than  half  a  dozen  ordinary 
cases  of  ovariotomy.  Still  Dr.  Keith  is  hopeful  that,  with  the  pro- 
gress of  science,  something  may  be  practicable  for  the  relief  of 
patients  afflicted  with  these  growths,  and  he  concludes  as  follows : 

*'  Though  the  greater  number  of  uterine  tumours,  if  not  malignant, 
give  little  trouble,  rarely  interfering  with  life,  and  often  not  even  with 
the  comfort  of  the  patient,  yet  in  a  certain  number  they  cause  the 
subjects  of  them  to  lead  useless,  dependent,  miserable  lives,  full  of 
suffering,  ending  only  with  life.  I  hope  the  time  is  not  far  distant 
when  many  of  these  unfortunates  will  look  to  surgery  for  relief  with 
as  much  confidence  as  those  afflicted  with  ovarian  disease  now 
do." 

6.  Dr.Gueneau  de  Mussy  having  recently  made  use  of  this  method 
of  treatment,  records  his  experience  of  it.  He  gives  particulars  of 
two  cases,  in  both  of  which  cessation  of  haemorrhage  followed  the 
application  of  heat  to  the  lumbar  region  by  means  of  Chapman's 
bags  ;  but  also,  it  is  very  important  to  note,  some  singular  and  rather 
alarming  phenomena  ensued. 

In  the  first  case  the  only  pathological  conditions  noted  about  the 
uterus  were  the  existence  of  pelvic  adhesions  on  the  right  side 
and  some  ovarian  tenderness.  Various  means  were  unsuccessfully 
employed  to  arrest  the  haemorrhage.  Dr.  de  Mussy  then  resorted 
to  the  bags  of  hot  water,  which  in  one  day  materially  diminished 
the  flow,  and  in  two  days  arrested  it.  By  this  time  the  patient 
complained  of  pains  in  the  lower  portion  of  the  body  and  in  the 
head,  and  very  shortly  she  was  seized  with  intense  dyspnoea  and  spat 
an  ounce  or  two  of  blood.  Examination  of  the  chest  revealed  sub- 
clavicular dulnets  on  the  right  side,  and  sub-bronchitic  expiration.  In 
nine  or  ten  days  this  "  adenopathie  bronchique,"  as  Dr.  de  Mussy 
terms  it,  had  materially  improved.  In  another  month  the  menses 
reappeared,  the  flow  being  considerable,  but  in  view  of  past 
experience  with  the  hot  bags  Dr.  de  Mussy  waited  five  days  before 
interfering.  Then,  however,  as  the  patient  had  faintings  and  the 
loss  of  blood  amounted  to  a  flooding,  the  hot  bags  were  again 
applied,  and  again  the  application  of  them  was  followed  by  the  same 
phenomena;  the  metrorrhagia  was  arrested,  iliac  and  sub-pubic 
pains  increased,  and  haemoptysis  recurred.  Some  time  elapsed 
before  the  pulmonary  symptoms  had  disappeared,  and  in  fact  they 
did  not  entirely  do  so  until  the  warm  weather  came.  The  monor- 
rhagia was  less  at  the  subsequent  periods. 

In  the  second  case  there  had  probably  been  a  miscarriage  two 
months  before  treatment  was  commenced.    The  uterus  was  rather 


482  Chronicle  of  Medical  Science,  [Oct., 

large  and  was  retroverted.  Here  the  employment  of  tbe  hot 
bags  was  attended  by  arrest  of  the  haemorrhage,  but  also  by  flush- 
ings, a  sense  of  weight  about  the  head,  and  on  several  occasions  she 
was  on  the  point  of  losing  consciousness.  The  hsemorrhage  was 
cured,  however,  and  the  physical  condition  of  the  uterus  was  found 
on  examination  some  days  afterwards  to  have  materially  improved. 

Dr.  de  Mussy  says  that  he  was  led  to  the  employment  of  Chap- 
man's bags  not  only  by  the  failure  of  all  treatment,  local  and 
general,  already  adopted,  but  also  because  of  the  confidence  that 
Trousseau  used  to  have  in  the  use  of  hot  injections  for  metror- 
rhagia. 

In  reference  to  the  causation  of  the  uterine  haemorrhage,  and  the 
sudden  supervention  of  haemoptysis,  he  says  that  he  is  inclined  to 
regard  the  uterine  haemorrhage  as  being  caused  by  the  presence  of 
tubercle  in  the  broad  ligaments  or  ovaries,  thus  expressing  the 
haemorrhagic  tendency  of  tubercle  which  is  encountered  whatever  may 
be  its  seat.  The  pulmonary  lesion  he  regards  as  existing,  but  being 
masked  by  the  uterine  haemorrhage,  becoming  active,  however,  after 
the  suppression  of  that  powerful  derivative. 

7.  Dr.  Chadwick,  in  a  paper  on  two  interesting  cases  of  ovariotomy, 
read  before  an  American  medical  society  a  few  months  ago,  makes 
mention  of  a  new  procedure  adopted  by  him  to  facilitate  diagnosis 
in  an  obscure  case  of  abdominal  tumour  which  was  complicated  by 
by  ascites.  He  put  the  patient  in  the  knee-elbow  posture,  with  the 
idea  that  if  the  tumour  were  a  fibroid  its  weight  would  cause  it  to 
sink  in  the  ascitic  fluid  until  it  rested  on  the  abdominal  walls.  A 
thin- walled  ovarian  cyst,  on  the  other  hand,  would  be  scarcely  heavier 
than  the  ascitic  fluid ;  it  would  consequently  not  change  its  position 
materially  on  change  of  the  patient's  posture.  Two  contingencies 
might  nullify  the  inference  to  be  drawn  from  these  indications — the 
presence  of  pelvic  adhesions,  and  a  partially  solid  character  of  an 
ovarian  tumour.  The  method  is  of  course  only  applicable  to  small 
and  medium-sized  tumours  surrounded  by  a  considerable  amount  of 
ascitic  fluid.  Governed  by  these  considerations  Dr.  Chadwick 
diagnosed  in  the  second  of  his  cases  an  ovarian  cyst,  probably 
unilocular,  free  from  adhesions,  and  with  no  solid  part,  but  surrounded 
by  a  varying  amount  of  ascitic  fluid.  The  accuracy  of  this  diagnosis 
was  verified  at  the  operation. 

In  the  same  paper  Dr.  Chadwick  suggests  that  when  puncture  of 
the  intestines  by  means  of  the  aspirator  becomes  necessary  for  the 
relief  of  flatulent  distension  of  the  abdomen,  advantage  might  be 
taken  of  the  presence  of  the  canula  in  the  bowel  to  administer  brandy, 
beef -tea,  &c.,  after  the  escape  of  the  gas. 

Dr.  Chadwick' s  excellent  paper  is  characterised  by  a  pleasing 
calmness  of  tone.  It  is,  moreover,  a  very  useful  contribution  to  the 
subject  of  ovariotomy. 

(8.)  Dr.  Bouyer,  of  Angouleme,  relates  the  particulars  of  an 
interesting  case  which  occurred  in  the  person  of  a  woman  aged  49 
years,  who  had  shown  signs  of  unusual  abdominal  enlargement  at  the 
age  of  14,  but  who  was  not  subjected  to  puncture  until  her  25th  year. 


1875.]  Report  on  Midwifery,  i^c.  483 

When  she  was  seen  by  Dr.  Bouyer  in  August,  1874,  he  diagnosed 
an  ovarian  cyst  without  adhesions,  and  advised  ovariotomy.  This 
he  successfully  performed.  In  spite  of  the  frequent  punctures  no 
adhesions  existed.  The  pedicle  was  transfixed  in  the  abdominal 
wound  by  means  of  a  pin  passing  through  it  and  the  abdominal 
parietes.  The  patient  got  almost  well,  but,  in  spite  of  warnings,  per- 
sisted in  going  to  stool  in  severe  weather  very  lightly  clad,  and 
thus  got  chilled,  and  died  of  pneumonia  twenty-one  days  after  the 
operation. 

Diseases  or  Childeen. 

1.  On  Aphasia  in  Children.     By  Dr.  A.  Clabus  (' Jahrbuch  fiir 

Kinderheilk.,'  pp.  369-400,  July,  1874). 

2.  Cerehroscopic  Review  of  the  Paris  Hospital  for  Sich  Children  in 

1874.     By  M.  Bouchut  ('  Gazette  des   Hopitaux,'  January, 
1875). 

3.  Skin  'Eruption  in  a  Child  caused  by  JBroonide  of  Potassium  taken  hy 

the  Mother.     By  Dr.  Tilbury  Fox  ('Lancet,'  Nov.  7,  1874). 

4.  Imperfect    Teeth    and    Zonular  Cataract.      By  Mr.  Jonathan 

HrTCHiNSON  ('  Lancet,'  March  6th,  1875). 

5.  On  the  Treatment  of  Prolapsus  Ani  in  Children.     By  Dr.  G-UAL- 

TiERO  LoEiGiOLA  aud  Baron  von  Langenbeck. 

6.  On  Croup  and  Diphtheria.  By  Sir  "William  Jennee,  Bart.,  M.D., 

E.E.S.,  and  Dr.  Geoege  Johnson,  F.E.S.  ('  Lancet,'  January 
2nd  and  16th,  1875). 

7.  Purpura  Hcemorrhagica,  transmitted  from  the  Mother  to  the  Foetus. 

By  Professor  DoHEN  ('Arch,  fiir  Gynsek.,'  Band  vi,  p.  486, 1874). 

8.  Laceration  of  the  Navel   String.      By    Dr.    W.    Peannkuch 

('Arch,  fiir  Gyneek.,'  Band  vii  Heft,  1,  1875). 

9.  Acute  Pemphigus  of  the  Newly -horn  and  of  Young  Children.     By 

Ladislas    Falot,  M.D.    ('Annales   de   Gynsecologie,'  July, 
1875). 

10.  Successful  Ovariotomy  in  a  Child  seven  and  a  half  years  old.     By 

Geoege  Cupples,   M.D.    ('  Eichmond  and  Louisville   Med. 
Journ.,'  Jan.,  1875). 

11.  On  the  Breasts  of  Newly -horn  Infants.  By  Dr.  he  Sinett  ('Arch. 

de  Tocologie,'  June,,  1875). 

12.  On  Trismus  Nascentium.     By  Dr.  Wilhite  (' Amer.  Journ.  of 

Med.  Sc.,'  April,  1875). 

1.  The  interesting  lesion  which  is  the  subject  of  this  memoir 
has  been  largely  studied  in  adults  by  many  very  able  physicians 
both  in  this  country  and  abroad,  but  so  far  as  we  know  special 
observations  of  the  affection,  as  it  is  seen  in  children,  have  not 
hitherto  been  made,  or  at  least  have  not  yet  been  published  in  a 
connected  form. 

The  following  is  a  condensed  summary  of  the  principal  groups 
of  diseases  in  which  aphasia  has  been  observed  in  children : 

i.  Aphasia  in  idiot  and  deaf-mute  children. — May  be  congenital 
or  acquired  ;  is  caused  by  cerebral  lesions  ;  in  congenital  aphasia 


484  Chronicle  of  Medical  Science.  [Oct., 

the  most  frequent  alteration  is  a  partial  atrophy  of  the  anterior 
lobes  of  the  brains.  In  acquired  idiocy  and  aphasia,  chronic  hydro- 
cephalus or  encephalitis  are  met  with.  Aphasia  may  occur  in 
early  childhood  from  repeated  attacks  of  epilepsy,  or  as  a  remote 
result  of  impaired  nutrition.  Idiotic  aphasia  may  be  explained  by 
the  absence  of  ideas  ;  that  of  deaf  mutes  by  default  of  perception 
of  articulate  sounds,  and  the  latter  may  accidentally  arise  in  cases 
in  which  deaf-mutism  follows  acute  diseases,  as  measles  and  scarlet 
fever. 

ii.  Aphasia  consecutive  to  acute  diseases. — This  variety  is  not 
rare ;  though  not  mentioned  in  treatises  on  children's  diseases ;  it  is 
especially  met  with  after  acute  specific  diseases,*particularly  after 
typhoid  and  other  eruptive  fevers. 

