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THE

LONDON

MEDICAL REPOSITORY

MONTHLY JOURNAL,

AND

REVIEW.

EDITED BY

D. UWINS, M.D.

Licentiate of the Royal College of Physicians of London, one of the Honorary
Secretaries to the London Medical Society,

Lecturer on the Theory and Practice of Medicine, and Physician

to the City Dispensary

S. PALMER, M.D.;

AND

MR. GRAY,

Apothecary, and Lecturer on the Materia Medica and Botany.

Quaarere Verum. Horace.

VOL. XL

FROM JANUARY TO JULY, 1819.

LONDON :

PRINTED FOR THOMAS AND GEORGE UNDERWOOD,

32, FLEET STREET. '

1819.

J. MOYES,

GREVILLE STREET,

LONDON.

CONTENTS

1. Two Cases of Paralysis treated with Nux Vomica, and the

Dissection of a Morbid Brain. By C. B. Rose, Sur-
o;eon, Swaffham - - • - - 1

2. Remarks on the mode of Communication and on the Treat¬

ment of the Venereal Disease. By Thomas Cooke,
Surgeon, Northampton - - - ■ - 14

3. Case of Death from Oxalic Acid. By John Wesley

Williams, Surgeon, Portsea - - - 20

4. Case of fatal Hemorrhage from a Leech Puncture. By

A. White, M.B. - - - - - 23

5. Case of Croup. By L. Leese, Surgeon - - 26

6. Remarks on the Theory and Treatment of Fistula. By

M. Breschet, Paris - - ^ _ §9, 177

7. Medical and General Topography of Huddersfield. By

J. K. Walker, M.D. - - - 93^ 189

8. Case of Amputation of the upper Arm. By John Burgis,

Surgeon, Market Drayton - - - - 101

9. On Puriform Discharges from the Ear. By J. H. Curtis,

Surgeon, Soho Square - - - ^ - 103

CONTENTS.

PAGi;

10. Case of Fever in which Bottled Porter was administered

with effect. By H. Whitmore, Surgeon, Great Bath
Street 105

11. Quarterly Report of the Diseases of the Boys in Christ’s

Hospital. By Henry Field, Apothecary - - 107

12. Singular Case of Hernia of the Stomach. By Gordon

Smith, M.D. - - - - - 182

13. Case of Delirium Tremens in which Opium was used with

advantage. By R. Southam, M.D., Buckingham - 185

14. Case of an extensive Fracture of the Cranium. By W.

STAVELY^Surgeon, Bideford - - - 187

15. On Sarsaparilla. By Richard Battley, chemist,

London - - - - - -190

16. The Doctrine of Contagion discussed. By John

Mitchell, M. D. - - - ~ - 191

17. Remarks on Eruptive Diseases following Small-pox and

Vaccination. By J. Fosbrooke - - 265,463

18. Remarkable Case of Pneumonia. By T. W. Wansbo-

rough. Surgeon, Fulham - - - - 277

19. Two Cases of Lithotomy in Females. By M. Clemot,

Rochefort - - - - - -281

20. Remarks on Mr, AbernetJiy^s and Mr, Lawrences Opinion

on Life. By James Woodham, Medical Surgeon,
London - - - - ^ - - 353

21. Essays on Medical Improvement, (No, I.) By a Physi¬

cian - ' - - - - - 357

22. Case of Pneumonia. By W. Furnivall, Surgeon, &c. 360

23. Case of Scarlatina. By T. W. Wansborough, Fulham 362

24. Animadversions on Medical Nomenclature, with the propo¬

sal of a new one. By T. Parkinson, M.D., London 364, 478

25. Cases of, and Remarks on Hydrocephalus. By W. Cooke,

Surgeon, Prescot Street - - - - 441

26. Two Cases of Morbid Dissections. By Gordon Smith,

M.D. - - , . - - 477

CONTENTS.

authenticated cases, observations, and dissections.

PAGE

Case of Pulmonary Disease - - - _ 285

DEPARTMENT OF NATURAL HISTORY, &c.

1. On Animals of the Class Vermes, especially on* Intestinal

Worms. By S. F. Gray - - - 27, 108

2. On the Solanese Order of Plants. By S.. F. Gray - 201

3. On Generation in Imperfect Plants. By S. F. Gray - 287

4. Monthly Calendar of Natural History, (from February to

March). By Dr. T. Forster - - . 292

5. On the Metamorphoses of Insects. By S. F. Gray - 373

6. Monthly Calendar of Natural History, (from March to

April). By Dr. T. Forster - - - 378

7. Enumeration of those Indigenous Plants which have an

Emetic Property. By S. F. Gray - - - 489

8. Monthly Calendar of Natural History, (from April to

May). By Dr. T. Forster - - - 492

PART IL

ANALYTICAL REVIEW.

1. Brodie on Diseases of the' Joints - - - 33

2. Magcndie on Urinary Concretions - - - 50

3. on the Philosophy of Life - - - 115

4. Hall on the Mimoses - - - - - 129

5. Msculapius's Hospital Pupil’s Guide - - - 138

6. on Poisons _ - - _ _ 213

7. Blane on Medical Logick - - - - -216

8. on Hydrencephalus - - - . 293

9. Thomsoids London Dispensatory - - _ 297

10. A/gc jBTewzie on Lachrymal Diseases - - - 299

1 1 . HallaraTi on Insanity - - « - > 309

12. Clutterbuck, Percivaly Graham, Millar, Porter, Parkinson,

Dickson and Brown, on Epidemic Fever - - 380, 494

CONTENTS.

PAGE

13. Medical Botany ~ - ~ - - 401

14. Powers Treatise on Midwifery . . - 402

PylRT IIL
SELECTIONS.

1. Thompson on Sulphurous Gas with Sulphuretted Hydrogen 61'

2. Brande on the Medico-Chemical Treatment of Calculous

Disorders « - - - - 140, 230, 313

3. Paris on the Alliaceous Odour of Arsenic - - 144

4. Yeats on the Opinions of the Ancients respecting Conta¬

gion - ' . 411,504

PART W,

FOREIGN MEDICAL SCIENCE AND LITERATURE.

ANATOMY, PHYSIOLOGY, PATHOLOGY, PRACTICE OF MEDICINE,

AND SURGERY.

On the Nervous Ganglia of the Nasal Cavities - - 65

Cases of Tetanus - - » - - - 67

Obstruction of the Thoracic Duct - - - - 68

Employment of the Prussiate of Quicksilver in/ Syphilis - 71

Extirpation of the Parotid Gland - - - - 75

Case of Bronchocele - - - - - 76

Nature and Causes of Asthma? _ - _ > 145

Cases of Paralysis cured by Cicatrization of the Brain - 155

Emphysema from a Gunshot Wound of the Trachea - 163

Pascal on Intestinal Worms - - - - 233

Inflammation of the Cerebral Membrane without Fever - 241
Portal on Peritonitis - _ - « . 244

Patissier on the Apoplectic Cyst - - - - 319

Baple on QEdematous Angina of the Larynx - - - 320

CayoVs Case of Aneurism of the Aorta, simulating GEdema of

the Glottis 337

Removal of the first Metacarpal Bone - - - 34O

CONTENTS.

Vll
PACE

Rostan*s case of Fracture of the Femur by Muscular Con¬

traction 341

■v

Condition of the Stomach during Vomiting - - 414

JRosfrtnV Case of Transposition of the Viscera - - 419

Fischers Case of Rupture of a sound Heart - - 422

Rupture of the Heart from chronic Inflammation - - 427

Ozanam on Cardiac Syncope . „ - - 428

Case of Diabetes - ^ _ - - 429

Inflammation of the Arachnoid Membrane from external

Injury 510

Lcrrej/’^ Case of Wound in the Thorax - " - - 511

Rupture of the Vense Cavse - - - - 512

Hydatids from chronic Inflammation - - - ib.

Case of Lymphatic Tumor in the Inguinal Region - - ib.

CHEMISTRY AND NATURAL HISTORY.

New Substitute for Cinchona - - - - 79

Description of a new Vegetable Alkali - - - 166

Natural and Chemical History of the Menispermum Cocculus 517

MEDICAL JURISPRUDENCE.

Cases of Asphyxia from the Effluvia of Privies - - 73

On the Respiration of the Foetus in Utero - - - 159

Cases of Poisoning by Colocynth - - - - 161

Orjila on the Adulteration of Wines ^ _ 249

MIDWIFERY.

Cases of the Csesarean Operation - - - - 77

Case of Extra-Uterine Pregnancy - - 254

Duclos on an Elongation of Part of the Uterus during Par-

turition - - - - - - lb. V

Duclos Case of Dropsy of the Amnios - - - 515

PART V.

MEDICAL AND PHYSICAL INTELLIGENCE.

Royal Society, Proceedings of - - 167, 343

Vlil .CONTENTS.

PAGE

London Medical Society, Anniversary of - ^ ' - ’342

- — - - - - , Pettigrexvs Oration at - 520

Hunterian Society, Formation of ' - « - 432

Academy OF Sciences at Paris, Proceedings of - - 343

Miscellaneous Intelligence - 80, 167, 168, 169, 342, 346, 433
Hospital for Small-Pox and Vaccination, Report from - 257
Notices of Lectures ~ - 81, 170, 257, 346, 434, 529

Literary Notices - - ~82, 171, 257, 346, 434, 529

Meteorological Tables kept at Richmond 84, 172, 258,347, 435,530
Meteorological Tables of London 85, 173, 259, 348, 436, 531
Registers of Diseases in London, with Observations on prevail-
■ ' ing Diseases - - ~ - 86, 174, 260, 349, 532

Quarterly Prices of Substances used in Pharmacy 262, 534
Quarterly Priues of Phials - * - - - 263,535

Monthly Catalogue of New Books 88, 176, 264, 351, 535

Notices to Correspondents - 88, 176, 264, 352, 536

THE

LONDON MEDICAL

REPOSITORY.

No. 61. JANUARY 1, 1819. Vol. XL

PART I.

ORIGINAL COMMUNICATIONS.

Two Cases of Paralysis, treated with Nux Vomica ; and the
Dissection of a Morbid Brain, By C. B. Rose, Surgeon,
Swaffham, Norfolk.

For the introduction of nux vomica as a remedy in para¬
lysis, we are indebted to Dr. Fouquier, of I’Hdpital de la
Charite in Paris ; and I believe we have to thank Dr. Gran¬
ville, a Lecturer of our metropolis, as the first who (in a
Letter read to a Medical Society of London in November
1816, and published in the 38th Number of the Reposi¬
tory,) gave to his professional brethren on this side the
Channel the valuable information. A new remedy, brought
forward in this country with such high commendations, by an
eye-witness of its effects, (a Physician of very superior ta¬
lents and great attainments in professional as well as general
knowledge,) must necessarily have attracted the attention of
many of our inquisitive Practitioners; and it certainly is
rather extraordinary, that after a lapse of two years w^e should
not have been presented with the result of some isolated, if
hospital practice could not have afforded reiterated trials. I
feel convinced, that in the absence of the latter, one or two
only of the former would be serviceable, by acting as land¬
marks to the less enterprising members of the profession, who
require something more than exotic information to drive them
from the too frequently useless routine prescriptions. As a
proof also of the specific effects of this article of the materia
medica on paralysis, although a single case of recovery will

VOL. XI. — NO. 6l. B

^ Original Communications.

aid but little towards establishing it; still, when followed by
others, as 1 trust it will, it becomes valuable ; and as a register
of its peculiar action on some one or other of the organic
systems, from idiosyncrasy or otherwise, it may be curious,
if not useful, to lay before the medical public the following
([ think, the first) cases on record in this kingdom. For the
above reasons I shall be more prolix and particular in describ¬
ing the very minutiae of the first case, than many of its readers
may think necessary, or it may really deserve ; but if an error,
they will, I dare say, consider it one on the right side,

Robert Patterson, of B - , forty years of age, of a weakly

constitution, leucophlegmatic temperament, who had always
lived abstemiously, consulted me on account of a palsy of the
right side, affecting the nerves of locomotion only; with
which he was attacked a fortnight before : upon inquiry into
the history of the case, 1 learnt that for a few days previous
to the paralytic attack he felt a great oppression on his
breathing, but which he had nothing of after he became pa¬
ralyzed : he certainly had no apoplectic fit, as his mental
faculties were not suspended even at the very onset of the
disease ; for he was conscious of the abstraction of command
over the muscles of the affected side. He experienced the
attack about six o’clock on a very cold morning of last
March. The parish Surgeon was called to him, who bled
him once freely, applied a blister to the back of his neck,
purged him, and ordered a low diet. When 1 first saw him
he had in a considerable degree recovered the use of his
lower extremity, still he moved it awkwardly; his articulation
was so bad I could not understand ail he said, and he could
not in the slightest degree move his arm, or elevate or rotate
the hand ; his pulse was weak and slow ; tongue healthy ; no
dyspeptic symptoms were present; his foecal evacuations were
very offensive and of a greenish colour, but his bowels had
been constipated ; the temperature of the lame hand (judging
from iny feeling only) appeared to be a trifle below the healthy
one ; the skin was rough and dry, but its sense of feeling
perfect. I began the treatment with a brisk mercurial purga¬
tive, and ordered him to live on a nourishing diet ; to take a
large quantity of mustard with his food ; and to endeavour to
direct his will to the sleeping muscles, but not to carry his
attempts sufficiently far to fatigue them.

On March £8th he began with the powder of nux vomica
in three grain doses ter de die ; I gave him also pil. hydrar-
gyri, 5 grains omni nocte, and a powder composed of rhubarb
and magnesia omni aurora. From this day to April 4th the
doses were augmented every forty-eight hours; so that at the
latter time he had to take 15 grains of the powder for each

Paralysis Treated with Nux Vomica.

dose. When taking the 10 grain doses, the effects of the
drug began to discover themselves by producing slight tvvitch-
ings of the extremities, and a sensation as if some fluid was
running down the interior of the affected arm : indeed, of so
particular a kind was the feeling, that the man repeatedly
asked his wife if she could not hear it run.

On the morning of the 4th, about an hour after taking the
first powder that contained 15 grains of nux vomica, a strong
tetanic convulsion came on, and affected the whole body ;
but the paralytic side most severely : it dilated the mouth
laterally, and closed the jaws; then a rigd contraction of the
flexor muscles of the extremities, followed by a powerful con¬
traction of the extensors thrusting out the limbs : his bowels
were rather costive; pulse regular and languid, as when he
began the medicine; the warmth of the body much in the
same state ; of a night in bed the lame side more moist with
perspiration than the strong ; his mouth being slightly affected
by the mercury, I desired him to omit it, but to continue the
morning powder, and to persist in the use of the present dose
of nux vomica for another 48 hours.

April 8th. Yesterday he felt so much rigidity of the lame
arm and leg, that he could not get off his chair; he was
drowsy also ; his bowels costive, and their evacuations
offensive. ^

To-day he speaks better, and can walk better ; he can lift
his arm up to the arm of his chair; he feels occasionally a
pricking sensation in his limbs, and some pain every night;
he frequently has startings in the paralyzed limbs, more parti¬
cularly of a night; the peculiai sensation of a fluid running
down his arm continues: his appetite is small ; his pulse re¬
gular, and not so languid; and his countenance is less slug¬
gish. I ordered him a calomel purgative for to-night, and
the day after to-morrow to begin the nux vomica again in
doses of 18 grains ter de die ; and I desired him when he
feels that particular sensation in his arm, to endeavour at
that time to move the limb, for he said he felt as if he could
do any thing with it.

April lOtli. He moves his arm up to the arm of his chair
with greater ease; his pulse is regular; the alvine dejec¬
tions are rather dark coloured, and offensive in smell; the
bowels continue costive,

April 13th. I saw Patterson ; he yesterday had another
tetanic fit, about an hour after having taken his morning dose
of the nux vomica (18 grains); it came on him when asleep;
the spasm did not last more than a minute, if so long ; it
not only affected the extensors of the limb, but the flexors of
the jaw ; he was verj^ low and languid for three or four hoyrs

4 Original Communications.

after the fit ; he has very frequently twitchings of the affected
muscles, more particularly of a night; he feels a great heat,
much perspiration, and when in bed, the sensation very strong
of pins and needles irritating the skin of the affected side
only : his leg is drawn up at times, so that he cannot walk
but with very great difficulty.

To-day I see but little improvement in the volition of the
lame side; his health continues the same, with a moderate
appetite; excepting a little drowsiness his head is not at all
affected by the drug; his pulse is very regular and soft, at
70; tongue clean ; and he is not dull or heavy, but in good
spirits.

April I2th. He takes pulv. nucis vomicae a scruple ter
de die.

15th. An intelligent friend, and a naturalist (Mr. Scales,
jun.), informed me, there was a “ considerable alteration for
the better” in my patient, for with his elbow resting on the
arm of his chair he can raise his hand three or four inches
high. I sent him six doses of the nux vomica, with 23 grains
in each.

‘ 17th. There has been a rapid improvement in the para¬

lyzed arm, for on this day he gets his hand nearly to his
mouth, and bends the fore-arm a little upon the arm ; he can
also grasp any thing placed in his hand.

' 18th. ' Gave him pulv. nucis vom. 26 grains ter de die.

19th. My patient was brought in a cart to see me; he is
looking very well, and walks and talks better; he can to-day
lift his hand above his head, and bring the cubitus to more
than half flexion on the humerus, if he rests his elbow on
some fixed point; he grasps firmer with his fingers, but can¬
not yet hold any thing in his hand a minute; the medicine
produces a considerable degree of vertigo and severe spasmo¬
dic contractions, which last three or four hours ; he continues
to feel the particular sensation of something running in the
flesh. 1 desired him not to fatigue the arm by too frequent
efforts to move it; for when he does move it, he suspends re¬
spiration, and seems as if he was lifting a weight that required
all the strength he was master of to elevate it.

20th. I sent him six more of the powders without in¬
creasing their quantitjq and desired him to take a little wine
and more porter, for his appetite was but moderate.

29th. I had not an opportunity of seeing my patient till
to-day : I learnt that on the 24th his head was very much
affected with vertigo from the medicine, and so much spasm
produced in his lower extremities, that he could not walk
alone ; his wife led him to the door and left him standing; a
tetanic spasm attacked him, and he I’eli to the ground byck«

Paralysis Treated with Nux Vomica.

wards : in consequence of this iny friend advised him to take
his medicine but twice a day ; indeed when taken thrice, its
effects were continuous, and thus the remedy was more pain¬
ful, and nearlj? as irksome as the disease ; at this time he was
able to lift a box-iron with its heater from the floor and place
it upon a table; and to hold a walking stick in his hand ; the
extensor muscles do not recover their power in the same ratio
with the flexors ; and he has not yet the least power of moving
the thumb either by the flexors or the extensors ; the pain is
very considerable in the arm, but it has left the leg and thigh;
his walking and speech are better ; and he is looking better;
his bowels are regular; pulse natural, and alike in both arms.
The arm is, and has been from the first, very flaccid, and the
skin of the hand remarkably dry and rough ; for the first fort¬
night it gave out an odour, his wife says, “ like a sweaty foot.”
I now ordered him a smaller dose (a scruple), to be taken
thrice instead of twice a day, wishing to keep up a more con¬
stant, but not so powerful an effect, as he began to be tired
of the severe discipline; and considering him in a convalescent
state, I was more desirous than ever that he should persevere
in the use of this galvanic drug.

May 6th. My patient came to see me : there appears but
little improvement in his speech, or the moving of Ids lower
extremity ; but he uses his arm with more freedom, and what
he does with it requires not the effort which he was obliged
to make on the 19th of April. The power of the flexors
continues progressively to return, but he has gained very little
in the extensors ; he can only very slightly extend the fingers
or use any of the extensors of the arm ; yet during the spasm
produced by the medicine his fingers are fully extended, and
the extensors are more acted on than the flexors ; he has con¬
siderable power in, wdth the full command of the latissimus
dorsi and pectoralis major muscles. When vapoured, and
always when he gapes, the flexors of the fingers of the lame
hand involuntarily contract, so that the hand is firmly
clenched ; and when he sleeps there is a tonic spasm of these
muscles sufficiently strong to produce a degree of pain
which obliges him to put some soft body into his hand to
prevent so great a contraction ; his bowels and pulse are in
their natural state. As there had not been an improvement
within the last fortnight equivalent to that in the week pre¬
ceding, w'hen the effects of the drug were more violent, I
desired him to take 25 grains of the nux vomica thrice a day.

May 9th. My friend informs me my patient cannot be
prevailed upon to take his medicine more than twice a day;
for, he says, when taken thrice, the effect of the first dose is
not off before he should take the second, and it is so pow'erful

Original Communications,

that if he take the second early in the day, he cannot get
about at all in consequence of the vertigo, dimness of sighq
and stiffness of the limbs which it produces, I now desired
he would take pulv. nuc. vom. 271 grains of a forenoon, and
to repeat it at bed^time.

14tli[. Patterson came to see me. I found he had im¬
proved, for he bent and extended the fore-arm on the
humerus with greater facility; he has also regained, in a
slight degree, the power of moving the thumb, both in flexion
and extension. If he goes long without exercising the
muscles of the affected limbs, they feel very stiff and useless,
and it is some time before they recover themselves. In two
or three hours after taking the night dose the startings come
on, awake him, and prevent his falling asleep again ; his
pulse to-day was not so full or strong, and it intermitted
frequently : his appetitte good, and bowels regular.

i8th. i learnt that my patient continued to improve, and
that he could use the bellows with his lame hand. I sent him
half a dram of pulv. nuc. vom. for a dose, to be given noon
and night.

20th. He came to see me, and appeared to be progressively
improving; his pulse not intermitting, and at its standard
heat; appetite very good.

27th. He came to see me again, and alighted from his
luggage-cart without assistance : he told me, that on the day
previous he felt a great faintness and sinking, with a rapid
beating of the heart, and quickness of breathing, which
continued all day; and that his appetite diminished: on
this day he felt better, but his pulse was very fluttering and
irregular; his tongue white; bowels regular; he had but
little appetite. The medicine had not produced so much
dizziness and vertigo ; but considering that it had caused the
above unpleasant symptom, I desired him to omit it for a few
days, and take twice a-day some infusion of cascarilla; and
as the pains in the affected limbs prevented sleep, 1 gave him
one grain of opium omni nocti : latterly he had not taken a suffi¬
ciency of ale and porter, and 1 desired he would be less
abstemious,

30th. He was better ; his pulse was become regular,
but weak ; the three preceding days he had felt very much of
the palpitation of his heart, and with it always a great flut¬
tering (as he described it) of the muscles in general, which
mostly commenced in those of the abdomen. Since omitting
the nux vomica, the locomotive powers of the arm had not
diminished. I gave him some pills composed of the com¬
pound galbanum pill, carbonate of ammonia, and ammo-
niated iron, to be taken three times each day.

Paralysis Treated with JSlux Vomica.

June Scl. He remained better; the unpleasant symptoms
bad not returned since I saw him last; his pulse was much
improved ; there were occasional intermissions ; his appe¬
tite was bad ; and his bowels costive ; he retained the power
of the lame arm undiminished. I gave him a cathartic of
calomel and jalap, and desired him to continue the tonic
pills.

June 10th. Patterson has had no return of the flutterings ;
his pulse is regular and strong ; appetite good, and bowels
healthy ; the command over, and power of the affected
muscles have increased, although he has not taken any nux
vomica for a fortnight : during the time he omitted he had no
tetanic symptoms, and less pain, heat, and perspiration in the
limbs, 1 desired him to begin the nux vomica again, in doses
of 23 grains bis in die, and increase the dose everj^ third
powder. From the 13th to the SOih he took 26 grains at a
dose, but on the latter d'dy he called to say he could not take
the powders if made so strong : he had not taken them
regularly : he had gained both strength and freedom of mo¬
tion. 1 gave him a scruple of the powder to be taken twice
a day.

July 1st. He told me, that on the 28tli of June, on coming
home from church, he felt very giddy, and his head very
uncomfortable, and the power of moving his left arm and
hand diminished ; it was still not quite recovered to the
state immediately preceding that event : up to that time he
bad continued in a slow but progressive improvement; his
pulse, appetite, and spirits were very good. As the medicine,
in the last doses, had affected him but very shghtljg I again
gave it in doses of 25 grains twice a da3^

lith. He had a return of the faintness, fiutterings, and
palpitation of the heart; they lasted about 24 hours. I
ordered him to omit taking his powders.

14th. He was pretty well recovered from his late disagree-
able feelings ; his pulse was again very good ; and power of
action continued to be restored to the paralyzed members,.
As the dose of the drug could not be increased without pro¬
ducing effects of too serious an aspect, and having seen that
during a discontinuance of its use he had continued to im¬
prove, I laid it aside, and gave him two brisk doses of calomel
and jalap, for he had a good deal of ecthyma in his legs, with
much local heat, and afterwards the tonic pills which he had
before taken. He took them only a week.

August 24th. My patient again called on me, and I was
happy to find that he had gained ground since I last saw him :
although he had taken no more medicine, it was Very evident
the natural powers were gradually returning; but he com-

Original Communications*

plained of a general feeling of fulness, and as if it was passing
towards his head. I feared a second paralytic attack was
threatening, and as his pulse was good, 1 took twelve ounces
of blood from his arm. 1 saw him the week after, and he said
he had felt somewhat lighter from
terial change,

November 3d. My patient called to tell me that he continued
to improve both in strength and freedom of action, and that he
expected to be able to go to day-labour again in the spring.

When the successful administration only of a new and
powerful medicine is made known, we are likely to over-rate
its powers, and expect too much efficacy from it ; we are in
consequence disappointed, and prematurely throw it aside,
without giving it a fair trial. That the publication of the above
case of recovery from paralysis, during the exhibition of nux
vomica, may not mislead in a similar manner, I shall proceed
and relate a case in which the drug produced no effect wdiat-
ever upon the disease, notwithstanding its action upon the
frame was extensive and exceedingly powerful.

Mr, Headly, about 30 years of age, of a thin spare habit
and sanguineous temperament, was affected with a great dimi¬
nution of the power of extension of the thumb, index, and
middle fingers, and the wrist, nearly amounting to a paralysis,
the sequela of three attacks of colica pictonum ; the first
about three years since ; the second in January last, which
left a weakness of the hand and arm, the strength of which he
had considerably recovered, when in August last he had a
third, at which time I w^as called in, and found the power of
the extensors of the wrist and fingers above mentioned nearly
gone. He is a tin-man by trade, and is daily exposed to the
fumes of melted solder. 1 thought this a favourable case to
try the nux vomica in, and he began to take it in five grain
doses ter de die, on August £4th, and on the 3 1st, w'hen taking
it in doses of ten grains each, he first began to feel its effects ;
its action was confined to the lower jaw and tongue, pro¬
ducing a great stiffness in them, but did not destroy the power
of moving them. I continued to increase the dose, and he
was similarly affected every day, until September 9th, when
after having taking 25 grains at two P, M., and repeated the
dose at eight, at the expiration of an hour its action com¬
menced with redoubled violence on the jaw and tongue, and
very soon extended to the inferior extremities: he could bend
them readily while sitting; but when he attempted to get
upon his feet, the extensors thrust the limbs out so suddenly, •
that he fell backwards into his chair again; his lame hand felt
cramp, but nothing more ; this state continued nearly two

hours ; his pulse was not at all affected, nor the pupils of his

the bleeding, but no ma-

Paralysis treated with Nux Vomica,

eyes ; nor Iiis bead by vertigo; nor had he any pain or perspi^
ration in the parts affected by the drug, and he ate, drank', and
slept as usual. He continued the powders to the 14th, on
which day he took half a dram ter de die; it produced the
same effects daily, but in a less powerful degree, and without
any beneficial result, therefore I discontinued its use, deter¬
mining to try the extract. I could get the watery extract
only, which he began to try on the 25th, and took a grain
pill of it ihrice a day, increasing the quantity every sixth dose:
it produced no effect until Oct. 7th at night, on which day he
had taken 10 grains at ten A.M., the 'same quantity at four
P.M., and fifteen grains at eight in the evening. About an
hour after the last dose its action commenced, and, as with
the powder, was confined to the jaw, tongue, and inferior ex¬
tremities, and also affecting them in a similar degree. This
preparation caused a heaviness of the head, which almost
amounted to pain at the back part, and a nausea at the
stomach : it did not in the slightest degree affect the pulse.
He persevered in the use of the extract in fifteen grain doses
for a few days longer ; but its effects now usually arising after
the morning dose, consequently incapacitating him for work
while upon him, making him lose more time than he could
afford, and having no amendment to encourage his per¬
severance in the trial, he gave it up as a hopeless case.

As our knowledge of the cause of paralysis is at present
very limited, which it necessarily must, whilst the anatomy
and physiology of the brain are so imperfectly understood, I
trust a few remarks on the above cases will not, on perusal,
be considered superfluous. In many instances we are foiled in
our most strenuous endeavours to discover either the exciting
or proximate cause ; but I think the symptoms in the case of
hemiplegia elucidated them both in a great degree: the man
had apparently laboured under a congestion of blood in the
lungs, shown by the oppression on his breathing, unattended
with inflammation, hydrops, or spasm ; exposure to cold early
of a morning in March constringed the vessels of the lungs
and skin, and drove the blood on those internal parts which,
were in a state most disposed to receive a morbid impression :
of what that state consists, and why it should be confined to
one side of the body, I fear we shall very long, if not for ever,
remain ignorant : be that as it may, had the cause in this
case been extravasation or effusion, apoplexy would have
accompanied paralysis ; and the patient’s recovery renders it
almost certain that neither lesion of substance, nor local com¬
pression from tumors, was the cause : we must infer, then,
that cold was the exciting cause ; and the proximate cause
consisted in suspended function of the nerves from san-

VOL. XI. —NO. 6l. c

Idr Original Communications*

giiiiieous congestion of the brain and nervous chords. The
employment of the subject of the latter case plainly evinces
the exciting cause of the disease : and here again, in what way
the lead acts, it is difficult, if not impossible, to say ; for it may
be by changing the state of the nerves affected, so that they
cannot transmit the mandates of the will; or its action may
be on the power of contraction inherent in the muscular fibres,
and rendering them unable to obey those mandates when con¬
veyed. When administering a new and violent remedy, we
should not only observe its action upon the disease, but upon
the constitution also, with the hope of discovering an antidote
for some other malady, or of elucidating some obscure points
in physiology or pathology, and for the obvious reason that
some of our most valuable drugs have very deleterious pro¬
perties. On examining the detail of the above cases it will
be seen, that, in the first, effects were produced, some benefi¬
cial, and others which could not be renewed with impunity ;
whilst in the latter, effects powerful, but neither useful nor
prejudicial. Of the beneficial, it is I think particularly de¬
serving of notice, that the first sensible effect of the drug upon
the disease should be the production of a sensation as if a
fluid was running down the interior of the arm, and of twitch-
ings also. I conceive w^e must attribute this feeling to the
actual passage of the nervous influence along the nerves, and
that from this period we may date the commenoement of the
recovery of their natural actions, and in future cases welcome
these effects as harbingers of a successful termination. I
think no one can peruse the above cases without feeling per¬
suaded that the action of the nux vomica upon the nervous
system is direct, and that the effects on the arterial system are
most probably indirect; for surely as it excites the nerves so
powerfully, it may be considered an irritant to them ; and, as
Sir E. Home has observed, that mechanically irritating a
nerve increases the action of the accompanying artery, it is not
a too far-fetched analogy to authorize me to conjecture, that
thus it excites the heart; and thus I should say the palpita¬
tion of the heart in Patterson’s case (undoubtedly the effect
of the remedy, for it was not present when the drug was^
omitted,) was produced. That its action should be confined
almost solely?^ to the paralyzed parts is exceedingly curious ;
but not more extraordinary, nor more explicable, than the
peculiar limits of the disease. It will be seen also, that the
action of the nux vomica was more powerful on the flexors
than the extensors, and that the former recovered their
function earlier and with greater rapidity than the latter; also,
that the drug had an extraordinary powder of exciting the
calorific process. These circumstances are much in eonfirma-

Paralysis treated with Nux Vomica,

‘tioii of two physiological opinions : the former, that the
tlexors have inherent in them considerably more irritability
than the extensors ; and the latter, that nervous influence is
one and a powerful agent in producing and regulating animal
heat. The accumuiatioTi of heat requiring an increase of
evaporation to restore the standard point, the habitual associa¬
tion of the two functions of a necessity is productive of more ^
plentiful secretion of perspiration, a constant attendant on
the increased heat from the use of the nux vomica. Its
effects not being alike in both cases, only show the difference
of the constitutions ; either that in Headly^s case there was
not that particular concatenation between the nervous and
arterial systems, which existed in Patterson^s, that allowed of
the indirect action of the nux vomica ; or the nervous
system was less susceptible to its action; for perhaps the
palpitations and flutterings might have been produced in
Headly’s case also, had the dose been further increased. —
And now, in regard to the mode of administering the nux
vomica. Some of the French physicians have given it in a
lavement; but its introduction into the stomach must be
preferable, if it sit easy there. And respecting the form of
the drug, whether the powder, oj spirituous, or aqueous
extract is to be preferred, as my limited experience does not
enable me to give an opinion, 1 cannot furnish the reader with
that information better than by relating the substance of a
letter, dated July 1818, with which I was favoured by Dr.
Fouquier, in reply to some questions I addressed to him
through the medium of my friend, Mr. Scales, Jun. wdien
on a visit of scientific inquiry at Paris, who also accompanied
nim to the hospital, and witnessed the beneficial eff’ects of
this extraordinary medicine on several cases of paralysis,
which were in different stages of convalescence, I would
give a full translation of his letter, but for the length to which
It would extend this communication. He writes me — •
That since the specific effects of the nux vomica have been
known to him, he has preferred the alcoholic extract in the
form of pills, to either the aqueous or the substance in
powder ; that its effects are more powerful than either of the
other preparations; and that he begins with doses of one
grain twice a day, gradually ihcreasing the dose.’’ He goes
on to describe the particular effects of the remedy, which are
precisely such as are noticed in the preceding cases, excepting
those of vertigo and palpitatio. FLe says : If too large a
dose is given, its effects then discover themselves on the
healthy members: to obtain a cure it must be given a suffi¬
cient time, and the dose so regulated, that sensible effects
may be daily produced by it.” On the subject of what kind

1£ Original Communications,

of cases it is most likely to effect a core in, he says i

Although the return of motion is very tardy, and more
particularly in paralysis, from an effusion of blood into any
part of the brain, (epanchement da sang), still, when it is
independent of effusion, extravasation, or change of structure
in the brain or nerves, we can depend upon its efficacy/^
And he affirms, that it is no less specific for paralysis in
general than mercury for syphilis, or bark in ague.” I gave
in the first instance the powder, because I could not pro¬
cure either of the extracts : indeed, very lately my druggist
told me he had applied at Apothecaries’ Hail tor the alcohol
extract, and was told that the man who sent him must be a
fool, for there was nothing in the nux vomica for spirit to
extract — if not, ‘ tis passing strange,’ that Dr. Fouquier
should prescribe it, and particularly order it to be iuade
with the best rectified alcohol.*’ 1 procured the aqueous
extract, and it will be seen by the doses given, that it is much
less powerful than the spirituous. Extracts are so very
frequently rendered inert by the application of too much heat
during their preparation, that it is exceedingly difficuii to get
them retaining all the virtue of the drug; but when good,
they are certainly to be preferred to the drug in substance,
because patients more readily continue their use, and their
bulk does not nauseate : but that the latter is as effectual as
the former, my first case fully proves, it is very obvious that
great care is required in administering so active a medicine;
but to limit its effects to the affected members only, would be,
I think, over-wary : in every case I should advise the dose
to be increased until decided ihreatenings of its deleterious
action were visible. Although it is from potent medicaments
only we can look for extraordinary effects ; yet, in receiving
Dr. Fouquier’s positive assertion respecting the efficacy of nux
vomica in paralysis, we must not forget that it originated
from a practice, the offspring of his own truly ingenious mincL

The nature of the proximate cause of paralysis is so occult,
that any fact which may throw only a slight degree of light
upon the subject must be considered interesting. My com¬
munication has arrived at a length, that its value, i fear, will
ijot be a recompense for the space it occupies; still, as the
following mortem examination presents morbid appear¬
ances that seem to bear some relation to the symptoms which
arose during the progress of the disease, 1 shall trespass
somewhat further, and give a brief history of the case, and
rlissection.

Elizabeth Hall, aged 25, on waking in the nioroing of
October 17th, 1817, discovered that she had nearly lost the
power of articulation, and the use of the superior and inferior

Taralysis treated %mth Nux Vomica.

extremities of the right side ; she had felt a pain and heavi¬
ness in her head for some time, but in no other way had she
felt unwell; she menstruated regularly; her diet consisted
only of the daily fare of the indigent. She was treated
strictly on the antiphlogistic plan, and on the 20th the pain
of the head was completely removed ; her speech a little im¬
proved, but the paralysis of the limbs continued in the same
state : thus she continued for ten days, when fever super¬
vened, with a pulse neither rapid, full, nor hard ; her tongue
with a thick white fur ; and her bowels very constipated, but
the fmces were not unnatural in odour or colour; and she
complained of a dull pain all over her head : this state of
things continued about a week, when her attendants informed
me she had two or three fits, during which she could not
speak to be understood ; from this time a degree of paralysis
commenced of all the muscles of voluntary motion, so that
they could not obey the will steadily ; for instance, when she
wanted to convey her hand to her mouth, it wandered in
various directions before it arrived there; ail the symptoms
daily increased until her death, which took place on the IStli
of November; and for a week previous to that event her
bowels w^ere obstinately costive ; she could not retain het
urine ; she apparently became idiotic, and her memory failed
her very much ; her right eye (for she had been blind from
amaurosis of her left from birthj) was less irritable than
natural, yet the pupil was not much dilated ; and she continued
sensible to external impressions until a few hours before her
death. She had a very copious secretion of mucus about
the fauces, which impeded respiration and deglutition ; and
on the day of her death she w'as continually making
efforts to draw the phlegm from her throat with her
fingers. I was permitted to examine the body, and began
my dissection with opening the head. It required a con¬
siderable degree of force to elevate the cranium, from the
extraordinary number of vessels which connected it with the
dura mater. I found the vessels of the cerebrum and its
meninges, and the cerebral sinuses, gorged with blood ; sec¬
tions of the cerebrum discovered an unusual number of
bloody points on its surface showing great congestion: the
prosecution of the dissection of the cerebrum discovered no
other morbid appearances, except that there was somewhat
more fluid in the ventricles than was natural : here E
observed two preternatural oval eminences on the thalami
nervorum opticorum, parallel with, and about three lines
posterior to the anterior commissure : they were mere protu¬
berances of the substance of the thalami.

Proceeding on to the upper surface of the cerebellum, I

14 Orighial Communicatiom,

found its posterior superior margin had been inflamed, for the
number of red vessels was exceedingly increased.

The examination of the inferior surface of the brain pre¬
sented the largest portion of disease, and the most material
morbid alteration of structure, for the cineritious matter be¬
tween the thalami and the nervi optici w as very soft ; and the
left half of the tuber annulare was diseased in an extra¬
ordinary degree, its substance being very much disintegrated
and softened, but not containing pus : part of the right half
partook of the same disease, but not to the same degree or
extent; it appeared as if the morbid action was extending
itself in that direction : every other part of the encephalon
was distinct, and looking healthy, but contained too much
blood.

The elevation of the abdominal parieties exposed a liver
very Arm and dark-coloured,'appearing as if more blood had
circulated through it than in health ; a spleen small and soft ;
the large intestines exceedingly distended with air, and con¬
taining a considerable cjuantity of hardened faeces.

We learn from the above history, that in a case of paralysis
affecting in the first instance one half of the body only, and
afterwards extending to all the voluntary muscles, upon
examining the brain a diseased state of the opposite half of
the tuber annulare was discovered, apparently extend¬
ing itself throughout the whole of that body. If the exten¬
sion of the paralysis W'as the consequence of the morbid action
having extended from the left to the right side of the tuber-
culum, may we not infer that the tuber annulare is the
centre whence emanates the nervous influence destined for
the muscles of locomotion Or, that the communication
between the nerves of those muscles and the cerebellum was
cut off, and the transmission of the will thus prevented .f* Or,
was the general paralysis the effect of the attack of inflamma¬
tion which evidently took place in the latter part of the second
week of her illness ; and w hich, after death, was found to
have been seated in the cerebellum ?

II.

Jlemarks on the Mode of Communication y and on the Treatment
of the Fenereal Disease, By Thomas Cooke, of North?-
ampton. Member of the Royal College of Surgeons in
London.

In the Repository for September, Mr. Diamond, in ad¬
verting to a paper of Mr. Hey"s in the second part of the 7th
Yolurne of the Medico^Chirurglcal Transactions, proposes as

Cooke on the Venereal Disease. 15

a question, In what manner is the venereal disease commu¬
nicated to a female by the male, when he shall at the time have
no symptoms of the complaint on him and it wordd afford
me as well as him much satisfaction to see the subject dis¬
cussed: but it strikes me it should clearly be made to appear
that the disease can, and is occasionally communicated under
such circumstances.

The observations of Mr. Hey struck me so forcibly when I
saw his paper in February 1817, that 1 then committed to
writing the following remarks; and as I think they may pro¬
bably be interesting, shall transmit them for insertion in the
Repository, should they be thought worthy a place in that
useful miscellany.

Having for many years been engaged in a military prac¬
tice, various opportunities have been afforded me of noticing,
the peculiarities the venereal disease occasionally assumes ;
not merely as it affects the male, who come most under the
care of the medical officer, but also the wives and children of
soldiers, who likewise claim attention. But not having seen
any mention made of those varieties which have occasionally
presented themselves to me, till I met with Mr. Hey^s paper,
I thought it not improbable I might have been deceived, as
it is not usual with military Surgeons to give credit to much
more than comes under their actual observation ; nor is it cus¬
tomary with them to keep a register of the diseases of soldiers’
wives and children, to which to refer ; but having now been
several years in private practice, I have taken notes of cases,
in some of which many of these peculiarities occurred : 1 will,
therefore, briefly detail the least objectionable of them, in the
hope that they may be interesting to the profession, and the
respectable author of the paper to which I have before
alluded.

On the 6th of March, 1804, I was engaged to attend M. D.,
who expected to lie-in about the following June : on the 12th
I w'as called upon to visit her. From the inquiries then
made, I was led to conclude she was affected with lues Ve¬
nerea, which was confirmed upon examination. There was a
very great puriform discharge from the vagina, several sores
upon the labia-pudenda and parts adjacent, with an incipient
bubo : after lowering the system by refrigerants and ape¬
rients, a mercurial course was adopted. I ordered the pilula
hydragyri to be taken, and afterw'ards inunction of the mer¬
curial ointment, which was used till the mouth was consider¬
ably affected ; w'hen the pifls were again had recourse to, and
continued till all appearance of disease was removed. On
the 5th ofMavshe was delivered, between the seventh and
eighth month of pregnancy, of a dead child. On the l6th

Original Communications^

of February, 1805, she was again delivered, between the sixth
and seventh month, of a dead child; and on the 15th of June,
1806, being at a distant town, she was delivered of another
child, which lived about a month. The mother states that it
was covered with an eruption, particularly upon its face, hands,
and feet. She has had four children since, and all of them
perfectly healthy, and without at any time the smallest appear-
ance of thedisease; it therefore terminated with the third child;
from which 1 conclude its morbid powders then became ex«
hausted. Being, from tlie peculiar circumstances attending the
case, very desirous of satisfying myself respecting the accuracy
©fit, I was anxious to ascertain if the account cf the husband
and wife would correspond with that which I bad noted down
at the time of my attendance. 1 therefore requested that
they wmuld call upon me. 1 separately questioned them
upon it; and it afforded me much satisfaction to find that it
accorded with their former statement. It appears that they
were married in August 1803 ; and in about six weeks symp¬
toms of disease appeared upon her. She was quite ignorant
as to the nature of it, till her female friends intimated their
suspicions. The symptoms gradually increased till she be¬
came so sore that all intercourse with her husband became
inadmissible.

The husband stated, that in 1795 or 1796 he had the vene¬
real disease in Galway, Ireland ; but being a soldier, and not
wishing to go into the regimental hospital, procured some pills
and lotion, and cured himself: that in 1801 he contracted the
disease again at Killala, in Ireland ; and then had large sores
or chancres, for which he procured some medicine and lotion
from the Surgeon of the hospital, which he supposed quite
cured him, as he never afterw^ards had any symptoms of the
disease. He had not had any sexual intercourse for more
than two months previous to his marriage ; but although he
regularly had with his wife from the time he was married, till
he was prevented by her very diseased state, he never had any
symptom of disease himself.

1 have frequently remarked, that those wdio have been cured
by astringent applications are not so susceptible of the disease
as those that have not, hence primary sores were but seldom
seen in such persons ; and it is well knowm that lotions of that
nature are frequently used as preventives.

As might naturally be supposed, I was very minutely ques¬
tioned as to the possibility of his communicating the disease
to his wife, wdien he had no appearance of it himself; and
after considering all the circumstances attending it, and com¬
paring it with others of a similar nature, I felt no hesitation
in giving it as my opinion, that it must have been occasioned

Cooke on the Venereal Disease,

by him : he then became desirous to know if it would be
necessary for him to adopt measures to free himself from it;
but as he had no appearance either of primary or secondary
sjnnptoins, none were proposed nor ever used to my know¬
ledge ; and I think, from having known him for many years,
that he is deserving of implicit credit. I therefore judge this
case will go far in proving that the disease may be communi¬
cated to the female by the male at a time when there is no
appearance of it upon him ; and that it may, and frequently
does, remain dormant in the system for years without occa¬
sioning any visible constitutional effects : but how long it
will retain its morbid tendency is difficult to say, as it is pro¬
bable that will very much depend upon the susceptibility of
the individual exposed to its influence, and other circum¬
stances. In this case it was retained upwards of two years,
when its effects upon his wife ceased ; but that probably w^as
in consequence of her constitution not being so obnoxious to
its contagion after that period; though it is to be observed
it extended to the third child. That the husband had the dis¬
ease in a latent state there can be but little doubt; and that
he communicated it to his wdfe is pretty certain ; but in what
way, has hitherto, I believe, eluded the ken of our senses, and
perhaps ever will. Numerous cases of a similar nature have
come to my knowledge; and in all of them, though the hus¬
bands declared that they bad no disease upon them, nor did
any appear upon examination, still it w^as acknowledged they
had had the disease, and had been cured by some external ap¬
plication ; procured, too often, from some illiterate person.
In some cases the glands appeared corrugated from such appli¬
cations. It is a remarkable fact, that nearly the wffiole of
those who fell under my care with secondary symptoms,
which are so tedious and generally very difficult of cure,
had been thus improperly treated in the first instance.
Therefore it became an established practice with me to secure
the constitution by mercury ; and leave the sores to heal by
cleanliness, and a little lint to absorb the discharge from them.
And though this mode w^as tedious, it was sure ; which in¬
duced me to adhere to it rather pertinaciously, and per¬
haps rather more so than was warranted, a different mode
having of late years been adopted by men of approved
talents.

It would ill become me to disregard their authority ; and
on that account I shall merely state the result of my own
observations, with remarking, in the words of a distinguished
author, that ‘^credulity in matters of physic has been the.
principal cause of the slow advancement of it; and that an

VOL. XI. — NO. 6l. D

iS Original Communications,

absolute resignation to the opinion of any man, however gxeat,
without taking proper pains to judge, examine, and search
into the truth of it, is a slavish submission, and very unbecom¬
ing a rational creature.”

If i am not mistaken, it has of late years been the practice
with some very respectable Practitioners to cure primary
venereal sores with escharotics; giving little if any mercury
to secure the constitution. But from what I can learn, it was
usual to tell the patient such sores were not venereal, though
very much like it ; two very remarkable instances of which
fell under rnv notice in the spring of 18lG,

My adviee being requested by an officer of a dragoon regi¬
ment, of which I had the medical care, respecting an ulcer
upon the preputium, and no doubt remaining either upon mine
or my patient’s mind as to the nature of the complaint, a mer¬
curial course was proposed, sotne antiplilogistics being pre¬
mised. In a few days after, business of an urgent nature
required his attendance in London, and this induced him to
consult a professional gentleman of great respectability there,
who informed him it was not venereal, though vciy much
like it ; and cured him in a week or ten days with only two or
three times dressing. Very soon after I was again applied to
for my assistance by another officer of the same regiment
under precisely the same circumstances, and it originated from
connexion with the same female as in the former case : but
being now put upon my guard, I determined to act with more
caution ; I therefore advised him to be perfectly satisfied as
to the nature of the disease before any measures were taken
for its removal ; adding, if it was not venereal, nothing more
than cleanliness would be required ; but if it were, the sore
would graduall}" enlarge and get worse. At the end of a
week it assumed the true venereal character, with which mili¬
tary men in general are too familiar to be much mistaken.
Tired of further delay, he now requested me to adopt the
plan 1 proposed. But at the end of a few days his friend re¬
turned from town, full of glee at having been cured with only
a few external dressings, regimen and medicine not having
been thought at all necessary. The effect of such agreeable
intelligence may be much easier conceived than described ;
restriction was no longer to be endured; and away he speeded
to the iEsculapius who bad performed so great a miracle,
in about a fortnight he returned to his regiment apparently
quite well. Facts are stubborn things, and it was now very
difficult to support either my opinion or practice : argument
must give way to proof. My cbjections to this practice may
be stated in a very few words: i do not like secondary symp-

Cooke on the P enereal Disease.

toms ; when they begin there is no knowing where they will
end ; at least 1 have often been puzzled and perplexed to
arrest their merciless ravages.

I am not ignorant of what has been said bv Mr. Pearson on
cachexia syphiloidea, and by Mr. Abernethy on pseudo-syphilis;
and though L have no objection to these distinctions, yet I
think the subject in need of much investigation, as all those
cases which could be considered as coming under such de¬
scriptions, that have fallen under my care, and they have been
rather numerous, were cured by mercury in some form or
other ; and that after other means had been tried in vain, the
sores having invariably broke out again at no great distance
of time, or showed themselves in other parts. This has in¬
duced me to continue in the old beaten path, until facts have
established the superiority of a different mode of treatment,
I shall now state a cttse or two in illustration of what 1 have
advanced.

In the spring of 1814, a medical officer of a regiment of
dragoons called upon me to request my opinion respecting
one of the officers of the regiment who had a sore throat,
which, on inspection, I found to have all the characters of a
venereal one; and, therefore, without hesitation, pronounced
that opinion.

I w'as then informed that he had onl}^ been a very short
period released from his bed, where he had been confined for
a considerable length of time with two very extensive sores
in the groin, which the senior medical officer of the regiment
had declared were not venereal, and cured them without mer¬
cury. My opinion being given wnthout any knowledge of
.this circumstance, was considered as free from bias of any
kind ; a mercurial course was proposed and adopted, and by
which the patient was cured.

On the 2d June, 1814, a private soldier of the same regi¬
ment was transferred to my care in the most deplorable state
imaginable; in short, he was a complete Lazarus : not an idea
was entertained that he could recover; but on the IQth of
October following he was sent to Chelsea.

This case was attended by a peculiar circumstance which
I bad never noticed before ; three weeks after he had been
under my care it is noted that his gums are tender as if be
was taking mercury, and his breath has llie mercurial fetor,
thoush none had been used since he was transferred to me.
He had been taking cinchona, opium, and nitric acid.

On the 17th of August it is again noted, ‘‘ his breath still
jetains the mercurial fmtor, bis mouth quite sore, and spits
considerably.”

On the 3d of September it is again noted, his moutli is

Original Communications^

still very sore, and the mercurial fsetor very strong/’ To enter
further upon this would be digressing too far from my subject,
and therefore I shall leave it without any comment.

Upon inquiry into the history of this case, 1 was informed that
■when he was at Dorchester, some years since, he had a chancre,
and applied to his Surgeon for relief ; that this gentleman gave
him some dressings, desired him to keep himself clean, and
go about his business ; that he obtained fresh dressing from
the hospital sergeant when he wanted it, and the sore got
well; and that he has not since had any of the same kind;
that when the sores broke out about his body and limbs he
applied for relief, and was then admitted into the hospital
(14th of September, 1813), and put under a mercurial course;
and that had been his general treatment till delivered over to
me. From these and many similar cases that have laiieii
under my care, I am disposed to think that the disease, in its
primary state, is often curable without mercury ; and that its
virulence does often become much mitigated by reason of
general and inadequately resisted diffusion, or other causes ;
and after running a certain (in some instances a mild) course,
exhausts itself, and ceases spontaneously. Such appeared to
be the case vrith the husband of M. D. s and though it is
known to be so occasionally, 1 think that will tiot warrant the
subjecting of our bodies to the unresisting influence of that
disease, the consequences of which might, and frequently are
either fatal, or occasion mutilation and decrepitude in our¬
selves or offspring : and these are my reasons for thinking
that to cure the disease by topical means alone, in its primary
state, is pernicious and highly dangerous.

I have often had reason to regret that the farriers of regi¬
ments could not be prevented from practising in this way ;
the evils attending it have been very great, and often seriously
felt by the country, in the loss of the valuable services of
numbers of its bravest defenders.

I have perused Mr. Feigusson’s paper upon the venereal
disease in Portugal with much satisfaction ; and his ideas
upon the subject accord pretty generally with those of my own.

III.

Case of Immediate Death from Oxalic Acid^ taken in mistake
for laxative Salts. By John Wesley Williams, of
Portsea, Member of the Royal College of Surgeons in
London. ^

It is much to be deplored that the benefits arising from the
progress of science should he checked by the drawback of the
fatal misuse of many of the powerful materials which are

Williams on Oxalic Acid,

thereby made known to us. Every precaution to keep such
substances from persons unacquainted with their active
qualities should be strictly observed. I do not consider it a
happy addition to the conveniences of domestic life, that so
poisonous a substance as oxalic, acid, so fatally resembling
salts, should be commonly used for removing stains from boot-
tops, when other strong acids, the muriatic for example,
would fully as well effect the purpose, without the liability of
these awful errors.

I was summoned to the assistance of Anne Prouse, residing
in Portsea, early on Monday morning, the 2d of November,
but she expired before my arrival. 1 was informed by her
husband that she arose to prepare breakfast at a quarter
before seven o’clock, leaving him in his room. At half past
seven she returned, saying that she had taken salts, and com¬
plained of the most agonizing pain. She asked for some oil,
which was uiven her: soon after which she had an evacuation
from the bowels.

She threw herself upon the bed, became convulsed, and
expired. I’hus, allowing half an hour for her occupations in
lighting her fire and boiling her kettle before she dissolved the
supposed salts, death must have ensued in rather less than
half an hour after she had swallowed the draught.

The crystals which she made useofwere given her by a friend,
who had casually found the parcel in clearing out a grocer’s
shop I Mrs. Prouse had given a dose to a neighbour who
was unwell; but, I'ortunately, she laid it in a place where it
became mixed with dust, on which account she wiselv cast it
aw'ay. The children of Airs. Prouse narrowly escaped the
fate of the mother. She endeavoured to persuade three of
them to take some of the same portion, as a preventive of the
fever in their vicinity; but on being informed that taking
physic required them to omit their breakfast, they, with a
happy firmness, refused to take the dose.

A basin was shown me in which it was supposed that
the salts had been mixed. 1 noticed some obscure crystals
irregularly strewed over the basin ; but such was their indefi¬
nite figure, from having been moistened, that i could not
satisfy myself that they were not an unrefined species of
Epsom salts.

I should have mentioned that the poor woman appeared of
a weakly and infirm slate of body. One or two dejections
from the bowels had taken place, but it could not be told
whether they were sanguineous or not; nor had, bloody
vomiting occurred; so that the whole suspicion of poisoning
rested on two facts — the occurrence of excruciating pain after
tlie substance swallowed — and the fatal event succeeding it.
1 confess I almost gave way to the belief that the salts (sup-

22 Original Communications.

posing them of ordinary .quality,) had acted powerfully on a
peculiar diathesis.

On inspecting the half liquified remnant in the basin, I
perceived a whiteness in the fluid parts, which 1 attributed
to some portion of milk remaining in the basin that was used ;
but this appearance was afterwards satisfactorily ascertained
to be from the lime in the water used to dissolve the crystals.
I took the basin home with me, to prove its contents by a
chemical examination.

I took a particle of the substance on the point of a bright
knife, and observed a stain produced similar to that of strong
acids. This gave me a suspicion of its corrosive nature. A
solution of two grains in four ounces of Farlington water
gave a sensible cloud. This I supposed was from the affinity
of the substance to lime. I now believed that it might be
oxalic acid. A like quantity dissolved in four ounces of the
water of Portsea island, rendered it turbid, but considerably
less so than in the former instance. This further proved that
lime was the substance affected by the affinity, as on treating
the water of either spring (both being used in the water works
of these towns,) with oxalate of ammonia, it appeared that
Farlington water superabounded in lime when compared
with that of Portsea. 1 now added lime water to a solution
of the matter in distilled water, and a most abundant precipi¬
tate of oxalate of lime w^as formed.

1 next proceeded to prove its acid qualities. A drop of the
exceedingly dilute solution alluded to above perceptibly
changed the tinge of litmus paper; but when a bit of crys¬
tal was presented to moistened litmus paper, the purple was
changed to the brightest red. My syrup of violets was thick
and crystallizing; i could not therelbre depend on it as a
further test ; but from the striking and undeviating affinity for
lime, and its effects in reddening litmus, qualities remarkable
in oxalic acid, 1 fairly concluded that such was the poison.

Examinatio post mortem. — Tlie friends objected to an
inspection of the body : but although I could not consistently
forego this point, for the sake of their feelings I restricted the
examination principally to the stomach; a view of that
viscus being most important in tracing the effects of corrosion.

At five oTlock in the evening of the same day, accompa¬
nied by Dr. Lazzaretto, of Portsea, I proceeded to the house
for this purpose, h bloody serum was passing at the mouth.
The abdominal parieties on being pressed gave the elastic
crackling feel of air confined in the cellular membrane. The
section of the abdominal coverings exposed the intestines
highly inflamed, and distended with fiatiis. The stomach
appeared inflamed at particular points externally, particularly
near the pylorus. This organ was shrunk, and contained

Williams on Oxalic Acid^ 23

about eight ounces of a dark, grumous, pulpy matter, more
like meconium than any thing to which 1 can compare it; so
viscid and tenacious, as to adhere strongly to the liands ; there
were membranous tiakes intermixed with it derived from the
velvet coat of the stomach, which seemed destroyed through¬
out. Thus the disorganization of the stomach, which so
remarkably occurs from corrosive poisons, proved in connexion
with the rapid deprivation of life, that oxalic acid was the
substance peculiarly capable of producing these effects.

Examination of the contents of the stomach, — I should
first state that the knife used in laying the stomach open
was impressed with an indelible stain.

The surgical needles were so completely stained and cor¬
roded, that my pupils put them into lime water to decompose
the crust, and a remarkable deposit was quickly formed. The
matter found in the stomach was so adhesive, that I could not
in that state subject it to examination. I therefore poured a
pint of boiling water on if, stirring it well, to dissolve any
crytals, and filtered it through paper. A transparent pale red
liquor was produced, which probably owed its colour to
sanguineous fluids heightened by the acid. This filtered
liquor so much diluted, affected litmus paper, and on pouring-
lime water to a quantity of it, a very copious sediment of
oxalate of lime ensued. Hence it appeared that oxalic acid
was the real cause of death. An inquest gave a verdict of
Death by oxalic acid, taken in mistake for salts.’^

After the inquisition was over, the remaining members of
the family incurred the risk of the mother’s fate.

On taking down the sugar jar for tea, they met with some
impediment in taking out the sugar, and on examining the jar
they found a loose paper containing a quantity of this acid.
And probably more than an ounce had fallen into the sugar
and was mixed with it.

The crystals were brought to me, and the identity with
oxalic acid was fully apparent.

1 have troubled the Repository with this account, as I
recollect several cases similar to this have been inserted in.
that Journal.

IV.

A Case of Hcemorrhage, which terminated fatally from the
Application of a Leech. Communicated by Anthony
White, M. R., Surgeon to the Asylum, Consulting
Surgeon to the General Penitentiary, and Assistant Sur¬
geon to the Westminster Hospital.

It has been rarely (if ever) recorded, that the application of
a leech has been directly productive of death to the person on

Ot'igi rial Commwncations,

whom it was placed : such an occurrence I have once wit¬
nessed ; and on several occasions my assistance has been
requested to restrain haemorrhage which had continued many
hours, and where every usual method had in vain been
adopted, and where the blanched and exhausted condition of
the patient was not sufficient to cause a spontaneous cessa¬
tion of the how of blood. The case of death to which I
allude happened in my immediate neighbourhood : the cir>-
cumstances were the following, A gland under the angle of
the jaw became enlarged and painful, in a female child two
years and a half old : the mother, at the request of her apo¬
thecary, placed a leech on the tumor; the direction given
was, that when the leech liad fallen off, a large poultice was
to be applied to the bite, into which it might bleed ; and it
was requested that the poultice should be kept on all night.
The leech was applied at night; the poultice also; tiie
child put to bed: thither also, at the same time, went the
mother.

The next morning the child was found with pallid face and
bloodless lips, and its whole body bedewed with chilly sweat,
the usual precursor of death, arising from slow baeraorrhagic
exhaustion. The blood had flowed during seven hours, and
was found in a large coagulated mass under the sheet. The
unhappy mother had of course slept during this period:
the volatile and other stimulants which i directed to be admi¬
nistered were of no avail ; depletion had gone beyond the
recoverable limit, and the patient died before i left the
bouse.

It is remarkable that in this exhausted state blood was yet
slowly oozing from the leech wound ; and I have witnessed
in many other instances, where, even during fainting, the
blood has flowed from the peculiar bite of this animal.
Children, on account of many inflammatory affections, and
where the use of the lancet is impracticable, become the
frequent subjects of leeching ; and many parts of the body,
from structure and situation, are ill calculated to bear pres¬
sure, or to have it effectually applied. The relation of the
following case, which led me to adopt a method of restrain¬
ing hmmorrbage, is an example: — My friend, Mr. M^illiani
Pritchett, bad directed leeches to be applied over the trachea
of a child affected with croup ; the bleeding from one of the
punctures became alarming ; styptics after the usual fashion
had been in regular order applied, and all as regularly failed.
On my seeing the child with Mr. Pritchett, I found it much
exhausted, and the blood pouring over the throat in a rapid
stream. The weak condition of the patient forbade me to reite¬
rate the attempts which are usually adopted, and on closely
inspecting the parts, a small pulsating arterial stream was

Williams on Ilccmorvhage from Leech Punctures. 25

discernible. On the spur of the moment the following
method was adopted : 1 procured a fine sevving needle, which
I passed through the leech-bile, piercing as much of the skin
on each side as was sufficient to obtain a moderately firm hold:
the bite or wound thus transfixed, I conveyed beneath the
needle a few turns of common thread, which gave me complete
and effectual pressure on tlie orifice. The method used by the
farriers after bleeding the horse, which is to pass a pin
through the orifice, and afterwards to wrap round or behind
the pin apiece of hair or dax, nearly resembles the plan I
adopted. A piece of cork or wax was adjusted on each end
of the needle, which the next day was removed : the portion
of skin necessarily pierced on each side of the wound is so
small that very little pain is experienced by the operation.
The plan is so simple, yet so certainly effectual, that I have
for the last five or six years constantly adopted it, where, from
situation or structure, pressure was inadmissible; or danger,
during the night, of a recurrence of the bleeding w'as appre¬
hended. A very recent case in which leeches had been
applied over the scrotum of a boy eight years old, with a con¬
genital hernia, anff where (arising from three of the punc¬
tures,) haemorrhage had returned during the night, the patient
was with difficulty recovered from its excess, the needles were
effectually applied. 1 have from this circumstance thought
the subject of sufficient importance to the community to give
publicity to the method which has invariably succeeded. The
th roat, scrotum, and perinaeum, are parts of the body’^ to wdiich
leeches are frequently applied, and which, from situation and
structure, are ill adapted to receive or bear pressure : when
the bleeding cannot be restrained with facility in these situa¬
tions, 1 have oftentimes saved my patient much exhaustion
and alarm, and myself much trouble, by adopting the plan 1
have explained. Where the leech, wdth its teeth, has punc¬
tured a large cutaneous artery, which not unfrequently hap¬
pens, and where, from its imperfect division, contraction can¬
not take place, 1 have occasionally succeeded in restraining
the bleeding by pushing the point of a lancet into the leech
puncture ; but this method is uncertain of success. From the
report of many of my’’ professional friends it is certain that
infants occasionally perish from the effect of leech punctures;
and many cases of great hazard, no doubt, frequently occur
from the same cause to children beyond the infant age, and
even to adults of delicate and lax structure. 7 he circum¬
stances connected with each case will regulate the adoption
(among Practitioners) of the method which 1 have recom¬
mended. The histories I have detailed are of themselves, i

VOL. XI. — NO. 6i. E

O jig i n a I Co m m u n ic at ions.

trust, of sufficient importance to warrant this very simple, yet
effectual, method of restraining liaLunorrhage, being the subject
of communication to the medical public.

Farliament Street.

Case of Croup. By L. Leese, Surgeon,

In transmitting the following case of croup, my motive is
to exhibit the beneficial result of prompt and efficient mea¬
sures in this rapid and fatal disease ; without pretending to any
novelty of treatment.

A family in tlie city, in the year 1815, possessed two re¬
markable fine children, both of whom they lost in the month
of October of that year, in one week, by croup. On the
5th of October, of the present year, [ was called early in the
morning to a very fine child of the same parents, aged nine
months, whom I found with most decided symptoms of croup.
Pulse 160°, and interrupted. I immediately ordered ten
leeches to be applied to the throat, an ounce mixture with
four grains of tartarized antimony, a tepiH bath every three
hours, and a fomentation to the throat every hour from the
falling off’ of the leeches; the good elTect of these remedies
was apparent in a few hours, and before the following morn¬
ing they had removed symptoms that threatened speedily to
extinguish life.

[ am decidedly of opinion, that had there been any delay in
the application, or want of entire confidence and active co¬
operation on the part of the parents, and others of the family,
this child would also have been lost in less than forty hours,
as both the others were.

I am hereby induced to recommend the employment of
persons who are in the habit of providing and applying
leeches; in the due application of which we are often disap¬
pointed : when a given number are sent for, they are fre¬
quently attempted to be applied by inapt persons, or the
leeches may be inert: in the present case a woman was sent
for them, who brought a great number, so that if some did
not readily adhere, others were at hand, the patient thereby
saved from fatigue, and delay prevented. By this n)ode, in
many cases, highly important results may be gained or
avoided,-— no less lhan life or death.

DEPARTMENT OF NATURAL HISTORY, &c.

On the Animals of the Class V ermes in general, and on the In^

testinal Worms of Mankind in particular. By S. F.,G ray.

Amongst the numerous species of animals which are
already knowm, there are none more important than those to
w'hich the generic name of vermes is now confined. This
importance arises from many of them living within the body
of mankind ; and others in the bodies of animals. The know¬
ledge now possessed of these animals is very small, and almost
entirely confined to the external form, and the names which
have been given to them by those few naturalists who have
written upon the animals of this class.

Lamarck, from a consideration of the anatomical structure
of these animals, considers them as forming the first rudi¬
ments of that series of animals which passes on successively
from the vermes to the epizoaria, insects, Crustacea, arach-
nides, and terminates in the cirrhipedes. This anatomical
structure is very different in the various species, and can
scarcely be characterized in a generical manner, for there is a
very considerable difference between the organization of a
hydatis compared with that of the strongyli that live in the
stomach and larger intestines of the horse : and yet these last
animals are much more imperfect than insects, and still more
so than the moliusca with which Linnaeus had confounded
them, but which approach very near to what are called the
more perfect animals.

But although positive characters can scarcely be given,
which are common to all these worms, there are certain ne¬
gative characters which apply to them. Thus none of these
animals exhibit an}'^ appearance of radiation, neither have any
of them a head forming the seat of any peculiar sense, and
still less as forming the focus of sentiment. Hence the best
way of describing them seems indeed to be the definition
given by Lamarck himself, as hereafter mentioned.

The vermes have been confounded with the annelides of
the present naturalists, but there is an immense difference in
the anatomy of these tw'o classes, since the annelides have a
nodose longitudinal medulla as the organ of sense and mo¬
tion, a regular circulation of red blood through arteries and
veins, and they breathe either by internal or external gills.

The following enumeration of the genera and species of
worms is the completest hitherto published, and is taken partly
from Uudolph and partly from Lamarck, with occasional re^
ference to other authors.

28 Original Communications.

CHARACTER OF THE CLASS.

Vermes. Animals soft, Jong, mostly naked, without any
head, blind, and without feet.

Mouth with one or many suckers ; tentacula none.

Organization. An alimentary tube or sac ; breathing
water by their e*^ternal pores ; the generation of some species
is by buds, and of others inclining to oviparous : none have a
brain, a nodose longitudinal medulla, any organs of sense, or
any vessels of circulation.

Order I. — Vermes Molles.

ISaked, soft, and without any apparent stiffness, of very
different shapes, and for the most part irregular.

A. Fermes molles vesicularii. Either vesicular or termi¬
nated behind by a bladder, or else adhering to a bladder-like
cyst in which they are contained.

1. Ditrachyceros, Sultz ; Diceras, Rudolph. Bod^
ovate, flat, covered with a transparent tunic, furnished in the
fore part of the body with two long horns covered with fila¬
ments.

1). Tudis. About a quarter of an inch long, one half of
which w^as taken up by the horns ; four of these were ejected
from a woman 26 years of age after taking a cathartic medi¬
cine, along with great numbers of others which seemed to be
the ovaria of toenias. Body hollow, filled with a watery
liquor, the internal surface tubercular as well as the external.

2. Hydatis, Lamarck; Cysticercus, Rudolph. Bladder
external, cystose, usually containing only a single worm.
Body vesicular, pitcher-shaped hlied wdth water, narrowing
in the forepart into a thin neck, having at its summit four
suckers and a crown of hooks. — The hydatides have been
consideied by some as mere deposits of lymph ; a great
abundance ol them in animals cause a considerable degree of
disease : they are superficial, or but moderately immersed in.
the viscera of various animals. l\vo species are enumerated
by Lamarck, neither of which are found in mankind.

3. Hydatigera, Lamarck ; Rudolph. Blad¬

der external, cystose, almost always containing a single worm.
Body long, depressed, wrinkled, terminating behind in a
caudal bladder shorter than the body, and filled with water,
the fore-end having four sucking mouths, and being armed
wdth a terminal crown of hooks. — ^These have been included
by Rudolph in the same genus as the preceding, under the
common name of cysticercus, of which he enumerates fifteen
species as having been found in animals. Of these only one
has as yet been found in man.

11. cellnlosa. Head four-sided, beak round, hooked ; neck

Gray on Vermes,

very short; growing smaller in the fore-part; body cylin¬
drical, caudal bladder transversely elliptical. Scarce half an
inch long when extended, and about a line wide; the caudal
bladder shorter. Head large in proportion; mouths orbicular
placed in the corners; body retractile within the bladder, and
appearing through its transparent sides like a hard globe
within it. Skin papillose. Found between the muscles in
the brain, and in the axillary fovea of man, and in almost
every soft part of the hog, sometimes in great numbers, the
pork being then said to be measly.

3'. CcENURUs, Rudolph; Polycephalus, Zeder. Bladder
external, thin, cystose, tilled with water containing man3r
worms adhering together. Bodi/ long, rather Hat, slightly
wrinkled, terminated in the fore-part by a swelling furnished
with four suckers and a crown of hooks. — These aia- included
bv some in the next genus, but are flat: thev are found in
the brain of sheep, at the bottom of a bladder rather larger
than a pigeon’s egg; the worms themselves are about one-
sixth of an inch long: the sheep afflicted with them lose
their senses, become blind, and die in great numbers; the
cure is attempted by puncturing the skull at the sutures, by
trepanning and extracting the bladder, or by passing a sharp
pointed wire up each nostril till it reach the skull , after
which operation the sheep sometimes lies as if dead for 12
hours; occasionallv an accidental contusion breaks the blad-
der, and the sheep recovers.

4. Echinococcus, Rudolph ; Polycephalus, Zeder.
Bladder external, cystose, filled with w'ater containing several
very small worms, like grains of sand adhering to the internal
surface ; body globular or top-shaped, smooth ; the apex
having four suckers and a crown of hooks. — Three species of
this genus are known, all found in the viscera of animals.
One is found in mankind.

B. Hominis. The bladder is sometimes as big as the fist,
the worms smaller than sand, yellowish. T he specimens of
Meckelan are supposed to have been found in the brain, but
Rudolph rather imagines they were found in theliver; Rudolph
himself has some of these worms in small bladders, ejected by
the anus, and which probably passed from an abscess of the
liver into the duodenum.

B. V ermes molles plain. Body soft, flat.

.5. I’jE M A, Galen ; Tinea, Pliny; ylli/sel/nin( luis^ Ida lysis,
Zeder. Body soft, very long, flat, jointed, terminated in the
fore-part w'ith a head-like nodule. Terminal nodule having-
four suckins: lateral mouths. — I’hese worms resemble a white

O ^

riband with jagged edges, and are divided into joints, the
larger species having in general the smallest joints ; each joint

Original Communicatiom,

appears to be a separate animal ; and yet the fore-end, after
generally growing narrower, terminates in a swelling with
four mouthsj the oesophagi of which afterwards unite into a
single canal which transverses the whole length of the worm.
Each joint has usually a pore on one of the edges, and some¬
times a little button or perforated nipple ; internally each
joint appears to have an ovary sometimes resembling a bunch
of grapes, the ova of which may be pressed out through the
lateral pore in great numbers. All the worms of this genus
live in the intestines only of animals. Rudolph enumerates
116 species, of which however only tw^o are found in man¬
kind, both of which are called indiscriminately tape-worms
from their appearance, and frequently confounded.

T. lata. Terminal nodule, simple, not beaked, ob¬
tuse; neck none, joints in the fore-part very short, the others
squarish, with lateral pores. Grows to the length of twenty
feet, and generally half an inch broad, rarely an inch ; Goezius
however had an imperfect specimen 60 ells long ; said to be
more frequent than the next species in Switzerland and Rus¬
sia, often found in France, but rarely in Germany, Holland,
and England. Rudolph says he never knew it found in a
dead body^

T. Solinm. Terminal nodule armed, hemispherical, broader
than long, beak obtuse ; neck growing thick toward the ter¬
minal nodule ; joints towards the fore-end, very short, the
following ones squarish, the remainder oblong ; all the joints
rather blunt; with one of the lateral edges obtuse and fur¬
nished with a perforated nipple, the other sharpish and not
perforated, the pores being generally placed on alternate
sides. Found in the small intestines of mankind, usually by
itself in Germany, Holland, England, and the East ; but in
France generally in company with the preceding. Called by
the French le solitaire, yet Rudolph procured four specimens
with terminal nodules which had been ejected by stool, from
the same person. The terminal nodule is very small, flat ;
neck three or six times as long as the head, also flat. These
worms are sometimes found folded together, several of the
joints being in coition with others of the same individual;
sometimes two worms are found closely adhering from the
same cause. The joints are sometimes ejected singly, and
thought to be a different species, called in English gourd
worms: the tmnia itself has also been conceived to be formed
by the union of these separated joints ; and the nipple on
their edge was thought to be a proboscis. Some have vainly
imagined that persons afflicted with either of these worms
dislike music, and are irritated by it.

7. BoTKYOCErnALUS, Rudolpli ; LiniiEeiis ; Rhy-

Gray on f crnies.

telminthiiSj Bhytisj Zeder, Body soft, long, flat, jointed ;
terminal nodule four-sided blunt, with two pits on the sides
opposite to each other ; either naked or armed with
suckers. — Of these there are nineteen species hitherto de¬
scribed as inhabiting other animals, mostly in fishes. Accord¬
ing to Lamarck the taenia lata just spoken of belongs to this
genus.

7. Tricuspidaria, Rudolph; Teenia, Linnaeus; Bhytis,
Zeder. Body soft, long, flat, deeply wrinkled at the hind end ;
mouth near the fore-end, two lipped, each lip having two
th ree-pointed spines. — Of this genus only one species is
known, which is found in the pike, perch, and other fish ;
either free in the intestines, or included in a cyst in the liver,
and sometimes also in the mesentery : it is from an inch to
two feet long, and about one-eighth of an inch broad.

S. Ligula, Bloch; jPascfo/a, Linnaeus. Body long, flat,
strap-shaped, smooth, sometimes having a longitudinal
groove; rather blunt at each end : mouth and anus not sepa¬
rated. Of these nineteen species have been already de¬
scribed, some being found in aquatic birds, others in fishes;
either in the intestines or in the hollow of the abdomen, twist¬
ing themselves round the intestines. It is a species of this
genus that by its irritation causes the bleak to have those
irregular motions and to leap out of tlte water in the latter
end of summer; at which season they are called mad bleak
by fishermen and anglers.

9. Li NGUATULA, Fioelich ; Polystoma, Zeder. Body soft,
long, flat, growing narrow behind ; mouth manifold ; open¬
ings four to six, simple, placed uitderneath and towards the

fore-end; anus . — Six species are known, found in the

Kmgs and other parts of animals ; one of which is found in
mankind, viz.

L. pinguicola. Flat, oblong, truncated before, sharp
pointed behind; six pores placed in a semicircle. These
pores, or mouths, may be pushed out or retracted at the will
of the animal; about three quarters of an inch long, and a
quarter wide. Found by Treutler in a fat, but hollow, reddish
tubercle about the size of a hazel nut, in the cellular substance
of the indurated ovarium on the left side of a country woman
twenty years old, who died, after a difficult labour, of san¬
guineous apoplexy.

10. PoLYSTOMA, Be La Roche, Body long, flat, con¬
tracted towards the fore-end, pointed behind ; mouth, six
bilocular concave suckers, with two holes each placed in a
row under the fore-end ; anus underneatlq near the hind-end.
— Only one species is known, which is found sticking to the
gills of the tunny, of a grey colour, about an inch long.

Original Commanicattons,

11. Planaria, Muller. oblong, flattish, gelatinous,

naked, contractile, rarely divided or iobed ; mouth and anus
underneath. — Of this genus many species are known, of which
sixteen are discriminated by Lamarck : they are not intestinal,
but live in ponds, rivulets, or the indentures of the sea coasts.
It is not, however, certain, whether they really belong to this
class, or to the annelides, as some suppose the black spots on
them to be eyes, which would necessarily require the presence
of optic nerves, and a brain, and of course remove them
from this class.

\2. Fasciola, Linnaeus, Distoma, Retz. Bod^ soft,
oblong, flat, sometimes rather cydindrical ; pores two, one near
the fore-end, being the mouth, the other below, or on the side
distant from the former, being the anus. — It is also doubtful
whether these are vermes or annelides. They live in the
intestines, and other viscera of animals. Eighty -one species
are known, of which only one is found in man.

F. hepaiica. The fluke worm. Obovate, flat; neck sub¬
conic, very short ; pores round, the ventral one the largest.
Found in the gall-bladder of mankind, and in the livers of
sheep, &c. causing in these animals an ascites : when full
grown are about an inch long, and half an inch broad, yellow,
green, or brown. Is capable of passing through very narrow
passages, by lengthening itself.

C. Fcj^mes moUes heteromorphi. Body sometimes flat,
sometimes cylindrical, frequently of an irregular shape.

33. Monostoma, Zeder; Festucaria, Schrank. Body
soft, long, of many forms, flat or cylindrical ; pore single, ter¬
minal, or on the end of the fore-end, appearing to be the
mouth; anus wanting. — These singular worms have in many
of their species no appearance of any intestines. Ldfieen
species have been described, as found in the intestines of the
mole, of some birds, and fishes.

14. Amphistoma, Rudolph ; Abilgaard. Body

soft, cylindrical, rather irregular; pore at each end, single;
being perhaps the mouth and anus. — Several of this genus
having a swelling at the fore-end resembling a head ; eleven
species are known, which are found in the intestines of qua¬
drupeds and birds.

15. CAPtYOPHYLLGEUS, Gmeliii; Phyllinej Abilgaard.

Body soft, flat, long, growing narrower behind, the fore-end
spread out wide, fimbriated contractile; lipped, rarely

conspicuous; anus terminal, behind. — Only one species is
known, found in fresh water fish, growing to two inches long;
the fore-end is usually spread out like a spatula, and as crisp
as the petals of a pink.