(1.)  Aphasia  following  typhoid  fever.  Dr.  Clarus's  account  of 
this  is  exceedingly  interesting.  It  appears  that  the  lesion  occurs 
nearly  always  in  boys,  and  between  the  ages  of  eight  and  eleven. 
The  epoch  at  which  it  appears  is  somewhat  variable,  but  generally 
it  occurs  late  in  the  course  of  the  fever.  In  most  of  the  cases  the 
attack  of  typhoid  w^as  severe.  In  a  fatal  case  which  occurred 
in  the  practice  of  Eisenschitz  no  grave  cerebral  lesion  was  found  at 
the  post-mortem  examination ;  and  it  is  probable  that  the  aphasia 
w^as  due  in  this,  as  in  the  great  majority  of  the  cases,  to  starving  of 
the  cerebral  substance  from  insufficient  nutrition.  Dr.  Clarus,  how- 
ever, himself  mentions  a  fatal  case  of  his  own  in  which  ramollisse- 
ment  was  found  consecutive  to  embolism  of  the  left  sylvian  artery. 

(2.)  Aphasia  consecutive  to  other  eruptive  fevers.  This  variety 
is  rarer  than  the  foregoing.  Here  again  the  lesion  occurs  more 
frequently  in  boys  than  in  girls,  and  the  age  varies  from  eight  to 
nine  years. 

iii.  Aphasia  consecutive  to  acute  cerehral  affections. — (1.)  Cerebral 
embolism.  Endocarditis  seems  to  be  the  most  common  pathogenic 
condition.  The  aphasia  may  be  complicated  by  hemiplegia  or  hemi- 
chorea,  and  there  may  be  cerebral  ramollissement.  It  is  w^orthy  of 
note  that,  in  two  cases  out  of  five  mentioned  by  the  author  (those 
of  Kelly  and  Lacambre),  the  cerebral  lesion  was  found  at  the 
autopsy  to  be  seated  in  the  right  hemisphere. 

(2.)  Aphasia  after  traumatic  lesions  of  the  encephalon  :  "  cerebral 
commotion "  is  said  to  have  caused  aphasia  in  two  cases  quoted, 
though  this  condition  is  believed  to  be  rare  in  children.  These  two 
cases  recovered — one  completely,  the  other  nearly  so.  Fractures 
were  associated  with  the  other  cases  mentioned. 

(3.)  Aphasia  after  inflammation  of  the  brain  and  its  meninges. 
(a)  Tubercle  and  abscess  of  the  brain.  The  only  case  of  this  kind 
known  to  the  author  is  one  of  Dr.  West's,  (h)  Tubercular  menin- 
gitis— one  case  by  Bouchut.  (c)  Encephalitis  and  abscess  of  the 
brain — a  case  of  Rilliet  and  Barthez. 

iv.  Aphasia  consecutive  to  chronic  affections  of  the  train. — This 
variety  is  relatively  frequent.  Cerebral  sclerosis  and  atrophy  may 
be  attended  by  aphasia  as  seen  in  idiocy. 

Cerehral  tumours, — These  do  not  appear  to  cause  aphasia  very 


1875.]  Report  on  Midwifery,  ^c.  485 

often,  compared  with  their  relative  frequcne\'.  It  appears  that  en- 
tuzoa  of  the  braiu  cause  aphasia  more  frequently  than  other  tumours  ; 
and  Dr.  Clarus  gives  six  cases  caused  by  hydatids  within  the 
eucephalon. 

V.  Aphasia  in  Neuroses, — Aphasia  has  been  known  to  follow 
convulsions  in  children.  Dr.  Hughlings  Jackson  has  recorded  two 
cases,  in  which,  however,  he  admits  the  possible  existence  of  a  patho- 
logical lesion  in  the  corpus  striatum.  Dr.  Ogle  has  in  this  Review 
shown  the  occurrence  of  aphasia  with  chorea,  and  so  has  Bouchut 
in  '  Bull.  Ge'n.  de  Therap.'  The  prognosis  in  these  cases  is  favorable. 
Aphasia  may  be  produced  reflexly,  and  in  particular  by  worms  in 
the  intestines. 

Prognosis. — It  is  obvious  that  the  prognosis  of  aphasia  in  children 
is  variable,  and  must  be  subordinate  to  the  causation  of  the  malady. 
G-enerally  speaking,  when  it  arises  in  the  course  of  acute  specific 
diseases,  the  prognosis  is  less  serious.  Much  the  same  may  be  said 
of  neurotic  aphasia.  But  in  the  congenital  cases,  and  in  those  due 
to  embolism  or  organic  lesion  of  the  brain,  the  prognosis  is  extremely 
grave. 

As  regards  treatment  there  is  none  very  special,  except  in  the 
cases  of  reflex  origin  (intestinal  worms),  and  perhaps  in  some  of 
the  traumatic  cases  in  which  spiculse  of  bone  are  injuring  the  brain. 

2.  In  a  few  introductory  remarks  Dr.  Bouchut  says,  that  the 
twelve  years  during  which  he  has  published  essays  on  cerebroscopy 
have  confirmed  his  view  of  the  importance  of  lesions  of  the  optie 
nerve,  of  the  retina,  and  of  the  choroid  produced  by  diseases  of  the 
brain,  meninges,  and  the  spinal  chord.  Some  of  the  lesions  dis- 
covered by  the  ophthalmoscope  are  of  themselves  diagnostic,  as 
retinal  thromboses,  miliary  aneurisms  of  the  retinal  artery,  certain 
"  steatoses "  of  the  retina,  tubercles  of  the  choroid,  &c.  Dr. 
Bouchut  says  that  all  the  neurites,  neuro-retinites  or  choroidites 
are  formed  according  to  laws  which  he  formulated  long  ago,  and 
which  are  immutable.     They  are — 

(1.)  Neuro-retiuitis  of  mechanical  origin,  when  an  obstacle  to  the 
meningeal  circulation  (meningitis  or  acute  hydrocephalus,  meningeal 
eff*usion,  tumour  compressing  the  encephalon,  thromboses  of  the 
meningeal  veins,  &c.),  hinders  the  return  of  blood  within  the 
cranium.  Thus  the  serosity  of  the  subarachnoid  space  descends  as 
far  as  the  sheath  of  the  optic  nerve,  as  has  been  established  by  Key 
and  Schwalbe,  compresses  the  nerve  in  such  a  way  as  to  narrow  the 
retinal  artery  and  to  retain  within  the  eye  the  blood  of  the  retinal 
veins. 

HypersBmia  with  papillary  oedema  is  thus  produced ;  a  dilatation 
and  a  varicosity  with  thrombosis  of  the  retinal  veins  involve  more 
or  less  quickly  alterations  in  the  nutrition  of  the  optic  nerve  and 
retina. 

(2.)  A  descending  neuritis  when  chronic  inflammation  of  the  brain 
or  cerebellum  descends  by  the  optic  nerve  to  the  papillse.  This  is 
the  case  with  tumours  of  the  brain  or  cerebellum. 

(3.)  An  ascending  rejiex  neuritis  resulting  from  diseases  of  the 


486  Chronicle  of  Medical  Science,  [Oct., 

spinal  cord  in  ataxy,  chorea,  &c.  This  is  the  effect  of  the  action  of 
the  great  sympathetic  which  takes  its  origin  in  dorsal  region  of  the 
cord. 

(4.)  A  diathetic  neuritis  or  choroiditis  which  reveals  tuberculosis, 
leucaemia,  syphilis,  glycosuria,  &c.  Hence  arise  those  cases  of 
tubercular  neuritis  and  choroiditis,  of  sypliilitic  choroiditis,  of  leu- 
caemic,  glycosuric,  or  albuminuric  retinitis  which  everybody  is 
beginning  to  know  of. 

These  .are  the  different  kinds  of  lesions  of  which  Dr.  Bouchut 
affirms  anew  the  existence  in  the  cases  reported  in  his  service,  many 
of  which  were  verified  by  autopsy.  The  long  series  of  cases  briefly 
narrated  include  cases  of  traumatic  meningeal  haemorrhage,  typhoid 
meningitis,  tubercular  meningitis,  granular  meningitis,  meningitis 
with  consecutive  hemiplegia,  tubercular  meningitis  and  vertebral 
caries,  cerebral  haemorrhage,  tumour  of  the  brain,  acute  traumatic 
myelitis,  paraplegia  with  contraction,  convulsions  after  measles, 
infantile  paralysis,  diphtheritic  paralysis,  chorea  with  optic  neuritis, 
hemichorea,  tubercular  pneumonia — a  most  instructive  and  valuable 
series  of  cases  all  observed  in  a  children's  hospital. 

Dr.  Bouchut  truly  says  that  the  ophthalmoscope  has  become  as 
indispensable  to  the  physician  as  to  the  oculist.  He  says  that  the 
evidence  ascertained  by  the  ophthalmoscope  shows  that  chorea,  con- 
sidered by  many  physicians  as  a  simple  neurosis,  is  to  be  referred  to 
a  congestive  affection  of  the  anterior  columns  of  the  spinal  marrow, 
and  refers  to  his  observations  here  given  in  proof  of  this  statement. 

Hysterical  paralysis  or  paraplegia  do  not  cause  any  neuro-retinal 
alteration,  while  those  which  are  symptomatic  of  myelitis  and  spinal 
ataxies  do.  Dr.  Bouchut  thinks  the  ophthalmoscope  remarkably 
valuable  in  those  cases  of  acute  general  tuberculosis  which  are 
accompanied  by  typhoid  symptoms,  and  which  may  therefore  be  mis- 
taken for  typhoid  fever,  and  he  gives  a  fatal  case  in  which  the  cor- 
rectness of  the  diagnosis  made  by  the  ophthalmoscope  was  fully 
verified  by  the  discovery  after  death  o£  tubercle  throughout  the 
body. 

In  illustration  of  the  great  value  of  ophthalmoscopic  examination 
he  says  thus — 

"From  hypersemia  and  hypersemic  swelling  of  the  optic  nerve 
result  the  diagnosis  of  mechanical  or  inflammatory  hyperaemia  of 
the  brain  in  meningitis,  in  cerebral  haemorrhage,  in  cerebral  effusions, 
and  in  some  cases  the  diagnosis  of  ataxic  or  other  spinal  diseases. 

"  By  papillary  oedema,  combined  wnth  hyperaemia,  I  recognise 
oedema  of  the  meninges  or  impediment  to  the  cerebral  circulation, 
determined  by  meningitis,  by  certain  cerebral  tumours,  by  ventricu- 
lar hydrocephalus,  by  cerebral  haemorrhage  and  meningitic  effusions, 
by  thrombosis  of  the  sinues,  &c. 

'*  By  neuro-retinal  and  choroidal  anaemia  I  recognise  the  cerebral 
haemorrhage  of  ramollissement,  and  if  the  anaemia  is  absolute  it 
means  death.  Arteries  and  veins  of  the  eye  empty  of  blood,  and 
the  choroid  mesh  exsanguine,  that  is  arrest  of  the  cerebral  and 
cardiac  circulation. 


1875.]  Report  on  Midwifery,  ^c.  487 

"  By  optic  neuro-retinitis,  exudative  and  fatty,  I  recognise  chronic 
meningo-enceplialitis  ;  the  encephalitis  of  cerebral  tumours,  and  the 
alteration  of  nervous  substance  which  accompanies  these  tumours. 

"  By  retinal  varices  and  thromboses  I  distinguish  thromboses  of 
the  meninges  or  of  the  sinuses. 

"  By  aneurisms  of  the  retinal  arteries  we  recognise  miliary  aneurisms 
of  the  brain. 

"  By  simple  retinal  haemorrhages  one  recognises  compression  of  the 
brain  by  effusion,  haemorrhagic,  or  other ;  but  if  these  haBmorrhages 
are  accompanied  by  retinal  steatosis  it  is  because  there  is  cerebral 
steatosis,  and  this  is  the  case  in  chronic  albuminuria,  leucocythaemia, 
and  glycosuria. 

"  By  atrophy  of  the  optic  nerve  one  distinguishes  tumours  of  the 
brain  and  cerebral  or  spinal  sclerosis. 

*' Lastly,  we  do  not  get  tubercular  granulations  in  the  choroid 
without  there  being  similar  ones  in  the  lungs  and  other  organs." 

We  are  glad  to  note  that  Dr.  Bouchut  promises  to  publish  an 
'  Atlas  of  Medical  Ophthalmoscopy,'  which  he  is  preparing. 

3.  Dr.  Pox  here  records  a  fact  which  has  not  hitherto,  it  is 
believed,  been  observed. 

A  child  three  months  old  had  an  eruption  which,  at  first  sight, 
seemed  to  be  probably  due  to  vaccination.  The  child  had  been 
vaccinated  about  a  month  before  it  was  seen  by  Dr.  Fox,  but  some 
pimples  had  been  observed  on  the  cheeks  about  six  days  after  the 
vaccination.  These  gradually  spread,  so  that  when  the  child  was 
brought  to  the  hospital  there  were  acneiform  spots  on  various  parts 
of  the  body. 

There  was  no  constitutional  syphilis. 

Becognising  the  resemblance  of  the  eruption  to  that  caused  by 
taking  bromide  of  potassium,  Dr.  Fox  made  inquiry  whether  that 
drug  had  been  taken,  and  it  turned  out  that  the  mother  had  been 
taking  it  for  the  previous  eighteen  or  twenty  months  for  epilepsy. 

The  medicine  was  discontinued,  and  the  eruption  at  once  began 
to  disappear.  She  then  resumed  it,  and  very  speedily  a  fresh  out- 
break of  the  eruption  occurred.  It  is  curious  that  the  mother  her- 
self had  not  had  any  eruption  on  the  skin. 

4.  In  an  able  communication  read  before  the  Pathological  Society 
on  March  2nd,  1875,  Mr.  Hutchinson  has  made  some  very  interesting 
statements  which  deserve  the  attention  of  all  who  see  much  of 
children's  diseases. 

Mr.  Hutchinson  says  that  for  some  years  past  it  has  been  a  matter 
of  general  knowledge  amongst  ophthalmic  surgeons  that  when  children 
are  the  subjects  of  cataract  they  usually  show  also  badly  developed 
teeth ;  the  malformation  of  the  teeth  being  variously  ascribed  to 
congenital  syphilis,  rickets,  and  general  defective  development.  Im- 
perfect teeth  of  the  kind  referred  to  by  Mr.  Hutchinson  are,  he 
believes,  met  with  in  connection  with  but  one  form  of  the  cataract 
of  childhood,  namely,  the  "  lamellar  "  or  "  zonular  "  form.  There 
may  be  fair  vision  with  this  cataract,  which  is  believed  to  be  invariably 
symmetrical.    It  does  not  appear  to  be  associated  with  any  particular 


48S  Chronicle  of  Medical  Science,  [Oct., 

diathesis,  and  it  is  very  exceptional  to  meet  with  it  in  more  than  one 
child  in  a  family.  These  tucfcs  lead  to  the  inference  that  it  is  pro- 
bably the  record  of  some  temporary  disturbance  iQ  the  nutrition  of 
the  lens  rather  than  the  result  of  any  permanent  impairment  of  the 
patient's  health.  It  seems  to  be  a  disease  of  the  earlier  years  of 
childhood.  The  congenital  cataract  belongs,  Mr.  Hutchinson  thinks, 
to  an  entirely  different  category. 

The  condition  of  teeth  observed  in  this  form  of  cataract  is  said  to 
be  wholly  different  from  that  met  with  in  congenital  syphilis,  and 
consists  not  so  mucli  in  alteration  in  the  form  of  the  teeth  as  in 
defective  development  of  the  enamel.  This  may  occur  in  association 
with  the  malformations  which  characterise  hereditary  syphilis,  and 
hence,  doubtless,  the  confusion. 

The  incisors,  canines,  and  first  molars  suffer  most,  the  bicuspids 
escaping  entirely.  It  appears  that  i\iQ  permanent  teeth  alone  exhibit 
changes  which  can  be  relied  upon  for  diagnosis.  Tliey  are  pitted, 
dirty,  broken,  and  display  sharp  edges.  Non-development  of  enamel 
and  erosion  of  the  exposed  dentine  appear  to  be  the  especial  features. 
A  point  of  singular  interest  is,  that  there  is  usually  a  history  of  con- 
vulsions in  early  infancy  in  cases  of  lamellar  cataract,  an  observa- 
tion which  we  owe  to  Arlt,  and  which  is  confirmed  by  Mr.  Hutchinson. 
Another  important  point  resulting  from  this  is,  that  it  appears  from 
inquiry  that  these  defects  of  the  teeth  usually  result  from  attacks  of 
inflammation  of  the  gums  in  early  infancy,  and  that  mercury  holds 
the  chief  place  in  the  causation  of  stomatitis.  Should  this  prove  to 
be  so,  it  has  obviously  a  very  important  bearing  on  the  propriety  of 
using  mercury  in  the  diseases  of  infancy.  It  appears  that  inquiries 
into  cases  of  lamellar  cataract  lead  to  the  belief  that  the  connection 
between  this  form  of  cataract  and  fits  is  almost  universal.  Mr. 
Hutchinson  considers  the  connection  of  the  malformation  with 
rickets  entirely  wanting  in  proof. 

Mr.  Hutchinson  sums  up  his  results  as  follows  : 

"  1.  That  it  is  exceptional  to  meet  with  lamellar  cataract  excepting 
in  association  with  an  imperfect  development  of  the  enamel  of  the 
teeth,  but  that  definite  exceptions,  in  which  the  teeth  are  quite 
perfect,  do  occur. 

"2.  That  the  kind  of  defect  observed  consists  in  the  absence  of 
the  enamel,  and  is  shown  on  the  incisors,  canines,  and  first  molars 
of  the  'permanent  set  to  the  almost  invariable  exemption  of  the  pre- 
molars. That  for  purposes  of  diagnosis  the  first  molars  are  by  far 
the  most  important,  and  may  rank  as  the  test  teeth  since  they  not 
unfrequently  show  the  defect  when  others  escape. 

*'  3.  That  it  is  highly  probable  that  the  defects  in  the  development 
of  the  teeth  are  usually  due  to  the  influence  of  mercury  exhibited 
during  infancy,  although  it  is  quite  possible  that  other  influences, 
attended  perhaps  by  inflammation  of  the  gums,  may  occasionally 
produce  similar  results. 

"  4.  That  teeth  of  the  kind  alluded  to  are  met  with  very  often  in 
persons  who  are  not  the  subjects  of  zonular  cataract?. 


1875.]  Report  on  Midiviferi/,  ^c.  ^  48& 

"5.  That  it  is  very  rare  to  find  lamellar  cataracts  without  history 
of  convulsions  in  infancy. 

*'6.  That  there  is  probably  no  direct  connection  between  the 
occurrence  of  convulsions  in  infancy  and  the  development  of  lamellar 
cataract. 

"  7.  That  whilst  there  is  every  reason  to  believe  that  the  defective 
teeth  which  are  met  with  in  connection  with  zonular  cataract  are  the 
results  o£  mercury,  the  evidence  seems  opposed  to  the  belief  that 
the  lenticular  opacity  is  due  to  the  influence  of  the  drug. 

"  8.  That  the  very  frequent  coincident  occurrence  of  lamellae  with 
defective  teeth  is  to  be  explained  by  reference  to  the  frequency  with 
which  mercury  is  given  for  the  treatment  of  convulsions  in  infancy. 

"  9.  That  there  is  no  reason  whatever  for  supposing  that  lamellar 
cataracts  have  any  connection  with  hereditary  syphilis. 

"  10.  That  whilst  it  is  certainly  true  that  lamellar  cataracts  are 
commonly  met  with  in  young  persons  who  show  general  defects  of 
development — short  stature,  ill-shaped  heads,  defective  intellect, 
dwarfed  lower  jaws,  or  other  physiognomical  peculiarities — yet  there 
is  seldom  any  proof  of  the  existence  of  rickets,  whilst  it  is  quite 
possible  that  the  particulars  mentioned  may  be  due  to  the  disturbance 
of  the  nervous  system  in  infancy  in  connection  with  the  convulsions. 

"  11.  It  is  very  important  to  distinguish  between  mercurial  teeth 
and  syphilitic  teeth  ;  that  the  peculiarities  presented  by  each  usually 
render  this  easy,  whilst,  however,  the  two  are,  as  might  have  been 
expected,  not  uncommonly  met  with  together." 

5.  In  the  "  Report  on  Midwifery  and  the  Diseases  of  Women  and 
Children"  published  in  the  October  (1871)  number  of  this  '  Review,' 
there  was  a  reference  to  the  use  of  the  actual  cautery  in  prolapse  of 
the  rectum  in  young  children  proposed  by  M.  Panas,  respecting 
which  Dr.  Lorigiola  has  kindly  addresised  a  letter  to  the  reporter 
expressing  his  astonishment  at  the  use  of  the  actual  cautery  in  this 
affection,  and  recommending  the  subcutaneous  injection  of  a  solution 
of  strychnine  into  the  tissues  near  the  anus. 

Dr.  Lorigiola  says  he  has  for  a  long  time  used  with  great  success  a 
solution  of  sulphate  of  strychnia,  and  that  he  has  thus  treated  six 
cases,  none  of  which  required  more  than  two  injections.  Dr.  Lorigiola's 
formula  for  the  solution  is  as  follows  : — 

1^     Sulphatis  Sfcrychnise. 

Centigramtna  duodecim. 
Solve  in 

Aqua  font,  destil. 

Gramma  duodecim. 
Filtra  per  chartam. 

The  quantity  required  for  each  injection  is,  Dr.  Lorigiola  states, 
from  four  to  twent}''  drops,  according  to  age.  The  learned  doctor 
says  that  the  operation  is  painless  and  is  never  followed  by  poisonous 
effects.  Converted  into  English  equivalents,  Dr.  Lorigiola's  solution 
will  represent  one  grain  and  four  ffths  of  sulphate  of  strychnia  and 
three  drachms  of  water.  Dr.  Lorigiola,  who  is  Chirurgo  Primario 
del  Civico  Ospedale  di  Rovigo,  will  doubtless  be  glad  to  learn  that 


490  Chronicle  of  Medical  Science.  [Oct., 

Baron  von  Langenbeck,  the  distinguished  German  surgeon,  has 
obtained  excellent  results  from  a  less  dangerous  drug  than  strychnine, 
which,  liowever  safe  in  the  hands  of  so  able  and  accomplished  a  sur- 
geon as  Dr.  Lorigiola,  cannot  be  regarded  as  quite  devoid  of  risk 
when  injected  subcutaneously.  Baron  von  Langenbeck,  in  a  com- 
munication on  the  employment  of  ergotine  in  surgery  ('  Berlin  Klin. 
"Wochenschrift,'  No.  52,  1873),  states  that  he  has  successfully  used 
ergotine  in  cases  of  procidentia,  invagination,  or  intussusception  of  the 
rectum.     The  solution  is  injected  into  the  peri-rectal  tissue. 

This  method  of  treatment  certainly  deserves  attention  in  a  disorder 
so  troublesome  as  prolapsus  aui. 