16. Tetrarhyncpius, Rudolph; Tentacularia^ Bose.

Brodie on Diseases of the Joints,

Body sackllke, oblong, resembling a club, the fore end obtuse,
contracted at the hind end ; suckers four, proboscidiform,
retractile, placed at the fore-end ; arms behind, terminal. —
These vermes are generally very small, and inhabit the
stomach, intestines, and liver of fishes. Four species have
been described.

17. ScoLEx, Muller. gelatinous, long, rather flat,

broad at the fore-end, pointed at the hind-end, contractile ;
mouth terminal, orbicular, surrounded with four folding ears of
various shape. — Only one species of this genus is known. These
worms are very small, and are found in the intestines of fishes,
especially flat fish.

18. Tetragulus, Bose. long, club-shaped, rather

flat, ringed transversely ; rings uarrow, the lower edge
fringed with short spines ; mouth, under the broader extremity,
armed wdth two hooks on each side;a;2Ms terminal, behind.—
Only one species is known, about one-eighth of an inch long;
found in the lungs of Guinea pigs.

19* Sagittula, Bastiani. Body soft, oblong, rather
flat ; fore-end terminated by a pyramidal swelling, armed with
points directed backwards ; hind-end has two appendages,
opposite to each other, and shaped like a thigh ; proboscis
single, retractile, inserted on the upper part of the animal,
under the apex of the pyramidal swelling. This singular
worm, the S. hominis of Lamarcke, was found in a stool
ejected in a verminous cardialgia. From the form of its
appendages it was described by Dr. Bastiani. Act. Acad.
Sienn. vol. vi. p. 241, as a biped animal.

(To be concluded in our next Number.)

PART IL

ANALYTICAL REVIEW.

Pathological and Surgical Observations on Diseases of the

Joints. By B. C. Brodie, F.R.S. Assistant-Surgeon to

St. George's Hospital, and Lecturer on the Theory and

Practice of Surgery.

A YOUNG Surgeon or general Practitioner having com¬
pleted his studies, and commenced the management of mor¬
bid affections on his own individual account and responsi¬
bility, will very soon be called on, in the most common

VOL. XI.-— * NO. fll, F

Analytical Review,

course of events, to exercise his skill in cases of diseased
joints; than which cases, indeed, nothing in the whole depart-
inent of medical surgery is more important in its nature, or
more frequent in its occurrence. Let us then suppose one of
these instances to have occurred. We will imagine that our
youthful novice is summoned for the first time to pass his
judgment, and commence his remedial operations upon a
morbid affection of one of the great articulations. The ques¬
tions which will immediately present themselves to his mind
as of the highest moment to solve, are, first, what is the pre¬
cise seat of the disordered action ? and, secondly, what is the
particular nature of such disorder? And as a directory to the
more ready solution of these important problems, w'e have the
greatest satisfaction in recommending the volume which is
now before us for review.

That kind of generalization which arises out of an indolent
acquiescence in the application of general terms has been in¬
juriously made to apply to the subject of articular maladies,
and the expressions ‘‘ scrofulous diseases, and v^^hite swel¬
lings,’^ have stood too much in the way of minute investiga¬
tions and accurate views. These terms (says Mr. Brodie)
have been used without any well-defined meaning, and almost
indiscriminately ; so that the same name has been frequently
applied to different diseases, and the same disease has been
distinguished by different appellations. Confusion with re¬
spect to diagnosis always gives rise to a corresponding confu¬
sion with respect to the employment of remedies; and hence I
was induced to hope, that if it were possible to improve our
pathological knowledge of the diseases to which 1 have al¬
luded, this might lead not indeed to the discovery of new
methods of treatment, but to a more judicious and scientific
application of those which are already known, and a conse¬
quent improvement of chirurgical practice.”

Our author’s arrangement of articular affections is, first,
Inflammation of a common rather than specific nature of the
synovial membranes of joints. Secondly, U/ceratiom of this
membrane. Thirdly, More specific or peculiar disease of the
same part ^ in which the membrane undergoes a morbid change
of STRUCTURE. Fourthly, Ulceration of the cartilages zohich
enter into the composition of joints. Fifthly, That disease
of these parts zvhich has its origin in the cancellous structure of
the bones f and which Mr. Brodie regards as the only, pro¬
perly speaking, scrofulous derangement. To the above
general division are added, caries of the spmcy other affections
of the joints which are of a more miscellaneous character;
and, lastly, inflammation of the hursw mucosw.

We shall aim at presenting our readers the sum and sub-

Brodie on Diseases of the Joints.

stance of Mr. Brodie’s able dissertations on these several par¬
ticulars, merely premising that some valuable papers of this
author in the Medico-Chirurgical Transactions had antici¬
pated a considerable portion of the present volume, in refer¬
ence especially to the distinction between synovial and
scrofulous inflammation. It does not however in the pre¬
sent instance appear that the repetition of the auth®r’s self is
objectionable; since the volume, as it now stands, constitutes
a complete treatise of diseases of the joints, and will, we hope,
get into the possession of many individuals who are without
the opportunity of consulting the excellent volumes which
are sent into the world from the Medical and Chirurgical
Society.

In treating first of disordered action in the synovial mem¬
brane, Mr. Brodie alludes to that collection of fluid in the
joints which has been named by authors hydrops articuliy or
hydrarthus. He admits that such a collection in the capsule
of the joint may in some cases arise from a debility or dimi¬
nished action in the absorbents, by which the effused fluid is
suffered to collect without any actual or positive increase in
the quantity exhaled. The possibility of such an occurrence
is questioned by some pathologists in the present day; but
we think that in indolent strumous habits these depositions of
fluids do occasionally occur, without any membraneous in¬
flammation as their cause. Such inflammation is however
their most ordinary source, and the swelling in this last case
is occasioned by a morbid increase of secretion from the sur¬
face of the synovial membrane. This inflammation seldom
occurs in very early life, and unlike the irritation productive
of white swelling, it is exceedingly rare as individuals approach
the age of puberty, while, unlike that irritation also, ‘‘ it is
very frequent in adult persons/’ Sometimes it is constitu¬
tional, as from a rheumatic diathesis, or where the individual
has taken mercury in too large quantities; but its most Fre¬
quent exciting source is the application of cold, and hence
it is easy to explain why it occurs much more frequently in
the knee than in any other joint; and why it is rare in the
hip and shoulder, which are defended by a thick mass of
muscles from the influence of external temperature.”

In the first instance the patient experiences pain in the joint,
which although it affects the whole articulation, is often referred
principally to one spot, where it is felt more severely than elsewhere.
The pain usually continues to increase during the first week or ten
days, when it is at its height. Sometimes even at this period the
pain is trifling, so that the patient experiences but little inconiTni-
ence from it ; at other times it is considerable, and every motion of
* the joint is distressing and difficult.

36 Analytical Review.

‘‘ In the course of one or two days after the commencement of the
pain, the joint may be observed to be swollen. At first, the swelling
arises entirely from a preternatural collection of fluid in its cavity,^
In the superficial joints, the fluid may be distinctly felt to undulate,
when pressure is made alternately by the two hands placed one on
each side. When the inflammation has , existed for some time, the
fluid is less perceptible than before, in consequence of the synovial
membrane having become thickened, or from the effusion of lymph
on its inner or outer surface ; and in many cases, where the disease
has been of long standing, although the joint is much swollen, and
symptoms of inflammation still exist, the fluid in its cavity is scarcely
to be felt. As the swelling consists more of solid substance, so the
natural mobility of the joint is in a greater degree impaired.’-

Mr. Brodie very properly adverts to the form of the tumor
as of some consequence to attend to; this depending upon
the sittiation of the ligaments and tendons which resist the
fluid in certain directions. Thus when the knee is affected
the swelling is principally observable under the anterior and
lower part of the thigh, under the extensor muscles, where
there is only a yielding cellular structure between those
muscles and the bone. It is also often considerable in the
spaces between the ligaments of the patella and the lateral
ligaments and the same obtains in other joints, the swelling-
depending in a great measure upon the ligaments and tendons
in the neighbourhood, and on the degree of resistance w hich
they afford.

There is one particular circumstance of distinction between
this inflammation of synovial and that which takes place on
serous membranes such as the pleura, viz. that while the latter
soon occasions the effusion of coagulable lymph, it requires a
long-continued inflammation of the former to effect the same;
and pus very seldom in this last case is generated without
actual ulceration.

“ After inflammation of t]ie synovial membrane has subsided, the
fluid is absorbed, and in many instances the joint regains its natural
figure and mobility; but in the majority of cases, stiffness and swel¬
ling remain. Sometimes the swelling has the same peculiar form
which it possessed while the inflammation still existed, and while fluid
was contained in the joint; and we may suppose, that it depends
principally on the inner surface of the synovial membrane having a
thick lining of coagulable lymph : at other times the swelling has the
form of the articulating extremities of the bones, that is, nearly the
natural form of the joint, and it probably arises from the thickened
state of the synoviah membrane. From whichever of these causes a
swelling remains after the inflammation has subsided, the patient is
very liable to a recurrence of the disease.’^

The treatment of this complaint must in some measure de- ^
pend upon whether it have originated from constitutional

Brodie on Diseases of the Joints,

predisposition, or have been brought about by the intensity of
exciting causes, especially of cold. Sarsaparilla may be em¬
ployed with advantage when mercurial irritation has occa¬
sioned the disease, and anti-rheumatics when the diathesis of
rheumatism is conspicuous. With respect to local applica¬
tions, leeches and even general blood-letting are called for
when the inflammation is active, and if the swelling has
rapidly risen to such a height as to occasion a considerable
tension of the soft parts, the pain will be best relieved by
means of warm fomentations and poultices; but otherwise
cold evaporating lotions seem to produce a better effect.’^
In the more chronic form Mr. B. recommends as a cardinal
point that the limb should be kept in a state of perfect

quietude.” Cupping is here advisable, which our author

prefers to leeches for the most part; and when the inflam¬
matory action is got somewhat under, a succession of large
blisters is recommended, applied at a little distance from the
joint, if such joint be deep seated, and over it if it be super¬
ficial. For example, if the synovial membrane of the hip
be inflamed, the blister may be placed on the groin and nates;
but if the disease be in the wrist, it may be applied to the
lower part of the fore-arm.” Stimulant liniments are to be
used when the inflammation is in a great measure relieved,
and Mr. B. objects to the common formulae of the pharma¬
copoeia as being of insufficient strength. Fie recommends
the addition of the oleum terebmihin(z or tinctiira lyttce to them,
and gives the following as a formula which he employs with
advantage : R 01. olivoe, ^iss. acidi sulphuric, ^S5. M. ft. lini-
mentum. The above proportion being applicable to hos¬
pital practice, and a less quantity of acid being expedient in
the higher classes of society, in the individuals of which the
cuticle is comparatively thin, and the skin tender. There is
also a recommendation of the following application to the
parts under the circumstances supposed ; an application from
which we have ourselves seen in these cases most unequivocal
benefit, more especially in those instances in which there
appears a tendency to what is called humour in the frame; and
in which it appears desirable to direct such humorous irrita¬
tion from internal parts to the surface of the body. The pre¬
paration alluded to consists of a dram (or more) of the antimo-
niurn tartarizatunij to an ounce \\\q' utiguentum cetacei,
which produces a pustular and vicarious eruption on the skin.
Gentle exercise of the joint is now also desirable, which may
gradually become more bold and free as the inflammation
passes otf, and a stifl'ness and swelling only remain. Friction,
Mr. Brodie tells us, should be used with caution ; it being
liiofe applicable to a contracted state of muscles and tendons

SS Analytical Review.

lliaii to the consequences of membraneous inflammation ; and
the same remark applies to pumping hot water on the part, as
recommended by Le Dran.

Through the detail of our author’s cases we cannot of course
follow him ; suffice it to say, that although the symptoms
characterizing the synovial inflammation are almost always
pretty easily detected by accurate observation, they are
not always of so simple and uncoraplex a nature as the above
account might lead some to suppose : and with respect also
to their duration and event there is more variety than can be
easily explained ; sometimes the inflammation, wdtb all its
consequences, disappears in the course of a few weeks ; at
other times stiffness, enlargement, and induration last for
months and years. But even when solid substance is effused
so as to occasion hardness, a perseverance in steady friction,
with the occasional use of mercurial ointment and camphor,
according to the complexion of the malady and the judgment
of the Practitioner, may so excite the action of the absorbents
as to restore the joint to its proper size and functions.

Before dismissing the subject of synovial inflammation,
Mr. Brodie adverts to some instances of this disease compli¬
cated with scrofulous, pseudo-syphilitic, and rheumatic con¬
ditions of the system; and in which the knee affection, puru¬
lent ophthalmia, and a sort of spurious gonorrhcea, took place
either in succession or in a kind of vicarious alternation.
The young Surgeon should always be ready to meet these
anomalous occurrences, and ought ever to recollect that
admixtures, so to say, of constitutional complaints and topical
maladies, may take place in such a nicety, and to such an
extent, as book descriptions must fail to follow.

The next articular derangement upon which Mr, Brodie
'dwells, is that in which the synovial membrane becomes the
subject not merely of common inflammation, but of a morbid
change of structure. The facts of specific inflammation, so
to say, are among the most remarkable of pathological pheno¬
mena: thus, apparently, the same degree of vascular derange¬
ment shall be cancer in one structure and tubercle in another;
and even when disorganization does not thus result, there is a
peculiarity and sm-generis character in some kinds of irrita¬
tion which appear to be not entirely dependent upon the par¬
ticular seat of the disorder. Rheumatism, for example, may
be said to be an inflammation of the aponeurosis of muscles:
but allowing this to be the case, such predication does not
explain the w hole of the business, since this same membrane
shall, in common with other parts, at times become the resi¬
dence of inflammatory disorder without the result being ac¬
tual rheumatism : so in respect of the synovial membranes of

Brodie on Diseases of the Joints,

the joints; they are sometimes obnoxious to common, some¬
times to peculiar inflammation ; and in that peculiarity now
under notice, the part inflamed eventually “ loses its natural
organization, and becomes converted into a thick pulpy sub¬
stance of a light brov/n, and sometimes of a reddish brown
colour, intersected by white membraneous lines. As the dis¬
ease advances it involves all the parts of which the joint is
composed, producing ulceration of the cartilages, caries of the
bones, wasting of the ligaments, and abscesses in different
places.” This species of disease in the synovial membrane

is rarely met with except in the knee. 1 have never known,
(says Mr. Brodie) an instance of it in the hip or shoulder.
It is probable that the influence of the external cold may
operate as one of the causes by which the disease is produced,
and this explains why it occurs frequently in the knee, and
seldom in the deep-seated articulations.” The knee mem¬
brane may in this respect be somewhat in the same relative
situation to that of other joints, as the parenchyma of the
lungs is to parenchymatous structure elsewhere found; tuber¬
cles being more readily formed in the pulmonary than in other
organs, principally because they are exposed more than such
others to those derangements that are consequent upon varied
temperature.

This disease generally takes place in persons who are not much
above the age of puberty. In its origin there is a slight degree of
stiffness and tumefaction, without pain, and producing only the most
trifling inconvenience. These symptoms gradually increase. In the
greater number of cases, the joint at last scarcely admits of the
smallest motion, but in a few cases it always retains a certain degree
of mobility. The form of the swelling bears some resemblance to that
in cases of inflammation of the synovial membrane, but it is less re¬
gular. The swelling is soft and elastic, and gives to the hand a sensa¬
tion as if it contained fluid. If only one hand be employed in mak¬
ing the examination, the deception may be complete, and the most
experienced Surgeon may be led to suppose that there is fluid in the
joint when there is none : but if both hands be employed, one on
each side, the absence of fluid is distinguished by the want of fluctua¬
tion.

The patient experiences little or no pain, until abscesses begin to
form, and the cartilages ulcerate ; and even then the pain is in many
instances not so severe, as where the ulceration of the cartilages occurs
as a primary disease: and the abscesses heal more readily, and dis¬
charge a smaller quantity of pus, than in cases of this last descrip¬
tion. At this period the patient becomes affected with hectic fever ;
loses his flesh, and gradually sinks, unless the limb be removed by an
operation.

“ The progress of this disease varies in different cases. In gene¬
ral, one or two years elapse before it reaches its most advanced stage;

Analytical Review,

but sometimes the period is much longer ; and occasionally it be-^
comes indolent, so that it remains during many months without any
sensible alteration/'

It is to be distinguished from other affections of the joint
by the gradual progress of the enlargement^ by the stiffness of
the joint without pain, the soft elastic swelling without fluctua-
tion, and by its not yielding to that treatment wJtich would
reduce common inflammation. With respect to its treatment
in the advanced stages, as it is now a disorder of structure,
nothing can be expected to prove radically remedial except
the amputation of the limb. “ By means (says Mr. Brodie)
of rest and cold lotions, the progress of the disease may be
somewhat checked, as the suppuration of tuberculated lungs
may be retarded by occasional bleeding and a milder climate.
When there is considerable pain in consequence of the carti¬
lages having begun to ulcerate, some benefit is derived from
the use of warm fomentations and poultices. But no method
with which 1 am acquainted is capable of doing more than
somewhat checking the progress, and somewhat relieving the
symptoms of the complaint/^

The next section of Mr. Brodie’s w^ork is devoted to the
consideration of those disorders of the joints in which the arti¬
cular cartilages become ulcerated as an original affection ; and
not, as in the instances before referred to, as a mere secondary
occurrence and consequence of morbid action, originating in
the neighbouring soft parts. This disease, when it takes place,
as it most frequently does in the hip-joint, has been variously
designated by writers,” the morbus coxarius, the disease of
the hip,” the “ scrofulous hip,” the scrofulous caries of
the hip-joint.” — At least (says Mr. B.) it is to this disease
that these names have been principally applied, though pro¬
bably other morbid affections have been occasionally con¬
founded with it.” The following is the very accurate and
faithful account which our author gives of the symptoms of
this disease : —

The ulceration of the articular cartilages occurs at any period of
life, but principally in children, or in adults under the middle age.
Of the whole number of those who have come under my own ob¬
servation, labouring under this disease, not more than about one-fifth
were above thirty years of age ; the youngest was an infant of a year
old ; the oldest was a woman of sixty. As the knee is more liable to
inflammation of the synovial membrane, so is the hip more liable
than other joints to ulceration of the cartilaginous surfaces. In
general the disease is confined to a single joint; but occasionally two
or three joints are affected in the same individual, either at the same
time or in succession. Sometimes the patient traces the beginning of
his symptoms to a local injury ; but for the most part no cause can

Brodie on Diseases of the Joints,

be assigned for the complaint, and often the cause to which it is attri¬
buted appears to be imaginary rather than real. ?

“ Where the hip is affected, the only symptoms met with for
some time are pain, and a slight degree of lameness in the lower limb.
The pain at first is trifling and only occasional; afterwards becoming
severe and constant. It resembles a good deal the pain of rheu¬
matism, since it often has no certain seat ; but is referred to different
parts of the limb in different individuals, and even in the same
individual at different periods. As the disease advances, the pain
becomes exceedingly severe, particularly at night, when the patient
is continually roused from his sleep by painful startings of the limb.
Sometimes he experiences some degree of relief fronj the pain in a
particular position of the joint, and in no other.

“ As the pain increases in intensity, it is more confined in its
situation. In the greater number of instances it is referred to the
hip and the knee also, and the pain in the knee is generally the most
severe of the two. At other times there is pain in the knee, and none
in the hip. Wherever the pain is situated, it is aggravated by the
motion of the joint ; but it is aggravated in a still greater degree by
whatever occasions pressure of the ulcerated cartilaginous surfaces
against each other. Hence the patient is unable to support the
weight of the body on the affected limb ; and if he be placed on aa
even surface, in a horizontal position, and the hand of the Surgeon be
applied to the heel so as to press the head of the femur against the
concavity of the acetabulum, violent pain is the consequence;
although this be done in so careful a manner that not the smallest
, degree of motion is given to the hip-joint. This circumstance is well
deserving of attention ; and no one should attempt to give an opinioa
as to the nature of a disease connected with the hip, without having
made an examination in the manner which has been just described,

“ When the disease has existed for some time, the nates undergo a
remarkable alteration in their form. They become wasted and less
prominent : so that instead of their usual convexity, they present the
appearance of a flattened surface ; they are flaccid to the touch', and
hang more loosely towards the lower edge; and they have the
appearance of being wider than those of the other side.*

Mr. Brodie then goes on to remark on another symptom
of this affection, namely, the alteration which is observable
in the length of the diseased limb. The apparent elongation
of this limb is produced by the position of the pelvis beiiig
altered in such a way, that the crista of one ilium is visibly

* This alteration in the appearance of the nates was first pointed
out by Mr. Ford, in his very admirable Treatise on the Disease of the
Hip-Joint. It is not, however, absolutely diagnostic of the affection
under notice, since it occurs in some other affections in which the
muscles of the part are necessarily rendered quiescent. It is of im-
'portance also to recollect, that this appearance of the nates only takes
place after the disorder has existed for some time. — Rev.

VOL. XI. - NO, 6l. G

40, Analytical lleview,

depressed below the level of that of the oilier’^.” Such
depression being occasioned by the patient extending the
diseased limb forward, in order to touch the ground without
pressing his weight upon it, the whole weight of the body
being instinctively made to rest on the sound limb. “ This
inclination of the pelvis is necessarily attended with a lateral
curvature of the spine, and hence, it happens that one shoulder
is higher than the other, and that the whole figure is in some
degree distorted.” In the advanced stages of the disease
the affected limb becomes not only in appearance, but
actually shortened, and this circumstance is of easy explica¬
tion, since, when the head of the thigh bone is destroyed
by ulceration, there is nothing to prevent the muscles from
pulling that bone upwards. Indeed the head of the femur
becomes often lodged on the dorsum of the ilium, so that the
same effect is produced as in a dislocation of the hip upwards
and outwards.

As it will always prove of the utmost importance to dis¬
tinguish the complaint now under notice from inflammation
of the synovial membrane, genuine white swelling, or merely
violent sciatica, we shall present to our readers the following
points of diagnosis in Mr. Brodie’s own words : —

“ The ulceration of the cartilages of the knee differs with respect
to its symptoms, from inflammation of the synovial membrane, in
this; that the pain in the former is slight in the beginning, and
gradually becomes very intense, which is the very reverse of what
happens in the latter. But there is another circumstance which
forms a remarkable distinction between the ulceration of the car¬
tilages, and most other diseases to which this joint is liable. The
pain in the first instance is unattended by any evident swelling;
which comes on, never in less than four or five weeks, and often not
until several months have elapsed from the commencement of the
disease. The reason of this is too manifest to require explanation,
and it is equally unnecessary to point out the importance of it, as
affording the means of making a more ready diagnosis. We must
not indeed conclude indiscriminately, whenever there is a slight
pain in the knee, unattended by swelling, that the cartilages are in a
stale of ulceration, since this symptom may equally arise from inflam¬
mation of the bones themselves, of the ligaments, of the fatty sub¬
stance of the joint, or from simple nervous affection ; and instances
will occur to every Surgeon, where there is reason to believe that
the above-mentioned symptom arises from one or other of these
causes. But when the pain continues to increase, and at last
becomes very severe, when it is aggravated by the motion of the

* John Hunter, it is known, was the first to propose this explana¬
tion of the apparent lengthening of the diseased limb, under the cir¬
cumstances supposed. — Rev.

Brodie on Diseases of the Joints.

joint, andhy the pressure of the articulating surfaces against each other ;
and when after a time a slight tumefaction lakes place, such as I
shall presently describe; we may conclude that the disease consists
in an ulceration of the cartilages; and in all such cases, which have
come under my own observation, their subsequent progress, atjd
the morbid appearances presented by dissection, where an opportunity
has occurred of observing them, have fully justified this conclusion.

“ The swelling which attends this disease in the knee, difters from
that which occurs in either of those of the synovial membrane, which
I have formerly described. It arises from a slight degree of in¬
flammation having taken place in the cellular membrane external
to the joint, in consequence of the disease within it. The sw'elling
is usually trifling, appearing greater than it really is in consequence
6f the wasting of the muscles of the limb. It has the form of the
articulating ends of the bones; that is, the natural form of the joint.
No fluctuation is perceptible, as w'here the synovial membrane is
inflamed ; nor is there the peculiar elasticity which exists where
the synovial membrane has undergone a morbid alteration of
structure.*'

It will be noticed, that we have laid particular stress, both
in the present and previous extract, upon the cirqumslance
of the especial pain which results from that kind of upward
pressure of the limb which brings the articulating surfaces in
contact ; that is, we have printed those lines in italics which
refer to this mark of cartilaginous disease, since it is perha{)S
the most distinctive of any that can be pointed out. When
inflammation occurs in the synovial membrane, or in any
other portion of the joint, it is easy enough to conceive that
motion must cause pain ; but the pain in cases where^
the cartilages are not the seat of the morbid processes, is as
much or more aggravated by rotating, than by pressing the
limb upward.

This cartilaginous disease of the joints is for the most
part tedious. Irritation and consequent pain will exist
sometimes for two or more years, with only a very slight
degree and extent of ulceration. Mr. Brodie mentions one
instance in which pains had lasted a year without even attract¬
ing much of the patient’s attention. In this case (he says)
no pus was, formed in the joints, and the ultimate recovery,
was complete without the smallest detriment to the motion of
the limb. Sometimes, however, the progress of the disease
is much more rapid. There was a patient in St. George’s
Hospital, in whom, in the course of four months, tlie
destruction in the head of the femur and acetabulum was
such as to occasion a real shortening of the limb to tlie extent
of an inch.”

From the small degree of vascularity jiossessed by carti¬
lage, Mr. Hunter imagined that the disease in question

44’ Andlyticat Revietn^.

of thd

, , w » ^ Brodie^

however, is of opinion, that cartilaginous ulceration occurs
from ‘/the action of its own vessels;^’ and he substantiates
this opinion by the recital of two cases in which dissection
proved that the layer of cartilage next the bone was in a
healthy state in some parts, while it was ulcerated and
absorbed in the part next the cavity of the joint.

On the Treatment of the Cartilaginous Affection. Rest
is one of the principal ingredients in the remedial process.
“ The keeping the limb in a state of perfect quietude, is
a very important, if not the most important circumstance
to be attended to in the treatment.” It is onlv in this kind
of articular disease, Mr. Brodie tells us, that he has found
caustic issues of service, and in this they are most unequivo¬
cally beneficial. “ Setons and blisters kept open by means
of the "savine cerate, appear to operate nearly in the same
manner as caustic issues, and may be used with advantage
in the same description of cases.” Bleeding, with a view to
stop ulceration, Mr. Brodie objects to. In the early stage
the warm-bath, he tells us, is sometimes of service. Stimu¬
lant plasters, embrocations, and frictions, are either ineffi¬
cacious, or injurious. In hip cases, blisters may be applied
on the hates, round the great trochanter, and in the groin.

The hollow behind the great trochanter of the femur is
in many respects the most convenient situation for caustic
issues ; but in some cases the application of the caustic
pn the outside of the hip is attended with better effects.” — -

Wheii the pain is very severe, a seton in the groin is more
calculated to afford immediate relief than the caustic issue ;
but the caustic issue can be better depended on for the
production of a cure.’' The same general rules are appli¬
cable to the cartilaginous disease, when it takes place in
other joints beside the hip. In all cases a state of most
perfect quietude is indispensable. Abscess io a joint, when
it happens as a consequence of cartilaginous inflammation, is
almost necessarily fatal when occurring to any extent in
adults, but young children do frequently recover after a
considerable degree of suppuration. The early puncture
of such abscess is not desirable, and partly for this reason,
that it is not easy to evacuate the whole of its contents
without much handling and compressing, wffiich is always
objectionable. In all these cases of cartilaginous disease
early applications are of most indispensable consequence,
for “ the formation of even the smallest quantity of pus in
the joints, in cases of this disease in the young person, con¬
siderably diminishes, and in the adult very nearly precludes

originated from the vessels’ of the contiguous part
bone acting' upon the vessels of the cartilages. Mr.

Brodie 07i Diseases of the Joints*

the possibility of any ultimate good being derived, except
from amputation. On the other hand, where abscess has
not begun to form, there is perhaps no disease among thore
which coiue under the care of the Surgeon, in which he
can employ his art with a better prospect of success than
this.” [f the patient does recover after the abscess has
been formed in the joint, he seldom has the use of the
parts afterwards, the bones composing the joint being united
by anchylosis.

Mr. Brodie concludes this division of his volume by stating,
that in some cases the synovial and the cartilaginous diseases
are so combined together, even in their earlier stages, that
it is almost impossible to infer from symptoms, which has
been the original point for the commencement of the
morbid action. We are always pleased to observe in authors
a disposition to recognise and mark complicated affections ;
and we think it one of the most useful precepts that can
be impressed on the mind of junior practitioners, that they
are not to expect divisions and distinctions in diseases in
the same manner that book descriptions are partly obliged to
give them.

Having dismissed the consideration of those diseases, the
commencement of which is in the articulating cartilages,
Mr. Brodie proceeds to animadvert upon the scrofulous
affection of joints which begins in the cancellous structure
of the bones. It is this disease that constitutes the true
white swelling, and it never takes place but in subjects of
a scrofulous diathesis, which is not so absolutely the case
with the other articular diseases, although it must be admitted
that individuals of a strumous temperament are, cceteris
paribus, more obnoxious than others to derangements, even
in the ligamentous and cartilaginous portions of these parts.
This scrofulous affection of joints is common among
children, and it is very rarely indeed observed after thirty
years of age. The knee is the joint most frequently, the
hip and shoulder the parts least commonly attacked. Its
symptoms correspond in some sort with the cartilaginous
aiffection, but the pain is never so severe, and indeed is often
so slight, and takes place so gradually, that it is scarcely
noticed.” — The swelling is puffy and elastic, and though
usually more in degree than it is in those cases in which the
ulceration of the cartilages occurs as a primary disease, it
is not greater in appearance because the muscles of the limb'
are not equally wasted from want of exercise.”

“ As the cartilages continue to ulcerate, the pain becomes some¬
what, but not materially aggravated. It is not severe until abscess
has formed, and the parts over the abscess have become distended and

Analytical Review,

inflamed. The skin under these circumstances assumes a dark red
or purple colour. The abcess is slow in its progress ; when it bursts
or is opened, it discharges a thin pus, with portions of curdly sub¬
stance floating in it. Afterwards the discharge becomes smaller in
quantity, and thicker in consistence, and at last it nearly resembles
the cheesy matter which is found in scrofulous absorbent glands.

“ In most instances several abscesses take place in succession, but
at various intervals ; some of which heal, while others remain open
in the form of fistulous sinuses, at the bottom of which carious
bone may be distinguished by means of a probe.

“ The disease not unfrequently remains in this state for several
months, or even for a much longer period, without the constitution
being materially disturbed. In the less fortunate cases, the patient
at last becomes affected with a hectic fever, under which he gradually
sinks, unless the cause of it be removed by amputation. At other
times a curative process begins; the sinuses close; the oedema sub¬
sides ; and the patient ultimately recovers, either with or without an
anchylosis ; accordingly as more or less destruction of the articulating
surfaces has taken place. But the cure is always tedious, unless the
disease has been arrested at a very early period. It is not uncommon
to see a patient with a scrofulous joint, in a state of imperfect
anchylosis, with a single sinus remaining open, and waiting for many
years, before even such a cure as anchylosis affords, can be said to
be completed. The chance of ultimate recovery is not the same in
every articulation; and I have observed, that it is much less where
the disease attacks the complicated joints of the foot and hand, than
when it is situated in those, which, though of a larger size, are of
a more simple structure.”

With respect to the treatment, it is very properly remarked
by Mr. Brodie, in the first place, that the practitioner should
ever recollect the inflammation is not of a common but a
specific kind, and therefore less likely to be remedied, while
the constitution is more likely to be injured by abstractions
of blood than in other cases. This hint we think both
Surgeon and Physician would do well to recollect, while,
thinking of expedients to mitigate those topical irritations
which are the results of constitutional predisposition. I.
have seldom (our author goes on to remark) known any
benefit to be derived in these affections from the use of
blisters or stimulating liniments ; nor in the cases in which I
have tried them have I observed caustic issues to be pro¬
ductive of those good effects which are so distinct in another
variety of disease.’^ Cold lotions are occasionaiiy serviceable ;
but the main point in the treatment is, that the joint should
be kept in a state of quietude,'’ When abscesses are form¬
ing, fomentations and poultices may be employed; and after
these have burst, such applications are to be coiitinued or
exclianged I’or simple dressings, as cii cuniaianccs may require.

Brodie on Diseases of the Joints*

Pressure by means of stripes of linen spread with soap cerate,
or adhesive plaster, may be made with advantage, when the
matter of the abscess, seems upon the decline, and there is a
tendency shown to the curative process by means of anchy¬
losis, Country air, especially that of the sea-coast; a
nourishing and plain diet; regular habits; and steel medi¬
cines, constitute the articles of general treatment. Chalyn
beates are especially and conspicuously useful in these
affections. It is necessar}^, however, to continue them for
a considerable length of time, and it will often be found
expedient to vary their forms. When much febrile irritation
is present, Mr. Brodie recommends the substitution of the
mineral acids for the steel preparations. The question of
amputation our author very properly leaves to be decided, in
a great measure, by the particular circumstances of the case,
and the judgment of the surgeon. When the scrofulous
diathesis is very decided and strong, the loss of the limb will
sometimes only be a mean of transferring as it were the
diseased action to another part. At other times the hectic
wasting consequent upon a large suppurating surface may be
arrested by amputation.

The following we extract from among the successful cases of
this disease, which are to be found in Mr. Brodie’s volume: —

“ William Moulds, six years of age, having a scrofulous aspect,
was admitted into St. George’s Hospital on the 23d of February,
1814.

“ His left knee was an inch and a half in circumference larger than
the other. The swelling was puffy and elastic; without fluctuation,
having nearly the form of the articulating extremities of the bones ;
but filling up the space on each side of the ligament of the patella.
The joint admitted of considerable motion, but not of complete flexion
and extension. He complained of pain, which was worst at night:
but never very severe. It was somewhat aggravated by pressure.

“ His parents attributed the complaint to some trifling hurt, which
he had met with a year ago; soon after which, a slight degree of
pain, and tumefaction, was first observed, which had continued ever
since, and had increased, particularly within the last month.

“ On his admission, with a view to the relief of the external in¬
flammation, blood was taken from the knee by means of leeches and
cupping. A cold lotion was applied ; and he was directed to take ^ j
of the vinura ferri, with a few drops of the tinctura ferri muriatis three
times in the day. On the 3d of March the knee was bound up in
stripes of linen spread with soap cerate, chiefly with a view to restrain
the motion of the diseased joint, without interfering with tlie patient’s
bodily exercise.

“ March 20. The swelling was somewhat diminisluid ; and he
did not complain of pain.

“ April 1. He was in all respects better. As the foriicr prepa-

48 Analytical Review*

Rations of iron had begun to disagree with him, they were changed
for ten grains of the carbonate of iron, three times in the day.

“ April 20. Scarcely any swelling of the joint remained: and
there was no pain or stiflhess. He quitted the hospital.”

Caries of the spine” (the next subject of our author^s in¬
vestigation,) may have its origin, he tells us, sometimes in
an ulceration of the intestinal cartilages, and at other times in
a morbid condition of the cancellous structure of the bodies of
the vertebrae and it is of consequence to keep this fact in
recollection, since the probability is, that issues, w^hich at
times seem so serviceable in spinal affections, and at other
times appear to be worse than useless, may, or may not, be
applicable, as the disorder has, or has not been in its com¬
mencement cartilaginous. The two varieties of the disease,
Mr. Brodie confesses to be of more difficult distinction in the
instance of these than in that of other articulations : but, may
not something, at least, be inferred in the way of diagnosis
from the constitutional habits and stamina of the sufferer ?

“ It is evident, that two orders of symptoms may be the result of
caries of the spine: — 1st, Those which are the immediate conse¬
quence of the morbid condition of the vertebrae themselves, and of the
intervertebral cartilages. 2dly, Those which arise from pressure on
the spinal marrow, or from irritation propagated in some way or
^ another to this important part of the nervous system. I believe it
.will be found that when the disease is situated above the lumbar re¬
gion, it almost constantly happens that these two sets of symptoms
are combined, whereas when the vertebrm of the loins are alone
affected, the latter sc’t of symptoms are generally wanting. Perhaps
this may be accounted for partly from the greater magnitude of the
bodies of the lumbar vertebrae, in consequence of which a much more
extensive caries is ne;cessary to produce the same quantity of incurva-
; tion here, than elsewhere ; and partly from the circumstance of the
spinal marrow here terminating in the bundle of nerves belonging to
fthe lower extremities; which possess a different structure, exercise
, different functions, and are probably of a less susceptible nature than
the spinal ma.rrow itself.

‘‘ Caries of the lumbar vertebras usually occasions a pain in the
loins, which;, after a longer or shorter period of time, is followed by
an external abscess, showing itself in the groin, or in some other situa¬
tion, and it constitutes one of the diseases, which are confounded with
each other , under the name of psoas or lumbar abscess.

“ A pa in, and some degree of tenderness in that part of the spine
iWhere the disease has begun ; a sense of constriction of the chest; an
uneasy fe( ding at the pit of the stomach, and of the whole abdomen;
a disturbe d state of the functions of the alimentary canal, and of the
urinary L (ladder; a sense of w^eakness and aching, and occasional
cramps oi f the muscles of the extremities ; one or more of these symp¬
toms, ac( 'ording to the part of, the spine, which is'affected, and other

Brodle on Diseases of the Joints. 49

circumstances, are in most instances met with before the form of the
back has undergone any alteration.

In the greater number of cases which have come under my ob¬
servation, the curvature of the spine has been first noticed about six
months after the commencement of the other symptoms. In one case
only the interval was as long as two years.’"’

Mr. Brodie goes on to caution the young Surgeon against
mistaking that curvature of the spinal column which arises
from a weak condition of the muscles, or a rickety alFection
of the bones, from that under consideration. The curvature
from mere weakness is always gradual, never angular; and
thus it may be distinguished from the curvature arising from
caries.’’ In the treatment of spinal disease, rest and a hori¬
zontal position are absolutely indispensable ; caustic issues
are sometimes abundantly useful, at other times their appli¬
cation does not seem to do any thing but irritate ; and this
want of correspondence in the effects of one and the same
remedy is partly, perhaps, referrible to the principles above
adverted to. All instrumental contrivances are to be depre¬
cated beyond those which are constructed with a view simply
to support the column of the vertebras, and takeoff the weight
of the head from the ulcerated surfaces,” when the patient is
so far convalescent as to be permitted to resume in part the
upright position. The}^ ought never to be employed for
the purpose of elongating the spine and correcting the
deformity.”

In the next chapter some remarks are introduced on common
inflammation of the articulating extremity of a bone ; on ex¬
foliation without any obvious cause ; on the loose cartilaginous
substances which are sometimes found in the joints; on fun¬
gus haematodes, or medullary sarcoma occurring in joints ; and
on the effects of gout upon the articulations. In these re¬
marks, however, we meet with nothing of sufficient moment
to justify the extension of this article, already carried far be¬
yond our prescribed limits; and we must hasten to a conclu¬
sion by slightly adverting to the last topic of this most inte¬
resting volume, viz. inflammation of the bursae mucosae.
The resulting disease is of course more superficial than when
the affection falls upon the synovial membrane of the joints
itself. Like that inflammation it is sometimes acute, but
more frequently chronic. There is no bursa more liable
to be inflamed than that between the patella and the skin ;”
and in this case a superficial observer, judging from the
general form of the tumor, and the fluctuation of the fluid,
without noticing the greater redness of the skin, and the cir¬
cumstances of the fluid being over, instead of under the
patella, might mistake the case for one of inflammation of the

VOL. XI. - NO. 61. H

Analytical Review,

synovial membrane of the joint itself.” Ganglions are for the
most part constituted of a species of dropsy of the bursas
mucosae, which occurs somewhat in the same manner as the
fluid is deposited from the tunica vaginalis testis, after that
membrane has been the seat of inflammation. These drop¬
sical collections in the bursae may continue for months or
even years. In the treatment of inflamed bursae, leeches, and
afterwards blisters or liniments, are called for, with constitu¬
tional remedies according to circumstances. When the pre¬
ternatural collection of fluid has become chronic, a puncture
may be made of the tumor, if it does not yield to friction and
blisters. Mr. Brodie tells us, from having seen the perma¬
nently remedial effects of suppuration, when that process had
been accidentally produced, he has been induced to bring it
on by artificial means in order to prevent the re-accumulation
of the fluid ; upon similar principles with those which direct
the permanent cure of hydrocele. He cautions, however,
against an indiscriminate adoption of this practice ; and one
instance he adverts to w'here the passing a seton through a
large tumor of a bursa mucosa, situated between the scapula
and latissimus dorsi muscle, occasioned death. He tells us,
that if the diseased bursa be situated superficially, it may be
removed with as much facility as an encysted tumor; at the
same time he says, he has never performed this operation
himself, nor has he ever heard of its being done by others,
except on the bursa which is situated betw^een the patella and
the skin.

Thus have we endeavoured to put our readers in possession
of the general substance of one of the most useful volumes
that has ever fallen under our critical inspection. Mr. Brodie
we think deserves well both of the profession and the public,
for patient investigation and the display of pathological
acumen. The half dozen engravings which are introduced at
the end of the book, though perhaps they might have been
spared in point of utility, are executed not simply wdth
fidelity to nature, but also with a nicety and beauty that
cannot fail to command universal admiration.

Recherches P hysiologiqnes et Medicates sur les Causes, les
Symptomes, et le Traitement, de la Gravelle. Par F. Ma-
GENDiE, Docteur en Medecine de la Faculte de Paris,
Professeur d’Anatomie, de Physiologic, et de Semeiotique,
&c. &c. Octavo, pp. 91- Paris, 1818.

The importance of the study of urinary concretions, and
the imperfections of our hitherto acquired knowledge respect-

Magendie on Urinary Concretions.

ing their formation and treatment, must be sufficiently obvious
to those upon whose notice the distressing and often ungo¬
vernable symptoms to which they give rise are almost daily
obtruded. We shall therefore not waste our own time, nor
unnecessarily tax the attention of our readers, by declama¬
tion on such evident truths; but proceed directly to an ana¬
lysis of tlie very creditable and scientific production which is
destined to form the subject of our present article.

In publishing this work, it is the professed object of Dr.
Magendie to state the result of his investigations respecting
urinary calculi; and at the same time point out the applica¬
tion of chemical knowledge and carefully executed physiolo¬
gical experiments to practical medicine. The volume consists
of an introductory section, containing a definition of calculous
diseases and general exposition of their leading symptoms,
and eleven chapters. 1’he former offers nothing original or
interesting. Of the latter, we shall attempt a faint but faith¬
ful outline. In order to preserve unbroken the thread of ana¬
lysis, we think it best to refrain, at present, from all critical
remarks, and state, in conclusion, any views or objections
which may suggest themselves in the progress of our review.

Chapter First. On the Nature of the Gravel and
Stones voided by Calculous Patients/^ Dr. Magendie here
traces historically the progress of knowledge respecting the
chemical constitution of urinary concretions, from Paracelsus
to Marcet. All the calculi, subjected to his own examina¬
tion, have invariably consisted of uric acid combined with a
small portion of animal matter, probably the mucus secreted
by the membrane of the urinary passages. The other varie¬
ties, composed of the oxalate and phosphate of lime, magnesia,
and cystic oxyde, are described as being of very rare occur¬
rence. Hence correct notions on the properties of uric acid,
and the circumstances which determine its presence in the
urine, are essential to a knowledge of the causes of gravel.

In the Second Chapter, these particulars relative to the
uric acid are fully developed. It is the opinion of Dr. Ma¬
gendie, and experiments in confirmation of it have been, some
months since, detailed by him*, and are here re-produced,
that the urine of man and of those animals which feed on
highly azoted substances, exclusively contains the uric acid;
and that its proportion varies with that of the azoted aliment
which the individual consumes. Not a trace of the acid, he
asserts, is discoverable in the urine of purely herbivorous

* See on this subject Memoire sur les Proprietes Nutritives des
Substances qui ne coiitienncnt pas d’Azotc. Aniiales de Chimic,
Septciiibre, ISlfi.

52 Analytical Reviem,

animals. The obvious inference is, that there exists between
the diet and the presence of uric acid in the urine, a very
intimate relation.

The following is a correct sketch of the chemical composi¬
tion and history of this acid. One hundred parts of it by

weight, consist of —

Azote _ _ - . 39,16

Carbon . 33,6 1

Oxygen. . 18,89

Hydrogen - - - 8,34

100,00

When pure, it is solid, of a pale yellow colour ; specifically
heavier than water; destitute of taste, smell, or very evident
action on tincture of litmus, and not decomposed by air.
Water, at the temperature of 60*^, dissolves but 1,1720 of its
weight; at 212° but 1,1150, and deposits it, on cooling, in the
form of small scales. It is insoluble in alcohol ; and the salts
which it forms with salifiable bases, are only sensibly soluble
as far as the bases are so, and exist in excess ; and susceptible
of decomposition by almost all the acids. Finally, this acid
has a very feeble capacity of saturation.

We have next a description of the principal properties of
the cystic oxyde: it is semi-transparent, yellowish ; and, when
distilled, yields carbonate of ammonia of a fetid odour, and a
heavy offensive oil such as is obtained from animal substances,
but less considerable in quantity than that which results from
distillation of uric acid. Like this acid, however, it seems to
be principally composed of azote; and hence its formation is
probably dependent on similar causes. It is but sparingly
soluble in water ; and not at all in the acetic, tartaric, or citric
acids. It is soluble in the muriatic, nitric, sulphuric, phos¬
phoric, and oxalic acids, lime-water, and pure potash and soda,
and their carbonates. These characters constitute a farther
relation between it and the uric acid.

The Causes of Gravel” occupy the Third Chapter.
In order to ascertain these, it is necessary to inquire into the
circumstances which determine the separation of the uric acid
from the urine, wherein ordinarily it remains dissolved.

From what has already been advanced respecting the solu¬
bility of the acid in water, it will appear that the urine of
man, in health, being about 86°, can only dissolve 1,1500 of
its weight. This granted, the following are the principal, if
not the sole causes, at present known, which, by diminishing
the solvent property of the mine with respect to the acid, may
produce urinary concretions.-— 1st. Increase of the quantity
pf uric acid, that of the urine remaining unchanged, or no|

Magendie on Urinary Concretions.

suffering a proportionate increase. 2d. Diminution of the
quantity of urine, that of the acid continuing the same, or not
proportionately diminishing. And, 3d. Reduction of tlie
temperature of the urine, its quantity or nature remaining un¬
altered, or suffering the modifications above indicated.

Chapter Fourth. Among the “ Circumstances which
increase the proportion of uric acid and thus contribute to
the production of gravel,’’ a sumptuous fare, composed of
animal substances, and habits of indulgence, occupy a con¬
spicuous rank. A sedentary life, and advanced age, are also
favourable to its formation. As strikingly illustrative of the
influence of regimen upon it, Dr. Magendie cites the case of
a commercial gentleman, who, exposed to great and repeated
vicissitudes of fortune, was invariably tormented with gout
and gravel whenever opulence brought with it the means of
sensual enjoyment, and was as constantly forsaken by them
when the luxuries of the table were no longer accessible.
Persons, moreover, of commonly temperate habits, are ob¬
served, a few hours after taking an inordinate meal, to dis¬
charge high-coloured urine from wliich uric acid is very
copiously deposited.

So long as the quantity of urine is sufficient to hold in solu¬
tion the uric acid, the augmentation of the latter is not pro¬
ductive of inconvenience ; but the proportion of urine be¬
coming inadequate, concretions are speedily developed.

The Circumstances which augment or diminish the quan¬
tity of Urine, and hence favour or oppose the formation of
Gravel,” are reviewed in the Fifth Chapter ; but, as these
circumstances are presently to be recapitulated, it only needs
here be remarked, that a regimen composed of vegetable sub¬
stances, with water, beer, cider, or the weaker wines, has a
singular effect in promoting the urinary secretion ; while in
those who employ an animal diet with strong wines or
spirituous liquors, its quantity is invariably small : and even
weak fluids, when taken warm and consequently operating
upon the skin, will, by exciting an increased flow of perspi¬
ration, induce a similar result. Herbivorous animals con¬
stantly discharge a much larger quantity of urine than carni¬
vora of equal bulk ; and in the latter, when restricted to a
regimen exclusively vegetable, this secretion is sensibly
increased. By contrasting the urinary discharges of the
rabbit and of the cat, and appealing to his well known expe¬
riments in which dogs were confined to a regimen of sugar
and water. Dr. Magendie believes that the preceding propo¬
sitions may be satisfactorily established.

Some other causes are here adverted to ; but these, the
^recapitulation will comprehend; and the Sixth Chapteb^

4 '

Analytical Review^

upon the Influence of the Temperature of the Urine on the
developement of Gravel,” may be briefly dismissed by re¬
marking, that in advanced age the temperature of the human
body, and consequently that of all its fluids, sufler a very sen¬
sible reduction ; and that probably the action of severe and
long-continued cold on the surface, may also, b}^ exercising a
similar influence, contribute to the production of urinary
concretions.

In the Seventh Chapter, other particular Causes of
Gravel” are reviewed. As some individuals, w^ho, from their
age and habits of dietetic indulgence, would seem predisposed
to the invasion of calculous diseases, entirely escape ; and as
others, in situations and circumstances diametrically opposite,
occasionally sufler from them ; there must exist some un¬
known causes capable of facilitating the solution of uric acid,
even when present in excess in the urine, and, consequently^
of producing its separation when not secreted in an inordinate
proportion. Such, at least, is Dr. Magendie’s explanation of
a statement made by Dr. Scudamore* respecting the frequent
and exclusive prevalence of calculous disorders among the
indigent and almost w'holly herbivorous inhabitants of Tun¬
bridge and Lewes; and of the fact, acknowledged by him¬
self, that they sometimes occur in very temperate persons
affected with flatulence, acidity, pyrosis, and other signs of
disturbed digestion, and have even been known invariably to
follow the dietetic employment of salad and raw fruits. This
is a circumstance rather unfortunate for the character of con¬
sistency which the theories of a philosopher ought to sustain.
But w'e have promised not to disturb the Professor in his
azotic dreams.

The opinions of British waiters respecting the dependence
of calculous complaints on a deranged state of the stomach
and liver, or intestinal acidity, are decried by Dr. Magendie
as unscientiflc, and unworthy of nien signalized by their pro¬
gress in the paths of experimental philosophy. The indiges¬
tion frequently attendant on these diseases should, he thinks,
be regarded rather as a secondary affection, of simultaneous
origin, than as either cause or consequence of the formation
of urinary concretions : that they are, in fact, co-existent
eftects of other causes.

It has long been remarked that the inhabitants of tem¬
perate and humid countries are extremely^ prone to the
attacks of gravel; while those of the cold and equatorial
regions enjoy a signal immunity from it. Calculous diseases,

* See Dr. ScudamoreT masterly Treatise on the Nature and Cure
of Gout.

Mageiitlie 07i Urinary Concretions, 55

for example, are of very rare occurrence in India. How
far then does climate, it may be inquired, influence their
production ? hi reply to this question l)r. Magendie affirms,
that such difference is referrible not so much to atmo¬
spherical peculiarities as to the nature of the aliments which
the people commonly employ; and he strengthens his
argument by an observation of M. Orfila respecting the
excess of uric acid in the urine of the inhabitants of Majorca,
who subsist principally on fish and other highly seasoned
animal substances, and strong spirituous liquors, and their
consequent subjection to calculous disorders

To the dietetic employment of hard waters, and culinary
salt, and the ingestion of fruit stones, was the formatioa
of urinary concretions once very commonly ascribed. The
fallacy of such crude notions, it were in this enlightened
age almost needless to expose. There exists not between
the elements of these concretions, and muriate of soda, or
the ligneous substance constituting the envelope of certain
fruits, the slightest resemblance. Almost equally remote
is the analogy between them and the calcareous matter
of the selenitic waters. These waters in fact operate as a
preservative against calculous affections, and may be advan¬
tageously administered in their cure. The villagers of
Arcueil, whose waters are loaded with carbonate of lime,
exhibit a singular exemption from the ravages of stone
and gravel.

On recapitulation of all that relates to the causes, direct
or indirect, of urinary concretions, they are evidently reducible
to the following heads : — 1st. Mature and old age. 2d. Diet
unduly nutritious, and principally composed of highly azoted
• substances. 3d. Deficiency of exercise, literary labour, and
confinement to bed. 4th. The habit of drinking too little,
whatever be the nature of the beverage. 5th. Indulgence
in generous wines and strong spirits. 6th. Abundant
perspirations, and all serous evacuations occurring in persons
otherwise predisposed to gravel. 7th. The mischievous
habit of retaining the urine long in the bladder. And,

I 8th. Particular causes, the effects of which cannot be

I _ _ _ _

* Do not many of the nations of the more northern and arctic
regions subsist principally on fish and other animal substances?
; And does not the intense cold to which they are constantly exposed,
by its evident influence on the temperature of the urine, favour the
j precipitation of the uric acid, and consequently the developement
I of calculous diseases ? How then happens it that such diseases are
I so rare among them as is reported by travellers, and acknowledged by
f Dr. Magendie ? — Rev.

56 Analytical B evicts »

mistaken, although their mode of operation is at present
inexplicable.

The preceding remarks, it is obvious, are only applicable
to the concretions formed of uric acid. The particular
causes of those which consist of the phosphate or oxalate
of lime, or cystic oxyde, are utterly unknown. ' Happily,
however, these varieties are, comparatively to the former,
of very rare occurrence.

Remarks on the Symptoms of Gravel, and the situations
where the concretions form,” compose the Eighth ChapteRo
It contains nothing new on the symptomatology or diagnosis
of calculous affection.

Chapter Ninth, Curative indications, and general
Remedies in the Treatment of Gravel.” The following are the
principal curative indications which present themselves in this
disease;-— to diminish the quantity of uric acid secreted by
the kidneys; to augment the secretion of urine; to prevent,
by saturating it, the solidijication of the uric acid ; and, the
concretions once formed, to favour their discharge, and
attempt their solution. We shall pass in successive but
rapid review', the means whereby it is proposed to accomplish
these four indications.

1. General abstinence in the consumption of food, and re¬
striction to small quantities of flesh meat, and other alimentary
substances abounding in azote; or, in severe cases, the utter
prohibition of them, and of strong wines and spirituous liquors.
For those who consume animal food at breakfast, it will
suffice to discontinue this practice. Others should be
directed to reduce the quantity taken at dinner. Bread,
particularly that made of rye, pastry, farinaceous and green
vegetables, rice and sugar, may commonly be allow'ed with-
0!it limitation, except, indeed, pastry and wheaten bread, which
contain azote inconsiderable quantity. Several cases are men¬
tioned in illustration of the efficacy of this mode of treatment ;
but when, from the number or volume of the concretions, the
disease assumes an unusually obstinate or severe form, it will
be necessary to have recourse to more energetic measures.

2. The most simple method of increasing the secretion
of urine consists in the copious ingestion of aqueous and
diuretic fluids ; and a complete cure of calculous affections
has sometimes been accomplished by the mere adoption
of this easy practice. It signifies little what be the nature
or composition of the beverage; for all vegetable infusions
and mineral waters, and other boasted specifics in gravel, are
probably indebted for the reputation wffiich they enjoy to
their diluent properties. Such, however, as are most con¬
genial to the taste and stomach of the patient, should be

Magendie on Urinary Concretions,

preferred, fn very severe cases they may be drank to the
amount of five or six quarts dailv. The only inconvenience
to be dreaded from this practice is the debilitating influence
which it sometimes exerts on the digestive organs. Such
inconvenience may yet be frequently obviated by the ad¬
ministration of iced drinks. Wine and spirits should only
be allowed in a largely diluted form.

3. The preceding means proving inadequate to prevent
the solidification of the uric acid, other measures, suggested
by chemical and physiological knowledge, must be resorted
to. These consist in saturating the uric acid with earthy or
alkaline bases, so as to form the various urates ; a class of
salts much more soluble than uric acid itself. The sub¬
stances in question are pure potash, soda, lime, magnesia, and
their carbonates, with excess of base. Their respective doses
and modes ot administration are too well known to require
description here. It is requisite, however, that they should
be administered in such quantities, and so perseveringly,
as to impart a decidt^clly alkaline character to the urine.
Mere saturation of the uric acid will not suffice; for the
urates are only soluble in an excess of their respective bases,
and may be decomposed by the weakest acids. d'hus, if
there exist not an excess of alkali in the urine, the urates
might be precipitated, and form a new species of concretion
quite as troublesome as the more ordinary kinds. No

.exclusive preference can be given in praclice to any of the
varieties of alkali above mentioned. Any one of them not
agreeing, or after a time ceasing to agree w'iih the stomach,
some other must be substituted for it. And it is essential to
the permanent success of these remedies in calculous diseases,
that the diet should be revolutionized, and all the causes
favourable to their developement be obviated in the way
which lias before been pointed out.

4. The measures recommended by Dr. Magendie to be
pursued in the expulsion of urinary calculi, or in the attempt
at their dissolution, are such as experience, or the perusal of
the preceding pages, would naturally suggest to every intelli¬
gent practitioner. When the discharge of the gravel is
effected with facility, and the symptoms are consequently
slight, the copious ingestion of pure water, or other simple
aqueous fluid, will generally be sufficient to remove them.
The evacuation of the smaller calculi may also be expedited
by exercise on horseback, or in a rough carriage, and
occasional emetics, which latter have, moreover, the effect
of relie vinji: the digestive organs from the embarrassment so
frequently attendant on these diseases. But such measures
are obviously improper when a calculous attack is accom-

YOL, XI, — NO. 1

58 Analytical Review,

panied by severe pain, fever, vomiting, stranguary, and
other phenomena, indicating the presence of high constitu¬
tional irritation and disturbance. Under these circumstances,
abstinence, local and general blood-letting, fomentations, and
the warm-bath, may be beneficially employed. And if, on
the decline of these active symptoms, the expulsion of one
or more concretions do not take place, it will be proper, with
a view of determining this important event, to prescribe a
continuance of the bath and fomentations \vith diuretics, dry
frictions on the loins and abdomen, employed in such a
direction as to favour the descent of the calculus from the
kidney, active exercise, and repeated emetics. If there
be reason to suppose that the calculus is arrested at the
inferior extremity of the ureter, or retained in any excavation
of the bladder, its extrication should be attempted by the
introduction of a sound into this organ, or of a finger into
the rectum"^. The removal of a stone impacted in the
urethra may be accomplished by copious administration
of weak fluids, oily injections into, or methodical pressure
upon the canal, or, finally, by a surgical operation. All the
practicable means of effecting the expulsion of calculi having
failed of success, it only remains to attempt their dissolution ;
and this, obviously enough, if attainable, will, according to
the views and doctrines of our Professor, be accomplished
by a prohibition of azoted alimentary substances, and the
judicious employment of alkaline remedies. Such treatment,
even if the main object of its institution be not attained, will
at all events tend greatly to palliate the sufferings of the
patient.

I'he Tenth Chapter, on the Empirical Treatment of
Gravel,^’ relates merely to the occasional efficacy of purga¬
tives, rhubarb, small doses of magnesia, cinchona, cold and
sulphureous baths, country air, change of residence or occu¬
pation, and powerful moral affections, in this disease. While
allowing the notorious fact of their beneficial operation, Dr.
Magendie finds himself utterly at a loss to explain, consist-

* No mention is here made of a method which has been judi¬
ciously recommended, and often successfully employed, with a view
of promoting the expulsion of a calculus, after its descent from the
ureter into the bladder, ere by residence in the latter organ, its
volume, and consequently the difficulty of its evacuation, have been
increased. This method consists in placing the patient’s body, and
causing him as much as possible to keep it in that position, which
will bring the internal orifice of the urethra into the most depending
situation ; and meanwhile increasing the urinary secretion by the
copious exhibition of tepid and diluent fluids. — Rev.

Magendie on Urinary Concretions. 6^

cntlj with the doctrines which he has been broaching and
the theory which he seeks to establish, this stubborn pheno¬
menon.

“ The Treatment of Gravel when .the Concretions are not
formed of Uric Acid,” constitutes the subject of the Eleventh
and last Chapter. Ignorant of the causes which determine
the formation of calculi composed of cystic oxyde, of oxalate
or phosphate of lime, Dr. Magendie professes himself inca¬
pable of pointing out any fixed or scientific plan of treat¬
ment for their removal.

As the cystic oxyde, however, is a highly azoted substance,

' and hence probably indebted for its origin to the influence of
the same causes which produce the uric acid; and as it is,
moreover, soluble in the alkalis and their carbonates; the
treatment which is so successfully emplov^ed against uric
acid concretions might also be very plausibly instituted for
the removal of the former variety. Experience itself can
alone determine the result.

From the employment of the mineral or vegetable acids
against urinary concretions composed of phosphate of lime,
Dr. Magendie has never witnessed any beneficial result. On
the other hand, the morbid deposition has appeared to be
augmented by their use. The only method then to be pur¬
sued in such cases, must have for its object the maintenance
of an abundant urinary secretion in order to favour the disso¬
lution of the salt, and the prevention of the uneasiness and
debility invariably attendant on the affection.

Neither theory nor empiricism, concludes Dr. Magendie,
has yet indicated anything relative to the treatment of that
rare varietv of concretions which are composed of oxalate of
lime. ^

Here the volume closes. During our examination of it
w'e have cursorily noticed the traces of overw eening attach-
' ment to a favourite theory, and slightly glanced at some
inconsistencies which it displays. 'Fo the correctness of the
learned author’s experiments and deductions respecting the
I influence of azote in the production of uric acid, our own
; observation, we must candidly declare, furnishes great and
’ almost insuperable objections: and this, it will be seen, con¬
stitutes the foundation-stone both of his theory and his book.
Yet, W'hile questioning the principle of its operation, w'e are
by no means disposed to doubt the success of the practice
which he inculcates. The same end may unquestionably be
attained by very opposite means. And we can positively
assure Dr. Magendie, that we have repeatedly seen all the
phenomena of gravel subdued, and the inordinate secretion of
uric acid speedily reduced, by perseverance in a diet con-

60 Analytical Review,

fiisting of plain animal food, sea biscuit, rice, potatoc, and
other farinaceous vegetables, with a moderate allowance of
white wine or diluted brandy; and from which animal and
oils, fruit, salad, and other green vegetables, sugar, bread,
pastry, and all alimentary substances prone to fermentation in^
the stomach, have been rigorously excluded. The success ot
this plan is greatly expedited by the occasional prescription of
magnesian purgatives, and the administration ot the solution
of pure potash (the liquor potassce oi' the London Pharmaco¬
poeia), largely diluted, to the amount of two or three drams
daily*.

Unable, at present, to enter into a comprehensive detail of
our opinions and experience on this very important subject,
we shall take an early opportunity of claiming the attention of
our readers, and, we trust, that of Dr. Magendie also, to their
more full developement and illustration.

An English translation of Dr, Magendie’s interesting little
work, is, we are glad to observe, already announced ; and we
earnestly recommend professional men not merely to purchase
but to peruse it. The scientific views which it developes,
and the spirit and ardour of research which it displays, while
they carry reproof to the heart of the indolent, cannot fail to
stimulate and instruct the zealous. We are, indeed, no
strangers to the obloquy and neglect with which, in this coun¬
try, foreign medical literature has too commonly been treated.
But notions, thus illiberal and contracted, are, we would fain
hope, rapidly giving way to more correct and enlightened
view's. Nor shall we ever cease most loudl y to deprecate and
deplore an indulgence in prejudices so incalculably hostile to
the best interests of science, and alike disgraceful to the in¬
tellect and to the heart whence they emanate, and wherein
they are suffered to exist.

CORRESPONDENCE WITH THE REVIEWING DEPARTxMENT.

We have received a letter of remonstrance, signed Mem¬
bers of the Committee of the City of London Truss Society,”
on account of an allusion which was made in our last Number

* Few Practitioners are seemingly aware of the extent to which
this admirable medicine may be given, not only with impunity, but
with the most decidedly beneficial effects. After several years’ exten¬
sive trial of its powers, we have had no reason to complain of the
pernicious consequences w'hich are commonly attributed to its large
or long continued employment. A similar preparation of Wa would,
we have no doubt, prove a valuable acquisition to the Pharma¬
copoeia. — ^Rev,

Sulphurous Acid Gas with Sulphuretted Hydrogen Gas. 61

to a sermon preached in behalf of that excellent Institution. In
this letter we are charged with unjust conduct towards the
preacher, and with alluding improperly to the charily for which
he preached : to both of which accusations v\e plead absolutely
and unconditir)nall V not guilty: nay, the very showing of the
letter fully bears us out in the propriety ot our strictures.
I'he thing, however, was alluded to en badinage, and we are
sorry that it should be taken up by any persons or party in a
serious’manner. Towards the particular individual concerned
we bear the highest respect, but we have often lamented, no,
laughed at his wrong-headedness on medical topics ; and
with respect to the institution, the cause of which he so ably
and eloquently advocated, so far from wishing to do it the
smallest injury, we do not hesitate to express it as our most
sincere conviction that there is not a charitij in the metropolis
more worthy of every support : but let not one good thing be
lauded at the expense of another ; and let it be recollected,
that it is quite as much an interference with nature to place
a truss upon a protruded intestine, as it is to administer a ca¬
thartic in a constipated state of the bowels, or to withdraw
blood in order to avert the consequences of inflammation.
The fact is, that art must interfere with nature when nature
commits aberrations; and Surgeon and Physician in this re¬
spect are precisely in the same predicament. At the same
time it is for them both to be careful, lest, in washing to do what
is necessary, they proceed too far; and it behoves them like¬
wise to indulge a mutual good-will and esteem for each other.

N. B. We have been obliged to abandon our design of
presenting a slight retrospect of the chemistry of 1818 in our
present Number, on account of the unexpected press of other
matter. Our engagement on this head we shall endeavour to
fulfil in the February Number, when w^e shall, at the same
time, give a general nosological synopsis of the year with the
accompanying meteorological remarks.

PART ILL
SELECTIONS.

On the Action of Sulphurous Acid Gas on Sulphuretted Hy¬
drogen Gas. By A'iiomas Thomson, M.D. F.R.S.

It was first observed by Mr. Kirwan, that when sulphuretted
hydrogen gas was mixed with sulphurous acid gas, the bulk of

Selections.

ihe two gases diminishes, and a quantity of sulphur is depo®
sited cn the sides of the jar. He found that five measures of
sulphurous acid and six measures of sulpinireited hydrogen,
when thus mixed, were reduced to three measures^. On
turning to Messrs. Aiken’s Dictionary of Chemistry and Mi¬
neralogy, published in J807, i find exactly the same experi¬
ments related as those previously given by Kirwan in his
paper “ On Hepatic Air,” 1 conceive, therefore, that these
gentlemen did not make any experiments on the subject them¬
selves ; but simply adopted Mr, Kirwan’s results; though the
want of a reference to that gentleman might at first lead to
the notion that the experiments related were their own. The-
nard, in his “ Traile de Chimie,” vol. i. p. 539, informs us,
that the action of sulphurous acid gas on sulphuretted hydro¬
gen gas has been fully examined ; that the two gases decom¬
pose each other reciprocally, and form water and sulphur;
that the action is instantaneous, if the gases be moist ,* but
very slow if they be dry ; and that rather more than two parts
of sulphuretted hydrogen are requisite to decompose one part
of sulphurous acid.

These were all the circumstances respecting the action of
these two gases on each other which I could find in chemical
books at the time that 1 was employed in preparing the fifth
edition of my System of Chemistry for the press. As they did
not appear at all satisfactory, I found mystdf under the neces¬
sity of omitting all attempts to explain this action in my Sys¬
tem, and to place the fact among the list of subjects w hich
required further investigation ; of which 1 found myself under
the necessity of drawing up a pretty copious list. These topics
1 propose to investigate in succession ; and I shall lay the re¬
sult of my experiments occasionally before the readers of the
Annals.

d he gases employed by Kirwan were probably not absolutely
pure. He did not examine wdth sufficient care-the volumes of
the twm gases requisite to produce the greatest condensa¬
tion; nor is his account of the properties of the residual gas
sufficient to enable us to understand its nature. There is the
same want of precision in the account given by I'henard.
According to him, rather more than two volumes of sulphuret¬
ted hydrogen are decomposed by one volume of sulphurous
acid gas, and the result is water and sulphur. In these two
gases the w^eight of the atom is just double the specific gravity
(supposing the specific gravity of oxygen gas to be unity).
We may, therefore, substitute atom for volume.

* Phil. Trans. 1786, p. 118.

Sulphurous Acid Gas with Sulphuretted Hydrogen Gas. 6S

Sulphur. Atoms.

2 atoms sulphuretted hydrogen contain* *2 atoms + 2 hydrogen.

2 atoms sulphurous acid contains . 1 4-2 oxygen.

From this it is obvious, that if the two gases decompose
each other, and form w'ater and sulphur, they will be com¬
pletely condensed when we mix two volumes of sulphuretted
hydrogen with one volume of sulphurous acid ; proportions
which do not tally completely with the statement of T henard.

On repeating the experiment over mercury with gases per¬
fectly pure and sufficiently dry, 1 found that the two gases are
completely condensed, and lose their gaseous state entirely
when we mix three volumes of sulphuretted hydrogen gas
with two volumes of sulphurous acid gas. Two volumes of
the former, when mixed with one of the latter gas, did not
undergo complete condensation. The substance formed w’as
quite dry ; and 1 could not separate any moisture from it by
the application of heat, or bj^ any other method which I could
think of. Hence \\e have no experimental proof of the for¬
mation of water; nor is theory more favourable to the notion.
Let us substitute, as before, atom for volume, that we may
judge of the elements which have acted on each other.

Atoms. Atoms.

3 atoms of sulph. hydrogen contain* • *3 sulphur -}- 3 hydrogen.

2 atoms sulphurous acid contain . 2 sulphur + 4 oxygen.

So tliat there are present three atoms of hydrogen and four
atoms of oxygen. Were these bodies to unite and form water,
it is obvious that there would remain one atom of oxygen gas
uncombined, which would amount in bulk to the fourth part
of the sulphurous acid gas, or half a volume. In my experi¬
ment I mixed over mercury twelve cubic inches of sulphuret¬
ted hydrogen with eight cubic inches of oxygen gas. If
Thenard’s statement were accurate, namely, that water is
formed during the action of these two gases on each other, the
residual oxygen gas would have amounted to two cubic inches;
whereas there was no residue, except an insignificant bubble
of common air not larger than a pea.

1 think after the preceding detail there cannot be a doubt
that the hypothesis of Thenard, that, when these two gases are
mixed, they are converted into water and sulphur, is inaccu¬
rate. In reality, the two gases unite together and form a com¬
pound, which has hitherto been mistaken for sulphur, though
it possesses properties somewhat different from that combus¬
tible substance.

Its colour is orange-yellow, without any mixture of the
greenish tinge which distinguishes sulphur. It is not tasteless,
like sulphur, but gives a sensibly acid impression to the tongue :
this impression becomes at last hot, or peppery, and continues

Selections,

in the mouth for a considerable time. When the dry com¬
pound is applied to paper stained blue with litmus, it does not
produce any sensible change on it; but if we moisten the
paper ever so little, it is immediately rendered red by it.
Hence f conceive that this compound possesses acid proper¬
ties. But it is an acid that cannot be applied to any useful
purpose in chemistry, as it is decomposed by all liquid bodies
that [ have tried ; namely, water, alcohol, nitric acid, sul¬
phuric acid ; and as it does not sensibly unite with the salifi¬
able bases when presented in a dry state. The acid which
gives the red tinge to vegetable blues is neither the sulphuric
nor sulphurous ; for when the compound is agitated in barytes
water, no immediate precipitate takes place ; though if we
boil the mixture, a dirty grey precipitate at last falls.

When the compound is heated, it becomes soft and ductile;
but requires for fusion a higher temperature than sulphur.
But if the heat be continued, a kind of effervescence takes
place, and the compound is converted into common sulphur,
which burns in the usual manner.

When the compound is agitated wdth water, that liquid be¬
comes milky, acquires a slightly acidulous taste, and a quan¬
tity of common sulphur is speedily deposited. The very same
decomposition is produced by alcohol.

With potash it does not combine unless winter be present,
and in that case nothing is formed but common sulphuret of
potash.

1 have tried the action of various other re agents upon this
compound; but the phenomena presented were so little re¬
markable that they seem scarcely entitled to be related.

This is, perhaps, the first acid compound hitherto observed
which contains both oxygen and hydrogen united to a com¬
bustible basis. Though of little importance in a practical
point of view, it is of some little value as far as the theory is
concerned ; for it possesses the properties of acidity in a very
weak degree, so much so that f have not been able to succeed
in uniting it with any salifiable basis. This, I think, is a suffi¬
cient proof that Dr. Murray’s notion, that the greatest degree
of acidity is given to bodies by the joint union of oxygen and
hydrogen, is not countenanced by chemical facts, nor con¬
sistent with the phenomena of tlie science.

1 have not given this new compound a name, because it is
not likely ever to be employed for any useful purpose. Per¬
haps the term In/drosulplt/nous acid, though not quite correct,
might be applied to it without much impropriety.

(From Thomsons Annals of Philosophy,)

On the Nervous Ganglia of the Nasal Cavities,

PART IV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE. /

II -<•

'it-

ANATOMY AND PHYSIOLOGY.

I. Me?noiro)i the Nervous Gans^lia of the Nasal Cavities.
The intimate connexion which exists between the sensatibirt
of taste and smell, must have been noticed from the earliest
periods of human observation. The powerful influence which
certain substances applied either to the pituitary or palatine
membrane are known to exert on the adjacent organ, pre¬
sents a sufficiently striking illustration of this fact : 3’et are
we not aware that ^ it has hitherto attracted, except in a very
desultory way, the notice of the Physiologist, or been eluci¬
dated by his researches. By demonstrating that such rela¬
tions of liie olfactory and gustatory organs are dependent on
the presence of certain nervous ganglia, and that these
ganglia communicate as well with each other as with various
ganglia in the vicinity. Dr. Cloquet*, of Paris, hopes to esta¬
blish a fact, alike interesting to anatomy and physiology.
The following is an outline of the description into which,
with this view, he has minutely entered.

The anterior palatine foramen, opening on the palatine
vault immediately behind the two middle incisor teeth, and
befurcating as it ascends in order to communicate with each
nostril by a distinct orifice, must be well knowm and recol¬
lected by even the most superficial anatomist. From the in¬
terior of these canals, two yet smaller branch off to the right
and left, but are interrupted in the middle of their course
and replaced by others. Their superior opening, perfectly
distinct from the orifices of the palatine canal, exists at the
point of union between the vomer and superior maxillary
bones. It has long been disputed by anatomists whether the
pituitary membrane lines or contributes to close the prin¬
cipal passages of this canal. Cuvier, and Jacobson, a Danisli
anatomist, have, however, recently decided that this orifice,
although existing in other mammifera, is deficient in the hu¬
man subject and the horse; and that principally in herbivor¬
ous animals the adjacent region of the nasal cavities is occu¬
pied by a peculiar organ liberally supplied with nerves, and

* Nouveau Journal de IViedecine, Juillet, 18 1 S.

VOL. Xi. - NO. 61. K

66 Foreign Medical Science and Literature.

Erobably conferring on its possessor some faculty not enjoyed
y man, as that of distinguishing the poisonous from other
plants. — In the prosecution of his researches on this point,
Dr. Cloquet has discovered that there exists in the anterior
palatine canal of the human subject, at the point of bifurca¬
tion of its two branches, a small reddish, fungus, rather hard
mass, buried in adipose cellular structure, and most commonly
of an ovoid form. It is a real nervous ganglion ; and from
its larger extremity, which is turned upward, sends oft to the
spheno-palatine ganglion of Meckel the two nervous filaments
discovered by Cotugno, and named by Scarpa the naso-pala-
tine : hence these nerves have a' different course from that
commonly assigned to them. The smaller extremity of the
ganglion furnishes one or two filaments which pass through
the small palatine canals to the palatine vault, where they
anastomose with the branches of the palatine nerve. 1‘hus
the naso-palatine ganglion, as it is termed by Dr. Cloquet,
communicates with Meckel’s ganglion, both by the naso¬
palatine and by the proper palatine nerve.

In the inferior animals this ganglion is frequently more
voluminous than in man, and in the ruminantia is particu¬
larly developed. On this account the peculiarities which it
presents in the sheep are very minutely traced by Dr. Clo¬
quet, previously to his proposed description of it in the other
classes. Having thus established the connexions of the naso¬
palatine with the spheno-palatine ganglion, he next proceeds
to demonstrate the disputed existence of the latter, and its
connexions with the other ganglia of the head.

The spheno-palatine ganglion, first described by Meckel, is
situated externally to the spheno-palatine foramen; small but
variable in size, reddish, somewhat hard, triangular or cordi-
form ; convex on its external, and flat on its internal surface,
and so buried in the adipose substance of the pterygo-maxil-
lary fissure, that its developement requires considerable ad-^
dress, and it is frequently overlooked by anatomists. Trom
this ganglion, three, four, or five nerves are sent off to the
pituitary membrane. They pass to the nasal fossae through
the spheno-palatine foramen, near the posterior extremity of
the middle spongy bone. It also distributes nerves to the
palate and neighbourhood of the pharynx. After having spe¬
cified various reasons for believing that the spheno-palatine is
absolutely analogous, both in structure and function, to the
other nervous ganglia, Dr. Cloquet concludes by obaerving,
that from these various communications of the nerves of the
mouth and nasal cavities, the naso-palatine ganglion may be
reasonably supposed to contribute to the production of the
sympathetic phenomena which connect the senses of sineli

Causes of Tetanus^

and taste ; and that it explains, to a certain point, how some
substances, applied either to the palate or nasal membrane,
reciprocally affect the other organ.

PATHOLOGY (INCLUDING MORBID ANATOMY) AND
PRACTICE OF MEDICINE.

11. Cases of Tetanus^. — Notwithstanding the rapid pro¬
gress which has been made in pathological anatomy within
the last few years, it is yet much to be regretted that profes¬
sional men, even the most zealous in the prosecution of it,
have too commonly restricted their inquiries to the condition
of the various organs contained in the cranium, thorax, and
abdomen, of the subject under examination ; while that im¬
portant viscus, the spinal marrow, from whence almost every
part of the human body derives its principal supply of nerves,
and the morbid alterations of which must, consequently, deve-
lope the most interesting and instructive views in general
pathology, has been consigned to utter forgetfulness or
neglect.

Dr. Franck, uncle of the Physician by whom the cases
about to be detailed have been communicated, first excited,
by the publication of a memoir upon this subject^, the atten¬
tion of Practitioners to it : and from that period the exami¬
nation of the vertebral canal has been very commonly prac¬
tised in Germany, Italy, and, we may now add, France and
Britain. Hence medical literature has been enriched by con¬
tributions of high practical value, respecting the pathology
of the spinal chord. Professor RacchettiJ has recently pub¬
lished, at Pavia, a most interesting monograph on the various
diseases of this organ ; and a work of inferior extent and
importance on the same subject has been given to the world
by Mr. Copeland ||.

It is unfortunately true, that no positive knowledge respect¬
ing the seat of tetanus has hitherto been acquired. Several
Physicians of great ability and experience have indeed
suspected that it may exist in the spinal marrow : and this
presumption seems at length to have been almost converted
into certainty, at least as far as regards vulnerary or symp¬
tomatic tetanus. In the hope of thereby rendering a service
to Practitioners, Dr. Franck proceeds to record two cases of

* Bulletin de la Society M^dicale d'Emulation. Juillet, 1818.

t De Vertebralis Columnae in Morbis Dignitale. Paria, 1791-

I Della Struttura, delle Funzioni e delle Malattie, della Midolla
Spinale, &c. 8vo. Milan, 1816.

II Observations on the Symptoms and Treatment of Diseased Spine,
8vo. 1815.

68 Foreigi} Medical Science and Lilef'ature,

tetanus, which have been observed and described by Pro¬
fessor Brera in a communication delivered, in 1816 and 1817,
to the clinical school of the University of Padua.

The first case occurred in a female, aged twenty-two. The
affection assumed a nervous character. Various remedies
were prescribed in vain. The patient died after a fortnight’s
suffering. On dissection, the thoracic and abdominal viscera
were found drenched with suppuration. The spinal marrow
was softened, and very deeply diseased. The morbid condi¬
tion of the internal organs was probably dependent on the
spinal lesion.