6.  Two  communications  on  the  relation  of  croup  and  diphtheria 
to  each  other  appeared  a  little  while  since  in  the  same  numbers  of 
the  •  Lancet'  from,  respectively,  the  two  able  physicians  above  named. 
The  importance  of  these  papers  cannot  be  over-estimated.  They 
embody  the  latest  thoughts,  reflections,  researches,  and  observations 
of  two  singularly  competent  scientific  physicians,  and  as  such  are 
entitled  to  our  careful  and  respectful  consideration,  not  alone 
because  of  the  eminence  and  competence  of  the  physicians  iu 
question,  but  also  on  account  of  the  importance  of  the  views  pro- 
pounded and  conclusions  set  forth  by  them.  The  chief  and  most 
weighty  conclusion  advanced  is  nothing  less  than  that  croup  and 
diphtheria  are  identical.  This  clinically  most  important  statement 
is  one  which,  when  duly  confirmed,  as  it  doubtless  will  be  by  many 
other  observers,  will  form  a  definite  advance  in  practical  medicine, 
inasmuch  as  it  simplifies  our  knowledge  of  disease,  and  fortifies  us 
in  the  treatment  of  it.  It  should  not  be  forgotten  that  the  same 
opinion  was  long  since  advanced  by  Bretonneau,  of  Tours,  and 
upheld  in  this  country  by  Dr.  Semple,  though  not  generally 
accepted. 

It  is  obvious  that  if  these  views  prevail  the  belief  that  has  hitherto 
obtained  that  croup  is  essentially  a  disease  peculiar  to  children  must 
be  materially  modified.  Diphtheria,  as  every  one  knows,  is  not 
confined  to  childhood,  though  many  of  its  peculiar  manifestations 
may  be  remarkably  pronounced  in  the  earlier  years  of  life,  e.  g. 
difficulties  of  respiration,  owing  to  the  relative  smallness  of  the 
larynx  and  the  marked  tendency  to  spasm  seen  in  children.  Of 
course,  it  must  be  clearly  understood  that  laryngismus  stridulus, 
**  spasmodic"  or  '*  false  croup,"  as  it  is  called — a  disease  which  is 
quite  peculiar  to  infants — is  not  in  question.  What  has  hitherto 
been  known  as  **  true  croup,"  croup  attended  by  exudation,  is  now 
declared  to  be  really  due  to  diphtheria,  abundant  evidence  being 
adduced  in  support  of  this  view.  Sir  W.  Jenner  says  that  diphtheria 
commencing  in  the  larynx  is  exceedingly  rare,  that  is,  that  it  is  very 
rare  to  get  the  exudation  first  in  the  larynx.  Usually  it  commences 
in  the  pharynx  and  spreads  downwards  into  the  larynx.  It  is, 
therefore,  important  that  in  all  cases  of  "  croup"  the  pharynx  should 
be  at  once  examined. 

Catarrhal  laryngitis  with  spasm  is  readily  cured  by  emetics,  not 
so,  of  course,  with  those  cases  of  "croup"  which  are  due,  as  Sir 


1875.] 


Report  on  Midwifery ^  ^c,  491 


W.  Jenner  says  all  cases  of  "  true  croup  "  are,  to  dipbtheria.  Later 
years  have  satisfied  him  that  in  cases  which  presented  all  the  charac- 
ters of  "true  croup,"  which  are  sporadic,  spread  to  no  other  person 
in  the  house,  come  on  apparently  from  exposure  to  cold  and  damp, 
are  attended  by  albumen  in  the  urine,  a  symptom  which  formerly 
he  thought  only  present  in  diphtheric  cases.  The  anatomical 
ciiaracters  of  "  true  croup  "  and  diphtheria  being  undistinguishable 
by  the  best  pathological  anatomists,  the  clinical  features  being  the 
same,  Sir  W.  Jenner  practically  pronounces  for  the  identity  of  the 
two  affections  in  the  following  words  : — "  So  my  opinion  has  under- 
gone some  modification,  and  I  am  inclined  now  to  the  belief  that 
there  is  no  such  disease  as  idiopathic,  simple,  membranous  inflam- 
mation of  the  larynx.  I  say  I  am  inclined  to  this  belief.  I  am  not 
sure  that  it  is  true;  but  as  I  formerly  thought  that  the  weight  of 
evidence  was  in  favour  of  their  non-identity,  I  am  now  inclined, 
from  my  further  experience,  to  think  that  the  two  diseases  are 
really  identical,  that  the  so-called  croup  is  really  diphtheria." 

Dr.  Greorge  Johnson  is  more  emphatic.  He  states  in  that  part 
of  his  excellent  contribution  which  deals  with  the  pathology  of 
diphtheria  :  "  I  wish  to  express  emphatically  my  entire  concurrence 
in  the  conclusion  long  since  arrived  at  by  Bretonneau,  Trousseau, 
and  all  the  leading  French  pathologists,  that  all  cases  of  so-called 
croup  which  are  associated  with  the  formation  of  false  membranes 
in  the  air-passages  are  essentially  diphtheritic ;  and,  on  the  other 
hand,  that  what  we  in  this  country  call  inflammatory  croup,  or 
catarrhal  laryngitis,  never  results  in  the  formation  of  false  membrane." 

To  those  practising  amongst  children  the  foregoing  statements 
must  be  of  singular  interest  and  importance  ;  for  it  is  obvious  that 
enlightenment  on  the  pathology  o£  the  affections  should  bring  im- 
provement in  their  therapeutical  management.  Probably  the  old 
heroic  treatment  for  "croup " — bleeding,  calomel,  tartar  emetic,  and 
other  *'  depressants  " — has  long  been  on  the  wane  among  the  best 
practitioners,  and  it  is  to  be  hoped  that  it  has  now  received  its 
death-blow,  and  that  a  more  generous  and  supporting  medication 
will  supplant  it. 

7.  Professor  Dohrn,  of  Marburg,  relates  a  case  of  this  rare  descrip- 
tion. The  mother  was  41  years  old,  and  this  was  her  second 
pregnancy.  She  entered  Dr.  Dohrn's  clinic  with  the  characteristic 
symptoms  of  well-marked  purpura,  which  appeared  at  the  beginning 
of  the  eighth  month  of  pregnancy,  but  which  under  suitable  treat- 
ment had  almost  disappeared  at  the  time  of  delivery  at  full  term. 
The  labour  was  normal,  and  there  was  no  hsemorrhage  of  importance. 

The  child  at  birth  showed  purpuric  spots  resembling  those  of  the 
mother,  but  no  other  abnormity.  The  spots  were  rapidly  absorbed, 
as  also  were  some  which  appeared  after  birth. 

8.  Dr.  Pfannkuch  writing  on  this  subject  says  it  is  now  well 
proved  that  the  cord  can  be  spontaneously  lacerated  during  labour. 
This  may  be  produced  in  two  ways — either  by  general  stretching  or 
by  recoil.  The  first  can  only  rarely  happen,  for  since  the  fundus  of 
the  uterus  follows  the  advancing  child,  the  cord,  in  spite  of  ita 


49^  Chronicle  of  Medical  Science.  [Oct., 

frequent  coiling,  remaius  sufficienfc,  and  the  elasticity  of  the  tissues 
prevents  laceration  by  too  excessive  stretching.  The  second  occurs 
more  frequently.  In  this  way  the  cord  has  been  lacerated  whilst 
the  woman  was  lying  quietly  on  her  back,  the  child  being  expelled 
far  from  the  genitals.  The  most  common  cause  is  the  fall  of  the 
child  through  labour  coming  on  when  the  woman  is  in  an  unusual 
position,  as  when  standing.  The  author  has  made  a  series  of 
experiments  to  ascertain  the  force  required  to  lacerate  the  cord,  in 
the  following  way.  The  placenta  was  wrapped  up  in  a  piece  of 
coarse  linen  and  hung  freely  ;  the  navel  string  was  passed  through  a 
hole  in  the  middle  of  the  cloth,  and  to  its  end  a  bag  was  attached  to 
receive  the  weights.  In  a  first  series  of  experiments,  twelve  in 
number,  the  distance  fallen  through  was  equal  to  the  whole  length 
of  the  cord ;  in  two  cases  500  grammes  was  sufficient  to  tear 
through  the  cord.  But  as  in  labour  the  child  can  never  fall  through 
the  whole  length  of  the  cord,  a  second  series  of  experiments  was 
performed  when  the  distance  fallen  through  was  half  the  length  of 
the  cord.  Here  in  six  cases  the  cord  was  torn  through  by  a  weight 
of  700 — 1000  grammes  ;  in  the  other  cases  the  injury  was  so  severe 
that  a  slight  increase  of  the  weight  would  have  been  sufficient  to 
lacerate  the  cord.  The  anatomical  structure  of  the  cord  explains 
how  it  is  it  affords  so  little  resistance  to  a  sudden  laceration.  All 
the  parts  have  one  after  the  other  to  sustain  the  full  force  of 
the  lacerating  weight ;  first  the  amniotic  covering  in  the  concavity  is 
broken  through,  then  usually  the  arteries  follow,  then  the  vein,  and 
last  of  all  the  convexity  of  the  cord.  The  more  suddenly  the  force 
acts,  the  nearer  the  laceration  usually  is  to  the  point  of  application 
of  the  weight.  The  author  concludes  by  saying  that  in  all  cases  of 
labour  in  which  the  whole  weight  of  the  expelled  child  can  act  upon 
the  cord  there  is  not  only  the  greatest  probability,  but  it  is  almost 
certain  the  cord  will  be  lacerated. 

9,  Dr.  Faloy  defines  acute  pemphigus  of  the  newly  born  as 
follows  :  An  exanthematic,  cutaneous  disease,  nearly  always 
apyretic  and  without  gravity,  often  epidemic  and  sometimes  con- 
tagious, rarely  mortal,  characterised  by  a  discrete  or  general  erup- 
tion of  vesicles  which  develop  simultaneously  or  successively,  filled 
with  a  liquid  at  first  limpid,  then  opaque,  and  giving  rise  to  an 
epidermic  exfoliation  with  impetiginous  crusts  and  superficial 
ulcerations,  terminating  by  macula  which  gradually  disappear 
ultimately,  leaving  but  traces  of  the  phlegmasia  or  simple  solution 
of  the  continuity  of  the  tegumentary  surface. 

After  reviewing  the  difi'erent  opinions  of  authors  on  the  causes  of 
pemphigus  Dr.  Faloy  is  led  by  the  observations  he  has  made  to  the 
opinion  that  neither  divers  cachexies,  nor  diatheses,  nor  syphilis  are 
the  ordinary  causes  of  pemphigus  neonatorum .  He  contends,  on  the 
contrary,  that  most  of  the  children  attacked  by  this  eruption  present 
no  symptom  of  general  debility.  The  author  admits  that  pemphigus 
is  an  exanthem  which  may  coincide  with  the  general  state  of  the 
economy,  but,  as  M.  Hardy  has  said,  having  always  the  character  of 
being  an  accidental  and  not  a  necessary  manifestation  of  a  per- 


1875.]  Report  on  Midwifery ^  ^c,  4^3 

manent  constitutional  condition.  The  state  of  debility  sometimes 
observed  in  these  children  may  be  the  result  of  the  exanthem  and 
not  the  cause  of  it.  Pemphigus  presents  itself  in  two  very  different 
forms:  (1.)  Acute  benign  pemphigus.  (2.)  Acute  malignant  pem- 
phigus. In  the  first  case  it  may  be  febrile  or  apyretic,  simultaneous 
or  successive,  partial  or  general,  syphilitic  or  non-syphilitic,  pruri- 
ginous  or  impetiginous.  In  the  second  form  pemphigus  is  always 
febrile ;  it  may  be  solitary,  forming  but  one  vast  bleb  over  the  whole 
surface  of  the  body,  or  it  may  be  constituted  by  two,  three,  or  four 
huge  blebs,  distinct  at  first  but  tending  constantly  to  unite. 