A young man, aged nineteen, was the subject of the second
case. He had received a contusion on bis right thumb; and
twelve days afterwards became sensible of a stiffness in the
lower jaw. From negligence and imprudent exposure to the
air, the difficulty of motion of the jaw became aggravated,
and the whole body affected with rigidity. The patient was
conveyed to the clinical school in a state of universal spasm
and contraction of the facial muscles. He was, moreover,
affected with cold perspirations and pains all over the body,
but principally in the lumbar region, and along the vertebral
column. The face was red, and the pulse contracted. Under
a conviction of the existence of inflammation of the spinal
marrow, one hundred and twenty leeches were applied along
the vertebral column ; and the prussic acid was administered.
After the abstraction of the blood there was a sensible dimi¬
nution of the spasms; but they soon recurred with increased
violence, and were followed by paralysis and death.

Examination of the body proved of the highest importance
as far as regards the theory of the disease. The spinal mar¬
row was in a state of decided inflammation, exclusively, how¬
ever, about the origin of the cervical nerves, and not in the
slightest degree implicating the other portion of the organ,
or the cerebellum. The inflammation, in fact, zms confined to
the right side of the spinal marrow^ obviously corresponding
with the hand upon wffiich the injury had been inflicted. Seve¬
ral other remarks on tetanus may be seen in the work of Pro¬
fessor Brera*.

III. Obstruction of the Thoracic Duct. — That this import¬
ant little vessel is much more frequently the seat of obstruc¬
tion, and consequently of fatal disease, than is generally
suspected, we have long entertained an opinion. And if
minute examination were instituted in those cases of gradual
emaciation, unattended by any of the symptoms of pulmonary

• Prospetto de Risultamenti Otteniiti nella Clinica Medica dell
I. II. Universita di Padova, nelle 1816-181 7.

Obstruction of the Thoracic Duct,

or intestinal affection, which almost daily occur, we have no
doubt that this fact would be established as clearly as any one
at present comprehended within the pale of pathologicai
science. The following case, recently reported by a German
writer, Dr. Hopfengartner, of Stutgard*, presents great inte¬
rest in its connexion with this subject, and is alike curious and
valuable as a record of morbid anatomy.

Jn one of three instances of obstruction of the thoracic duct
described by Mr. Astiey Cooper, the vessel was found filled,
in its whole length, by a cheese-like mass. A similar sub¬
stance apparently forms in the lymphatic vessels near large
lymph-abscesses. But Dr. Hopfengartner had not seen a
sufficient number of such cases to be enabled to form a deci¬
sive opinion concerning the relation of this phenomenon to
the origin and progress of the abscess. Anatomical inspec¬
tion is, he observes, in these cases, beset with many difficul¬
ties, which he has not yet had an opportunity of solving
so satisfactorily as to attain any accurate conclusions on
the subject.

The patient to whose history we have adverted, a boy aged
eight, was admitted into Stutgard Hospital on account of
obstinate tinea. His spine was very much distorted ; and he
was so greatly emaciated as rather to resemble a skeleton than
a living body. Abandoned from birth by his parents, he
had been subjected to the mal-treatment of needy and negli¬
gent relations. Destitute of sufficient covering and of bed,
the poor creature had suffered dreadfully^ during the preced¬
ing hard winter, from the inclemencies of the season. For
several months past, a little bread and brandy had constituted
his only nourishment. He some time since had been seized
wdth incessant vomiting: his faeces were scanty ; and all his
joints so stiff that he was nearly incapable of motion. The
pulse was small and rapid ; the temperature of the surface
reduced; and the appetite for food insatiable. After three
jnonths’ perseverance in the employment of the tepid bath,
nutritious diet, and external remedies, the boy was much im¬
proved in strength, appearance, and the use of his limbs;
and in the commencement of winter he left the hospital.
Attention to his moral and physical education was not ne¬
glected ; and for a whole year he remained well. About the
close of the following wdnter, a tumor, with evident suppura¬
tion, was observed at the inferior angle of the left scapula, and
increased, within a short time, so as to reach the tenth rib.
Upon incision, there escaped a considerable quantity of lymph,

’ * Journal

VI. Stuck.

der Practischen Heilkundc, 1817* XLIV. P>and.

70 Foreign Medical Science and JJtei^ature.

mixed with chees}^ flakes. The discharge kept up by
the introductioo of a seton, and the patient supported by
nourishing food and cinchona. Emaciation excepted, he was
now perfectly well. The discharge, after gradually diminish¬
ing, completely ceased in August. But the cavity of the
abscess was found, on the introduction of the probe, to be
quite as large as in the commencement.

The cessation of the discharge was followed by violent
vomiting and diarrhoea; and the patient sunk rapidly, without
the presence of any decided febrile symptoms. After some
days these phenomena subsided, and a fresh abscess formed
below the first. It soon brake spontaneously, and gave issue
to a small quantity of lymph. The patient grew daily w^eaker;
his respiration difficult and pulse accelerated. On the 24th
of August he was suddenly seized with convulsions, which,
after continuing twenty-four hours, terminated in death on
the evening of the 25th. Till the convulsive seizure, the
patient had retained his recollection unimpaired. During
the last four days, camphor and snake-root had been largely
administered.

Upon dissection, on the 26th, the surface of the body was
found covered with livid spots; but there were no marks of
putrefaction. The vessels and sinuses of the dura mater were
distended with black blood ; and the vessels of the pia mater,
even in their minutest ramifications, w^ere most unusually
gorged. The brain felt considerably indurated ; and the
convolutions lay so closely together as to give to the whole a
turgid appearance,' The substance of the brain itself, and
that of the cerebellum, displayed no organic lesion. The
lateral ventricles contained about four ounces of limpid fluid.
The left lung was universally adherent to the costal pleura,
and connected to the pericardium and diaphragm by a thick
cellular structure. The lung itself possessed but half of its
natural volume ; and was compact, of a dark red colour,
gorged with blood, but not tuberculated. The right was per¬
fectly sound. An intimate adhesion subsisted between the
pericardium and the heart. Its separation having been care¬
fully effected, the surface of the heart itself w^as seen covered
with numerous white tubercles of the size of a lentil. The
adhesion had been formed by a thick red cellular structure.
The proper membrane of the heart was thicker than com¬
mon, and from it the white tubercles projected. The heart
itself was in a natural state. After the complete removal
of the thoracic viscera, a white mass, of the volume of a
pigeon's egg, first presented itself : it w'as situated close
to the vertebral column on the left side, about two fingers'
breadth above the diaphragm. The cellular membrane was

Prussiate of Quicksilver in Sj/philis.

now carefully detached, and the following appearances were
observed : — From the left rib a white mass of the thickness
of a finger descended close by the spine to. the diaphragm.
It was in several parts tuberculated, and the largest pro¬
minence formed the mass which has just been described.
Fro m this mass several branches of variable thickness and
length went off to the ribs. One of these, after having
perforated the intercostal muscles, terminated in the cavity
of the abscess. The whole of the mass, both trunk and
branches, was invested with a delicate transparent membrane.
From the point where this mass terminated above, the
membrane in question was continued in the form of an
empty canal to the left subclavian vein: yet the injection of
air from the canal into the vein, or in the opposite direction,
was utterly impracticable. The mass itself resembled in
colour and consistence coagulated albumen, and imparted
a greasy sensation to the finger. The cavity of the abscess
extended over the whole left part of the back, from the
inferior angle of the scapula to the sacrum. It had merely
a covering of skin, and contained but a very small quantity
of thin pus. Its parietes displayed a livid appearance. The
spine was very much curved to the right. The left ribs
were completely flattened, but those of the opposite side
unusually arched. The right cavity of the thorax was about
twice as large as the left. The volume of each lung cor¬
responded to the space of its containing cavity. Nothing
particular was remarked in the abdomen. The omentum
was much wasted, and the bladder distended with urine.
The rectum contained some indurated faeces.

IV. Employment of the Prussiate of Quicksilver. — Some
intimations published by Professor Chaussier, respecting
the anti-syphilitic properties of this substance, which he
considers as preferable to every other mercurial preparation,
seem first to have excited the attention of a Spanish Phy¬
sician, Dr. Salamanca, to the remedy. And the facts
detailed in his Observations on the Utility of Prussiate
of Mercury in Obstinate Syphilis, and other Y^ymphatic
Diseases*,” tend strongly to support the opinion of the
Parisian Professor. We shall transcribe two out of the
six cases here recorded, as sufficiently illustrative of the
employment and operation of this powerful compound.

Fiist Case, — The subject of this was a merchant of
Gibraltar, aged 34, of highly bilious temperament and
extreme irritability. For two years he had suffered from

* Observaciones Medicas sopre la Utilidad del Prussiato de Mer¬
curic, &c. Bulletin de la Societe Medicate d’Ern illation, AoCit, 1818.

foreign Medical Science and Literature*

a syphilitic taint, for which mercurial frictions had been
twice unsuccessfully prescribed. Besides pains of the bones,
aggravated at night, there existed signs of congestion of the
liver. Other mercurial preparations, venesection, cinchona,
and opium, had proved equally unavailing. The patient,
disappointed of relief, and sensible of his increasing debility,
resorted to Dr. Salamanca ; who finding the disease accom¬
panied with considerable emaciation, hectic fever, cough,
colliquative sweats, a lateritious condition of the urine, and
tumefaction in the region of the liver, requested a consultation
withj two other Physicians. The malady was pronounced
to be an incurable hepatic phthisis. Yet Dr. Salamanca, in
order to satisfy his, patient, prescribed tonics, opium at night,
and a blister on the right hypochondrium. Perseverance
in this plan for some days was productive of relief. The
cough and fever yet continuing obsdnate, Dr. Salamanca
directed his patient to take in a little water every morning
one table-spoonful of a solution of four grains of prussiate
of quicksilver in six ounces of distilled water; at noon, '
decoction of cinchona and guaiacum was exhibited; and
at night opium with benzoic acid. The first six days tlie
mercurial solution excited bilious vomiting; but subsequently
it operated only by stool, i^lter submission to this treat¬
ment for nearly a month, the fever began to remit during
long intervals ; the cough, diminished, and was attended
with sero-purulent expectoration; and both these, and all
the other symptoms finally yielded to the plan, assisted
by the repeated application of blisters. The patient returned
to Gibraltar perfectly recovered.

Fourth Case. — A young lady, aged fifteen, had for four
years been affected with scrofulous ulcerations of the neck.
Mercurials, tepid and mineral baths, carbonate of soda,
muriate of barytes, and other remedies, had been tried
without effect; when Dr. Salamanca prescribed a solution
of four grains of prussiate of quicksilver in eight ounces
of distilled winter, one table-spoonful of which was to be
taken every day fasting. For the few first days slight
vomiting was induced, but shortly afterw'ards the ulcers
began to yield a more copious lymphatic discharge, and
three-out of five w^ere soon completely cicatrized. The cure
was accomplished in four montiis. The lady almost
immediately married, and one of the two children which
she has borne, displayed the traces of a similar affection;
but at the period of Dr. Salamanca’s communication the
tumors were disappearing under the use of the prussiate
of quicksilver in minute doses. The Spanish Physician
has also prescribed this remedy with signal success in

Asphyxia from the Effluvia of Privies. 73

confirmed, and otherwise incurable herpetic and psoric
complaints.

MEDICAL JURISPRUDENCE.

V, Cases of Asphyxia. — Under the present section
we may properly introduce a very interesting account of
the asphyxia of privies, which has lately been published
in one of the French journals*.

Th ree masons employed in repairing a privy which had
been emptied about a fortnight, were in the act of clearing
out some water accumulated in it, when a large additional
quantity rushed suddenly upon them, and gave out effluvia
so extremely offensive as to suffocate one of the men, who
had been removing a stone at the point from v/hence it
issued. He struggled for some time in the mud before
he became insensible. A comrade in the attempt to rescue
him, fell also. The father of the first, witnessing the danger
of his son, ran to give assistance, and shared the fate of
his predecessor. All three were speedily extricated, and
conveyed at nine o’clock in the morning to the Hotel Dieu.

The first brought in was the weakest of the two younger
men. He was the first w'ho fell into the privy, and was the
last extricated. He was aged ^1, and of good constitution.
On examination he was found wholly void of consciousness,
sense, and motion. The body was cold ; lips violet ; and
countenance livid. A bloody froth issued from the mouth.
The eyes were dim, and the pupils immoveably dilated.
The pulsations of the radial artery were small and frequent ;
those of the heart irregular and tumultuous; respiration short,
difficult, and convulsive ; and the limbs relaxed. The
patient, exposed on a bed to the air, was made to inhale
oxygenated muriatic acid gas, which produced a momentary
excitement. A vein was opened in both arms successively,
the first not yielding a sufficient quantity of blood. After
this the pulsation of the heart became more regular, and the
pulse somewhat developed. Respiration also was less
difficult; but the surface continued cold, and the face livid.
Frictions were now employed on the trunk and extremities ;
and an ethereal draught administered. The mouth ceased
to foam ; the exhaustion was less menacing ; and the patient
uttered at times a plaintive sound. Soon afterwards he
became violently agitated, and continued so for two hours ;
in consequence of which the cold bath, with cold affusions,
was had recourse to. Immersion seemed at first to aggra¬
vate the symptoms. Respiration grew very difficult ; the

* Nouveau Journal de Medecine. Avril, 1818.
— NO. 61.

VOL. XI.

74 Foreign Medical Science and Literature,

motions more violent; the face pale. The brachial vein
bled afresh to a very large amount. The patient vras con¬
veyed in a state of syncope, cold and motionless, to his
bed. T’he pulse was scarcely perceptible ; respiration,
panting. After some hours he revived, and frictions with
warm cloths were employed. The pulse then rose; the
skin became warm and covered with a genial moisture, and
the eyes half unclosed : yet respiration continued short
and tight. At four o’clock the pulse was calm and regular,
and the skin in a favourable state. Sinapisms applied to
the feet at night produced active stimulation. The patient
passed a tranquil night, and at three o’clock in the morning
consciousness returned. From that time all the symptoms
subsided, and restoration was complete on the third day.

I’he father, a strong man, aged 60, had been much less
severely affected ; and by the assistance of a draught speedily
administered, had voided the water previously introduced
into his stomach. liis senses had been retained; but the
whole body, and particularly the thoracic muscles, was
agitated by convulsive motions. The jaws also were at
times affected with spasm; skin cold; respiration irregular,
and pulse much embarrassed. There was no frothing at
the mouth, but frequent inclination to vomit. After two
hours the spasms had subsided, and the pulse became re^
gular ; yet the nausea continued. By the employment of
a large dose of ipecacuanha, a sulphuric acid potion, and a
glyster, all the symptoms w^ere on the morrow dissipated.

The third patient, aged 19, of a decidedly bilio-sanguineous
temperament, with short neck^ capacious chest, and muscles
strongly marked, displayed the following phenomena. His
agitation was extreme. All the muscles w^ere affected

with severe but transient contractions, succeeded by spasms,
with curvature of the trunk backwards. He seemed to
suffer acute pain ; and his cries resembled the bellowing
of a bull. The face was less pale than in the subject of the
first case ; the pupil dilated and immoveable, and the mouth
filled with white froth. Respiration was convulsive ; the
action of the heart disordered, and the skin cold. Inhalation
of oxygenated muriatic acid gas produced a powerful effect.
A vein was opened in the arm, and the flow of blood was
with difficulty suppressed. The motion and vociferation
of the patient were such as to require confinement. An
hour afterwards the cold-bath was employed; and a sort
of stupor succeeded every act of affusion. Otherwise, the
effects were similar to those experienced in the first case.
The calm w'hich ensued was of short duration, and the cries
^nd contortions soon recommenced. Respiration became

:£

'■I

: t

VjXtivpation of the Parotid G land.

laborious and interrupted; the pulse thread-like, and of
incalculable rapidity. In an hour afterwards the whole
body was hot, although covered with perspiration. The face
grew pale; the pulse weaker; the agitation gradually sub¬
sided ; and in about two hours the patient died without
having recovered his consciousness. — On dissection, forty
hours after death, (the weather being then stormy) the head
and trunk were already putrid ; the skin bluish, and
elevated bv gas. The blood contained in the various cavities
was black and fluid. The brain was greenish and tender.
The bronchiae displayed a red colour, progressively deepening
as their minute divisions were traced. The posterior part
of the lungs was gorged w ith black blood ; but the organ
was generally crepitous. The stomach presented traces
of recent irritation, and several signs of irritation of a more
remote date. The intestinal canal was greenish. The liver
of a greenish black colour, was in a state of congestion. All
the viscera exhaled the smell of putrid fish. The internal
membrane of some of the larger vessels was of a bright red
colour. Several of the persons present at the dissection
were subsequently alfected with lassitude, stupor, sleepless¬
ness, and violent cholic.

Another interesting case of asphyxia by the gas extricated
from stagnant water, has likewise been communicated by
Dr. Chomel*. W e have not room to transcribe the particulars.
Suffice it then to observe, that the subject of it, after having
lain in a well three quarters of an hour without sense or
motion, was drawn up in a state of apparent death ; that he
presented symptoms very nearly resembling those described
in the preceding cases; and that by the employment of vene¬
section, inhalation of oxygenated muriatic acid gas, stimu¬
lant injections, an emetic which operated only by stool, an
ethereal mixture, and sinapisms to the lower extremities, he
was restored on the third day.

SURGERY.

VI. ^Extirpation of the Parotid Gland. — To those who
: correctly know^, and will take the trouble calmly to review, the
’ situation and connexions of this gland, its removal by the
I knife must really seem an enterprise of no common difficulty
j and peril. Several enlightened Surgeons have even gone so
j far as utterl3^ to deny the practicabilitj^ of such an operation,
j That it has, however, more than once been actually and suc-
I cessfully accomplished, the splendid page of British Surgery
affords evidence sufficient to convince the most incredulousf.

* Nouveau Journal de M^decine. Juillet, 1818.
t For farther information on this subject, see the Medico-Chirurgical
Journal, Vol. I. page 457.

76 Foreign Medical Science and Literature,

A case, purporting to be of a similar description, has lately
been published by M. Degland* ; but whether in this in¬
stance the parotid itself were really extirpated, may be very
fairly questioned. A swelling, of the volume of a nut, arose
on the region of the right parotid gland, in an aged female,
and gradually acquired the volume of a small hen’s egg. It
was hard, circumscribed, indolent, and hut little moveable.
Considered cancerous by M. Degland, it was cut out appa¬
rently with almost as little hsemorrhage as ceremony. But
the particulars of the operation are very imperfectly detailed.
The tumor after excision presented an ovoid figure ; and,
on being cut into, gave issue to a yellowish, syrup-like, in¬
odorous fluid, partly accumulated in the centre, and partly dif¬
fused through its substance. In colour and consistence it re¬
sembled the cartilages of the lumbar vertebrae. The wound
was cicatrized in twenty-six days. The figure of the mass
removed, its previous mobility, its anatomical character, the
nature of the contained fluid, the neglect of any mention of
the parotid duct, — -all conspire to show, that instead of the
parotid, a diseased lymphatic gland, mistaken for it, had pro¬
bably been here removed. We hardly need add, that the parotid
is of a triangular form, and completely immoveable even in a
healthy state. It wdll, moreover, be recollected, that an ab¬
sorbent gland, extremely prone to morbid enlargement, lies im¬
bedded in the centre of the parotid ; and we doubt not but
that M. Degland, if he had examined the part on which he
had operated with sufficient attention, would have found the
latter untouched, but reduced in bulk, like all other organs
when subjected to continual pressure. We have been in¬
duced to notice the preceding case, as w^ell with a view of
reprobating the careless and unsatisfactory manner in w^hich
the disease and operation are described, as of impressing on
the minds of Surgeons the practicability of extirpation of a
diseased parotid gland with perfect safety and success.

VII. Fronchocele, — Professor Walter, of the university
of Landshut, has lately published, respecting the treatment of
bronchocele, a pamphletf which merits particular attention.
He distinguishes the affection into four different species. In
the first, which he names aneurismal hroncJiocele, the arteries,
veins, and capillary vessels, are alike dilated. The second,
or lymphatic hronchocelej seems to depend upon the effusion
of coagulable lymph into the cellular structure of the thyroid
gland. Scirrhous and infiammatory bronchocele, constitute
the third and fourth divisions. Professor Walter’s monograph
is devoted exclusively to a consideration of the aneurismal

* Nouveau Journal de M^decine, Juillet, 1818.
t Bulletin de la Soci4t6 Medicale d’Emulation, Juillet, 1818.

Cases of Casarean Operation.

species ; and the following is one of the cases therein de¬
tailed : — A man, aged 24, had an enormous aneurismal bron-
chocele, which impeded both respiration and deglutition^
The Professor made an incision one inch and a half in length
at the point where the left superior thyroideal artery w'as seen
to pulsate. A second incision, cautiously practised, laid bare
the vessel; and after several smaller arteries had been se¬
cured, a ligature was passed round it. At the expiration of a
fortnight, the left portion of the tumor was reduced at least
one-third in volume. The ligature of the opposite artery was
accomplished on the 17th of June, but in consequence of
the vessel being covered by the enlarged thyroid gland, the
operation occupied three quarters of an hour. On the 15th
of July the patient left the hospital. At that time he swal¬
lowed with facility ; and the bronchocele, sensibly reduced,
hung down in the form of an empty sack. Two j^ears after¬
wards, the Professor learned that the subject of this operation
had entered into the army.

The result of this experiment is certainly calculated to
counteract the unfavourable impression left upon the minds
of Surgeons by the failure of a similar attempt made some
years since in one of the London hospitals*; and would,
doubtless justify its repetition in any instance w'here the
bronchocele, by its pressure on the oesophagus or trachea,
menaced fatal consequences. In the unfortunate case to
which we have alluded, death took place from secondary
haemorrhage. We have no doubt that, if it were necessary,
one or both of the inferior thyroideal arteries might also be
tied by any Surgeon correctly acquainted, as all Surgeons
ought to be, with the relative anatomy of the parts upon which
he was operating.

MIDWIFERY.

VIII. CcBsarean Examples of the success of

this daring and terrible operation have hitherto been so rare
among us, that we feel great anxiety to collect, and consider
it our duty to record, every well authenticated case, of recent
occurrence, where the fortitude of the patient, and the zeal
and intrepidity of the Surgeon, have been crowned with the
recompense which they so eminently merit. The two cases
about to be transcribed are of this gratifying description.
The last, although, strictly speaking, rather a case of gastro-
tomy than of Caesarean operation, will be read with peculiar
interest.

* This case, if we mistake not, is mentioned in Mr. Hodgson's
admirable Treatise on the Diseases of Arteries ; but we are unable, at
this moment, to refer to it. — Edit.

Foreign Medical Science and Literature.

The subject of the first history^ to be noticed, was s
woman, aged 82, of very diminutive stature, the aperture
of whose pelvis measured but two inches in the antico-pos“
terior direction, and three in the oblique. The waters had
been discharged twenty-four hours, and the infant displayed
evident signs of life. The operation was performed in the
following manner by Dr. Mergault:- — A longitudinal inci¬
sion of five inches was made on the right side of the abdo¬
men, about two inches above the umbilicus. The muscles,
peritonaeum, and uterus, were successively incised in the same
direction. The wound of the uterus corresponded wdth the
insertion of the placenta, which, consequently, was divided
by the scalpel. The hand was then introduced into the ute¬
rine cavity, and the child seized by the feet, and extracted'
living. The placenta was afterwards removed, and the uterus
cleared from its contained coagula. The wound, its edges
being supported in contact by three sutures, was dressed in
the usual manner. The state of the woman continued for
some days favourable ; but from the fifth to the sixth ab¬
dominal pains came on accompanied with fever. An icho¬
rous and offensive pus issued in abundance from the vagina
and the wound. During a fortnight’s continuance of these
symptoms, the cinchona was administered. In order to faci¬
litate the escape of the pus, the inferior angle of the wound
was subsequently dilated. From this period the woman ra¬
pidly improved ; and was, on the fiftieth day, perfectly re¬
established.

The other case occurred last year at Parma, and has been
communicated to the Societe M6dicale d’Emulation by
Dr. Franck, whose name will be received as a sufficient
pledge of the authenticity and correctness of the ensuing nar¬
rative f: — A woman, aged 28, was seized with labour of her
fifth child on the 28th of August. About midnight the child
had descended within the pelvic cavity. The membranes
were yet unbroken; when, after a most violent pain, the
child’s head suddenly retreated, and the w^oman experienced
dreadful agony and vomiting. The Surgeon in attendance
mistaking the nature of the case, recommended delay. About
six o’clock A. M. two other gentlemen were summoned, and
after hearing what had passed, and examining the abdomen,
w^ere convinced that the child had escaped transversely into
that cavity, between the stomach and umbilicus. The uterine
orifice was closed in the same way as it commonly is six hours

* Recueil periodique deda Society de Medecine de Paris. Juillet,
1818.

t Bulletin de la Society Medieale d’Emulation. Juillet, 1818.

Substitute for Cinchona Bark,

after delivery. The operation of gastrotomy was now de¬
termined on as the only resource, and performed at eight
o’clock by Ceceoni, Surgeon to the hospital, in the presence
of several other professional gentlemen. The situation of the
child having been correctly ascertained, with its head near
the liver, and its feet in the left hypochondrium of the mother,
an incision to the extent of five inches was made in this re¬
gion. On penetrating into the abdominal cavity a quantity
of bloody water rushed out. The intestines being cautiously
confined by the assistants, the operator found without diffi¬
culty both feet of the child in succession, and thus accom¬
plished its extraction. It was of the full grown size, but
dead. The umbilical chord and placenta were afterwards re¬
moved. The wound was then united by suture, but with the
precaution of leaving an aperture in a situation favourable to
the discharge of any fluid, '

The lochia made their appearance naturally. No untoward
symptom supervened. The abdominal wound was completely
cicatrized in three weeks, and shortly afterwards the w’^oman’s
health was quite restored. Had the nature of the accident
been ascertained a few hours earlier, and the operation been
promptly executed, it is highly probable that the child would
have been saved, as in the precediug case.

BOTAXY.

IX. New Substitute for the Cinchona. — The ensuing is a
correct sketch of the statement respecting a new kind of fe¬
brifuge bark, which has lately been published by Drs. Virey*
and Cloquetf, in tw'o of the French journals. M. Bose,
member of the Academy of Sciences, has received a speci¬
men of it from M. Hubert, botanist at the isle of Bourbon.

The substance in question, the bark of a shrub, is indiscri¬
minately employed by the negroes of Madagascar, and the
creoles of the other African islands, against the fevers so com¬
mon in those southern latitudes. It is both administered inter¬
nally in decoction, and applied to the temples and hands in
the form of powder moistened wdth vinegar.

This bark is rolled up like that variety of cinchona cordi-
. folia which comes from Loxa. Its epidermis is fawn-coloured,
and covered in patches wdth specks of a yellow farinous mat¬
ter, but less abundantly than that of the Angustura ferruginea.
The texture of this epidermis, about one line in thickness, is
granular, its taste bitter and aromatic. The more internal
part of the bark, or liber, is of a reddish-browm colour, and
of a singularly bitter and pepper-like taste, with somewhat of

* Journal IJniversel des Sciences Medicales. Aout, 1818,
t Nouveau Journal de Medecine. Septembre, 1818,

Medical and Physical Intelligence,

the sweetish flavour of liquorice root. It presents, upon frac¬
ture, no resinous appearance.

The shrub which yields this bark grows very common iti
Asia and the African islands. It was first figured by Van
Rheede, in his Hortus Malabaricus, under the name of the
Kaka-Toddali, From Linne and Wildenow it has obtained
the respective titles of paullinia Asiatica^ and scopolia aculeata;
and Jussieu has lastly called it Toddalia, from the designation
which it bears on the coast of Malabar. It is a small, prickly,
bushy shrub, and may be readily recognised by its flowers,
in axillary pannicles, composed of a calyx divided into five
teeth, corolla pentapetalous, stamina five, styles and stigmata
three. The fruit is a berry of the size of a pea, containing
five dry oval seeds. It is wrinkled, and full of volatile oil, re¬
sembling that of orange-peel. The leaves are alternate and
dull, and covered, like those of the Hypericum perforatum^ by
minute translucid points. They are oval, lance-shaped, some¬
what serrated, and even, like the stems and branches, armed
with prickles. Hence, this shrub must belong to the class
Pentandria, and order Trigynia, and to the natural family of
Terebinthaceic (of Jussieu) not far from the brucea, the astrin¬
gent bark of which is also febrifuge and anti-dysenteric.
The bark of the root is almost exclusively employed by the
negroes.

Dr. Cloquet states, in conclusion, that he has lately received
from Senegal a root almost completely resembling that of the
Toddalia, and employed by the inhabitants for a similar pur¬
pose. The principal difference consists in the greater size
and strength of the Senegal root. But no botanical notice
having been sent with the latter, the plant from which it was
obtained cannot, at present, be satisfactorily determined.

PART V.

MEDICAL AND PFIYSICAL
INTELLIGENCE.

ARSENIC TAKEN WITHOUT INJURY.

The object of this communication is to diffuse more generally the
opinion that charcoal is eminently an antidote to arsenic : from our
knowledge of chemistry we have reason to expect it should be, but
we ought not to trust to theory without some experience.

Mr. R - took last evening, through mistake, a considerable

quantity of arseniate of potash; he had previously been visited with
a severe pain in the head, from uncommon exertion during the day,

Medical and Physical Intelligence*

and had taken his supper immediately upon the top of the. dose ot
arsenic ; some suspicions were now excited, and assistance sent for,
which fortunately was near.

Found him with a quick pulse, considerable prostration of strength,
a sense of heat over the whole body, pricking in the limbs, the head-
ach gone, a disagreeable dry sensation in the throat, and some degree
of anxiety, as might be expected.

Gave tvventy*five grains of sulphate of zinc, which produced a very
little sickness : after waiting fifteen minutes, gave, at short intervals,
twelve grains more, together with half an ounce of pulverized char¬
coal, suspended in a teacup of water: no sickness produced, but the
heat and pricking were no longer felt, and the pulse became moderate.

Ordered half an ounce of charcoal and water as before ; a table-
spoonful of which to be given every fifteen minutes: an ounce ol oL
ricini, to be repeated at an interval of four hours, should not the first
quantity operate; and left him for the night.

Found this morning that he has slept comfortably most of the
night, has taken two ounces of oil, which has operated profusely and
frequently ; has no thirst or sickness at stomach ; pulse slow and re¬
gular; tongue swoln and pale, but lively at the margin ; countenance
good, and he will be able to attend to his ordinary business shortly.

Conclusions. — That the charcoal was the only agent in counteract¬
ing the effects of the poison ; and was the cause, together with the
torpor of the stomach, of his not puking from thirty-seven gr^hs of
white vitriol.

That the dose of vitriol retained in the system must have produced
an uncommon paroxysm of thirst, had it not been for the exhibition
of carbon ; and therefore that all metallic oxides must be inert, when
given with the medicine.

That with a view of inverting the action of the stomach, vegetable
emetics, and not mineral, should be resorted to, such as oxymel of,
squills, ipecacuanha, apocynum androscemifolium, lycopodium, se-
lago, and, above all, the distilled water of ranunculus flammula, the
operation of which is said by Dr. Withering (a respectable writer) to
be immediate.

Note. — There are two varieties of r. flammula, but both frequent
the same soil, and consequently possess the same properties. The
virtues of this plant (r. f.) ought to be investigated ; the sensible qua¬
lities are such as to deserve attention ; and the name of Dr. Wither¬
ing ought to be sufficient to give it a place in the materia raedica.

{From the Philosophical Magazine.)

NOTICES OF LECTURES.

Mr. Taunton will commence his next Course of Lectures on Ana¬
tomy, Physiology, Pathology, and Surgery, on Saturday, January
23, 18ip.

Dr. P- M. Latham and Dr. Southey will begin their Course of
Lectures on the Practice of Physic on Monday the 25th of January
next, at the Middlesex Hospital, at Nine in the morning,

VOL, X r. — NO. 6l. M

8^ Medical and Physical Intelligence,

Mr. Mac Kenzie will begin his next Course of Lectures on the
Diseases and Operative Surgery of the Eye, on Monday the 1st of
February, at a quarter past Ten in the morning. The Course will
be continued for two months, on Mondays, Wednesdays, and Fridays,
at l6, Newman Street, Oxford Street.

Mr. Curtis will commence his next Course of Lectures on the Ana¬
tomy, Physiology, and Pathology of the Ear, on Thursday, January
the 7th, at the Royal Dispensary for Diseases of the Ear, Carlisle
Street. — For particulars, apply to Mr. Curtis, at his House, No. 2,
Soho Square.

Dr. Weatherhead will deliver, in January next, a Course of Lec¬
tures on the Congenital Mal-formations, and Morbid and Accidental
Distortions of the Bones; whether originating in Utero, or as the con¬
sequence of Rickets, Mollities Ossium, Spina Bifida, Scrofulous
Affections of the Knee and Hip-joints, &c. — The particulars to be
had at Dr. W.^s House, No. 18, Upper Montagu Street, Montagu
Square.

Lectuhes ON THE Practice of Physic. — -Dr, C. F. Forbes,
Deputy Inspector of Military Hospitals, Physician to His Royal
Highness the Duke of Kent, Senior Physician to the Surrey Dispen¬
sary, Physician to the Royal Westminster Infirmary for Diseases of
the F<.ye, &c. will commence a Course of Lectures on the Practice of
Phyjrfc, on Wednesday, January 21st, at Nine o'clock in the morn¬
ing, at the Royal Westminster Eye Infirmary, Mary-la-bonne Street,
Golden Square. Terms of Attendance: — Single Course, Three
Guineas; Perpetual, Five Guineas. — Medical Officers of the Navy,
the Army, and the Ordnance, will be admitted to attend these Lec¬
tures on presenting a recommendation from the heads of their respec¬
tive departments to Dr. Forbes, at his House, No. 25, Argyll Street,
before Nine o'clock in the morning.

LITERARY NOTICES.

In the press, Laurentii lo. Rubi Epistolarum Edinburgensiurn,
Libri III. written during three Years’ attendance on the Medical
Institutions of that City; and calculated to illustrate, among other
matters, the System of Medical Education pursued there, the Habits
of the Students, and the General Process of Graduation in that
University.

The second volume of the Transactions of the Association of Fel¬
lows and Licentiates of the King’s and Queen’s College of Physicians
in Ireland, is just ready.

A second volume of the Dublin Flospital Reports will appear
shortly.

A Treatise on Midwifery, enforcing New Principles, which
tend materially to lessen the Sufferings of the Patient, and shorten
the Duration of Labour. By John Power, Accoucheur, Member
©f the Royal Medical Society of Edinburgh, ' '

Medical and Physical Intelligence,

An Account of the Epidemic and Sporadic Disorders which pre¬
vailed this year, 1818, at Rochester, and near it. By Walter
Vaughan, M.D., Licentiate of the Royal College of Physicians of
London. 8vo.

Illustrations of the Power of Compression and Percussion in the
Cure of Rheumatism, Gout, and Debility of the Extremities; and in
promoting General Health and Longevity. By William Balfour, M.D.
Author of “ A Treatise on the Sedative and Febrifuge Powers of
Emetic Tartar, &c. &c/'

Just published, Elements of Medical Logick ; illustrated by Prac¬
tical Proofs and Examples. By Sir Gilbert Blane, M.D., Physician
to the King, &c. he, &c. 8vo.

Practical Illustrations of the Progress of Medical Improvement for
the last Thirty Years; or. Histories .of Cases of Acute Diseases, as
Fevers, Dysentery, Hepatitis, and the Plague, treated according to the
Principles of the doctrine of Excitation, by himself and other Prac¬
titioners, chiefly in the East and West Indies, in the Levant, and at
Sea. By Charles Maclean, M.D., &c, 8vo.

Illustrations of the Power of Emetic Tartar in the Cure of Fever,
Inflammation, and Asthma; and in preventing Phthisis and Apo¬
plexy. By William Balfour, M.D., Author of “ A Treatise on
Rheumatism, he.''

Edward Percival, M.B., M.R.I.A., he. i» preparing for publica¬
tion, Practical Observations on the Pathology, Treatment, and Pre¬
vention of Typhus Fever. ''

Dr. Baron, of Gloucester, formerly President of the Royal Me¬
dical Society of Edinburgh, has in the press, an Inquiry respecting
some of the Diseases of the Serous Membranes of the Abdomen and
Thorax; together with Observations illustrative of Disorders of the
Mucous Surface of the Alimentary Canal, with five Engravings.

Remarks on the Prevailing or Epidemic Fever, commonly called
Typhus. By W. Oglevie Porter, M.D., Physician to the Clifton
Dispensary, &;c. Octavo.

Dr. Clutterbuck will shortly publish some brief Remarks on the
subject of the Prevailing Epidemic.

We have been very much gratified by the receipt of a small publi¬
cation, entitled The Medical Intelligencer,^’ issued from the
house of Messrs. Burgess and Hill, Great Windmill Street. — It con¬
sists of a Monthly Index to all the Medical Publications, and to those
articles in the other publications which have a bearing upon medical
subjects. This List the Proprietors announce their intention to pub¬
lish on the 4th of every month, and to deliver it free of expense. We
consider the design extremely liberal and well conceived; and hope
that it will be duly appreciated by the medical Profession.

A METEOROLOGICAL TABLE,

From the nst of NOVEMBER to the mh of DECEMBER., 1818.

KEPT AT RICHMOND, YORKSHIRE.

Barometer.
Max. j Min.

Ihe

Max

rm.

Min.

Rain

Gauge.

Winds.

—

Weather.

SE.

1 Cloud...

.22

SE.

1 Sun,. 4 Rain..

.35

.24

SE.

1 Rain. 2 Mist .. 4 Starl...

Calm.

1 Mist.... 4 Starl....

.25

1 Sun.. 3 Mist..

SE.

1 Rain. 2 Mist.. 4 Starl..

SSW..

1 Sun. 3 Cloud..

SW..

1 Sun.. 4 Rain...

ry o

f o

sw..

1 Sun,.

SW...

1 Sun..

s..

1 Sun.. 4 Rain,.

W..S..

1 Sun.. 4 Rain.

29,

SSW..

1 Sun.. 3 Rain.... 4 Mn...

SSE.

1 Mist... and Rain.

SE.SW.

1 Mist.. & Rain. 3 S. 4 M...

— ..

SE..

1 Mist.. 2 Cloud... 4 R...

SE..SW..

1 Sun.. & Mist. 3 R. 4 M.,..

SE..SW...

1 Rain.. 2 S.. & Sbo.4 M....

Vble.NbE.

1 Sun... 4 Cloud..

NW..

1 Cloud.. 2 Sun.

NE..

1 L loud.. 2 Sun..& Shows,.

NW.

1 Cloud.. 4 Rain.

NNW.

1 Cloud.. 4 Moon..

WNW.

1 Cloud.. 4 Moon,,

WbN.

1 Sun... 3 Cloud..

SW.

1 Cloud... 4 Moon...

sw...

1 Sun,. 4 Rain.

WbN..

1 Cloud... 3 Sun.. 4 Starl...

SW...

1 Sun., 2 Cloud..

SW...

1 Cloud.. 2 Sun..

The quantity of rain during the month of November was 3 inches 85-lOOths.

Observations on Diseases at Richmond.

The disorders under treatment this period were Amenorrhcea, Cepha¬
lalgia, Cynanche tonsillaris, Diarrhoea, Dyspepsia, Febris catarrhalis, Febris
simplex, Gonorrhoea, Hemiplegia, Herpes-labialis, Menorrhagia, Obstipatio,
Ophthalmia, Phthisis pulmonalis, Spasmi, Syphilis, Vaccinia, Variola, Ver¬
tigo, and Urticaria.

THE METEOROLOGICAL JOURNAL,

From the 20th of NOVEMBER to the \9th of DECEMBER,

Inclusive.

By Messrs. HARRIS and Co.
Mathematical Instrument Makers, 50, High Holhorn.

Moon

Rain

Therm,

Barom.

De Luc’s

Dr^.

Hygroni.

Damp,

Winds.

Atrno. Variation.

Fog

Fine

Fog

Fine

Clo.

Rain

Clo.

Fine

,15

Rain

Clo.

Fine

,21

Clo.

Fine

,04

Rain

Clo.

,19

wsw

Clo.

Rain

,13

wsw

Clo.

Rain

,13

Fine

Clo.

,12

wsw

Clo.

Rain

Clo.

Fine

wsw

.:io.

Fine

4-4

SSE

Rain

Clo.

,13

Rain

Clo.

- .1

,11

SSE

Fine

Clo.

,07

S Va,

S. Va.

Fine

Rain

,10

Clo.

ssw

Rain

Clo.

,21

Clo.

Rain

.20

Rain

Clo.

,17

Fine

Clo.

N'E

Clo.

Fine

NNW

Clo.

,03

Clo.

Fine

,VNW

WNW

Fog

Fine

W. .

Fog

Clo.

Fog

WSW

NNW

Fog

Rain

Clo.

1,09

SW^

Fog

Clo.

The quantity of rain fallen in the month of November is 1 inch

and 63-lOOths.

A REGISTER OF DISEASES
Beiween NOVEMBER 20th and DECEMBER IQth, 1818,

DISEASES.

Abortio . .

Abscessio' . .

Amenorrhoea .

Amentia .

Anasarca .

Angina Pectoris .

Aphtha lactentium •

• - anginosa • • •

Apoplexia .

Ascites .

Asthenia .

Asthma .

Bronchitis acuta • • •

— — chronica •

Cancer • • • •
Cardialgia • •
Carditis • • * •
Catarrhus • •
Cephalalgia
Cephalsea • •
Chorea • • • •

Cholera . .

Colica .

- - Pictonum

♦ • • # •

Convulsio .

Coryza . . ■

Cynanche Tonsillaris

- - - maligna • <

■ — - - Trachealis

- Tarotidea* <

Pharyngea

Diabetes

Diarrhoea .

Dolor lateris

Dysenteria .

Dyspepsia .

Dyspnoea . . •

Dysphagia .

Dysuria • • . .

Ecthyma .

Eczema .

Eiieuris • • • * .

Enteritis .

Entrodynia .

Epilepsia . . • •

Epistaxis .

Erysipelas .

Erythema loRva • • • •

■ - - nodosum

Febris Intermittent

DISEASES.

Febris catarrhalis’ • •

— • — Synocha .

- Typhus mitior

— - Typhus grav. • •

- - Synochus • • • •

- Puerpera .

Remit. Infant.

Fistula

Fungus .

Gastrodynia • • • » •
Gonorrhoea pura •
Haematemesis • • •

Hsemoptoe .

Hsemorrhois .

Flemiplegia . • • • •

Hepatalgia .

Hepatitis .

Hernia . . . . .

Herpes Zoster » • •

- circinatus •

-praputialis

Hydrocele
Hydrocephalus ••
Hydrothorax • • • •
Hypochondriasis

Hysteria .

Hysteritis .

Icterus .

Ileus . .

Impetigo sparsa •

Ischias* . . . •

Ischuria .

Lepra . * • •

Leucorrhoea • • • •

Lithiasis .

Mania

Melancholia • • « •
Menorrhagia • • • •
Mofbi Infantiles*

- Biliosi* • •

Obstipatio .

Odontalgia • • • •
Ophthalmia • • • •

Otalgia .

Palpitatio .

Paralysis • ■ • • » •
Paronychia • • • •
Peripneumonia • •

Peritonitis .

Pertussis . .

Observutioiis on Prevailiiiff Diseases.

DISEASES.

Phlogosis .

Phrenitis .

Phthisis Pulmonalis

Pleuritis .

Pleurodyne .

Pneumonia .

Podagra .

Polypus .

Porrigo larvalis • • •
-favosa .

Prolapsus

Prurigo mitis .

Psoriasis guttata .

- inveterata ♦ • -

Purpura hamorrhagia ■
Rheuma, acutus ••••>•

- chronicus • • •

Rubeola . .

Rupia . .

Scabies . .

Total*

Fatal.

5 !

DISEASES.

Scarlatina simplex • •
anginosa

Scorbutus

Scrofula . .

Splenitis . .

Strictura ........

Sycosis menti •••.

Syphilis .

Tabes Mesenterica

Tic Doloreux .

Tussis, &c, .

Vaccinia ........

Varicella .

Variola .

Vermes .

Vertigo .

VitiC'AnB.fehrilis •

Total of Cases •
I'otal of Deaths

1127

* Morbi Infantiles is meant to comprise those Disorders principally arising from den
tition or indigestion, and which may be too trivial to enter under any distinct head; Morbi
Bilinsi, such Complaints as are popularly termed bilious, but cannot be accirati lv classed.

Observations on Frevailing Diseases.

- ^ -

It will be remarked, that the proportion of deaths in the present
month’s list is somewhat above the usual average, and our readers will
perhaps be surprised to see the number seventeen in the fatal list against
asthma. Pulmonary affections have, indeed, been of uncommon severity.
Asthma, we all know, however, is somewhat of a vague term, and it is
more than probable, that in the hands of many some of these alleged deaths
from that source would have been registered under bronchitis.

Abortions have been rather frequent. Will any of our obstetric readers
favour us with their sentiments on the best general mode of preventing the
recurrence of these mishaps ? A question upon which the general prac¬
titioner has frequently to decide and act.

Of typhus gravior it will be seen that the numbers are exceedingly few.
Some of our readers will be surprised to learn, that it was stated but a
few days since by a practitioner and professor of celebrity, and that
in a large assembly, that there had not come under his notice a case of true
typhus for the last twenty }'ears !

A remarkable case of mental derangement, which terminated fatally, has
occurred in a female, whose husband has been insane, without much inter¬
mission, for nearly two years. In the first instance, the wife was almost in all
respects, as to symptoms, a counterpart of her husband, but typhoid
characters supervened suddenly, and she died as if from fever. Had this
melancholy case a legitimate title to the appellation of fever ? Would the
subject of the disease have imparted fever to another individual who should
have inhaled the exhalations from her body ?

One of our reporters has favoured us with the following remarks, in
addition to his list : —

“ Only six cases of asthenia are numbered ; but the melancholy fact is, that
asthenia is very general indeed among the poor, although the diseases it

Monthly Catalogue of Books, Sfc.

induces are more prevalent. Cynanche larvngea : this case is yielding to
profuse bleedings and cathartics, with epispastics. The diarrhoeas noticed
were consequent to fever, and in cases where cathartics had acted with
unexpected violence, and in which, although the discharge was restrained,
disease of the mucous membrane appeared to have been induced.
The single case of scarlatina was well defined; the contagion appearing to
be completely washed away as it were by free ventilation/^

MONTHLY CATALOGUE OF BOOKS.

Murray’s System of Chemistry, New Edition. 4 vols, 8vo,

Magendie’s Researches on Gravel; translated from the French.-
12 mo.

Dr. W. S. Hallaran’s Practical Observations on the Causes and
Cure of Insanity. Second Edition, materially Enlarged and Amended,

Sir Gilbert Blane’s Elements of Medical Logick; illustrated by
Proofs and Examples. 8vo.

Fyfe’s Comparative Anatomy, forming a Fourth Volume to the
Compendium. Second Edition. 8vo.

Dr. Maclean’s Practical Illustrations of the Progress of Medical
Improvement for the last Thirty Years; or, Histories of Cases of
Acute Diseases, as Fevers, Dysentery, Hepatitis, and Plague : treated
according to the Principles of the Doctrine of Excitation, by him¬
self and other Practitioners, chiefly in the East and West Indies, in
the Levant, and at Sea. Svo.

Dr. Armstrong’s Practical Illustrations of the Scarlet Fever. Se¬
cond Edition.

NOTICES TO CORRESPONDENTS.

Communications have this month been received from Dr. Southam,
Mr. Fosbrooke, Mr. Wansborough, and Mr, Harrison.

The Paper of Mr. F. we fear cannot be employed in its present shape.
Would it not be better that its substance should appear as an Original Com'-
munication, with the sanction of the Writers name ?

We feel also much obliged by the communication if Mr. H. ; but it is in¬
consistent zvith our plan to publish as original what has been before the
public previously in any shape whatever.

We are requested to notice that the word ennuid, in Mr. Fosbrooke ’s
Paper on Vaccination, in our last Volume, is printed ermined.— TFe may
take this occasion to say, that the Paper in question ought to have been no¬
ticed in our Retrospect as containing some valuable observations. We are
given to understand that Dr. Jenner has expressed his approbation of it.

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

THE

LONDON MEDICAL

REPOSITORY.

No. 62. FEBRUARY 1, 1819. Vol. XI.

PART I.

ORIGINAL COMMUNICATIONS.

General Remarks on the Theory and Treatment of Fistula*

By M. Breschet, of Paris.

The term fistula, in its most usual signification, is made
to designate a sinuous ulcer more or less deep, having
callous edges, with either an external or internal opening of
communication, and the discharge from which is not com--
mensurate merel}^ to the extent of its surface.

It is not intended in the present paper to dwell particularly
on all the several circumstances which are connected in

■ j *

the way of cause with the production of fistulous sores. I
purpose to confine myself to the consideration of their more
common source, or rather to treat of fistula as a certain kind
of irritation resulting from any agent which may be capable
of producing it. Let us suppose then the existence of an
abscess which answers to the above definition of fistula; the
suppurated discharge from such abscess must necessarily
be kept up by a something which has the power of generating
a perpetual irritation in the tissue from which the discharge
proceeds, fn other words, such tissue has become the seat
of an inflammation more or less violent in proportion at
once to the greater or less intensity of the exciting cause,
and to the degree of susceptibility by which the part affected
is endowed. Now the something which has given rise; to
the disturbance in question is either ,a recrementitious. pr an
excrementitious matter: how produced, we are not at present
to investigate. , < .

VOL, XI. - NO. 62. N

Original Communications.

From among the several species of irritation that may
thus be induced by the application of extraneous matter to
any particular part, it may suffice to select as an example the
phenomena arising out of the application of milk to some
of the tissues of an organic body. This liquid, which Nature
has destined to be the peculiar aliment of the young, is
accordingly mild in its nature, in order to be adapted to that
susceptibility of the digestive organs which marks the early
periods of existence; and no further irritation, therefore,
results from its contact with the mucous surface of the young
stomach than is necessary for the process of assimilation.
But this matter, thus bland and mild when received into the
stomach, displays very different qualities when it is injected
into the cellular substance, or in any^way made to penetrate
that membrane. In this case an inflammaiion is excited,
which terminates sometimes by suppuration, and at other
times by gangrene. I have confined myself in this place to
the mention of milk as a cause of irritation when thus applied
to a part of which it is not an appropriate stimulus ; but the
effects of other extraneous fluids have been rendered suffi¬
ciently familiar by the labours of modern physiologists. ’ The
most general of these effects is inflammation, of greater or
less violence, which in the majority of cases terminates
in suppuration : and the cause having thus been applied,
it is less surprising that it should continue to act, or be sus¬
ceptible even of renewal. The resulting abscess will be
a longer or shorter time in making for itself an opening,
either externally or in one of the internal cavities, in propor¬
tion both to the intensity of the inflammation and to the
accidental situation of the affected tissue in reference to the
body’s surface. And the external exit or internal discharge
of the pus will be sometimes effected by the powers of
nature, and at other times assisted and regulated by the
interference of art. The matter of the discharge itself is
modified by the material which has proved its exciting cause,
and in fact consists of pus mixed with such material in
variable proportions; this being diverted from its natural
course by the new pas”sage which has been made for it, and
which passage is more or less long and sinuous ; a perpetual
irritation is engendered, which proving more than equal to the
prevention of the cicatrizing process in the parietes of the
abscess, thus becomes the occasion of several phenomena,
which 1 shall endeavour to treat of successively. But in the
first place let us turn our attention to the particularities
of the tissue that may thus become the seat of diseased
action.

There is scarcely any portion of an organized body

Breschet on Fistula.

unsusceptible of fistulous formation in some part of its
substance. We observe, for instance, that these abscesses
run through muscles and other fibrous structure, and occur
likewise in the cutaneous, cellular, and other tissues; and
with respect to the viscera we find occasionally fistulous
abscesses will take place in all those organs that are paren¬
chymatous in their structure: indeed the brain itself has been
the seat of them ; but my present design does not extend
beyond the consideration of that particular tissue which
is tlie more ordinary seat of these affections, not so much as
it should appear from the particular affinity, so to say,
between the matter producing the abscess, and the substance
in which it is engendered (which might be conceived to
be the case), as from the quantity in which this substance
is found, together with the constitution of its texture. It
is the cellular tissue to which I allude. This tissue is indeed
univetsally distributed through the body, and forms as it were
the woof of all the other portions of the organized being,
entering into the composition of every organ, and furnishing
a common envelope and general mean of communication.
But the circumstance connected with this substance, which
especially demands our attention at the present moment,
is its abundance about those mucous conduits which are
destined to convey particular secretions. The cellular tissue
which surrounds these canals is almost destitute of fat, and
thus presents a peculiar formation in reference to the func¬
tions of the part; for as the existence of adeps in these ducts
would necessarily contract their calibre, and thus impede the
course of their contents. Nature has provided against such
accidents by the peculiarity alluded to. In some parts this
tissue is disposed in the form of laminae, which surround
the actual cells, and thus constitute a kind of interfila-
mentous structure.

Now if we consider the effects of a constant percolation
through this tissue of a matter diverted from its natural course
and order, it will be easily conceived that such a change must
in consequence take place in the internal economy of the
system in question, that a new sort of membrane must
be formed endowed with new properties. A mucous tissue
is indeed thus produced in a fistulous passage; the result of
an irritation become permanent; this irritation, carried to
a still higher degree of intensity, in process of time comes
to form an entirely new kind of tissue, and by this sort of
transformation is converted into what is called callosity. I
shall in this place confine myself to the consideration of
the principal circumstances relative to this change, and to
the physiological and practical deductions which they furnish.

Origmal Communications.

We are informed by Dr. Baillie, that the celebrated John
Hunter taught in his surgical lectures, that fistulae have an
internal surface analogous to a mucous membrane ; such, for
instance, as that which lines the urethra.* This luminous
suggestion has since been more fully established as theory
the recent discoveries in pathological anatomy, and
dissections of subjects who have died under these affections
have proved satisfactory on the point.

In a young man twenty years of age a tumor of an indo¬
lent kind, and attended with fluctuation, was observed on the
groin of the left side : this swelling had lasted some days
without any alteration in the colour of the skin ; it at length
burst spontaneously, and an enormous quantity of foetid
purulent matter was discharged. The pains which had been
felt near the vertebral column prior to the appearance of
the tumor in the groin, and which still continued after the
bursting of the tumor, together with the appearance of the
discharged matter, were sufficient indices of the caries of
the vertebrae. The subject of the aflection survived the
opening of the abscess about two months, and the following
are the appearances which an examination post mortem
displayed.

The vertebral column v/as carious from the last dorsal to
the second lumbar vertebra : from this caries all the way
down to the external opening in the groin, a membranous
canal was continued, which was about an inch in diameter.
The internal surface of this canal was of a lively red colour;
it was villous in its structure, and pressure caused blood to
ooze from it in the same manner as from an irritated mucous
membrane. This surface was also, through the whole length
of the canal, covered with a purulent matter, which might
be conceived to be produced in a twofold manner, viz. from '
tbe caries itself, or from the irritated membrane, brought
into irritation by the passage over it of the carious discharge.

* Baillie’s Morbid Anatomy, translated by Mr. Ferrall. Dr. B.
remarks in a note, that “ Mr. Hunter has treated of fistula, in his
lectures on surgery, as possessed of a smooth glossy surface like that
of the urethral membrane.’^ We find also in Hunter's Treatise on
Inflammation, &c. something analogous to this enunciation ; but the
statement is far from being a complete and satisfactory developement
of the transforming process to which we have above alluded. The
following is the passage of Mr. Hunter to which we refer : I con¬

ceive that a deep wound, proceeding to 'suppuration, and forming
granulation or a fistula, becomes in some degree analogous to an
excretory duct, having the faculty of peristaltic movement from its
base to its external opening."

Walker on the Topography of Huddersfield y <^c. f)3

The membrane in question was separable from the adjoining
tissue in the same manner as are other villous membranes ;
that of the stomach, for example. These appearances then
left no room for doubt respecting the actual nature of the
tissue thus newly formed, and proved its analogy with mucous
structure, in the way that [ shall endeavour to point out.
The instance thus adduced, it may be remarked, may serve as
an example of fistulous formation in general ; and it will,
therefore, not be necessary to multiply cases. I shall merely
remark, that in some of these abscesses callosities are formed
more conspicuously than in others ; a difference which is re-
ferrible to the greater or less degree of irritation caused by
the presence of the offendin
this new canal.

If, then, from the consideration of this single case, we ex¬
tend our regards to the general rationale of fistulous forma¬
tion, it will be perceived that the actual state of parts
displa3md by morbid dissection, justifies the inference that a
new tissue is positively formed ; which, as well in its organi¬
zation as in its functions and properties, is analogous to a
mucous membrane. 1 am now^, then, to pursue the investiga¬
tion of this accidentally^ formed mucous tissue, and more par¬
ticularly to notice, first, its seat; secondly, the mode of its
development ; thirdly, its organization ; and, lastly, its parti¬
cular and essential functions.

(To be Concluded in our next,)

A Sketch of the Medical and General Topography of Hud-
dersfieldy and its adjacent District. By J. K. Walker,
M.I). 8cc. &c, '

(Concluded from page 450, Vol. X.)

The remaining plants belonging to the phenogamous vege¬
tation w'hich I have had an opportunity of discovering in this
district, will be found in the present Paper classified accord¬
ing to the system of Linnaeus. Conscious of already having
engrossed too large a share of the Repository, I had de¬
signed, as is usual, to have dismissed the subject of botany at
this point, and not to have led my reader into that daik and
mysterious department of the vegetable kingdom compre¬
hended under the term cryptogamia ; but the recently revived
attention of the scientific world to this subject, some new' glim¬
merings of light cast upon this obscure class, coupled with the
extraordinary beauty of this group, which comprises so many
and such multiform tribes, each furnishing a striking manifesta-
^ tion of the infinitude of creative wisdon), have induced me

g matter or liquid poured out into

94 Original Communications*

to deviate from the usual practice, in submitting some account
of the cryptogamic vegetation of the district. And I am the
more inclined to do so from the assistance which 1 have re¬
ceived from a skilful botanist*, who has devoted himself v/ith
such singular success to this department of botany, and who
has favoured me with the result of his researches, of which I
have availed myself on the present occasion. It, how¬
ever, I should appear to my readers to have descended to
needless minutiae, in recording what in their eyes may seeiri
very insignificant, especially a thing of such humble preten¬
sions as muscologic vegetation, I would remind them, that this
order, to which so much unaccountable neglect has hitherto
attached itself, is by far the most curious, as well as the most
complex in mechanism, of all the cryptogamia. It is true,
indeed, that if we measure the attention due to this singular
tribe by the standard of their known utility, the scantiness of
their claim, I fear, might hardly redeem them from neglect.
To the superficial observer they present confessedly very little
which promises to indemnify for the labour these little beings
demand ; to the student of nature, however, who loves to
pierce the veil which shrouds from vulgar eyes the apparent
anomalies of creation, and to scan her productions of every
size and feature, this unfrequented path will not be found
barren. In no group, even in the phenogamous division, do
we detect organs of fructification more singular or more com¬
plex. If the small size of many of this singular tribe has with
some robbed them of their attraction, it is not to their want
of beauty, but to the finiteness of our capacity, that the evil is
to be traced. With regard to the term ciyptogamia, applied
in the sense it now is, it has always appeared to me a little
too confined, and not a little incorrect. Whatever might be
the opinion of Linnaeus, it is notorious that hitherto the skill
and sedulity of his followers have not succeeded in extending
the system of their great master, as was once confidently pre¬
dicted, throughout every department of the vegetable king¬
dom. Hedwig, Bridel, Smith, Hooker, and others, have in¬
deed, by the brilliancy of their discoveries, shed much new
light upon this obscure subject; much more, however, re¬
mains to be accomplished before we can draw an exact line of
demarcation between cryptogamous and agamous plants.
With what kind of consistency can we apply the term crypto¬
gamia to a tribe of plants, where, after the most elaborate
research, no floral organs have ever been detected ? It has
ever been a misfortune with the abettors of systems to gene¬
ralize too indiscriminately ; and perhaps it was no more

* Mr. Leland, of Halifax.

Walker on thi Topography of Huddersfield y S^c, 9<5

than the common parental attachment which authors bear to
their system, that led Linnreus to conclude that the law
of re generation, which he was the first to detect and de¬
monstrate in the greater part, must consequently pervade
every department of the vegetable world. It was, indeed, a
necessary corollary from the doctrine which he constantly
maintained, that all animal and vegetable productions pro¬
ceed either from egg or seed ; a doctrine not borne out by facts
in natural history; for how many myriads of animalcula are
propagated by a different process; some by heat and putre¬
scence; others, as the vorticellae, e. g., multiply to an indefi¬
nite extent simply by division of the body What reason,
then, can be assigned that should exclude similar exceptions
to the general law of vegetable reproduction; and why is it
deemed a thing incredible that plants should be found where
floral organs are absent; where, indeed, they are not wanted,
because other means of propagation are provided ? Has the
least wellfounded similitude to sexual organization been de¬
tected in the fungi, or algae if not, with what propriety can
we appropriate to these the term cryptogamia ; which, by its
very etymology, assumes as a datum that such organs do exist,
however they may have eluded our researches ^ Would not
a term of greater latitude (suppose cryptogenesia, e. g.) be less
liable to objection in the present crude and imperfect state of
our knowledge, or at least might it not leave the question in a
state of abeyance, till better evidence shall set this controverted
point at rest.^ It has become of late a very predominant opi¬
nion that a large proportion of this class (such as the algae,
fungi, &c.) are entirely agamous, which adds to the cogency
of the above arguments. Even in the genera included in the
group salvinige, which, in the opinion of some botanists,
proximate the closest to phenogamous vegetation, it is yet a
matter of controversy whether the plants that rank in it have
what ought to be termed pistilla or stamina. That, however,
which Necker has designated in pilularia, marsilea, and sal-
vinia, by the term besimences, (or bodies formed independent
of impregnation,) has not been confirmed by the observation
of others. Jussieu, e. g. has witnessed in these plants a
transverse dehiscence, which he considers as anthers.

Names of Plants in the Neighbourhood of Huddersfield, continued.

TETRADYNAMIA.
1. Siliculosa.

157* Thlapsi Bursa pastoris.

2. Siliquosa.

158. Cardaraine pratensis.

159. - amaia.

- 5 - -

157. The seeds of this plant form a favourite granary with small
birds, mice, &c. 158. This has been used as a salad herb : it was for-

Original Communications. .

160. Erysimum Alliaria.

161. Sisymbrium Nasturtium,
1(52. Raphanus Raphanistrum,

MONADELPHIA.

1 . Vecatidria.

163'. Geranium parviflorum.

164. Malva sylvestris.

DIADELPHIA.

1. Hexandria.

165. Fumaria claviculata.

2. Octandria.

166. Polygala vulgaris.

3. Decandria.

167. Spartium scoparium.

168. Genista tinctoria.

169. — - anglica.

170. Ulex europaeus.

171. Anthyllis vulneraria,

372, Vicia lathyroides.

173. - - Cracca.

174. Orobus tuberosus.

375. Ornithopus perpusillus.
176. Trifolium officinale.

POLYA DELPHIA.

1. Folyandria.

177.

Plypericum Andros^mum

178.

- pulchrum.

179.

- - - humifusum.

180.

— - - — ■ perforatum.

SYNGENESIA. *

1. Folygamia Mqualis.

181. Tragopogon pratense.

182. Sonchus oleraccus.

183. Leontodon Taraxacum.

184. Hieracium Pilosella,

185. Prcnanthes mur.

186. Lapsana communis.

187* Arctium Lappa,

188. Carduus pratensis.

189* “ palustris.

2. Folygamia Supcrjiua.

190. Tanacetum vulgare.

I9E Gnaphalium dioicura.

192. — - - — — sylvaticum,

193. - - - - rectum.

194. Senecio tenuifolius.

195. Beilis perennis.

19^* Tussilago Farfara,

merly employed as a diuretic, and latterly it has been introduced its
nervous disorders, to a dram or two of the powder twice or thrice a day,
160. The leaves of this plant are very acrimonious, and are, by some
writers, considered as powerfully diuretic. 161. Hoffman recommends
this as useful in strengthening the viscera, and promoting the fluid
secretions, &c. l62. A noxious weed in agriculture. lb4. L. E.

Ranked as the first of the four emollient herbs. Decoctions of the
leaves are used in emollient glysters, cataplasms, fomentations, &c.
3 65. Fum. clavic. and officin. have both been deemed of use in ob¬
structions of the viscera. 167. L. D, Decoctions of the tops and
seeds are diuretic, and stand recommended in hydropic cases ; the
seeds, however, often prove cathartic. I68. The flowers have been
used for a yellow dye. 171. This plant also gives out a yellow,
which has been used for colouring. 180. This plant has long been
celebrated as a corroborant and diuretic, and was once so esteemed
as antimaniacal, as to have received the name of “ Fuga Dremonum.^^
183. Vid. Pharm. Edinb. and Lond. 187- Regarded by some as
antirheumatic. Mr. Bryant, in his Flora Dietetica, says, that the
tender stalks of this plant when boiled resemble asparagus. 190*
Useful in infusions. 19b. L. E. D. Useful in coughs and disorders
of the lungs in general ; the flowers were an ingredient in the pectoral
decoction of the E. Pharm. ; there is scarcely any herb more com-
3

Walker oti the Topography of Huddersfeldy 97

3 97* ^’ussilago Petasites.

398. Soliclago Virgaurea.

J99- Chrysanthemum Leucanthe-
mum.

200. Anthemis nobills.

201. - - Cotula.

202. Achillea Millefolium.

3. Polygmnia Frustranea.
303. Centaurea ni^ra.

204. - Cyanus.

GYNANDPJA.

1. Monanclria,

205. Orchis bifolia.

206. - - conopsea.

207. - viridis.

208. Epipactis cordata.

209. — — — latifolia.

MONOECIA.

1. Triandria.

210. Carex dioica.

211. - pulicaris.

2. Tetrandria*

212. Urtica urens.

213. - dioica.

3. Polyandria,

214. Quercus Robur.

215. Betula alba.

21^. Fagus sylvatica.

217. Carpinus Betulus.

218. Corylus Avellana.

POLYGAMIA.

1. Mo7ioecia,

1 219* Valantia Cruciata.

220. Acer Pseudoplatanus.

221. - campestre.

2. Dioecia.

222. Fraxinus excelsior.

CRYPTOGAMIA.

1. Filices*.

223. Equisetum arvense.

224. - limosum.

225. - hyemale.

226. Ophioglossum vulgatum.
227* Osmunda Lunaria.

228. - — regalis.

229. Lycopodium clavatum.

230. - Selago.

231. - - — alpinum.

232. Polypodium \ulgare.

233. - Phegopteris.

234. - — - Dryopteris.

235. Aspidium Oreopteris.

236. - Filix mas.

mon in this neighbourhood than this. I98. FI. and fol. D. Ph.
Bitter and astringent. 199» Geoffrey says that this herb, gathered
before the flowers come forth, yields an acrid taste, and that it is use¬
ful as a diuretic. 200. Vid. Ph. L. E. 201. A very acrid plant,
and will even blister the hands. 202. Fol. rough, bitter, and aro¬
matic: what properties they possess are principally astringent and
antispasmodic. 205. Rad. amylaceous. 213. Root, plant, and
juices have been employed in hcemoptysis, hsemorrhoids, &c. 214.

The common oak : fruit, bark, leaves, and cup of the fruit have all
been used internally and externally for their tonic and astringent vir¬
tues. In the proportion ofSj.to |iij. of axunge it is sometimes
used by the poor as an ointment for piles. 222. The bark has been
used in place of cinchona in intermittents, &c. 223. The E. sylva-

ticum also has, I understand, been gathered in Saddleworth. 227*
Royal moonwort root, when boiled in water, is employed in the north
of Europe like starch to stiffen linen. 229. Semina ; effects absorb¬
ent. 232. Rad. taste at first sweet, then nauseous and bitter ; de-

* Vide Smith’s Flora Rritannica.
VOL. XI. — NO. 62.

O rigina I C ommiinications.

237- Aspiclium aculeatum.

238. - — - Filix foemina.

239* * - clilatatum.

240. Asplenium Trichomanes.

241. - - — viride.

242. - Ruta rnuraria.

243. - Adiantum ni

grum.

244. Scolopendriiim vulgare.

245. Blechnum boreale.

246. Pteris aquilina.

scribed as an astringent. 239- Polypodium crista'tum of Hudson,
Withering, Hull, and many other authors; but Dr. Smith saysP.
cristatum Linnaei distinctissima species est, Siberise incola. 244. Sub¬
astringent. 246. Rad. smell nauseous ; taste viscid, bitterish ; effects
anthelmintic

* The mosses, says an able writer, are distributed over the whole
face of the globe; they abound in moist situations, and generally
prefer the shade of the forest. Many grow on the sterns and branches
of the larger vegetables ; but are not to be confounded with those
noxious parasites that consume the plant to which they attach them¬
selves ; for we often find them on trees whose health is evinced by the
vigour of their growth. The slender tufted fibres that compose their
roots introduce themselves into the crevices of the old bark, in which
there is always a greater or less deposit of vegetable mould. Their
little narrow tapered pointed setting leaves collect and inhale the
moisture of the atmosphere, decompose water and carbonic acid, re¬
tain the hydrogen and carbon, and reject the oxygen of the acid gas
just as the leaves of other vegetables do. So far from injuring the
health of the trees that bear them, in some instances they contribute
to their preservation; associating in a body they close together their
small delicate branches, and form those thick cushions or fenders,
that, in northern regions, protect the roots and branches of the forest
from the severity of the frost. Insignificant as may be the appear¬
ance of these cryptogamous beings, they are qualified to withstand
every variation of season; after having defied the extremity of heat
and cold they resume their verdure, and display their forms in the
midst of ice and snow; nay, winter is the season when they expand.
The reader will find the mosses here arranged according to tiie system
of Hooker and Taylor. — Vide iMuscologia Britannica.

The poor Laplanders have many uses for the mosses of which we
are ignorant. Of the polytrichum commune, or golden maiden
hair, they form beds by means of thick layers, one of which serves as
a mattress, and the other as a coverlet; and Linnmus tells us that
he himself often made use of such a bed, during his travels in Lap-
land. These mossy cushions are very elastic, so that a bed may be
rolled up into a parcel small enough to be carried by the inhabitants
in their journies. Of the sphagnum palustre (or the grey bog moss)
they form a covering for their infants, and even line their cradles with
this moss.

247. Pteris crispa,

248. Cyathea fragilis.

2. Musci*,

249. Sphagnum obtnsifolsum®^

250. — - — squarrosum.

251. - - - - acutifolium.

252. Phascum serratum.

253. - - axillare.

254. Gymnostomum pyriforme.

255. Tetraphis pellucida.

V\"a]icer on the Topography of Huddersfield^ S^c* 99

256. Splachnum sphoericum.

257. - - - - ampullaceuin..

258. Polytrichum undulatum.

piliferum.
commune,
iirnigerum.
aloides.
nan urn.

259.

260.

261.

262.

263.

264. Tortula mnralis.

265. - ruralis.

266. - subulata.

267. Encalyptra vulgaris.

268. Grimmia apocarpa.

269. - - pulvinata.

270. Weissia cirrata.

271. - - - — controversa.

272. Dicranum bryoides.

273.

274.

275.

276.

277.

278.

adiantoidcs.

taxifolium.

cervicnlatum.

squarrosuni.

SCO pari urn,

heteromallum.

279’ Trichostomum aciculare.

fasciculare.

Didvmodon trifarium.
Funaria hygrometrica.
Orthotricum crispum.
- affine.

280.

281.

282.

283.

284.

285. Fontinalis antipyretica.

286. Anomodon curtipendulum.

287. Bartraraia pomiformi&.

288. - fontana.

289* Flookeria lucens.

290. Flypnum complanatum.

291.

292.

293.

294.

295.

undulatum.
denticulatum.
mu rale,
sericeutn.
alopecurum.

296. Flypnum dendroides.

- splendens.

- proliferum.

- praslongiim.

- - — rutabulum.

297. -

298. - —

299. —

300. ■ —

301. -

302. ■ — ■

303. -

304. -

305. -

306. -

307. -

308. -

309. Bryum androgynum.

310. —

311. * —

312. -

313. -

314. - —

315. —

316. -

317. ■ —

318. —

319. —

- cuspidatum.

- loreum.

- triquetrum.

- squarrosum.

- aduncum.

- comrautatum.

- cupressiforme.

- molluscum.

pyriforme.
carneum.
argenteura.
capillare.
ccespiticiura.
nutans,
ventricosum.
punctatum.
ligulatuna.
hornum.

Hepaticce.

320. Jungermannia epiphylla.

321.

322.

323.

324.

325.

326.

327.

328.

329.

330.

331.

332.

333.

sinuata.

asplenioides.

lanceolata.

bicuspidata.

ncmorosa.

albicans.

reptans.

complanata.

dilatata.

platyphylla.

ciliaris,

varia.

julacea.

I beg to observe, that the above catalogue of cry ptogamous
plants by 110 means comprises all that are indigenous in this
district, which presents an extraordinary variety of mosses ;
of which the above, however, are the principal. Like other

is also found, though rare. I'he bar-

272,

tram i a arcuata

Dicranum glaucum

and the trichomancs tunbridgense

grow

m great

beauty in different parts of Saddleworth and near Stay ley Bridge.

32i. Found in Bcllbank Wood, near Bingley, and in Middleton
Wood, near Leeds.

100 Original Communications*

subalpioe countries that are intersected with a range of hills
and deep ravines, the shelving locks and broken piles afford
a convenient nidus for lichens and mosses to fix themselves^;
and the stone fences that so commonly prevail are another
cause of the rich profusion of this class of vegetation. There
are few districts, 1 am persuaded, that promise so rich a har¬
vest of brilliant discoveries in lichens, or where the botanist is
so likely to meet with new species, as in this part of the Vale of
Calder. At present, however, the want there is felt of a
scientific rcork on this abstruse subject, (which should settle
the arrangement of the lichens with the same precision that
has been employed in the mosses,) presents serious difficulties
in the study of this class. To whom can we so well look to
for the removal of this difficulty as to the able author of the
Muscologia Britannica? And though we possess many foreign
works on the subject of the algae and fungi to a similar source,
1 trust we shall owe a treatise on these obscure classes in our
own language, which will supply what has so long been an
hiatus valde deflendus.” In taking leave of the subject of
the natural history of this district, I congratulate the world
on the prospectf of a brighter era, which seems to dawn
upon iis in the awakened attention of the scientific world to
this fascinating study. To the contemplative mind it can
never lose its attractions ; and to professional persons
its intimate alliance with their art will always render it en-

* We know, indeed, very little of the utility of the lichens ; it is
certain, however, that were it not for them, many rocks, which are
now clothed with verdure, would continue to present a dry and barren
surface. On these spots the lichens yield the first covering : to the
decay of these the growth of musci succeeds, which, by conversion
into mould, became the pabulum of the grasses and other minor
plants. By a similar law the sphagna of marshes in process of time
change into a very porous mould, into which the rush strikes root,
and subsequently a foundation laid for other plants, so that from
marshes have sprung np meadows ; and thus it is that these diminu¬
tive plants perform a most important function in pioneering the way
to more exalted vegetation. — The blasia also has been disco-
vered in this district. Dr. Linneeus, in his Inauguration Speech,
says, “ Who ever beheld or described our diapensia? Who the bla¬
sia, unless Miclieli alone.?” I have not inserted this in the above list,
doubtful whether it belongs to the jungermannia or to another class.

t The many literary and philosophical societies that are now in¬
stituted in different parts of the kingdom are a proof of this. A society
formed for this purpose, and for the advancement of the arts and
sciences in general, is now on the point of being formed at Leeds,
and the splendid patronage which it has received bespeaks fully the
public opinion of its importance.

T3uigis’s Case oj Amputation of the Upper Ann, 101

gaging. But whatever be the subordinate motive of attrac¬
tion in entering the vestibule of this great temple of nature,
let the tirst object be to interpret rightly her secret operations;
and, while we surve}’^ with delight her spacious area, her lofty
pillars, her magnificent dome, let us not forget to trace the
harmony and unerring proportion that pervades every apart¬
ment of this beauteous edifice, in which all faithful inter¬
preters will recognise the finger of that invisible Almighty
Architect, who sits enthroned on the riches of the universe.

III.

Case of Amputation of the Upper Arm, By John Burgis,
Surgeon, Market Drayton, Salop.

I WAS called in to a case some time back, wheiein amputa¬
tion of the upper arm became ultimately necessary, the lower
one, from the elbow, having gone into a state of complete
mortification. It was the consequence of the wheel of a
waggon, heavily laden, passing over it at the bend ; by which
all the superficial vessels were divided as well as nerves, the
bellies of several muscles (the supinator radii longus, the pro¬
nator radii tenes,) were nearly severed, and the humerus frac¬
tured at its flattened extremity, immediately above the con¬
dyles. Tlie subject was a young girl, aged about fourteen;
and in addition to the injury she sustained in the arm, the leg
of the same side w'as also greatly crushed, but no bones
broken. There was a deep confined w’ound about the middle,
anterior and inner side of tlie tibia, (occasioned by the turned
up portion of one of the horse’s shoes,) wfith a contused
sprained ankle. For many days the leg threatened to go into
the same state as the arm, several livid coloured vesicles mak¬
ing their appearance about the outer ankle, and the discharge
from the wound long continued bloody and ichorous.

The accident happening in the country, some hours had
elapsed before I saw her, by which time inflammation and
lumification had taken place to such an extent, as to render
amputation improper till that and the sympathetic fever had
; subsided.

j For the first six days the arm bore a very favourable aspect,
I considering the extent of injury ; the discharge, though great,

I was not ichorous, or particularly offensive, and healthy granu¬
lations had actually begun to arise. She could also bear the
arm shifted about, so as to almost have justified the assertion
that no bones were broken ; and I began to entertain hopes
tliat it might be saved, at least with an anchylosis.

In two more days, however, all prospects of so favourable

102

O rigin a I Com m un tea tioii s ,

a termination had vanished ; the discharge had become acri*
monious, exceedingly offensive; the granulations flabby,
pale ; and the humerus was first discovered denuded of its in¬
vesting vital membrane.

The ninth da}^ in the evening, things bore a still more unfa¬
vourable appearance, so that speedy amputation became the
only means left to save life, which 1 determined on performing
the following morning. The stench emitted from the wound
rendered the room, and almost the house, insupportable : the
lower arm appeared rapidly parting wdth its heat and sensibi’-’
lity, and the wound itself looked green and tahited. The
probe could also traverse the humerus hare for above two
inches upwards. Joined to this, night perspirations and a
weakening diarrhoea had existed for the last three days, with
thirst and loss of appetite. The leg also occasioned much
pain, as it had not put on a determined character whether it
would sphacelate or take on an health}^ action.

The tenth day, in the morning, the arm, from the wound
downw’ards, was coldj livid, considerably inflated with foetid
gas, and the cuticle easily separated under the fingers on the
slightest pressure. 1 looked upon the wound to form a suf¬
ficient line of demarkalion, every portion of the integuments
above it appearing healthy, but I feared the bone was dis¬
eased to some extent.

Every necessary arrangement being made, and the patient
removed from bed on a table, the arm w'as extended, and the
tourniquet applied almost up in to the axilla, as I intended
operating as high as 1 had arm to do it with, in order to secure
an healthy portion of bone.

1 made my first incision at one stroke dozmi to the muscles,
about an inch and a half below the insertion of the deltoid,
and separated the bone about the insertion of the said muscle.
The arteries being secured, (three in number,) the stump was
dressed in the usual manner; the patient was put to bed, and
an anodyne administered. The tourniquet was left loose
about the stump, ready to screw on in case of hemorrhage.

I'he hectic symptoms now soon left her ; a healthy action
became -established in the leg, which suppurated, broke, and
discharged a great quantity of healthy pus from several
apertures.

On the fourth day from the operation I removed the dres¬
sings, which were become offensive. The stump looked
healthy, and promised to unite by the first intention.

On the sixth day it had acquired somewdiat of its old fertor,
was qtiite open, and appeared going into a sloughing state, the
discharge turning the dressings black.

Un the seven ih day i removed several sloughs from the

103

Curtis on Fiiriform Discharges from the Ear.

face of the honCj wliich looked black, as though it would ex¬
foliate. She was allowed bark, wine, camphor, and carbo¬
nate of ammonia liberally.

On the eighth day the ligatures separated ; more sloughs
came away, leaving the end of the bone barely covered with
the common integuments.

On the ninth day the discharge appeared improved; the
inside of the wound looked much healthier, promising to ter¬
minate favourably. The next day appearances were still
more favourable ; and in twelve more the stump healed up
without 'any exfoliation taking place from the bone, and it con¬
tinues sound to this da^g being nearly three months since the
performance of amputation. The leg is also well, and the
girl enjoys a good state of health.

On examining the removed portion of arm, the humerus
was found fractured, as before observed ; and the periosteum
was sloughed away, and separated from the bone by deposi¬
tions of matter to within three-fourths of an inch of the
severed extremity. The most striking phenomenon was the
obliteration of the brachial artery, which had become com¬
pletely ulcerated through, at the site of the wound, the coats
of which must have been injured at the time of the accident;
and this explains at once the rapid change for the worse
which took place from the sixth day ; the collateral branches
proving, in this instance, unequal to supply the loss of their
parent trunk. But is it not somewhat surprising, hemorrhage
did not occur

IV.

On Puriform Discharges from the Ear, By J. H. Curtis,

Surgeon, Soho Square.

Of the diseases of the ear, one of the most obstinate and
perplexing to Practitioners, is that attended with a purifonn
discharge, and so termed from this circumstance. The last
stage of this affection, Mr. Saunders, in his excellent Treatise,
has stated to be generally incurable. With all deference to
so great a character, this I consider rather owing to his
not having sufficiently varied his remedies and pushed them
to the required extent, than from the real incurablemature of
the malady. The injections used by Mr. Saunders 1 have
found generally too weak in the proportions of the ingredients
employed ; and I have found it also necessary to vary the
combination of the ingredients much more than he had
thought it proper to attempt. It is only by an extensive ex¬
perience that we get acquainted with what the ear or any

104

Oris^inal Comniuiiicattous.

other organ is able to bear ; and T have had opportunities, at
the Dispensary, of putting every mode of practice to the
test. The same observations I have made in respect to the
local remedies, apply no less to the constitutional treatmenty
which requires here to be actively and constantly attended to.
ITe success of the practice 1 have adopted in this disagree¬
able and obstinate complaint cannot be better illustrated than
by the recital of a few cases, selected from the records of my
practice, in the order in which they have occurred.

Miss B,, of St. John Street, aged twenty-six, had been
from her childhood affected with deafness and a puriform
discharge from one ear : after having been under the care of
several eminent vSnrgeons in town for upwards of two years,
without relief, she applied to me. On inspecting the ear, I
found the meatus much excoriated by the discharge, which
w^as very profuse and offensive; the tympanum i observed
W’as partly destroyed, as air could be forced out at the pas¬
sage. In other respects the ear appeared perfectly sound.
Adopting my usual plan of not stopping the discharge hastily,
I ordered a blister to be applied behind the ear, w'hich was
kept open for a fortnight : after wdiich the patient used an
injection of zinci sulphas ; but this not appearing to have the
desired effect, I had recourse to the argenti nitras, as recom“
mended by Mr. Saunders in cases of this nature : the patient
began by using ten grains in four ounces of water, and 1 in¬
creased it to the extent of thirty-five grains, which completely
healed the parts ; and 1 had the farther satisfaction, at the
same time, to find her hearing restored.

It may be necessary, perhaps, to mention that it took nine
months to complete the cure.

A similar case of a young Nobleman yielded also to this
treatment; but his case, though not of so long standing, I at
first sight considered more difficult of cure, from his having
a polypus extending directly across the meatus, which I re¬
moved with an instrument I had constructed for the purpose:
immediately after the operation he was enabled to hear ; but
the discharge continued for some time, though at last it was
happily suppressed.

Another case of the same nature occurred also in a Lady of
distinction, brought to me by her Physician, whose hearing
was defective in both ears in consequence of a puriform dis¬
charge. This case yielded in a short time to a varied combina¬
tion and change of injections, consistiiig of solutions of ziiici
sulphas, plumbi superacetas, cupri sulphas, argenti nitras,
joined occasionally with camphor and opium.

A great number of cases of a like description have come

AV^liitiiiore’s Case of Fever treated by Fotlled Porter, 105

under my observation, as already stated, at the Dispensary,
and have yielded to a similar plan, properly persevered in for
a length of time.

The above cases, then, I trust, will sufficiently prove that
diseases of this nature are curable where a proper plan of pro¬
ceeding is persevered irr.

Case of Fever, successfully treated by the free Use of Bottled
Porter. By Henry Whitmore, Surgeon, Great Batfi
Street, Clerkenwell.

I HAVE been induced to transcribe for publication the fol¬
lowing case of fever of the typhoid character, wherein the free
use of bottled porter seemed to arrest the progress of this dis*
ease more speedily, although given at an advanced stage of it,
‘than any other remedial process I ever saw employed: the reco¬
very loo was far more rapid than is usual from such attacks of
fever. How far the success of this treatment may have de¬
pended upon the quantity of carbonic acid gas contained in
the stimulating fluid employed, or the peculiar tonic property
of it, I leave to the discrimination of the reader to decide.
Perhaps it is more fairly referrible to their happy combina¬
tion ; for I am not aware of any substance whatever which has
at any time been exhibited in fever, capable of imparting such
tone to the system, (the loss of which seems chiefly to constitute
the malady,) and at the same time to convey so much of the
carbonic acid gas as very good bottled porter.

On the 6th ultimo 1 was called to the only child of Mr.
Cook, No. 5, Lane’s Court, Warner Street, aged five years.
I found her in a very febrile state, having fluffied countenance,
tongue white, skin dry and parched, pulse quick and wiry,
with constipation of the bowels; which last symptom was
removed by giving two powders, each containing pulv. rhei et
: hvdr. submur. ait grains iv. given at an interval of four hours ;

sn antimonial powder was administered at bed-time.

I 7th. — A gentle diaphoresis /may be felt; pulse less hard ; in

I all other respects the same : gave saline mixt. and rep. pow'-
i der at night.

) 8th, 9th, and lOlh. — Mixture continued without the poW"'

I der at night.

I 11th. — Was called to my patient early this morning, a
material alteration for the wmrse having taken place in the
night; found her muttering, unconscious of passing events;
tongue browm, encrusted, rough, hard, and dry; no thirst;
pulse fluttering, at somewhat more than 180; countenance
VOL. XI. — NO. 62. p

106 Origmal Communicalions,

dejected and pale, save a fixed patch of red on the centre of
each cheek; extremities^ cold : applied a blister to the spine;
warm poultices of vinegar and linseed powder to the feet ;
and gave one of the following draughts every four hours : —

R Mist. Camph,

iEtheris rectific. gr. x.

M. ft. haust.

12th. — Six of the draughts have been taken; patient to all
appearance worse; an entire loss of animal heat; a cold
clammy sweat pervades nearly the whole body ; pulse not to
be counted, or rather not to be felt at the wrist; tongue quite
black and hard ; removed the blister, it had risen well and ’
discharged much : a little wine was attempted to be given,
but which was steadily and clamorously refused -by the
patient : a bottle (fbij.) of very good porter was then procured,
which was eagerly drank by my little patient in the course of
the day, taking a tea-cupful at a time. The enema fermenli
was administered at night.

13th, seven A. M. — Countenance somewhat improved ; an
imperfect return of sense; knows every body about her,
though unable to speak ; flushes of heat are sometimes
thrown over the body ; pulse still imperceptible at the wrist ;
ordered another bottle of porter to be procured immediately,
and given ad libitum; the poultices to be continued to the
feet, and another to be applied over the region of the heart.

Ten P. M.— The whole of the porter has been taken;
patient in every respect much better; has responded to the
calls of nature as she was wont to do ; has spoken several
sentences correctly; much heat ; pulse can be distinctly felt
at about 120; eyes suffused; tongue white at its edges, with
a dark brown streak down its centre; much watching and
restlessness, together with a very troublesome cough ; ordered
the porter to be discontinued, but gave no medicine.

1 1th. — Patient has had awery good night, and seems much
refreshed by sleep ; tongue much cleaner; a gentle moisture
on the skin; has taken nourishment wdth avidity; cough very
troublesome ; ordered mist, amygd. c. oxym. scillae.

12th. — Found her sitting up ; cough better.

13lh and 14th. — Progressively recovering.

13th. — Took leave of my patient.

On reading over this case, 1 find I have omitted to men^
tion a practice which was^ attentively pursued through the
whole of the febrile paroxysm, viz. sponging the body fre¬
quently with equal parts of warm vinegar and water.

Field on Diseases in Christas Hospital.

107

A General P^iew of the Diseases usually occurring in Boys
during the Period between Infancy and Puberty, deduced
from Observation of those in Chrisds Hospital. By Henry
Field, Member of the Society of Apothecaries in London,
and Apothecary to Christ’s Hospital*.

[Continued from page 301, Vol. X.]

TABLE OF DISEASES.

1818

Sept.

✓

1818

Oct.

1818

Nov.

1 vn n pti p tnncillpns ... ...... ......

• • • •

c • • •

0 lie

— ■ ■ C^.i\ \*A rrli cilie •

Plpiirnrl\7np •***«*a^««

8 ^1/1 /YnfQlmQ a

X L ^ O vj V 1 U LI L X U • • 4 • 4 ®

12 Nausea, Gastrodynia, Diarrhoea . .

A V IX X X L^ ^ X 1 XX J&v

IXLi Ueb X LlbLUlctlXo •••••••••••••••••••• ••••

X j * ■ £jv/oLv.^X ••*••••••••••••• •••••4

XU X X UX Ji'U i>lX vib »•••••• ••••••••••••••••

• • • •

1 ( OLclLHcb ••••••♦••♦•••©••••••••••••••••••

Totals . .

The autumnal season has been unusually warm ; very few
days have occurred that could be called cold, even to the
close of November. The wind has been generally between
west and south. Much rain has fallen ; and vegetation has
been uncommonly rapid, giving the earth the appearance of
Spring, rather than the approach of Winter.

The boys of this School have been, during the present pe¬
riod, extremely healthy.

The termination of the fifth year of these reports gives me

* This report was transmitted for insertion in the preceding Num¬
ber, but was omitted by mistake. Our readers, while they feel
obliged to Mr. Field for the series of valuable communications with_

which he has favoured the Repository for so long a time, will
doubtless lament the announcement that the present Paper is to be

the last of the kind.

lOS Ordinal Communkation$,

an opportunity of observing, that the number of boys admitted
into the Infirmary as medical patients has been only 260,
much belo'sv the general average, and thirty-six fewer than in
the preceding year. The deaths have been only three: one
from mesenteric atrophy; one from phthisis pulmonaria ; and
the other consequent upon pertussis, terminating in suppura¬
tive inflammation.

The only disease of any consequence which has taken place,
has been pertussis. Several of these cases were severe, and
one of them terminated fatally, as already mentioned. Some
instances of croup occurred in February.

Having continued these reports during the space of five
years; — a time which appears to me sufficiently long to give a
fair view of the diseases usually to be expected among boys
during the period between infancy and puberty, particularly
wffien the extensive scale upon which such reports have been
founded is taken intU consideration;- — I am now about to take
my leave of the medical public.

As little more has been attempted than a faithful detail of
facts, and as nothing can have a stronger tendency to promote
the healing art than the accurate delineation of facts, i flatter
myself that these endeavours to add to the stock of medical
knowledge have not been altogether unavailing. - If such has
been the case, my labour has been fully compensated. 1 have
only to, add, that if any thing new or peculiarly interesting
should hereafter occur in this department of medicine^ I shall
readily, take an opportunity of communicating it.

DEPARTMENT OF NATURAL HISTORY^ &c.-

On the Animals of the Class F ermes in general^ and on the In-
Atestinal W arms of Mankind in particular. By S, F. G ray.

[Continued from page 33, Vol. XI,]

Order II. — ~ F ermes rigid u li,

]3odp slightly stiff, so as to be rather elastic, naked, cylin¬
drical, thread-shaped, mostly regular. — The internal construc¬
tion of these worms is more perfect than that of the last
order; the intestinal canal has always two apertures, although,
on account of the transparency of the animal, and the small¬
ness ol the openings, they are frequently difficult to be per¬
ceived: and it is in these worms that Nature seems first to
have established a new system of generation decidedly sexual.

20. Ecu I N o RHYNCHUS, Zoega ; Acauchrunij Acharius.

100

Gray o?i Vermes,

Body long, cylindrical, sack-like; proboscis terminal, single,
retractile, furnished with hooks, in one or more rows. — Of
this genus no less than sixty-two species have been described,
all intestinal ; but happily none are found in man. One
species cafled E. Gigas is very common in swine, the male
being about three inches long, and the female from six to
fifteen.

21. PoRocEPHALus, Humboldt- Body cylindrical, not
jointed, rather club-shaped, the fore-end variously deformed
and contracted; proboscis terminal, contractile; hooks live,
crooked, retractile, lying hid in a groove under the proboscis.
— Only one species is known, found by Humboldt in an Ame¬
rican serpent.

22. Liorhynchus, Rudolph. Body long, cylindrical,

rather stifi’; terminal, obtuse; sucker XohoVdY, without

any valve, emitted from, and retracted into the mouth at plea¬
sure. — Only three species are known, all intestinal.

23. Stron GYLTjs, M uller. jBoc/j/ long, cylindrical ;

end narrower, terminated in the males with a purse, with a
short style, but in the females quite plain. — lliirty-four spe¬
cies have been described, as Ibund in the oesophagus, in¬
testines, and kidneys of animals. One only is found in man.

S. gigcis. Head obtuse; mouth girt with six fiatiish
nipples; purse of the male truncated, whole; tail of the
female rounded. — Found in the kidneys of men, horses, oxen,
&c.; from five inches to three feet long, and from an eighth
of an inch to half an inch tliick, the female smaller than tiie
male ; generally red and filled with blood ; but in the suppu¬
rated kidney of a horse, a very large one was found of a
white colour. Has been confounded by some with the
ascaris lumbricoides, or round worm.

24. CucuLLANus, Muller, Body long, cylindrical, the
fore-end obtuse, the hind-end narrower ; mouth terminal,
covered with a striated cowl. — Generally found in the stomachy
and intestines of fish ; only eleven species have been described.

25. Ascaris, Hippocrates ; Fusaria, Zeder. Body
long, cylindrical, narrow at both ends ; fore-end three
valved ; mouth terminal, very small, covered with rounded
valves. — This is a numerous genus, of which twenty-seven
species have been already described. They are generally
found in great numbers together in the stomach and intes¬
tines of animals. One is found in man.

yl. lumbricoides. Body furrowed on each side; tail rather
blunt. — Grows in- man from an inch and a half to fifteen
inches long ; colour various according to the food lately
taken; oviparous; but several authors, deceived by the
genital organs being prolapsed, have described it as vivi-

110 Original Gommimications,

parous ; easily expelled by purgative medicines, especially
the oily ones. ^

26. Fissula, Lamarck; Ophiostomaj Rudolph. Bodi/
long, cylitidrical ; the hind-end narrow, the fore-end two-
parted ; mouth terminal, two-lipped; anus near the tip
of the tail. — This genus of worms was confounded with
the ascarides, from which they differ in the form of the
mouth ; three species are only known, either intestinal or
found in the air-bladders of trouts.

27. Trichocephalus, Goez ; Mastigodes^TLed^eY. Bodt/

long, cylindrical; the hind-end thicker, rather club-shaped ^
the fore-end much narrower, nearly hair-like; terminal;

round, very small, scarcely distinguishable. — Nine species
have been described, all intestinal, but only one is found
in man.

T. hominis. Hair-like and very long, head acute, indis^
tinct ; the body of the male rolled up spirally, of the female
nearly straight. — • Called by Rudolph T. dispar, from the
difference observable in the sexes. Found in every human
subject examined by him, and once in the large guts of
a woman to the number of a thousand and more. These
worms are from an inch and a half to two inches long,
the hair-like part being two-thirds of the length ; the male
is a little smaller than the female; usually found in the
colon and coecum, rarely in the small guts.

28. OxYURUS, Rudolph. Body long, cylindrical, grow¬
ing narrow behind and becoming awl-shaped ; mouth ter¬
minal, naked, round. — These worms have been confounded
with those of the former genus. But tw'o species have been
accurately determined ; one found in man, and the other
in the horse,

O. vermicularis. Head blunt, with a membrane on- each
side like a bladder; tail awl-shaped. — Found in great
numbers in the large guts, especially of young persons,
chiefly in the rectum, from whence they sometimes crawl
into the vagina; when full grown they are nearly half
an inch long, slender, wdnte, and very elastic. Has been
frequently confounded with other species, Redi has
figured (Tab. x. fig. 5.) the larvae of a musca for this worm.
Coulet confounds it with the separated joints of the toenia;
Linnaeus mentions an ascaris pollicaris, which is certainly
a tricocephalus, or the ascaris lumbricoides above mentioned.
Bloch cites Wuff’s Medico-Chirug. Obs. lib. ii. cap. 4, for
a number of ascarides having been found enclosed in a
sacculus between the coats of the stomach, but Rudolph
supposes these to have been rather strongyli.

£9. Hamularta, Treuttler; Lingiiaiula^ Schrank ; Ten^

Gray on Vermes. 11 1

tacidaria^ Zeder. Body long, cylindrical, nearly equal
th roiigliout, stiffish ; mouth below the fore-end, having two
thread-shaped suckers like tentacula. — Three species only
are known, all intestinal, and one found in man.

H. subcompressa. Rather compressed, the fore-end nar¬
rower. This species was found by Treutller, in the winter
of 1789, in the preternaturally enlarged bronchial glands and in
their absorbent vessels, of a young man 28 years old, who
died exhausted by excessive venery. About an inch long,
brown variegated with white, nearly transparent towards
the hinder-end.

30. Tilaria, Muller; Capsularia, Zeder. Body cylin¬
drical, thread-shaped, equally thick throughout its length,
smooth, frequently very long, rather stiff ; mouth terminal,
round, very small. — Forty-three species have been described,*
all found in animals, but more frequently in the cellular
texture and the membranes than in the intestinal canal. One
is found in man.

F, Mediueusis. Very long, margin of the mouth tumid,
acumen of the tail bent. — From two to eight or twelve feet
long, chiefly found under the skin in the cellular membrane,
especially in the feet, and, very rarelyq even in the tunica
conjunctiva of the eye. Grows to the thickness of middling
packthread. Endemial in the warm regions of Asia and
Africa. Its name arises from its being common at Medina;
but in England we more usually call it the Guiney worm.

31. Gordius, Linnaeus. Body cylindrical, thread-shape,
equally thick throughout its whole length, smooth; mouth. ...
anus.... . — The difference of these worms from fiiaria
is not properly known ; they are not found in animals, but live
in water, or the mud, and sand of the shores, twisting them¬
selves into knots, and then again untwisting themselves.

Order III. — Vermes hispidi.

Body furnished with silky threads, or spines on the sides.
None of these worms live in the bodies of other animals, but
crawl at the bottom of the water. The lateral spines or
ciliae distinguish them strongly from the other two naked
orders ; yet it is not probable that they possess any system
of circulation, or that the lateral appendages are true gills,
or that they have any real sensation, or are even oviparous,
but only gemmiparous.

32. Nais, Gmelin. Body creeping, long, linear, trans¬
parent, flat : garnished on the sides with scattered silky
threads, either simple or in bundles. — The mouth is some¬
times a mere slit, sometimes a hole with two lips. Lamarck
only enumerates three species as certainly belonging to
this genus.

112

O rigin a I Co m municaiions*

33. Sty LA HI A j Lamarck ; Linnseus. jBoJj/ creep¬

ing, linear, transparent, with silky threads on the side ; ^bre-
end split in two, with a style-like proboscis springing from the
fork; anus terminal. — The only species enumerated by
Lamarck in this genus, is the nereis lacustris of Linnaeus.

34. Tubifex, Lamarck; Lumbricus, Muller. Bodi/
thread-shaped, transparent, ringed, or in some measure
jointed with small spires on sides ; mouth and anus towards
the extremities. — These worms live in tubes sunk in the
mud or sand of the shores ; they have been mentioned by
some authors under the name of lumbrici.

EPIZOARLTI.

Body soft, or in some cases covered with a slight
crust variously shaped, head doubtful, feet none, but often
various appendages of different forms, not jointed; form
symmetrical, with the first rudiments of parts in pairs; mouth
sucking, with tentacula or armed with hooks; organs of
sensibility, respiration, and fecundity unknown. — These animals
appear to be the rudiments of a new class of animals to be
inserted between the vermes and annelides ; they are externally
attached by their suckers to the bodies of animals, and live
by exhausting them of their blood or other fluids. It is
in them that the radiated system of the inferior animals is
totally abandoned, and the system of parts in pairs of the
superior animals is begun to be employed. Very few are
known at present.

1. Chon DR ACANTHUS, De La Roche. Body oval, not
jointed, narrow below, covered on the upper part with
cartilaginous spines ; eyes none ; mouth umier the anterior
extremity, sucking, armed with two forked hocks and two
short tentaculas. — Found on the gills of the doree.

2. Lern^a, Linnaeus. Body soft, oblong, cylindrical,

sometimes inflated and^ irregular, destitute of limbs; mouth
sucking retractile, under the fore-end; tentacula two or four,
simple or branched, sometimes wanting ; ovaria two,

behind, external, hanging, filled with egg-shaped gemmules.
— Of these there are several species, all adhering either to
the gills, the lips, or the fins of fishes: the 1. branchealis
found on the gills of the cod is eaten by the Greenlanders.

3. En TO MO DA, Lamarck ; LerruEa, Linnaeus. Body soft

or somewhat hard, oblong, rather flat ; limbs, on the side,
symmetric, not jointed; sucking, under the foreend;

tentacula none, sometimes two small horns', false onaria two,
external, hanging to the hind-end; anus terminal;— These
are found, like the last mentioned worms, adhering to fishes.

113

Gray on Vermes,

It remains to say a few words respecting the intestinal
worms in particular. From the. preceding enumeration
about 600 nave been' discovered and examined, so as to
be reduced to their proper families: forty-five others are
mentioned by authors, but in such a manner that they
cannot be referred to any genus.

The principal intestinal worms found in man have been
long known : Hippocrates, mentions the ascaris lumbricoides,
and the a. verrnicularis, in his Aphorisms; and in his work
on diseases the taenia solium is compared to cucumber seeds.
Pliny mentions a tinea (taenia -lata), of 300 feet long !
Aretaeus first mentions {he existence of hydatides in hydropic
persons. Avicenna is the earliest writer who notices a
worm as living under the skin, probably the filaria Medi-
nensis. The remaining species have only been observed
occasionally. In what manner they are first introduced is
utterly unknown; certainly, however, not, as has been sup¬
posed by some, from outwardly, as similar worms do not
occur out of animal bodies ; and they have frequently been
found in the human foetus and those of dogs, sheep, and
fowls: hence other naturalists of great name still retain
the doctrine of spontaneous generation, and affirm, that the
production of these worms is peculiarly" favoured by the
youth of the subject, their being of the weaker sex, and
the weakness of the particular. Although mankind are
subject to worms, yet they are by no means equally so with
other animals: the larger worms are usually single, except
the ascaris lumbricoides ; and as to the ascarides vermiculares,
which last seldom exceed a thousand, they are simply
immersed in the villous lining of the intestines; but in
other animals worms are frequently found in far greater
numbers, so that the lungs, kidneys, and other viscera
are entirely corroded by them. In fowls, and especially
water fowls, the intestines are frequently stuffed out with
taenise ; and their number in the red-throated diver requires
ocular demonstration to enforce belief; the whole intestinal
tract from the fauces to the anus being turgid with worms
of eight different species.

The symptoms from whence the presence of worms in
the human system are prognosticated are for the most part
fallacious, and common also to scrofula and a weak habit
of body ; which, as before stated, is favourable to their
production. The ascaris lumbricoides and the taenia some¬
times occasion spasmodic affections ; the ascaris verrnicularis
produces very troublesome itchings of the anus and geni¬
tals ; and the filaria Medinensisis known by the subcutaneous
pains to which it gives rise.

VOL. XI. — NO. 62,

114

Original Communications.

In respect to aiithelmintliics, experiinents made with living
worms have shown that those which live in warm-blooded
animals soon die in cold water, while those of cold-blooded-
animals are frequently found crawling amidst the frozen
viscera, and may be kept alive for several days in cold water :
they are killed in spirit of wine, sooner or later according
to its strength : the mild oils, if not too cold, do not shorten
th eir life out of the body; indeed Coulet found that he could
not keep the gourd worms alive so long in any fluid as in
oil of almonds, in which they lived for *24 hours ; but
in the foetid empyreumatic oils no worms have been found
to survive a few minutes. In water rendered bitter with
aloes the ascaris lumbricoides lived half as long as in w^arni
water, but in rose water or orange flower water one-sixth
of the time, and the smaller ascarides died almost immediately
in the two latter fluids. In wine they lived longer than
in warm water, but soon perished in simple syrup.

From these experiments we are led to the following
practical conclusions. Cold water in copious draughts,
(which may be rendered at once more agreeable and more
efficacious by the addition of rose water or orange flower
water,) is one of the simplest anthelminthics : and from
this we may explain the effect of water in which quicksilver
had been boiled, used formerly, and, probably with success,
but rejected by the moderns because quicksilver is not soluble
in water ; upon which solution, however, it is now known
that the effect does not depend : also the unforeseen
dejection of worms, even taeniae, when in febrile diseases
copious dilution with cooling drinks has been resorted to.
The foetid empyreumatic oils are the most efficacious
vermifuges known, the intestines being previously cleansed
by a brisk cathartic, such as the oleum buxi, oleum lateritium,
and oleum petrolei Barbadensis of the London Pharma¬
copoeia, (editions before 1788.) Of which the ol. latent, alone
remains in the shops, being retained by the farriers as a ver¬
mifuge ; but as it is seldom possible to persuade a human
patient to swallow a second dose of these oils, that of turpen¬
tine is at present substituted for them : even the farriers so
far study the palates of their equine patients as to give to
the better kind of horses the Barbadoes balls, made of
undistilled petroleum. In animals which have been killed
by a strong dose of camphire, most of their intestinal worms
have been found dead, and the tsenise expelled as far as the
rectum, which in common cases they do not enter., Semen
cinee, tansey seed, helminthocorton, cabbage-tree bark, and
Indian pink root, are also used with success against the
ascaris lumbricoides : the two latter, however, are in general

115

Morgan’s Sketches of the Philosophy oj Lif e.

so violent in their operation as to require great care in their
exhibition. Besides these, the filings of tin, the down of
cowhage, and pulverized charcoal, are used as mechanical
agents to dislodge worms, by irritating them, and thus
rendering them more easy to be carried by the stools. It
is doubtful whether the powder of fern root used against
the tenia, is to be considered as acting upon them in a
deleterious or mechanical manner. The ascarides vermi-
culares are, from their situation, little affected by medicines
taken internally, and can scarce be got rid of otherwise than
by injections of water or barley water in as large a quantity
and as cool as the bowels will allow, by which they are
soon expelled ; the use of oily clysters being less efficacious.
The filaria Medinensis requires manual extraction by a careful
hand lest it should break. A few families in the East
Indies possess the secret of a vegetable poultice which
causes the Vvorm to crawl out in the course of a single
night, but object to the revealing of the plant, as it forms
the only resource of their families.

In a future paper it is my^ intention to mention the species
which are found in our common domestic animals, as an
exercise for the younger members of the profession to employ
themselves in collecting and preserving.

PART 11.

ANALYTICAL REVIEW.

Sketches of the Philosophy of Life. By Sir T. C. Morgan,
M.D., Fellow of the Royal College of Physicians of
Londou.

This is no every-day performance. With Sir Charles
Morgan’s postulata, in respect to the omnipotence of organi¬
zation, we are by no means disposed to accord ; but, while we
radically object to many of his inferences on the great ques¬
tion of mind and matter, we are, at the same time, ready to
allow that his work displays throughout indications of a very
superior understanding : “ Swift, (says an epigrammatist) for
the ancients has argued so well, ’tis apparent from thence that
the moderns excel.” We might perhaps with propriety ven-

116

Analytical Review^

ture upon the same kind of point in reference to the ability
shown by the author before us; and maintain, that mind is
evidenced by the very ingenuity of argumentation employed
to establish its non-existence.

Into these controversial points, however, it is not our pre¬
sent design to enter. Metaphysioiogy^ is very well in its way,
but our readers would not be thankful to us for furnishing
them with a large supply of it ; and in the following critical
notice of Sir Charles Morgan’s production, we shall princi¬
pally confine ourselves to those particulars about which both
the mentalist and materialist may think pretty nearly in the
same manner.

In the preliminary remarks that are affixed to this book,
the author we find taking the same ground with the late Dr.
Beddoes, in reference to the prospect of moral improvement
in the habits of mankind, from an unprofessional cultivation
of organic physiology. It is obvious enough that the discus¬
sion of this .problem would be also in some measure out of
place if introduced into the pages of the Medical Reposi¬
tory. We shall therefore lay this business likewise on one
side, and proceed to the medico-physiological part of the inte¬
resting volume before us.

Sir Charles Morgan first animadverts on the character and
causes of organic combinations ; and in the following extract,
on the subject of equivocal generation, we find a pretty cor¬
rect sample of his mode of treating these topics ; the very
agitation of which is supposed to involve much more in the
way of consequence than it actually does.

“ Whether, in the existing state of things, equivocal generation, or
the spontaneous combination of the elements in organic forms, be in
any case possible, is a question that admits of some doubts ; as far as
direct observation has extended, living organizations have uniformly
been found to originate in germs, produced within the economy of
other similar individuals previously existing. But there are many
species, concerning whose production nothing positive is known ;
either their extreme minuteness, or the circumstances under which
they are developed, precluding experimental investigation. The in¬
fusorial microscopic animals, the plant which discolours stagnant
water, the vegetation termed mouldiness, hydatids*, and other animal-

* Hydatids are small animals of a vesicular form, arranged by
Cuvier among the tape worms. They are generated in the ^ery sub-
stance of different viscera of men and the higher animals. They are
frequently found in the brain of sheep; in which situation they cause
vertigo, speedily followed by death. If these and similar parasitical
animals are the preducts of germs swallowed with the food, and de-

117

Morgan’s Sketches of the Philosophy of Life.

culse, developed in diseased structures, or in fluids, the products of
human industry, start into existence under conditions in which the
supposed presence of germs is attended with manifold difficulties.
The maxim of omne animal ah om is undoubtedly founded upon a
very general analogy; but it is perhaps more deeply rooted in certain
other doctrines, to which interest and passion have given inveteracy.
Between these opinions there is no connexion: but were it"

otherwise, the supposed consequences of an opinion form the feeblest
arguments’ tliat can be opposed against its probability. In the present
state of knowledge, therefore, the question cannot be considered as
perfectly at rest.'^

In proceeding to the consideration of those laws which in¬
fluence the integration, if we may so express it, of an orga¬
nized being, our author tells us that all substances are not
indifferently adapted to the business of assimilation ; each
species of animal and plant is nourished by food rendered ana¬
logous to it by a peculiar constitution and he goes on to
state, that as alimentary matter must necessarily contain one or
more of the four elements, carbon, hydrogen, oxygen, and
azote ; metals are therefore totally incapable of becoming or¬
ganized. When treating on the curious and disputed ques¬
tion respecting the assignment of perception to plants. Sir
C. Morgan makes loco-motion the pivot upon which the dis-
tinction should turn, between mere organic susceptibility to
i impressions from without, and positive sensation. This dis-
. pute, (he says) like many others, is, perhaps, merely verbal,

; and dependent upon the greater or less degree of latitude at-
; tached to the word perception.” That class of beings, how¬
ever, termed zoophytes, evidently furnislies a difficulty to the
physiologist when he is endeavouring to draw the line of de¬
marcation between the vegetable and animal tribes of being ;
for although many of these, like plants, are divested of loco¬
motive powers, and remain fixed to the spot upon wdiich they
; are produced,” their peculiarities seem at the same time to de-
: note a lower degree of that faculty which is conceived to be
i absolutely distinct in its nature and essence from mere organic
i irritability.

Having mentioned the principal circumstances connected
with the development, progress, and maintenance of organized
structure, the author goes on to assert that

“ In proportion as this system is more perfect, as the vascular, re-

posited by the circulating fluids, they must either be capable of an
independent existence, or their germs must have been preceded in the
order of creation by those of the animals in which they were destined
to be developed.

118 Analytical Review,

spiratory, and digestive apparatus are more complete, the animal is
exposed to derangement from a greater variety of accidental causes.
If, therefore, the development of intellect had not kept pace with the
structural complexity, and thus furnished a principle of counterac¬
tion proportionate to the increase of danger, man and the higher ani¬
mals, instead of commanding upon the face of the earth, would have
been the first species in the system of nature to disappear from its
surface."

Whether this be quite a correct assumption, admits, to say
the least, of much doubt ; the fact, however, of the increase
of susceptibility to external impression, in proportion to the
progress and development of intellect, is very remarkable, and
constitutes quite a sufficient reply to those speculators who
talk of a want of foundation for the medical art. If we abide
by nature in one particular we must in all others ; and thus
revert from social to savage existence.

From the law^s of assimilation and organic combinations,
our author proceeds to take a view of the constituent por¬
tions of an organized being ; the concurrence of a solid and
fluid,” he tells us, ‘‘ seems necessary to vitality ; and the influ¬
ence of these parts is evidently reciprocal. For as the fluids
are at once the materials from which the solids are formed ;
so the solids, on the other hand, by their living energy, ela¬
borate and concoct the fluids.” But

“ It is a law of living energy that its exertion is attended with a
condensation of the substance of the organ in which it takes place*
The earlier, therefore, a subject be examined, the greater will be the
proportion of fluids in its composition. The superior density of par¬
ticular organs exposed to constant and violent action, the hardness of
the palms of labourers, the solidity of the muscles in the arms of
smiths, afford marked instances of the operation of this law.

“ This progressive induration of the solids, though at first it car¬
ries the body from feebleness to strength, eventually causes a rigidity
of fibre incompatible with the healthy action of the capillaries. At
the same time that the nutritive functions are thus obstructed, the ner¬
vous fibre is rendered less susceptible of impressions, till at length the
movements become embarrassed and are suspended, and the machine
is delivered over to the exclusive dominion of physical causes."

One of the greatest difficulties which the physiologist
finds in contemplating the parts of an organized being is
constituted by the apparently complicated structure of even
the minutest conceivable portion of the frame. The
^lightest puncture made with a needle in the skin will
excite pain, and wdll draw blood. Upon this spot, therefore,
are assembled a nerve and a blood-vessel, besides the
nutritive vessels and absorbents necessary to each,’" and

119

Morgan’s Sketches of the Philosbphy of Life.

as far as observation (even when assisted by the microscope)
has extended, this complexity of structure is still per-
i ceptible.” As, however, each part demonstrably performs
: separate and peculiar functions, it is susceptible of ab-
I stract consideration : and Bichat, the celebrated French
! Physiologist, was the first to adopt a term which at once
serves to convey to the mind this, if we may so say, indi¬
vidual and connected existence. In muscles,” says Sir C.
Morgan, “ besides their arteries, absorbents, nerves, See. there
is a substance which exclusively contracts; in the nerves
there is a matter which alone enjoys the power conveying
impressions.” The number of these several parts is pro¬
portionate to the more or less complicated functions of the
living being; and to such parts the French, as just stated,
„ directed by Bichat, have applied the appellation of tissues.
The basis of all animal and vegetable forms is the cellular
tissue, which enters into the structure of other tissues,
and performs to each fibre and vessel the same offices which
it fulfils towards the organs; at the same time that it serves
as a bond of union, cementing and consolidating the whole.
“ This substance consists of an assemblage of whitish
transparent laminae, crossed by filaments of a milky lustre.
They are so interlaced with each other as to form cells of
various shapes, which communicate amongst themselves
i throughout the whole body.

We have thus dwelt more largely than might seem to
! be expedient upon the rudimental or elementary portions
) of the Essay before us, since it is of much consequence for
1 the pathologist to gain accurate notions of the primordial
i structure of the body, and because we have found it common
for students in anatomy to gain a considerable acquaintance
with the several parts of the frame, without having had
their minds duly impressed with the necessity of contem¬
plating the organized being, both in its minute formation
' and functional totality.

On the subject of arteries, veins, absorbents, and capillaries,
w'e meet with nothing of sufficient moment to arrest the
; attention of the professional reader. With respect to the
' relative composition of animal and vegetable matter, and
the question why nitrogen predominates in the former,
we meet with the following observations : —

“ It has been imagined, that the predominance of nitrogen in
i animal compounds is derived from the very minute quantities
i of it which some vegetables contain, by the elimination of the other
I three principles during the various animal processes : but if this
•I were the fact, the fluids of carnivorous animals should contain

120

Analytical Review*

more nitrogen than those of the herbivorons tribes — a proposition
positively contradicted by observation. The late Sir B. Harwood
was in the habit of exhibiting the transfusion of blood, by emptying
the veins of a dog, and redlling them with thos^ of a sheep. The
dog, though a carnivorous animal, enjoyed perfect health while
circulating the blood of one that is herbivorous ; and was not
otherwise annoyed by the experiment, than from the incident fatigue
and the soreness of the wound.

“ From these considerations it may be concluded, that nitrogen
either exists as an ingredient in hydrogen or carbon (a proposition
very improbable), or that it is itself a compound of some of the
elements of vegetable combinations. One or the other of these
hypotheses must be admitted, to explain the phenomena of animaliza-
tion, since no other conceivable source exists for the fourth principle,
which enters into chyle during the digestion of vegetable substances.*’

The same observations apply (says our author) to
sulphur, phosphorus, and other constituents of organized
bodies;” and we would recommend the consideration of
these facts and inferences to Magendie and other chemical
reasoners on the production of calculi, and several matters
in the animal frame. It would seem quite fair to assume
that vegetable blood, w^hile circulating in animal vessels,
as in the adduced instance, would give the same secretory
and excretory products as had before been formed by the
animal’s proper fluid : and if such be the fact, the wdiole
of that theoretic edifice must tumble to the ground, which
is constructed upon direct chemical relation betw'een
the ingesta and egesta.

In the third chapter Sir C. Morgan treats of the com¬
bination of organs and functions;” and he here introduces
several remarks drawn from human and comparative anatomy,
on the adaptation of parts to the purposes they are destined
to fulfil in the animal economy. This adaptation, in* some
instances, is sufficiently obvious, while in others an obscurity
still attaches itself to the question of function as connected
with organization.

This observation applies with particular force to the liver, which,
though an organ of great size, and predominantly influential in the
constitution, performs functions whose necessities are by no means
well understood. The importance of this viscus in the animal
economy may be inferred from its early developement in the fetus,
and from its universal existence in every animal possessed of a heart.
Even insects, though devoid of other glands, secrete from the
internal surface of certain membranous bags a yellow fluid, appa¬
rently equivalent to bile.

“ The /chemical constitution of the bile has been diligently

121

Morgan’s Sketches of the Philosophy of Life.

studied, and is well understood ; but the relations of its alimentary
constituents to its operation in precipitating the chyle are not thereby
rendered more intelligible. The bile is an oily or soapy compound
of a greenish yellow colour, of a viscid consistence and intensely
bitter taste. I’he oily matter it contains approaches in its properties
very nearly to the character of spermaceti ; and it is held suspended
in the fluid by a very large quantity of soda, and by some albumi¬
nous matter having a strong tendency to putrefaction. In what
manner this alkaline product contributes to the formation of the
chyle cannot even be conjectured. Though the digestive functions
are deranged by an obstruction of the gall ducts, though flatulence
and dyspepsia are the usual concomitants of jaundice, yet an
absolute suspension of the chylopoietic action is by no means a
constant consequence of the absence of bile in the intestines. From
the cathartic eflfects of the artificial soaps, physiologists have been
inclined to consider the bile as the natural stimulus of the intes¬
tines; and there seems some reason for the supposition, since the
presence of an unusual quantity of this fluid in the alimentary canal
increases, in an inordinate degree, the force of the peristaltic motion,
d’he early developement of the liver in the foetal economy at a time
when the functions of the intestinal canal are in abeyance, and this
organ, as a part of the alimentary system, is perfectly useless, has led
the French physiologists to imagine that it is in some way cvinnected
with the maintenance of the peculiar healthy constitution of the
blood. The great size of this organ likewise adds probability to the
hypothesis, since it is much larger than would suffice for the mere
formation of the bile, which in quantity is perhaps inferior to the
saliva. The liver, especially that of fish, is a viscus abounding in
oil ; and the quantity of carbon and hydrogen which this substance,
as well as the constituents of the bile, contains, seems to warrant
the supposition that these elements are abstracted from the blood
in that organ. It will be stated in a future page, that the abstraction
of carbon from the blood is the immediate function of the lungs,
and that this function is momentarily essential to life. In the foetus
the decarbonizing process has not commenced in the lungs; and it is
not impossible that the large size of the foetal liver may arise from the
activity of that viscus, as vicarious to the respiratory organs. But
that the liver really does operate this change upon the blood, is by no
? means proved. There is, however, this additional argument in
\ favour of the supposition, that it is the only gland which receives
1 the materials of its supply from the venous system, whose blood
j is characterized by a superabundance of carbon. The Greek phy-
! sicians attributed to the liver a large share in the manufacture of the
I blood ; and its extensive influence in the constitution is certainly
I not compatible with its limited action as one of the chylopoietic
i viscera. But before the French theory can be admitted as more than
mere conjecture, there is one point essentially necessary to be proved,
.which is, that secretion is performed by a selection of the elements of
the blood, and does not consist in changes effected in the entire mass
of fluids upon which the glands operate.’"’

VOL. XI. - NO. G2. II

122 Analytical Review*

OF the pancreas and the spleen also it is difficult to
predicate the precise uses, although the probabilitj^ is, that
the latter, according to the suggestion of Dr. Haighton and
Mr. Cline, serves as a sort of diverticulum for receiving,
during the quiescent state of the stomach, a quantity of
blood necessary to its increased vitality during the activity
of its function.” It is, however, a well known fact, that
this organ may be occasionally taken from the body without
subjecting the animal to much inconvenience; a circum¬
stance which still increases the difficulty of our investiga¬
tions respecting the why and wherefore of its existence.

On the laws of the circulating and respiratory system we
find nothing but what must be sufficiently familiar to the
generality of our readers. When adverting to the function
of secretion, the author introduces the following piece of
tlieoiy on the disturbance of the system consequent upon
a suppressed secretion of urine.

“ The suppression of this secretion, if it subsists but for a short
time, overloads the circulating fluids with hyper-animalized matter ;
which, while it stimulates the solids to inordinate action, is itself
prone to decomposition; and thus deranges the chemical constitution
of the blood, and excites febrile action.”

We doubt whether this explanation would bear the test
of rigid scrutiny : it may be questioned whether febrile
action is at any time occasioned by a chemical alteration
in the condition of the circulating blood, even when such
fever results from the introduction into the body of specific
morbid poisons from without. That changes in this fluid do
take place as a consequence of the perturbation produced
by fever will be allowed ; but it should be recollected, that
the blood merely, even of an hydrophobic animal, has no
power to inoculate another animal with hydrophobia ; the
impregnated poison being confined exclusively in these
cases to one particular secreted fluid.

When treating on the brain, Sir C. Morgan, at the
same time that he allows to Gall and Spurzheim the
credit of having succeeded in demonstrating this part of
the organization to be fibrous, and not glandular or pulpy,
and that the fibres of different parts of the brain pursue
different directions, denies at the same time that these
theorists have gone beyond a mere gratis dictum in respect
of their phrenological tenets; and asserts, that the notion
of attaching distinct functions to different portions of the
brain is contradicted by the best ascertained facts in me^
taphysical science.”

“ There is, however, no part of the history of nervous apparatus
more embarrassing than the subject of its separate functions. The

123

Morgan's Sketches of the Philosophy of Life.

appearances which the anatomy of this tisswe exhibits, warrant th®
supposition, that the nerves of sensation and volition, the brain and
spinal marrow, are perfectly alike in substance and arrangement; and
physiologists in general are agreed in referring the different sensations,
propagated by the several organs, to peculiarities in the terminations
only of the different nerves. But, notwithstanding this apparent
identity of structure, and the possibility of perception being, under
certain circumstances, seated in the spinal marrow, it is still the
exclusive property of the nerves to feel, and the more peculiar province
of the brain to perceive and to will. A slight pressure made upon
the brain throws the animal into profound sleep, and obliterates the
perceptive and voluntary faculties; yet the surface of this organ may
be scratched or irritated by chemical stimuli, without exciting the
attention of the animal,

“ The relation of the nervous and muscular systems is purely vital,
and, consequently, involved in the darkest obscurity. If the con¬
tractility of the muscles be excited by the transmission of electricity
through the nerves, the circumstances are still unknown which deter¬
mine the electric discharge. It seems now very decisively proved,
that the muscles possess in themselves the principle of their motions;
and that the nerves stand to them merely in the relation of excitors.
The nature of the influence wdiich the involuntary muscles receive
from the nervous system is perfectly incomprehensible. Their nerves
are chiefly derived from the sympathetic plexus, and are perfectly
independent of volition."

The laws of vital functioiT' fall next under the author’s
consideration; and we find him resolving every thing in
respect of the mutual action of life supporting powers, and
the circumstances of the body upon which they exercise
their agency into sensation and reaction. Here the same
difficulty occurs with that to which we have before adverted,
as to the propriety of applying the term sensation to effects
in which consciousness is not present. If with Bichat we
divide the consequences of excitation into organic insensible
contraction, organic sensible contraction, and animal contrac¬
tion, including in this last term all those muscular movements
which are directed by the will, we shall be liable to err
in our inferences, since, as Sir C. Morgan well observes,

the circumstance of a muscle being connected or not
with the nervous apparatus, and thereby being subservient
or independent of volition, is utterly foreign to its structure
as a muscle; and if the nervous communication betw^een
the brain and an organ of animal contractility be cut ofif,
its muscular properties still remain entire and unaltered,”
Beside, when we once attempt to draw a well defined line
of distinction between voluntary and involuntary actions,
we find ourselves foiled nearly in the same manner as we

ft/

124 Analytical Review*

do when attempting to trace an accurate and absolute
distinction between vegetable and animal vitality.

We need not pursue Sir Charles Morgan through his state¬
ments on the relation of excitability to stimulation ; which,
however, are exceedingly well put, although nothing of no¬
velty could be looked for on this head. We find him, we
think, rather too much of a Brunonian with respect to the
rationale of catarrhal irritation ; for, although it does not ap¬
pear that he would go the length of defending uncondition¬
ally the axiom of Brown, frigus nunquam nocet fiisi calot'
excipitf he remarks, it seems probable that catarrh, that
vexatious torment of our insular climate, is the more frequent
result of a sudden transition from cold to heat than (as is
usually imagined) from heat to cold.’^ Speculators who
argue for the necessity of exterior heat to engender catarrh,
seem to us to overlook the law^s of reaction and tendency in
the body to maintain an equilibrium of temperature. In our
minds it is not the general vicissitudes of temperature in either
way wdiich for the most part prove noxious, but their partial
applications; it appears that such partial subductions of heat,
by accumulating irritability, cause the relations of excitation
and excitability to be changed locally ; and that thus is that
irritation produced in the mucous membrane of the nose,
which is the essence of catarrh, and which is more or less vio¬
lent according to the topical or constitutional circumstances
of the sufferer.

Habit is the next law of the system upon which our author
comments ; and it would of course be unjust to expect any
thing under this division of the subject beyond what we every
where meet with ; a delicate precision in language, and a
mastery in stating and illustrating well established facts. To
some of our readers the following experiment may be novel
and interesting : —

To the law of habit (says Sir C. M.) may be referred the very
singular phenomena of ocular spectra, described in Dr. Darwin’s
Zoonomia. If the eye be steadily fixed for any length of time upon
one of the primitive colours, so as to become fatigued by its contem¬
plation ; and then be suddenly removed to some compound colour,
of which the first is a constituent, this second colour will not excite
the same ideas in the mind which it usually does ; but that which
the combination should raise if the primitive colour first contem¬
plated were altogether absent from the combination ! Let a red
wafer, for example, be fastened in the centre of a sheet of white paper,
and placed in a strong light. If the eye be steadily fixed upon it, so
that the rays proceeding from it shall impinge continually upon the
same points in the retina; and if when the efforts begin to create a
sense of fatigue and of pain, the eye be then removed to another part

125

Morgan’s Sketches of the Philosophy of Life,

! of the paper, a bright green spot will be seen in size and shape re-
i sembling the wafer. Of this curious experiment the explanation is
simple. White is a sensation produced by a due mixture of red,
blue, and yellow (abstraction being made of the intermediate tints) ;
and green results from a combination of blue and yellow. A pencil
of white light would, therefore, appear green if all its red rays were
' removed. But that portion of the optic nerve which has been fati¬
gued by the contemplation of the wafer, being no longer stimulated
by the red rays, it is aft’ected in the same way as if they were absent
from the combination. The impression therefore made upon the
mind is that of a green circle, corresponding with the circle of ex-
I hausted tissue in the optic nerve.'’'

While still further pursuing the subject of excitability and
excitation, Sir C. Morgan is led to make a remark or two on
the question of tonic agency. It is, perhaps, among the most
remarkable facts connected with living agency, or rather the
agency of dead upon living matter, that a very small portion
ol a substance which has the power of mechanically contract¬
ing the animal fibre when deprived of vitality, shall display
somewhat of a similar effect upon a living organized being when
taken into the stomach. The bark of some trees, for instance,
is capable of combining with dead animal substances, and con¬
stringing or contracting it permanentl}’^ ; and the same sub¬
stance, w'hen taken medicinally, will produce the effect of
adding tone or firmness to a relaxed muscular condition of
the recipient. This coincidence of effect led to the supposi¬
tion of analogous operation ; but permanent excitation in
living bodies, it ought to be recollected, is a state widely dif¬
ferent from tension or tone in dead matter; still, as we have
just remarked, it is a singular fact that the powers productive
of one effect should at times occasion the other ; and this fact
must be left at present as an ultimate one, which has not re¬
ceived a satisfactory solution. Tannine too, it must be re¬
marked, is not an universal ingredient in tonic medicines ;
nor does experiment evince a real condensation of substance
in persons restored to health by the use of these remedies.
Their operation, indeed, is obviously vital ; but whether it
falls upon the minute capillary system, or is excited upon the
: stomach, and through that organ sympathetically on the other
i tissues, is by no means clearly ascertained.” Invivum corpus
j (says Dr. Brown) agunt medicamenta. By which he meant
to infer, that w e should be very careful not to generalize too far
I from mere analogical data.

i Respecting the connexion of spasmodic or irregular con-
I traction of the muscular fibre with vascular irritation, Sir C. M.

I makes the following pertinent remarks ; and we the more
\ readily make use of such liigh authority for establishing the

125 Analytical Review,

frequently consecutive occurrence of inflammation, or even
a vascular excitement that is under the grade of inflamma¬
tion, since, as we have more than once intimated, it appears to
us that too much in the present-day pathology is consigned to
the vessels to effect in the way of diseased production,

“ Those muscles which obey the dictates of volition, are neces¬
sarily liable to great variations in the quantity of their action. They
become, therefore, like other organs of occasional activity, the seats of
a local orgasm, the centres of fluxion, from which they derive a tem¬
porary increase in their living powers. The first efforts of muscular
motion are, therefore, never so vigorous as those which occur after the
orgasm has for a certain time subsisted, in the end, however, the
maintenance of this condition tends to induce inflammation ; the first
approaches of which are marked by that painful sensation we term
fatigue — a sensation closely resembling rheumatic pains. Linder the
influence of diseased excitement the muscles may be thrown into
spasmodic action ; consisting either in quick alternations of contrac¬
tion and relaxation, or in permanent and immoveable contractions; of
which the two diseases, St. Vituses dance and locked-jaw, afford fami¬
liar instances; and it is somewhat singular, that in the last of these
diseases the blood exhibits the marks of excessive inflammatory ac¬
tion, as if the protracted contraction of the muscles had excited a
real inflammation in those tissues.”

For the reasons already alleged, we shall pass by with very
little comment that section of our author’s work which is de¬
voted to the discussion of mental phenomena.” Suffice it
to say, that Sir Charles Morgan’s aim throughout is to combat
the notion both of a spiritual and material principle of life,
and to establish the necessity of organic actions. Such neces¬
sity, he maintains, ‘‘ determines the highest faculties of intellect,
no less than the simplest impulsions of vegetable nutrition;
and operates as despotically in producing a Caesar or a New¬
ton, as in originating a Polype or a Tremella.” We agree
with him to the extent of supposing the absolute necessity of
some organic change in the process of all living function ;
but, then, w^e would maintain, that such change is consequent
upon an impulse beyond the control of organization, and that
volition may excite in a direction contrary to organic ten¬
dencies : otherwise morality is a name destitute of meaning, and
responsibility for actions an assumed principle without the
smallest foundation in fact.

To the following positions, how^ever, respecting the mode
of conducting inquiry and deducing inference on the subject
of vital actions, we readily, and without any qualification,
subscribe.

‘‘ If the adeption of a vital principle be regarded as essential to the
formation of any rational theory of life, it will btill be necessary to

127

j Morgan’s Sketches of the Philosophy of Life.

remodel the notions which are attached to that term. It must not be
taken as representing a sentient principle per sCy nor as an individual,
nor as even the main cause of vital phenomena. Every element
which enters into the organic compound is possessed of its own inde¬
structible r.iodido suo to the general effect. The chemical qualities of
oxygen and hydrogen, the physical properties of the several tissues;
in one word, the attractions and repulsions, elasticity and gravitation,

I &c. of every particle, are necessary and essential causes, ajid must be
I considered as contributing equally with the hypothetical principle to
! the formation and functions of the entire machine.

“ In denying, therefore, the necessary exfstence of a vegetative
, soul, and in pausing in our researches at the properties of contracti¬
lity and sensibility, it is not necessary to consider these boundaries as
strictly impassable. But in attempting to extend the limits of in¬
quiry, the map must be traced after the discoveries of a Columbus;
not covered with an imaginary Terra Australis, or .fancied Atlantis ;
even though such territories should be vouched on the imposing au¬
thority of another Plato.”

On the above admirably expressed opinions we shall
only permit ourselves just to add, that although the fancied
existence of some substantive property, whether it be the
■^ux^ of the ancients, or the spirit of animation of Darwin,
or the materia vitez diffusa’^ of John Hunter, must neces¬
sarily lead to nonsense or to nothing; yet we are quite
justified in concluding, that there is a sohiething connected
with vitality, w^hich must ever elude the grasp of human
intellect ; and of which .something we are not brought
an iota nearer the knowledge, by the recent discoveries
in physics and chemistry, than were either the ancient me¬
taphysicians, or the fanatic disciples of alchemic faith.

By the perusal of the last chapter of Sir Charles Morgan’s
work, we must confess ourselves to have been somewhat
disappointed. From the author of the appendices to
Lady M.’s work entitled France,” we expected something
beyond what we found in the present. As far, however, as
the discussion of the rationale of disease does go, there is an evi-
dent indication as well in this as in other parts of the volume
of much acumen and good sense. The following objections
to the principle of considering disease as a something
abstract and tangible in its nature, accords entirely with our
owm sentiments on the same head ; and it would seem suffi¬
ciently obvious to supersede the necessity of enunciation,
were it not that we still find a disposition in some, even
of the best and most learned writers of the day, to conceive
and act as if deviations from health could be substantiated
and parcelled out like so many objects in natural history.

“ Sickness and health (says Sir C. M.) are so often contrasted
with each other, that they have acquired in the imagination a sort

las

Analytical Review,

of substantive character, and are scarcely recognised as mere
expressions of modality. Considered as thingSy in their nature oppo¬
site and contradictory, they are rarely regarded as having any
common connexion, much less as being the results of the same
general laws, as consequences of the same principles of action.
There are perhaps few educated persons who would fall into this
mistake, if the question were proposed to them in its naked abstrac¬
tion ; but there are still fewer, who, in the ordinary occurrences of
life, do not act as if guided by such an error.*'

We question, however, the rectitude of that assumption
which identifies febrile contagions and diffusible
stimuli,” or at least states their operation to be analogous.
This assumption constitutes a fundamental error in
Brown’s Theory of Life and Disease ; and we are surprised
to see so acute and cautious a reasoner as is our author
tending towards the same tenets.

On the vis medicatrix, or presiding principle, Sir C.
makes the following sensible remarks : — •

“ There is a mysticism in this doctrine highly agreeable to feeble
minds, and against which the strongest intellect is not always proof. i
In France, the vis medicatrix forms the basis of professional practice;
and though in England no great respect is paid to it as a guide in the :
treatment of disease, yet it still creeps into general reasonings, and is
occasionally heard from the mouths of theorists and teachers.

“ There is in this doctrine a contradiction implied in the very terms
of the proposition, “ a regulating princijdey subject to irregularity
If there existed in the animal mechanism a curanve principle, the duty
of the physician would cease ; for there could remain no office for
man to perform where nature had placed a sentinel to guard against i
external violence, and a force to countermine and to obviate the-
attacks of the enemy. The proposition of assisting nature, when it is |
slow in its operations, and of repressing it when too violent, is in l
direct contradiction with the fundamental principle of the theory.
Either the vis medicatrix is equal of itself to the preservation of the f
system, and sufficient to its own purposes, or it is a superfluous f
and unwarrantable term, introduced into medical reasonings, without j
ground, and contrary to philosophical logic.*’ !

The following remarks respecting contagious diseases and I

morbid poisons in general, will be interesting to the reader, i
especially under the present circumstances of doubt and |i
uncertainty on the subject of lues venerea, and on the safest i:
and most efficient method of counteracting the effects of \
the venereal poison. j

♦ I

“ The several contagions by which disease is propagated, exhibit \
very many curious modifications of action, depending upon the i
influence of habit. The most remarkable instances are to be found in i
those febrile contagions which attack the same person but once. But \

Hall on the Mimoses.

almost every morbid poison loses -something of its impressive force
in constitutions which have been previously exposed to its action.
Physicians and nurses, who are habitually environed by contagious
atmospheres, are much less frequently the victims of disease than
their exposure to risk should warrant. Not only individuals, but
nations become thus exempt from contagious influence; or at least
suffer less violent derangement from its impetus. The leprosy, for
which so many hospitals were endowed by our ancestors, has dis¬
appeared from Britain as an epidemic : and the typhus gravior
is not only less prevalent, but less fatal in its attacks, than it was a few
centuries back. ' /

‘‘ This is not to be exclusively attributed to the personal immunity
of the moderns. Cleanlier habits and more wholesome diet have
co-operated powerfully towards abating the malignity of this disease.
There is, however, another malady, whose symptoms are undoubtedly
milder than they were on its first appearance in Europe, and with
which the changes of diet, &c. have nothing to do. In this instance,
the alteration can alone be explained by a constitutional case-hardening,
common to the whole generation. It may be questioned, whether
the curability of this disease, without mercury, which has recently
become the subject of experiment, be not a consequence of the
diminished sensibility of the animal to its peculiar poison.’'

Here we must stop ; merely further announcing, that such of
our readers who may, from the slender analysis we have given
of Sir Charles Morgan’s work, be induced to a more thorough
investigation of its contents, will find even in this last chapter
(which we consider the least satisfactory of the whole book,)
some intimations on the theory of medicinal action and
dietetic excitation, which will prove, as far as they extend,
by no means unworthy an attentive perusal.

II.

0;z the Mimoses ; or^ a Descriptive, Diagnostic, and Practical
Essay on the Affections usually denominated Dyspeptic,

. Hypochondriac, Bilious, Nervous, Chlorotic^ Hysteric, Spas¬
modic, By Marshall Hall, M.D, Author of A
Treatise on Diagnosis formerly Senior President of the
Royal Medical Society, and Physician’s Assistant in the
Royal Infirmary, Edinburgh.

One of the most important lessons which the student of
medicine has to learn, is the art of distinguishing betw^een
diseases of function and diseases of structure; and this art
is only to be fully mastered in the school of actual practice.
^ There are, however, general and leading points in morbid
affections, by attention to which the judgment maybe much
VOL, XI, — NO. 62. s >

130

A nautical Review.

facilitated 4n the distinctions alluded to; and we think those
authors deserve well of the profession and the public, who
devote their attention to the combination and concentration,
as it were, of these momentous particulars.

Dr. Hall had already proved himself gifted with an
accuracy of distinguishing powers, by his useful work on
diagnosis; and in the small volume which is now to be
noticed, we meet with additional indications of industry and
discernment.

“ There is a class of disorders, (says Dr. H.) each of which is sin¬
gularly characterized by being complex, multiform, various, and
changeable, and by imitating, from the appearance and predominance
of particular symptoms in particular instances, other diseases very
different in their nature.

“ These affections have been variously and perhaps too exclusively
attributed, by some authors, to a state of derangement in one or more
of the chylopoietic viscera ; and by others to an unequal and undue
distribution of the blood, by which a state of arterial excitement or
of venous congestion is induced in some particular organ, or in some
particular part of the sanguiferous system.

We fully agree with our author, that the ascription of
those complaints by one set of pathologists to vascular, and
by another class of reasoners to ventricular derangements,
is too exclusive;’’ and it is not uncommon to find the whole
frame, as it were, out of joint, without any traceable localities
in the induced derangement : such topical affections, whether
of the circulating or chylopoietic systems, even when they do
occur, being merely incidental consequences of universal
disturbance : but on this head we must not trust ourselves
Imre to enlarge.

With respect to Dr. Hall’s term of designation, we hardly
know whether to approve or not of its selection. Any thing
that wears the semblance of affectation is in some degree
objectionable ; and we have already too many names in
medicine, for what, in strict propriety, are nameless things.
Di seases, as the author last reviewed justly observes, are not
substantive and abstract existences. To talk, then, of

mibiosis ^ as an order, and to sub-divide this order into the
several genera of “ mimosis acuta, chro7iica,^* decolor^**

urgens,^^ and inquieta,” is to imply that the several con¬
ditions which the above terms are designed to represent
iire to be met in a palpable shape, and with an undeviating
regularity. The denomination mimosis, it is hardly necessary
to state to our readers, is derived from the Greek word
fjLifMOi, imitator, and is intended to denote the appearance
without the reality of a specific affection. Thus, should an
individual be the subject of cough, expectoration, and other

Hall on the Mimoses,

ISl

symptoms which at times proceed from puliooiiic disorganiza¬
tion, and yet should such disorganization not be actually
present, the disease would, in the proposed nomenclature
of our ingenious author, be named a mimosis.

Under the head of mimosis acuta, the reader of this
volume will find some very valuable remarks on distinctions
between organic affections of an acute kind, and those
derangements which merely consist in temporarily deranged
functions.

“ The severer form of the mimosis acuta (says Dr. H.) is early
and principally characterized and distinguished by the concurrence
of the following symptoms ; namely, weakness, tremor, fluttering,
faintishness, tendency to perspiration, susceptibility to hurry and
agitation, and loss of flesh.

“ The countenance is rather pale and thin ; the lips are pale, and,
with the chin, frequently tremulous, especially on speaking; the
surface of the face is generally affected with an appearance of oily,
clammy, and swarthy perspiration, especially near the nose; there
is a loss of colour, and usually a degree of sallowness and darkness of
the complexion in general, but principally about the eyes.

“ The tongue is almost invariably loaded ; sometimes only slightly,
whilst its edges are clean and red ; at other times it is more loaded,
swollen, and oedematous, formed into deep sulci or plaits, and marked
by pressure against the contiguous teeth, the inside of the cheeks
being also impressed in the same manner ; the papilloe-of the tongue
are numerous and enlarged; the gums red and swollen; the teeth
and the mouth in general foul, and the breath loaded and foetid : in
a third instance the tongue may, however, be clean, but lobulated,
whilst the internal mouth and breath are little affected. The first
state of the tongue is observed when the affection has not continued
long; the second, when its accession has been particularly slow and
gradual; and the third, when a similar but chronic state of disorder
has long subsisted, and has at length been succeeded by the mimosis
acuta.

“ There is a tendency to perspiration on slight exertion or any
surprise, and sometimes in the night or early in the morning; the
skin is in general cool, rather moist, and clammy. The hands
are apt to be cold ; and the nails occasionally assume a lilac hue.

“ The patient is usually affected with great tremor, observed on
holding out the hand, on carrying a cup of tea, for instance, to the
mouth, on attempting to stand erect, or walk, or on being fatigued
or hurried. The patient is liable to experience faintishness in the
upright position, if sustained for a little time ; and he feels
unaccountably feeble and weary.

‘‘ There is an early and daily loss of flesh. This, as well as the
restoration of flesh during recovery, may be ascertained by weighing,
as exemplified in some of the cases of this affection to be given
hereafter.

13^

Analytical Review.

** The patient experiences headach and vertigo, and he is nervous^
and easily hurried and agitated. There is sometimes heaviness for
sleep ; sometimes great wakefulness and restlessness. There is
almost universally a peculiar sense of fluttering about the heart and
pit of the stomach ; and there is frequently an acute pain in some
part of the course of the colon.

“ The appetite is generally much impaired, and there is often
loathing of food; but sometimes the appetite is even greater than
natural, and there is almost constant craving. The digestion is
various, being sometimes quick, and at other times attended with
great sense of load, distention, flatus, eructation, hiccup, and even
vomiting. The bowels are at first constipated ; afterwards constipa¬
tion and diarrhoea alternate, and sometimes the latter symptom
becomes nearly permanent ; the motions during the constipation are
small, during the diarrhoea scanty, extremely foetid, dark coloured,
often accompanied by blood, and frequently attended by tenesmus.

“ The urine is extremely loaded in the commencement of the
mimosis acuta, but may become perfectly transparent during its
continuance ; it is often high coloured; and, like the other symptoms,
the appearance of this secretion is very liable to change.

“ Besides the symptoms just enumerated, there are others which
prevail more or less in almost every case; but they are, on the whole,
less constant and more diversified ; and of these one sometimes pre¬
dominates so much over the rest, as to engross the attention of the
patient, and sometimes of the practitioner, too exclusively. The
secondary affection is then considered as idiopathic, and the symptom
is apt to be treated as the disease. It is therefore of the utmost
importance to present the reader with the following distinct enumera¬
tion of these symptoms : —

1. Headach, vertigo, stupor, &c. — 2. Cough, viscid expectoration.
— 3. Paroxysms of oppressive dyspnoea. — 4. Palpitation of the hearty
frequency and irregularity of the pulse. — 5. Frequent and violent
hiccup, vomiting of food. — 6. Some convulsive and spasmodic affec¬
tions. — 7* Pain in the epigastric, or one or both of the hypochondriac
or chondiliac regions. — 8. Constipation, diarrhoea, tenesmus. — 9. Me-
licna. — 10. Icterus. — 11. Severe pains of some of the limbs.*^

We have presented the above account of the characters by
which mere functional derangements are marked with a view
at once of doing justice to the author, and because we think,
as before hinted, one of the most momentous concerns for
a practitioner to attend to, both for his credit and his satisfac¬
tion, is that of carefully scrutinizing whether a malady to
which he is summoned, be, if we may so express it, real and
radical, or merely apparent and functional. We would
discard with our author the terms nervous,’’ bilious,” and
the like, as terms which are either too vague to mean any
thing, or else involve an hypothesis which is frequently
without any stable foundation.

Hall on the Mimoses.

133

The following we select from several cases with which
Dr. H. presents us, under the head of mimosis acuta.

July 8th, 1818. — Mr. S. F. aged 22. He had worked during
one year in the lace frame, principally during the night, when he
became affected with the following complaint, about four months
ago. He first experienced an unusual degree of weakness, which
incapacitated him for his employment; he then complained of a
propensity to sweating on any slight exertion or emotion, with pain
of the head, loss of appetite, constipation. See. At first, too, he lost
his flesh rather rapidly, to the amount, as he supposes, of about
14lb. The countenance became palish and sallow, and he was told
he had a liver complaint. The general weakness increased, and
a degree of trembling was observed when he lifted his cup of tea to his
mouth, when he attempted to walk, or underwent any fatigue. — At
present the prolabia are rather pale, the face near the nose is affected
with an oily perspiration, the eye-lids are dark, and the general com¬
plexion is of a palish, sallow appearance. The albuginea is perfectly
white. The tongue is white, loaded, and clammy. He perspires more
than usual on any exertion. He has no headach or vertigo now, and has
had no cough at any time. There is a sense of fluttering about the heart
and stomach, especially on lying down. He says that he is low spirited,
and does not like to be long alone or still. His appetite is still
impaired ; he complains of a sense of load at the stomach, with
eructation, but he has no hiccup. The bowels are open. The
urine was at first much loaded, but it is less so now. He complains
of shifting pains about the limbs. — These complaints have been
nearly stationary lately, the progress they appeared to be making
at first having been arrested. — The patient became gradually better,
after the date of this report, by taking opening medicines, bathingj
and using gentle exercise, with a change of air.’^

When treating more especially of the diagnosis, Dr. H.
remarks, that “ the mimosa acuta, in its severer but simpler
form, has been generally mistaken fov fever ; in its less severe
form it is necessary to distinguish it from insidious organic
disease, and in its complications, the mimosis acuta must
he carefully discriminated from an original and local disease of
the part symptomatically affected’’ W e have some doubts
with regard to the propriety of the first point of distinction,
since it would seem questionable whether the general dis¬
turbance alluded to under the definition, might not, unless
arrested in its course, come soon to be actual and positive
fever. Dr. H. if he admits this, will perhaps reply, that the
same thing may be said in reference to the occurrence of
organic disease, as such disease might come to establish itself
from unchecked functional disorder : but in this last case
a new series of actions would be set up ; while fever, if fever
does occur in the way now supposed, would prove merely
an increase in degree, not a something new in essence.

134 Analytical Review.

Insidious organic disease is to be distioguished, says Dr,
from the mimosis acuta by its dejinite form, and by a
regular, slow, progressive, and almost unvaried course, during
which the patient becomes gradually affected with paleness,
debility, and emaciation, with comparatively little tremor.’’
These circumstances of distinction we wish to point put,
particularly to the junior practitioner, as of the highest con¬
sequence to attend to. If the pulse, for instance, is quick
in mere functional disease, it is not of that unvaried celerity
that marks organic affection ; neither does emaciation in
the former pursue that regular and progressive course that
it does in the latter. The mode of perspiration too, which
we do not find particularly pointed out by Dr. Hall, is very
essential to take into account : in organic disease the sweats
are, for the most part, of a hectic character, but partial,
and of partly regular occurrence, while in mere functional
disturbance the sweats are more irregular in point of time,
and more universally diffused over the body. Let it however
always be recollected, when one particular organ is the medium
by wLich a mimositic affection is displayed, that such affec¬
tion is very apt to terminate in actual organic disease. But
this is by no means invariably the case. Who does not
know, that what are very improperly called sick, or bilious
headachs, last sometimes for years, and then disappear,
without leaving behind them any traces of encephalic dis¬
organization ? and it often requires repeated recurrences of
spasmodic asthma to engender organic 'derangement of the
pulmonary or cardiac tissues^.

With respect to the treatment of the mimosis acuta. Dr.
Hall’s sheet-anchor is constituted by the use of purgatives ;
and as the derangement usualjy occurs as a consequence of
sedentary habits and confinement in impure air, the treatment
comprises “ a particular attention to diet, air, exercise,
bathing, and spunging,”

The following are Dr. Hall’s directions as to the employ¬
ment of cathartics.

“ The medicines I have generally employed have been calomel,
the pil. hydrarg. rhubarb, aloes, senna, the sulphat of magnesia, and
pure magnesia. They must be varied according to the previous state
of the bowels, and to their effect on the alvine evacuation. This
previous condition of the bowels is a state of constipation, of diar¬
rhoea, of tenesmus, or of Melaena.

* Some difference of sentiment obtains on this head, as our readers
will perceive by turning to a very interesting paper on asthma in the
foreign department of the present Number.

Hall 0/i the Mimoses,

135

In the case of constipation an active dose of calomel may be
given; and if its effect is such as was desired, it may be repeated at
first every fifth night, and afterwards once a week, or once in ten
days, always ensuring its operation, if necessary, by a solution of the
sulphat of magnesia in an infusion of senna, or by pills of aloes and
rhubarb. This medicine should also be repeated on the intermediate
days. The object I have ever had in view has been to avoid pur¬
ging, but to induce a large, copious, and consistent evacuation daily ;
and when I have been enabled to effect this, I have considered it at
once as a source and criterion of increased strength or health of the
alimentar}'^ canal. Frequently, however, when the patient is very
feeble and infirm, the medicine appears to accumulate without opera¬
tion, and the effect on the bowels is apt, by a repetition of the dose,
to be extreme: this event may in general be obviated, either by the
administration of a proper enema at the time when the medicine was
expected to move the bowels, or by inserting into the rectum a sup¬
pository of tuffy or inspissated molasses, or of soap and honey, or
other similar substance.’^

We could have wished him to have added to his sugges¬
tions respecting the propriety of occasionally varying the
purgative, some rules with regard to the combination of dif¬
ferent cathartic drugs. Of the utility of uniting several
articles in one prescription, we are disposed to think the
simplicity of modern practice rather too neglectful : certain
it is that a mixture of several is often much more effectual
than the same mass of only one or tw^o ingredients ; and
beside, it is well known that some purgatives display their
agency more powerfully on one, and some on another part of
the intestinal tube.

With respect to the treatment of the local affections which
occur in the mimosis acuta, we do not find any directions on
which it appears necessary particularly to enlarge. Melmna,
without disorganization, Dr. H. tells us, he generally finds yield
to purgatives with pil. hydrag. Our own plan in these cases
of intestinal haemorrhage has been usually a combination
of infusion of roses with sulphate of magnesia and syrup
of white poppy ; a combination which we have scarcely ever
prescribed but wdth the happiest effect.

The mimosis chronica of Dr. Hall answers to the disease
described by most authors under the title of hypochondriasis :

it is denoted by fits of despondency and gloom, of invincible
disinclination for exertion, of pain about the head, sinking of
the precordia, and heat or fulness of the stomach.'"’ The
same marks of diagnosis are to be attended to, mutatis
mutandis, as in the more acute and active state of the com^
^ plaint: and here Dr. Hall particularly points out the absence
of the loss of flesh as one of the principal circumstances of

136

Analytical Review.

distinction between this and organic ailment. With regard
to the treatment, “ as the affection is of longer continuance,' a
more persevering nse of the pil. hjdrarg. and of gentle
purgatives of rhubarb and aloes; and a more constant and
indeed habitual attention to diet, with gentle exercise, are
necessary.

As the mimosis chronica is the hypochondriasis, so is the
mimosis decolor the chlorosis of other authors. ‘‘ This occurs
principally in female youth ; but frequently in married wo¬
men both young and old, and occasionally in the young and
sedentary of the male sex.” — It may be characterized in
general as uniting a morbid state of the complexion, and
generally of the surface, with recurrent pain of the head and
of the side, palpitation of the heart, fluttering and nervous¬
ness, and some tendency to loss of flesh and to oedema.”

Under the head of diagnosis, between the mimosis decolor
and other diseases, we meet with the following remarks, which
are well worthy of attention : —

The state of the complexion, the tinge of surface, and the seat of
pain, in the mimosis decolor, has very frequently led to the suspicion
of chronic disease of the liver. The diagnosis is made by an atten¬
tion to the contrast of symptoms, by observing the state of the con¬
junctiva, urine, and faeces, by ascertaining the recurrent nature of the
pain of the side, and by a careful examination of the region of the
liver. By these means the list of chronic diseases of the liver would
be considerably curtailed, for I can recall at this moment numerous
instances of this error in diagnosis.”

That discoloration of the skin which attends diseases of
cachectic debility and disturbance of function, and which
arises from a torpid inactive state of the circulation and con¬
sequent inaction of the sebaceous follicles of the skin, is too
apt to be taken as an index of hepatic obstruction, and mer¬
cury in consequence given, without the smallest necessity, in
point of fact, for the administration of a particle of that
medicine. The liver is a large and convenient corner for im¬
becility and idleness to resort to upon all occasions. We are
always ready to applaud such authors as have courage and
discernment enough to bear up against the overwhelming in¬
fluence of hepatism, ' -

This mimosis decolor is liable to be complicated with tran¬
sient and continued affections of the head, with sudden and
continued cough and dyspnoea, with palpitation of the heart,
with both transient and protracted pain in the side or abdo¬
men, with Melaena, and with leuchorrhoea ; in all of w^hich
the Practitioner must carefully distinguish by the rules -before
laid down between mere pain and actual inflammation p and

Hall on the Mimoses.

J37

he must, at the same time, recollect the pi'obability of a transi¬
tion from functional disturbance into actual or inflammatory
disorder of organ.

Purging is still recommended in this species of mimosis,
I and there cannot be a question of its great utility; but we
are disposed to think that, with purgatives, steel and other
tonics may be here employed with more advantage than our
author seems to imagine; nay, we are certain that a judicious
use of this class of medicinals may be made to apply in the
disorders now under consideration with especial benefit :
even actual inflammations may be warded off by the induc¬
tion of such a state of permanent excitement as shall overcome
the debility out of which the vascular irritation would other¬
wise grow. For the leucorrhoea connected with the mimosis
decolor. Dr. H. recommends a continued local application of
sulphat of zinc, in the proportion of from one to twm drams
and a half to a pmt of pure water. The way in which this
application is continued is by a scroll of linen, made of a form
and bulk nearly sufficient to fill the vagina, this scroll being
fully embued with the solution mentioned. We were sur¬
prised to find no notice taken of that very efficacious medi¬
cine the tinct. lyttae in these complaints.

The mimosis urgens is the fourth division of Dr. Hall, and
this is more like the hysteria of authors; it is denoted by
sighing, sobbing, tears, or laughter, with a sense and expres¬
sion of suffocation, and with some urgent affection of the head,
heart, respiration, stomach, or muscular system.’^ Spasmodic
affections are here especially frequent, and the disorder is
marked, as the author well expresses it, by hurry and ur¬
gency.^’ Inflammations are in this case likely to grow out of
the spasms, and it requires sometimes much nicety to distin¬
guish which is the actual state of parts. At this moment w'e
have a patient under treatment who had been verN^ injudi¬
ciously, taking steel for supposed spasms; a complete diapho-
ragmatis was engendered, but it was found necessary to go very
cautiously to work with anti-inflammatory measures, as their use,
even in a regulated and necessary measure, actually brought
on very distressing spasms. In this state of things alarm is,
however, apt to be more than commensurate to danger ; and
sometimes, as Dr. Hall observes, the trachea becomes so vio¬
lently seized as to deceive a cursory observer into the suppo¬
sition of actual croup.” — The attack of the mimosis urgens
is relieved by aether, sp. ammoniae comp, (arom.) opium, &c.;
by stimulating liniments; b}" fomentation with hot water;
and if necessary, by blood-letting. The prophylaxis consists
in removing the original disorder, and especially in the due
administration of purgative medicines.” ,

VOL. XI, - NO. f)2. T

Analytical Reviez^.

Under the head of mimosis inquiela (the last of our author s
divisions) is included, a continual restlessness ; wakefulness;
delirium ; continued, rapid, and hurried breathing ; frequent
dry cough ; a sense of fluttering and hurry ; some spasmodic
affection; hiccough; and great frequency of pulse.” — “ Ihis
state may sometimes be merely the effect of derangement in
the digestive organs ; sometimes it implies some obscure dis¬
ease, as its cause ; (query, is it then proper to apply the term
,to the state sometimes it arises from the too copious action
of a purgative ; or from too copious blood-letting; audit is
sometimes the precursor of dissolution.” In the first case

a purgative is the remedy on which most reliance is to be
placed.”- — In the case of an obscure disease, it is plain that
this must be removed before relief can be obtained.” — In
the other cases the tinctura opii, the sp. ammonise comp,
wine; stimulating liniments; proper fluid nourishment, cau¬
tiously given wdth wine; bathing the face with cold w^ater ;
the effervescing medicine ; fanning, and a free air, are the
principal remedies.”

We deem the symptoms characterizing this state impor¬
tant to take notice of, both on account of prognosis and prac¬
tice. It is usually the forerunner of death after protracted
disease ; and we think it at least questionable, wdiether by a
bolder and more copious administration of the diffusible
stimuli, of wine, cordials, ammonia, &c. the vital principle
might not oftener than it is be preserved from sudden ex¬
tinction.

We now close the little volume, the substance of which we
liave endeavoured to present to our readers, with sentiments
of much respect for its author. Patience in investigation, and
accuracy in distinction, are among the most useful attributes
that can belong to a Physician; and these qualities Dr. Hall
evidently possesses in no inconsiderable measure.

The Hospital PiipiFs Guide, being Oracular Communications, ,
addressed to Students of the Medical Profession : including
plain and useful Directions relative to the best mode of At--
tending to the various Branches of Medical Study. To i
which is added, an Account of the Days and Hours of Attend¬
ance of the Physicians and Surgeons at St, Thomas’s and \
Guy’s Hospitals. By ^sculapius.