The  prognosis  is  very  different  in  the  two  kinds ;  recovery  is  the 
rule  in  the  first,  while  death  is  always  the  consequence  of  the 
second.  Dr.  Ealoy  does  not  think  syphilis  is  very  often  a  cause  of 
pemphigus  ;  he  attributes  it  rather  to  excessive  heat. 

10.  Dr.  C  apples  records  the  successful  removal  of  a  dermoid  cyst 
of  the  ovary  from  a  child  seven  and  a  half  years  old.  The  abdominal 
enlargement  had  been  first  observed  about  four  months  before  the 
date  of  operation.  One  noteworthy  point  in  the  case  is  the  occur- 
rence of  an  accident  by  which  the  abdomen  was  injured  by  the  fall 
of  a  heavy  piece  of  timber  three  years  previously. 

Dr.  Cupples  mentions  that  he  secured  the  pedicle  "  by  a  single 
carbolized  catgut  ligature,  divided  and  returned  within  the  cavity." 
The  operator  is  to  be  congratulated  on  his  success ;  nevertheless,  a 
caution  is  necessary  against  trusting  too  much  to  catgut  ligatures, 
which  certainly  have  a  greater  tendency,  however  skilfully  applied, 
to  become  unfastened  than  have  ordinary  ligatures. 

Carbolized  catgut  is  obviously  a  very  desirable  material  for  the 
ligature  perdu  ;  but  the  results  obtained  by  ligaturing  the  pedicle 
and  returning  it  within  the  abdominal  cavity  are  unquestionably 
inferior  to  those  obtained  by  securing  the  pedicle  outside  the  abdo- 
minal wound  by  an  efficient  clamp.  The  unparalleled  experience  of 
Mr.  Spencer  Wells  warrants  and  amply  confirms  this  statement. 

11.  In  a  paper  read  by  Dr.  de  Sinety  before  the  Societe  de  Biologie 
of  Paris,  the  author  avers  that  the  investigations  prove  the  occurrence 
of  lactation  in  newly  born  infants  ;  nay  more,  he  asserts  that  the 
foetal  breasts  may  contain  colostrum.  He  states  that,  as  in  the  adult, 
colostrum  is  first  found,  and  that  subsequently  the  secretion 
becomes  like  that  of  the  suckling  mother.  The  sex  of  the  infant 
makes  no  difference.  He  bases  his  statements  on  chemical  and 
anatomical  investigations. 

12.  Dr.  Wilhite  reports  fourteen  cases  of  trismus  nascentium,  in 
support  of  Dr.  Marion  Sims'  theory  that  the  -disease  is  due  to 
mechanical  pressure  on  the  medulla  and  nerves  by  a  displacement 
inwards  of  the  occipital  bone.  This  may  occur  in  protracted  labours 
and  in  those  cases  where  the  foetal  cranial  bones  are  too  fiiUy 
ossified.  He  describes  two  forms — the  acute,  where  death  takes 
place  within  two  or  three  days,  and  the  chronic,  in  which  the  child 
gradually  wastes  away.  The  first  symptom  in  both  forms  is 
inability  to  suck,  and  this,  he  says,  is  pathognomonic  of  the  disease. 
The  treatment  should  consist  in  keeping  the  child  lying  on  the  side, 
not  on  the  back,  so  that  there  is  no  pressure  upon  the  occipital  bone. 

lia--LTi.  S2 


4S4 


Books,  ^c,  received  for  Review, 


[Oct., 


BOOKS,  PAMPHLETS,  &c.,  RECEIVED  FOR  REVIEW. 


On  Poisons  in  relation  to  Medical  Juris- 
prudence and  Medicine.  By  Alfred  S. 
Taylor,  M.D.,  F.R.S.  Third  Edition. 
London,  Churchills.     1875.     pp.  834. 

Essays  and  Papers  on  some  Fallacies  of 
Statistics  concerning  Life  and  Death, 
Health  and  Disease,  with  Suggestions  to- 
wards an  Improved  System  of  Registra- 
tion. By  Henry  W.  Euaisey,  M.D.,  F.R.S. 
London,  Smith,  Elder  &  Co.  1875.  pp. 
322. 

Researches  into  the  Antagonism  of 
Medicines  ;  being  the  Report  of  the  Edin- 
burgh Committee  of  the  British  Medical 
Association.  By  John  Hughes  Bennett, 
M.D.  (Reprint.)  London,  Churchills.  1875. 
pp.  100. 

The  Skull  and  Brain  :  their  Indications 
of  Character  and  Anatomical  Relations. 
By  Nicholas  Morgan.  Illustrated.  London, 
Longmans.     1875.     pp.  208. 

Notes  on  the  Treatment  of  Skin  Dis- 
eases. By  Robert  Liveing,  M.D. ,  &c.  Third 
Edition.  Revised  and  Enlarged.  London, 
Longmans.     1875.    pp.  116. 

Lessons  on  Prescriptions  and  the  Art  of 
Prescribing.  By  W.  Handsel  Griffiths, 
Ph.D.,  &c.  London,  Macmillan.  1875. 
pp.  150. 

The  Surgeon's  Pocket-Book  ;  being  an 
Essay  on  the  best  Treatment  of  Wounded 
in  War,  for  which  a  prize  was  awarded. 
Specially  adapted  for  the  public  medical 
services.  By  Surgeon-Major  J.  H.  Porter. 
London,  Griffiths  &  Co.     1875.    pp.  291. 

Nature  and  Treatment  of  the  Deformities 
of  the  Human  Body  :  being  a  course  of 
lectures  delivered  at  the  Meath  Hospital. 
By  Lambert  H.  Ormsby,  M.B.,  &c.  Illus- 
trated. Dublin,  Fannin  &  Co. ;  London, 
Bailliere  &  Co.     1875.    pp.  263. 

The  Retrospect  of  Medicine.  Edited  by 
W.  Braithwaite,  M.D.,  and  James  Braith- 
waite,  M.D.  Vol.  LXXI,  January  to  June. 
London,  Simpkin,  Marshall  &  Co.  1875. 
pp.  384. 

A  Manual  of  the  Diseases  of  the  Heart : 
their  Pathologv.  Diagnosis,  Prognosis,  and 
Treatment.  By  R.  H.  Semple,  M.D. 
London,  Churchills.     1875.    pp.  296. 

Medical  Politics;  being  the  Essay  to 
which  was  awarded  the  first  Carmichael 
prize  by  the  Council  of  the  Royal  College 
of  Surgeons,  Ireland,  1873.  By  Isaac  Ashe, 
M.D.,  &c.  Dublin,  Fannin  &  Co.  1875. 
pp.  174. 

Health  in  the  Nursery,  and  How  to 
Feed  and  Clothe  a  Child,  with  Observa- 
tions on  Painless  Parturition.  A  guide  and 
companion  for  the  young  matron  and  her 


nurse.     By  E.   Holland,   M.D.     Second 
Edition.     London,  Lewis.     1875.    pp.93. 

The  Gentle  Treatment  of  Spinal  Curva- 
ture. By  H.  Heather  Bigg.  London, 
Churchills.     1875.    pp.  64. 

On  Concussion  of  the  Spine,  Nervous 
Shock,  and  other  Obscure  Injuries  of  the 
Nervous  System  in  their  Clinical  and 
Medico-legal  Aspects.  By  John  E.  Erich- 
sen.    London,  Longmans.    1875.   pp.  340. 

The  Diseases  of  the  Heart  and  of  the 
Aorta.  By  Thomas  Hayden,  Physician  to 
the  Mater  Misericordiae  Hospital,  &c.  Il- 
lustrated. Dublin,  Fannin  &  Co. ;  London, 
Churchills.     1875.    pp.  1232. 

On  the  Relation  between  Diabetes  and 
Food,  and  its  application  to  the  Treatment 
of  the  Disease.  By  Arthur  S.  Donkin, 
M.D.  London,  Smith,  Elder  &  Co.  1875. 
pp.  186. 

A  Practical  Treatise  on  Diseases  of  the 
Eye.  By  R.  Brudenell  Carter,  F.R.C.S. 
With  numerous  illustrations.  London, 
Macmillan  &  Co.     1875.    pp.  591. 

Reports  of  the  Inspectors  of  Factories 
for  the  half-year  ending  April,  1875. 

A  new  Manual  of  Physiology.  A  course 
of  lectures  on  physiology  by  Prof.  Kiiss. 
Edited  by  M.  Duval,  M.D.  Translated 
by  R.  Amory,  M.D.  London,  Bailliere 
&  Co.     1875.    pp.  531. 

Journal  of  the  Scottish  Meteorological 
Society.  New  Series  July  1874— July  1875. 
Edinburgh,  Blackwoods.     pp.  142. 

A  Report  of  the  Hygiene  of  the  United 
States  Army,  with  Descriptions  of  Mili- 
tary Posts.  (From  the  Surgeon-General.) 
Washington.     1875. 

The  Successful  Treatment  of  Internal 
Aneurism  by  Consolidation  of  the  Contents 
of  the  Sac.  By  JolliflFe  Tufnell,  F.R.C.S.I. 
Second  Edition.  London,  Churchills.  1875. 
pp.  71. 

Twenty-ninth  Report  of  the  Commis- 
sioners in  Lunacy  to  the  Lord  Chancellor. 
1875.    pp.  307. 

Transactions  of  the  New  York  Academy 
of  Medicine.  Instituted  1847.  Second 
Series.  Vol.  I.  New  York,  Appleton  & 
Co.     1874.    pp.  393. 

Die  Resultate  der  Gelenkresectionen 
im  Kriegenach  eigenen  Erfahrungen. 
von  E.  Bergmann.  Mit  20  Tafeln  Giessen. 
1874. 

Des  Indications  et  des  Contre-Indica- 
tions  de  1' Hydro therapie.  Par  M.  le  Dr. 
Leroy-Dupre,  Medecin  en  Chief  de  I'Etab- 
lissement  Hydrotherapique  de  Belle vue, 
Paris,  Bailliere  et  fils.     1875. 


1875.] 


Books,  ^c,  received  for  Review. 


4&5 


Dei  Fenomeni  c  delle  Funzioni  di 
Transudamento  neU'organismo  Aniraale 
Meraoria  del  Dottore  Filippo  Pacini. 
1874. 

Annali  Clinici  dello  Ospedale  dei  Pelle- 
grini di  Napoli.  Vol.  III.  Napoli.  1875. 
pp.  246. 

Pamphlets. 

Bad  Homburg  and  its  Resources  :  for  the 
use  of  English  Visitors  especially.  By 
Dr.  Hoeber.     Homburg.     1875. 

Thermo- dynamical  Phenomena  ;  or,  the 
Origin  and  Physical  Doctrine  of  Life,  and 
the  New  Theory  of  Fermentation.     By  H. 

A.  Huntley.     Madras,     1875. 
Cantho-plasty  as  a  Remedy  in  certain 

Diseases  of  the  Eye.     By  C.  R.  Agnew, 
M.D.    New  York.     1875. 

A  Series  of  American  Clinical  Lectures. 
Edited  by  E.  C.  Seguin,  M.D.    Otitis.   By 

C.  R.  Agnew,  M.D.    New  York.     1875. 
Impressions  of  Madeira.     By   William 

Longman,  F.G.S.     (Reprint.) 

The  Clinical  Thermoscope  and  Uni- 
formity of  Means  of  Observation.  Two 
Notes  by  Edward  Seguin,  M.D.  New 
York.     1875. 

Abstract  of  a  Clinical  Lecture  on  Phthisi- 
cal Laryngitis.  By  James  Sawyer,  M.D. 
(Reprint.) 

Reports,  "Weekly,  Monthly,  and  Quar- 
terly, of  Births  and  Deaths.  From  the 
Registrar-General. 

Report  of  the  Richmond  District  Asylum. 
Dublin.     1875. 

Report  of  the  Chinese  Hospital.  Shang- 
hai.    1874. 