We are pleased to see our old friend ^sculapius make his \i
second appearance on the stage. W^e recollect being im¬
pressed with the good sense and useful remarks contained in i

139

Tlospilal Pupil' $ Guide.

this little manual at its first appearance; and vve are glad
to find that it has been so well received by our young students.
In now noticing it we wish rather to recommend than to super¬
sede its perusal ; and, indeed, it is of a nature not susceptible
of analysis. VVe cannot, however, refrain from presenting to
our readers the follow'ing extract from its pages, which will
sufficiently prove, without any further comments of our own,
both the juogment and good taste of the wn’iter : —

“ Medical science and medical practice claim the unwearied atfen-
tion of the student. And here, Gentlemen, I must be permitted to
caution you against blindly adopting any system of opinion or prac¬
tice which may be taught in the schools to which you may be re¬
spectively and more immediately attached; this would be to degrade
you to the ranks of empiricism. Think for yourselves. It generally
happens, that systems are carried to extremes by their authors; and
that, however valuable and excellent they may be in the hands of
judicious Practitioners, they will invariably prove hurtful when acted
on by those who embrace the dogmas of the Professor without
thought, and without discrimination; and who in the loneliness of
their minds find only one uniform spectral impression ; even the illu¬
sion occasioned by the coruscations of genius ; perceived through the
vapour of a clouded understanding, and reflected upon an eye already
tinged with the morbid hue of prejudice, already distorted by the
obliquity of the judgment. Be it yours. Gentlemen, to judge, to
examine, to determine for yourselves: listen to the system of ^mur
Lecturer, adopt it, act upon it: but preserve your independence, and
be not enslaved by it. Enlarge your minds by perusing other sys¬
tems, and contrasting these with that you have been more immedi¬
ately taught : and amidst every contradictory and favourite hypothe¬
sis, maintain your own liberty of thought and action, dismiss the
prejudices of education, and bring the decisions of your cool and in¬
formed judgment to the test of experience.

Let your conduct be the same with regard to medical practice ;
recollect, in fact, that ye are men of intellect; you go to learn, not to
imitate; you seek instruction, and not a mechanical capacity of
writing a prescription. Allow me to introduce one other caution.
Do not expect to meet with disease at the bed-side, as you see it in
the theatre, or in your study. Here you are presented with abstracted
cases of well defined disease, cases in which every symptom, not
necessarily pertaining to the specific morbid action, is omitted. But
in practice this is comparatively rare, and hence you will frequently
be at a loss how to define and classify disease; and if you be a sys¬
tematic Practitioner, you will scarcely know how to direct the appro¬
priate remedy, since you have been accustomed to connect a regular
train of symptoms with certain constant organic lesions, and these
have hitherto been associated in your minds with a certain class of
materia medica. But it will not do, CJcnllemen ; it is first principles
you have to acquire; it is the soul of physic you have to obtain.
Practice and reficctioii will build up the body to maturity, and make

140 Analytical Review,

the perfect man. Be therefore greedy of medical lore, and steal evefy
half hour you can obtain for this important purpose.’"

The following is ^sculapius’s plan of study for those young
men whose destination is two years" studj^, and subsequently
■general practice : — •

“ PLAN OF STUDY.

FIRST YEAR.

Winter. — Anatomy and Dissections; Surgery and Hospita
Practice as Surgeon’s Pupil ; Physiology ; Chemistry; Theory and
Practice of Medicine,

“ Hospital Practice ; diligent Reading; Midwifery;

Botany.

“ SECOND YEAR.

“ Winter. — Anatomy and Dissections; Surgery and Hospital
Practice as Dresser for six months; Physiology; Chemistry; Theory
and Practice of Medicine.

“ Summer. — Hospital Practice ; ditto as Physician’s Pupil for six
months ; diligent Reading ; Midwifery and Botany.’"

W e find that it will be necessary to revert to the plan of
our predecessors, and again give half yearly Retrospects of
Medical Literature; as the space we can allow for Analysis
is insufficient for the notice of all the medical works w hich
issue from the press during the year. It is intended, then, for
the future, that the July and January Numbers of the Repo¬
sitory shall each contain the preceding six months’ general
Review; and w^e shall defer our proposed chemical, meteorof
logical, and nosological abstracts till the close of the six
months from January ; commencing them in separate divisions
and tables from the time of the last report respecting them.

PART m.
SELECTIONS.

Observations on the Medico-Chemical Treatment of Calculous
Disorders. By W. T. Brande, Sec. R.S., &c.

{From the Quarterly Journal of Science and Arts.)

If there be any branch of physic which can be called philo¬
sophical, it is that which relates to the treatment of calculous
complaints; for in it the offending substances can be col¬
lected and analysed, and the effects of medicines unequivocally
judged of by their increase, change, or disappearance.

There are very few cases in which chemical principles are

Brande 07i Calculous Disorders.

141

successfully applicable to the treatment of disease ; but tlie
only rational observations which have been given to the public
concerning the causes and treatment of these affections, have
originated with Chemists and chemical Physicians. Of the
remarks of Paracelsus, Van Helmont, Stahl, Boerhaave, and
others of their school, it will be unnecessary to say more than
that they are vague, incorrect, and absurd ; though Fourcroy,
with that useless diligence which characterises many parts of
his great work, has laid more stress upon their notions than
mere historical relation required.

In 1776 Scheele pointed out the existence of a concrete
acid in urinary calculi ; and that illustrious Chemist may be
considered as the first writer whose observations on the che¬
mical constitution of calculi are entitled to any notice. In
1798, Dr. Pearson prosecuted the inquiry which Scheele had
opened ; and his researches were published for that year in the
Philosophical Transactions. But it was in 1797, that the
most important addition was made to our knowledge upon
this very important subject, by the publication of a masterly
paper by Dr. Wollaston, in which we are not only made ac¬
quainted with the existence of several new substances in
urinary calculi, but also with some highly valuable facts re¬
specting the treatment of cases in which they occur. Yet,
with this light upon the subject, medical and surgical Prac¬
titioners remained, with few exceptions, grossly ignorant, and
continued to graft their own erroneous views upon the errors
of their predecessors : they neglected the valuable body of
chemical evidence which had been adduced, and till within
these few years scarcely any person appeared moderately in¬
formed upon the subject, apparently for the want of some
connected and popular view of all that had been done, so
digested and arranged as to be intelligible to medical men.
This desideratum Dr. Marcet seems to have supplied, in his
Essay on the Chemical History and Medical Treatment of
Calculous Disorders; and the medical world, as well as the
public at large, should feel much indebted for the perspicuous
and useful manner in which he has fulfilled his task.

The object of the present essay is to throw the most im¬
portant facts connected with the chemico-medical treatment
of these disorders into a yet more popular form, with a view
of exciting attention to the simple principles of their early
treatment, and of showing the dangerous consequences of de¬
laying an easy prevention, where cure is impossible, except
by the manual operation of the Surgeon.

In the year 1808 I undertook, at the request of Sir Everard
Home, to examine the collection of urinary calculi contained
jn the splendid Museum of the College of Surgeons ; and the

142

Selections,

observations which that examination suggested, were pre¬
sented to the Royal Society, with the addition of some
valuable remarks by Sir Everard Home, and the - whole
honoured by a place in the Philosophical Transactions for
1806. In some subsequent papers also presented to and
published by that learned body, we have jointly prosecuted
different branches of the same inquiry; and in the present
digest, 1 propose to give a sketch of ail that is important in
these papers, illustrated by such other facts and observations
as have since presented themselves.

Some General Observations on the early Symptoms of Gravel,
and on the Modes of treating them.

- -

It is of the utmost importance that the early symptoms of
gravel should be carefully attended to; for we are often able,
with little difficulty, to check their progress, and to form
useful anticipations of the probable duration and extent of
the complaint, it is in this stage, and this only, that we may
rationally speak of solvent medicines ; and that it is really in
our power to prevent that kind of accumulation which ends in
stone either of the kidney or bladder. The only medical
writer who has candidly and sensibly discussed this very im¬
portant j)art of our present subject, is, as far as I know, Dr.
Marcet, in the last chapter of his valuable essay already quoted;
but as my own views upon this subject differ in some points
from those which he has there propounded, 1 shall beg leave
to state them in general terms.

It is necessary to bear in mind, that of the numerous sub¬
stances contained in the human urine, there are rarely more
than three which make their appearance in the form of deposit
or gravel; these are phosphate of lime, phosphate of ammonia
and magnesia, and uric acid. The two former substances con¬
stitute a Tchite sediment, the latter forms a red deposit; and it
is above all things necessary clearly to distinguiffi between the
two, and not to confound them, as many practitioners are apt
to do, under the general name gravel, or sand. The urine,
in its healthy state, is alwuiys an acid secretion ; and this excess
of acid retains the earthy salts, above alluded to, in a state of
solution ,• but whenever this inherent or natural acidity of the
urine is diminished, whether by disordered digestiou, irregular
secretion, particular kinds of food, or improper medicines, a
tendency to form the white deposit immediately ensues. When,
from any cause, this white sand is observed, the internal use of
acids will, in most cases, diminish or remove it ; this is a fact

of the utmost importance in its treatment, for which we are

143

Braude 0}i the early Symptoms of Gravel.

indebted to the discoveries of Dr. Wollaston, in this branch
of chemical medicine.

Concerning this white sand, there are two questions of im¬
portance. The first relates to the circumstances of its appear¬
ance ; the second to the mode of treating it.

W hite sand is very frequently symptomatic of disordered
digestion, and is apt to appear in any case where excess in
eating or drinking has been committed. It often seems to be
produced by the free use of amylaceous or farinaceous diet.
It may always be abundantly formed by alkaline medicines,
and persons who habitually?- drink soda water, or take magnesia,
are frequently voiding it. Its appearance, in the latter cases,
has often led to serious errors. 1 have known soda water
exhibited in a case of stone in the bladder, produce abundance
of white sand, which the ignorance of the patient and his me¬
dical attendant led them to refer to the solvent pow'er of the
medicine upon the stone, which they thought was gradually
giving way and being voided ; whereas, great mischief was
doing, by giving the urine more than its usual tendency
to deposit the phosphates, and consequently to augment the
size of the calculus ; for it deserves particular remark, that
the urine has a natural tendency to deposit the above-men¬
tioned phosphates upon any extraneous body in the urinary
passages, and often upon the inner coat of the bladder, if it be
at all diseased.

The use of magnesia will also occasion the deposit of the
phosphates by the urine ; and I have heard the white sand
described as magnesia passing off by urine.

The tendency of the urine to deposit white sand whenever
its natural acidity is diminished, is shown by the addition of a
little alkali to recently voided urine, which immediately throws
down a white powder.

The acids naturally in excess, or uncombined, in healthy
urine, and which may be regarded as holding the earthy phos¬
phates in solution, are the phosphoric, the uric, and the car¬
bonic. Berzelius has stated the lactic acid to be one of these,
but my own experiments do not induce me to coincide in the
opinion of that active chemist. Dr. Marcet has controverted
my idea respecting the uniform presence of carbonic acid,
(Essay, page 159, note,) but, whenever I have made the expe¬
riment in the way he mentions, that is by exposure under
the exhausted receiver of the air pump, I have procured it in
some quantity ; and whenever 1 have added baryta water to
recently voided urine, the precipitate, immediately separated,
has contained carbonate of baryta.

The appearance of white sand does not seem deserving of
much attention where it is merely occasional, and where it

144

Selections^.

follows indigestion brought on by accidental excess ; ifj, how¬
ever, it invariably follows meals, and if it be observed in the
urine, not as a mere deposit upon cooling, but at the time the
last drops are voided, it becomes a more serious disorder; for
it is sometimes the forerunner of other forms of the disorder,
sometimes it creates much irritation, and sometimes may even
collect and concrete into a calculus, more especially if the
complete evacuation of the bladder does not take place. I have
known it considered as the effect of irritable bladder, where it
has, in reality, been the cause.

In these cases then, the best mode of treatment, both for
cure and prevention, becomes the next subject of inquiry ; and
acid medicines are, in most cases, properly and effectually
resorted to. It will first be right to consider the kind of acid
most effectual, and afterwards to notice cases in which acids
are hurtful.

(To be continued in our next Number.)

On White Arsenic. By Dr, Paris.

’ {From the Quarterly Journal of Science and Arts.)

After the various controversies upon the subject of arseni¬
cal tests, it is not a little singular, that the discordance which
exists in the different chemical works of authority, upon one
of the most important characters of arsenious acid, should
have escaped animadversion. Does the arsenious acid, zchen
volatilized, yield, any alliaceous or peixeptible odour ? The fact
is, that unless the arsenical vapour be deoxidized by the pre¬
sence of some body which has a powerful affinity for oxygen,
it is perfectly inodorous, the alliaceous or garlic-like smell
being wholly confined to metallic arsenic in a state of vapour ;
such a deoxidation takes place when the arsenious acid is
thrown upon ignited charcoal, or when heated in contact with
those metallic bodies which readily unite with oxygen, as anti¬
mony, tin, &c. It is stated by Orfila, and other chemists, that
if it be projected upon heated copper, the alliaceous odour is
evolved ; this certainly takes place if the copper be in a state
of ignition; for at that temperature its affinity for oxygen
enables it to reduce the arsenious acid ; but if a few grains of
this substance be heated on a plate of copper, by means of a
spirit lamp, or a blow-pipe, no odour is perceptible, for the
whole of the acid is dissipated before the copper acquires a
sufficiently exalted temperature. If the arsenious acid be
heated on a plate of zinc, the smell is not evolved until the
zinc is in a state of fusion ; if, instead of these metals, we em¬
ploy in our experiments, gold, silver, or platina, no alliaceous

145

yiuture and Causes of Asthma f

smell whatever is produced. The practical application of these
facts, and their extreme importance in medical jurisprudence,
are so obvious, that no apology is necessary for troubling you
with a detail of them. Mr. Faraday has obliged me by re*
pealing them in the laboratory of the Royal Institution, and
with results similar to those which I have stated.

PART IV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

PATHOLOGY (INCLUDING MORBID ANATOMY) AND
PRACTICE OF MEDICINE.

I. Asthma, — Ow the very important question whether
the asthma of aged subjects be really a nervous affection f a
Memoir, alike distinguished by the ability and candour with
which it is written, has lately been published by M. Rostan*.
The abstract which w^e are about to give, will embrace all
its more prominent and essential features.

The physicians of antiquity, destitute of the light of anatomi¬
cal inspection, were but little acquainted with the morbid altera¬
tions of the internal organs. Their pathology was restricted to
the rigorous observation of symptoms ; and in this they have
indeed left models worthy of our imitation. To certain
assemblages of morbid phenomena were applied names
expressive only of such assemblages, and not of any alteration’
W'ith which they were connected. Thus, by most of the
names transmitted to us, external phenomena only are
expressed. On the same principle, difficulty of respiration
has been designated asthma, without regard to the different
lesions whereby it may be occasioned. The physicians of
succeeding ages trod in the steps of their predecessors ; and'
when a more enlightened system of philosophy at length
allowed the bodies of the dead to be converted to the service
of the living, a mistaken respect for established opinions
threw its darkening film over the eye of the observer.
Medicine, however, has shared the salutary influence of that
severe spirit of inquiry which, within the last fifty years,
has been introduced into the study of the other sciences, and
communicated to them such a mighty impulse. Without
retracing the splendid discoveries of morbid anatomy, modern

* Nouveau Journal de Medecine, Septembre, 1818.
— NO. 6^.

VOL. XI.

146

Foreign Medical Science and Literature.

medicine may be certainly regarded ay indebted to them for
the certainly of diagnosis, and the general superiority of cha¬
racter which it so strikingly exhibits. And if, as cannot be
doubted, the facility of cure is proportioned to our know¬
ledge of a disease, anatomical inspection must indeed be
fraught with inestimable advantages.

It is probable that the empire of nervous diseases, to
which all morbid phenomena of obscure character are at
present most conveniently referred, would be daily circum¬
scribed by a patient and laborious attention of professional
men to anatomical researches. But the fatigues of practice
and the prejudices of friends frequently oppose an insupexable
obstacle to them in private situations ; while, in hospitals,
the subjects of nervous aifections rarely sojourn longer than
is necessary for the cure of the acute disease for which
they have been admitted ; and are afterwards irrevocably
lost sight of. But it is otherwise in those receptacles of the
aged, where the inmates, terminating their existence, are sooner
or later submitted to the necessary examination. Of the
opportunities afforded by his situation in a large establishment,
which is devoted to the reception of the aged and infirm,

M. Rostan has availed himself to observe and register the
facts, and establish the opinions, about to be developed.

Previously to the exposition of these views, M. Rostan
thinks proper to take a rapid retrospect of the symptoms of
nervous asthma, as delineated by Pinel and Cullen. These
we need not retrace. The same general phenomena, he
observes, characterize the cases about to be recorded ; and
dissection will show the organic changes from which they
have resulted.

Asthmay dependent on ossification about the hronchicCj and
on aneurism of the left 'oentricle of the heart.

A female idiot, aged 6l, had, from the period of 1812,
attracted notice on account of periodical dyspnoea, which j
constantly recurred in the winter ;'^and which, although so (
violent during the night as to menace suffocation, completely ^
disappeared in the morning. Respiration was performed f
with a hissing rattling sound ; the face livid, violet, and J
covered with cold perspiration. The patient assumed a i:
sitting posture: her head seemed sunk into her chest. M
Antispasmodics invariably afforded a transient relief. During
summer the woman continued perfectly well. In 1817, the e
attack was unusually severe. Respiration was noisy and ib
convulsive. Neither cough nor expectoration existed. The ?
symptoms occurring towards evening were dreadfully aggra- i
vated during the night. No palpitations of the heart; pulse
frequent, regular; countenance livid, swollen ; position sitting, j y.

Nature aud Causes of Asthnta 7 147

M'ith the head bent forward on the thorax, and the latter on
the knees ; limbs oedematous.

March 19th. The sitting posture no longer tenable from
debility. The patient lies on the right side.

21st. Respiration rattling. The patient reclines on her
back ; features shrunk and decomposed. Death on the
morning of the 2,Sd.

Dissection. — Externally no emaciation; neck very
short. Thorax. — Right side.^ Old ligamentous adhesions
at the inferior part ; effusion of three pints of serum ; lung
in a state of congestion. — Crft side. Stronger adhesions
with less fluid ; lung gorged. Bronchia? red, and their
mucous membrane thickened; bronchial glands much en¬
larged ; and several ossifications, of the size of a bean,
around the bronchia. — Heart. Left ventricle greatly thick¬
ened ; the aortic orifice contracted. i\bdomen sound.

Asthma y dependent on ossification of the aorta, with active

aneurism of the left ventricle.

A woman, aged 74, who for 18 years had been asthmatic,
experienced every winter an evening fit of suffocation wLich
continued during the night. In the winter of 1817, great
anxiety was induced by a severe moral affection. Her
symptoms, on a morning visit, were then frequent, moaning,
noisy respiration ; cough, with debility and white opaque
expectoration ; feeble pulse; little palpitation ; violet-coloured
face, with slight oedema of its right side. Head bent forward
on the sternum, but inclining to the right; position sitting,
with the body supported on the right elbow. The thorax
was every where sonorous. The dyspnoea growing worse,
the woman died on the 30th of March.

Dis SECTION. — Externally. Body slender; countenance
pale; no swelling. — Thorax. — C^eft side. Some adhesions;
lung crepitous but somewhat gorged with blood. — Right side.
Inferior lobe of the lung hepa^ized and grey-coloured ; an
albuminous membrane on the pleura ; and beneath this
membrane white and almost cartilaginous scales ; bronchije
red and injected. Heart small, but much indurated ; cavity
of the left ventricle greatly diminished ; its parietes thick¬
ened, and the orifice of the aorta contracted; points of ossi¬
fication in the vessel and its valves. The hepatization of the
lung had probably'^ taken place subsequently to the trial of
the thorax by percussion.

Asthma, with appearance of an advanced organic affection oj
the heart ; and the symptoms of which completely subsided.

A woman, aged 70, and previously healthy, was admitted
into the infirmary on Dec, 20'th, 1S16, on account of nocturnal

14B Foreign Medical Science and Literafure.

attacks of suffocation. It yielded in about a month to ihc
employment of antispasmodic remedies. But in March the
anxiety, suffocation, and orthopnoea, recurred with increased
violence ; and with these symptoms were combined oedema
of the lower limbs ; gangrene of some parts of the surface,
to which blisters .had been applied; bloody and brownish
expectoration; small intermittent pulse; palpitations; pale¬
ness of the face, with violet lips ; and extreme debility. The
final struggle seemed to be approaching, when all the symp¬
toms, with the dyspnoea, the disturbance of the circulation,
and swelling, gradually subsided; and on the 18th of April
weakness alone remained. During summer, this patient for
a short time quitted the infirmary; but the disease recurred,
and proved fatal in December following. Dissection showed
the existence of active aneurism, with ossification of the
aorta. The lungs were sound. The stomach w'as cancerous,
with polypous vegetations in its lesser curvature. The
intestinal canal had a minutely injected appearance.

Asthma, dependent on active aneurism of the right ventricle;
resulting, itself , from malformation of the thorax.

A wmman, aged 71? of small stature, and with depression
of the right side of the thorax, had been subject to paroxysms
of dyspnoea, during winter, as long as she could recollect.
They had hitherto always yielded less to medical treatment
than to the influence of a more genial season.

On the 22d of March, 1817, suffocation was menaced
during the night; and there was cough, with expectoration
of frothy mucus. The left region of the thorax sounded
obscurely on percussion. The pulse w'as unequal and
irregular. No palpitations. The appetite was lost; urine
suppressed ; and debilit}^ extreme. The face was livid and
swollen ; and limbs oedematous. Death took place on
the 24th.

Dissection. — Externally. Tolerably plump; lower
limbs swollen; chest narrow, elongated, and depressed on the
right side. Thorax. — Right side. Lung small, gorged with
blood, covered with violet spots, and crepitous ; four ounces
of fluid in the cavity. — Left side. A pound of serum ; lung
small, gorged, and crepitous ; bronchise red. Heart dilated,
voluminous ; left ventricle natural ; aortic orifice somewhat
contracted; parietes of the right ventricle half an inch in
thickness. Abdomen sound.

Asthma, proceeding from ossification of the aorta, with
dilatation of both ventricles of the heart.

A woman, aged 75, who for some years had been subject
So nocturnal fits of dyspnoea, during winter, was admitted

149

Nature and Causes of Asthma'^

itito the iuiirmary on the 2 1st of February, 1817, witli
difficult and frequent respiration, cough, and mucous, and
sometimes bloody expectoration. The chest was without
pain, but it sounded obscurely in the right and posterior
region. There were occasional palpitations ; an irregular,
unequal, and intermitting pulse; and oedema of the right
side, and particularly of the corresponding leg ; and flushed
countenance. The patient lay on her right side ; her sleep
was broken by cough, anxiety, and tits of suffocation. After
I lingering six weeks, with slight variations, she expired in a
paroxysm on the 30th of March, exhibiting the symptoms
of disease of the heart in its last stage.

I Dissection. — Exterior. Veins of the face and neck
injected; general dropsy; thigh of a violet colour; vesicles
filled with serum. Thorax. — RiAit side. Adhesion of the

pleura and lung in their two superior thirds; effusion of fluid
in the inferior part; lung crepitous, somewhat gorged
bronchiae red and inflamed. — Leftside, No adhesions, and
little effused fluid. Heart voluminous, soft; both ventricles
dilated ; the aortic valves ossified ; the aorta exhibiting
depositions of bone, of several lines in extent. Abdomen.
Internal surface of the stomach violet-coloured, brownish;
small intestines red.

Asthmn, dependent on chronic pleurisy and active aneurdsm of

the right ventricle of the heart.

A woman, aged 6 1, had been for fifteen years subject to
evening paroxysms of suffocation, orthopnoea, and anxiety,
during the winter only. They were unaccompanied by
i palpitation. In March, 1817, she sustained her last and most
severe attack of these symptoms, with pain in the right region
i of the chest, and dropsical swellings of the limbs, face, and
I abdomen. Frothy blood of a bright red colour at first, but
1 ; subsequently blackish, had also been for six weeks expec-
i ! torated ; when on the’lSth of April she died.

Dissection. — Thorax. — Right side. Lung strongly
’ adherent to the pleura by^ numerous layers of albumen, dis-
{ posed one upon the other, and some of them so solid as to
; I lacerate the lung on separation. The lung, greatly reduced in
i volume and flattened, contained no air. Some encysted
•' \ tubercles occupied its indurated posterior part. The pleura
! was here and there red from congestion. The cavity con-
;|| tained a small quantity of reddish fluid. Heart greatly en-
'] larged, and remarkable dilatation of the right ventricle, with
il its parietes exceedingly thickened. Bronchiae red, and con¬
i' taining, particularly towards their ramiflcations,- a bloody
i I mucus. Abdomen sound.

i ;

I ■

' ’ll

150 Foreign Medical Science and Literature,

Active aneurism of the hearty and particularly of the ’ left

ventricle ; and other morbid changes^ giving rise to the

phenomena of periodical asthma.

A woman, of 75, who described herself as asthmatic, had
been subject for an indefinite period to attacks of suffocation,
requiring medical assistance every winter. They occurred
night and morning. The anxiety and dyspnoea had been
unusually violent during the preceding winter. On the 25th
of March, 1817; the woman was carried off by asthenic
peripneumony.

Dissection. — -Thorax. — Right side. Strong adhesions,
of a remote date, over the whole costal surface of the lung ; a
soft, recent, albuminous membrane of a diaphragmatic
surface; the two inferior lobes presenting a grey and red
hepatized aspect.- — Lft side. Strong adhesions over the
whole circumference of the lung, which was gorged with
blood, but not hepatized. Bronchiai red and thickened.
Heart enormous; both ventricles considerably thickened,
particiilarlj'^ the left, the parietes of which were more than an
inch in thickness. Patches of ossification, some of them nearly
an inch in diameter, deposited on the aorta, beyond the origin
of the subclavian arteries. No disease in the abdomen.

To these cases may be added most of those cited by M.
Rostan, in his late Memoir on the Distinction of Aneurisms
of the Fleart into active and passive^:” as, first, that of a
woman named Diimay, whose dyspnoea came on in a morn¬
ing, but subsided during the day ; and in whom was found, on '
dissection, an active aneurism of the right ventricle : secondly, ,
Chevillard, reported to have been asthmatic for twenty-eight ;
years, and affected every winter with nocturnal fits of dyspnoea ;
who exhibited, on dissection, a similar organic change : thirdly, ^
Malhere, who for fifty years had been subject in wdnter to c
dyspnoea, aggravated at evening and night; and on whose o
decease an enormous enlargement of the heart was disco« k
vered : and, lastly, Duvourdy, who offered all the symptoms ^
of asthma, of which chronic pleurisy and active aneurism of )c
the right ventricle were found to be the cause.

* Nouveau Journal de IMedecine. Avril, 1818. The object of jo
this very instructive Memoir is to prove, that the causes which have ov
been assigned as productive of active aneurism, or dilatation with jit
thickening of the parietes of the heart, and passive aneurism or diiata- isl
lion with wasting of the parietes of the organ, and the signs respec- ps
lively attributed to these different lesions, by Professor Corvisart, are jn
by no means the result of constant experience : in fact, that the several (jjsi
particular species of organic disease to which the heart is obnoxious, f.u
exhibit during life no distinctive signs which may be relied upon as
positively diagnostic. See RErosiTORV, Voi. X. page 496'. j

151

Asthma usually an Organic Affection,

By modern writers on the diseases of the thorax it has been
observed that most of these affections are commonly mistaken
for asthma. Both Baumes and Corvisart^ express astonish¬
ment at the frequency of this error : and Bayle confirms the
opinion entertained by M. Rostan, that dilatation of the right
'ventricle causes shortness of breath and habitual dyspnoea.
To the development of this truth the present memoir is de¬
voted. Even Cullen, it is curious to see, remarks that asthma
may terminate in pulmonary phthisis or hydrothorax, and
commonly proves fatal by occasioning aneurism of the heart
and large vessels^;. Yet he seems not to have suspected that
the asthma was merely the first degree of these affections.

; The preceding facts, in M. Rostands opinion, inconteslibly
prove that the symptoms attributed to asthma depend on a
morbid change of the respiratory or circulating organs. All
the asthmatics examined by him during the last seven years
have invariably presented some of these lesions : and his
; situation at la Salpetrihre is represented as singularly favour-
i able to such researches. In all the cases just cited the pro-
; gressive development of the symptoms had been for several
I years vigilantly watched. During severe winter nearly four-
! fifths of the inmates of the wards suffer from dyspnoea. In
summer tl^ese affections disappear, to return with the cold
j season. Deaths then frequently take place, and lead to the
; discovery of the lesions in question. A few persons in whom
I the disease has attained its last stage experience no remission
I during; the summer. These suffer also in the day time.

! Hence it may be concluded that periodical asthma is only the
j commencement of the organic affection, and that the symptoms
j become continual in its more advanced stage.

Many objections, M. Rostan is aware, may be started to the
correctness of his inferences from the preceding facts : and
his memoir is concluded by a very fair exposure, and attempt
at refutation of them. The more prominent features of the
discussion respecting the nine objections w'hich he has stated
I and examined, will be preserved in the ensuing rapid outline,

1 . Ossification of the aorta in aged persons, here represented,
as the most common cause of diseases of the heart, and conse¬
quently of asthma, is, it may be objected, the inevitable result
of the progress of age, and hence a physiological phenomemni
rather than a disease, and that the subjects of vascular ossifica¬
tion frequently exhibit during life no symptom of its exist¬
ence. — But ossification of the aorta is surely not less a disease
than the opacity of the crystalline observed in advanced age.

* See their respective Traite de la Phthisic Pulinonaire; and
Traite des Maladies du Coeur.

t First Lines. Vol. II. page 227. Edinburgh edition, 1803.

]5'2 Foreign Medical Science and Literature,

It produces ebaiiges in the heart and vascular system whicfa
destroy life. i\nd if, as very rarely happens, it produce no-
disturbance in the respiratory or circulating organs, the same
absence of all external phenomena is sometimes observed in
deep-seated lesions of the lungs, stomach, and other viscera.
Yet who ever doubted the commonly fatal consequences, of
pulmonary tubercles or gastric scirrhus? M. Rostan has pre¬
served a large osseous tumor which had been developed in
the substance of the liver, without giving rise to any pheno¬
menon indicative of its existence during life.

£. Ossifications of the large vessels exist almost univermlly in
old persons. — Hence they almost invariably suffer from dysp¬
noea during winter : and no objection is constituted by this
frequency.

3. Persons affected with asthma have sometimes been cured.-—
Never in old age. Some, after having exhibited the symp¬
toms, have indeed experienced a remission, and died of other
disease ; but the organic affection was still discoverable. The
absence of all symptoms in this interval is explicable in the
same way as that which takes place in other latent diseases.
A woman under the care of M. Rostan, aged thirty-four, and
who for three years had displayed all the signs of cancer of
the stomach, and had attained the last stage of emaciation,

, gradually recovered ; and remained during twenty years in a
state of apparently perfect health. At the age of fifty-four
vomiting of a blackish matter reappeared, with an evident
tumor in the epigastric region, and terminated fatally in three
months. On dissection the stomach, liver, pancreas, and
omentum, and adjacent organs, were found implicated in an
enormous ulcerated cancer.— -Even admitting the 'occasional
recovery of asthmatics, it is probable that incipient organic
diseases of the thorax may sometimes disappear in young or
middle aged persons; in the same way as intestinal tumors
and aneurism admit of a spontaneous cure.

4. On the examination of some asthmatics ?w morbid altera¬
tion has been discovered. — This may be the result of negligent
or superficial inspection ; and is directly and invariably con¬
tradicted by Rostan’s experience: no welHauthenticated ex¬
ample of it is on record. The Sepulchretumj indeed, contains
the history of a man subject to dyspnoea, in w'hom after
death nothing was discovered, but considerable thickening of
the parietes of the left ventricle of the heart! Moreover, pe¬
riodical asthma being only the first degree of an organic
affection, the latter may be sometimes readily overlooked *.

* Jn order to judge of the thickening or other changes of the pa¬
rietes of the heart, it is necessary to cut them in a transverse direc-

153

Asthma an Organic Disease.

5, 6, and 7. These objections and the refutations offer
nothing very solid or satisfactory. In the latter, respecting
the tendency of nervous diseases ultimately to induce organic
lesions, M. Roslan inquires why all local diseases, and why
phthisis and cancer of the various organs, may not (as well as
asthma) be referred to a nervous influence ? and whether it be
not more rational to admit that the existing symptoms are
attributable to an incipient organic affection, than search for
their origin in a nervous state incapable of demonstration.

fl. IVhj/ is the same organic alteration not invariably met
with in asthmatics^i Why are the same symptoms produced
alike by aneurism of the left and right ventricle^ by chronic
pleurisy, or other morbid alteration of the lungs^ — To dissi¬
pate tliis objection the most simple notion of the structure
and functions of the human organs will suffice. Suffocation,
the principal phenomenon of asthma, is obviously dependent
on an embarrassment of the lungs, primitive or secondary.
The disorder most frequently^ occurring in old persons is
doubtless that which originates from stagnation of blood in
the pulmonary structure ; consequent on some obstacle in the
greater circulation* *.. The aorta once obstructed, the blood
stagnates in the left ventricle and corresponding auricle, and
subsequently in the lungs. 1 he patient then assumes the'
sitting posture, and rests upon his hands. The thorax is di¬
lated by deep and frequent inspirations. He seems anxious to’
distend the cavity to the utmost, in order to contain the excess
of blood accumulated in the lungs by the impeded circula¬
tion. If the obstacle, on the other hand, exist primarily in
the pulmonary organ; if the patient be affected wdth chronic
inflammation of it, or of the pleura, the dyspnoea is more
readily explained, as well as the enlargement of the right
cavities of the heart, which constantly takes place when this
organ has long struggled against opposed difficulties; a con¬
dition, as before observed, adverted to by Bayle.

9. The last and most embarrassing objection remains to be
noticed. . The periodicity of asthma is a phenomenon appa¬
rently wrapped in impenetrable obscurity. Why, it may be
inquired, the disease being organic, and consequently invariable,
is the patient affected with dyspnoea more at one time than
another"^ The regular paroxysms of pneumonic diseases, of

tion, a thing very rarely done. See the Elemens de Pathologie G4ne-
rale; par M. Chomel.

* This stagnation is demonstrated by the inspection of bodies in
which the lungs of persons destroyed by asthma, or, more correctly
speaking, by aneurism, are invariably found gorged with blood, and
resembling in appearance the spleen or liver (splenises ou hepatises).

VOL. XI. - NO. 62. X

154 Foreign Medical Science and Literature.

cancer, of the stomach, and phthisis, are, M. Rostan replies,
equally inexplicable as the more perfect remissions of asthma.
Cullen, indeed, and other authors who have written on the
si^bject, assert, that the symptoms never completely remit in
asthmatics. Yet it is certainly otherwise with some in the
earlier attacks of the disease, Cullen, however, thinks that
organic diseases^ acting constantly, may produce periodi¬
cal dyspnoea^. It seems probable that the cause of such
periodicity may exist in the atmosphere which exerts such a
direct influence on respiration and circulation, and is subject
to continual variations. The difference which exists in va¬
rious persons as to the hour of the attack is possibly referrible
to individual peculiarity of constitution. The paroxysm of
asthma is, in Cullen’s opinion, dependent on a degree of
plenitude of the pulmonary vessels ; whence it is probable
that suppressed perspiration, and diminished determination of
blood to the surface of the body, may favour its accumulation
in the lungs, and consequently occasion asthma. Hence it is
evident that the cold of winter and the temperature of night
may influence the intermissions of the disease. And, again,
the more abundant secretion of bronchial mucus which takes
place during night may oppose an additional obstacle to re¬
spiration. Hence the temporary benefits derived from ex¬
pectorants, counter-irritants, and anti-spasmodics in asthma.
Such, in M. Rostan’s opinion, is the most probable explana¬
tion of a phenomenon, the cause of which will perhaps long
remain unknown.

Without imagining that he has succeeded in solving all the
difficulties of the subject, or refuting all the objections which
might be advanced, M. Rostan considers it established as an
incontrovertible truth, that the asthma oj aged people is inva^
riahly the symptom of an organic lesion.

li. Cure of paralysis by cicatrization of the substance of the
brain. — Diseases, even when yielding to the combined efforts
of nature and art, leave upon the organs which they have at¬
tacked evident traces of their invasion. The study of this
re-organization of structure has, however, been utterly neglected
in internal pathology : for the morbid anatomist has rather
been occupied in describing the ravages of disease in the
viscera, than in determining the process by which the repara¬
tion of an organ, materially diseased, is, under the influence

* M. Rostan is in possession of a case, too long for citation here,
the subject of which experienced convulsions, and other symptoms,
during several years periodical in their recurrence. On dissection a
carcinomatous tumor of the volume of an egg was discovered in the
substance of the brain.

155

Cure of Paralysis by Encephalic Cicatization.

of life and art eventually accomplished. From this ignorance
results the unfavourable prognosis of organic diseases. Many
difficulties are indeed opposed to such a mode of contem¬
plating pathological anatomy. In hospitals the opportunities
of cli nical observation are commonly transient ; and in private
practice the symptoms are seldom noted with the requisite
precision ; or vulgar prejudices agaiitst dissection obstruct
the inquirer in his anatomical researches. Yet science would
be signally benefited by determining what are the organic
lesions susceptible of reparation ; what the mode of re-orga¬
nization employed by nature ; and what the means whereby
the curative process may be assisted. Thus, morbid anatomy
W'ould become, as it has been described by Morgagni, the real
luminary of medicine.

Without aspiring to attain a result which naust be the work
rather of time than of genius, Dr. Serres* has undertaken to
expose in succession the modes of cure of several organic
diseases ; commencing wjth those of the brain, and the para¬
lysis consequent on them. Such an attempt will, in his
opinion, indicate the object towards which the views of the
Physician and Anatomist ought mainly to be directed-.

Effusions of blood or abscesses, occurring in an organ of
such delicate structure as the brain, were considered by Mor¬
gagni absolutely incurable : and such has generally been the
opinion and language of the most celebrated Physicians of
the present day. paralysis has invariably its origin in

organic alteration of the brain, cerebellum, or other portion
of the nervous system : and if nature be really inadequate to
the reparation of such ravages, the disease which they occa¬
sion must necessarily be incurable. This conclusion, how¬
ever, is invalidated by facts ; and it is the object of Dr. Serres
to develope the mechanism employed by nature in the cure
of paralysis. In order to prevent misconception respecting
his views, the following questions are proposed : — Is a cavity
formed in the substance of the brain, or other part of the ner¬
vous system, susceptible of obliteration ? Can the brain be
regenerated after having been, to a certain extent, altered or
even destroyed ? And is the paralysis dependent on such
organic lesions curable ?

Dr. Serres acknowledges that there has been a time wdien,
with Morgagni, he would have replied to these questions in
the negative. Farther observation has, however, at length
convinced him that all the resources of nature are yet un¬
known. The facts to which he appeals in proof of the cor¬
rectness of his new opinions remain to be detailed.

* Journal Universel des Sciences Medicales, Juillet, 3 818.

156 ' Foreign Medical Science and Literature^

First Case.- — A clockmaker who had recovered from cere¬
bral apoplexy, complicated with perfect hemiplegia of the
right side, was admitted into the Hospital of la Pitie, under
the management of Dr. Serres. Six weeks afterwards he
walked, and began to use his right arm : but being at this
period abused and abandoned by a wonMin with whom he
bad cohabited, be died in a few hours after receiving the in¬
telligence of her desertion. On dissection, Dr, Serres was
astonished to find the cavity formed in the brain by the apo
plectic seizure almost wholly obliterated. It occupied the
medullary centre of the organ, distant about five lines from
the optic thalamus and corpus striatum. Complete re-union
had taken place in its posterior part, about an inch and a half
in extent. Between the lips of the division was found a
white, rather faded, and in some parts bluish substance. The
anterior portion not being entirely closed, an interval of two
or three lines existed there. Cellular meshes passed from
side to side ; and the areolse contained some drops of a yel¬
lowish fluid. Its internal parietes exhibited numerous granu¬
lations resembling those commonly designated fleshy vegeta¬
tions. The surrounding substance was injected, and had
acquired, to the distance of some lines, a yellow vinous
colour ; apparently indicating that the cavity had possessed
greater length than depth. Here,^’ observed Dr, Serres to
the students wdio witnessed the dissection, is naturally ex¬
plained the cessation of the paralysis, of which we have
W'atched the progress. Nature has proceeded in this case as
in the solution of continuity of bone or muscle. Had the
patient survived the effect of the moral commotion beneath
which he sank, the cicatrization of the cerebral lesion, and
consequently the cure of the hemiplegia, would probably have
been completed in a few weeks.’’

After some time the practice of Br. Serres afforded a fresh
opportunity of verifying this important fact.

Second Case.-— A water-carrier had so far recovered from
an attack of apoplexy, complicated with hemiplegia, as to
resume his wonted occupations. His former habits of intoxi¬
cation were, however, unchanged. One Sunday evening, on
his return from a tavern, he was stricken with apoplexy, and
lay in the street till morning, when he w^as conveyed to la
Pitie. It appeared from the report of his wife, that previ-
ousl}^ to this attack he bad been constantly at work, and had
even about a fortnight since joined in the amusement of
dancing. The man was now insensible, and completely para¬
lysed on the left side; but when severely pinched he moved
the right. Respiration participating the paralytic affection,
he died on the third day^

157

Case of Cicatrization of the Brain',

The return of motion on the former attack, which took
place ten months previously, had been very ^^radual. ft was
first manifested in the inferior extremity. Kepeated dissec¬
tions had convinced Dr. Serres that in this case the left hemi¬
sphere of the brain had been, to a certain extent, disorga¬
nized ; and that Trcun such disorganization the hemiplegia
had resulted. But what changes had taken place in the left
hemisphere during the recovery ? And wdiat was become of
the cerebral lesion upon which the paralysis had been depen¬
dent ? — These interesting questions, dissection of the body
enabled Dr. Serres most clearly to elucidate. The left hemi¬
sphere of the brain was first cut down by slices to the medul¬
lary centre. Here the cerebral substance was observed to
assume a yellowish colour, and to be speckled with capillary
blood-vessels. The handle of the scalpel was now employed
to scrape it away ; and at length a large cicatrix was disco¬
vered, resembling in figure an undulatory line, and extending
in an antico-posterior direction. Complete re-union had
taken place between the borders of this cerebral wound ; in
the centre of the line of re-union, the brain exhibited a blackish
blue colour; and in the vicinity of the lesion the cerebral
substance was considerably firmer than elsewhere. The
borders of the cicatrix could not be separated without lace¬
ration of the surrounding structure. After two days’ macera¬
tion in distilled water, minute cellular areolae, somewhat
resembling honey-comb, were perceptible on the line of cica¬
trization ; but they were scattered here and there, and did not
communicate with each other ; and so firm had the cicatrix
become, that it was impossible to restore the cyst to its pri¬
mitive state.

Here, remarks Dr. Serres, is presented a striking instance
of cicatrization of the substance of the brain, and of the pro¬
cess of re-organization employed by nature in the cure of
paralysis. The intimate connexion existing between the
formation of the cyst in the brain, on the first attack of apo¬
plexy, and the instantaneous development of hemiplegia in
the opposite side of the body cannot be for a mornent mis¬
taken. Equally impossible is it to deny that in proportion as
cicatrization took place, the limbs regained their lost mobi¬
lity : for the annals of the science present such a number of
cases of incurable paralysis, dependent on the non-cicatriza¬
tion of the cerebral cyst, that the proposition in question may
be regarded as constituting a medical axiom, and the citation
of any particular example were unnecessary. Such a cicatrix
was some time since seen at I’Hotel Dieu, occupying the
whole extent of one of the hemispheres of the brain.

Cruvelhier has, it should seem, in his excellent w'ork on

158

Foreign Medical Science and Literature,

morbid anatomy*, fallen into an error in asserting, on the au“
thority of Dr. Serres, that apoplexies are sometimes cured by
the formation of a cerebral cicatrix. Paralysis^ not apoptex^j
Dr. Serres describes as admitting of cure by this process : and
so erroneous are the ideas which have been published on this
subject, that he considers it right to rectify those ascribed to
himself. Among a great number of cicatrices which he has
since met with, some, although the re-union w^as immediate,
exhibited puckered and as it were fringed borders. In others
the labia were separated by small cells, containing minute cal¬
careous granulations. Lastly, those which took place in the
' corpora striata were more rapidly formed ; and hence the
paralysis was cured with greater facility. The re-union was
sometimes so exact that, independently of the surrounding
vascular injection, it would have been difficult to detect the
cicatrix ; but, in other instances, the borders of the w ound,
become callous, w^ere incapable of cicatrization ; and, singu¬
larly enough, motion in this case was sometimes restored as
though the cicatrization had been complete. Such result^
however, was never observed in the medullarv centre of the
hemisphere.

It has before been observed, that the loss of motion in para¬
lysis is dependent on the internal destruction of part of the
brain ; and that by the re-organization of this portion, the
power of motion is restored to the limbs. The following
fact, in addition to those already adduced, will, Dr. Serres
thinks, suffice to remove every doubt which may be enter¬
tained on this subject.

Third C ase. — A man who had recovered from apoplexy in
THotel Dieu, was sent to la Pitie for the treatment of the
hemiplegia with which it had been complicated. The progress
of recovery was uninterrupted, and the cicatrix apparently
formed with corresponding rapidity. While yet imperfectly
restored, and tottering, he had the misfortune to fall from a
high scaffold and fracture several of his ribs. The paralysis
of the left side immediately returned, although the loss of
motion was not so complete as it had been on the former
attack. He died, and the following was the state of the
brain exhibited on dissection : In the centre of the right
hemisphere was found a recent cicatrix, the circumference
of which displayed an aspect nearly resembling that men¬
tioned in the preceding cases. The lips of the cicatrix were
yet completely united at both extremities, but it had been ,
ruptured at the middle part, and thus was formed an exca¬
vation capable of containing a musket-ball. Effused blood,

Essai sur TAnatomie Pathologique, 181b.

159

Does the Foetus in JJtero respire ?

proceeding from the rupture of the internal capillariesi of
the cyst, occupied the interior, and separated the borders
of the cavity. The yet adherent portions were separated
without much difficulty.

Th is case serves, in Dr. Serres's opinion, to complete the
theory of paralysis by the formation of a cicatrix in the sub¬
stance of the brain. For it is evident that the cyst had been
completely obliterated, and that the fall had destroyed the
central part of the cicatrix, ruptured the capillaries, and
produced the sanguineous effusion. Nor is it less obvious
that the paralysis had disappeared with the formation of the
cicatrix, and recurred afresh on the production of a new cyst.
In a work which he is about to publish on apoplexy and
paralysis, Dr. Series promises to adduce additional facts
illustrative of the relation between the recurrence of paralysis
and the destruction of cerebral cicatrices, or the formation
of new cysts beside the old one. At present he contents
himself with drawing from these cases the- important con¬
clusion, that ci/sts formed in the suhstmice of the brain j as well
as the paralysis dependent on them^ are certainly curablcy
and that the process of re-organizatian is the same in the ence^
phalon as in other organs,

MEDICAL JURISPRUDENCE.

III. ^Respiration of the foetus in utero, — Among the many
objections which have been advanced against the correctness
of any inference drawn from the pulmonary proof respecting
the performance of respiration after birth in a new-born
child, the alleged possibility that the respiratory act may
take place while yet the foetus remains enclosed in the uterus
seems entitled to particular attention. The occurrence of
this curious phenomenon, on the examination of pregnant
animals, has been too respectably attested to be treated with
the incredulity which, at first sight, it may naturally inspire.
Osiander asserts, that the foetus may respire, and even cry,
when, on the escape of the liquor amniij its mouth is near
the uterine orifice : and Bichat, on cautiously opening an
impregnated uterus, has observed through the membranes
very distinct respiratory motions, repeated at regular intervals,
and commonly slower than those of extra-uterine respiration*.

By M. Filleau, a French surgeon, several facts, leading
to a directly opposite conclusion, have, however, been re¬
cently observed f. Frorg thesg he is induced to believe that

* Dictionnaire des Sciences M4dicales. Article Docimasie Pulmo-
naire. Tome X. page 73.

t Nouveau Journal de M^decine, Septembre, 1818.

l60 Foreign Medical- Science and Literature,

the foetus is incapable of respiring in utero, even when the
membranes enveloping it have been ruptured, and delivery
has been long retarded. The cases noted by him in illustra¬
tion of this subject, have been communicated to the Medical
Society of the department of the Seine, and published in its
journal.

The first case was that of a strong and well made female
child, which died during delivery, when the waters had been
for some time evacuated. The lungs were found collapsed
and of a deep brown colour. The left lung having been cut
in pieces and thrown into water, all the fragments sunk.
Air was introduced into the right lung, which immediately
expanded, and assumed a vermilion hue.

- Another infant had remained forty-eight hours in the uterus
after the rupture of the membranes, and was destroyed by
the violent efforts which the narrowness of the pelvis made
necessary in its delivery. M. Filleau, who, as well as the
mother, had distinctly felt the motions of the foetus, expected
to find some traces of introduction of air into the respiratory
organs, but the lungs were flaccid and of a deep brown colour.
Small portions of them, placed in water, instantly sunk to the
bottom of the vessel. On the introduction of air into another
part, it immediately swelled out, became of a bright red
colour, and swam when put into water.

The third case relates to a child detained fifteen hours
above the superior aperture of the pelvis after the escape
of the waters. During this interval its movements had been
repeatedly felt by the mother, and also by M. Filleau, parti- ^
cularly on the introduction of his hand into the uterus, in the
act of delivery. On dissection the lungs were found compact,
livid, and considerably heavier than water.

M. Filleau in conclusion remarks, that the compression
to which the body of the foetus is subjected in the uterus
opposes an insuperable obstacle to the dilatation of the thorax,
and that no infant has ever been heard to moan or cry pre¬
viously to the complete extrication of its trunk from the vulva

of the mother^', and, lastly, that the first act of inspiration

This is obviously an incorrect assertion, and has several times
been decidedly controverted by the observations of experienced and
respectable men. We may cite the venerable name of Dr. William
Hunter in attestation of the interesting and important fact, that the
human foetus may respire as soon as the head is expelled in delivery.
To this may be added the testimony of Baudelocque, Osiander, and
Schmitt; the last of whom has published several illustrative and
perfectly satisfactory cases on the subject. See Dictionnaire des
Sciences Medicales. Tome X. Art. Docimasie* Upon this principle

Poisoning bj/ Colocynth. ]6l

does not take place till some moments after the full accom¬
plishment of delivery. The commencement of the respiratory
process while the communication of the foetus with its pla¬
centa still existed, 'Would, in his opinion, be pregnant with
danger. '

Another objection commonly adduced against the adequacy
of the pulmonary proof to incontrovertibly determine the
momentous question of respiration before birth, is founded on
the acknowledged difficulty of distinguishing the effects pro¬
duced by artificial inflation of the pulmonary organs from
those consequent on the natural execution of the respiratory
process. But if the experiments instituted by Bedard, in
elucidation of this subject, may be implicitly relied on, the
juridical Physician is at once furnished with a test, alike simple
and easy of attainment, whereby his diagnosis may be deter¬
mined. This distinguished anatomist asserts, that the lungs
of a child which have not respired but been inflated, may be
deprived of the whole of the air artificially introduced into
them, resume their original density, and sink in water; while
those of a foetus, wherein respiration has taken place, acquire
new physical properties, and no pressure to which they can
be subjected will cause them to subside to the bottom of a
vessel of water. The former of these experiments was
repeated by Bedard, in the presence of Dr. Lebreton, on an
inflated lung, wdth the most decisive result^.

IV. Poisoning by colocynth, — The following examples of
the poisonous effects produced by the internal employment of
colocynth ( cucumis colocynthis ) are recorded by Professor
Orfila in the second edition of his celebrated treatise on
poisons*, which has recently been published.

1. A sadler, aged twenty-eight, who had been subject to

was mainly rested the successful defence of two young women, about
two years since, tried for child-murder at the Warwick assizes. The
medical gentleman, who advocated the cause of the accused, expressed
himself most anxious that the minds of the jury should be duly
impressed with the important truth, that a child may breathe, and
even cry audibly, as soon as the head is delivered, and yet subse¬
quently perish before the whole body is expelled. That this, in fact,
constitutes one of the objections to the general rule of the trial of the
lungs in water, and will be particularly liable to occur in a first
labour, where the obstacles to delivery are commonly greater than
in subsequent labours.” This doctrine was further corroborated by
the evidence of a respectable Surgeon ; and several in court had
volunteered, if necessary, to attest its accuracy. — Editor.

* Bulletin de la Societe M^dicale d’Emulation. Novembre, 1818.

t Toxicologic Generale, &c. Par M. P. Orfila. Deuxi^me edi¬
tion. 1818.

VOL. XI, — NO. 62. Y

162 Foreign Medical Science and literature,

the haemorrhoids, and for some time complained of pains in th-e
stomach, and other symptoms of indigestion. This affection,
his companion, a German workman, promised radically to
remove by means of a popular remedy ; and with this view
two glasses of a bitter decoction, subsequently proved to
be that of colocynth, were administeredc Frequent alvine
evacuations, accompanied with colic, were the first conse¬
quences of its ingestion ; and some hours afterwards the man
complained of great heat in the bowels, of a sense of dryness
in the fauces, and unquenchable thirst. In the evening pro¬
fessional assistance was obtained, without, however, exposing
the real origin of the symptoms. The patient had a small
and extremely rapid pulse. The tongue was red, the abdo¬
men tense and highly intolerant of pressure, with very violent
pain fixed in the vicinity of the umbilicus. No faeces had
been discharged. Venesection, emollient fomentations and
injections, and chicken broth, were prescribed. The man
passed a restless night. On the following morning the abdo¬
men was still more swollen and painful. A vein was again
opened and the tepid bath employed. Six hours afterwards,
farther aggravation of the pain and retention of urine, with
painful retraction of the testicles. The abdomen was now
covered with fomentations ; blood also w^as drawn from it
by cupping, and twelve leeches were applied to the region
of the anus. At the same time an emulsion of gum acacia,
and emollient injections with nitre, were prescribed. On
the morning of the third day all the symptoms, the retention
of urine excepted, still continued without abatement. The
pulse was small and thready. The cough and coldness of
the extremities supervened. The head and thorax were
bathed in a clammy perspiration, and the occurrence of gan¬
grene was apprehended. Towards night the pains subsided,
the abdomen became less tense, and exhibited signs of fluc¬
tuation. The attendants were for a while elated by this
seeming amelioration, but the man died before morning. An
acknowledgment was now made by his wife of the act of
imprudence which had been committed. On dissection, the
abdominal viscera exhibited marks of the most violent dis¬
order. The peritoneal cavity was filled wdth a whitish fluid,
containning flocculi of the same colour. The intestines were
reddened, and thickly studded with black specks. Most of
them were either adherent or covered with adventitious mem¬
brane. The mucous coat of the stomach was detached and
ulcerated, and the peritonaeum in an almost putrid condition.
Traces of inflammation existed also in the liver, kidneys, and
bladder.

2. The friend of Professor Orfila, by whom this case has

F,mph^sema from a Gunshot Wound of the Trachea, 163

been communicated, was likewise called to a young woman,
who had just swallowed half a glassful of bitter decoction pre¬
scribed by the same German empiric. Violent pains in the
abdomen were immediately felt. A preparation of colocynth
was at once recognized in the remaining decoction, and the
symptoms speedily gave w'ay to the employment of baths,
oily and mucilaginous drinks, and opiates.

3. A baker, labouring under quartan fever and cachexy,
took the same remedy, suffered severely from it, and lost his
fever. Yet he continued feeble and languid, with a leaden
complexion, and died, after six months, from an attack of
paralysis.

SURGERY.

V. Emphysema from a gunshot wound of the trachea,-^
Ambrose Par6 has recorded a case wherein emphysema was
produced by a sword cut, which had divided part of the
trachea and one of the jugular veins; but Dr. Canin is pro¬
bably the first who has described this affection as resulting
from the solution of continuity of a ring of the trachea, with¬
out any corresponding division of the integument*. In the
former case the origin of the emphysema was as evident, as in
the latter difficult of detection. Such a lesion as is detailed
by Dr. Canin, undoubtedly constitutes a rare case in surgery,
and may hereafter be ranked among the causes of traumatic
tetanus.

On the 9th of February, 1814, after the battle of Williams-
burgh, the man, who forms the subject of the following case,
was conveyed, among a great number of wounded French
and Russians, to the military hospital at Hamburgh. He
was twenty-three years of age, and very tall, and presented,
on admission, an enormous figure. When undressed and put
to bed he could rest in no other than a sitting posture. From
the elasticity and crepitation peculiar to emphysema, it was at
once evident that the cellular membrane contained an aeriform
fluid. The swelling which pervaded the whole body was
particularly conspicuous in the cheeks, eye-lids, breasts and
scrotum, and prepuce. The limbs were so stiff as to be alto¬
gether incapable of motion, and the whole surface of the
body had a glistening appearance. Respiration was difficult,
and small quantities of a bloody and frothy mucus were occa¬
sionally expectorated.

On examination of the thorax, no breach of surface, ecchy-
mosis, or depression, could be detected ; and the interpreter

* Bulletin de la Soci4t6 Medicale d^Emulation, Janvier et Fevrier,

1818.

164

Foreign Medical Science and Literature,

being absent, it was impossible to acquire any infornoation
respecting the cause of the emphysema. Indeed, so great
were the dyspnoea and tumefaction of the cheeks and lips,
that they rendered articulation very indistinct. After farther
search, a slight ecchymosis was observed on the anterior part
of the neck ; and on examining the man’s cravat, a round and
black depression, apparently made by a musket-ball, and
corresponding to the ecchymosis just mentioned, was found
upon it. This discovery threw light upon the subject.

A blow inflicted on the thorax will frequently fracture
the ribs, without producing an external wound ; because the
bones offer a resistance not possessed by the elastic integu¬
ments. On the same principle may be explained a lesion of
the cartilages of the larynx or trachea by a blow received
upon the throat : and hence Dr. Canin hesitated not to regard
the emphysema in this case, as being remotely caused by a
musket-shot, and, proxiniately, by a wound of some portion
of the respiratory canal. The swelling of the integuments
rendered very difficult an accurate examinatibn of the larynx
and trachea. It was, however, at last clearly ascertained
that the thyroid and circoid cartilages had escaped injury ;
but that the first ring of the trachea offered not, anteriorly,
its natural resistance. Hence it became obvious, that the
breach through which the air had insinuated itself into the
cellular membrane, existed at this point. The situation of
the ecchymosis, and the pain experienced on pressure, con¬
curred to strengthen this inference. Persuaded of the
cause of the ecchymosis, Dr. Canin proceeded to divide the
skin over the wounded cartilage, and the cellular structure
which might oppose the passage of the air. The tension
of the integument preventing the formation of a transverse
fold opposite to the first ring of the trachea. Dr. Canin made,
with a convex bistoury, a longitudinal incision extending one
inch downward from the inferior border of the cricoid cartilage.
A second stroke of the knife through the cellular substance
established a direct communication with the w'ounded car¬
tilage ; the tw^o fragments of which were now distinctly
visible. The air rushed out with violence, and the patient
was sensibly relieved. In a short time respiration became
more free ; and the apprehensions excited by the enormous
sw'elling, and particularly by the imminent danger of suffoca¬
tion, were dissipated. The limbs gradually recovered some
power of motion.

The wound was dressed with a vinous application, and
the body of the patient enveloped during eight days by
flannel compresses moistened with vinegar. The resolution
of the air contained in the scrotum proceeding more slowly

Description of a new Vegetable Alkali, 165

than elsewhere, recourse was had to the application of lime-
water. During the first days of the treatment, light diet, with a
little warm wine, and barley-water for ordinary beverage, was
alone allowed. The quantity of aliment was afterwards
progressively increased ; and on the 18th day the wound was-
completely cicatrized.

Dr. Canin adds, that at the siege of Dantzick, in 1807, he
had seen a partial emphysema of the neck, consequent on the
division of the integument and cricoid cartilage by a musket-
shot. During the same year, at the battle of Friedland, a
similar accident occurred to an officer of the Russian imperial
guard ; but he had not an opportunity of ascertaining the
particular point on which the injury of the respiratory canal
had been inflicted.

CHEMISTRY.

IV. Description of a new vegetable alkali,^ — The cele¬
brated French chemists, Messrs. Pelletier and Caventon,
have recently discovered in the strychnos nux vomica and the
ignatia amara^ a new alkali, possessing some analogy to
morphium, and united with an acid ; and to which, in honour
of their count^man Vauquelin, they have given the name of
Vauqueline, This acid, difficultly obtained, is white, crystal¬
line, intolerably bitter ; and appears under the form of a four¬
sided prism, terminated by a pyramid with four faces, some¬
what flattened. It is sparingly soluble in water, but very
soluble in alcohol, and is composed, like most other vegetable
substances, of oxygen, hydrogen, and carbon. Although
essentially different from morphium, it is, like that, remark¬
able for its alkaline properties. It restores the blue colour of
litmus when reddened by an acid ; and forms, in combination
with various acids, neutral salts soluble in water, and more
or less readily susceptible of crystallization. When treated
with diluted nitric acid yields a nitrate ; but the concen¬
trated nitric acid re-acts upon its elements and decom¬
poses it. The solution, at first of a blood-red colour, passes
afterwards to yellow, and yields oxalic acid. The acetate is
extremely soluble ; the sulphate less so, and crystallizes in
rhomboidal scales.

This alkali possesses the most powerful poisonous proper¬
ties, and to it is attributable the deleterious character of the
substances from which it is obtained. Half a grain of it

* Society Philomatique, Stance du 30 Juillet, 1818; Annales de
Chimie et de Physique, Tom. VIII. page 323 ; and Nouveau Jour¬
nal de Medicine, Juillet — AoUt, 1818. ^

155 Foreign Medical Science and Literature.

blown into the throat of a rabbit, killed the animal in five •
minutes. The convulsions began after a lapse of two
minutes. Half a grain introduced into a slight incision
of the back of a rabbit destroyed it in three minutes and
a half. The convulsions took place in one minute. An
atom of nitric acid was saturated with V auqueiine. The
quantity of alkali employed might be estimated at three-
fourths of a grain. The solution had at first a saccharine,
but immediately afterwards an austere and bitter taste. A
rabbit, to which it was administered, died in four minutes,
ft seems to destroy life in much smaller doses than mor-
phium, and operates with greater rapidity than pic rotoxine,
(the active principle of cocculus indicus), and in a different
manner upon animals submitted to the comparative trials
instituted with these two substances.

Messrs. Pelletier and Caventon consider it useless to enter
into any minute description of the various phenomena and
lesions produced by the ingestion of Vauqueline, as they
closely resemble those which are determined by the action
of the nux vomica and ignatia amara.

A fat oily matter has been obtained by these gentlemen .
from the direct operation of boiling ether on these two
substances ; and from the experiments which they have
instituted with it, the poisonous effects which it produces
on the animal economy are wholly attributable to the
V auqueiine yshich it contains; for on separating this principle
by repeated additions of rectified ether, the oil, even when
administered in quadruple doses, no longer excited its wonted
influence on the animal organs.

From one of the French Journals which has just reached
us*, we moreover learn that the indefatigable Messrs.
Pelletier and Caventon have announced, in one of the
last sittings of the Societe Fhilomatique, the existence, in
the spurious angustura {angustura ferruginea\ of a vegetable
alkali, to which this bark is indebted for all its poisonous
properties. They are at present unable to decide upon the
peculiarity of the difference of the alkali in question from
Vauqueline f io viliich it exhibits some resemblance; but the
Editors are authorized to state that the alkali of the angustura
is an alkali sui generis^ and, consequently, distinct from all
others at present known. It will shortly form the subject of
a particular memoir, which will be noticed by us imme¬
diately on its publication.

• Nouveau Journal de M^decine, Novembre, 1818,

Medical and Physical Intelligenee,

167

PART r.

— ^ -

MEDICAL AND PHYSICAL
INTELLIGENCE.

Royal Society. — Dec. 10. — A paper, by M. Theodore de Saus-
sure, was commenced, entitled Observations on the Decomposition of
Starch by the Action of Air and Water at common Temperatures.

Dec. 17. — The above paper was concluded. A portion of starch
simply boiled in water was exposed for two years under a glass jar in
a temperature between 68® and 77^» At the end of this time, about
one-third of it was found converted into saccharine matter, having all
the properties of sugar prepared from starch by the action of sulphuric
acid, according to the method of Mv Kirchhoff. On observing this
curious circumstance, the author was induced to examine more at¬
tentively the nature of the changes which took place. He found that,'
besides sugar, a species of gum was formed, similar to that obtained
by roasting starch ; also a peculiar intermediate substance, which he
denominated amidine, while a substance remained, insoluble in water
and acids, which gave a blue colour with iodine, and was probably
starch somewhat altered in its properties. The author states, that
when air :s present during the above process, water and carbonic acid
gas are given off in considerable quantities, and that charcoal is depo¬
sited ; but, on the contrary, that when air is excluded no water is
formed, that only a little carbonic acid and hydrogen are extricated,
and that no carbon is deposited. The author was unable to determine
whether the presence or absence of air affected the quantity of sugar
obtained. The paper was concluded with some remarks, which ren¬
dered it probable that water is fixed, during chemical operations, upon
organized substances more frequently than is usually supposed.

SCIENTIFIC INTELLIGENCE, AND NOTICES OF SUBJECTS
CONNECTED WITH SCIENCE.

(From Dr. Thomson’s Annals of Philosophy.)

I. Action of Iron on Water,

M. Guibourt has shown by a set of experiments, which appear ac¬
curate, that iron has the property of decomposing water at the com¬
mon temperature of the atmosphere. The decomposition is most
rapid when the quantity of iron bears a great proportion to the quan¬
tity of water. In that case the temperature rises considerably, the
decomposition goes on more rapidly in proportion as the temperature
is more and more elevated. — (Journ. de Pharm. June, 1818, p..241.)

M. Robiquet has ascertained that the black oxyde of iron formed
by the action of water on iron at the ordinary temperature of the

168 Medical and Physical Intelligence,

atmosphere, is exactly similar to the oxyde formed by the action oi
red hot iron on steam. Now it is well known that this last oxyde
is a compound of one atom of protoxide and one atom of peroxide.
The octahedral iron ore of mineralogists is a similar compound.—
(Ibid. p. 308.)

II. Carbonate of Iron.

As far as we know at present, the only oxyde of iron capable of
combining with carbonic acid, is the protoxide. Carbonate of iron
found native is a compound of an atom of carbonic acid and an atom
of protoxide of iron. 1 have never been able to succeed in my attempts
to form a precarbonate of iron, though analogy leads me to suspect
the possibility of the existence of such a salt.

III. Action of Prussian Blue on Starch.

M. Vincent, an apothecary in France, has published the following
curious fact. If four parts of starch and one part of Prussian blue be
mixed and triturated together in a mortar, so as to make as intimate a
mixture as possible, and this mixture be boiled in a considerable
quantity of water, the liquor, before it reaches the boiling temperature,
acquires a green colour; it then becomes brown, and there remains a
precipitate, which does not recover its blue colour, though treated with
acids. The liquor has the property of forming a very fine Prussian
blue, when treated with a solution of sulphate of iron mixed with an
equal volume of solution of chlorine. When the liquid is evaporated,
no gluey substance is deposited ; but if it be reduced to a small volume,
and allowed to cool, it gives a glutinous matter, which dries in the
open air, and is again easily dissolved in water. The starch then is
altered in its nature and converted into a kind of gum. — (Ibid. p. 325.)

IV. heumic Acid.

Some years ago a paper by Mr. Henderson, on the acid of rhubarb,
was inserted m i\iQ Annals of Philosophy. The result of his experi¬
ments led him to consider it as a peculiar acid, which he distinguished
by the name of reumic acid. The only characteristic property, how¬
ever, by which he was able to distinguish it, was that of dissolving
mercury.

A set of experiments on the juice of the rheum ponticum has been
lately made by M. Lassaigne, with a view of verifying the results
obtained by Mr. Henderson. The juice of this plant is abundant,
and very acid ; but the acid possesses all the characters of the oxalic,
and has no action whatever upon metallic mercury. The reumic acid,
of course, does not exist as a peculiar acid. — (See Ann. de Chim. et
Phys. viii. 402.)

Vl Perchloric Acid.

Sir Humphrey Davy has verified the curious discovery made some
years ago by Count von Stadion, of a combination of chlorine and
oxygen, containing more oxygen than chloric acid, and which there¬
fore may be distinguished by the name of perchloric acid. A par¬
ticular account of the experiments of Count von Stadion will be found

Medical and Physical Intelligence, 169

in the Annals of Fhilosophy, ix. 22. I have likewise given an account
of this curious acid in the last edition of my System of Chemistry.

VI. Sea Snake of America.

Extracted from a letter from T, Say, Esq. of Philadelphia, to
Dr. Leach : —

I have to regret that many of the scientific journals of Europe
have taken serious notice of the absurd story which has originated to
the eastward about the sea serpent; a story attributed here to a de-
fective observation, connected with an extraordinary degree of fear.
You have probably been informed that Capt. Rich has explained the
whole business ; he fitted out an expedition purposely to take this
leviathan; he was successful in fastening his harpoon in what was
acknowledged by all his crew to be the veritable sea serpent (and
' which several of them had previously seen and made oath to); but
when drawn from t*he water, and full within the sphere of their vision,
it proved to their perfect conviction that the sea serpent which fear
had loomed to the gigantic length of 100 feet, was no other than a
' harmless tunny (schomber thynnus) nine or ten feet long. Thus na¬
tural history is probably indebted to Capt. Pvich for keeping from its
pages an account of a second kraken ; and a memorable instance is
j added to the catalogue of credulity already pregnant with warning to
naturalists.^^

LETTER FROM MR. LEESE TO THE EDITOR.

Sm, — I take the liberty of stating, that by the addition of a word
i you have materially altered the sense of an important point in my
I case of Croup. I particularly recommended the sending for persons
] who were in the habit of applying leeches'. I therefore wrote “ a
j woman was sent for" — you have printed “ a woman was sent for
I them. I also wish I had given the name of the woman employed in
this case, who is very expert in their application, Mrs. Preen, 36,
Somerset Street, Whitechapel. I am, Sir, yours truly,

L. LEESE.

i . . .

Spt. Etheris Sulphuricus. — Mr. Wansborough has requested
us to insert the following in the Repository : — Take 8 oz. by weight,
ofsp. vin. rect. ; ditto, ditto, acid, sulph.; mix them gradually at inter-
j vals of two or three hours, putting in about an ounce of ol. sulph. each,
lime, until the whole is mixed: then adjust your retort and reepient;
the latter must be immersed in cold water, which I did by driving a
nail in the counter, and placing the receiver Jn a large washhand-
basin that held nearly a gallon. I then secured it by a string round
the neck of the retort against the edge of the basin, and fastened it to
the nail in the counter. Having done this, and luted the joint of the
neck of the retort and the recipient, I filled the basin with water, and
applied the flame of an Argand, and drew over until a white fume
appeared to fill the retort; I immediately withdrew the lamp, and the
black froth arose.

VOL, XI.— NO. 62.

170

Medical and Physical Intelligence*

Upon measuring the product, it was 7 ounces.

1 took of potass, subcarb. and dissolved it in ^ss. of water;
I added this to the produce of the first distillation, and submitted it to
a second, until three ounces remained in the retort. I thus obtained
five ounces of highly rectified sulphuric aether at about sixpence an
ounce, a most beautiful article, and far superior to any I ever pur¬
chased.

We are requested to acknowledge, that we were not present at the
delivery of a Sermon to which we alluded in our December Number,
and that the account we gave of it was merely from report: to this
acknowledgment we have not the smallest objection, and, indeed, are
rather pleased than otherwise, in having to announce that the con¬
demnation of medicine was not of the kind and to the extent that we
suspected, — Edit,

NOTICES or LECTURES.

Mr. Gray, Author of the Supplement to the Pharmacopoeia, will
,give this Spring a Course of Lectures on Botany, as follows: —

Lecture 1. Usefulness of Botany, Rise and Progress of it, particu¬
larly in England.

2. Definition of a Plant, General Structure and Physiology of
-Vegetables.

3. Organs of Growth, viz. Root, Stem, Leaves, &c,

4. Organs of reproduction in their unimpregnated State, i. e, the
Flower and its Parts.

5. Organs of reproduction in their impregnated State, i, e, the
Fruit and Seed.

6. Arrangements of Plants hitherto proposed by Ray, Tournefort,
Rivinus, Linnseus, Jussieu, and Decandolle.

7. Method of Studying Botany ; Mode of Collecting and Forming
a Herbarium.

8. Intimate connexion of the Knowledge of Insects w'ith Botany;
Usefulness of Entomology to Medical Persons ; a slight Sketch of the
External Parts of Insects, Arrangement, Mode of Collection and Pre¬
servation. Valedictory Address,

These Lectures will be immediately followed by Twelve Excur¬
sions into the Neighbourhood of London for Practical Botany: as is
stated upon our Wrapper.

Mr. G. intends also to give in the Autumn, a Course of Materia
MedicUf in which these Lectures on Botany will be repeated, and a
similar Course on Chemistry will be given as introductory to the
Knowledge of Pharmacy in general.

Dr. Uwins has abandoned his intention of commencing a Course
of Lectures on Ma teria Medica, &c. in consequence of the above well-
matured plan of Mr. Gray. In the Autumn, however, his Lectures
on the Theory and Practice of Medicine will be resumed; which will
be so planned in respect to time and place, that Students will be able
conveniently to attend, during the same season, both Mr. Gray^s
Course and that of Dr. U.

Medical and Physical Intelligence,

171

LITERARY NOTICES.

j Speedily will be published, the Medical Topography of Upper
Canada. By John Douglas, Assistant Surgeon, 8th regiment.

A Lecture on Dropsy. By George Gregory, M.D., Licentiate of
; the Royal College of Physicians in London, and Senior Physician to
the St. James’s Dispensary,

On the 15th of Februaiy next will be published, a Report of the
! Practice of Midwifery at the Westminster General Dispensary, for
; 1818; including several curious Computations on Labours, the Mor-

I tali ty of Lying-in Women and Children, and the Probability of Mis-
j carriage; with a Collection of Medical Formulae. By A. B. Gran-
I vilLe, M.D., F.R.S., F.L.S., M.R.S., Physician in Ordinary to his

: Royal Highness the Duke of Clarence, Member of the Royal College

of Physicians, London, and Physician-Accoucheur to the Westmin¬
ster General Dispensary^

The third Edition, with considerable Additions, of Dr. Scudamore's
Treatise on the Nature and Cure of Gout and Rheumatism ; includ¬
ing General Considerations on Morbid States of the Digestive Organs,
and some Remarks on Regimen, is nearly ready for publication.

In a few days will be published, in octavo, Observations on the
Nature and Treatment of the Epidemic Fever, at present prevailing in
the Metropolis, as well as in most Parts of the United Kingdom. To
which are added, Remarks on some of the Opinions of Dr. Bateman,
in his late Treatise on this Subject. By Henry Clutterbuck, M.D.,
Licentiate of the Royal College of Physicians, and one of the Physi¬
cians to the General Dispensary.

In spring last. Dr. Watt, of Glasgow, published a Prospectus con¬
taining a specimen of a new work, to be entitled “ Bibliotheca Bri-
tannica ; or, a General Index to the Literature of Great Britain and
Ireland : with such foreign works as have been translated into
English, or printed in the British dominions: including also a copi¬
ous Selection from the writings of the most celebrated Authors of all
ages and nations. In Two Parts. In the First the Authors are ar¬
ranged Alphabetically; and of each, as far as possible, a short Biogra¬
phical Notice is given ; to which is subjoined a Chronological List of
his Works, their various Editions, Sizes, Prices, &c,, and in many .
instances the Character of the Work. — In the Second the subjects are
arranged Alphabetically, and under each the Works, and principal
parts of Works treating of that subject, are arranged in Chronological
order. This Part also includes the anonymous Works which have
appeared in this Country, inserted according to their respective sub¬
jects and dates." — A first part of this Work, consisting of thirty-five
sheets or 280 pages, is in the press, and will be published in February.

It is estimated that the whole will be comprised in six Parts, making
two handsome volumes in quarto.

17^

A METEOROLOGICAL TABLE,

from the 21^^ of DECEMBER; ISlSt to the 20th of JANUARY.

1819.

KEPT AT RICHMOND, YORKSHIRE.

Baron

Max.

leter.

Min.

I'he

Max

rm.

Min.

Rain

Gauge

Winds.

Weather.

w. ■

1 Sun...,

vv.

1 Sun...

sw.

1 Sun...

SE.

1 Sun... 3 Mist...

•

SE.

1 Mist... and Sun.

SSE.

1 Cloud...

13 Cloud... 2 Sun.4Starl..

NE.

1 Sun. 2 Cloud.. 4 Starl...

NbW.

1 Sun...

SN.

13 Sun... 2 Cloud.. 4 M...

SW.SE.

1 Cloud.. 4 Moon..

5..SE..

1 Sun...

SE..

1 Sun..

S.SE.

1 Cloud.. 4 Rain.

SE..

1 Mist....

SSE.

1 Rain....

' 8

29*

WbN.SSE.

1 Sun... 4 Rain..

SW....

1 Shower., and Sun..

SSW...SW....

1 Sun... 2 Show, and Sun.

SW...SSW..

1 Shower.. 4 Snow...

SW..SSW....

1 Sun..

ssw...

1 Sun.. 4 Showers.

sw....

1 Rain.... 3 Sun...

sw...

1 Sh. ofi\..&S.4Sh.ofs.&M..

\ 23

VVbN..

1 Sun.. 4 Showers of rain...

sw....

1 Sun. .& Showers ofrain....

WbN...

1 Sun...

19129

w.sw.

1 Sun... 3 Cloud.. 4 Rain.

20128

W..SE..

1 Sun.. 3 Cloud.. 4 Snow..

The quantity of rain during the month of December was 1 inch 34-lOOths.

Observations on Diseases at Richmond.

The disorders under treatment were Colica, Diarrhoea, Dysuria, Epistaxis,
Erysipelas, Febris catarrhalis, Febris simplex, Fistula, Gastrodynia, Obsti-
patio, Ophthalmia, Phthisis pulraonalis, Pneumonia, Podagra, Rheuma-
tismus. Scabies, Tcenia, Variola, and Vertigo.

17S

THE METEOROLOGICAL JOURNAL,

31
1
2

8
9

18
19

From the 20th of DECEMBER, 1818, to the IQth of JANUARY,

ISip, Inclusive*

By Messrs. HARRIS and Co,

Mathematical Instrument Makers, 50, High Holhorn,

Therm.

Barom.

De Luc’s
Dry.

Ilygrom

Damp.

Winds.

Atmo

ssw

wsw

Clo.

WN\^

Jlo.

WNW

Fog

ENE

Fog

ESE

Fog

SSE

Fog

SE*

Cio.

Clo.

NTE

Clo.

Fine

32.

Fog

Clo.

WNW

Fog

Fine

Clo.

SSE

Fog

■5

Fog

Fine

■5

Fine

.50

S. Va.

Clo.

fine

SSW

Fine

Rain

Clo.

Fine

Rain

vVSW

Fine

wsw

Fine

Clo.

Fine

Clo.

Rain

Rain
Rain
L lo
Rain

Fine

Clo.

Fine

Rain

Fine

L'lo.

The probable quantity of rain (the gauge having frozen and burst in the latter
part of the month,) fallen in December is 1 inch and 29-lOOths.

174

A REGISTER OF DISEASES

Between DECEMBER 20th, 1818, and JANUARY IQth, 18 Ip.

DISEASES.

Total.

Abortio .

Abscessio .

Amenorrhoea .

Anasarca* . .

Aneurisraa- * • * . .

Aphtha lactentium ....

Apoplexia .

Ascites .

Asthenia .

Asthma .

Bronchitis acuta .

" chronica * • • «

Bronchocele .

Cancer .

Carbunculus » * . . .

Cardialgia .

Catarrh us .

Cephalalgia . . .

Cephalasa .

Chlorosis . .

Chorea .

Cholera .

Colica .

- Rictonum ......

Convulsio .

Cynanche Tonsillaris, • •

- Trachealis • •

— - Tarot idea* • • *

• . - Pharyngea • •

Diarrhoea . . .

Dolor lateris .

Dysenteria . . . • *

Dyspepsia . . * .

Dyspnoea .

Dysphagia .

Dystocia • . . .

Dysuria .

Ecthyma .

Eczema. .

Enteritis . .

Entrodynia .

Epilepsia .

Epistaxis ............

Erysipelas .

Erythema lotva .

- nodosum * * • ♦

Exostosis .

Febris Intermittent ....

- - catarrhalis

- Synocha .

DISEASES.

Febris Typhus mitior • •

- Typhus grav. • • • •

■ - Synochus .

- Tuerpera .

- Remit. Infant. • •

Fistula . .

Furuncuiiis . . .

Gastritis .

Gastrodynia .

Gonorrhoea pura .

Hsemoptoe . .

Hsemorrhois • « • . .

Hemiplegia .

Hepatalgia .

Hepatitis . . .

Hernia .

Herpes Zoster .

- - circinatus .

- labialis .

— ■ — - praputialis » • • •

Hydrocele .

Hydrocephalus .

Hydrothorax • . .

Hypochondriasis .

Hysteralgia .

Hysteria .............

Icterus . . . . . .

Impetigo scabida .

Ischuria .

Leucorrhoea . . • •

Lichen simplex .

Mania . .

Melancholia .

Menorrhagia .

Morbi Infantiles* .

- Biliosi* .

Obstipatio .

Odontalgia .

Ophthalmia .

Otalgia . . * * •

Palpitatio . .

Paralysis .

Paronychia .

Peripneumonia .

Peritonitis . .

Pernio . . .

Pertussis * ♦ * .

Phlogosis . . .

Phrenitis . . .

Phthisis Pulmonalis * • * •

5
2
1

6
11

5
2
1

6
1
1

6
2

3
12

4
1

13
2
7
1

15
42

16
21

8
3

12
10
3
' 9
9
1
30

Observations on Prevailing Diseases, 175

DISEASES.

Pleuritis .

Pleurodyne .

Pneumonia .

Podagra .

Poinpholyx henignus
Porrigo larva Us • • • .
— decalvans • • •
-favosa

Prolapsus uteri' • • •

Prurigo mitis .

Psoriasis guttata • •

Pyrosis .

Rachitis .

Rheuma, acutus • • •
- chronicus

Roseola .

Rubeola .

Scabies

Scarlatina anginosa

•

111

DISEASES.

Scrofula . .

Spasmi .

Strictura . . . . .

Strophulus confertus'

Syphilis .

Tabes Mesenterica • •
Tic Douloureux* • • • <

Tussis, &c. .

Vaccinia .

Varicella* * * .

Variola .

Vermes * * • * . .

Vertigo . .

\J I'UcanB. fehrilis • • •
- conferta * • •

Total of Cases •
Total of Deaths

1412

, , -- -- .wx, x-m^xj-x/x.. 0 p X liH.. 1 a 1 1 rtllMlii; llUlli UClJ

lition or indigestion, and which may be too trivial to enter under any distinct head; Morbi
Biliosi, such Compiaints^as are popularly termed bilious, but cannot be accurately classed.

Observations on Prevailing Diseases,

The diseases of the last few months have been principally catarrhal affec¬
tions of an obstinate and protracted character. Our readers will perceive
that asthma, bronchitis, and catarrh, stand prominent in the list. Genuine
phthisis has appeared to us to have recently displayed its ravages less exten¬
sively than was the case some few years since. Admitting this to be fact,
to what is such fact to be attributed ?

Anasarcal disorders, unattended with either hydrothorax or ascites, have
; occurred lately in more than their proportionate number. One case of ana¬
sarca has been marked by rather extraordinary features. The swelling in
i different parts of the body seemed to resist the usual remedies, until a kind
I of metastasis took place, and the brain became for a time the seat of the dis-
I order. During one night delirium was so urgent that it was judged neces¬
sary to take away blood, which relieved the encephalic symptoms; but the
anasarcous accumulations returned upon their subsidence. In about a week
or two from this time blindness supervened ; and in the course of another
week there was true apoplectic stupor, accompanied by a sort of hysterico-
epileptic fits. From this state the patient has recovered under the employ¬
ment of large blisters to his legs and back, with sinapisms to the feet ; the
blindness, however, still continues; and there is reason to expect speedy
dissolution, although the pulse is calm and quiet, the sensibility in a great
measure restored, and very large drains of fluid still continue to pour them¬
selves out from the cuticular abrasions occasioned by the epispastics and sina¬
pisms. The event of this case shall be mentioned in the next Report.

One of our t orrespondents writes “ the case of anasarca, marked fatal,
was combined with asthma.”

“ The morbus infantilis was a tumor on the forehead, and enlargement of
the head like hydrocephalus, and accompanied with emaciation and pain.
Upon dissection the tumor contained a cheese-like matter. . The mesentery
was a mass of disease,’’

176

Monthly Catalogue of Books, S^'c.

A Reporter frora a considerable district in the north-east part of the towfi
states, that^‘ there is no particular disease distinguishable at the present'
period. Fever is now rarely seen. Cases of asthenia are still very pre¬
valent.''

MONTHLY CATALOGUE OE BOOKS.

Remarks on the Treatment of Wounds and Ulcers*, with. Cases
affixed, illustrating the high importance of Medical Surgery. By
Thomas Bedford, Esq., of Liverpool.

Also by the same Author, a New Edition, Observations on the
Advantages of a Union of Medical Science and Surgical Skill; toge¬
ther with some Remarks on Empirical Practice in Surgery.

A Practical Treatise on Tropical Dysentery, more particularly as
it occurs in the East Indies. By R. W. Bampfield, Esq., Surgeon.
Octavo. , . , •

Essays on the Morbid Anatomy of the Human Eye. By James
Wardrop, F.R.S. Edin. Vol, 11. Royal 8vo. ’

Transactions of the Associations of the Fellows and Licentiates of
the King and Queen’s College of Physicians in Ireland. Vol. II.
Octavo.

Dr. Marshall Hall’s Treatise on the Mimesis. Svo.

Medico-Chirurgical ’Fransactions. Vol. IX. Part First. :

Porter on Typhus Fever. 8vo.

An Essay on Catarrhal Fever and Inflammation of the Intestines
from Cold. By J. A. Gaitskell, M.D.

An Account of the Epidemic and Sporadic Disorders which pre¬
vail this year, 1818, at Rochester and near it. By Walter Vaughan,
M.D. 8vo.

Facts and Observations towards Forming a New Theory of the
Earth. By William Knight, LL.D., &c. Svo. ;

Medical Botany, No. I., to be continued Monthly. Svo.

A Treatise on two of the most important Diseases which attack the
Horse, In Two Parts. By William Wilkinson. 4to.

NOTICES TO CORRESPONDENTS.

Communications have been received this month from Dr. Gordon,
Smith, Dr. Walker, Dr. Southam, Dr. Dyer, Mr. Wansborough, and
Mr. Stavely. , ’

To Dr. D. and Mr, S. we shall forward private answers speedily.

The remainder of the Paper (f Ai. Breschet, likewise a Communica¬
tion from Professor Cleinot, of Koch fort, will appear in our ne-xt Number :
an apology is due to these highly respectable foreigners, as well as to our
readers, for permitting such delay in the translation and insertion of these
Papers. ' '

'The Papers ofDYS. Southam Smith are also intended for our next
Number : and Reviews tf Orfila on Poisons, Johnson' on Civic Life, Sir
Gilbert Plane’s Medical Logic, ^c. , ’

We are sorry not to have occasionally heard, as we had hoped, from
A. N., M.D. ,

Communications are requested to he addressed (post paid) to
Messrs. T. and G. UNDERWOOD, S2, Pleet Street, ‘ ^ '

THE

LONDON MEDICAL

REPOSITORY.

No. 63. MARCH 1, 1819. Vol. XI.

PART I.

ORIGINAL COMMUNICATIONS.

General Remarks on the Theory and Treatment of Fistula.

By M. Breschet, of Paris.

. . '

[Concluded from page 93, Vol. XI.J

I HAVE before remarked, that all the tissues of an
organized body may become the seats, and contribute to
the constitution of fistula, but that the cellular tissue, as
existing in greater abundance, more especially about
excretory canals, is the most obnoxious to fistulous forma¬
tion. This tissue is exceedingly abundant near the verge of
the anus, in the perinaeum, &c. ; now it is the change of this
cellular into mucous tissue to which I am called upon more
particularly to advert.

This change will be more or less promptly effected, accord¬
ing as the matter by which it is produced shall be of a nature
more or less irritating j but the (jualit^y of irritating is not to
be Judged of in an abstract way, since the mildest and
apparently most innocent material may, by being applied
to the parts in question, prove to be possessed of the most
active principles, as in the case of milk being introduced into
the cellular tissue in the way before referred to, a fact which
plainly indicates this tissue to be endowed with a sort of
specific susceptibility. Suppose we take a living animal, and
inject into the cavities of its cellular membrane, wine, alcohol,
pus, bile, or urine, the effects which follow in such instance
will by no means be found to accord with the degree of

VOL. XI.— NO. 63, 2a ■

178

Original Communications^

acrimony or stimulating quality possessed by the respective
finids. And so it is with fistulous irritation, the development
and progress of which have an especial reference to the
particular properties of the part affected.

In the first stage of fistula an ulcerated surface is developed,
which furnishes a larger or lesser quantity of purulent matter;
by degrees the irritation becomes permanent in consequence
of the fluids of the part being directed from their natural and
appropriate conduits by the vitiated suppuration, whether this
suppuration proceed from a carious surface, or otherwise;
the tissue now becomes stamped with new characters; its
colour changes to a red, which is owing to the development
of vessels in its texture ; and the continual passage through
it of the secreted pus changes both its sensibility and
its other properties from their natural condition. Its nutri¬
tion also becomes modified by these circumstances of change
in susceptibility, and these changes at length operate a differ¬
ence in the density of the part, so as to qualify it for the
performance of new functions. By these successive changes
then a red and villous membrane is eventually formed, which
is very different both in its constitution and properties from,
the cellular tissue, and it is also very unlike other systems
of serous tissue, inasmuch as it is transparent or diaphanous,
and invariably presents the form of a sac without any opening
(en ce que celui>ci transparent et diaphane a constamment la
forme d’un sac sans ouverture). As the new membrane
becomes more fully developed, it/takes on more completely
the character of a mucous tissue ; and the secretion from its
V surface, originally purulent, becomes as distinctly mucous as
is the natural discharge from those membranes to which the
name mucous is applied. The quantity of this mucous
excretion in fistula increases in the ratio of the diminution of
purulent discharge, and after a certain time the discharge
is merely mucous, without any mixture at all of pus.

The fistulous canal presents two surfaces and tw'o ex¬
tremities; the internal surface is modified according to the
nature of the secreted matter ; the external one forms itself
from the parts in its vicinity from which it is separated by a
bed of cellular tissue of greater or less density^ ; its superior
extremity terminates either in a natural excretory duct, or in

* In this part of the manuscript from which we translate the cha¬
racters are so difficult to decypher, that we are not sure whether we
either read or understand the author aright. The whole sentence in
the original, if we are not mistaken in the letters and wwds, runs thus:
“ i’externe recouvre les parties voisines dont elle est separee par une
coiiche plus ou moins 6paisse de tissu cellulaire.”— Edit,

Brescliet on Fhiula*

179

some surface, the conditions of which are sirch as were
before stated to be necessary to constitute a fistulous ulcer ;
the inferior extremity is invariably bounded by a cutaneous
or mucous surface.

This new membrane is endowed with organic properties in
the same manner as that to which it is most analogous in its
constitution. It contains blood-vessels which terminate by
exhalent extremities, as is shown by the exhalation of mucous
fluids ; and it is fair to infer the existence of absorbents from
the manner in which the parts increase.

Notwithstanding, however, the resemblance which obtains
between the membrane of a fistulous canal, and the natural
mucous ducts of the system, there exists a difference between
the two sufficiently marked to arrest attention. In the first
place this, which may be named aecidental membrane, is
without that cuticle which is observed on mucous surfaces ;
neither is its tissue furnished with those glandular corpuscles
which are designated by the name of mucous follicles, and
which serve for the constant secretion of an unctions fluid
for the lubrication of surfaces. But a further difference,
and one which is of still more moment, in a practical point
of view, consists in the constant tendency displayed by these
accidental conduits to self-obliteration, (a s’obliterer), although
both from their organization and the functions which they
perform, it would be expected that they would continue open
in the same manner as the natural excretories, which very
rarely indeed thus cease of themselves. Compare, for
example, the case of a fistula, even of long standing, but still
susceptible of cure, wdth that of an unnatural anus (un anus
centre nature), and mark their different phenomena.

The object of treatment in the first instance wdli be that of
aiming to restore natural conduits for the matter which the
fistula engenders, and to prevent, by the methods which the
art of surgery has invented, an ulterior direction towards the
newly formed cavity. These indications constitute indeed
the whole of the curative principles in relation to fistula ;
while in the other case, viz. that of a newly formed anus,
although all the fceculent matter of the intestines passes by
this last orifice, the inferior portion of the alimentary tube
is, nevertheless, preserved open, and its surface continues to
excrete a mucous discharge*.

The new membrane of wTich we have been speaking

* This difference relative to the facility by which accidentally
formed mucous membrane may be obliterated, and the great difficulty
of effecting the same in the natural mucous conduits ought to be

ISO

Original Communications,

possesses vital properties which in a still more marked
manner establishes its analogy with mucous tissues. it
possesses an actual sensibility, (une sensibilite cerebrale), the
degree of which is varied by circumstances, as is proved by
stiliettes and sounds occasioning in some instances excru¬
ciating, and in others only moderate pain. I have already
stated that the membrane secretes a mucous at first mixed
with a purulent matter, and which afterwards is free from such
admixture; and this secretion itself ceases when we succeed
in diverting the course of the liquor or matter upon which
it depends (si on en detourne le liquide ou la matiere) ; a
condition then is produced of parts, under which the oblitera¬
tion of the fistula is effected.

The course and direction of fistulous sores present varieties
according to the different circumstances of the cellular tissue
upon which they open ; the different degree of laxity of this
tissue, the mode of its organization, and the direction of its
constituent parts, all operate a modification of effect in refer¬
ence to this particular. Beside the_ common sinuosities of
fistulae, they occasionally terminate in or border upon internal
cavities, and the consequent accumulation of their fluids

recollected by those practitioners who calculate upon the permanency
of canals, which they may make artificially across tissues; and^ it
may serve to show the superiority of natural cures, or those, in other
words, in which the natural passages are restored over those which
are made by the formation of new conduits. Thus the forcible
passage of conic sounds through the membrane of the prostate
occasions a dilatation which is only maintained while the sound con¬
tinues to be passed ; but the tendency afterwards to narrowing and obli¬
teration is by no means so great, when by a persevering use of bougies,
we have endeavoured to re-establish the natural passage, it is on
this principle also that in fistula lachry mails, the methods of Hunter,
Monro, and others, have proved of less avail, and have therefore fallen
into disrepute, when compared with that plan of treatment which
endeavours to restore the natural course of the tears. Nothing, how¬
ever, is more common than the recurrence of fistula lachry mails after
the apparent cure of the disorder by the use of cotton threads, cat¬
gut, &c., and wherefore? It is because the malady in question has
less to do with the contraction of soft parts than with the osseous
canal. Introduce then into this canal, metallic canulm, (qui oftriront
aux parois osseuses plus de resistance qu’une simple membrane
muqueuse), and you will remedy, both promptly and radically, a
disease which almost defied surgery before this method was adopted.
M. Pupuytren has demonstrated the great advantages of this plan by
successfully treating many hundreds of cases which had obstinately
resisted other remedial attempts.

Breschet on Fistula,

isi

renders the disorder more complicated by the difficulty which
the surgeon finds in meeting with them, and by the occur¬
rence of new inflammation, and other untoward circumstances.

Callosities are common in fistula?, the origin and develop¬
ment of which have reference to the continual irritation
caused by the peculiar matter which runs through or crosses
them. They are produced by local irritation engendered
either by an interior or external cause. These callosities
consist of a specific change, a kind of whitening and degeneracy
I of the internal membrane of the passage, resulting from the

I accumulation of white fluids, either in the tissue of this

j membrane or in the adjacent cellular tissue. This change

I was formerly regarded as partaking of a schirrous or cancerous

I nature, and upon such notion of cancerous degeneracy was

j founded the surgical treatment of fistula. But experience

i has proved that rest, emollients, &c. are equal to the dis-

; persion of these callosities ; and every thing that we now

j know of cancerous production shows that the changes

I in question have nothing in them allied to cancer. This

: distinction is practically important; since well directed efforts,

for the purpose of suspending the degeneracy alluded to, may
almost always be made to supersede the necessity of an
operation, which, although in itself for the most part free from
immediate danger, is at the best exceedingly painful, and is
often productive of unpleasant consequences. I here allude
to the treatment of fistula by extirpation, a severe and cruel
operation, which, indeed, is now only practised by obscure and
ignorant surgeons, or by those who hold by their first pre¬
judices, in spite of the astonishing progress recently made
in surgical science. Instead of this operation of extirpation, a
simple one is at present usually had recourse to, and which,
although varied according to circumstances, consists, with
regard to its leading principle, in dilating the fistulous canal
through its whole length, with a view to favour the free issue
of the pus, and to present an opposition to the passage of
liquids or aeriform fluids by this their new conduit, the
deepest part of which should be the first to become reunited,
(de s’opposer au passage des liquides, des matieres ou des
fluides a’ereformes dans leur nouveau trajet, dont la partie la
plus profonde doit etre la premier d se reunir). This is the
grand and indeed sole object wffiich the Surgeop ought to have
in his mind when directing the applications used in fistula.

In conclusion, then, I would remark : —

1. That fistulous ulcers are unnatural conduits maintained
by a constant percolation of gazeous or liquid matter, which
irritates their paiietes, and thus prevents their union.

J8S

Original Commnnkatiom^

£. That invariably one extremity of these passages either
receives or itself engenders the perpetually irritating matter.

3. That remedial attempts ought always to be founded
upoo a knowledge of the particular nature of this cause of
irritation.

4. That there exists always in fistula a newly formed
tissue, which is of a peculiar nature, but having more resem¬
blance than any other tissue to mucous membrane.

3. That in some instances, as in simple fistula, the for¬
mation of this new tissue is the sole change in the organic
condition of the part affected.

6. But that in the generality of fistulous sores there at the
same time exists a species of degeneracy of a whitish cast
(degenerescence blanche), which it is very necessary to be upoo
our guard against either confounding with the cause of fistula,
or considering the effect itself to be of a schirrous or carci¬
nomatous nature, from which last it differs essentially^.

7. That the extirpation (Fabiation) of the parts attacked
with the degeneracy in question does not radically effect
fistula, but applies only to one of its consequences, and that
this effect would of itself cease, provided the cause of the
disease were obviated.

8. That this cause consists essentially in the continual
passage of excrementitious matter, of purulent fluid, of
secreted liquids, or of gazeous substances.

o. That the proper indications in the cure of fistula are to
prevent the formation of pus, or its passage through the
fistulous canal, to re-establish the orderly course of secreted
fluids, and to prevent the exit of air by the opening which
communicates with one of the extremities of the conduit.

10. That the causes of the mischief being thus destroyed,
it becomes thd Surgeon’s duty to obliterate the passage,
either by breaking it up through its whole length (en le
fendant dans toute sa longueur), by compressing it, or by so
irritating it with caustic applications or injections, as to
produce an inflammatory action through all its extent, from
which inflammation may result the adhesion of its parietes.

11.

Singular Case of Hernia of the Stomach. By Gordon
Smith, IVl.l). of the Twelfth, or Royal Regiment of
Lancers. ‘

In transmitting the following singular case, I arn aware
that the account may prove ratiier imsatisfiictory. This does

183

Smith's Case of Hernia of the Stomach,

I i\ot arise from the distance of the period at which it occurred;
j but from causes which the perusal will explain.

Private James Wilkie, 12th Light Dragoons, aged thirty-
four, was wounded by a lance at the battle of Waterloo, He
was admitted the same day into the hospital at Brussels;
where, without any possibility on the part of the medical
officers of the regiment of ascertaining the progress of his
cure, lie shortly recovered, and joined the rcgimentat Forges-
les-Raux, in Normandy, on or about the 2()th of August fol¬
lowing, in apparent good health, making no complaint, and
immediately resuming his duties as a dragoon. It may be
proper to observe, that several others who had been wmunded
and had recovered joined along with him, and that the jour¬
ney from Brussels was performed on foot. Wilkie, how¬
ever, was taken ill on the 5tii of September, with symptoms
of enteritis, and died on the evening of the 7th.

The detachment to which he belonged was at some dis¬
tance from Forges, where I was stationed; and I did not see
him during his illness. The gentlemen, however, who at¬
tended him had neither doubt nor difference of opinion as to
the presence of iudammation in the bowels, for the symptoms
’ were unequivocal. The Surgeon of the regiment, the other
j assistants and myself met for the purpose of opening the
i body.

On raising the sternum, the right lung came into view, as
in a common dissection ; but a dark membrane appeared to
be spread over the contents of the left cavity of the thorax,
and to screen every thing else from observation. Upon feel¬
ing it, we discovered that there was beneath it a considerable
quantity of fluid. At such an unexpected phenomenon we
were not a little surprised. On prosecuting our examination,
however, we found the supposed membrane to be the stomach,
which had passed through the diaphragm into the thorax,
leaving in the abdomen the two extremities, drawn close to¬
gether by the constriction of the orifice, through which the
whole fundus had passed. This (preternatural) opening was
on the left side of, and rather anterior to the passage of the
oesophagus. The fluid contained in the stomach resembled
blood, was very dark-coloured, and in considerable quantity.
The vascularity of the viscus was increased, more especially
towards the cardia and pylorus, while there were marks of
inflammation extending to the duodenum. Upon withdraw¬
ing the stomach from its singular position the orifice through
which it had escaped admitted the fore-finger with difficulty;
and the lung of the left side was found shrivelled and shrunk
into the upper portion of the cavity, which in the healthy
state it should have nearly filled. ^

184 Oikuial Coimnnnicatiom,

Upon fiirtiier investigation we discovered the cictitrix of a
large wound on the left side «of the spine, entering between
the fifth and sixth rib ; and demonstrably passing into the
cavity of the thorax. Uroni the nature of the weapon with
which it was understood that this had been inflicted, and the
appearances that presented themselves, the conclusion w^as,
that the spear of the lance had passed through the lung, and
perforated the diaphragm ; of the probability, if not the cer¬
tainty, of which tliere can be no question. So much for the
facts and appearances, to which I beg leave to submit, in few
words, a simple conjecture on the progress of those pheno¬
mena which during the life of the system in which they were
operating were unknown and undreamt of. It might, per¬
haps, be desirable to know the history of the case during the
period of treatment at Brussels. This it has never been in
my power to obtain ; and when the leading points in Its sub¬
sequent progress are recapitulated, perhaps it may not appear
of so much importance.

The \vound was inflicted upon the I8th of June; and the
recovery must have been rapid : for we find that he arrived
perfectly well to all appearance from a considerable distance
at the end of sixty-three days. Of these the journey must
have occupied nearly a fortnight. He had, of course, been
in a state of convalescence, nay, of established health for
some time previous to setting out. For the full space of a
fortnight further he continued to enjoy perfect health ; during
which period 1 ascertained that he never made any complaint
among his comrades; and that down to the very day on
which he fell sick he had regularly taken his food in such
quantity as. a natural appetite and a strong healthy man
require.

The supposition that all this mischief took place at once is
quite inadmissible. In the first instance the stomach would
not have obtained the accommodation which it was found
after death to occupy in the thoracic cavity, while the natural
volume of the lung w^as there. Nor can it be imagined that
the lung (in whatever way or from whatever cause it hap¬
pened) having wasted to comparative nothing, left its natural
residence unoccupied for a certain space of time, at the end
of which the stomach burst through a preternatural opening
(either recent or of long standing,) < in the diaphragm; and
becoming immediately strangulated in that opening, occa¬
sioned the symptoms that preceded and \vere connected
with the death of the subject.

It has been said, and must be assumed as data, that a sharp-
pointed weapon, of a length adequate to traverse the space in
question, entered the thorax, passed through the substance of

185

Case of Delitium Tremens,

the lung, and perforated the diaphragm. One of the first
internal consequences of this violent outrage upon parts of
such vital importance, must have been the opposition of the
soft and convex surface of the stomach to the lacerated meni-
brane in immediate contact with it. At first this may have
acted as a dressing or tent, with the combined effect of pre¬
venting haemorrhage and adhesion, and promoting cicatriza¬
tion ; eventually establishing a ring or permanent opening in
the muscular substance of the diaphragm. We know that
the intestines are ever ready to protrude through any opening
in their containing parts. This orifice in the diaphragm,
therefore, giving ample opportunity for a gastric hernia, the
stomach passed out of the abdomen, and became strangulated.

An objection to sudden rupture has been offered, from the
consideration of the lung, the force of whose resistance in its
natural state would have opposed the advance of the stomach,
and in all probability have occasioned much uneasiness. This
organ, however, had been severely wounded, and was found in
an extremely collapsed state. Interpreting this upon the
principle of absorption, we can conceive that as it diminished
in bulk, and abandoned its natural position, the stomach gra¬
dually extended itself upwards, until the whole of its capacity
having passed through the orifice, the common consequence
of hernia, stangulation took place, and proved fatal. It is
perfectly unnecessary to remark how fully the symptoms
which came on previous to death are explained by the dissec¬
tion : nor would it answ'er any purpose to inquire into the pro¬
bable consequences of this transposition of the stomach, if
strangulation had not taken place. The supposition that this
might not have taken place until some time after the protru¬
sion of the stomach was completed, appears totally inad¬
missible.

A preparation of the parts concerned in this extraordinary
derangement was made by the gentleman in whose hands the
case more properly^ occurred, but by some accident or other
was lost.

III.

Case of Delirium Tremens^ in which the Use of Opium was
conspicuously beneficial. By R. South am, M.D., of
Buckingham.

I WAS desired on the 27th of July last to see T. W., about
thirty-three years of age : he had been in the habit of occa¬
sionally indulging in the use of spirituous liquors. I found
him very much agitated, talking very fast, and rather inco-
YOL. XI. — NO. 2 B

186 Original Communkatmu,

berently ; hrs hands were moist with perspiration, accom¬
panied with great tremor; pulse 80; tongue covered with
moist white fur: he had complained of being unwell for a
day or two, with slight pain in the head, which had increased
the preceding evening, and during the night became so vio¬
lent, attended with delirium, that a Surgeon had been called
at an early hour in the morning, who abstracted about twelve
ounces of blood from the nape of the neck, by cupping,
which almost instantly relieved the pain in the head : he had
likewise taken a dose of ext. coloc. comp, and hydrarg. sub-
mur, ; and afterwards a solution of magnes. sulph. He now
(one P. M.) complained of a return of the pain in his head ;
as the purgative medicines he had taken in the morning were
then operating, I directed his feet to be bathed in warm
water, and a cloth wetted with cold vinegar and water to be
applied to the head ; after which the pain in the head abated,
and he became much calmer. About seven in the evening I
met the medical gentleman who had cupped him in the morn¬
ing ; the pain in the head and delirium had then returned
with more violence than when I first saw him : as it appeared
clearly a case of delirium tremens, it w as proposed to give
him a draught with tinct. opii ni,xx. (by measure) 3tia quaque
hora : the head was directed to be shaved, and kept con¬
stantly covered with cloths wetted with cold vinegar and
water, to be renew’ed as often as they became warm, and a
blister to be applied betw'een the shoulders.

Next morning, £8th, eight A. M., I w/as informed he had
had some quiet sleep in the night; he was then more calm
and composed than the preceding evening; pulse 80; skin
soft; tongue as before, covered with moist white fur; less
tremor in the hands, and not so clammy with perspiration :
had taken four doses of the tinct. opii, which was now di¬
rected to be repeated ever^^ four hours through the day, and
to take occasionally a cupful of beef-tea. Eight P.M. Has
been more composed during the day ; but complains occa¬
sionally of seeing different objects, as dogs, 8cc, moving about
the room : repeat tinct. opii 4tis horis,.,.

29th, eight A. M. Has passed rather a comfortable night;
not so agitated this morning; pulse 80; having had no stool
since the operation of the purgative medicines on the 27th,
a common clyster was directed to be given : repeat tinct.
opii 4tis horis. Eight P.M. H as bad a copious evacuation
from the clyster, and in every respect better : continue
tinct. opii.

SOth, eight A.M. Has had a comfortable night, with some
refreshing sleep ; head free from pain, and quite rational : the
tinct. opii was now directed to be repeated every six hours.

187

Stavely on Fracture of the Cranium,

Eight P.ivl. Not quite so well this evening; head uneasy,
and talks incoherently; the medicine was therefore ordered
to be repeated every four hours.

31st, eight A.M. H as had some sleep in the night, and
appears better this morning : repeat tinct. opii 4ti3 horis.
Eight P.M. No delirium; pain in the head abated: con¬
tinue.

August 1st, eight A.M. Has had some refreshing sleep in
the night, and in every respect better this morning. Eight
P. M, continues to recover.

As there was little variation after this time, it would be
tedious to report each successive day : it may therefore be
sufficient to add that he continued progressively to recover:
the cold applications to the head were used whenever the
pain or delirium appeared to require it, and with evident
advantage: the tinct. opii w'as repeated night and morning
about a week or ten days after. During the space of six
days the patient took ^iss of tinct. opii: although imme¬
diate relief was experienced in the first instance by cupping,
yet I did not think it advisable to repeat the operation, being
of opinion that even if a little present relief should be ob¬
tained from the most urgent symptoms, yet that it would be
at the expense of greater future mischief ; and the result has,
I think, justified the practice.

IV.

Ca^e of an extemive Fracture of the Cranium, By
W. Stavely, Surgeon, Bideford, Devon.

Jane Ho skin, aetat. 11 years, daughter of Mary Hoskin,
washerwoman, Falmouth, on the morning of the 2oth of
August, 1817, whilst in the act of hanging a large quilt on a
line from the window, 15 feet in height from the ground,
fell from Hience in consequence of the quilt containing a large
quantity of w'ater, as it was just removed from the tub; and
being overbalanced she fell in a perpendicular direction, (the
height above mentioned) and from the fall, in consequence of
the pavement in the court containing large rough pebble
stones, the whole of the superior part ol the cranium was beat
in. The friends being at that time perfectly unacquaintC'd with
the nature of the accident, and considering that it might be
nothing more than a common contusion, sent for Mr. Fox,
surgeon of that town, to attend the ghi. Mr. Fox being
absent in the country, induced them to send at my lodgings
COD shore, and on my arrival 1 found the girl sitting up, but no^

188

Original Communications.

as I should have expected from such an extensive fracture,
either in a state of insensibility or apoplectic stertor ; nor was
there any difficulty of breathing, or loss of voluntary motion,
tremors, or convulsions : although previous to the operation
being complete she became insensible, with sickness ; but
these were the only symptoms that accompanied this fracture,
her pulse being also regular. On my placing her in a chair,
by inspection I found an immense coagulum of blood, three
inches in circumference, and by subsequent examination and
scalping, that the junction of fhe t\vo ossa parietalia, forming
the sagittal suture, was completely beat in by the fall : and
on further inspection, by scalping, that the fracture extended
as far as the left orbit, and backwards to the occipital ridge.
From its extent 1 certainly thought that the girl had no
chance of recovery ; but in consequence of the leading symp¬
toms indicating compression, being at that time absent,
which afterwards only appeared by her being at intervals,
during the application of the trephine, incoherent, accom¬
panied by vomiting, arising from the sympathy of the par
vagum with the stomach, I w'as, under these circum¬
stances, induced to hope, in a trifling measure, for success ;
and accordingly, as she w^as a full heavy girl, bled her very
freely. I then had her removed to a table, secured by four
people, and performed the operation by trepanning her on
each side of the ossa parietalia, including a part of the
depressed portion ; and by means of Mr. Hey’s improved
saws, I was enabled to remove twenty-six large pieces of bone
from the depression, which occupied me from nine to three.
Just as I had completed the operation (being then under
'sailing orders,) my professional duty obliged me to go on
board, and at 4 o’clock the same afternoon I sailed for the
West Indies. The subsequent care of the case, such as
dressing the wound, devolved on Mr. Fox (a most respectable
surgeon of Falmouth), who witnessed the operation ; and from
him I learnt again, on my return to England, that the girl was
alive and well, and, as might be expected, large exfoliations
had taken place. It was eighteen weeks before the wound
healed from this cause ; and in consequence of her having
taken at times large doses of aperient medicines, such as
scammoiiy and calomel, and the antiphlogistic plan being
regularly enforced, she is no\v perfectly recovered,

My object for wishing the insertion of this case, and
recovery, from such an extensive fracture, is, that it may at
all times be a stimulus for the young practitioner to proceed,
and never to despair, how^ever great the depression may be, or
lio.wever extensive the fracture.

Walker on the Topography of Huddersfeldj S^c. 189

Appendix to Dr. Walker’s Paper on the Topography of

Huddersfield f S^c,

The following is a very incomplete list of the more rare
lepidopterous insects of this district, transmitted to me by
a very able entomologist ; who has, however, omitted the
insertion of several species of more general occurrence, as
not of sufficient interest to form a part of this list. The
arrangement is from Haworth’s Lepidoptera Britannica.”

Papilio napi
- cardamiiies.

■ - Edusa.

■ - - rhamni.

- Hyperanthus.

— — Pamphilus.
- lo.

- cardui.

- Semele.

- Galathea,

- - INJoegera.

- - iEgeria.

- C. album.

- Polychloros.

- Antiopa.

• - Atalanta.

- Paphia.

- Aglaia.

- Eiiphrosyne.

— Silene.

- - Dictynna.

- Artemis.

- Lucina.

- quercus,

■ - Phleeas.

- Icarus.

- Adonis.

- Sylvanus.

- Linea.

- Pages.

Sphinx Atropos,
- - convolvuli.

* - Elpenor.

. ocellata.

— populi.

- - stellatarum.

Zygtena filipendulaj
Bombyx Pavonia.

- quercus.

- rubi.

- - potatorius.

- - — Vinulus,

- - Cossus.

- Bucephalus.

— - Caja.

• - - — plantagineus.

• - Libatricus.

— — — tremulus.

■ - ziczacus.

- - coryli.

• - furculus.

- salicinus.

- antiquus.

Hepialus humuli.

Noctua Pronuba.

' typica.

- aprilina.

- - meticulosa;

- trilinea.

Phytometra Chrysites.

- interrogationis

of Haworth.

- - — — Iota.

- - arbuti.

Geometra betularia.

- sambucaria.

- thymiana.

Phalaena ulmata.

Pyralis urticalis.

Tortrix viridaria.

Alucita pentadactyla.

- - pterodactyla.

190

Original Communications,

VIo

On Sarsaparilla^, By Richard Battle y, Chemist, Sic.,

Fore Street,

Notwithstanding the long experience which the Pro¬
fession, both Medical and Surgical, have had of the qualities
of sarsaparilla, medical judgment is still divided respecting
its efficacy in the cure of disease. It will, therefore, probably
be considered fortunate if the ground of this difference of
opinion can be satisfactorily explained.

In surgical practice, indeed, the credit of sarsaparilla has
more uniformly been maintained, perhaps because Surgeons
are more frequently called upon to seek the means which
increase the restorative powers of the body, when reduced by
the various accidents, and by the class of diseases on which
they are more particularly consulted.

It is well known, however, that even the ablest Surgeons,
notwithstanding their uniform opinion as to the efficacy of
this medicine, have yet doubted whether the ordinary mode of
preparing it was best calculated to preserve its essential pro¬
perties; hence some have been led to prescribe sarsaparilla in
the inconvenient and bulky form of powder, hoping, amongst
the useless, at least to retain the efficacious parts.

In the course of my attention to the preservation and pre¬
paration of medicines in their active forms, I have been in¬
duced to pay some attention to this root; and I can assert, as
the result of direct experiment, that its medical properties
reside, exclusively, in ihe cortical part ; and that such proper¬
ties may effectually be disengaged by cold infusion in water;
the root thus treated becoming a tasteless and inert substance.
It follow’s that when the cortical part has been materially in¬
jured, or when, in the preparation of the medicine, the lig¬
neous part of the root has been chiefly regarded, the femedy
so prepared must be, in a great measure, if not wholly, ineffi¬
cacious. Various modes of improving on the simple infusion
will readily suggest themselves to practitioners; and I find
that an elegant preparation is produced by infusing the per-
fect root in cold lime-water; a menstruum particularlyr calcu-

* It is needless to say that we feel much obliged to Mr. Battley
for the present communication ; and that we shall always have a par¬
ticular gratification in presenting to our readers the Papers which he
may be good enough to forward to us. We are convinced that in
the present day of scepticism and simplifying, too little attention is
given to the analysis and constituent parfs of the medicines which
-are used in practice. — Edit.

Is Fever Contagious^

VJ\

lated to improve its medical properties when administered to
dyspeptic patients.

The component parts of sarsaparilla, as far as 1 have been
able to ascertain them, I shall reserve for a future communi¬
cation.

P.S. The Editors of the Medical Repository have oc¬
casionally noticed a preparation which I have introduced to
the Profession ; a component part of opium dissolved in
water, under the name of liquor opii sedativus. I shall
shortly have occasion to offer some further remarks on this
subject. I am in possession of various documents both from
Physicians and Surgeons of the highest rank, agreeing, in the
main, that it is a medicine of very extraordinary power, as
well when externally applied as when internally administered.
These testimonies will induce me to claim for it the earnest
attention of the Profession, as a medicine acting powerfully
on the nervous system, and more directly sedative than any
other preparation of opium, and consequently affording more
complete relief in the very extensive class of diseases of irri¬
tation.

VII.

On the Contagion hy which it is believed Fever is excited. By

John Mitchell, M.D.

[The following article on the non-contagious nature of Fever, is an excerpt,
translated from an Inaugural Dissertation by John Mitchell, M.D,, de
Febrihus Contimiis, et pracipuc de Medelis in iis adhibendis. It is pro¬
per to mention that Dr. Mitchell published his Thesis so far back as 1802,
on graduating as Doctor of Physic at the University of Edinburgh, where,
at the time, his opinions on the subject were considered very heterodox.
Although it is rarely that productions of this kind are calculated to appear
beyond the occasion they were intended to serve, yet as the subject now
excites much public attention, from the inquiry lately instituted in Par¬
liament into the validity of the doctrines respecting contagion in Fever
and Plague, and the policy of the present laws regarding Quarantine, we
trust it will not prove unacceptable to our Readers to be presented with
a faithful translation of the article in question, as it exhibits a concise
view of some of the arguments of the anti-contagionists.]

Many, as it has been often said, are the false theories and
suppositions which have existed amongst Physicians with
respect to fever, and many still exist. But none seem to me
more conspicuous or worthy of notice here than that about
contagion, w^hich some will have to be the chief and most fre¬
quent; others the sole exciting cause of continued fever.
Early in my studies, and before habit or prejudice had fami¬
liarized and given their indelible sanction to any theory or
opinion, having been brought into a situation where it was my

lyg Original Communications, 1

lot to see, and ray duty to scrutinize, into innumerable in¬
stances of the disease, I soon became convinced of the falsity
of the latter of these opinions, which from what I had read
as well as been taught, I otherwise might have adopted. In
the Royal Infirmary of Edinburgh it was my duty daily
to attend on many labouring under fever, who had not
been nigh either a person or place from whom or whence they
could have been supposed to catch such contagion ; while
causes quite adequate without it seemed manifestly to have
given rise to the disease in them. A striking example of this
fact was furnished by the military w'ho happened at any time
to be stationed in the Castle of Edinburgh, of whom a consi¬
derable proportion, and generally the most severe, of our
fever cases was made up. The patients from this place, when
questioned as to the cause of their complaints, almost uni¬
formly answered that they had caught them from cold while
on guard during the night. In the forenoon, in perfect health
and strength, these soldiers had gone to the guard-house, the
place of rendezvous, where during the night large fires are
kept. For the short time they remain in it they generally
indulge themselves in sleep, stretched out along the seats
or boards ; and then, as it were, half asleep and half roasted,
they are called upon, each in his turn, to take their appointed
stations without doors, where exposed to the cold, wind, rain,
and all the inclemencies of the weather, they have not long
remained until a sudden attack of fever seized them.

This fact, therefore, as I have already mentioned, could not
fail easily to shake the faith of any unprejudiced person with
respect to the universal influence of contagion ; and I was
hence induced to think upon, and pay greater attention to the
subject. Ill a few of the above cases, and of others admitted,
it might be argued, as I confess I indeed did at the time, that
contagion gave origin to them, from the circumstance that one
or more of the family from whence the sick person had been
brought, laboured under fever, or at least that he had been
accidentally near a febrile patient. But my general know¬
ledge in medicine increasing, and having daily before my eyes
how few these cases w'ere, and on the other hand how great
the proportion w as of these to whom w^e could not even in this
way trace contagion ; for instance, the military we have men¬
tioned from the Castle ; others suddenly seized with fever in
the open field while reaping during harvest time, with many
other sporadic cases : add to this, that I had never seen a fair ■

instance of any person in the Infirmary, either nurses or the I

sick of other diseases in a state the most predisposed to catch j

fever, having been infected from their attending on or being 5

about those labouring under it j particularly that I myself in j

li Fever Co)itagious?

the course of near three years had never been affected with
this disease by iny attendance on fever patients, even in
the worst cases, notwithstanding that I had been repeatedly
and successively called from my warm bed during the night
time to the fever ward, when quite cold and shivering, with my
rest broken, and my spirits depressed, I remained by the
bedside of the patient administering to him wine and cor-
dials, and doing what else he stood in need of,^ sometimes
in contact with him, slowly drawing off his water by
the catheter: nor, that amongst the Russian sick, then re¬
ceived into the Ro3^al Infirmary from the ships in Leith
Roads, I had taken no harm ; although quite fatigued, I had
frequently of an evening to take account of six, seven, or more
cases ; examining the state of the skin, pulse, tongue, odour
of breath, and other matters which it was necessary for
me to report in writing, besides now and then lending my
hand in stripping off their clothes, and getting them com¬
fortably laid in bed : lastl^q considering that it was the
decided opinion of Dr. Rutherford, the able Physician under
whom I acted, that although he had been Physician to the
Royal Infirmary for many years, he had never seen a case of
infectious fever in it. From such considerations, I say, I lost
my faith in the commonly received doctrine of febrile conta¬
gion ; and now, so far from believing it to be the chief and
most frequent exciting cause of fever, after attentively con¬
sidering the subject, 1 am firmly persuaded that such a thing
s does not exist.

But however I myself may thus have had reason to be
well convinced of the fact, neither my scanty stock of
materials, my inexperience in arranging them, nor the
limits of this Essay permit, that 1 shall convince others
of it, by bringing forward a full refutation of the doctrine
of febrile contagion. I'his is a doctrine than which there is
no assumed and gratuitous principle in medicine that has
longer and more extensively kept its ground, none whose
admission has so well accorded with every theory and hypo¬
thesis of the time, and none which has had in its turn more
plausible reasoning furnished it from all. Indeed it would
: seem as if Physicians of all and every sect had united them¬
selves in finding arguments to sirpport it.

; But let us only give up the term contagion, a term meaning
nothing, and such as Fordyce would emphatically say is only
i useful to fix a word for a matter in our minds; how contra-
; dictory, absurd, and whimsical, will the qualities, and every
i thing said about the Proteus appear to us! Until about a
century ago, whenever an epidemic appeared in this country,
? imported contagion was resorted to for its origin. Physi-
VOL. XI. — NO. 63. 2 c

1^ Onginal Communications*

cians looked for no other cause; nor did it matter how great a
ditference there was betw^een the phenomena of the disease in
the place from which and that to which it was imported ; and
every fever arising in a person as w^ell then as when not
epidemic, but sporadic, was thus never imputed to any other
cause than contagion, or having been nigh another labouring
under it. Such a supposition was supported by the most
ridiculous reasoning, reasoning which reconciled the most
opposite facts, and to them explained every difficulty. Every
author had his favourite mode of conveyance for this con¬
tagion ; and the most whimsical and far-fetched seemed, for
the most part, to obtain the greatest belief. Cloth, old
timber, goods, merchandise, and cattle of various descriptions
yielded, in one instance, the palm in point of credit, to
Meades pedlars’ packs and tailors’ boxes, by which alone
whole cities were held to have been depopulated and made
desolate. Once imported, Physicians kept up, as it were, the
farce, by explaining the action of contagion. For it either at
once got activity; or if it did not, it lay pent up during frosty
weather, in old houses, adhering to the walls, or perhaps
frozen in the ice until the spring, warm weather, or a thaw
gave it vigour and activity : during the summer again it
lay harmless until cold weather had concentrated it, until wet ■
weather had diluted and given form to it, until dry w'eaiher '
had permitted its ascension, volatilization, and evaporation, '
until it had assimilated the air to its own nature, until a
peculiar unknowm state of this had concurred with its opera- I
tion ; or, finally, until time itself should have had the effect of |
generating it. ;

But when at length the fancy^ for this imported contagion i
began to decline, at least when Physicians began to seek i
for the sources of contagion generating epidemic diseases in |
the places in which they happened, besides having recourse to
similar explanations to give activity to it, as they used when j
imported, they advanced others not less absurd, and found the j
origin of it, thus home-manufactured, in every sort of matter. I
Whales cast ashore, cattle killed, slaughter-houses, small fish |

in the Adriatic sea, locusts, and other animal matter, from i

various circumstances becoming putrid, the effluvia of rotten | '
hemp, flax, prunes, olives, almonds, capers, coflee, cabbage, |j,
onions, and black pepper, make some of the causes most 1:^
generally fixed on. it is Benedictus, I think, who tells us, i
that the shaking an old feather-bed at Wratislau, which had
lain by many years, raised a plague that destroyed no less ; '
than five thousand persons in tw^elve weeks. ^

With as little hesitation and difficulty^ did Physicians trace i ^
the origin of every sporadic case of fever; and perhaps their

Is Fever Contagious * 195

sophistry in this respect, at the present day, receives
more implicit credit than the suspicious origins mentioned
above for epidemics. Such was Paracelsus’s notion of
this all-powerful agent, febrile contagion, that he firmly
believed the disease could be communicated by imprecation,
or that a person labouring under a fever had the power of
bewitching his neighbour with it; somewhat similar to a
notion of an eminent Physician, Dr. Ash, who maintained
Small-pox were infectious at the distance of thirty miles.
Perhaps in a few years hence, scarce less wonderful and
incredible than these notions will appear the many stories
that have been told, and at the present day are believed as
Gospel. Thus, Forestus tells us of a man who was seized
with the plague from only putting his hand into an old trunk;
Fracastorius, that tvvenly-five Germans died of the plague,
infected by putting on one after another an old leathern coat ;
Boccacio, that two hogs fell into convulsions, and died
within an hour, only by tearing and snuffing at some ragged
garments which had been w'orn by a man who had died of the
plague. All that ever was, and still for the most part is,
inquired of a fever patient, is, Whether any of the family from
whence he comes are ill ? Whether he had been near a person
ill of fever, or any other, who, although retaining good health,
had? It is ten to one but some of these incidents have
happened, and thus the Physician rests confirmed in his
opinion as to the agency of contagion. Upon such a suppo¬
sition, however, it is plain that almost no person could escape
fever; as a Physician, for instance, must carry it always about
him, and, like the fabulous tree, the Bohan upas^ he would
poison and infect every one whom he approached. But
should a person altogether insulated, without the possibility of
having been even thus exposed to contagion, be seized with
fever, blindly determined to take the existence of it for
granted, we are then told that it is itself bred in the body.
Thus reasons the celebrated Lind: — We should never give
a negative to contagion ; the difficulties attending an inquiry
into the nature and causes of infection, and the influence of
various causes in its operation are great, and it should always
therefore be suspected. Countries and cities might have
escaped the dreadful scourge of pestilence had an alarm been
taken, and the fever at its first breaking forth been deemed
contagious.” 'To reply surely to such reasoning, is like the
impossibility of arguing with a madman against his own
ravings, or with a person who should assert the moon was
a globe of cheese. 1 could not hope to convince and bring to
l)is senses the one ; and as for the other, he will admit nothing
but what the matter refuses, a demonstrative negative proof.

196 Original Conmunicatmis.

As to this person, I should certainly be justified in throwing
the onus probandi of* the assertion on himself; and every unpre^
judiced person wiii admit the justice of the same inference with
respect to that of contagion being thrown on those who assert
its existence. But unfortunately for them, notwithstanding
all their attention to and research for it, so far from being able
to show us it, to prove its existence, or tell us what it is, they
know not even its qualities, some asserting one thing about it,
and some another, so as to endow it with the most opposite.
Some will have it to be of an animal, some of a vegetable,
some of a mineral nature, and some of all these. Some think
it is animalcule. Again some will have the quantity neces-»
sary for infection and its sphere of action great, others small,
others in any quantity and at any distance, and others by
contact alone. Some think its mode of operation is by being
received into the stomach, some by being inhaled by the
lungs, some by its affecting the nerves of the skin, some by
being transmitted through the absorbents, and some by all
these ways. Lastly, some will have it to produce its effects
instantaneously, some at stated and regular periods, and
some say it will lurk in the system and excite fever at any
distance of time, God knows how long. After stating these
absurdities, I might be allowed to conclude that we know of
no such thing as febrile contagion.

I shall, however, proceed a little further, and, for the sake
of argument, admit, in its fullest extent, the existence of this
contagion as the cause of every epidemic and of every fever
that occurs; and I shall contrast it with one of the other con¬
tagion, e. g. the Small-pox. It will clearly be seen how little
analogy there subsists between the two contagions. First then
with respect to the small-pox. It is allowed by all that no
other matter or cause will produce the disease in any one,
except its own peculiar contagion ; that this contagion is
brought from and carried to any place, even the most distant,
there infecting; that in climates the most different, the dis¬
ease thus produced exhibits the self-same appearances,
affecting at stated periods, after exposure or inoculation, and
once produced, running its course in a regular manner,
exhibiting on the same days of the complaint respectively
its more remarkable phenomena; that during life the disease
will not again recur; and, finally, that not one in k hundred
to whom the matter has been fairly applied escapes catching
the disease, provided he has not already had it, or does no't
at the time of its application labour under some general
affection of the system, whose cause is more powerful than
this contagion, w hich, if we judge Lorn tlie mildness of th§
disease occasionally produced, is not very much so^

197

Is I 'ever Contagious f

In the second place, with respect to fever in general ; it is
to be observed, that altogether different are the circumstances.
We have said that no other matter except the variolous con¬
tagion will produce the disease; and of consequence if pre¬
cautions were used to avoid exposure to it, as the philanthro¬
pic Haygarth says, it would in time be entirely extirpated.
But when fevers and plagues are e[)idemic in a country, no
precaution that can be used by shutting oneself up, and
avoiding all communication with the infected, will have the
effect of preventing a person being seized with the disorder ;
which, however, he ought not to catch, if we credit some
enlightened and experimental physicians, who, although yet
too strong in their prejudices to deny the existence of febrile
contagion, yet maintain that it infects only by contact; an
opinion which goes far to strengthen our own argument.
Mosely tells us, most of the Capuchins, the Jesuits, the
Hecollets, the Observantines, the barefooted Carmelites,
the reformed Augustines, all the grand Carmelites, the
grand Trinitarians, the reformed Trinitarians, the Monks
of Loretto, the Dominicians, and the grand Augustines, who
kept themselves secluded in their several convents, and took
every precaution to avoid the plague while it raged at Mar¬
seilles, perished by it.” And instances of a similar nature
are every where on record. To explain, how ever, these facts,
and show the existence of contagion, it is asserted that the
very food conveyed to them served as a kind oi fomites for it.
It would be more plausible to say the air they breathed
became infected with the contagion ; but this, because actual
contact with the sick is necessary, will not suit them. Even
with /bmte, however, I am at a loss to see how the disease
should be produced ; for if the contagion be a matter having
a strong attraction for the substance possessing it, where¬
fore does it so readily part with it? Again, if it be a matter,
so equally is the marsh miasma supposed to produce inter-
niittents ; but who, even the most zealous contagionist, ever
seriously believed that intermittents were either contagious,
or capable of communication hy fomites'^ yet no reason can
be shown why fomites should not exist as well in the case of
intermittent as of continued fever, since by the hypothesis
each is matter. Moreover, various causes, besides expovsure to
a person affected with fever, will induce the disease, allowing
for one moment that it does so. Speaking on this subject, 1
have already had occasion to mention a few of the causes
blamed for epidemics. VVe know for certain that the crews
of newly built ships are remarkably unhealthy, chiefly from
febrile diseases ; yet if any place could be supposed free from
contagion, they ought. Bad food alone and famine arc like-

198 Original Communications.

wise notable for producing fevers. Frank tells us, tbaFtlie
inhabitaiils at Bucia, being besieged and obliged to use bad
food, a bad putrid fever arose amongst them, whilst the be¬
siegers, provided with every plenty, remained free from it, and
did so, 1 dare say, after they got within the walls ot the con¬
quered. Sir John Elliot likewise mentions (see Lind’s Essay
on preserving the Flealth of E,uropeans,) that Naples, in 1764,
furnished an example of the most malignant lever from
scarcity of food. Lind, in his second book on Fevers and
Infections, recites several cases of infection (of which he bad
no doubt,) arising from other causes than contagion. “ The
slightest degree of infection (says he) is derived from the bad
smell of patients labouring under inflammatory diseases. A
lady with bilious colic affected another lady passing by wdth
retching and sickness, continuing for twenty-lour hours, and
a nurse wdth a fever, cut short, however, by a timely emetic.’^
The same slight degree of infection he has known arise from
people of a gross habit, labouring under other complaints as
well as inflammatory. He stales likewise cases of fever
from going near a maniac, from putting a person in his
coffin, and from small pox. Dr. Currie, of Liverpool, men¬
tions some bad cases of continued fever in the production of
which contagion had not the smallest share. And Willan, a
sturdy contagionist, in his Reports on the Diseases of London,
confidently affirms that the slow nervous fever of Huxham (a
species very frequent in this place, and which by all is said to
be contagious,) neither lakes its origin from contagion, nor
becomes infectious in its course. Many examples of the same
kind are to be found in authors. Some even contend, that in
children and youth there is so strong a predisposition to fever,
that it alone becomes the sole cause ; and to this opinion,
considering the delicate and curious fabric of the human body,
1 most iieartily assent ; and the more so because I am
supported by tire opinion of my illustrious preceptor, Dr.
Rutherford, wJio, in one of those conversations which I have
so often enjoyed with him, and which have so often opened
new truths to my mind, in speaking on the subject, I remem-^
ber took for its illustration the instance of Parom/chia, and
inquired where was the exciting cause that gave origin to it.

We have already given a specimen of the absurdities into
which Physicians fell when they attempted to support the
notion of exotic contagion being the cause of epideiiiics. 1
will venture to affirm that there is not one well authenticated
instance of an epidemic arising from such a cause, if we
were to admit such, it would appear singular that the yellow
fever of the \^ est Judies, the contagion of which, judging
from its effects, must be in a degree the most concentrated.

Is Fet 'tr Contagious f

iiialignaut, and pestilential, has never once been imported and
raised a plague here. But the truth is, as a few unprejudiced
West India Practitioners are now well convinced of, that even
there 3'ellovv fever is not a contagious disease. IN ay, so far
from contagion of fever being imported to one country or
tribe of people from a different, we are told that if people
labouring under the epidemic prevalent in one part of the
same country are retnoved to another not far distant, they
communicate the infection to no one. I'hus Rush speaking
of his contagious remitting fever of Philadelphia, says, “ this
fever did not spread in the country when carried there by
persons who were infected, and afterwards died of it:” and in
another place he observes, during four times it oceurrecl in
Charlestown; in no one instance, according to Dr. Dinning,
was it propagated to any other part of the State.” The cele¬
brated Dr. Lind’s works are full of facts to the same effect ;
and so also are Pringle’s, and a variety of authors. Even in
the noted instances of contagion, hackneyed by every author
in proof of its existence, viz. that of the Blackhole at Cal¬
cutta, that at the Oxford assizes, and that at tlie Old Bailey
in London, the sick in these places comaiunicated the dis¬
ease to no one. Of the first of these, no person doubts. Of the
second, we learn from Lord Bacon’s Natural History, that
those only who were present or attended business sickened on
it and died. And of the last, Pringle gravely tells us, this
sickness, as far as \^as known, spread no farther, there being
at the time no distemper in the air, nor other conciining cir¬
cumstances to propagate the infection.” But how different,
I repeal, from these circumstances are those which accom¬
pany the contagion of smalLpox. Lind tells us that Euro¬
peans have carried the small-[)ox to almost all pa i ts of the
world where they have opened a trade. This venom has been
Conveyed in an old blanket to nations of Indians, some of
whom it hath almost extirpated. . It will lie concealed for a
long time in contaminated vestures, so as to be carried in them
from England to the Cape of Good Hope, and even to
China.”

As to fever, in the next place, exhibiting the same regular
phenomena, it is so well known' to the contrary, that it may
seem to consume time to say any thing. It is so far from
observing the same appearance, that fevers not only in differ¬
ent climates, but even in the same, and almost at the same
time, vary in infinite degrees; insomuch that authors, to ac¬
count for this, at one time supposed the number ol specific
contagions giving origin to them were various. Now a days,
however, when this supposition has been given np, their
sophistry has fallen upon another mode of accounting for the

f2CX) Original Communications.

variety; that is, they say there is but one contagion, yet
acting so variously and producing such different effects, that
surely he does not merit the name of a philosopher who
would ascribe such varied effects to the same specific cause=

Again, so far from the contagion of fever observing the
same law with other contagions producing a general affection
of the system, viz. that the disease does not recur in the course
of one’s life, (a law tne wisdom of which cannot be sufficiently
admired, since its final cause is the preservation of the human
race'; so far, I say, does it differ from this law, that from
this deviation alone it might be inferred levers are not conta¬
gions. Observation shows that some people have as it were
a disposition to be affected with the disease at stated and re¬
gular periods ; and every one at all engaged in practice knows
too well how frequent llie relapses in fever are, and bow great
caution there is necessary in respect of diet and regimen with
febrile patients to guard against them.

It is scarcely necessary to mention that a fever once pro¬
duced is in a thousand instances stopped and cut short by the
timous exhibition of proper remedies, such as emetics, the
cold bath, &c. When indeed morbid matter formed the
proximate cause of diseases, and that the vis uaturtR medicatrix
was assigned the task of concocting and expelling this, few
were the opportunities of witnessing the fact. But now that
these suppositions are given up, and that recourse is had to
active practice without fear of disturbing concoction, and the
other operations of nature, or of leaving the latent poison in
the body. Practitioners have the satisfaction of witnessing in¬
numerable instances of fever cut short. Dr. Gregory, 1 tliink,
says, that in the course of his practice he has seen about one
huudred and fifty cases of fever cut short by the use of emetics
alone ; and Dr. Currie relates, that out of seventeen patients
at one time labouring under fever, he was able, by means of
the affusion of cold water, to put an end to the fever in
fifteen.

Lastly, as to the circumstance that people are every where
exposed to fever without catching the disease, much has
already been said to show its truth. Mosely, formerly
quoted, says, that Rhazes lived 120 years, and often prac¬
tised in plagues. Hodges remained in town and attended
the sick during the great plague in London, in 1665. Kaye
was in the midst of practice in the sweating sickness, in 1551,
without any inconvenience. Procopius informs us, that
during a terrible plague at Constantinople, in 543, which
almost destroyed the whole city, no Physician or other
person got the plague by attending, dressing, or touching the
sick/^ Russel likewise acquaints us, that the dread of con-

Remarks ( nical Classification. JiOI

tagloii being worn off, he attended the sick with impunity.
And it is a fact, that physicians, nurses, and other attendants
on the sick, notwithstanding their fatigue, remain as healthy
as other people, though, if we believe in the doctrines of con¬
tagion, their whole bodies ought to be saturated with it.
Such facts, one should think, it would be puzzling to account
for; but terms without meaning are the auxiliaries called in
to explain them. Thus, all those escaping are said to have
either a peculiarity of constitution, (although, by the bye, I
should rather think, from the few affected, that it is these
few in whom this peculiarity or idiosyncrasy resided,) or from
habit, that they are familiarized to it. Pray how do they at
first escape it before this habit is acquired ? If contagion be
any real matter existing, I deny that any matter can be thus
applied to the human body, without producing its peculiar
effects. Mercury, digitalis, emetics, cathartics, See. all are
known from the effects they produce, as also other contagions.
Thus we read that a certain elector of Bavaria, who had kept
himself carefully secluded from the contagion of small-pox until
he had reached beyond the usual age for this disease, having
been accidentally exposed to it, sickened ^ from it and died.
In short, this febrile contagion is nothing*else than a fable.
It is another Pandora’s box of the ancients. It is a hobgob¬
lin, it is a spectre, it is a ghost, about which, in our childish
days, we have listened to the hair-erecting tales, when
enslaving fear, with a Circsean wand, magnified and changed
every midnight sound and form into the appalling Furies,
before reason had taught us to dispel the clouds of super¬
stition, or experience enabled us to combat the errors of pre¬
judice, which, once imbibed, entangle all of us long, many of
us, for ever.

DEPARTMENT OF NATURAL HISTORY, &c^

On the Plants belonging to the Natural Order of Solanere. '

By Mr. Gray.

Among the studies which, although perhaps not abso¬
lutely necessary to the professional Practitioner of medicine,
yet are of great use to him occasionally, and afford him a
source of employment during his youth, until he acquires that
maturity of years which is required to attain the full confi-
idence of his patients, and consequent fulness of employment ;
there is none that rank higher than botany, and none that are
of easier attainment, or that afford more pleasure in the pur¬
suit. The botany here intended to be recommended is not
YOL. XI. — NO. 63, 2 D

Original Co.,^ ions,

the mere remembrance of names, whose signi¬

fication is frequently at complete variance with the proper*
ties, or literary history, of the plant which they are intended
to denote, or which commemorate persons known only to the
writer ; nor is it the knowledge of those plants which it is
probable the student never will have the pleasure to see, and
of course can be but little interested to know what are their
botanical characters : but a plain, yet accurate account of
the indigenous plants of the British islands, and of those
usually cultivated for sale, with the uses to which they are
applicable.

Previous to a particular account being given of any plants,
it w'ill be necessary to consider the arrangements which have
been proposed, as their number is too great to be recollected
without some mnemonic arrangement. The original culti¬
vators of botany soon discovered that many plants had a
family likeness; that the number of those well-marked fami¬
lies was but small, and that there were other plants which did
not seem to belong to any of these families. The first attempt
at scientific arrangement was made by Csesalpinus, and fol¬
lowed, but riot with equal skill, by Morrison : Ray, however,
and Tournefort, have had the good fortune to share a greater
portion of the public regard. Their arrangements were dif¬
ferent, but they both agreed in retaining the natural families
of plants, and in accommodating the system to them ; in
avoiding innovations as to the names hitherto given to plants
by only choosing the names which appeared to be the best ;
and in using such characters to distinguish plants as w^ere
most easy to be perceived by young students. Ray followed
Csesalpinus in preferring tbp fruit for the basis of his system,
as being the most perfect state of the plant; while Tourne¬
fort preferred the flower, as being that which is first pro¬
duced, is the most attractive state of the plant, and which
may frequently be observed in dried specimens brought from
abroad, although the bringers have neglected, or not known
the ultimate produce.

The many characters that w^ere necessary to be taken into
consideration in order to retain the natural families, render¬
ing the arrangement difficult to be understood by the more
hebete kind of students, led Rivinus to propose a merely
artificial arrangement, by which a student, on examining the
corolla or bloom of a plant if it had any, or observing its
absence, could from this single character distinguish its class ;
while a second examination of its fruit showed the subdivi¬
sion under which it should be arranged, and these subdivi¬
sions follovved each other in an invariable order in each class.
The elder botanists had not given anv names to tiie smaller

Object lonV^ l^otai Sj/stein,

plants, but denoted them Ky'flieir generic name with the addi¬
tion of what is now called the specific difference : Rivinus,
however, for the sake of uniformity, gave names to every
plant, and these names were usually composed of two words,
the first expressing the genus ; the second, or trivial name,
some remarkable character expressive of the species. His
own works were published in a style too expensive for com¬
mon use, and left imperfect by his death : his system, how¬
ever, has had many followers; but most of these, as Ruppius,
have, from an aversion to innovation, left the usual desig¬
nations of plants as they found them, so that the common
and artificial systems went hand-in-hand together. It is,
therefore, probable that had no stop been put to the progress
of the science, it would by this time have been brought far
nearer to perfection, and there would have been less discre¬

pancy^ between the old and new botanists than at present.

Unfortunately in some degree, Linnaeus arose like a meteor in
the horizon of science. His consummate vanity caused him
to profess the destructive maxim, that the whole of the old
structure must be destroyed in order that he might have the
credit of rebuilding it on his own plan : while the impurity of his
mind, so clearly evinced by the obscene names by which he used
to distinguish the several parts of bivalve shells, names which
the most devoted of his followers have been obliged to forego,
led him to choose the sexual parts of plants for the basis of his
vegetable system. His real merit consisted in the perseve¬
rance with which he reduced most of the known plants to his
own system : the rapidity of bis publications in a cheap form
rejecting the expense of plates ; the extreme neatness with
which he displayed the characters of his genera, and the differ¬
ences of bis species ; as also the equal neatness of his descrip¬
tions, so that the eye is immediately directed to the informa¬
tion required ; in which two last typographical particulars he
was then unrivalled, and has scarcely been equalled since.
A part also of his fame must be ascribed to the dexterity with
which he avoided mentioning the plants, &c. he had not re¬
duced to his system, without the least notice of their exist-
ence : wdiereas Ray, and since his time Jussieu, giveilists of
the plants which they cannot arrange in their systems for want
of the necessary information : and thus on the one hand they
candidly acknowledge the imperfection of their systems; and
on the other stimulate the student to complete them. Lin¬
naeus did not in his earlier writings make use of trivial names,
but employed his new specific differences; afterwards, hovv-
ever, he adopted the use of trivial names; and the invention of
them has been ascribed to him, but falsely. He also laid it
down as an axiom that what he styles genera are the work of

504 Original Communications,

nature, and yet was equally positive that their characters, as
had been previously stated by Rivlnus, must be ded uced only
from the various structures of the flower arid fruit, and not
from any other parts : and he also considered the fltwer as
more constant in its structure through the various species, of
a genus than the fruit. In consequence of the first of these
opinions, his system, although confessedly an artificial one,
contains numerous species which do not agree with their
generic character, or which even belong to other classes than
those in which they are placed : so thar it neither exhibits the
natural affinities of plants, as in the systems of Ray and
Tournefort, and those to be next considered; nor has it as a
whole that lucid neatness required in a mere artificial system,
and which it really possesses in the lower divisions.

The apparent methodical exactness which pervaded the
system of Linnaeus caused the adoption of his system by the
German and English naturalists, and they still retain it.
Portunately the national pride of the French, and the plates
given with the Institutions of Tournefort, from the greater
ease with which the eye conceives a print than the mind a
verbal description, operated as checks to the progress of the
Linnaean system in France and Italy : and the attention of the
southern naturalists has ever been devoted to the improve¬
ment of the common system. They have, indeed, adopted
not only the typographical arrangement of Linnaeus, and his
manner of description, but also his canon, that the characters
of the genera should be taken from the fructification alone :
still their labours are merely the same attempt to discover the
natural affinities of plants, as was the intention of Ray and |
Tournefort ; crippled however by the confinement of the cha- i
racter to the fructification alone. These self-imposed fetters "|
produce in some cases, as in the reseparation of abies and |
larix from pinus with which they had been united by Lin- ^
nmus, a necessity for the utmost subtilty in finding clistinc-
tions in the flower or fruit, and render the characters of these
genera inconveniently long and recondite, as may be seen in |j
Jussieu or Decandolie. Some men delight in exhibiting their
feats of swimming in chains, and humorous rustics in the j;:
absurdity of races in sacks; so some naturalists seem to find jl
equal delight in imposing difficulties upon themselves, which -
may, at once, show their own dexterity, and tend to prevent v
competitors from treading in their footsteps: thus Fabricius x
pretended to establish an arrangement of insects from the is
structure of their mouth alone, without taking anv other part x
ipto consideration. Ihe confinement of the creneric cha~ i
facters to the fructification is grounded upon the flower and U
fruit being said to be the most, essential' parU of the plant, )•

205

On ike Plants of Order, Solanea,

and those for whose use the other parts exist; but, in fact,
every part is alike essential to the existence of a plant, nor
can one part be said to be more so than another : hence it
cannot be doubted by any impartial student but the maxim
.of Ray, that the characters whereby plants are to be distin¬
guished and recognised may be taken from all parts of them,
and that their comparative merit depends upon the ease with
which the plant may be identified by their means, is equally
scientific, and far easier in its use than the limitation imposed
by Rivinus and Linnaeus, as also more analogous to the mode
. of classification recognised and practised in the other branches
of natural history. And, in fact, notwithstanding Jussieu and
Decandolle both insist upon the characters of the genera
being taken from the fructification alone, yet they also annex
characters of a secondarj^ rank taken from other parts ; and
even Sir J. E. Smith has annexed to each species in his Com¬
pendium additional specific distinctions from characters re¬
jected by Linnaeus; a practice indeed not entirely unknown
to the Swede himself: so that from their own showing it ap¬
pears that these disgraced characters may yet be employed ;
and that they are in general easier in their application than
the others, we may appeal to the judgment of every practical
botanist.

It is ray intention to review occasionally the families into
which plants are naturally divided, to notice such species as
are indigenous to our islands, or cultivated in them, and which
are at the same time of use, particularly as diet or medicine.
The present paper is on the solanece, a family ol which the
individuals are remarkable for their powerful action on the
human frame.

SOLAN EiE.

CL VIII. Plantes dicotyledoncs, monopetales, hypogynes-.
Ord, 57. Les Solanees. Jussieu.

Cl, V. Ord. 1. Pentandria monogynia. Liruiccus.

Calix five cut or five parted, often persistent.

Corolla regular, five cut.

Staynina five, inserted in the base of the corolla, alternating
with its lobes.

Ovarium disengaged ; style one ; stigma simple or two^
furrowed.

Pvuit two-partitioned, many-seeded : sometimes capsular,
bivalve, partition parallel to the valves ; sometimes a berry
With central seed bearing receptacles.

Seeds numerous; perisperm fleshy; corculum annular or
spiral; cotyledons semicylindrical.

Stem herbaceous or frutescent.

Leaves alternate.

206

Original Communications,

Flowers often extraxillary*

Obs. A fifth part of the flower is frequently deficient,

Fjssential Character, Corolla regular ; stamina five; fruit

bilocular ; corculum annular or spiral ; leaves alternate.

VERB A SCUM, T. L. Blattaria, T.

Calix five parted.

Corolla rotate, five lobed, unequal.

Stamina five, unequal; filaments inclined, generally villous
at the base.

Capsule two valved, ovate or globose.

Sp. 1. C. Thapsus, Tapsus barbatus ; Great white mullein,
High taper, Cow’s lungwort.

Leaves decurrent, downy on both faces ; stalk simple.--
Spike cylindrical, flowers sessile, gold yellow, ^

Sandy road sides; flowering in July and August. Peren¬
nial.

Leaves slightly astringent, a decoction of them useful in
diarrhoea, yield about one-third of an astringent extract.

Flowers slightly sweet-scented, sweet to the taste; distilled
water slightly scented ; essential oil small in quantity, and
sweet-scented. Yield about one-half of an agreeably sm-elling,
and sweetish extract. Their infusion, made with care to avoid
taking the irritating down on the calyx^is i|sed as a demulcent
and relaxant in colds, coughs, and other diseases of the chest,
especially by private Practitioners and Farriers, for which
purpose it is very etficacious.

Down of the leaves rolled up is used instead of moxa as a
cautery ; and also for tinder.

2. F. Lychnitis, V. album. White flowered mullein.

Leaves oblong, wedge-shape, naked on the , upper face ;

stalk angulato-paniculate ; filaments bearded, yellowish. —
Flowers on footstalks, white.

Chalky road-sides; flowering in July and August; peren¬
nial.

It has been used for the
efficacious.

3. V . pulxerulentum. Hoary mullein, Norfolk mullein.

Leaves ovato-oblong, rather serrated, powdery-downy on

both faces ; stalk cylindrical paniculate ; filaments bearded,
white; anthers bright red. — Glows very large and much
branched; flowers gold-yellow.

Sandy ways ; flowering in July ; biennial.

4. V. nigrum. Sage-leaf black mullein.

Leaves oblong, heart-shaped, petiolate, crenate, rather
downy; filaments bearded, purplish. ^ — Spike loose; flowers
gold-colour.

preceding, but is probably not so

Blacky and While Henbane, 507

Light and chalky soils; flowering in July and August;
perennial.

Root astringent, used in diarrhoeas.

Leaves and flowers used instead of common mullein.

4. F . mrgatum. Large flowered mullein.

Leaves oblonsj-lanceolate, toothed, sessile ; radical leaves
sublyrate, downy; stalk branchy; flowers aggregated, sub-
sessile. — Grows six feet high, flow'ers very large, yellow.

Sandy fields ; flowering in July and August ; biennial.

5. F , Blattaria. Blattaria lutea, Yellow moth mullein.

Stalk branchy; leaves embracing the stalk, crenate, oblong,

smooth; radical leaves sinuate; peduncles solitary. — Grows
th ree feet high ; flowers gold-colour; stamina purple.

Gravelly soils; flowering in June and July annual.

This plant is said to attract moths.

Seeds used to inebriate fish in ponds so that they may be
taken by the hand.

IlYOSCIAMUS, T. L.

Calix tubulose, five cut.

Qorolla funnel-shape; limb spreading obliquely, five lobed,
lobes unequal.

Stamina five.

Stigma headed.

Capsule ovate, compressed on both sides, hollowed into a
groove, covered with a lid.

Sp. 1. II. niger. Henbane. (Pharm. L. D. E.)

Leaves embracing the stalk, sinuate ; flowers subsessile. —
Hairy, stinking ; corolla yellowish with purple veins.

Among rubbish, also cultivated for medical use ; flower¬
ing in July; annual.

Leaves narcotic, anodyne, equal in their effects to opium,,
and not apt to produce costiveness ; boiled are used externally^
in piles and the gout as an anodyne, applied to ulcers they
have produced delirium, being eaten they occasion loss of
sight and intellect, fainting, stupor, convulsions, pains of tha
bowels, and bloody stools : the inspissated juice in small
doses has been lately employed in many obstinate cases.

Root less fetid than the leaves, tastes sweetish but acrid, is'
powerfully narcotic, used in toothach either rubbed on the
gum, or inserted in the hollow^ of the tooth.

Seeds less narcotic than the root or leaves, but more so than
the seeds of white henbane, although frequently sold for them;
the fumes arising from them when heated being conveyed to
an aching tooth by. means of a funnel, have frequently been
used with good success.

2. II. alhus. White henbane.

<208 Original C omniuni cat ions i

Stalk-leaves foot-stalked, heari-sliape, sinuate, acute; floral-
leaves, not in the least notched ; flowers subsessile ; corolla
bellied.

Where ballast has been thrown on shore, thus imported
from the South of Europe, an annual.

All the parts of it are much milder than those of the black
or common henbane in their operation.

NICOTIANA, T. L.

Caliv pitcher-shape, five cut.

Corolla much longer than the calix, funnel-shape, fi^v^e cut,
regular.

Stamina five.

Stis^ma nicked.

Capsule tw'o valved.

Sp._l. N. Tabacum. Petum, Tobacco.

Leaves lanceolate-ovate, sessile, decurrent.

Cultivated in America, and upon the Continent, froni
whence it is imported, its cultivation, notwithstanding the
separation of the United States, being forbidden in the
British Islands, to the great loss of the landed interest ; an
annual.

Leaves yield with water about one tiiird of extract, of a
bitter and sharp taste ; and wdth spirit of wine, about one-
sixth of a similar extract. They are emetic and cathartic to
a violent degree, as also narcotic, vulnerary, detergent, and
consolidating, and when properly prepared are equally effi¬
cacious with hemlock in the treatment of many stubborn
diseases. The green leaves or their juice are used to burns
and painful tumors or eruptions. The fumes inhaled are
emetic, and produce vertigo in those unused to them, but to
others they are anodyne and narcotic. They are also injected
into the rectum in obstinate costiveness, ascaridcs, and to stimu¬
late the intestines in cases of drowning. A decoction of ^ij
* to 3vj is used as a stimulating glyster in apoplexy. The leaves
soaked in brandy or urine, and applied to the wrist, have had
an emetic effect, and applied to the navel are used to purge
untoward children, who refuse internal medicines : are also
made into an ointment against the itch. Henbane leaves are

frequently sold for them.

£. N. rustica. English tobacco.

Leaves foot-stalked, ovate, not notched ; flowers blunt.

A native of America, sometimes found on dunghils in
England. Cultivated by Gerarde in 159^. An annual.

Agrees in medical use with henbane.

Sold by herbalists for mandrake leaves and tobacco.

209

On the Plants of the Order ^ Solanecr.

DATURA, L. Stramonium, D,

Calix large, tiibulose, bellied, five cornered, five cut at the
tip, soon falling off, leaving the orbiculate peltate base.

Corolla very large, funnel-shape; tube long; limb five
cornered, five folded, five pointed.

Stamina five.

Stigma two plated.

Capsule thorny or smooth, ovate, two-celled ; cells two or
many parted ; partition prominent.

'' Sp. 1. D. Stramonium. Thorn apple.

Pericarpia ovate, thorny ; leaves ovate, sinuate, smooth,
narrowed at the base into a petiole. — A very branchy, ill-
looking plant ; flower white.

A common plant in America, continually brought from
hence with pots of plants, or ballast, and found on rubbish
and dunghils ; flowering in July. Annual.

Leaves stink like those of elder, and their distilled water is
still more disagreeable; eaten for spinach it has frequently
been fatal, or if taken in small quantity only produced a tem-
porar}^ idiotcy, with agreeable sensations, as does also the
decoction. Boiled in oil till crisp, and the oil made into an
ointment, useful in obstinate ulcers, and those that slough
rapidly : boiled with lard, is much used for burns of all kinds,
and cancerous breasts.

' Herb dried and smoked is anodyne, and lately much used in
asthma : the extract made of it is acrid, and crackles under
the teeth like sugar candy: this has been used in epilepsy,
i Seeds, in doses of half a drachm, are used as a trick in
! America to produce a kind of pleasant delirium and forget-

; fulness : the fume of them is also used to appease the itching

I of chilblains.

I MANOR AGORA, T. Atropa, L.

I Calix top-shaped, five cut.

j Corolla scarcely twice as long as the calyx, bell-shape,

;1 five cut.

I Filaments five, dilated at the base, convenient.

Ovarium with two glandules at the base.

I Llerrj/ globose ; receptacles prominent within.

Sp. 1. M. officinalis. Mandrake.

No other species. Cultivated in England, flowering in
f May. Annual.

j Root supposed to be soporific and narcotic,
j Fruit, like the root, the subject of many'^ fables not w^orthy
of repetition ; said to be highly soporific ; yet Lyncoeus in his
I lectures once ate fasting a whole apple with its seeds without
j the lea4 appearance of its producing any sleepiness, or indeed
I VOL. XI. — NO. 63, 2e

210 Original Commimications*

any ill effects : this leads us to suppose the modern plant
to be different from that of the ancients.

Leaves anodyne, used as an external application in erysi¬
pelas, and indurated glands. Henbane leaves are frequently
sold for them in the London herb shops.

ATROPHA, L. Belladona, T.

Calix bell-shape, five cut.

Corolla bell-shape, twice as long as the calyx, five lobed,
equal.

Filaments five, thread-shape*.

Berry globose, sitting on the calix.

Sp. i. A. Belladona, Solanum lethale. Deadly nightshade,
Dw'ale.

Leaves ovate, not notched; stalk herbaceous. — A branchy
dark colour plants flowers deep purple.

An European plant, bdt only found here near buildings;
flowering in June ; perennial.

Root made into a poultice wdth milk, of great use in hard
tumors and ulcers, a-

Leaves when fresh are applied also to tumors and ulcers;
applied to the eye they cause a dilatation of the pupil, which
slowly recovers its power of contraction, unless mechanically
irritated, when it instantly contracts. They have been used
internally in cancerous affections, and ill habits of body, in
doses of one to three grains, increased gradually till vertigo
appears.