Report  of  the  Executive  Committee  of 
the  Dublin  Sanitary  Association.     1875. 

Report  of  the  Present  Sanitary  Condi- 
tion of  the  Borough  of  Droitwich.  By 
Horace  Swete,  M.D.     1875. 

Ha^matinuria.  By  J.  Warburton  Beg- 
bie,  M.D.  A  Paper  read  before  the  Medico- 
Chirurgical  Society  of  Edinburgh.     1875. 

Address  in  Medicine. — Ancient  and  Mo- 
dern Practice  of  Medicine.  Delivered  at 
the  Meeting  of  the  British  Medical  Asso- 
ciation in  Edinburgh.  By  J.  W.  Begbie, 
M.D.,  &c.     1875. 

Reports  of  the  Inspectors  of  Factories. 
(Parliamentary  Paper.)     1875. 

Annual  Report  of  the  Fever  Hospital 
and  House  of  Recovery,  Cork  Street. 
Dublin.     1875. 

Cases  of  Disease  in  the  Orbit.  By  Henry 

D.  Noyes,  M.D.    New  York.     1875. 
Baldness  :  its  Cause  and  Cure.    By  Mi- 
chel Cardin.     Manchester.     1875. 

How  We  Die  in  Large  Towns.  A  Lec- 
ture on  the  Comparative  Mortality  of 
Birmingham  and  other  large  towns.    By 

B.  Foster,  M.D.     1875. 

Seventeenth  Annual  Report  of  the 
General  Board  of  Commissioners  in  Lu- 
nacv  for  Scotland.     1875. 


Review  of  the  Inspectors'  Report  on 
Insanity  in  Ireland  in  1873.  By  Robert 
Stewart,  M.D.     (Reprint.)     1875. 

The  Syphilitic  Affections  of  the  Nervous 
System.  By  J.  Hughlings  Jackson,  M.D. 
&c.     (Reprint.)     1875. 

National  Association  for  Providing 
Trained  Nurses  for  the  Sick  Poor.  Re- 
port of  the  Sub-committee  of  Reference 
and  Enquiry.     1875. 

Report  of  the  Committee  of  the  Order 
of  St.  John  of  Jerusalem  in  England  : 
Nurses  for  the  Sick  Poor.     1874. 

Ling's  Educational  and  Curative  Exer- 
cises. By  M.  J.  Chapman,  M.D.  Fourth 
Edition.  Edited  by  Augustus  Georgii.- 
London,  Renshaw.     1875.     pp.  84. 

Proceedings  of  the  New  York  Academy 
of  Medicine.     New  York.     1875. 

Significance  of  Disturbed  Action  and 
Functional  Murmurs  of  the  Heart.  By 
J.  R.  Learning,  M.D.  (Reprint.)  New 
York.     1875. 

Report  on  Mechanical  Treatment  of 
Uterine  Displacements.  By  H.  F.  Camp- 
bell, M.D.    Atlanta,  Georgia.     1875. 

Etude  Chirurgique  sur  la  Source  Sul- 
phuree  Sodique  et  lodo-Bromuree  de 
Challes  (Savoie).  Parle  Dr.  F.  Garrigon- 
Chambery.     1875. 

Note  sur  la  Chronologic  et  la  Geographie 
de  la  Peste,  dans  la  Premiere  Moitie  du 
XIX  Siecle.  Par  J.  D.  Tholozan  (Re- 
print.) 

De  la  Genese  du  Cholera  dans  I'lnde  et 
de  son  Mode  d'Origine.  Par  J.  D.  Tholo- 
zan.   Paris.     1875. 


Journals. 

Dublin    Journal    of   Medical    Science. 

(Monthly.) 
Edinburgh  Medical  Journal.  (Monthly.) 
Journal  of  Mental  Science.    (Quarterly.) 
Irish  Hospital  Gazette.     (Monthly.) 
The  Veterinary  Journal  and  Annals  of 

Comparative  Pathology.  Edited  by  George 

Fleming,  F.R.G.S.  Vol.  I,  No.  1.  (July.) 

1875. 
Indian  Medical  Gazette.     (Monthly.) 
Canada  Medical  and  Surgical  Journal. 

(Monthly.) 
Nature,  a  Weekly  Illustrated  Journal 

of  Science.    September. 
American   Journal  of  Insanity.  Utica. 

July,  1875. 
The  American  Journal  of  Obstetrics  and 

Diseases  of  Women  and  Children.     New 

York.    August,  1875. 
New  York  Medical  Journal.    New  York. 

(Monthly.) 
Archives  of  Dermatology.    Edited  by  L. 

D.  Bulkley,  M.D.  New  York.  (Quarterly.) 
Philadelphia  Medical  Times.  ( Weekly.) 
The  Druggist.  New  York.  (Monthly.) 
Chicago  Journal  of  Nervous  and  Alental 

Disease.    (Monthly.) 


496 


Books,  S^c,  received  for  Review.  [Oct.,  1875, 


New  Remedies  :  a  Quarterly  Eetrospect 
of  Therapeutics  and  Pharmacy.  Edited 
by  F.  A.  Castle,  M.D.    New  York.      1875. 

Archives  Generales  de  Medecine.  Paris. 
(Monthly.) 

Bulletin  General  de  Therapeutique. 
Paris.     (Fortnightly.) 

Gazette  Hebdomadaire.  Paris.  (Weekly.) 

Eevue  des  Sciences  Medicales  en  France 
et  a  I'Etranger.     (Quarterly.) 

Schmidt's  Jahrbiicher  der  Gesammten 
Medicin.     (Monthly,) 

Archiv  fiir  Gynakologie.  Berlin.  (Quar- 
terly.) 

Archiv  fiir  Palhologische  Anatomie  und 
Pbysiologie.  Von  Rudolf  Virchow.  Ber- 
lin.    (Monthly.)     1875. 


Deutsches  Archiv  fiir  Klinische  Medicin . 
(Monthly.) 

Athenaeum.  Monatsschrift  fiir  Anthro- 
pologie,  Hygiene,  Moralstatistik,  &c.  Re- 
digirt,  von  Dr.  Eduard  Reich.  Erster 
Jahrgang.    Heft  1—4.    Jena.     1875. 

Nordiskt  Medicinskt  Arkiv.  Redigeradt 
af  Dr.  Axel  Key.  Sjunde  Bandet.  Andra 
Haflet.     Stockholm.     1875.     (Quarterly.) 

Lo  Sperimentale.  Giornale  Critico  di 
Medicina  e  Ghirurgia.  Florence  and  Rome. 
(Monthly.) 

El  Anfiteatro  Anatdmico  Espanol. 
(Weekly.) 

0  Correio  Medico  de  Lisboa.  (Fort- 
nightly.) 


NOTICE    TO    READERS. 

The  Editor  is  particularly  desirous  of  having  all  Reports  of  Hospitals,  Asylums, 
Sanitary  Boards,  Scientific  Societies,  &c.,  forwarded  to  him,  as  also  Inaugural 
Lectures,  Dissertations,  or  Theses,  Medical  and  Scientific  Addresses,  &c. 


INDEX  TO  VOL  LVI 


OP  THE 

BRITISH  AND  FOREIGN  MEDICO-CHIRURGICAL  REVIEW. 


PAGE 

Abdominal  tumours,  bruit  in         .  466 
Absorption,  philosophy  of      .         .  209 
Aitken's  *  Outlines  of  Medicine  *    .  158 
Alkaloids    in     decomposing    sub- 
stances        242 

Allen  on  medical  problems  of  the 

day  .  .  ■  .  .  .  .363 
AUis  on  chloroform  and  ether  .  456 
American  ophthalmology  .  .  172 
Analysis  of  water,  by  Fox  .  .  159 
Anaesthetics,  relative  strength  of  .  456 
Anderson,  McCall,  on  eczema.  .  161 
Animal  mechanism,  by  Marey  .  98 
Antiseptic  surgery,  present  po- 
sition of 253 

Aphasia  in  children  .  .  .  483 
Aqueous  humour  of  eye,  philosophy 

of 209 

Archives  of  electrology .        .         .  426 
Arlidge  on  lung-disease  from  dust- 
inhalation  433 

•            report  on  medicine     .         .  458 
Arloing  on  nerve- section  in  neur- 
algia   462 

Arlt  on  ophthalmic  medicine  .       1 

Army  surgeons,  instructions  for  .  424 
Arnaud  on  the  plague  in  Barbary  .  151 
Arndt  on  pathology  of  sunstroke  .  458 
Asylum,  West  Riding,  reports        .  167 

Baker  on  origin  of  cerebro-spinal 

meningitis  ....  246 

Barrett  on  management  of  infancy  181 
Bartholow  on  uterine  fibroids  .  223 
Baths,  cold,  in  cerebral  rheumatism  451 
Baxter  on  hydrocele  in  a  woman  .  223 
Beard's  '  Archives  of  Electrology' .  426 
Beck  on  iodide   of  potassium   in 

syphilis 457 

Beigel  on  diseases  of  women  >  .  178 
Beneke  on  pathology  of  cancer  .  469 
Berlin,  antiseptic  surgery  at  .  278 

Bile-colours 210 

Biliary  secretion,  drugs  acting  on .  452 


PAGE 
Blake  on  poisoning  by  aconite  and 

chloroform  ....  238 
Blood,  colourless  corpuscles  .  .  206 
■    ■        physiology  of     .         .         .  206 

■  red  corpuscles  and  reagents  206 

■  stains,  diagnosis  of    .         .  248 

white    corpuscles,    migra- 
tions of 207 

Books  received  .  .  .  250,  494 
Boracic  acid  as  an  antiseptic  .  267 

Bouchut's  cerebroscopic  researches  485 
Bouchut  on  action  of  eserine.  .  447 
Bourneville    on     temperature     in 

eclampsia 473 

Bouyer,  case  of  ovariotomy  .  .  482 
Brainworkers,  longevity  of  .  .  248 
Breasts  of  new-born  infants  .  .  493 
Buchanan  on  the  circulation .  .  411 
Bulkley's     cases     of     congenital 

syphilis 23 

Bull  on  leprous  diseases  of  eye  .  143 
Burdwar  fever,  on,  by  Roy    .        .  415 

Calberta  on  the  aqueous  humour   .  209 
Calculus   extracted  through  a  fis- 
sure   224 

Cancer  uteri  treated  by  tincture  of 

iron 217 

Carbolic  acid  for  malignant  pus- 
tule   449 

Carcinoma,  pathology  of  .  .  469 
Carter  on  leprosy  .         .         .  422 

on  mycetoma     .         .         .39 

Cases  of  echinococci  .  .  .  226 
Cataract  and  imperfect  teeth  .  487 
Cerebroscopic  observations  .  .  485 
Cerebrospinal    meningitis,    origin 

of .246 

Chadwick  on  echinococci  in  pelvis  226 

on  ovariotomy       .         .  482 

Chambers  on  diet  in   health  and 

disease 339 

Chemical  Society's  Journal  .  .  429 
Chemistry,  physiological,  by  Moore  166 


498 


INDEX   TO   VOL.    LVI. 


PAGB     I 
Chemistry  and  therapeutics,  rela- 
tions between    ....  171 

Watts'  dictionary  of     .  409 

Children,  aphasia  in      .         .  .  483 

diseases  of,  report  of      .  472 

syphilitic  diseases  in       .420 

Children's  diseases,  by  Steiner        .  398 
Chloral  as  an  anodyne  in  labour    .  474 
in   large   doses   in  hydro- 
phobia      .....  460 

and  special  change  in  urine  213 

use  of,  in  cancer  of  uterus  .  479 

Chloride  of  zinc  as  an  antiseptic   .  266 
Chloroform  and  ether  as  anaesthe- 
tics   ......  456 

influence  of,  on  foetus  472 

Chlorosis  with  aphasia  of  the  sex- 
ual organs  ....  480 
Cholera-epidemic  of  1872      .         .     73 

influence     of    microscopic 

agents  in 352 

reports,  De  Renzy  on         .  169 

Circulation,  Buchanan  on       .         .411 

physiology  of     .         .  208 

Clark  on  galvanism  in  endometritis  231 
Clarus  on  aphasia  in  children 
Clay's  '  Obstetric  Surgery '    . 
Clinical  Lectures,  by  Davis  . 
by  Paget 


Clinique  Medicale,  by  Lendet 

Cold  baths  in  cerebral  rheuma- 
tism   

Congenital  syphilis 

Controversy,  the,  on  disposal  of 
the  dead 

Corelysis,  operation  of 

Corpuscles,  colourless,  on 

Coulard  on  rheumatic  erythema    . 

Cox  on  heredity  and  hybridism    .. 

Cremation,  books  on      .         .         . 

objections  to 

Croup  and  diphtheria,  affinity  of  . 

Cumming  on  uterine  souffle 

Cunningham  on  microscopic  organ- 
isms in  air,  &c. 

Cutaneous  exhalation,  on,  by  Eris- 
mann 

Cupples,  case  of  ovariotomy  in  a 
child 

Cyclopaedia  of  Medicine,  by  Ziems- 
sen  

Cystitis,  local  treatment  of    . 

Cysts  of  vagina     .... 

Cystocele,  Stoltz's  operation. 


483 
385 

184 

298 

90 

451 
23 

120 
9 
206 
464 
53 
120 
131 
490 
478 

348 

212 

493 

430 
230 
218 
225 


Da  Costa,  lectures  on  heart-strain  171 
Dactylitis  syphilitica     .         .         .23 
Darwin  on  marriages  between  first 
cousius      ,         ,         ,         ,         ,  363 


PAGB 

Davis's  (Xathan)  clinical  lectures  184 
Dauvergne  on  dietetic  treatment  450 
Dead,  disposal  of  the    .         .         .  120 

generation  of  alkaloid  in  the  242 

Deakin  on  hydrotherapeutic  treat- 
ment of  intermittents        .         .  455 
Decidua,  formation  of  the     .         .  480 

structure  of       .         .         .  214 

epidemic  of       .         .         .85 

De  Reny  on  cholera  reports  .  169 
Derivation    of    biliary    colouring 

matters 201 

Dermoid  cyst  of  ovary  .  .  .  225 
Diabetes  mellitns  and  liver  glycogen  211 
Diagnosis  aided  by  nitrite  of  amyl  450 
Dictionary  of  medical  science,  by 

Dunglison  ....  156 

Diet    in    health    and  disease,  by 

Chambers  ....  339 

Dietetic  treatment  .  .  .  450 
Diet  of  infants  .  .  .  .184 
Disease,  nomenclature  of  .  .  428 
Diseases  of  children,  by  Steiner  .  398 
Disinfection,  science  of  .         .  248 

Disposal  of  the  dead  .  .  .  120 
Dohrn,  transmission  of    purpura 

from  mother  to  infant       .         .  491 
DragendorfF    on     chemical    toxi- 
cology        108 

Drosdoff,  action  of  compressed  air 

on  blood-pressure  ,  .  .  208 
Drugs  acting  on  biliary  secretion  .  452 
Dublin  Lectures  on  public  health  168 
Duncan  on  mechanism  of  parturi-  433 

tion 391 

Dunglison's  medical  dictionary  .  156 
Dust-inhalation  and  lung-disease   . 

Eassie  on  cremation  .  .  .  120 
Echinococci,  cases  of,  in  pelvis  .  226 
Eclampsia,  puerperal,  temperature 

in 473 

Eczema,  on,  by  McCall  Anderson  .  161 
Eldridge  on  physiological    teach- 
ing        ^    209 

Electric  stimuli  to  brain  .  .214 
Electrology,  archives  of  .  .  426 
Endometritis  cured  by  galvanism  231 
Engelmann  on  formation  of  decidua  480 
Entozoa,    microscopic    researches 

into 539 

Epidemic  cholera  in  India  .     73 

Epileptics,  parturition  in  .  .  474 
Erichsen  on  hospitalism  .  .  151 
Erisman  on  exhalation   of    water 

by  skin  ....  212 

Erythema  related  to  rheumatism  464 
Eserine,  action  of,  in  chorea  .  447 
Estradere  on  use  of  phenic  acid    ,  449 


INDEX   TO    VOL.   LVI. 


499 


PAGE 
.  143 
.       1 


Eye,  leprous  diseases  of 
Eye,  surgery  of     . 


Faloy  on  pemphigus  in  infants       .  492 
Ferrier's  '  Guy's  Medical  Jurispru- 
dence'          108 

Fibrocystic  tumours  of  uterus  re- 
moved      .....  232 

removal  of      .  481 

F  leischer  on  chloral  in  cancer  of 

uterus 477 

Fleming    on    veterinary    sanitary 

science       .....  378 
Fluctuation  and  tinkling  in  abdo- 
minal tumours  ....  466 
Forensic  medicine,  report  on  .         .  234 
Fox  on  disposal  of  slop- water         .  161 

on  pathology  of  nerve-centres     32 

on  skin- eruption  in  suckling 

child  from  bromide  of  potassium  487 

on  water  analysis    .         .         .  159 

Frankel  on  aphasia  of  sexual  organs 

in  chlorosis        ....  480 
Frey's    histology    and     histo-che- 

mistry 327 

Freund  on  echinococci  in  pelvis     .  226 
Functional  derangements  of  liver, 

by  Murchison    ....  186 
Fmigus-foot  of  India,  Carter  on    .     39 

53 

231 

23 

214 
217 

207 
211 

478 

188 

460 

171 

219 

140 
108 
217 

120 

218 
418 

327 


Galton  on  hereditary  genius  . 

Galvanism  in  treatment  of  endo- 
metritis    ..... 

Gee  on  pseudo-paralysis  in  inherited 
syphilis      .         .         . 

Generation,  physiology  of      . 

Gibb  on  cancer  uteri     . 

Globules,  white,  of  blood,  migra- 
tions of 

Glycogen,  formation  of,  in  liver    . 

Goodell  on  turning  in  contracted 
pelvis        ..... 

Granular  contracting  kidney,  on, 
by  Maclagan      .         ... 

Grazi's  case  of  hydrophobia  treated 
by  chloral ..... 

Griffiths  on  chemistry  and  thera- 
peutics        

Grigg  on  abnormality  of  infantile 
uterus 

Guy's  Hospital  reports . 

medical  jurisprudence 

Gynaecological  surgery . 

Haden  on  the  burial  of  the  dead  . 

Hsematocele  treated  by  incision 
and  drainage     .         .         .         . 

Hamilton  on  syphilitic  osteitis 

Handbook  for  physiological  labora- 
tory, by  Sanderson  a»d  Klein    , 


PAGE 
Hansen  on  tetanus        .         .         .  462 

on  leprous  diseases  of  eye  .  143 

Head-injuries  and  survivorship  .  244 
Health,  public,  lectures  on    .         .  168 

manual  of    .         .  157 

Heart-strain,  lectures  on        .         .  171 
Heat  to  spine  in  metrorrhagia       .  481 
Heidenhain  on  diabetes  mellitus    .  211 
on  influences  of  irri- 
tation on  blood-pressure  .         .     208 

Heintze  on  structure  of  the  deci- 

dua 214 

llemans  on  treatment  of  hema- 
tocele         218 

Heredity,  on,  by  Ribot          .         .     53 
Herrgott  on  use  of  vaginal  obliter- 
ation   480 

Hicks  on  local  treatment  of  cyst- 
itis   230 

Hindoo  plan  of    disposal  of    the 

dead 121 

Histology,  practical  teaching  of  .  327 
Hogg  on  river  pollution  .  .  249 
Holden  on  sphygmograph  .  154 

Horton  on  diseases  of  tropics  .  47 
Hospitalism,  Erichsen  on  .  .  152 
Hospital  reports  .         .         .  140 

Huth  on  intermarriage  .         .  363 

Hydrocele  in  a  female  .         .  223 

Hydropathy,  by  Leroy-Dupre        .  427 
Hydrophobia  treated  by  chloral     .  460 
Hydrotherapeutlc  treatment  of  in- 
termittent fever         .         .        .  455 
Hutchinson  on  imperfect  teeth  and 
zonular  cataract         .         .         .  487 


Imperfect  teeth  and  zonular  cata 

ract 

India,  sanitary  work  in 

sanitary  reports 

Infancy,     management      of,      by 

Barrett 

Infant  diet,  by  Jacoh    . 
Infantile  uterus,  abnormal  from  . 
Infection,     syphilitic,    congenital 

sources  of  ... 

Inherited  syphilis 
Injuries  to   head    in    relation    to 

survivorship       .... 
Intermarriage,  on  .         .         . 

Iodide  of  potassium  in  syphilis     . 
Iodine  injected  into  uterus    . 
Ireland,  manual  of  public  health 

for 157 

Iridectomy,  operation  of       .         .13 
Iridodesis,  operation  of          .         .     12 

Jaborandi,  use  of,  in  polvdipsia    ,  i5Q 


487 

72 
72 

181 
184 
219 

25 
23 

244 
363 
457 
219 


600 


INDEX  TO   VOL.   LVI. 


Jackson,  Hughlings,  on  inherited 

syphilis  and  nervous  diseases  .  23 
Jacobi  on  infant  diet  .  .  .  184 
Johnson     on     childbirth     among 

negresses  ....  477 

Jones  on  the  theory  of  life  .  .  172 
Journal  of  Chemical  Society  .  429 
Jurisprudence,  medical         .         .  108 

Keith's  cases  of  removal  of  fibro- 
cystic uterine  tumours      .         .  232 

Kidney,  on  contracting  granular, 
by  Maclagan     ....  188 

Kirby  on  uses  of  phosphorus  .  452 

Keen's  histology  .        .        •  327 

Laboulb&ne  on  bruits  in  abdominal 

tumours             ....  466 
Lactation  in  new-born  infants       .  493 
Lacteal  ducts        ....  214 
Laptschinsky    on  red    blood-cor- 
puscles       206 

Laycock  on  jaborandi  in  diabetes 

insipidus  ....  457 

Leprous  diseases  of  the  eye  .  .  143 
Leprosy,  Carter  on       .  .         .  422 

Leroy-Dupie  on  hydropathy  •  427 

Lendet's  '  Clinique  Medicale '  •  90 
Lewis  on  microscopic  organisms  in 

cholera,  &c.  ....  348 
Life,  the  simplicity  of  .         .  172 

study  of,  by  Dr.  M.  Jones     .  172 

Lisle  on  the  use  of  sea-water  in- 
ternally ....  454 
Lister's  practice  in  1875        .         .  262 
Liver,  functional  derangements     .  186 

origin  of  glycogen  in      211,  212 

Longevity  of  brain- workers  .         .  248 
Longmore's  instructions  to  army- 
surgeons  424 

Lung-disease  from  dust-inhalation.  433 
Lymphangitis,  Troisier  on     .         .  180 

Maclagan  on  contracting  granular 

kidney 188 

Malignant     pustule     treated    by 

phenic  acid  ....  449 
Maly  on  bile -colouring  matters  .  210 
Mammary  pendulous  tumour  .  218 
Mapother  on  skin  diseases  .  .  166 
Marey  on  animal  mechanism  .  98 
Materia  medica,  the  teaching  of    .  171 

Stille  on       .         .  414 

by  Phillips  .         .  405 

McLeod  on  disposal  of  the  dead    .  120 
McSwiney  on  mammary  tumours  218 
Measurements  of  uterus        .         .  476 
Mechanism     of    natural     morbid 
parturition        ....  391 


PAGH 
Medical  dictionary  by  Dunglison  156 

jurisprudence,  works  on    .108 

missions    ....  303 

Medicine,  outline  of,  by  Aitken  .  158 
Medical  problems  of  the  day,  by 