Berries have often proved fatal to children ; they produce a
torpor of the stomach, so that the operation of emetics is
suspended ; hence vinegar and other acids are the most suc¬
cessful antidotes to their effects. The juice of them stains
paper of a fine purple, and may be made into an useful
anodyne syrup.

PHYSALTS, L. Alkekengi, T.

Calix five cut.

Corolla rotate, five cut.

Anthers five, oblong, erect, connivent.

Berry globose, covered with the enlarged bladder-like calix.

Sp. 1. P. Alkekengi, Halicacabum, Winter cherry.

Leaves in pairs, not notched, acute; stalk herbaceous.

Native of South Europe, but cultivated here.

Berries No. 10 — 15, or their juice, are diuretic, and highly
recommended in dropsy by Cassalpinus, as also in gravelly
complaints.

SOLANUM, T.L. Lycopersicon, T. Melongena, T,

Calix five cut.

21]

On the Plants of the Order, Solanea.

Corolla rotate ; tube very short ; limb five cut, spreading.

Anthers five, upright, connivent, opening at the tip with a
double pore.

Berry roundish.

Corculum spiral.

Sp. ]. S. Dulcamara, S. lignosum, Bitter sweet, Woody
nightshade.

Stalk unarmed, shrubby, climbing; heart-shaped, smooth,
the upper ones eared; corymbi opposite to the leaves;
flowers violet ; berries scarlet.

Hedges ; flowering in June and July ; a climbing shrub.

Root diuretic, and may be substituted for sarsaparilla as a
depurative in lues Venerea.

Leaves applied outwardly as an anodyne and resolvent
application : the juice, in doses of two or three ounces,
purges violently,.

Stalks made into a decoction, or rather infusion, is an
excellent diaphoretic and diuretic ; useful in Jaundice and
glandular obstructions.

Berries operate violently both as an emetic and cathartic.

Sp. 2. S. nigrum. Common nightshade.

Stalks unarmed, herbaceous ; leaves ovate, dentato-angu-
late ; racemes nodding. — Branchy; flowers white; berries
generally black, rarely yellow.

Near houses; flowering from June to September. Annual.

Leaves externally applied are refrigerant and abate pain ;
useful in erysipelas, headach, and swellings of the tonsils ;
an infusion of one or two grains taken at bedtime, occasions
a copious perspiration, is diuretic, and usually purges the next
day; and hence Gataker conceives they might be of great use
in many obstinate diseases.

Sp. 3. aS. tuberosum. Batatas, Potatoes.

Stalk unarmed, herbaceous; leaves pinnatifid, not in the
least notched ; flower-stalks subcorymbose.

Native of the Peruvian hills, cultivated in most parts of the
torrid and temperate zones, as no herbaceous plant yields so
much nutriment upon so small a space of ground, and with so
little labour, as this plant. When first introduced into Europe,
it was necessary to vaunt its aphrodisiac and febrifuge
qualities to bring it into fashion : at present it is only con¬
sidered as nutrient.

Starch of the root very soluble in water; hence distin¬
guished from the common kind by the absurd name of arrow¬
root; used as a food of very easy digestion.

Leaves generally wasted, but ought to be burned for the
potash they yield.

Berries, the juice may be fermented and distilled for spirit.

21^ Original Communications,

Sp. 4. S, Li/copersicon. Poma amoris,' Tomatoes, Love
ap|>les.

Stalk unarmed, herbaceous ; leaves pennate, cut ; racemes
two-parted, leafless; fruit smooth, hunched.— Fruit scarlet I

when ripe. |

Native of America, cultivated in gardens, but destroyed by
the first frost, scarcely ripens its fruit. An annual. I

Leaves anodyne, used in poultices. !

Berries eaten in soup, and made into a beautiful red i
sauce, at present confined to the higher classes. |

Sp. 5. S, Melongena, Mala insana, Egg plant. Mad j
apples.

Stalk unarmed, herbaceous ; leaves ovate, not notched, j

downy ; flower-stalks hanging, thickened ; calyces unarmed. 1

— Fruit resembling an egg in colour, size, and shape. I

Native of India, cultivated in the south of Europe, and also j
here, but is very tender. }

Fruit eaten raw is narcotic, but when dressed in a proper i
manner is used as food. ■

CAPSICUM, T. L. I

Calix five cut. |

Corolla rotate ; tube short ; limb five cut, spreading, ;

Anthers five, upright, connivent, opening horizontally. !

J3erry juiceless. i

Corculum semicircular. I

Sp. 1. C. annuum. Guiney pepper. i

Stalk herbaceous; flower-stalks single. Fruit when ripe |
scarlet. |

Native of South America, but cultivated in our gardens. j
A tender annual. j

Fruit very hot and acrid, used as a rubefacient ; the tine- |
ture is equally hot, and the resinous extract left on distilling !
off the spirit is of an acrimony still more intolerable ; none of i

the acridness is carried over by the spirit. It is much used as |

a stimulant sauce either in powder or -pickled. It is also |
added to vinegar and spirituous liquors, to increase their j
apparent strength, and to porter and twopenny to give them a i

stimulant quality. An infusion in water or vinegar is used j

with great effect as a gargle in ulcerated sore throat, and |

an ointment made from it is used as a liniment for paralytic i
limbs. I

These are the only genera and species of this family i
which are indigenous in this country, or cultivated here |
for sale. i

Orfila on Poisons.

213

PART IL

ANALYTICAL REVIEW.

Secours a donner aux Personnes Empoisonnees ou AspJiyxiees;
suivis des Moyeris propres d reconnaitre les Poisons et les
Vinsfrelathy et d distinguer la Mort reelle de la Mort appa-
rente. Par M. P. Orfila, Medecin par quartier de S.M.,
&c. &c. 12IIIO. pp. 238. Paris, 1818.

Principally with ^ view of giving another and more
especial recommendation of this important little volume, and
stating the extraordinary claims which it possesses to the no¬
tice of professional men, have we been induced to revert to
it ; if, indeed, any eulogy which we may pronounce upon its
merits can elevate in the public consideration a work stamped
with the name of Orfila : a name already known and honour¬
ably distinguished wherever medicine is cultivated as a science;
.and to which the historian of future ages, in tracing its pro¬
gress and revolutions during the nineteenth century, will
have occasion frequently to recur.

The object of Professor Orfila, in the composition of the
present work, is, as the Committee* appointed to examine
the manuscript, in their report to the Faculte de Medecine
de Paris, observe, to render popular the most important in¬
formation contained in his well-known treatise upon poisons,
and to point out every thing relative to the different species
of asphyxia ; the treatment of children seemingly stillborn ;
the characters which distiriguish real from apparent death ;
the management of burns ; and various processes whereby the
adulteration of wines may be detected.

The importance of a work, undertaken upon such prin¬
ciples, and by such a writer, and the utility of which it is cal¬
culated to be productive, are too evident to require explana¬
tion. Almost equally superfluous were it to add that the
execution is every way worthy of the project. The various
diseases which the plan of the publication is destined to com¬
prehend; the poisonous substances, or other causes whereby
they have been induced ; and the methods of treatment which

* The gentlemen constituting this committee were Messrs. Percy,
Pinel, and Vauquelin.

214 Analytical Review.

they respectively require, are described and exposed with all
the accustomed clearness and accuracy of the Professor; and
in language simple, precise, and from being as much as pos¬
sible divested of all technical phraseology, universally intel¬
ligible.

The poisons are here distributed by Professor Orfila into
four classes, — the uritanty the narcotic y the narcotico-acrid,
and the septic"^'. Under these are arranged, according to their
supposed or acknowledged properties, all the various sub¬
stances of the mineral, animal and vegetable kingdoms which
produce, on their application to the organs. of the human eco¬
nomy, deleterious consequences. The last class principally
comprehends the injuries and diseases resulting from the bites
and stings of venomous or rabid animals, and the ingestion or
contact of those possessing from natural or morbid disposi¬
tion a pernicious character. Upon*. the principles and pecu¬
liarities of this arrangement ; the characters, physical and
chemical, by which the various poisons may be best discri¬
minated ; and the methods whereby it is proposed to obviate
or control their pernicious operation on the animal organs; we
shall not pause to offer any comment or explanation ; because
we observe in them nothing essentially different from the
opinions and practice inculcated by Professor Orfila in his
larger work : and with this we presume that there is no con¬
scientious or enlightened Practitioner in the whole country,
who would not blush to acknowledge himself unacquainted. '

In the treatment of persons who have been bitten by a rabid
animaly encouragement of the flow of blood from the recent
wound by the application of pressure or a cupping-glass; en¬
largement of it by the scalpel, if small and deep; diligent
ablution with salt or soap and water ; complete and even re¬
peated cauterization, succeeded by blisters ; and, if danger be
still apprehended, by the institution of a purulent drain; are the
means of prevention^principally relied on by Professor Orfila.
When the wound has been inflicted in the interior of the
mouth, the actual cautery will be obviously preferable to such
caustic applications as, by admixture with the saliva, would
have their action extended to the surrounding healthy parts.
In the vicinity of any considerable artery, it is advisable rather
to touch the bitten surface wdth a pencil dipped in muriate of
antimony, than to risk the occurrence of haemorrhage, on the
separation of the eschar produced by cauterization. If the
bite be of long standingy and the wound consequently cica¬
trized, and there be a certainty that the animal by which it

* In the Professor’s larger' w^ork, two other classes of poisons are
introduced; — the astringent and acrid.

Orfila on Poisons,

Q.15

has been inflicted was really rabid, it should immediately be
laid open, cauterized, and caused to suppurate.

M. Brugnatelli, it is observed, has recorded several facts
which tend to prove that chlorine (oxy-muriatic acid) applied
to the wounds which have been inflicted by rabid animals, will
prevent the development of hydrophobia. A long time since,
Cliizel announced that this remedy, administered internally,
had saved several persons bitten by a rabid wolf. Until
experience shall have decided upon the efficacy of this agent,
the treatment of the wound by cautery should on no account
be neglected.

The internal treatment of the wound injlicted hy rahid
animals consists in the administration of mucilaginous drinks,
diaphoretics and opiates. Venesection is indicated by a full
and hard pulse; emetics and purgatives by gastric disorder,
and a foul state of the mouth and tongue. Light food and

moderate exercise, and abstinence if febrile sjmiptoms exist,
should be enjoined. Immediately after the application of the
cautery two doses of the root of the alisma plantago, the asto¬
nishing eflects of which in hydrophobia have lately been
loudly talked of, may be given at an interval of two hours.
Each dose should contain from twenty to twenty-four grains
of the powdered root.

This, upon the whole, appears to us to be practice some¬
what more inert and temporizing than we should have ex¬
pected from such a man and in such a malady. We feel
surprised that the excision of the bitten part, unquestionably
the best, and perhaps the only preventive of hydrophobia
which may bp confidently relied upon, is never once recom¬
mended or even mentioned. And it is almost equally strange
that no allusion whatever is made to the employment of
copious venesection, a practice of which we have heretofore
received such flattering reports in actual hydrophobia; or to
the opinions respecting the spinal seat of this terrible disease ;
wffiich, with considerable plausibility and no despicable weight
of evidence to recommend them, seem to be rapidly gaining
ground both in England and on the Continent.

On the important sections of Professor Orfila’s work which
relate to asphyxia, and the distinction of real from apparent death,
we shall not at present pause, or offer any comment. We are
preparing an abstract of them for the foreign department of
our ensuing Number, as we have done for that of the present,
the section on the means of detecting the adulteration of wines,
with which the volume closes.

It now only remains for us to notice the plan of treatment
recommended by Professor Orfila in burns; and upon this
subject there is nothing advanced which either, from its no-

<2 1 6 -A nalytica I Review,

velty or peculiar value, need detain us long. The practice
consists in the topical employment, by immersion or washy
of cold water, ice, lime-water, either alone or mixed wdth
liquor acetatis plumbi, and subsequently simple or saturni’ e
cerate ; or if the weight of dressings be intolerable, a lini¬
ment composed of equal parts of lime-water and linseed oil.
Poultices consisting of linseed meal, mallow root, and poppy
heads, are to be applied in the event of the development of
inflammation ; and in extensive superficial burns, bleeding,
rigid abstinence, and antispasmodics, are enjoined. In a word,
the practice here inculcated very nearly resembles that of the
old-school Surgeons of our own country : nor is any allusion
made to the stimulating treatment first introduced by Dr,
Kentish ; and which, although not susceptible of indiscrimi¬
nate application, may, under certain circumstances, be em¬
ployed with decided alleviation of present sufl'ering, and the
most obvious eventual success.

To the attention not only of professional men, but to that j
also of the gentlemen and clergy inhabiting situations remote |
from medical assistance, we beg leave then, in conclusion, to j
3'ecommend the English transaltion of Professor Orfila’s little j
work, which we are happy to learn is already on the eve of |
publication; and which w^e sincerely hope wdll escape the |
unmerited fate that, to the disgrace of our character as a libe- j
ral and enlightened nation, too frequently awaits the laudable |
effort to transplant, and, as it were, naturalize among us the |
most valuable productions of foreign medical literature. j

II. [

Elements of Medical Logickj illustrated hy Practical Proofs !;
and Examples; including a Statement of the Evidence re- [
spectmg the Contagious Nature of the Yellow Fever, By j!
Sir Gilbert Blane, Bart., Fellow of the Royal So-
cieties of London, Edinburgh, and Gottingen, Member of
the Imperial Academy of Sciences of St. Petersburgh, and '
Physician to the Prince Regent. ;

A READER has right to expect from an author that there ;

should be as exact a correspondence as possible between the |i
matter and the name of his book. Yet this is an act of fair
dealing between man and man which is often violated. We \
admit that there is an extreme difficulty in affixing any title i
^ at all to some works, (v/e speak of works on medicine,) in
which neither any definite subject nor end can be discerned. J
Such w^orks might bear the general designation of libri me- ^
dici, according to the practice of a poor bookseller with ii
whom we are acquainted, who, when he despairs of trans- «

217

Blane on Medical Los^ick*

'lating the hard title-page of some Latin or Greek author,
contents himself with inscribing on it, ‘‘ liber Latinus,*' or
^ liber Gragcus/^ Whatever difficulties, however, a reader
might have in giving a name to such compositions, little is
experienced by an author. Puzzled as he might, perhaps, be
to find an appropriate designation, an attractive title readily
oifers itself* We do not mean to accuse Sir Gilbert Blane of
having written the volume before us without a subject or an
^nd ; because his subject, or rather subjects, are interesting
in their nature, and we are able, as we imagine, to discern his
end. But to those who have been allured by this book in the
same manner as ourselves ; who, like us, have waited with
anxious expectation to see how so important a subject would
be treated, we cannot help signifying that it is 7iot a work on
the Elements of Medical Logic.” That the reader may
judge for himself, we will lay before him an analysis of what
is contained in this volume, according to the order which the
author has observed, reserving, for the close of this review,
some remarks on the nature and importance of medical logic.

Sir Gilbert Blane has divided this work into an Introduc¬
tion — seven Sections — -and a concluding Chapter.

The Introduction is occupied with a discussion of the ques¬
tion, Whether medicine is a useful art? or, rather. Whether it is
an art at all ? An datur ars medecince ^ Sir Gilbert Blane
balances with much gravity and deliberation what he pre¬
sumes may be said on both sides of this question ; and deter¬
mines, as might have been foretold, that it is an art, and a
useful one. We think, with deference to the author, that
to argue such a point in this country, at least, and in the pre¬
sent state of medicine, was to impose upon himself an unne¬
cessary labour. The scepticism which he has struggled to
overthrow, does really no where exist ; for though it may be
sometimes affected from a love of paradox, or for the sake of
argument ; though the blunders of the ignorant, and the tricks
of the avaricious, do still supply the lively with jests, and the
grave with invectives against us; the truth is, that medichld
itself, both as a science and an art, is every day rising into
greater estimation with men of all ranks. This Introduction
occupies but a few pages, and is concluded by the following
sentence, in which the author makes known the object of his
work : — ►

“ It is the author’s intention, with unfeigned diffidence and humi¬
lity, to endeavour to point out in what medical truth consists ; what
are the difficulties that have obstructed its progress, and what the
means of obviating them ; in other words (if he may be allowed to
adopt professional technology), to expound the physiology, pathology,
and therapeutics of the medical mind.'*

VOL. XI. — NO. 63.

218 Analytical Review*

.ft '

We cite this passage by no means with the presiimpticr!
that we can make the professional technology/^ in the latter
part of the sentence, intelligible ; but for the purpose of re¬
gretting that the good intention expressed in the former part,
of endeavouring ‘‘ to point out in what medical truth con-*
sists/’ was abandoned in the prosecution of the work, as we
find it noticed in no other passage. The first of the seven
Sections in this Treatise on Medical Logic comprises some
preliminary observations, and an enumeration of what our
author calls the energies peculiar to life.” From its length
it forms a considerable part of the whole work. These preli¬
minary observations are on the wonderful manner in which
“ every faculty of the mind is corelative with, or represents,
and reflects, as it were, the elements and laws of universal na¬
ture.” A sentiment which, as we are informed, is more fully
illustrated in a lecture on muscular motion read before the
Royal Society; and also “most ingeniously and appositely
alluded to” in Madame de Staei’s account of German poetry.

It is, perhaps, a little singular that a sentiment of this kind
should find its way into such dissimilar compositions as a
lecture on muscular motion, an account of German poetry,
and a Treatise on Medical Logic. For what is there said
upon it we refer to the work itself* : fearing, at the same
time, that the remarks will not be found easy of comprehen¬
sion to such as want a metaphysical niceness of mind. They
seem to have been forced from their former situation (the
lecture before mentioned and a discourse read before a lite¬
rary society at Edinburgh), for no other reason than to save
the labour of meditating a more appropriate introduction to j
the arrangement of “ energies” before which they stand. It |!
is certain they have no connexion which we can discover I
either with any other subject treated of in the book, or with
the arrangement itself.

With regard to this arrangement. Sir Gilbert informs us
that his motive in “ submitting it,” is to show^ what are the
obstacles to physiological investigation.

It is incumbent on those who allege that there are obstacles to
physiological investigations seemingly so insurmountable, to specify
what they are. The author, therefore, submits to the Profession the
following enumeration of the properties peculiar to animated nature,
meaning under it to describe all the ultimate facts, or primary ele- •
m^nts, which form the grand work of physiological and pathological
science/’

r These energies may be arranged as follows: — i

1. The Generative. — 2. The Conservative. — 3. The Tem-

* Page lb and following.

219

Blane on Medical Logick,

peralive. — 4. The Assimilative.— 5. The Formative. — 6. The
Restorative, — 7. The Motive. — 8. The Sensitive. — 9. The
Sympathetic. ' '

This arrangement differs from any with which the author
is acquainted, inasmuch as it is not founded on an enumera¬
tion of functions and organs, but on elements pervading and
belonging to the whole animal system. It is meant to com¬
prehend all the properties in which the essence of life consists,
and which characterize and distinguish it from inanimate
matter on the one hand, and from moral and intellectual na¬
ture on the other.”

We do not wish to speak captiously of the arrangement
here proposed, especially as it is evident from the opening of
the second Section, that although the author does not regard
it as a perfect, he looks upon it as an original and important
‘^scheme.” — “ In an attempt (he says) which is new; in a
subject of which he has taken a view peculiar to himself ; he
does not dare to think he has attained any thing like perfec¬
tion. It is evident, however, that it is only by following out
an analytical scheme of this kind, that a foundation can be
laid for the genuine principles of theoretical medicine.” Ac¬
cording to the opinion w^e have been able to form on the best
method of classifying the phenomena of living bodies which
are the facts of physiology,' no stronger objection could be
urged against any classification than what Sir Gilbert believes
to be the peculiar excellence of his scheme, namely, that “ it
is not founded on an enumeration of functions and organs.”
We are not indeed acquainted with any physiological arrange¬
ment of which an enumeration of organs forms a part ; but
since a function is the result, for the most part, of several organs
w^orking together to the same end, as in the example of diges¬
tion, it is impossible to form any precise idea of a function
without adverting to the organs which concur to produce it.
And this is one of the great advantages of a classification of
functions, that the organs on w'hich they 'depend are con-
stantly called to mind, and thus anatomy and physiology pre¬
serve their natural relation to each other.

The object of physiological classification is to exhibit at
one clear and comprehensive view the phenomena of living
' bodies by placing them in such an order as shall best serve to
illustrate the nature of each phenomenon, its dependence
upon others, and the harmony and co-operation of ail. And
what are the striking phenomena of living bodies but the
functions themselves, digestion, circulation, respiration, sen¬
sation, loco-motion, &c. ? Accordingly, the method pursued
by the most eminent physiologists has been to distribute the
functions into classes and orders. The faulty and imperfect

220

Analytical lietyiem*

division of the old school into vital, natural, and animal
functions, has given way in our time to the more luminous
"^ distribution of the French physiologists, Griniaud, Bichat,
and Uieherand’^, who are indeed much more to be admired
for their skill in arranging than for their precision in reason^
ing upon the facts of physiology. Nevertheless, Sir Gilbert
Blane deviates from the method of these men, and from every
other method with which he is acquainted. His classification
is founded on properties peculiar to animated nature,’’ on
elements pervading and belonging to the whole animal sys¬
tem,” and finally, on the simple enumeration of nine ener¬
gies.” In a treatise on medical logic, containing a chapter
on the errors which spring from “ ambiguity of language,”
we did not expect to see properties,” “ elements,” and
energies,” confounded together as if they had the same
meaning. From this variety the term energy is, however,
selected, as more appropriate than the rest ; and in the ac¬
count which follows of each particular energy, the language
is diversified by employing the word energy” or faculty”
indiscriminately. But does our author really mean any thing
more by the generative energy than the function of genera¬
tion; of by the motive energy, tlian the function of muscular :
motion ; or by the sensitive energy, than sensation ? To be '
convinced that he does not, nothing more is necessary than to I
pay attention to his own expressions in the remarks upon |
these particular energies. In the few words on the ‘‘ gene- \
rative energy,” generation is the only term employed, p. 24. i,
Mark what is intended by the motive energy : The motive, ||
by this is meant muscular action in its most extended sense.” f
And in those on the sensitive energy, p, 56, “ the sensitive. 1
Sensatio7i being a simple idea does not admit of definition,” r
&c. Thus the generative, motive, and sensitive energies, are f
here declared to be nothing more than generation, muscular %
motion, and sensation ; and what is sdll more strange, these a
very energies are by a singular forgetfulness at the 81st page, js
called “ functions.” We are alwaj^s most anxious to avoid ji
^ even the appearance of a vexatious cavilling about words, ^
but it is upon words only that this question turns ; for if this
method of framing new classifications in physiology be once
. -tolerated, if the coining of a new name is to be mistaken for k
the invention of a new system, which is to change the whole 41
aspect of a science, and be proposed as the basis both for a i
“ scheme of nosological arrangement and a plan of physiolo- -jo
gical instruction,” we may soon be inundated by a torrent of Ip
new systems. We see no good reason w'hy the digestive,

* See the Preliminar}’- Discourse in Richerand’s Physiology. j

Blane o;i Aledical Lo^ick.

cimilati’oey^ respirative, secretive ^ excretive, and several other

energies” should not have been admitted, which would have
swelled the catalogue, and might have been easily manufac¬
tured by the same process. But we cannot forbear, at the
same time, asking Sir Gilbert, what that distinguished philo¬
sopher^, to whom he has dedicated this volume, would say to
that theorist who should resolve, in imitation of our author,
to build a new system of metaphysics, by Asserting that
thought is the cogitative ; remembering, the recollective ; and
imagination, the imaginative energy ?

The generative energy is placed first in order; the next is
the conservative, which means that power by which the
living body is prevented from running into putrefaction.”

He follows Mr. Hunter in thinking this to be a particular
antiseptic principle in life.” We cannot now enter into the
grounds of our dissent : we view it as depending upon the
rapid and constant change of all the nutritive particles of the
body — as the result of all those functions which produce the
habitual composition and decomposition of our organs, and
therefore not a distinct and independent principle.

The temperative succeeds the conservative. It is that
power which the living body has of maintaining an uniform
degree of heat. We are aware that both Chaussier and
Bichat have classed this power as a distinct function, under
the name of calorification. The sources of animal heat are
undoubtedly still involved in much obscurity; but there is
evidently more than one source, and the means by which a
higher temperature is resisted differs from those by which we
resist a lower. The first appears to be owing chiefly to the
production of cold by the extensive evaporation wdiich takes
place on the surface of the body. The second appears to be
partly dependent on respiration and the circulation of the
blood, and partly on the new chemical combinations that are
formed during the depositions of the secreted fluids and the
various nutritive matter of the body. It is also indirectly in¬
fluenced by the functions of the brain and nerves. As, there¬
fore, the uniformity of animal heat arises from several dif¬
ferent functions co-operating to produce it, it cannot on that
account be called, with any propriety, either a separate func¬
tion, or arranged as an independent energy” in the system
of Sir Gilbert : neither can the next energy, the assimilative,
and for a similar reason. This consists in the chemical
changes brought about in the decompositions and combina- »
lions effected by the pow'er and processes peculiar to life, as
manifested in digestion, secretion, and the preparation of the

* Dugald Stuart, Esq.

Analytical Review,

materials for the growth and repair of the body/^ The assi¬
milative, then, is no one energy, no one function, but the result
of several. Of the formative energy,’’ our author tells us,
it has not usually been stated as a principle distinct from
the last. The slightest reflection, however, must evince, that
it is quite a separate act of nature, and as different from the
assimilative as the construction of an edifice is from the pre¬
paration and collection of its materials.” Still it differs little,
if at all, from the function to which the name of nutrition”
is given by most physiologists ; nor indeed does Sir Gilbert
appear to intend by it any thing different. “ The proper
function of the formative faculty is growth and repair.”
Under the title of Restorative Energy” are included two
very different things, which it would have been impossible to
anticipate, viz. sleep, and the vis medicairix naturtB. It is
unnecessary to make any remark upon this part of the ar¬
rangement, for we cannot persuade ourselves that it is in¬
tended seriously to attribute them to the same principle.
To the motive and sensitive energies” we have already re¬
ferred. The sympathetic is distinguished in nothing from
what we commonly understand by sympathy.

We have felt it to be our duty to object more strongly than
out of courtesy we were inclined, against the method wdiich
Sir Gilbert Blane has taken to frame an original scheme;
yet, in justice, we should assure the reader, that in what is
said upon each particular energ^q if no new physiological
facts can be found, still there are scattered many very judi¬
cious, and some acute reflections.

The chief subject of the second Section is the errors and
abuses that arise out of false and misapplied theories.” The
view which is taken of it contains nothing either original or
profound. The opinions of many great men are brought to
show how even the pre-eminent for learning and for the
highest endowments of mind, are liable to fall into these mis¬
chievous errors. But the examples are such as have been
selected again and again with the same object. Aristotle is
re-condemned for his syllogistic logic.” Bacon is once
^more introduced to show that so illustrious a philosopher
did not entirely disbelieve in amulets and charms.” Hip¬
pocrates himself is, as usual, a flagrant exemplification of this
liability, for he referred all diseases to excess, defect, or
vitiation of the four humors, blood, phlegm, black bile, and
yellow bile. Illustration still more opposite is sought for in
the false principles of the mechanical and mathematical phy¬
siologists, who flourished as contemporaries of Harvey, or
immediately after him. We are again informed that
Borelli, in investigating the force of the heart by experi-

Blane on Medical Logick* C23

meiit, estimated it at 180,000 pounds, Hales at 51 pounds,
Keil at 1 pound,” and that “ the mechanical powers of the
stomach were about ihe same time subjected to experimental
research by Pitcairn, who gravely gave out that he found this
visciis in the human subject exerted a force equal to 12,900
pounds in compressing food in the process of digestion*.”
But it is Boerhaave who furnishes to Sir Gilbert ‘‘ the most
singular and the most celebrated” example.

“ Towards the end of the seventeenth and beginning of the
eighteenth century physiologists had begun to perceive that life was
regulated by laws peculiar to itself, and that some other principles
than those of mechanism and chemistry ought to be resorted to in
explaining the operations, whether of health or disease. Glisson and
Willis, in England; Baglivi, in Italy ; and Hoffman, in Germany, led
the way in this reformation, and there was a fair prospect of a more
legitimate system of reasoning being established. This was checked
and retarded by the appearance of Boerhaave in the beginning of the
eighteenth century. He was a man of uncommon capacity, great
erudition, and indefatigable industry, and a zealous and honest
searcher after what he conceived to be truth. But probably from
the habitual application to his favourite study, chemistry, he suffered
himself to be deluded into what is now viewed as a most fallacious
train of reasoning. This he delivered in language so imposing, that
his doctrines prevailed universally for about fifty years in the schools
of physic, and among the Practitioners of all Europe ; and it is
equally astonishing and humiliating to contemplate how the assent
of an enlightened age should have been'won over to a body of doctrine
so puerile and shallow.”

Boerhaave’s Theory of Inflammation and Principles of Pa¬
thology are then brought in proof of these allegations,”
and their fallacy is exposed by arguments so obvious, that we
need not repeat them. One great cause, in the opinion of
Sir Gilbert, is to be assigned for these melancholy proofs of
the dangers of false and perverted theories.

“ The early physiologists, (he tells us,) in all their reasonings have
almost entirely overlooked all those energies peculiar to life, which
have been enumerated ; namely, the generative, the conservative, the
temperative,the assimilative, the formative, the restorative, the motive,
the sensitive, and the sympathetic, not to mention the affections of the
mind.’’

* In a note the author tells us that Dr. William Hunter (whose
name he does not mention, even for the purpose that follows, without
coupling it with a long and resounding eulogium,) was heard in his
lectures to express himself wittily on the subject. “ Some physio¬
logists, gentlemen, will have it that the stomach is a mill ; others, that
1 it is a fermenting vat ; others again, that it is a stewpan : but in my
I view of the matter, it is neither a mill, a fermenting vat, nor a stew-
j pan, but a stomach, gentlemen, a stomach.”

£24 Analytical Review.

1 The author then proceeds to discuss the qiiestionj Wbethef
anatomy and physiology are useful to medicine, and what is
their use ? His arguments in their defence may be thus
briefly enumerated 1 . They are useful in detecting false
theories. 2. They serve as a sort of gymnastic exercise of the
understanding. 3. They banish superstition and qaackery*

4. Even the most powerful theories of physiologists afford
useful suggestions.’" 5. They serve for the better discrimina¬
tion of morbid affections, 6. At all events anatomy is useful
in surgery. And, 7. the state of health ought to be fully known'
as a standard by which to measure the magnitude, as well as
to ascertain the nature of diseases.” They who, like our¬
selves, estimate highly the uses of physiological knowledge;
not as a matter of curiosity only, but as it is capable of ex¬
tensive practical application to medicine, will feel no obli¬
gation to Sir Gilbert for so negative a defence. The cause
would have h’hen more successfully advocated if its bearings on
pathology had been simply unfolded. The misfortune is,
that physiology has been too generally cultivated, as if it were
a distinct study. The individual, which is much less than the
relative importance of this science, has been commonly the
only standard by which its value has been measured ; and to
this’cause, in our judgment, it should be ascribed, that the
theories of physiology have been regarded, even by sensible
men, to be barren speculations, and its facts to be unavailable
in practical medicine. While, however^ we think more
highly than Sir Gilbert of this branch of medical knowledge,
we admire the truth contained in the just and animated
passage which follows : —

** But if the benefits derivable to medicine from physiological-
science are so limited, from what other and better source is improve¬
ment to arise? The answer is, from accurate observation; in other
words, from enlightened empiricism. It seems an abuse of words to ■
restrict the term science to physiology and pathology, and to with¬
hold it from those processes of the understanding by which facts are 4

ascertained and accumulated, and useful inferences deduced from *

them constituting observation. Shall we dignify with the title of ^

science the absurd positions of Pitcairn ; the puerile and shallow i

hypothesis of Boerhaave and Sylvius; and deny it to those solid and J

applicable truths, the fruits of chaste observation and sober expe¬
rience, ascertained by those methods of induction which it was the
great aim of Bacon to recommend and introduce, as the only parent J
of legitimate, substantial, and useful knowledge] The truth seems to c
be, that a higher order of intellect, a more rare and happy genius,
a more correct and better tutored understanding, is required to elicit ii
practical truths by observation, than to coin theories."

The third, fourth, fifth, and seventh Sections need no c
particular notice ; it is almost sufficient to mention the title of k

•Blane on Medical Logick. 225

each. The third is on ihe great diversity observable in the
constitution of individuals. Some sensible remarks will be
here found on Dr. Hamilton’s work on the utility of Purga¬
tives. The fourth is on the difficulty of appreciating the
edorts of nature, and discriminating them from those of art.
The fifth, which might have been altogether omitted, is on
superstition. And the seventh, which is entitled, on the
ballacy of Testimony,” informs us that quacks are not to be
trusted ; that colchicum and hermadactylus are the same drug ;
and that Tra. guaiaci ammoniata wall cure some cases of gout
and rheumatism. VVe are sorry to meet with such matter
under such a title.

The subject of the sixth Section is evidently one w'ith
which Sir Gilbert is familiar; one which deeply interests
his feelings, and on which he has therefore written with a
vigour of thought and animation of language, n0t to be found
in any other part of this work. The chapter is entitled, “ on
the Ambiguity of Language but in reality it is a dissertation
on the yellow fever. The controversy upon the contagious-?
ness or non-contao-iousness of the vellow fever of the West
indies IS as remarkable as any known in the history of me¬
dicine for jarring opinion and irreconcileable evidence : for
the numbers who fight for victory with obstinate and intemt
perale zeal, and the few who with moderation and firmness
contend for truth. Since the time when Sir Gilbert wrote his
work on the Diseases of Seamen, he has somewhat changed
his views, and is now the warm advocate of the contagious¬
ness and foreign origin of the West Indian yellow fever. The
grounds on which he holds these opinions are fully unfolded
in the present chapter. We pass over the historical account
of the different periods of time at which this fever is recorded
to have made its appearance, not only in the different West
India colonies, but in America, at Charlestowm, Boston,
Philadelphia, New' York, South Carolina, and all the maritime
towns of the United States ; and in Europe, at Cadiz, Gibraltar,
&c., and as far north as Leghorn.

We may venture to say, in conformity with the opinion of
Baron Humboldt, (who at the same time believes in the con¬
tagious nature of tlie disease,) that however strong may have
been the ground of suspicion, there is no undeniable proof
that it has or lias not been curried by infected persons from
one of these places to another. Whoever wishes to be ac-
qiiaiirted w'iih the 'presumptive proofs ip favour of the foreign
origin of this fever, to which Sir Gilbert gives the name of
Pestilential Epidemic, will find them advanced with much
force and eloquence in the loO and three following pages of

VOL, XI. — iso. 6d.

226

Analytical Reviezc^

this chapter. But neither the yellow fever, nor any other
disease, is disproved to be contagious, because we are unable
distinctly to trace its origin. Contagion is only known by
its effects. Should a case of small-pox be seen for the first
lime, and pronounced uninfectious because no source of in¬
fection could be detected, the error would soon, be revealed
by the only undoubted testimony of which the case admits;
viz. the communication of the same disease to those who had
not yet been affected by it. It is not therefore essentially'’
necessary to the truth of their views, for the contagionists to
prove “ that this epidemic has never taken its rise but in
seaport towns, where it can in most cases be traced to the
arrival of shipping conveying infection.” We agree with the
author, that the simple question is, Whether the present
disease is communicable from one person to another?” It
might be hasitily imagined, that nothing would be more easy
than to determine this simple question, while in reality few
things are more difficult. Let the proof of this be sought for
in the discordant sentiments of so many men, who never¬
theless write each unalienably attached to opinions which are
the fruits of his own observation. j

The difficulty itself may be ascribed to several causes. If i
a disease were to exist distinouished from all other diseases
by a train of remarkable symptoms, and if this same disease !
were manifestly communicable to others, none would hesitate !

to pronounce it contagious. But if a disease, believed to be [

contagious, bears a strong resemblance in its symptoms to
other diseases, universally^ known to be non-contagious, some |
perplexity is the unavoidable consequence. This is exactly i*
the perplexity in which the yellow fever is involved. It is i
agreed by ail parties, that several diseases exist in the West |
Indies distinct in their origin, but in some important respects |
confounded as to their symptoms. Sir Gilbert enumerates
three: — the endemic, or the marsh remittent, caused by
marsh exhalations: — the pestilential epidemic, or typhus ic-
terodes, assumed to arise from human effluvia, and alone con¬
tagious : — the sporadic, arising from several causes, such as
change of climate, intemperance, &c.

This is of course the enumeration of a contagionist : a non-
contagionist retains only two of these fevers, the marsh and
sporadic. Granting the accuracy of our author’s arrange¬
ment, the symptoms of the pestilential epidemic are acknow¬
ledged to have a striking similarity both with the marsh and
sporadic fevers of the West Indies. The most conspicuous
point of resemblance is the colour of the skin : the resem¬
blance, however, is not perfect here ; for the colour of

Blane on Medical Logick*

the former is a dingy orange, in the other two a bright
yellow*/’

This is not quite correct. It is true that the yellow co¬
lour which attends the marsh is commonly bright ; but yellow¬
ness of the skin is far from being a general character of this
fever. While in the sporadic, or that fever which arises from
the sudden effect of climate on the constitutions of young,
robust, plethoric new-comers to the colonies, it occurs almost
as an universal symptom. But it is seen in two distinct
forms, at very different stages of the fever, originating from
two separate causes, and affording a different prognosis.
The first form is that here spoken of; a bright yelloVr of
different shades, wdiich commonly takes place early in the
attack, depending upon the admixture of bile wdth the blood
and other circulating fluids, which tinges the conjunctiva,
the serum of blisters, the serous effusions into the cavities of
the chest, belly, &c., and is not to be regarded as a very
unfavourable symptom. The other form is the dingy brown
or orange, and here assigned exclusively to the pestilential
epidemic as its peculiar attribute. It appears in the last
stages of the sporadic fever at the same period with the
black vomit, and with passive haemorrhages from the nose
and several other parts ; it depends either on the extravasation
or transudation of the fluids in the capillary vessels. The
black vomit, as it is now called, is likewise almost an universal
symptom of the sporadic fever. It is also marked in its
violent forms by phrenitic delirium in the beginning and,
coma at the end. The piercing pains in the eyes and head
and violent cramps in the legs, are among the symptoms of
this fever, as well as of that described by Dr. Chisholme,
which is believed by him and the contagionists to be brought
to Grenada in a ship from the coast of Africa, in 1793. But

one of the most material distinctions,” says Sir Gilbert
Blane, is, that few of those who have had the true typhus
icterodes, or pestilential epidemic, are liable to it a second
time.” We assert, that this is equally true of the sporadic,
and future exemption is not only the consequence of one
attack of this fever itself, but a total exemption is often the
result of any other disease or mode of regimen which reduces
the plethoric constitution of a new comer. Again ; if it be
maintained by the advocates of contagion, that the typhus

* Sir Gilbert suggests in his work on the Diseases of Seamen, and
alludes to the opinion in a note to this passage, that this colour is
“ not owing to bile," but that it is an error loci, or depraved state of
the red globules. The same colour, he observes, appears in the
echymosis that follows contagion.

228 Analytical Review,

icterodes assumes the character of a malignant epidemic,
rapidly spreading and widelydestructive, the same may be said
of the sporadic. It attacks perhaps an individual only when
the arrival of strangers is rare, as at present; it attacks large
bodies of men ; it has attacked, and with terrible havoc, whole
battalions, when the individuals composing them were equally
strangers to the climate, and equally predisposed to the dis¬
ease. And yet this sporadic disease has in no one instance
been known to be infectious : those who have attended the
sick have never taken it, nor has it been once observed to
spread by the approach or contact of others. When it once
disappears, nothing more is heard of it, till it returns with
the arrival of more strangers from temperate climates.

If all this be true, it cannot surely create much surprise,
that there have been, and still are, those who, after a long re¬
sidence in the West Indies, during which they have again
and again witnessed the ravages of this terrible fever of
climate, showing itself with every formidable symptom, and
attended with every peculiar circumstance employed to paint
the malignant epidemic of the contagionists, — and yet not
contagious, and yet not communicated, nor communicable:
it cannot, we say, create much surprise, that these should
maintain, and maintain obstinately, that they have seen the
yellow fever, and that it is not contagious. We are aware
that Sir Gilbert maintains the singular paradox, that those who
have never been to the West Indies are better judges of the
nature of the disease than those who have seen it on the spot.

A soldier,” he says, p. 149, “ in the midst of battle, knows
much less about the main incidents and results, than a shep¬
herd on the neighbouring hill,” And therefore a Practitioner
in the midst of oOO men labouring under yellow fever, knows
much less about its contagiousness than a Physician who
only reads an account of it at home. We hope that such an
example of medical logic wall not be imitated, though it is
from the pen of one from whom W'e might reasonably have '
expected a better specimen of logical inference. Sir Gilbert
has the candour to inform us, which may perhaps explain the
foregoing quotation, that he knows little of the yellow fever
from his own observation. [ have not experience of ray
owm to decide on the various points of difference, for the four
campaigns in which 1 served in the West Indies were in
years comprehended in one of those intervals before alluded
to between the appearance of these great epidemics. The
mortality was indeed comparatively very moderate there
during the whole of that war ; chiefly owing, no doubt, to
there not having been great bodies of land forces transported
thither during that time and with this explanation w e per«

229.

Blane on Madkal Losikk^

fectly concur. If land forces had been transported, be would
have seen in, alPprobability the sporadic fever, which has
been described as the effect of climate, attacking such num¬
bers without being contagious, as to shake his confidence in
the opinions he now entertains.

We are ver^^ far from supporting the extravagant doctrines
of those who deny the existence of contagion as the source
of any disease ; nor would we be understood even to go so far
as to assert that there has not existed a contagious yellow
fever in the West Indies, for we speak of the West Indies
only. But we are not as deeply convinced as Sir Gilbert of
the matter of fact as established by evidence.”

There is in this dissertation much more reasoning on the
probability than testimony as to the fact. To the authorities
brought in favour of contagion, might be opposed a much
greater number against it, and the historical view will be
found to supply nothing but suspicions, which may or may
not be well founded. But while we do not deny that there
may have been a contagious yellow fever, we affirm with con-
lidence that there has been a non-contagious yellow fever,
assuming, whenever it had food to prey upon, all the characters
of a malignant epidemic. We should do an act of injustice
to Sir Gilbert Blane if we did not, on taking leave of this
subject, express our admiration of the manner in which the
discussion is conducted. Without one intemperate expres¬
sion, he has continued to infuse into the question all the
honourable spirit of controversial zeal.

The limits of this review have imperceptibly extended so
far, that no room is left for the few closing remarks we had
intended to offer. Our ample and, we fear, tedious analysis
of the contents of this volume, will convince our readers
at least of the justice of that criticism which we ventured to
pronounce at the outset, viz. that whatever its title may be,
i this work is on the elements of medical logic. Instead,

I however, of expressing our opinion at large on this subject, as
we promised, we must be content to refer the reader to an
admirable paper on one important branch it should have in¬
cluded, viz. the nature of medical evidence, which is to be
found in the Transactions of a Society for the Improvement of
Medical and Chirurgical Knowledge. The author of this paper
is Dr. George Fordyce, a man whose name and memory we
reverence; and whose penetrating mind, precision of Ian-
guage, and philosophical habits of viewing every question,
would have admirably adapted him to treat the whole of
this subject w'iih all the method and comprehensiveness it
1 requires.

230

Selections,

. PART III,

SELECTIONS.

Observations on the Medico-Chemical Treatment of Calculous
Disorders. By W. T. Brande, Sec. R.S., &.c.

{From the Quarterly Journal of Science and Arts.)

[Continued from page 144.]

The mineral acids, namely the nitric, the sulphuric, and the
muriatic, have each been employed; and there are perhaps
particular cases, in which one is more proper than the others ;
but they are all of them improper in cases where there is
much irritation of the urinary passages ; and as they are apt
to produce this, though effectual in checking the formation of
white sand, they require to be cautiously exhibited, and their
effects prudently watqhed over.

The nitric acid may be exhibited in doses of from five to
twenty drops night and morning, or thrice a day. It may be
taken in plain or barley water. From ten to thirty drops of
the dilute sulphuric acid, and from five to twenty of the mu¬
riatic acid may be taken in the same way ; that is, diluted till
they become palatably acid.

Of these acids the -nitric is perhaps most apt to disagree, ,
and to occasion those symptoms of indigestion which are ah- »
nounced by flatulency and eructations ; and in a few parti- -
cular cases, its long continued use has rendered the stomach r
reluctant as to food, though many instances might be cited ‘ I
of its tonic effects, as a promoter of digestion and increaser of ^
appetite.

The sulphuric acid may most properly be termed a tonic ;
it generally admits of being longer persevered in than either fi:
of the others ; it seldom gripes or nauseates, and almost a
promotes the functions of the stomach, where they are
gish or irregular.

The muriatic acid agrees, in most cases, with the stomach,
but not so with the bowels, which always become more re-
laxed during its use, than where the other acids are employed, LI
This circumstance, however, often recommends it; for consti- d:
pation very frequently attends the state of body which favours ki
the formation of white sand ; and hence aperient medicines la
are alone adequate, in some cases, to suspend or prevent the U
disorder.

Where the mineral acids agree^ they are usually very effec-

Braude 0}i the early Symptoms of Gravel. 231

live, and in a few days they diminish, or entirely prevent the
formation of the sabulous deposit ; but where they disagree,
they rather increase its quantity, or they tend to the produc¬
tion of a mucous secretion, probably from the coats of the
bladder, which envelopes, and is voided with the sand ; and
which, in particular cases, may certainly tend to increase the
risk of its agglutination, and of the formation of a concretion
in the bladder. The mineral acids too, almost always dis¬
agree with children, who are equally liable with adults to an
increased secretion of the phosphates, and in whom prompt
and effectual treatment is equally requisite to prevent the
formation of stone in the bladder.

Here then recourse must be had to another, mode of treat¬
ment, namely, to the vegetable acids.

The tartaric acid^ either in its pure form, or as it exists in
cream of tartar, maybe used in pretty liberal doses; of the
former, from five to twenty grains, and of the latter, from
twenty to forty, or sixty grains may be used, either dissolved
in barley water, or administered in any convenient vehicle.
The cream of tartar is more apt to relax the bowels than the
tartaric acid ; a circumstance, which, as has been hinted above,
often tends to its beneficial efficacy.

The citric acid, however, seems on the whole preferable to
the tartaric: it maybe given in the same way, in doses of from
five grains to half a drachm; it rarely proves inconveniently
I purgative, and is very effectual in modifying the secretion
j of urine.

Cases are by no means uncommon in which a white sabulous
I deposit in the urine, often going to a great and alarming extent,

I appears symptomatic of, or in some way connected with irre¬
gularity of the biliary secretion ; pain in the region of the liver,
sallow complexion, whitish brown and dry tongue, are its
j usual concomitants in these cases; and there is a very trouble-
i some irregularity of bowels, generally tending to costiveness of
an obstinate kind ; sometimes succeeded by or alternating
with relaxation. I have known persons returning from warm
climates, in this predicament, and upon being questioned as to
their complaint, gravel and sand are usually uppermost in the
mind. They often have recourse to the solvents of empyrics,
which, with very few exceptions, are strong alkaline solutions;
or they consult medical men, who, hearing of the sand, and
j inadvertent as to its kind, prescribe soda water, solution of
i potash, magnesia, and the like ordinary preventives. This
I alkaline treatment invariably does harm ; the patient’s diges-
I tion, already feeble, becomes more impaired ; the sand pre-
I viously perhaps small in quantity, is rendered abundant; the
! j bowels pass from occasional to constant irregularity, and every
symptom becomes slowly, but mischievously, and in many

Selections,

232

cases irretrievably augmented. Cases of this kind I describe
with the more confidence, having seen several. I allude to
them now as particularly improper in most cases for the
mineral acids in large doses, whereas by the vegetable acids
they are always greatly benefited. But in these, and a number
of similar cases, the best and simplest plan of treatment, is not
to employ medicine, so much as diet; to adopt a general acid
system ; to abstain from soda water, and all alcalis ; to refrain
from malt liquor; to take weak lemonade, and an occasional
glass of cider as ordinary drink at meals : if accustomed to
wine, to prefer champagne and claret to Madeira or port,
but to take little of either; if the bowels remain constipated,
to take a drachm or two drachms of Epsom salt in a half pint
tumbler of lukewarm water in the morning fasting ; or, what is
more pleasant, to stir a teaspoonful of magnesia into an occa¬
sional glass of sour lemonade; to eat salads and acid fruits,
and more especially oranges, which in this state of things are
an heroic remedy.

1 have said that there are few cases in which the vegetable
acids, properly administered, produce any aggravation of the
symptoms, or where they can be said to disagree ; yet such
cases do occur, and a very copious deposition of white sand
shall be attended with a peculiar irritability of bladder (inde¬
pendent of calculus, for those cases I propose afterwards to
consider), which is aggravated by any of the above-mentioned
acids, and yet in which they are most decidedly indicated. In a
paper which I presented to the Royal Society in 1812 (Philos.
Trans. 1813, p. 213,) and in which ihave detailed some cases
illustrative of the operation of acids in preventing the white
deposit, I have spoken of the beneficial effects of carbonic acid,
where, from peculiar circumstances, the other acids disagree;
and since that period several cases have occurred, attended by
equally beneficial results. The mode of exhibiting this acid is,
either simply dissolved in water, in which case it may easily be
prepared by the patient in a Noot/i’s apparatus, or procured
from tile dealers in artificial mineral waters; or it may^ be
administered in the form of a saline draught in the state of
effej vescence, as by dissolving thirty grains of carbonate of
potassa, and twenty grains of citric acid, in separate tea-cups
of water, mixing the solutions in a large tumbler, and drinking
the whole during the effervescence. This dose may be
repeated two or three times a day, or oftener if expedient.

It may now be asked in what manner the acids which have
been mentioned, act. Do they pass off by the kidneys, and
produce a direct effect upon the urine by rendering it more
acid, and capable of retaining the phosphates in solution; or do
tjiey act indirectly upon the digestive and assimilating organs,
so as to modify the action of the kidneys, and, consequently,

Pascal on Intestinal Worms,

£3S

to affect their secretion. In my communications to the Royal
Society, I have briefly discussed this question, which, though
undoubtedly curious, does not appear practically important ;
and I have now little to add upon the subject. The experi¬
ments which I made on the passing off of carbonic acid by the
kidneys, I have since repeated with similar results. The
recently voided urine was introduced into a phial, furnished
with a bent tube, passing into lime water, and the whole
apparatus put under the receiver of the air-pump. I invariably
found carbonic acid evolved during the exhaustion, and ob¬
served its quantity to be greater after drinking liquors con¬
taining it in an uncombined state. 1 am quite aware of the
uncertainty of experiments of this kind, and of the ever-varying
composition of the urine; but I cannot give up the opinion
that the existence of a large quantity of carbonic acid in the
stomach is connected with its secretion in the kidneys.

I have stated above that the uncombined carbonic acid of
the urine often acts an important part in retaining the earthy
phosphates, but more especially the ammoniaGo-magnesian
phosphate, in solution ; and its escape is, in these cases,
attended by the deposition of the triple salt, in the form of a
film upon the surface of the urine, the cause of which was first
pointed out to me by Dr. Wollaston.

I have already adverted to the importance of attending to
the diet in cases of white sand, and to the necessity of keeping
the bowels open by the occasional use of mild aperients,
where the acid regimen alone is insufficient. It frequently
happens, I believe, that much of the benefit of the mineral
acids may be referred to their mere tonic effect, to mending
the digestion, and thus improving the general state of health.
The febrile affections of children are very frequently attended
by an apparently alarming deposit of white sand in the urine,
and a dose of calomel wall often carry off both the fever and
the sand. It is thus too, that air and exercise, bark, bitters,
and mineral tonics, are often successfully resorted to in urinary
complaints of the kind we have been considering.

CTo be continued in our next Number.)

PART IV.

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

PATHOLOGY (INCLUDING MORBID ANATOMY) AND
PRACTICE OF MEDICINE.

I. Intestinal Worms.^ — Several interesting communications
on this subject have recently been published in the Foreign
VOL, XI. - NO. 6S. 2 II

2S4 Foreign Medical Science and Literature.

Journals. Of these, as relating to a class of diseases thaii
which none are attended with more obscure and equivocal
symptoms, or give rise to more frequent and serious errors in
practice, we shall proceed to lay before our readers a correct
abstract. The first paper we shall notice is on the vermis
Tricocepha/us^ or Trichuris, by Dr. Pascal*.

This variety of intestinal worm, discovered by Roederer
and Wagler, has been described with considerable minuteness
by Wrisberg. They all erroneously regarded the filiform
appendix which terminates the animal anteriorly, and to which
the head is attached, as its tail. It may exist in the human
body, even in great numbers, without manifesting its presence
by any external phenomenon ; but this will depend on the
degree of sensibility, natural or acquired, of the individual
aftected. When, however, from any cause, its numbers are
such as to constitute a morbid state, certain symptoms, yet
but little understood, announce its presence. In the follow¬
ing cases the characters of the disease which it induces are
displayed in their utmost simplicity.

Case 1. — A girl of strong constitution, and highly sanguine
temperament, and previously healthy, became, at the age of
three years and a half, spiritless and languid. She sensibly
wasted, without any diminution of her appetite. In Novem¬
ber, 1817, she was suddenly seized with universal rigor, which
was succeeded in about two hours by copious vomiting of a
red fluid, resembling wine lees. On Dr. Pascal’s visit in the
evening, the child complained of severe pains in the abdomen,
which was somewhat swollen. Two stools had been passed
during the day, but respecting their appearances nothing was
knowm. The pulse w'as small, wiry, extremely rapid ‘ the
face red, irregularly coloured, or rather striped ; the eyes pro¬
minent, and pupils dilated ; the breath acid ; the tongue
covered with a yellowish mucus ; and the whole abdomen
painful on the slightest touch. Syrup of wormwood, with
sulphuric ether, was prescribed.

Next day, 26th, pulse and countenance unchanged; the eyes
immoveably fixed ; respiration stertorous and interrupted ;
trembling of the lower jaw, and grinding of the teeth. Three
grains of calomel produced two liquid and highly offensive
evacuations.

27th. — 'Tetanic stiffness of the limbs and trunk ; deglutition
impeded ; two evacuations by the bowels, the first scanty
and yellowish, the latter more copious and blackish ; in¬
sensibility.

28th. — Pulse intermittent and very rapid; deglutition im¬
practicable; other symptoms unchanged. — Died on^ the
morning of the 29th.

* Bulletin de la Faculte de Medecine de Paris, See. 1818. — No. HR

Pascul on Intestinal Worms,

235

Dissection twenty- eight hours after death. — General
appearance pale and discoloured ; face violet j abdomen
largely iriHated, and its whole inferior part occupied by an
ecchymosis. On opening the abdomen, there escaped a great
quantity of intolerably fetid gas. The stomach contained
about six spoonsful of a whitish semi-transparent fluid. Its
mucous membrane, and that of the small intestines, were of a
pale colour, and very abundantly smeared with mucus. 'I'he
ccecum and greater part of the colon were in a very advanced
state of putrefaction, and exhaled a horrible stench. A pro¬
digious quantity of iricocepali was found in them; but
neither this, nor any other portion of the intestinal canal, con¬
tained ascarides or lumbrici.

Case 2. — A boy, aged nine, of delicate constitution, com¬
plained, in January, 1814, of extremely severe pains in the
head, which lasted from twenty-four to thirty hours. During
this paroxysm, the pulse was small and wiry, the tongue dry,
and respiration oppressed ; but the temperature of the surface
was not raised. it terminated by partial and transitory
sweats; was succeeded by perfect health; and recurred at
uncertain intervals. The child having, some time before,
frequently voided lumbrici, his complaints were attributed to
the presence of these animals; but a remedy, administered
with this view, failed in procuring the expulsion of any. In
February, the paroxysms recurred more frequently; and the
intervals of a pyrexia, which at first continued several days,
were now restricted to a lew hours. The tono;ue at that
period was white, and covered with apthae ; the breath acid;
the abdomen swollen, and sore on pressure ; fseces scanty,
dry, and brownish; pulse small, wiry, slightly intermittent;
face red and streaked ; headacb intense. Five grains of
calomel produced several stools, and the discharge of six
liicocephali ; and the decoction of filix mas was prescribed
as common beverage. Dr. Pascal’s visits were discontinued
till the 15th of March, when he learnt that the paroxysms had
increased both in frequency and violence ; that the boy
became insensible during the invasion, the muscles of his face
were convulsed, his eyes rolled in their orbits, his respiration
was oppressed ; and that, in the calm which succeeded these
violent agitations, his strength was exceedingly depressed.
These various phenomena were observed indiscriminately at
the commencement, middle, or termination of the paroxysm.
The face was constantly red, and, as it were, marked with
wheals. 4 he appetite, during the transient intervals of tran¬
quillity, was restored ; and tricocephali had several times been
voided in the stools, d’he pulse was now feeble, contracted,
very rapid, and intermittent. The expression of the coun¬
tenance, bathed in a cold and clammy^ sweat, announced im*

2S6

Foreign Medical Science and Literature*

pending death. Violent convulsions, during which the hands
of the patient were mechanically directed towards the head
and abdomen, preceded this event.

Dissection fifteen hours after death. — General appearance
pale; trunk and extremities stiff; 'face injected. A large
quantity of serum in the pericardium,— Abdomen. Several
of the mesenteric glands enlarged and scirrhous. The
stomach distended with gas. Several tricocephali in the
ileum, and an innumerable quantity in the coccum and colon.

Cases. — A boy, aged five, stout, but subject to nasal
hsemonhage, and who had frequently voided lumbrici and
ascarides, complained at bed-time, on the 8th of October, of
violent headach. At midnight he started from sleep with an
acute and inarticulate cry, and was found in extreme agitation;
his eyes prominent; his face red and streaked ; and his hands
incessantly directed towards the head and abdomen. Next
morning the pulse was small and contracted, although the
epistaxis had not, for some time, recurred. Two leeches
applied behind the ears took away a considerable quantity
of blood ; and the afternoon and night were passed in
tranquillity.

11th. — Agitation extreme. The patient rose and fell back
again on the bed ; face red and streaked ; pulse intermittent,
small, and concentrated ; screaming, with stertorous respira¬
tion. Six grains of calomel were administered, after which
the child vomited a dead lumbricus, and passed, by stool,
eight living tricocephali.

12th.- — Same state; stiffness of the trunk and lower extre¬
mities ; perspiration ; urinary and foecal discharges invo-
’ luntary, the latter containing a living lumbricus, and twelve
tricocephali ; aphonia. During the night the agitation
attained its utmost bound, and the child expired in dreadful
convulsions. No examination took place.

Tricocephali are frequently found in the intestines of per¬
sons who have died of mucous phthisis; but it does not
necessarily follow^ that the presence of the animal is a cha¬
racteristic phenomenon of the disease. It may be regarded
as an accidental circumstance, or rather as a complication.

In January, 18]?, Dr. Pascal examined the body of a man,
aged 69, who had died of mucous phthisis in the last stage of
marasmus. The intestinal mucous membrane was abundantly
smeared with thin mucus; but after the strictest search, a few
tricocephali only were discovered.

The body of a man, aged 40, and of athletic stature, who
previously enjoying robust health, had been executed for
murder, displayed a perfectly healthy state of all the organs,
with the exception of a slight adhesion of the left lung, and
the presence of a great quantity of tricocephali in the coecum

Pascal on Intestinal Worms,

237

and colon. The same observation was made in April, 1817,
on a robust man, aged 50, who bad committed suicide.

By several authors it has been asserted, that the mucus
which obstructs the intestines in mucous affections, is the
source of tricocephali : but this opinion, wholly destitute of
probability, experience has completely refuted. A more
plausible inference is that of Messrs. Alibert and Gardien,
who think that the abundance of intestinal mucus met with in
these diseases is the effect of the irritation produced by these
worms on the mucous membrane : but even this opinion,
founded as it is on the physiological theories of the day, ob¬
servation frequently contradicts; for in persons who have died
of mucus phthisis, and whose intestines have consequently been
covered with mucus, scarcely any w'orms have sometimes
been found.

In proof of this assertion, may be cited the dissection of the
subject of 69 years, which has just been recorded, and that of
the body of a man, aged 64, who, previously very robust, died
in January, 1815, in extreme marasmus, from decidedly
marked mucous phthisis, probably attributable to poverty and
unwholesome food. Yet dissection showed only a scirrhous
state of some of the mesenteric glands, and the obstruction of
the intestinal canal from the stomach to the arch of the colon,
with ropy mucus, while merely a dozen of tricocephali, and
one lumbricus, were discovered. To these examples may be
added that of the dissection of a delicate subject, suffering
from asthma, and strongly disposed to mucous phthisis, who,
after having been several times under the care of Dr. Pascal,
died suddenly in the fields at night, in April, 1817* On
dissection, serous effusion into the ventricles of the brain was
discovered. The stomach contained about two ounces of an
homogeneous pulpy matter, and the large intestines some
indurated faeces. The intestinal tube was copiously smeared
throughout with mucus ; yet five tricocephali and two
ascarides only could be found.

From the preceding cases Dr, Pascal concludes : — 1. That
tricocephali almost invariably exist in the human subject;' at
least, in the prosecution of his researches on mucous phthisis,
he had never examined a body without discovering some of
this species of worm. Q. That the affection produced by
tricocephali is independent of the mucous disease, and ought
to be considered as a phenomenon of the latter, but as a
distinct malady, although the two affections are sometimes
complicated. 3, That the following phenomena especially
characterize the disease produced by tricocephali, and distin^
guish it from all other verminous affections; — Small concen¬
trated pulse, such as is observed in all abdominal maladies,
but at the same time irregular or intermittent; face red and

238 Toyelgti Medical Science and Literature*

streaked; eyes prominent; intense lieadach ; griping pains
in the lower part of the abdomen ; and the symptoms of
other verminous affections in their most violent degree.
And, 4. that worms have nothing to do with the augmenta*-
lion of the intestinal mncus which takes place in mucous
diseases. Dr. Pascal closes his communication with a pro¬
mise of hereafter demonstrating that the fluid, found upon the
iolestiiial membranes of persons destroyed by mucous phthisis,
dilFers essentially from that which lubricates these surfaces in
the healthy state; and that there exists between the two fluids
but a veiy slight analogy.

The second case^ which presents itself, is one of that rare
variety of intestinal worm, the ditrachyceros rudis\, first dis-

* Bulletin de la Faculte de M^decine de Paris, &c. 1818, No. V.
t The following is the notice of this singular and uncommon
worm, recently published by Dr. Cloquet The genus ditracliyceros
at presents comprehends but one species, the D. rudis, bicornis rudis,
buUzer; cysticerus bicornis, Zeder ; diceras rudis, Rudolph. Cha¬
racters — Body oval, one line and a half long, flattened, terminating in
a point posteriorly, firm, contained in a membranous bladder, and
furnished anteriorly with a bifurcated horn which appears rugose to
the naked eye; but, when viewed in the microscope, is seen set with
narrow and elongated spikes. Habitation— Unknown as to the precise
part of the intestinal canal which it occupies. Description — Colour
fawn-like; length altogether about four lines. Body composed, 1st,
of an external, delicate, floating membrane, completely enveloping it
without adhesion, except in the vicinity of the horns; 2dly, ot a
membrane more strong and thick, which also adheres to the base of
the horns, and forms a sac without any opening; and, lastly, of a
vesicle smaller than the two preceding, and contained in the cavity^'
of the second. Both horns, each possessing the volume of a horse¬
hair, conical, rugose, and somewhat flattened towards their larger
extremity, where they unite and form a very short common trunk,
moveable in every direction, as on a pivot. Examined with the
microscope, these horns seem to be composed of a homogeneous sub¬
stance, in which are hollowed cells increasing in size as they approach
the peduncle. A kind of axis of a fragile substance traverses them
longitudinally, and numerous pyramidal spikes beset the surface.
The cavity of the body contains a very limpid fluid. The membrane
forming its parietes, when examined with a microscope, appears to be
studded, both internally and externally, with tubercles of a very
variable figure, oval, rounded, triangular, or lozenge-shaped, noicned
in their circumference, and separated by grooves. I he interior
vesicle of the body is of a deep brown colour, and exhibits, both in¬
ternally and externally, distinct grooves ; but has no outlet, and con¬
tracts to a point superiorly where it adheres to the internal parietes
of the body. — See Dictionnaire des Sciences Medicales, tome xxii,
article ilydatide; and also the Natural History department of the
last Number of the REPOsyrony.— Editor.

Pascal OH Intestinal Worms ^ €139

coveied and described in 1801, by Dr. Sultzer, of Strasbiirgh,
and never, we believe, a,u:ain met with from that time to the
present. Although, if the sytnptoms to which it gives rise
were more correctly-understood and distinguished,*^ and the
alyine discharges in every suspected case minutely examined,
this curiously organized animal might prove to be less rare in
occurrence than has hitherto been supposed.

In the hope of its affording some positive data for the
establishment of the diagnosis of the disease resulting from
the presence of this worm in the intestinal canal. Dr. Le
bayage has detailed the history, of which the following is an
abridgment: — A female, aged twenty>three, of dissolute
habits and nervo-sanguineous constitution, had suffered in her
health from repeated attacks of syphilis, when about two
years since she w^as suddenly seized with violent pains in the
abdomen. At first, a regular exacerbation took place about
eleven o clock in the morning, and terminated at four in the
afternoon. During this seizure the patient writhed about on
the bed with expressions of the severest pain. In two or three
weeks the paroxysm subsided, and the pains continued with
a diminished but more regular violence: occasionally, how¬
ever, some variations in their intensity were experienced. Jn
July, 1817, the condition of the young woman was un¬
changed, and general uneasiness, with anorexia, prevailed.
At this time, by the operation of a purgative, a very consi-
deiable quantity of worms, of the ditrachyceros species, was
discharged. Dr. Le Savage then first visited the patient, and
had an opportunity of examining the worms, wdiich had been
preserved for his inspection. Purgatives, administered both
by the mouth and rectum, produced no further evacuation of
tnem. The patient was considerably relieved, but not cured.
At the date of the last report she continued to feel pains less
violent in degree and often momentary in duration : they
were constantly felt in different points of the abdomen without
any one region being more affected than another. This sin¬
gular circumstance is explained by Dr. Le Savage, from the
great irritability of the young woman, on the supposition that
these pains are principally nervous, and mask the uneasy sen¬
sation which must necessarily reside in the region apparently
occupied by the worms.

M. Gaultier de Glaubry, in the third place, has communi¬
cated to the Medical Society of the department of the Seine,
several cases of convulsions induced by the presence of worms
in the intestinal canaf^. A young female child, who had been
attacked with convulsions, died on the sixth day. 'The ab¬
domen, on dissection, was found greatl}^ distended, and eleven

* Rccueil Periodique de la Society de Medecine de Paris, tomelxiv.

^40

Foreign Medical Science and Literature.

large and very long worms lying on the intestinal mass. The
stomach was pierced with holes, through which these animals
had passed: several were yet in the very act of passage. In
the interior of the stomach filty-two others were contained 5
and in the intestines only two.

In another child, destroyed on the seventh day of seizure
by a similar affection, M. Gaultier discovered, ist. a large
quantity of serum effused into the brain and its ventricles ;
and 2dly, lunibrici distributed here and there on the intestinal
mass. The stomach was completely lined w^ith worms ; some
just commencing the process of perforation, some half way
passed, and others almost completely through. Altogether
there were twenty-seven engaged in the parietes of the sto¬
mach, and thirty-six upon the intestines. The stomach, in¬
durated and voluminous, farther contained an enormous mass
of lumbrici.

In a third more successful case, the evacuation of a great
number of these worms was effected by the employment of
anthelmintics.

The two first of the preceding cases are rendered very re¬
markable by the passage of the worms into the peritoneal
cavity. Most of the Physicians who have treated on the his¬
tory of intestinal animals, consider the worms of the human
subject, and particularly theascaris lumbricoides, as incapable
of perforating the membranes of the digestive canal : yet they
all agree in admitting the occasional passage of these worms
into the thorax or bladder, when in consequence of the de¬
tachment of an eschar or of ulceration, a breach exists in the
intestinal tube. The orifices made by perforating worms are
commonly strait, corresponding nearly to the diameter of
the animal ; while those resulting from gangrene or ulceration
are usually much larger. Of the perforating worms, never
more than one passes by the same orifice; while in the other
varieties a single hole serves for the transit of a great number.
The escape of the first is alw^ay^s active; that of the latter
invariably passive, and determined rather by the contractions
of the stomach and bowels than by any effort of the animal
itself. Hence, we think, with the editor of another French
journal*, that it is very doubtful whether in the cases which
M. Glaubry has recorded, the perforations of the stomach had
actually been accomplished by the worms ; or, at least, that
they had not occurred previously to the extinction of the
vital principle.

By Dr. Stiebet, we have lastly to observe, a new species of
intestinal worm has recently been discoveredf. He distin-

• Nouveau Journal de Medecine, Juillet, 1818.
f Nouveau Journal de M6decine, Aofit, 1818,

Pascal oji Intestinal Worms.

241

guishes it by the name of dyacantlios polycephaluS. This
animal, now in the possession of Professor Blumenbach, of
Gottingen, was voided, living and enveloped in mucus, by a
boy aged eleven, who had for eight years been subject to a
Sipasmodic aflfection bordering on epilepsy ; ‘ and for which, at
the period of the evacuation of the worm, valerian and flowers
of zinc had been administered.

The animal in question is an assemblage of about twenty
individuals united by one common trunk, after the manner of
the compound zoophytes. The head of each presents two
tentacula, and two lips furnished with a minute hook. The
tentacula support interior!}^ a kind of horn-like claw, ex¬
tremely sharp pointed. They are, like the branches of polypi,
prodigiously retractile, and capable not only of shortening
but also of withdrawing as into a tube. The point where the
retraction takes place is moreover indicated by a slight ele¬
vation. During the repose of the animal, the tentacula are
applied one against the other, and the labia raised so that the
cavity of the mouth is completely closed ; but in the act of
suction, the tentacula are separated on the sides and ante¬
riorly. Behind the lips, in the cavity formed by the insertion
of the tentacula, is the mouth, rounded and encompassed by a
circular elevation. At the will of the animal there issues from
it a sucker; the anterior extremity of which constitutes a
small absorbent tube, and the posterior, by dilatation, the
digestive canal. Another part, which may be regarded as the
genital organ, projects behind the oesophagus, and terminates
in an open tri-lobulated cavity.

Dr. Stiebet is inclined to think that this animal is re¬
produced by a mode of generation, placed midway between
proper procreation and gemmation.

11. Fatal Inflammation of the Cerebral Membranes^ unac-^
companied by Fever. — Practitioners experienced in the ob¬
servation of diseases, cannot fail to have remarked, that while
in general any considerable affection of even the more unim¬
portant organs is followed by a degree of constitutional dis¬
turbance, corresponding to the severity of the local disease,
serious lesions of the viscera most essential to life do occa¬
sionally occur, and run their fatal career, without exciting in
the system any phenomenon indicative of their existence, or
calculated to arouse the attention and energies of the unsus¬
pecting Physician. More than once has it fallen to our lot
to see the fair reputation of the too hasty or unobservant
Practitioner irreparably wounded, and the hopes of a family
implicitly confiding in his opinions destroyed, by the event
of some obscure disease of the heart, brain, or abdominal
organs, which has pursued an insidious course, unwatched and

VOL. XT. — NO. 63. % i

S42 Foreign Medical Science and Literature.

almost unimpeded, to its destructive close. Such cases
breathe a' lesson to which no professional man, who properly
estimates the value of his character and the high duties of his
calling, can, or at least ought to be insensible.

The curious and important fact in pathology which has
elicited the preceding remarks, is well illustrated by the his¬
tory of inflammation of the cerebral membranes, a short time
since given to the public by Dr. Chomel*, and rendered
especially interesting by the rapidity of progress of the dis¬
ease, and the obscurity in which its diagnosis was involved.

A gentleman, aged forty-seven, of robust constitution and'
sanguine temperament, of active and impetuous character,
extremely irascible, and addicted to spirituous potation, be¬
came, in consequence of severe disappointments, more than
ever irritable in his temper and dissipated in his habits. From
such imprudence, debt and difficulties naturally resulted. In
August he first complained of abdominal pains, with general
uneasiness and debility, and of deafness of the left ear; in
which he, moreover, felt a severe pain extending towards the
forehead and sinciput : otherwise, his intellectual faculties
were unimpaired and his gait free. He was advised to go to
bed, and in the evening took several injections without relief.
There was some thirst, but no increased frequency of pulse or
elevation of temperature. The application of leeches to the
neck was prescribed, but not adopted : the night was passed
with little sleep; and the patient, incommoded by its heat,
several times left his bed. On the morrow, the colic had
given way to copious fecal evacuations ; but the headach had
become concentrated about the forehead. Some relief was
obtained from application of cold to the part, and the employ¬
ment of pediluvia. At three o’clock convulsions suddenly
came on, with turning up of the eyes, and violent and voci¬
ferous delirium. At eight the exclamations had ceased ; but
subsultus tendinum now prevailed ; the eyes were drawn
forcibly upward ; and the limbs were seized at times with
transient stiffness. The patient never spoke, and seemed
utterly insensible to surrounding objects. His gestures, how¬
ever, upon being pinched, conveyed an expression of pain :
he could not be made to drink. His respiration, commonly
tranquil, became at rare intervals suspirious.

On Dr. Chomel’s visit at ten o’clock he found the patient
in bed. His eyes were open, and directed without object from
side to side. He replied neither by word nor gesture to any
questions. Some automatic motions were executed by both
sides indiscriminately ; the pupils displayed an uniform dilata-

* Kouvcau Journal de M^decine, Ao6t, ISIS.

Chomel on Cerebral Injiammation. €43

tion and equal sensibility ; the face was neither pale nor
flushed ; the pulse regular and unaccelerated ; and the tem¬
perature natural. All fluids introduced into his mouth were
invariably rejected.

The train of phenomena above delineated, led Dr. Chomel
to the conclusion that their source existed in the brain ; and
he prognosticated the speedy termination of the disease. Its
precise nature, however, he did not attempt to determine,
although, from the sudden invasion of the symptoms, their
developement in consequence of a moral affection, their in¬
stability, and the absence of fever, he was inclined to con-'
sider them as of a nervous character. The application of
sinapisms to the lower limbs, and employment of antispas-
modic injections, were only prescribed. During the night the
condition of the patient remained unaltered. Between eight
and nine o’clock on the following moraing he recovered for a
while his consciousness, and answered correctly some ques-
,tions addressed to him. The thorax was pointed out by him
as the part principally affected. A little broth was adminis¬
tered during this interval of tranquillity. At half past ten he
again became insensible, and sank into a state of profound
stupor. Hiccups succeeded, with vomiting of a yellowish
matter. In this state he was conveyed at noon to La Charite,
where venesection w'as performed in the foot, and fresh sina¬
pisms were applied. The left pupil was now observed to be
more dilated than the right, and that the limbs of the right
side were the least insensible. Respiration became frequent'
and laborious ; the drowsiness increased ; frothy mucus filled
the mouth and nostrils and oozed upon the lips ; the pulse
grew intermittent; and the patient died at five in the even¬
ing, twenty-six hours after the accession of the convulsions
and delirium. On dissection, forty hours after death, the ex¬
terior of the body offered nothing remarkable. The stomach
contained about eight ounces of a brownish, turbid, and in¬
odorous fluid. The portion of mucus membrane surrounding
the cardia, displayed a reddish colour. The lungs were
sound; the heart somewhat larger than natural ; the gorged
capillary vessels of the cerebral membranes gave to them a
rose-like colour, which was also observed in the substance of
the brain. The arachnoid covering the hemispheres ex¬
hibited, in several points, adhesions formed by albuminous
granular concretions. On the inferior and lateral surfaces of
the brain, traces of membranous inflammation were also evi¬
dent. Puriform matter, of a greenish-yellow colour, and of a
consistence between liquids and solids, was lodged between
the pia mater and arachnoid, and dipped a little into the in-
Iterstices of the cerebral convolutions. The lateral ventriclet

244 Foreign Medical Science and Literature,

were dilated, and contained, each, aboat three ounces of a
dirty-looking fluid, not unlike unrlaritied whey, and containing
some albuminous concretions, which were more evident about
the choroid plexus than elsewhere. A small quantity of
similar fluid occupied the third and fourth ventricles. Tne
inflammation extended to the wboie medulla oblongata; but
the spinal marrow was not.implicated^.

III. Peritonitis. — Professor Portal has, in the commence¬
ment of the present year, published a memoir, the object of
which is to prove the non-existence, or at least the very great
infrequency, of primary peritoneal inflammation^. Our li¬
mits will not allow us to enter into a very minute analysis of
the production : and this we are the less disposed to regret,
since it appears entitled to our attention, rather from the name
of its venerable author, than the intrinsic value of the materials,
which enter into its composition.

In illustration of the doctrine that the inflammations of the
various membranes exhibit, in their external phenomena, no
difference from those of the organs which they respectively
invest. Professor Portal cites the testimony of Coiterus, w'ho
first demonstrated from anatomical researches, that in phre-
nitis, previously supposed to have its seat in the cerebral
meninges, the disease consisted of inflammation, not of the
membranes, but of the brain itself. The same author also,;
in tracing the history of an epidemic peripneumony which
prevailed at Rome in 1563, asserts that he discovered the seat
of the disease to be in the lungs, and not in the pleura. Pla-
terus, Valsalva J, and several other distinguished pathologists,
w^ere conducted, by the light of dissection, to the same in¬
ference. The declaration of Morgagni, that pleurisy differs
from inflammation of the lungs neither in its diagnosis, nor in
the treatment which it requires, is, on this point, considered

* Inflammation of the tunica arachnoides, it is observed by Dr.
Chomel, differs from that of the other serous membranes in a very
remarkable circumstance. In these, purulent exhalation takes place
on their free (or unattached) surfaces ; while in the former it almost
invariably occurs on the adherent surface of the membrane, that is,
between the arachnoid and pia mater, except it be in the interior of
the ventricles, when the pus is secreted by the free surface of the
arachnoid. This fact is almost constantly observed by those who
sedulously cultivate morbid anatomy.

t Journal Universe! des Sciences M^dicales. Janvier, 18 ip.

X Valsalva discovered no remarkable alteration in the pleura of
subjects who had previously exhibited all the symptoms commonly
considered as characterizing pleuritic inflammation.— Morgagni, de
Sfdibus et Causis Morbonm, Lib, II. Epist. 58»

Portal on Peritonitis,

245

particularly valuable and decisive ; inasmuch as he once had
held contrary opinions, and those opinions had yielded only
to the evidence of facts. A memoir, in farther corroboration
of this doctrine, was moreover published by the Professor him¬
self in 1789, and honourably mentioned, as he does not forget
to remind us, by Tissot.

In the face of such evidence, the Professor is astonished to
see that some estimable Physicians kill continue to regard as
signs characteristic of particular inflammation of the peri¬
toneum, the phenomena more correctly referrible to inflamma¬
tion of the abdomen, or of some one of its contained organs.
The most celebrated physiologists of modern times have not,
he observes, been able to discover in this membrane the sen¬
sibility or irritability possessed in an eminent degree by most
of the abdominal viscera. Yet he does not attempt to deny
that membranes may acquire from disease a sensibility not
naturally inherent in them. This change, however, always
takes place with less facility and violence in membrane than
in those organs which are naturally the most sensitive and
irritable.

The sole method of correctly deciding the point at issue,
obviously consists in the cautious selection and impartial
detail of facts deduced as well from anatomical as from
clinical observation. The following are the results of the
researches prosecuted by Professor Portal in the theatres of
anatomy.