N.Allen  .         .         .         .363 

Meningitis,  cerebro- spinal  .  .  246 
Mesopotamia,  plague  in  .  .  149 
Metrorrhagia  arrested  by  heat  to 

spine 481 

Meyer  on  ophthalmic  surgery        .       1 
Microscopic     researches    of    Drs. 
Cunningham  and  Lewis     .         .  348 

organisms    in    health 

and  disease  ....  348 
Microscopic  examination  of  air  .  349 
Midwifer)-,  report  on  .  .  .  472 
Milton  on  vapour  baths  .         .  428 

Missions,  medical  .         .         .  303 

Mitchell    on    nitrite  of  amyl    in 

spasm 450 

Montmeja  on  ophthalmic  surgery.  1 
Moore's  demonstrations  of  physio- 
logical chemistry  .  -  .  166 
Mosler's  case  of  splenic  tumour  .  467 
Murchison  on  functional  derange- 
ments of  liver  ....  186 
Mussy,  de,  on  heat   to  spine    in 

metrorrhagia  ....  481 
Mycetoma,  Carter  on  .  .  .39 
Mystics,  diseases  of       .         .         .  248 

Negros,  parturition  among    .         .  447 
Nerve  pathology,  recent  researches 
in 281 

section  in  neuralgia    .         .  462 

Nervous  centres,  pathology  of       .     32 

system,  diseases  of,  in  in- 
herited syphilis  .         ,         .23 

Neuralgia    as   treated    by  nerve- 
section       462 

Nitrite  of  amyl  in  spasm  .  .  449 
Nomenclature  of  disease  .  .  428 
Obstetric  Surgery,  by  Clay  .  .  385 
Operative  surgery  of  eye  .  .  1 
Ophthalmic  surgery  ...  1 
Ophthalmological  Society,  Ameri- 
can, Transactions  .  .  .  172 
Origin  of  cerebro-spinal  meningitis  246 
Outlines  of  medicine,  by  Aitken  .  158 
Ovarian  cysts,  serous  form  .  .  224 
Ovariotomy,  on,  by  Chadwick        .  482 

in  a  child  .         .  493 

■  case  of,  by  Bouyer      .  482 

Ovary,  dermoid  cyst  of  .         .  225 

Oxygen,  an  antidote  to  phosphorus  237 
Pagef  s  clinical  lectures  .  .  298 
PaUen  on  vagino-cerviplasty  .  220 
Panas  on  serous  ovarian  cysts       .  224 


INDEX  TO  VOL.  LVI. 


50l 


Parrot   on    pseudo-paralysis 
syphilis      .         .         .         . 
Parry  on  labour  in  epileptics 
Parturition  in  negro-race 
mechanism  of    . 


PAGE 


and 


23 

474 
477 
391 
458 
469 


Pathology,  report  on     . 
— —  — ^  of  cancer     . 

of  contracting  granular 

kidney 188 

of  nervous  centres       .    32 

*  Pathological   Society's    Transac- 
tions'        183 

Pathology,  researches  in  .  .  281 
Pemphigus  in  young  children  .  492 
Peritomy,  operation  of  .         .       5 

Persia,  plague  in  ...  149 

Pharmacopoeia,  commentary  on  .  414 
Phenic  acid  for  malignant  pustule  449 
Phillips's  materia  medica  .  .  405 
Phosphorus  poisoning  treated  by 

oxygen 237 

uses  and  administration  of  .  455 

Physiology,  report  on  .  .  .  206 
Physostigmin  in  chorea  .  .  447 
Pink -formation    of    glycogen    in 

liver 211 

Plague,  the,  in  Barbary        .         .  151 

,  the,  in  Persia       .         .        .  149 

Poisoning  by  aconite  and  chloro- 
form          238 

Poisoning  by  tobacco-smoke          .  234 
Potassium,  iodide  in  syphilis          .  457 
Power,  report  on  physiology          .  206 
Present  position  of  antiseptic  sur- 
gery   253 

Progress  of  ophthalmic  surgery    .       1 
Prolapsus  ani  in   children,  treat- 
ment of 489 

Pseudo-paralysis  in  inherited  syphi- 
lis      23 

Public  Health  Manual  for  Ireland  157 

Dublin  Lectures    .  168 

Puerperal  fever,  nature  of  .  .  479 
Pulmonary  lymphangitis  .  .  180 
Purpura  hsemorrhagica  in  infants, 

transmitted  from  mother         .  491 
Putzel    on  nature    of    puerperal 
fever 479 

Rajpootana  dispensary  report        .  248 
Recent  researches    in  nerve  pa- 
thology      281 

Reese  on  toxicology      :         .        .  108 
Reeves,  report  on  surgery     .         .217 
Reports  of  hospitals      .         .         ,  140 
■    of  Indian  Sanitary  Com- 
mission      72 

Report  on  forensic  medicine  .  234 
on  gynaecological  surgery    217 


PAGE 
Report  on  materia  medica     .         .  447 

on  medicine       .        .         .  458 

on  midwifery    .         .         .  472 

on  physiology    .         .         .  206 

on  surgery         .         .         .  217 

on  toxicology    .         .         .  234 

Reports  of  West  Riding  Asylum  .  167 
Researches  in  nerve  pathology  .  281 
Rheumatism  treated  by  cold  baths  457 
Rheumatism  with  erythema  .  464 
Ribot  on  heredity  .  .  .53 
Richardson,  report  on  forensic  me- 
dicine        234 

J.  S.,  on  diagnosis  of 

blood  stains       ....  248 
■  —  R.,  on  simplicity  of 

life 172 

River  pollution  and  water  supply  249 
Rouget  on  white  blood-globules  .  207 
Roux  on  tuberculous  arthritis  .  413 
Roy  on  Burdwar  fever  .  .  .  415 
Rupture  of  navel-string  ,  .  491 
Rutherford  on  biliary  stimulants  .  452 

Salicylic  acid,  action  of         .        .  452 

as  an  antiseptic       .  268 

Sanitary  work  in  India  .  .  72 
Secretion,  physiology  of  .  .  214 
Sea-water,  employment  of  .  .  454 
Semple,  report  on  materia  medica .  447 
Serdukoflf  on  uterine  dimensions  .  476 
Serous  ovarian  cysts  .  .  .  224 
Shropshire  medical  tarifE  .  .  170 
Simplicity  of  life  .  .  .  172 
Sinety  on  mammae  of  new-bom  in- 
fants   493 

Skin-diseases,  Mapother  on  .         .  166 
Skin-eruption  from  bromide  of  po- 
tassium from  suckling        .         .  487 
Slop-water,  disposal  of           .         .  161 
Smith's  commentary  on  pharma- 
copoeia        414 

Soltmann  on    electric    stimuli  to 

brain 214 

Spasm  treated  by  nitrite  of  amyl  ,  450 
Sphygmograph,  Holden  on    .        .  154 
Spinal  ganglia,  structure       .        .  214 
Splenic  tumour  treated  by  injec- 
tions   467 

St.   Bartholomew's    Hospital   Re- 
ports   140 

St.  George's  Hospital  Reports  .  140 
St.  Thomas's  Hospital  Reports  .  140 
Staphyloma,  operations  for  .  ,7 
Steiner  on  children's  diseases  ,  398 
Stille's  therapeutics  and  materia 

medica 414 

Stille  on  medical  jurisprudence  .  108 
Stoltz's  operation  for  cystocele     .  225 


60£ 


INDEX   TO    TOL.    LVI. 


PAGE 
Streatfeild's  ophthalmic  surgery  .  1 
Strychnia,  researches  on        .         .  236 

effects  of      .         .         .  248 

Sunstroke,  pathology  of  .  .  458 
Surgery  of  the  eye       ...       1 

■  '  obstetric,  handbook  of     .  385 

■  report  on         .         .         .  217 
— — —  present  position  of  anti- 
septic         253 

Survivorship  after  injuries  to  head  244 
Symptoms  of  inherited  syphilis  .  26 
Syphilitic  osteitis,  by  Hamilton     .  418 

diseases  in  children        .  420 

Syphilis,  inherited         .         .         .23 

Tait's  translation  of  Steiner  on 
diseases  of  children  .        .  398 

Tarchanoff,  on  biliary  colouring 
matters 210 

• on  excitation  of  pneu mo- 
gastric  nerves    ....  209 

Tariff,  medical      ....  170 

Taylor  on  dactylitis  syphilitica      .     23 

■  on  medical  jurisprudence  .  108 

on  syphilis  in  children       .  420 

Teaching  of  histology  .  .  .  327 
Teevan,     extraction    of     calculus 

through  a  fissure       .         .         .  224 
Temperature  in  puerperal  eclamp- 
sia      473 

Terrier  on  dermoid  ovarian  cysts  .  225 
Tetanus,  notes  on  .         .         .  462 

Thauoffer  on  spinal  ganglia  .  .  214 
Therapeutics,  report  on  .  .  447 
Tholozan  on  the  plague  .  .  149 
Thoma  on  physiology  of  blood- 
corpuscles  ....  206 
Thomas  on  tubal  pregnancy  .  474 
Thompson  on  cremation  .  .  120 
Tobacco-poisoning,  case  of  .  .  234 
Toner,  the  lecturer  .  .  .  171 
Toxicology,  Dragendorff  on  .         .  108 

report  on  .         .  234 

Transactions  of  American  Ophthal- 
mological  Society       .         .         .  172 

of  Pathological  Society  183 

Trask  on  injections  of  iodine  within 

uterus 219 

Tripier  on  nerve-section  in  neur- 
algia   462 

Trismus  nascentium,  on         .         .  493 
Troidier  on  pulmonary  lymphan- 
gitis   180 


PAGE 

Tropical  diseases,  by  Horton  .  47 
Tubal  pregnancy,  case  of  .  .  474 
Tuberculous  arthritis,  on  .  .  413 
Tumour,  pendulous,  of  mamma  .  218 
Turning,  rules  for,  in  contracted 
pelvis 478 

Umbilical  cord,  rupture  of  .  .  491 
Urinary  ingredient  due  to  chloral  213 
Uterine  cancer,  treatment      .         .217 

fibroid  treated  by  ergotin  223 

fibrocystic  tumours  re- 
moved        232 

mucous      membrane    and 

formation  of  the  decidua  .         .  480 
•                ■ struc- 
ture of 215 

■  souffle  and  foetal  heart       .  478 

Uterus,  inversion  of,  after  delivery  474 

injection  with  iodine         .  219 

measurements  of      .         .  476 

Vaginal  cysts  .  .  .  .218 
obliteration  for  inconti- 
nence of  uterine  .  .  .  480 
Vagino-cerviplasty  .  .  .  220 
Vapour  bathsi  on,  Milton  .  .  428 
Veterinary  sanitary  science  .  .  378 
Vitali,  researches  on  strychnia  .  236 
Voelckel's    case    of   inversion    of 

uterus 474 

Vignal  on  biliary  stimulants  .  452 

Walton  Haynes  on  diseases  of  the 

eye 1 

Wanklyn's  tea,  coffee,  and  choco- 
late   408 

Water  analysis,  by  Fox  .         .  159 

Watts'  dictionary  of  chemistry  .  409 
West  Riding  Asylum  Reports  .  167 
Williams  on  mucous  membrane  of 

uterus 215 

Wiltshire,  report  on  midwifery  .  458 
Winkler  on  lacteals  .  .  .  214 
Winter  on  action  of  salicylic  acid  452 
Wittich  on  amount  of  glycogen  in 

liver 212 

Women,  diseases  of,  report  on  .  472 
, ,  by  Beigel        .  178 

Ziemssen's  *  Cyclopedia  of  Medi- 
cine ' 430 

Zweifel  on  influence  of  chloroform 
on  foetus    .         .        .         .        .473 


END   OF   VOL.   LVI. 


tEINTED  BY  J.   E.  ADLABD,  BAETHOIOMEW  CLOSE. 


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