1. The peritoneum has rarely exhibited traces of inflamma¬
tion without evident inflammation of the neighbouring parts;
but as the nature and symptoms of the disease were, in such
cases, necessarily unknown, no conclusions could be drawn re¬
specting the morbid characters. Yet the peritoneum has some¬
times been found very red in persons who have died of various
eruptive diseases, and occasionally the surface of the membrane
has displayed, independent of this redness, graniform elevations,
either filled with serum and resembling small hydatids, or of a
fleshy or wart-like consistence. Sometimes they have been sof¬
tened, and as it were ulcerated, but invariably so diflerent in
.figure, volume, colour and consistence, from the cutaneous
eruption observed previously to the death of the individual, that
no resemblance existed between them.* The ensuing are ex-

* This seems to confirm the opinion of Cotunni, who thought that
in small-pox, pustules, resembling those of the skin, were not formed
in the interior of the body, but did not deny the existence in such
cases of internal pustules, varying in extent and in the intensity of
their red colour. See his masterly dissertation de Sede Variolarum,
8vo. Neapoli, 17fi9*

£46 Foreign Medical Science and Literature.

amples wherein the peritoneum displayed a red appearance,
resembling inflammation, and yet the subjects, during life,
had experienced neither abdominal tension nor any of the
symptoms, which are supposed characterize an inflammatory
affection of the membrane. A gentleman had his body, and
particularly his face, covered with a very red eruption, which
receding either spontaneously or under the influence of medical
treatment, was followed by general dropsy. On dissection,
the peritoneum was found much reddened and covered by
places with an eruption, remarkable for some small elevations
of an irregular figure. The liver was altered both in its sub¬
stance and volume. In another person who died of pulmo¬
nary phthisis after the repercussion of itch by a muriatic acid
lotion, the pleura investing both the lung, ribs and diaphragm,
and the peritoneum of the abdominal parietes and viscera
were covered with red patches, of unequal elevation in dif¬
ferent places and by a kind of irregular tubercles.

2dly. As to peritoneal inflammation, complicated with that
of the parts covering it externally, few' examples are detailed
by authors; but sonie cases, observed by himself, the Professor
has here recorded,

A gentleman who had long been subject to paroxysms of
gouty and rheumatic pains, regularly increasing in frequency
and violence, and principally affecting the low^er limbs, con¬
sulted Dr. Portal. Atrophy at length seized the right inferior
extremity, and violent pains were felt in the corresponding
lumbar region, where also a hard and painful swelling was,
on pressure, perceptible. The patient could soon no longer
walk, or scarcely sit. The pain and emaciation went on aug¬
menting. Impeded respiration rendering impracticable the
recumbent posture slight fever supervened, and severe
orthopnoea terminated the struggle. On dissection, the
muscles of the left (right?) lumbar region, including the
quadratus lumborum, the internal and posterior membrane,
and posterior portion of the transversus abdominis, were very
red, swollen, and softened. The posterior portion of the
peritoneum was also of a deep red colour, bordering on violet.
Between the quadratus and sacro-lumbalis, a collection of
concrete albuminous matter had taken place. In this instance,
it may be remarked that, although the peritoneum was in¬
flamed, none of the phenomena set down as particularly
characteristic of peritoneal inflammation had been exhibited
during life.

In a woman w'ho had died of hectic fever and dropsy, con¬
sequent on an attack of zona herpetica, with violent pains in
the lumbar region, Dr. Portal also found the external and

Portal on Peritonitis,

«47

internal oblique muscles, the transverse and those of the
back, very red and soft beneath that part of the integument
which was affected with the eruption. The anterior and in¬
ternal aponeurosis of the transverse muscle and the portion
of peritoneum covering that and the adjacent parts, were
likewise much inflamed. This w^oman had never displayed
any symptom of peritoneal, or rather of abdominal inflam¬
mation.

Again, on dissection of a child, who after having been for
several j^ears affected with symptoms of vertebral disease, hat}
apparently died from hydrothorax, consequent on pulmonary
phthisis, the bodies of the last dorsal and two first lumbar
vertebrae were found by the Professor reduced in volume
and attacked with incipient caries. Their anterior ligaments,
the adjacent portion of peritoneum, and both the costal and
pulmonary pleura, were very red and swollen. The lungs
were moreover ulcerated and full of steatomatous concretions,
and a quantity of reddish fluid was effused into the chest.

Sdly. Of inflammation of the peritoneum, conjoined with
that of the abdominal organs, examples abound in the works
of pathological writers, by whom, from their frequent silence
respecting it, such inflammation would seem to be regarded
as of little consequence. In decided phlegmasiae of the ab¬
dominal viscera, the Professor has observed that, while their,
investing peritoneum and the adjacent portion of the mem¬
brane exhibited traces of inflammation, the more remote
parts of it were perfectly free from any such appearance.
And commonly in metritis the peritoneum which covers great
part of the external and superior surfaces of the uterus, and
forms its ligamenta lata and rotunda, are more or less in¬
flamed. Hence, he confidently infers that, in these cases,
the morbid action has been propagated from the inflamed
organ to the peritoneum, instead of being originally^ seated in
and spreading from the membrane to the former. Such
transmission, he further contends, is effected by the medium
of the nerves, blood-vessels, and lymphatics, enclosed in the
common cellular structure. And thus most metastases may
be said to take place rather than by the cellular membrane.

After attempting to support this doctrine by a reference to
the natural inirritability of the peritoneum and its consequent
proportionate insensibility to injury and disease on the one
hand, and the exquisitely irritable constitution and suscepti¬
bility of the abdominal and pelvic organs on the other. Pro¬
fessor Portal proceeds further to substantiate his theory by
observing that the accumulations of fluid, which occur in the
peritoneal and other serous cavities, may be referred, not so ,

^48 Foreign Medical Science and Literature.

much to any disordered action of the exhalant or absorbing
vessels of the membrane investing them, as to a lesion of
some one of the solid viscera which they contain ; and that
organs, which have been the seat ot inflammation, frequently
exhibit only a dull or wdiite colour, while the membranes
covering them are found to have assumed the highest degree
of redness. From these remarks, and the facts developed in
his Memoir, the Professor considers himself completely
borne out in the following conclusions: —

1st. The most decided traces of inflammation are fre¬
quently found in the peritoneum of subjects, who during life
have experienced none of the symptoms regarded as cha¬
racteristic of phlegmasia of this membrane. 2. When such
symptoms really occur, one or more of the abdominal organs
will be found to have suffered from inflammation, and hence
doubtless the ancients were satisfied with the generic term of
inflammation of the abdominal viscera, without distinguishing
it by a name expressive of its restriction to a membrane,
whose structure appeared to them ill calculated to produce
the symptoms characteristic of inflammation. 3. If the
peritoneum be inflamed, such increased action is commonly
seen in the vicinity of some other inflamed organ or organs,
the lesions of which have been indicated by characteristic
symptoms preceding death."^ 4. The propagation of the
inflammatory process from the abdominal organs to the
peritoneum is a very frequent occurrence, while that of
peritoneal inflammation to the former rarely takes place,
and ought even then to be referred rather to the nerves,
blood-vessels, and lymphatics, than to the agency of the
peritoneum in the abdomen, or the serous membranes in the
other cavities, the principal function of which is to serve as
a support to the nerves and vessels. And 5. Peritonitis, as
it is now generally termed, no more constitutes a disease
distinct from phlegmasia of the other abdominal viscera,
than phrenitis from inflammation of the brain, or pleuritis
from that of the lungs.

* Professor Portal does not deny that, in some cases, the cause of
the inflammation may be so intense as to display its action simul¬
taneously on the peritoneum and the other abdominal organs ; but,
even in such instances, he is disposed to think that the external phe-
noniena presenting themselves, are attributable rather to the inflam¬
mation of the solid viscera, than to the aflection of the membrane;
recurring to his favourite argument respecting the occasional existence
of peritoneal inflammation in subjects who, during life, have displayed,
none of the characteristic phenomena of peritonitis.

Orfila on Adulteration of Wine$,

249

MEDICAL JURISPRUDENCE.

IV. Adulteration of Moines, — Wines may be adulterated
by a variety of* substances. The object aimed at in the
commission of this fraud is to conceal some defect of the
wine, or impart to it colour, smell, or strength.

Among the substances employed by wine-merchants, some
are wholly void of danger. Others, on the contrary, are
poisonous, and cannot be taken internally without inducing
pernicious or even fatal consequences. By this consideration,
Professor Ortila has been led to expose the means whereby
any one may be enabled to determine whether or not wines
have been adulterated.*

TVines adulterated with lead. — In order to soften acid and
tart wines, acetate of lead, ceruse, or more frequently litharge,
(protoxide of lead) is added to them. These preparations
communicate to the wine a sweet flavour. Of ail fraud this
is the most dangerous. Persons who drink liquids thus
adulterated experience all the symptoms characteristic of the
poison of lead.

White wines, adulterated with lead, exhibit, independently
of their sweet astringent flavour, several properties by which
they may be distinguished. 1. They scarcely redden tincture
of litmus, because the acid which they naturally contain is
saturated by the oxide of lead. 2. Sulphuric acid, or
aqueous solutions of the various sulphates, as sulphate of
soda or magnesia, render them turbid, and produce a white
precipitate, which immediately collects at the bottom of the
containing vessel, arid does not disappear on the addition of
water. 3. Muriatic acid, or solutions of the muriates, such
as salt water, yield also a white, heavy precipitate, soluble
in twenty-five or thirty times its weight of water. 4. The
subcarbonates of potash, soda and ammonia, operate in the
same manner. 1 he white precipitate which they determine,
insoluble in water, dissolves with wonderful facility in pure
nitric acid. 5. Chromic acid and chromate of potash pro¬
duce a beautiful canary yellow precipitate. 6. The hydro-
sulphuric acid, the hydro-sulphates, or aqueous solution of
sulphuret of potash, blacken these wines, and yield in a few
minutes a black precipitate. 7. If the precipitates resulting
from the means just indicated be collected on a filter, if,
after being dried, they are mixed with charcoal powder and
pure potash, and exposed for half an hour to red heat in a

* Secours a donner aux personnes empoison6es ou asphyxiees, &c,
Paris, 1818.

VOL. XI. — 'NO. 65. 2 K *

250 Foreign Medical Science and Literature.

crucible, we obtain metallic lead easily recognizable by its
deep blue colour; the facility with which it is scratched by
the nail, and the promptitude with which it dissolves in
nitric acid, yielding a liquid salt of a sweet llavour, and endued
with the property of forming a white precipitate with the
various sulphates, muriates, and carbonates. 8. These wdnes,
so adulterated, yield a white precipitate to aqueous solutions
of potash, soda, and ammonia. 9* Evaporated in a capsule
at the temperature of 212®, they yield a mass which, being
calcined to redness with powdered charcoal, furnishes at the
- end of thirty or forty minutes, metallic lead. This character
suffices to establish the existence of lead in wines.

Med zvinesj adulterated with preparations of lead, never
exhibit a colour so deep as they possessed previously to such
admixture. They become of a pale red hue. The presence
of lead in them may be demonstrated by means of the same
agents which serve to detect the metal in white wines. It is
necessary merely to note — 1. That ammonia commonly pre¬
cipitates them of a dirty green colour; while, in white wines,
the precipitate determined by it is w'hite. 2. That the hydro¬
sulphates may involve in error, if their operation be but
superficially examined. In fact, red wines, adulterated with
lead, yield to these agents a black precipitate; but most red
wdnes, even when containing no lead, exhibit nearly the same
appearance, for they turn black, and ultimately deposit flakes
of a blackish violet colour. Hence it is of consequence, in
availing ourselves of the character aflbrded by the hydro¬
sulphates, to observe that the blackish precipitate which they
form in red wines only, indicate the presence of lead, if after
having been collected on a filter and calcined with potash and
charcoal it yield metallic lead.

Moines adulterated zeith alum. — The object of this adultera¬
tion is to render wines of a deeper red colour and less change¬
able, and to give them an astringent flavour. The conse¬
quences resulting from such fraud are indigestion, vomiting,
visceral obstructions, and haemorrhoids. The adulteration mav
be detected by the following characters which belong to
alum : — 1. The flavour of such wines is acid, slightly sweet
and astringent. 2. They decidedly redden litmus paper,
because, independently of the acid peculiar to them, they
contain the uncombined sulphuric acid of the alum. 3, 1 hey
yield with ammonia a white or coloured precipitates, not
soluble in an excess of alkali. 4. Solution of pure potash
renders them turbid, but the precipitate disappears in an
excess of potash. 3, The subcarbonate of potash precipitates
them, but does not re-dissolve the deposit. 6. The acetate,
nitrate and muriate of barytes produce a copious white pre-

251

Orfila oh Adulteration of Wines*

cipitote insoluble in water and in pure nitric acid.^ 7. Of
all the means proposed for the detection of alum in wine, the
following appears to merit the preference. From the evapo¬
ration of several bottles of wine in a capsule, a reddish mass
is obtained, consisting of alum and the colouring matter and
tartar which form a part of the wine. This mass should be
dissolved in a considerable quantity of water and boiled with
charcoal. By these means an almost colourless liquid is pro¬
duced : this should be filtered and evaporated in a capsule
by a gentle heat, until a pellicle forms on the surface, when
it should be removed to a cool place. The tartar crystallizes,
and the supernatant fluid contains alum ; this fluid should
possess a sweet astringent flavour, and yield with ammonia
and pure potash a white precipitate; that, resulting from the
latter alkali, should be soluble in an excess of potash. Water
of barytes and its acetate and muriate ought to render it
turbid and produce a white precipitate, insoluble in water and
in nitric acid.

Wines adulterated with chalk. — This substance is sometimes
added to w'hite or red wines which possess disagreeable
acidity, in order to saturate the acetic and tartaric acids and
destroy their tart flavour by combination with the lime of the
chalk. Wines thus treated are in reality more soft, but
wlien containing an inordinate portion of acetate of lime,
they may induce disagreeable symptoms. The fraud then
may be detected by the following characters: — 1. Several
bottles of wine should be boiled in a capsule, or in close
vessels if the collection of the alcohol be an object. The
liquor, when reduced almost to the consistence of a syrup,
should be mixed with five or six ounces of distilled water,
shaken together for ten or twelve minutes, and filtered ; it
will be found to contain acetate of lime formed by the acetic
acid of the wine and the lime constituting the chalk. The
tartar contained in the wine will remain undissolved on the
filter. 2. Oxalate of ammonia poured into this liquid will,
if the wine really contained lime, produce a white or coloured
precipitate of oxalate of lime: this precipitate, washed and
dried on a filter, will yield quicklime upon calcination in a
crucible. 3. Quicklime may be distinguished by its properties

* If, under some circumstances, the wines containing alum exhibit
the characters just indicated, it is equally proved that certain wines,
not possessing an ‘atom of this substance, offer some of these pro¬
perties, and especially that there are others in which, notwithstanding
the presence of alum, it is impossible to develope all the characters
which have been specified, because they contain various other sub¬
stances. Hence we may conclude that such characters possess not
the value set upon them, and should be regarded as merely secondary.

252 Foreign Medical Science and Literature.

of dissolvingf in water, rendering green the syrup of violets,
being precipitated white by carbonic acid, and not rendered
tttrbid by sulphuric acid.

Wines adulterated zoith brandy. — Weak wines are some¬
times corrected by the addition of brandy: wines also are
occasionally manufactured by mixing cidei’ or other spirituous
liquor with santal, logwood, or various colouring substances.
Such fraud has no other inconvenience but that of more
readily producing intoxication, and frequently headach. The
admixture of brandy may be delected by the following cha¬
racters: — 1. The wine w'ill possess a much more penetrating
smeil of alcohol than pure wine wdiich contains only the
alcohol developed during fermentation and intimately com¬
bined with the other parts of the fluid ; while in wine to which
brandy has been added, the spirit is in some degree uncom¬
bined, and hence manifest to the organ of smell, 2. For
similar reasons, the flavour of such wines is much hotter than
that of unadulterated wine. 3. According to Renter, when
wine, containing brandy, is distilled by a very slow fire, and
the receiver is often changed, the brandy will be observed to
pass over first, even previously to ebullition; the water some
lime afterwards; and, lastly, the alcohol. Wines, on the
other hand, which contain no brandy, and are submitted to a
similar experiment, yield, first, water, next alcohol, and last
water: but this character is probably not to be depended
upon.

Means employed in imparting colour to zeines. — Old wines
in general possessing a deeper colour than the new, wine
merchants frequently attempt to imparl an additional one to
the latter.

White zoineSj when pale, are sometimes exposed to the air,
whereby their colour is rendered deeper. This process is
without danger. 2. As is^ also that which consists in colour¬
ing them with caramel 3. A yellow colour is imparled to
them by sulphurous acid gas. With this view they are poured
into a cask in which sulphur has been burnt. This is a dan?
gerous fraud if the acid be in considerable quantity: wine,
thus adulterated, exhales an odour resembling that of burning
sulphur, but loses it by ebullition for fifteen minutes. . 4. Pale
wines are sometimes coloured wath the berries of the vaccinium
myrlittus, or logwood, substances w’hich possess equally the
property of rendering them more astringent. This innocent
fraud may be detected by the difficulty of effacing from linen
the spots produced by such wines.

Wines adulterated zoith szoeet and astringent substances.—
admixture of sugar, raisins, sweet wines, or extract of oak or
willow bark, is not dangerous.

253

Orfiia on Adulteration of Wines.

Wines adulterated with other substaricesy as arsenious acid,
copper, or antimony, may induce the most violent symptoms.
Such a fraud has probably never been contemplated ; but,
as these deleterious substances may become accidentally com¬
bined with wines, it is necessary to expose the means whereby
their presence may be detected.

Wines containing arsenious acid. — 1. A mixture of ten parts .
of red wine and one part of solution of the acid, is precipitated
of a deep yellow colour by hydro-sulphuric acid, blackish
blue by ammoniaret of copper, and white by nitrate of silver.
2. A mixture of ten parts of the wine and seven of the acid
is precipitated of a golden yellow colour by hydro-sulphuric
acid, green by ammoniaret of copper, and white by nitrate of
silver. S. The best mode of detecting the presence of ar¬
senious acid, consists in collecting upon a filter the yellow
precipitate formed by hydro-sulphuric acid, and heating it
in a long and narrow glass tube, with equal parts of caustic,
potash, and charcoal. Exposure for some minutes to a red
beat, suffices to volatilize the metallic arsenic of the lustre
of steel, which attaches itself to the parietes of the superior
part of the tube, and thrown on live coals, exhales the odour
of garlick.

Wines containing a preparation of antimony. — 1. These,
when evaporated in a porcelain capsule and calcined in a
crucible vvith charcoal and potash, yield metallic antimony.
2. They are not precipitated by water. 3. They yield with
hydro-sulphate of potash a deep red precipitate, unless much
of the hydro-sulphate be employed when the precipitate is
black. 4. With sulphuric acid a deep yellow precipitate,
slightly verging to grey. 5. With tincture of nut-galls, a
dirty-white precipitate. It sometimes happens that red wines,
containing tartrite of antimony, are precipitated of a reddish
yellow or green colour by hydro-sulphate of potash, deep
violet by sulphuric acid, and bright violet by tincture of nut-
galls. Hence we may conclude, that it is necessary in
establishing the existence of an antimonial preparation in
wine, to separate the antimony in a metallic form by calcina¬
tion with charcoal and potash.

Wines containing a preparation of copper. — 1. A mixture
of ten parts of red wine with one of concentrated solution of
verdigris, is precipitated of a black colour by hydro-sulphate
of potash, soda and ammonia, chesnut-brown by prussiate of
potash, and deep grey by ammonia. This last precipitate is
not wffiolly soluble in an excess of alkali, and the supernatant
fluid is never blue. 2. The same quantity of wine, mixed
with seven parts of solution of verdigris, yields similar pre¬
cipitates, except that the product of the ammonia is black.

254

Foreign Medical Science and Literature^

3. The surest way of demonstrating the presence of a coppery
salt in wine, consists in evaporating the latter and calcining
the residuary mass with charcoal and potash. After halt an
hour’s exposure to red heat, copper, recognizable by its colour,
is obtained.

MIDWIFERY.

VI. Extra-uterine Pregnancy » — Dr. Recamier sometime
since reported to one of the medical societies of Paris ^ seve¬
ral examples of aberrations of this nature; among which is the
following: — He was consulted by a woman of about thirty-
six years of age, suffering from slight dysentery, which readily
yielded to sedative remedies. Six wrecks afterwards this
woman was suddenly seized with most violent colic, prostra¬
tion of strength, and decomposition of the features. She was
dying when Dr. Recamier arrived. Her abdomen, rather
more voluminous than natural, was not very sensible to the
touch. She expired in a few hours. On dissection, there w^as
found in the abdominal cavity, among the inteslinitl convolu¬
tions, a foetus, which, having been developed in one of the
Fallopian tubes, had escaped by a rupture, about tw'o inches
in length, the borders of which were still bloody.

VI. Spontaneous elongation of the anterior labium of the
Uterus during Parturition. — Among the obscure and embar¬
rassing circumstances which so frequently present themselves
ill the practice of Midwifery, w'e have seldom been called
upon to notice a fact more curious in itself, or more important
as it regards the conduct of the Accoucheur, tlian that which
constitutes the subject of a paper lately published by Profes¬
sor Duclos, of Thoulousef.

A lady, aged thirty-four, during the apparently favourable
progress of her fifth labour, uttered in the midst of a severe
bearing pain a continued cry, and exclaimed that the child w as
born. The midwife, however, on examination, found a long
substance hanging between the thighs, which she took for the
placenta prematurely expelled from the uterus. Haemorrhage
and syncope prevailed for a while. The pains subsided; but
considerable alarm and agitation ensued. Dr. Duclos arrived
four hours after the accident. The uterine contractions had
then ceased, and the h&emorrhage was slight. The paleness
of her countenance, and the smallness and debilil}^ of the
pulse, were such as to excite great apprehensions for her
safety. On examination, a cylindrical tumor W'as found by
Dr. Duel os, pendant from the vulva; about four inches long,

* Bulletin tie rAlhenee tie JViedecine de Paris. Bibliotheque Me-
dicalc, Tom. LVllI.

f Bulletin de la Facvilte de VRdecinede Paris, k.z. 1818> No. JX-t

255

Kemarkable elongalion of part of the Ulertis.

and two indies thick in the middle ; broader at its exit froiri
the vagina than at its lower extremity ; of a red vinous colour;
slightly puckered ; resistentand insensible. A small quantity
of black l)lood oozed from it. The Professor insinuated his
hand beneath the tumor to its base; but the head of the foetus,
partly engaged in the pelvic cavity, prevented its introduction
anteriorly into the uterus. The flattened base of the tumor
seemed to lose itself backward, and become confounded with
the posterior labium of the uterus ; the oriflce of which was
completely dilated. At first Dr. Duclos was inclined to regard
it as a polypus rendered more voluminous by the contractions
of the womb, and the pressure exercised on its base by the'
head of the foetus. But this opinion was abandoned on re¬
ceiving the positive assurances that it had existed only four
hours, had suddenly formed during a violent pain, and been
attended with haemorrhage. Nothing particular had been
previously remarked in the dilatation of the uterine orifice.

Alter much embarrassment and reflection as to the nature
of this unusual phenomenon, Dr. Duclos concluded that the
tumor must be formed by an elongation of the anterior labium
of the uterus; and that this part, strongly compressed on one
side by the pubic arch, and on the other by the head of the
foetus, had descended into the pelvis, and became gorged wdtli
blood during the expulsive efforts of the uterus. Under these
circumstances, immediate delivery by the forceps was deter¬
mined on, and the rectum in consequence evacuated. His
patient having been conveniently disposed. Dr. Duclos then
ruptured the membranes, IVom which a little fluid only escaped.
The child’s head occupied a great portion of the pelvic cavity ;
the occiput had nearly arrived beneath the pubic arch. On
raising it a little, the remnant of the liquor amnii escaped.
Meanwhile, the contractions of the uterus gradually returned,
and hence the application of the forceps was suspended. Yet,
although the process went on, the liead of the child advanced
with difficulty ; and the tumor obstructing the passage became
more elongated, notwithstanding the pressure ej^ercised upon
it from summit to base by Dr. Duclos. I’he head, engaged
in the vulva, being now arrested in the passage by the tumor
before it, he applied his lei’t hand on, and pressed strongly the
occiput, in order to maintain the a tterior flexion of the head ;
wliile with the indicator and middle finger of the right intro¬
duced into the rectum, he endeavoured to reach the forehead.
This point attained, he pressed it with force, in order to faeditate
the expulsion of die head and provoke the dilatation of the
perineum. By this manoeuvre it was also hoped, that the in¬
jury which might otherwise have been inflicted by the passage
of the head on the base of the tumor would be avoided. The

toG Foreign Medical Science and hiteraiure,

expulsive pains seconding the manual operation, the head oi ~
the child at last, with difficulty, cleared the vulva, and thus
the delivery was safely accomplished. After this the patient
was put to bed, and had the tumor and genital parts fomented
with an einoliienl decoction every four hours. Next day the
tumor had lost nearly half its volume, and the lochia were
abundant. Thirty-six hours after delivery, the tumor was no
longer seen, except on the borders of the labia. The fomenta¬
tions were continued, and the secretion of milk took place
without fever.

On the tenth day the tumor had wholly disappeared, but
the anterior labium of tlie uterine orifice preserved yet its
nipple-like form. This, however, was no longer to be seen
on the 20th, and the orifice of the womb presented no peculiar
disposition. In fine, both the woman and child eventually
did w^ell.

,In 1816, two years after the occurrence just described, the
same lady was again confined, and exhibited a similar pheno¬
menon. Delivery was, in this instance, advantageously ac¬
complished by laying the patient on her back upon the bed,
and compressing the uterine elongation against the arch of
the pubis with the left hand, while the right was engaged in
operating the anterior flexion of the head of the foetus. The
elongatioin, on the ensuing day, could not be seen externally ;
and on the fifteenth not the slightest vestige of it w'as dis¬
coverable.

The third and last case, in which Dr. Duclos has observed
this curious circumstance, was that of a young woman in
labour of her first child. In this instance, he regards the vio¬
lent contractions of the uterus as its cause. Iffie anterior
labium of the organ was elongated to the extent of two inches,
and slight haemorrhage took place. The manoeuvre employed
in the first case was here resorted to with success.

On the fifth day after delivery, the uterine elongation pre¬
sented itself under the form of a small nipple only ; and the
termination of the case was perfectly successful. No further
comment on the importance of these cases is necessaiy. Dr.
Duclos, in conclusion, observes, that whenever the resistance
of the parts forming the vulvo-vaginal orifice has been such
as to obstruct the passage of the foetus, he has commonly
effected its delivery without the aid of the forceps, by intro¬
ducing his fingers into the rectum, and exercising a strong
pressure on the child’s forehead, so as to force the occiput to
slide in front of the pubis.

Medical and Physical Intelligence

257

PART V.

— ^ —

MEDICAL AND PHYSICAL
INTELLIGENCE.

Hospital for the Small-pox, for Inoculation and for
Vaccination, at Pancras. — An account of the number of deaths
occasioned by the casual small-pox, extracted from the register for
twenty years before the practice of vaccination, and also for twenty
years since; also the number of deaths as reported by the Parish
Clerks of London, &c. copied from their general bills of all christ¬
enings and burials for the same periods: —

A. D.

1779

1798

Before Vaccination.

Hosp. Reg. Par. Reg.

1867 36,189

Since Vaccination,

A. D.

Hosp. Reg.

Par. Reg

1799

814

22,480

1818

Decreased in deaths since the practice of vaccination was intro¬
duced — at the Hospital, 1053 ; in the Parishes, 13,709.

Vaccination was introduced into practice at the Hospital for inocu¬
lation, by Dr. Wm. Woodville, with the disease taken from the cows
belonging to Thomas Harrison, Esq. of Gray’s Inn Road, on the Ipth
Ja-nuary, 1799* Six patients were vaccinated by the Doctor in the
presence of Sir J. Banks, Bart., Sir W. Watson, Drs: Garthshore,
George Pearson, Robert Willan, and several other Medical Gentle¬
men. The number vaccinated from that date to the 1st of January,
1819; amounted to 43,394 at this Hospital.

J. C. Wachsel, Resident .Surgeon.

NOTICES OF LECTURES.

Mr. Clarke and Mr. Blagden will commence their next Course of Lec¬
tures on Midwifery and the Diseases of Women and Children on Wednes¬
day, March 10th. For particulars, apply to Mr. Clarke, 10, Saville Bow;
Mr. Blagden, 22, Sackville Street; or to Mr. Stone, 2, Upper John Street,

Golden Square. - —

LITERARY NOTICES^

An Essay on Strictures of the Urethra; comprising a Summary of what
was already before the public on the subject, and an Account of several Ma¬
terial Improvements in the Treatment ; particularly by an Instrument sub¬
stituted for Bougies or Sounds, which dilates and contracts in the Passage at
will, and with any force. With an Appendix, noticing the Application of
this new Surgical Instrument to Gleet, and to Haemorrhage, and other Dis¬
eases of the Urethra, Oesophagus, Rectum, See. By James Arnott, Member
of the Royal College of Surgeons in London, formerly Surgeon in the Plon.
East India Company’s service.

Mr. J, S. Peckstone, of the Chartered Gas Light and Coke Company’s
Establishment, Peter Street, Westminster, has in tjhe press a Practical Trea¬
tise on Gas Light ; exhibiting, amongst other matter, an Historical Sketch of
the Rise and Progress of the Science, the Theories of Light, Combustion and
Formation of Coal; describing the Qualities of different Species of that Ar¬
ticle, on the most approved Apparatus and Machinery, now successfully
employed for generating, collecting, and distributing Coal Gas for the pur¬
pose of lighting Streets, Houses, &c. &c. Illustrated with appropriate Plates.

VOL. XI. - NO. 63. 2L '

25B

A METEOROLOGICAL TABLE,

From the ^Ut of JANUARY to the 20th of FEBRUARY, ISip.
KEPT AT RICHMOND, YORKSHIRE.

Baron

Max,

neter.

Min.

The

Max

rm.

Min.

Rain

Gauge.

Winds.

Weather.

W..

1 Sun...

S..

1 Cloud... 3 Rain. 4 Stall...

sw...

1 Sun..

3E..

1 Cloud.. 2 Rain....

SSW..SE..

1 Sun. 3 Rain,...

SW..

1 Sun...

1 39

SW..NE..

1 Sun.. 2 Cloud... 4 Rain....

NE..

1 Rain.... 4 Cloud....

E..

1 Mist...

NbE..

13 Cloud... 2 Sun.. 4 Rain..

NW..

1 Sun...

W.SW.

1 Sun...

w...

1 Sun..,.

sw.se.

1 Sun. 3 Snow..

WbN.

1 Sun...

SW.

1 Sun.2Mist,.3R.4Moon...

SW...

1 Sun., and Show....

sw....

1 Sun... 3 Show. 4 Moon...

29-

sw..

1 Sun... 3 Cloud.. 4 Moon..

s..

1 Cloud,... 4 Rain..

sw...

1 Sun., and Showers..

sw...

1 Sun., and Showers..

w..

1 Sun...andShow.4Moon..,.

WNW..

1 Sun...andShow.4Moon...

MW..

1 Sun...

SW..

1 Sun.

SE..

1 Cloud... 2 Rain.,..

sw..

1 Sh..&Sun..3 S.. 4 Stall...

SW..SE..

1 Sun. ..3 Cloud. ..4 Rain...,

S..SW..

1 Rain. 2 Sun., and Show.

20 129

SW.SE..

1 SuR.,.3Cloudy...4Rain.,..

The quantity of rain during the month of January was 6 inches 33-lOOths,
which is much more than has been observed by the Reporter before in an
equal space of time.

Observations on Diseases at Richmond.

The disorders under treatment were Abortio, Asthenia, Cynanche ton¬
sillaris, Dyspepsia, Febris catarrhalis, Febris simplex, PJstula, Gastrodynia,
Incubus, Lumbago, Menorrhagia, Obstipatio, Ophthalmia, Phthisis pul-
monalis, Vaccinia', Varicella, and Variola.

259

THE METEOROLOGICAL JOURNAL,'

From the 20th of JANUARY, to the \^th of FEBRUARY, ISip,

By Messrs. HARRIS and Co,

Mathematical Instrument Makers, 50, High Holborn,

I Moon

Kain

Therm.

Carom

De Luc’s

Dry.

Hygrom’

Damp.

Winds.

ssw

SSE

ssw

ESE

ENE

NNW

WNW

wsw-

wsw

ssw

•

4,7

.39

wsw

ssw

19l

Atmo. Variation.

Fine

Clo.

Fine

Rain

Clo.

Fine

Sno.

Fine

Rain

Fine

Rain

Fine

Rain

Fine

Clo.

Rain

Clo.

Rain

Clo.

Rain

Fine

Rain

Fine

Clo.

Rain

Clo.

Rain

Clo.

Fine

Rain

Fine

Clo.

Rain

Clo.

Rain

Fine

Clo.

Rain

The probable (the gauge being not quite perfect) quantity of rain fallen in
the month of January is 2 inches and 11-lOOths.

260

A REGISTER OF DISEASES
Between JANUARY 20th and FEBRUARY 1819*

DISEASES.

Abortio • • . .

Abscessio .

Amaurosis .

Amenorrhoea • ^ . .

Anasarca .

Angina Pectoris .

Aphtha lactentium • • • •

Apoplexia .

Ascites • • . .

Asthenia . .

Asthma .

Atrophia • . . - . .

Bronchitis acuta .

■ "■ 'chronica • • • •

Bulimia* . . .

Calculus X* .

Cancer .

Carbunculus . . •

Cardialgia . .

Carditis . . .

Catarrhus .

Cephalalgia

Cephalfea ' .

Chlorosis .

Chorea • . . • ••

Cholera • . . .

Colica • .

Contractura ..........

Convulsio .

Cynanche To?tsil laris • •

— - 'maligna .

■ . Trachealis • •

■ Farotidea* • • •

Pharyngea • •

Diarrhoea
Dolor lateris . • • •

Dysenteria

Dyspepsia .

Dyspnoea .

Dysuria • • . .

Ecthyma ........

Eczema .

Eneuris .

Enteritis .

Entrodynia .

Epilepsia

Epistaxis .

Erysipelas .

Erythema IxDa ....
Febris Intermittent

DISEASES.

Febris catarrhalis' • *

- Typhus mitior

- - Synoclms * * ^ *

- Puerpera .

Remit. Infant,

Fistula
Furunculus ...
Gastrodynia • • •
Gonorrhoea pura
Haematemesis •
Ha3maturia • . . ■
Hjemoptoe. ....
Hsemorrhois ...
Flemiplegia » • . ■

Hepatalgia .

Hepatitis .

Hernia ...... » .

Herpes Zoster * <
— - - labialis' •

Hydrocele . .

Hydrocephalus .

Hydrothorax .

Hypochondriasis ....

Hysteria .

Hysteritis .

Icterus .

Impetigo sparsa «...
Ischias. ............

Ischuria .

Lepra . . .

Leucorrhoea * .

Mania * . . . «...

Melancholia .

Menorrhagia ........

Morbi Infantiles^ ....

- Biliosi* .

Nephritis. . • • .
Neuralgia . . . »
Obstipatio
Odontalgia . •
Ophthalmia * .

Otalgia .

Paralysis ....
Paraplegia ....
Paronychia * .
Pemphigus. . . .
Pericarditis « •
Peripneumonia
Peritonitis ....
Pernio .

— »
C

4
9

4
1

5
2
9

14
57
21

15
1
7

Fatal.

Obsermtiojis on Frevailing Diseases.

261

•

ct3

DISEASES.

Pertussis .

Phlegmasia dolens ■

Phlogosis .

Phthisis Pulmonalis

Physconia .

Plethora .

Pleuritis .

Pleurodyne .

Pneumonia .

Podagra -

Porrio;o lar'Valis

decalvans
scatulata
-favosa • • •

Prolapsus

Prurigo mitis .

Psoriasis guttata • •

Pyrosis .

Kheuma, acutus • • •

- chronicus

Rubeola .

5
2
4
2
2
2
2

6
2

28
31
12

DISEASES.

Scabies .

Scarlatina simplex - <

Scirrhus . .

Scorbutus .

Scrofula .

Spasmi .

Splenitis .

Strictura .

Syphilis .

Tabes Mesenterica

Tussis .

Vaccinia .

Varicella .

Variola . . .

Vermes .

Vertigo .

Urticaria •

3
1
2

4
11

Total of Cases . 1296

Total of Deaths . , • • • • '48

* Morbi Iiifantiles is meant to comprise those Disorders principally arising from den
tition or indigestion, and which may be too trivial to enter under any distinct head; Morbi
Biliosi, such Complaints as are popularly termed bilious, but cannot be accuratelv classed

Observations on Premiling Diseases.

Fevers of a distinct and decided kind are by no means so generally pre¬
valent as was the case a few months since. Those instances which have
recently occurred under our^raore immediate care, have been such as
without a view to a prevailing epidemic, would scarcely have been con¬
sidered as cases of genuine fever. But these febrile ailments have occa¬
sionally run in families in a way that our ingenious correspondent. Dr.
Mitchell % would find it difficult to explain upon any other supposition than
of imparted miasma.

Pulmonic complaints of a catarrhal and asthmatic nature still continue
prevalent and protracted.

It is painful to see so large a register of small-pox cases, and some of them
fatal.

The instances of croup that have fallen lately under our care have yielded
to two grains of calomel every four hours, with an ointment to the chest,
composed of five grains of tartrite of antimony, and five of opium, to a dram
of ceratum cetacei.

A curious circumstance has occurred in one family of dispensary patients,
viz. that all the individuals of it, the mother excepted, (five in number,) have
within a very short time discharged several of the lumbrici teretes. No
symptoms or appearances of worms had been observed in any of them pre¬
viously. The mother states, that they have been living for some time in

* See the present Number of the RErosivony, page 191.

262 Medical and Physical Intelligence*

the neighbourhood of Cheshuiit, wliere the water was exceedingly foul and
muddy.

The following remarks have been forwarded to us by our correspondents
with their reports

“ Ophthalmia Mem. has become prevalent duringthe last three or four days
by the river side in Lambeth and Westminster; in one family of poor children
on the other side the water it is attacking each successively. The applica¬
tion of leeches, and cooling collyria, with the exhibition of antimonials and
purgatives, and particularly blisters to the temples well covered with the
antimonii tartras to remain on forty-eight hours, have generally produced a
speedy abatement of the synjptoms.

‘‘ Bleeding has been tried in the anasarcons cases. It has generally
relieved the difficulty of breathing for a few hours; but two have died.”

“ The case of hernia was umbilical, many years’ standing, and became
strangulated about three months ago, which (after several hours) the reporter
reduced. The same case how reported became strangulated again about
three weeks ago, which could not be reduced. She was sent to the Middle¬
sex Hospital, where the patient underwent the operation by Mr. Bell, and is
doing well.”

“ The fatal cases of small-pox were accompanied with an immense num¬
ber of large petechise.”

Our reporter from the North Eastern District having been prevented, by an
unforeseen circumstance, from sending the regular reports, states, that “ there
appears to have been, during the last month, nothing particularly observable.
Inflammation of the lungs and pleura have been among the most prominent
diseases. Fever appears to be declining ; it existing at present only in one or
two spots, where want of ventilation allows it to retain its contagious
influence.”

Qjiiarterly Report of Prices of Substances employed in Pharmacy.

Acacise Gummi elect.

lb.

Cardamomi Semina

•

lb.

Acidiim Citricum

Casearillae Cortex

<•

- Benzoicum

unc.

Castoreum

•

unc.

- Sulphuricum

P. lb.

Catechu Extractum

•

lb.

- Muriaticum

•

Cetaceum

- Nitricum

•

Cera alba

- Aceticum

- cong.

- flava

Alcohol ...

M. lb.

Cinchonae eordifoliae Cortex (yellow)

,/Ether sulphuricus

- lancifoli® Cortex (quilled)

- rectificatus -

- obloneifobae Cortex (red)

U •

Aloes spicatae extractum

- lb.

Cinnamomi Cortex

•

— vulgaris extractum

Coccus (Coccinella)

unc.

Althseae Radix

Colocynthidis Pulpa

lb.

Alumen

Copaiba

Ammonise Murias

•

Colehici Radix

- Subcarbonas

Croci stigmata

unc.

Amygdalae dulces

•

Cupri sulphas

Ib.

Ammoniacum (Gutt.)

Cuprum ammonlatum

■ - (Lump.)

Cusparias Cortex

Antbemidis Flores

Confectio aromatica

Antimonii oxydum

- S

- Aurantiorum

- - sulphuretum

- Opii

Antimonium Tartarizatum

•

- Rosas caniiiae

Arsenici Oxydum

- Rosae gallicae

Asafcetidae Gummi -resina

- lb.

- Seimas

8 •

Aurantii Cortex

Emplastrum Lyttae

•

Argenti Nitras

• unc.

- Hydrargyri

Balsamum Peruvianum

lb.

Extractum Belladonnae

line.

Balsamum Tolutanum

- Cinchonae

Benzoinum elect.

■ - Cinchonas resinosum

Calamina prasparata

— — Colocynthidis

•

Calumbae Radix elect.

— - Colocynthidis comp.

Cambogia

•

— - Conii

Camphora

■ — - Elaterii

Canelbc Cortex

— - Gentian??

•

Prices of Substances employed in Pharmacy . 2f)3

Extractnm Glycyrrhiza®
— — Hfematoxyli

— : - Humuli

- Hyoscami

- Jalapse

- Opii

- Papaveris

- Rhaei

- Sarsaparilla

— — Taraxaci

1^.

lb.

line.

unc.
Gd. Res.

lb.

Ferri subcarbonas
— sulphas . . -

Ferrum ammoniatum - - -

- tartarizatum

Galbani Gummi-resina.

Gentianas Radix elect. - - -

Guaiaci resina . . . -

Hydrargyrum purificatum

- praecipitatum album

- cum creta

Hydrargyri Oxymurias - unc.

- Submurias - - -

- Nitrico-Oxydum

- Oxydum Cinereum

- Oxydum rubrum

- Sulphuretum nigrum

- - rubrum

Hellebori nigri Radix lb.

Ipecacuanhae Radix . . -

- Pulvis - . -

Jalapas Radix ...

- Pulvis « . . -

Kino - - • - -

Liquor Plumbi subacetatis M.lb.
— Ammonias ....
— Potass* ....
Linimentum Camphor* comp.

- - sapoms comp.

Lichen - - - lb.

Lytt* - . . . - -

Magnesia ....
Magnesi* Carbonas

- - Sulphas

Manna - -

— communis

Moschus pod, (54 j.) in gr. unc.

Mastiche - . - lb.

Myristic* Nuclei . . -

Mvrrha . - •

Olibanum -
Opopanacis gummi resina
Opium (Turkey)

Opium (East India)

Oleum vEttiereum *

— Amygdalarum
— Anisi

Anthemidis
— Cassi*

— Caryophilli

— Cajuputi ...

— Carui . . - - -
— Juniperi Ang.

— Lavandul*

— Lini - • cong.

— Menth* piperit* - unc.
— Menth* viridis Ang. -
— Piment*

— Ricini optim.

— Rosmarini
_ Succini 25. 6<i.

— . Sulphuratum
— Terebinthin*

_. — rectificatum

Olivac Oleum - - cong

oz.

lb.

unc.

unc.
- rect.
P. lb.

G
0
1
1

4
1
2
2
0
1
1

5
0
0
0
1

6
0
0

3
20
22

10
1

5
1

4
1

3
0
0

5
3

6
6
1

6
10

01 iv* Oleum secundum
Papaveris Capsul* - (per 100)
Plumbi subcarbonas - - lb.

— Superacetas ...
— Oxydum semi-vitreum
Potassa Fusa ... unc.

— cum Calce - -

Potass* Nitras . - • lb.

— Acetas ....
— Carbonas ...
— Subcarbonas
— Sulphas
— Sulphuretum
— Supersulphas
— Tartras ...
— Supertartras . - .

Pilul* Hydrargyri - - unc.

Pulvis Antimonialis
— Contrayerv* comp.

— Tragacanth* comp.

Resina Flava - - lb.

Rh*i Radix (Russia) . . .

- (East India) opt. -

Ros* petala - - •

Sapo (Spanish) - . .

Sarsaparill* Radix (Lisbon)
Scammoni* Gummi-Resina - unc
Scill* Radix siccat. opt. Ang. lb.
Seneg* Radix - - -

Senn* Folia - - -

Serpentari* Radix
Simaroub* Cortex
Sod* subboras . . .

— Sulphas . . .

“ Carbonas . . .

— Subcarbonas . . .

— — exsiccata
Soda tartarizata
Spongia usta

5. d.

14 0

Spiritus Ammom*

M. lb.

aromaticus

— fetidus

— - succinatus

— Cinnamomi ...

— Lavandul* ...

Spiritus Myristic* ...

— Piment* ...

— Rosmarini - -

_ iEtheris Aromaticus

_ — Nitrici

_ „ Sulphurici

_ — Compositus

— Vini rectificatus - cong,

Syrupus Papaveris - - lb.

Sulphur ...

— Sublimatum

— Lotum - -

— Pr*cipitatum

Tamarind! Pulpa opt. . - -

Terebinthina vulgaris

- Canadensis

- Chia

Tinct. Ferri muriatis
Tragacantha Gummi - - -

Valerian* Radix - -

Veratri Radix - -

Unguentum Hydrargyri fortius

- - - Nitratis

- - Nitrico-oxydi -

TJv* Ursi Folia - - -

Zinci Oxydum - -

— Sulphas purif. - -

Zingiberis Radix opt. - . -

0
2
0
0
0
1

10
4
1
1
4
0
3
1
0
0
0
0
0
40
10
14
2
6

4
4
6
7

5
5
5
3
5
3

3
0
9
G
8
6
9

4
4
6
0
0
0
6
6
6
G
0
0
6
6
6
6
6
8
6
G
0
6
0
6
6
0
6
6
G
6
6
0
0
6
0
0
9
0
2
0
0

0 10
6 0

-5

Prices of New Phials per Gross - 8 oz. 705—6 oz. 585 — 4 oz. 475.-3 oz. 435.— 2 oz. mid

IJ oz. 365. — 1 oz. 305. — ^half oz. 245.

Prices of second-hand Phials cleaned, and sorted. - 8 oz. 465.— 6 oz. 445.-4. oz. 335.

3 oz. 305.— 2 oz. and all bdow this size, 255.

£64

Monthly Catalogue of Books, S^'c,

MONTHLY CATALOGUE OF BOOKS.

Two Essays: one upon Single Vision with two Eyes; the other on
Dew. A Letter to the Right Hon. Lloyd Lord Kenyon, and an Ac¬
count of a Female of the White Race of Mankind, part of whose
skin resembles that of a Negro, &c. &c. By the late William
Charles Wells, M.D., F.R.S.^L. and E. 8vo.

An Essay on Warm, Cold, and Vapour Bathing ; with Practical
Observations on Sea-bathing, Diseases of the Skin, Bilious, Liver
Complaints, and Dropsy. By Sir Arthur Clarke, M.D., &c. i2mo.

Medical Botany, No. H. 8vo. To be continued Monthly.

A Treatise on Midwifery, developing new principles, which tend
materially to lessen the sufferings of the Patient, and shorten the
Duration of Labour. By John Power, Accoucheur, &c. Member of
the Royal Medical Society of Edinburgh. Svo.

Facts and Observations on Puerperal Fever. By John Armstrong,
M.D. Second Edition. Svo.

Rubi Epistolarum Edinburgensium, Libri III., &c. &c. 12mo.

Ciutterbuck on Typhus Fever. Svo.

Remarks on Scepticism, especially as it is connected with the Sub¬
jects of Organization and Life. Being an Answer to the Views of
M. Bichat, Sir J. Morgan, and Mr. Lawrance, upon those Points.
By the Rev, Thomas Rennell, A.M. Svo.

Practical Observations on the Treatment, Pathology, and Preven¬
tion of Typhus Fever. By Edward Percival, M.B., M.R.LA.,
Member of several Medical Societies in London, Edinburgh, and
Dublin. Svo.

An Inquiry into the Effects produced on the Brain, Lungs, and
other Viscera; and on the Nervous System, by Diseases of the Liver.
By Thomas Milfs, M.D. Svo.

Second Edition of the Morbid Anatomy of the Brain in Typhus or
Brain Fever ; to which are added. Cases of the present Epidemic,
with a few Remarks on its Nature and Mode of Treatment. By
J'homas Mills, M.D. Svo.

Synopsis Zoo-Nosologim ; or, a Conspicuous View of Medical
Science, exhibited in 'I'ables and Aphorisms on Anatomy, Physiology,
Nosology, and Therapeutics. In Four Parts. With an entirely new
Classical Nomenclature. By T. Parkinson, M.D. 12mo.

A Series of Engravings representing the Bones of the Human Ske¬
leton ; with the Skeletons of some of the low'er Animals. By Ed¬
ward Mitchel, Engraver, Edinburgh. The Explanatory Reference
by John Barclay, M.D., Lecturer on Anatomy. Part I. 4to.

^NOTICES TO CORRESPONDENTS.

We are much obliged by the Communication of Mr. Fosbrooke, which, on
account of the immediately important topic on which it treats, shall be in¬
serted {at least part of it) in our next Number,

- - -

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

THE

LONDON MEDICAL

REPOSITORY.

No. 64.

APRIL 1, 1819.

VoL. XL..

PART I.

♦ f

— — f ‘■''7

ORIGINAL COMMUNICATIO]S(?Sr

T;X

Some Remarks upon the late Epidemic Eruptive Diseases,
supervening on Variola and Vaccinia, and upon Professor
Thomson’s Theory of the Identity of Modified Smallpox
and Chicken-pox ; with some Contributions to Diagnosis,
. By Mr. Fosbrooke^ a Member of the Profession.

Post ignem astherea domo
Subductum, m Abies et nova febrium
Terris incubuit cohors. — Hor.

The event of an eruptive epidemic subsequent to vacci¬
nation and variola, and upon which the medical world are
not unanimously agreed, has occurred and been variously
agitated. In the former opusculum which I had the pleasure
of transmitting to the Repository, I endeavoured to trace
the causes of secondary small-pox in general to various
sources of duplicity and deception, in the process of obtain¬
ing the prophylactic effects of vaccination: we now, find a
peculiar eruptive disease stated in an excellent philosophical
form of data, by Mr, Hennen’and Dr. Thomson, in the Edin¬
burgh Medical and Surgical Journal for October last and
January. In a series of hj'potheses offered by Dr. Thom¬
son, these are generalized into modified small-pox, and iden¬
tified with chicken-pock. ’

As a zealot of vaccination, so far I conceive such an hypo¬
thesis to involve the reputation of vaccination, that it wo^uld
be impossible to concede to any opinion so conclusive with¬
out very serious deliberation ; and if it results from the labouy
VOL. XI. — NO. 64. 2 m

Original Communications*

of inquiry and comparison that I am compelled to break a
lance with the learned Professor, I must confidently premise
that it is with much regret that contrary belief rushes upon
my mind, after the truly diffident and undogmatical mode in
which he has brought forward the subject, and the candour
with which he has invited opposing as well as auxiiiaiy state¬
ments ; and in imitation of his example, I must offer this
article to one of the first of British medical miscellaneous
publications, with the same holding clause of retracting, if
the evidence of accumulated investigations may force upon
me any retrocession from present convictions. Previous to
the adduction of any reasoning or facts, 1 must be permitted
to sketch in an analysis, the leading features in Mr. Hen-
nen’s cases ; and, at the same time, compliment the writer
upon the scrupulous and accurate attention with which he
has executed his adversaria, and so well deserving of imita¬
tion in the framing of data, from which any difference of
opinion is likely to arise.

Mr. H, states that small-pox had for some time existed in
this city and its neighbourhood (Queensbury House), both
under the usual and modified form, and likewise varicella
contemporaneously in its genuine and unequivocal form.

Cases in Series, with Remarks*

No. 1. Unequivocal Varicella. — The papulae become vesi¬
cular, their appearance commencing two days after indis¬
position. Their vesicular appearances retained two days,
ended in crustaceous desquamation, ^ote* This case seems
to have given origin to all the rest.

No. 2. Variola. — Commencing symptoms, four days^
febrile affection. May i7th to the 19ih, Vesicular. 20th,
21st, Completely pustular. The usual course of mild con¬
fluent variola, with pitting.

No. 3. Previously vaccinated. — Concluded to have vari¬
cella. May 17th, First appeared ill. 20tb, 21st, Mixed
pustular and vesicular eruption; distinct; decided by Dr.
Thomson to be varicella from coming out by fresh crops in
succession.

No. 4. Had had variola well marked. Taken June 7th,
9th. Eruption of papulae, which, did he not bear marks of
variola, might be taken for that disease.” 11th, Vesiculated.
13th, 14th June, become pustular. They desquamate after a
transition into horny scabs. Considered by Dr. Thomson to
be a good specimen of the modified small-pox, so well de¬
scribed by Dr. Willan.

No. 5. Mr. Hennen’s child. — On Tuesday the 9th, taken.
11th, Papular eruptions ; vespere vesicular 12th. The 15th,

2-67

Fosbrooke’s Remarks on Variola, S^c.

I took limpid fluid from the pustules, 14th, He says, with
more precision of language, that the fluid in the pustules
becomes thick and yellow. Vaccinated ; considered hy Mr.
Bry ce and Hr. Monro to be modified small-pox. Note. It
does not appear from this case that a mild disease is alw'ays
propagated by the most important form of contagion. Mr.
Hennen’s child catches the severe eruptive anomaly from the
trivial complaint of his brother; and in fact the whole series
originates with No. i, a case of mild varicella.

The next cases are very important. The six children ino¬
culated from the last case, “ who had never had small-pox,
cowpock, nor varicella.’^ — The/ experiment, highly im¬
portant in itself if the disease communicated was purely
varicella, became doubly so on the supposition that it should
turn out to be small-pox, for we had been taught to believe that
the modified small-pox produces the real disease in persons who
have never gone through it before, or who have not been pre¬
viously vaccinated ; but that it still retains its modified cha¬
racter in persons who have previously undergone either of these
diseases.” Note. In some authorities which I shall hereafter
cite from Hr. Pearson, &c., the same result followed, whether
the subject had been variolated or not; i. e. it was mild and
irregular. On this principle, which Mr. Hennen sets out with
a just confidence in, inoculation from the virus of cases which
were supposed modified small-pox, the production of genuine
variola was considered the experimentum crucis ; but here we
find that the contagion obeys no undeviating law of propa¬
gating its kind : in some cases it assumes the shape of vari¬
cella; in others variola unequivocally; and, finally, neither.

I shall now continue the abstract of such particulars as will
be necessary for reference in the course of this article.

No. 6. June 13th, Inoculated from Mr. Hennen’s child.
17th, fifth day of eruption, papulae appeared. 18th, IQth,
20th, 21st, Pearly coloured vesicles. 22d, A second erup¬
tion of minute pjearly coloured vesicles, depressed in the
centre, distinguished from the first by a great diminution of
size ; the first resembling the cowpock vesicle ; but, in¬
stead of being exactly circular, have angular projections from
their circumference.’^ Fifth day of the second eruption.
The first vesicles acquire a yellowish hue, discharge a thick
purulent looking fluid when punctured. Seventh day, The
eruption goes off partly in a vesicular, partly in a pustular
state; slight pitting. The brow’n coloured centre of the
vesicles horny and semi-transparent. Note. It is to be re¬
gretted that it is not remarked whether the pitting succeeded
vesicular scabs. I presume that the second eruption arises
from the constitutional diathesis of the first, and forms that .

268

Original Communications,

peculiar protecting crisis of eruption which occurs in variola^
No. 7, 8j 9, 10, 11. The disease observes no material varia¬
tion of phenomena at equal periods of time. In cases 7, 8.
The secondary eruption appears a day later. Disappearing
with vesicles and pustules, and finally with pustules ; the
eruption on the face in the majority of instances pustular; in
the lower extremities vesicular Note. These conclude the
inoculated cases, which, though in some instances more severe
than others, as tests do not prove the disease to have been
genuine variola. No. 12, 13, 14, 15. The three first had had
small-pox: 13 in the natural way ; a severe case; the erup¬
tion at first vesicular, afterwards partially pustular; matter in
some of these cases found to be purulent, in others clear
lymph. In No. 13 the eruption vesicular in the early stage,
an exudation on the face ‘‘ like broken dowr? jelly strewed
over the pustules” takes place: the eruption in the end dis¬
charges a serous fluid ; the secondary eruption not marked in
this case. Case 14 had repeatedly been with people labour¬
ing under small-pox with impunity. Secondary eruption
papular and vesicular; towards the conclusion pustular in the
face, wdth purulent discharge. No. 15. A fatal case. The
eruption papular and vesicular running into bags of purulent
matter conclusively ; caught from No. 12. Note, It is
worthy of observation that three out of four of these have this
disease with the greatest severityj secondary to small-pox.
That the fatal case was genuine small-pox, no one that saw
him expressed the least doubt. Here terminate these very’’
authentic records ? Dr. Thomson had seen 72 cases when he
penned his first letter. Of this number, eight after having small¬
pox ; twenty-seven after passing through the cowpock; two
co-existent with cowpock ; and thirty-five had not passed
through either small-pox or cowpock. Three of the chil¬
dren affected with this disease after cowpock had previously
passed through an eruption of the same sort, and in one of
these I had the best opportunities to observe that the disease
had each time exhibited the appearances which have been
supposed to be characteristic of chicken-pock.” In his second
letter (Edinburgh Journal for November) there are some addi¬
tional cases, in those who had either variola or vaccinia mild ;
in two cases it recurred twice; in others, who had neither

* In case 8, The vesicles form on the site of an herpetic eru})tion
additional proof of the disposition of the cuticular system to sympto¬
matic disease; where it is at all unhealthy or more delicate, as exem¬
plified in small-pox and vaccinia, where there is a breach of con¬
tinuity ; and, again, where there are erythematous vestiges of inflam¬
mation.

Fosbrooke^s Remarks on Variola,

pock, in some instances mild ; others severe, and a few fatal.
Professor Thomson says he could discover in no stage or ap¬
pearance of the disease, as it occurred in those who are vacci¬
nated, any symptoms by which he could distinguish it from
the three varieties of chicken-pock described by Dr. Willan,
or from the numerous cases which he had seen before or
since the practice of vaccination. He repeats the same re¬
marks more than once.

It is my intention rather to illustrate and contribute to the
diagnosis of these diseases, than to positively affirm that they
are all of any specific kind; and if what is recorded of the
past histories of varicella and variola be brought into a clearer
foreground, and may cast any light upon its general nature, I
shall be satisfied with the utility of what is done.

In the first place, I am not exactly of opinion that it was
varicella ; because the disease that the inoculated children
underwent does not meet the regular descriptions of systematic
writers. In the second place, a doubtful disease of another
character, and unequivocal variola, was derived from it; (Mr.
Hennen’s son probably gave rise to all the diseases that oc¬
curred in the Castle). In occurring a second time, in the
same individual, it does not, as far as I am instructed by
authors, obey the general law which nature has almost uni¬
formly stamped on chicken-pox, small-pox, cowpock, and
other exanthemata, that of non-reproduction; and, again,
where it thus recurred, it was in both instances, it is said, simi¬
lar; so that it could not be said to be the divided operation of
a double contagion. If Dr. Thomson’s subsequent theory
is admitted, of the identity of varicella and modified small¬
pox, varicella must have occurred twice in almost all the
Cupar cases. — (See report of the Cupar cases.)

In ensuing after variola and the vaccinia, it does not differ
from the general law of varicelloid disease. In Dr. Heber-
den’s first account of chicken-pock (Vol. II. Medical Trans¬
actions, p. 427), the characteristics of the mild varicella
are the first day reddish, second day, a small vesicle, sometimes
full, of a w'atery and colourless, sometimes of a yellowish,
hue. Third day, arrived at their full maturity. In cases
" No. 1 and 4 of Mr. Hennen, the disease is certainly thus re¬
gulated ; but Mr. Hennen’s inoculated cases contained
lymph the second day, and did not arrive at their maturity
till the sixth or seventh day of the second eruption ; occupy¬
ing a space of time from fifteen to eighteen and nineteen days
after the papulous appearance, before arrival to maturity.
Of the malignant kind of varicella, Heberden says, the erup¬
tion appears on the fourth or fifth after indisposition ; the

270

Original Communications,

most striking coincidence of progression which I observe
with the Castle cases appearing always five days after inocula¬
tion. He remarks neither in the mild nor malignant any
secondary eruption. He says the progress of the eruption
in the chicken-pock differs from the other, the one dies away
in about four days ; w'hereas the progress of the eruption in
the mildest kind of small-pox, from its first appearance to the
time of full maturation, is seven days ; and the pustules dry
away more slowly than those of other diseases.” ‘‘These two
distempers,” says Dr. H,, “ are not only different on account
of their different appearances, but because those who have had
the small-pox are capable of being infected with the chicken-
pock; but those who have once had the chicken-pock are not
capable of having it again.^’ Baron Dimsd^le is one of the
next who remarked the duplicity of resemblance in these two
diseases. He had found a case of a mild disease in a child,
in which the “ pustules were more numerous than he had
ever seen in the chicken-pox.” He gives other cases in which
the disease strictly resembled small -pox, but states that they
afterwards underwent small-pox with the regular appearances.
He adds, that the diseases which have been frequently taken
for small-pox are swine-pox and chicken-pox, which differ
from each other in scarcely any circumstance, except the size
of the pustules, and have by some been supposed to be the
same. Those cases in which either are attended with a great
number of pustules certainly resemble very much a mild kind
of small-pox. His discriminative characteristics are much
the same as given by Dr. Heberden, “ seldom if ever accom¬
panied by fever which deserves attention as such,” (The
inoculated children of Hennen had severe fever in some, if
not all). Dr. Young, in the Nosology of his Medical Litera¬
ture, says the “ swine-pock pimples are larger and more
pointed.” 1 mention swine-pock to aid inquiry.

Wilson on Febrile Diseases, Vol. 11. 378, gives it as a dis¬
criminative test, that “ the matter of the former (vesicles of
chicken-pock) never acquires the purulent appearance which
it always does in the distinct small-pox; the oidy form of
disease which can be confounded with chicken-pock.” In this
particular it is at variance with the inoculated cases.

If we admit, however, that these diagnostic descriptions
have by no means fully completed the pathology and pathog¬
nomic characteristics of varicella, and that only two of Mr.
Hennen’s cases bear an exact relation, we must examine if
they can be identified with the more modern descriptions of
Willan and Bateman. The lenticular varicella of Willan is
evidently the resembling variety : on the third day the con-

271

Fosbrooke’s Remarks on Variola^ S)X,

tained lymph becomes straw coloured ; the change in the con¬
tents of the vesicles to a purulent fluid does not ensue till the
eighth or ninth day; on the fifth day they begin to scab; in
the other cases a great deal later : on the ninth and tenth
days they fall off, leaving for a time red marks on the skin
without depression ; but in the other cases they frequently
leave tubercles and pits. The conoidal and globate* species
are the same, I am inclined to think, as the two species of
Heberden, the swine-pock and the hives, as it is popularly
termed : as all these criteria of the three species sometimes
exist together (but one greatly predominates”) ; we can¬
not insist upon this, an arbitrary objection to Mr. Hennen’s
cases being varicella ; hut the horny nature of the scabs, and
their assimilation to irregular cowpock, is very anomalous.
The reviewer *bf Willan (Med. Chirurg. Rev. for 1806,)
acutely observes, that diversities in small-pox and varicella
are equally great; the regular cases are easily distinguished;
it is the irregular ones that excite, and thei^e it is probable
will still be found occasionally to puzzle Practitioners in their
attempts to discriminate between variola and varicella. It is
not to be forgotten, that one author (Willan) himself has been
mistaken in his judgment on this point; conceiving that to
be varicella, which subsequent inoculation proved to be small¬
pox.” The maculce or defedation of the skin on the site of
the pustules is, I believe, not peculiar only to small-pox or
chicken-pock. Pitting, according to a writer whom I have
quoted in my notes anonymously, is usual in mild sraall-pox
and varicella ; w'hich is certainly a contrariety to Willan and
Cullen. Dr. E. G. Clarke maintains that pitting may occur
in varicella. Moss (on Diseases of Children, p. 226,) says,

chicken-pock has given rise to the opinion of persons having
small-pox twice, as they often pit like the sraall-pox.” Some
certain and easy criterion,” says the Editor of the London Me¬
dical and Chirurgical Review, 1807, is still much wanted to
enable us to discriminate between small-pox and chicken-pock.
It is not to be found in the appearance of the pustules, for,
though in general in chicken-pox they are smaller and more
acuminated than in small-pox, it is not always so ; many of
the pustules in a severe case of chicken-pox being as large and

* The globated vesicles (almost globular, says Mr. Hennen, of his
cases,) not having resemblance to variolous pustules, distinguish, ac¬
cording to Willan, the varicella from the small-pox. Pustules indiscri¬
minately occur in both ; and in small-pox the matter of the pustules
may consist of a colourless fluid, as in that variety termed variola
discreta chrt/stillina.

272

Original Communications*

globular, and sometimes with indentations as in the small-pox.' '
In duration also they sometimes equal the small-pox ; for we
have seen in repeated instances lately, the pustules full of
matter, were semi-transparent or opaque, as late as the terith
day of the eruption. The constitutional disorder is likewise
often very severe, both before the eruption and during its
progress to maturation.’’ This eruptive disease was prevalent
in the metropolis in 1807, and the foregoing extract
gives me reason to imagine w^as very much of the same kind
with the northern maladies. We may infer that there is no
deviation so eccentric as to render it entirely impossible that
these cases were varicella, if we admit these striking testimo¬
nies to its frequent irregularity. But is it not probable that
they were concealed under a like veil of deception t We
must recollect the derivation of numerous fatal cases, and
others severe beyond the known nature of varicella. The
horny scab has been witnessed in modified variola after
vaccination ; but it occurs here where it is not modified. If
it is chicken-pock, should it not leave a future susceptibility
to the genuine vaccine or variolous diseases, and may not this
be tried on the ?i/z-vaccinated or variolated patients as a test ?
Two series of experiments are related by Mr. Hennen ; six
persons were inoculated from unequivocal varicella; and
others w^ho had had the small-pox, with the matter of the
eruptive disease, without effect.

That ingenious, but frequently loose, writer, the late Dr.
Adams, names very confidently as a test (vide last edition of
Morbid Poisons,) the slough alw'ays being found beneath
the pustules of the small-pox, and never in varicella;

and the only exception to its being traced with the
same certainty are those irregular vesicular small-pox which
have appeared after cow pock, a7id on some other occasions.^*
How unsatisfactory! We regret that this has been unnoticed
in the cases before us. But let me not anticipate my
real ideas of the nature of this disease during comparison
and analysis.

I must now proceed to that part of the subject which more
immediately relates to the varioloid character of this disease.
Dr. Thomson finally generalizes the whole into modified
small-pox upon the following postulates: — First, Upon a
conviction that the descriptions of the progress and appear¬
ances of the eruption in small-pox, by our best systematic
wu'iters, are in many respects imperfect; that the diagnostic
marks which have been particularized between small-pox and
the disease termed chicken-pock are not to be relied on.
2dly, That secondary small-pox has occurred more frequently

2 ,

Fosbrooke’s Remarks on Variola^ 6)'C, 273

than recorded*'. Sdly, That there is every reason to think
that small-pox has an analogous power of modifying secondary
small-pox with vaccinia. 4thly, That what has been de¬
scribed as chicken-pock must consequently have been vario¬
loid disease : he supposes that cases of modified secondary
small-pox which may have occurred much, have been de¬
scribed as cases of chicken-pock, since we no rohere find any
part of the possible co-existence of these diseases^ ov o^ danger
in which medical Practitioners are of confounding them together,
5thly, He does not think that this hypothesis can be set aside,
till it shall be proved that chicken-pock eruptions occur gene¬
rally in persons who have not passed through the cowpock or
small-pock ; and prevail epidemically without cases of small¬
pox appearing among them. 6thly, On supposition that
those who have passed through the mild sorts of small-pox
are less secure against a second attack, than those who have
passed through the severe ; it will then be rendered probable
that many of the cases which have been considered as cases
of chicken-pock, preceding small-pox, were, in fact, only cases
of mild small-pox.

With respect to the first part of Dr. Thomson’s first prob¬
lem, it is natural to deem it singular that there should be
any inaccuracy or want of precision in the knowledge of a
pestilential disease so awfully diifused during the eighteenth
century; and that that vast experience should be likely to
furnish imperfect histories of variola or varicella must be con¬
jectural, when we reflect that the necessity is urged of dis¬
criminating between spurious and regular small-pox. Dr,
Willan has added little to the relations of Dirasdale and
Sutton. Morton,” says Dr. Heberden, mentions it, as if
he supposed it to be a very mild genuine small-pox.”

Mr. Ring observes, (Vol. VII I . Bradley’s Journal,) it is
well known that the small-pox is a Protaeform disease, assum¬
ing almost every colour and shape. Hence it follows that
there is no complaint with which the human body is afflicted,
that has given rise to more mistakes. Errors of this kind are
continually occurring; and if you wish for cases of this sort, it

* Dr. Adams (vide Popular View of Vaccine Inoculation, and
Rev. Ed. Med. Journal, Vol. IV. p. 337,) maintains, in coincidence
with the Professor, that cases of second small-pox after small-pox
have already been suffered to occur as frequently as these severe
cases of small-pox after cowpock. This he believes would never
have been doubted, had we not unfortunately been in the habit of
estimating the security of the patient by the severity with which he
has passed through the disease.

VOL. XI. — NO. 64. 2 N

274

Orwinal Communications.

would not be a difficult matter to collect a sufficient number
to fill a journal once a month. Tlience I conclude that the
most perfect descriptions, which we have the strongest
internal evidence of having been given, would not, in as
far as description goes, form decisive diagnoses of small-pox.

they were aware of the duplicity of resemblance, it must
have strengthened the motive to describe distinctly and with
precision. Dr. Pearson sav/ eruptions in four cases from the
vaccine inoculation, resembling so much those of small-pox,
that he should not have hesitated to consider them as belong¬
ing to this disease, if he had not excited them by a different
poison from the variolous (Vol. III. Bradley). My father, the
Rev. T. D. Fosbrooke, a celebrated literary character, in the
same volume expresses an opinion that they were entangled
with variolous contagion. Mr. Bryce, if I recollect correctly,
had seen something of this nature. Dr. Joseph i\dams says,
the secondary eruptions of vaccination are like the chrystilline
small-pox. He vaccinated soipe people who were out of the
reach of the variolous contagion, in all of whom the disease
took place in the chrystilline varioloid character; with others
the small-pox has vice versa assumed the vaccine character.
See Mr. Hennen. Mr. Ring had cases of vaccine inocula¬
tion not distinguishable from variola by any diagnostics with
which he was acquainted. See his remarks on Andre’s vario¬
lous-like eruptions at Petworth. 1 believe I might add to
these many other like opinions that appearances would not
always accurately decide the identity of variola. I shall now
endeavour to arrange any points of description which seem to
point out the nature of the Queensbury House cases, and
their unconformable characteristics.

The eruption of the distinct small-pox seldom appears later
than the third day (the only species with wdiich varicella can
be confounded). Mr. Hennen’s cases all on the fifth day.
In the distinct small-pox, from the first appearance, the pus¬
tules are surrounded with a perfectly circular inflamed mar¬
gin. In these cases the areola did not appear till the fourth,
fifth, or sixth day. In the milder cases of Mr. Hennen we
do not find the peculiar local swellings of small-pox. The
fatal case (15), is defective in some criteria of genuine conflu¬
ent or distinct small-pox. Idie interstitial ^kin w'as always
erythematose, with raspberry-coloured bases to the pustules;

nor are they surrounded,” says Wilson, speaking of the con¬
fluent small-pox,^* with an inflamed margin, as in the distinct
small-pox ; the spaces between the pustules are pale and
flaccid ; and the pustules themselves, about the time of matu¬
ration, oft^n appear like the pellicles fixed upon the skin.”

Fosbrooke’s Remarks on Variola^ 3^c. 275

V. Small-pox, Rees’s Cyclop. I’lie colour of the entire pus¬
tules in the advanced stage is consistent with the description
of confluent small-pox, as also the swelling of the face, an in¬
variable feature of the confluent. Though 1 suspect this case
in strict resemblance to differ much, yet 1 by no means intend
to insinuate that it was not such. The appearance of the
eruption principally in the face in these cases is a distinction,
according to Dr. Heberden, of the small-pox. In the Sut-
tonian system, p. 100, his circumstantial description, in the
first appearance of vesicles and of secondary pustules, agrees
in many particulars with these cases. The dark spot is well
known in distinct variola. The depressions in the centre
have always been considered as diagnostic of small-pox. See
the cases. I do not trace the verbal analogy between the
epidemic described by Dr. Rogers, of Cork, under the desig¬
nation of chrystilline, and any of these cases. Dr. Thomson
mentions it, but I apprehend as it appeared in those yet un¬
described. The cases of Sir George Dallas’s children, (vide
London Med. Review, 1807,) related by Mr. Goss, have
marks of being the same kind of eruptive disease as the Edin¬
burgh cases. Dr. Borland and Mr. Ferguson were of opi¬
nion that they were not small-pock. An epidemic is men¬
tioned by Mr. Quin, in Voi. 11. Med. Transact, p. 3/0, as
the summer advanced the pox were generally small and
wartyy suppurating very imperfectly, and the depressed apex
of each had commonly a black spot in it.”

In the article of small-pox, Rees’s Cyclopcedia, 1 believe
professedly written b}^ Dr. Bateman, he speaks of the dis¬
tinction between chicken-pock and modifications of small-pox
being fully established,” and 1 can merely refer to what has
been previously said, to diminish the perplexity of decision,
when speaking of varicella.

With respect to secondary small-pox having ensued much
oftener than has been recorded, Baron Dimsdale, as well as
many other most experienced and popular inoculators, would
not credit it : he thinks, to use his own words, ‘‘ that it was
more than probable, that those who have been entrusted with
the care of persons under eruptive disorders, have been, them¬
selves deceived, as to the nature and quality of such erup¬
tions.” By his account of varicella which 1 have given, he
was well acquainted with it as distinct from small-pox. I do
not think that because Dr. Fleberden and Dr. Monro primus
have partially denied secondary small-pox to have taken place,
that every contagious disorder described by them conse¬
quently as varicella was modified variola; for the fact is, that
the aggregate of cases of secondary small-pox, amounting, as

276

Original Communications.

I am instructed from good authoritjj to 3000, were casual,
and happening at remote distances of time and place.
Seventy cases have also been collected by Mr. Ring*.

As to the corresponding power of variola, in modifying
secondary variola, as is the case with vaccinia, I should be
theoretically predisposed, from the constituted resemblance
between these two diseases, to admit it. Mr. Hennen says,
that there is something in their mutual relation which has
not yet been satisfactorily elucidated;’^ it is an intention which
I shall not procrastinate long to illustrate the close approxi¬
mation of these two diseases to each other, in similitude
and identity of action. That very law of nature to preserve
the race of man, by which it almost unexceptionably happens
that the same” pure contagious disease shall affect the
same person only once through life, is the very basis of
the principle of these two varieties repelling each other.
They may be figuratively said to bear the same relation
to each other as the profile to the general face, in different
points of view, the same though unlike. But to return to the
postulate of modified variola and the chicken-pock described
bj" authors being the same ; this appears to be the most
feeble link in the concatenation, and if it breaks, the whole
is destroyed ; for if the chicken-pock W’as the variola

* This contagion is of that insinuating nature, that it pervades even
the constitution in an insidious manner in a state of rude health, and
is so tenacious of every thing to which it is attached, that I very much
question its possible extinction. Besides the very singular instances
of the certainty with which this contagion penetrates the system, as given
by Dr. Jenner, &c., cases have been previously related by Vogel and
Burserius. The skin always retains its susceptibility, not so the
constitution. Nurses are liable,” says Dr. Harrison, (Vol. V. Brad¬
ley’s Journal,) “ to variolous eruptions from attending upon children
in that complaint: with them they are purely local.” It has been
commonly the case when children have been exposed to variolous
contagion, that they have sipall-pox pustules, few in number, and dis¬
crete, and drying away on the third day. There is a case on re¬
cord of a woman who had small-pox eight times, and died the last.
Dr. Adams (New Edit, of Morbid Poisons,) quotes a writer who says,
that it has been ascertained that the small-pox has been imported
more than a hundred times in seven years, into the channel, and
thirty times in about six months, in the year 1800, by the channel
fleet alone. I am not inclined, says the Dr., to doubt the veracity of
this presumption, since there are so many w'ays, of a latent kind, in
which the disease may be imported by human agency, and totally
unconsciously. This appears more infrequent since the uniyersality
of vaccination.

•277

Waiisborougli’s Case of P neumoiiia.

modified by the variola, the secondary disease must be
expected to assume a given form, and some consistent regu¬
larity ; but it seems that there is nothing more decidedly
contrary, if all the cases of varicella or secondary small¬
pox, either after variola or vaccination, were consonant
to Mr. Hennen’s, and resembled each other, little diffi¬
culty would arise in thus compromising the matter: but
how often have practitioners witnessed its anteriority to
variola, and who does not recognise it every day in some
of its forms ; and if it was modified small-pox, why does it not
afford security against the vaccine disease, for the mildest
small-pox is known to have that effect? May we notreason
with equal plausibility^ that chicken-pock is the most ancient
in this country, and had existed before small-pox, as that
secondary small-pox had existed without notice, and that it
was at last regarded, because it might bring small-pox
inoculation into disrepute by being mistaken for it, and
erroneously used. The knowledge of cutaneous diseases
has not been much cultivated till of late years; and it is very
possible that this petty eruptive disease, with slight indis¬
position, frequently counterfeited by others, might have
been impassively attended to. Perhaps in some instances,
its contagion concurring promiscuously with variolous conta¬
gion, it may, since that period, have become indefinitely
aggravated.

- (To be Concluded in our next Number.)

II.

Remarkable Case of Pneumonia. By Mr. Wansborough,

Surgeon, Fulham.

- ^ -

On the morning of the 10th ult. ten o’clock, I was called
to visit a young man, twenty-five years of age : I found him
labouring under a violent attack of pneumonia, symptoms
extremely urgent, with short and quick respiration, inter¬
rupted by severe lancinating pains in the hypochondria, pulse
120, tongue dry and furred, considerable fever, and by con¬
sequence heat of surface much increased.

Twelve ounces of blood from a large orifice.

R Magnes. Sulph. ^iss. in

Infus. Rosarum, f. ^iss. Ft. Haiistus.

Secunda quaque hora sumendus, donee alvus respondeat,
Emplastrum Lyttse Magnum Sterno.

At four P. M. the draught had not operated ; the pulse
had undergone a trifling abatement from the bleeding, but

fi7S

Original Communications c

still retained its inflammatory character; symptoms much
the same as in the morning.

R Pulveris Antimonialis, grs. xiij.

H^'dr. Submur. gr. x.

Ft. massa in pilulas quatuor dividenda, quarum sumat unam se*
cund4 quaque hord.

R Liquoris Ammon. Acetalis, ^iv.

Aquae Distillatae, ^vj.

Syr. Aiirant. ^ss.

Liq. Antim. I’art.

Ft. haustds, alternis horis cum pilulis adhibendus.

11th. Has passed a very restless night; the medicines
produced four copious foetid evacuations ; this morning the
skin is moist, yet the tongue is much furred, and the pain in
the hypochondria increased, extending backwards between
the shoulders. The blood drawn yesterday exhibits a thick
huffy coat: I repeated the bleeding frdrn the same oriflee to
the extent of twelve ounces more; the pulse became less
frequent and fuller, and perspiration appearing over the
surface of the body. My patient experienced a slight mitiga¬
tion of symptoms.

Continue the saline draughts every six hours during
the night, to each of which add potassae tart, et mannae, aa3i.

12th. Symptoms nearly the same this morning as last
evening; a determination to the surface has been kept up
during the night ; the blister has risen well ; he has had a
better night and is more composed, but has not had much
sleep; pain abated ; pulse 100; free evacuations. .

Continue the draughts without the aperients.

13th. This morning an accession of all the febrile symp¬
toms has taken place ; the pain is more severely felt than
yesterday; tongue dry; pulse again increased to 120; no
evacuation of the bowels during the night.

R PotasscC Tart. ^i.

Infus. Scnnae, ^i. — M.

Ft. hausths, slatim sumendus.

Four o’clock, P. M. The draught has operated twice, but
without diminishing any of the symptoms, either febrile or
inflammatory ; his breathing is more frequent than in the
morning, and his distress is great from dyspnoea, which he
complains of much.

Eight o’clock. Difficulty of breathing increased; no mo¬
tion since the morning; skin excessively hot and dry: the
blood drawn yesterday exhibits exactly the same state as that
of the day preceding.

«79

Wansborough’s Caiz of Pneumonia.

Twelve ounces of blood were again taken from a vein
in the arm.

Deliquum supervened this depletion for the first time.

Emplastrum Ijttae slerno repetatur.

Ten o’clock. Much the same, except a slight alleviation
of pain in the hypochondria.

Continue the saline draughts, with the addition of vini
antimonii,

Twelve o’clock. Fever and pain in the chest increased.
As the case appeared desperate, from the determined progress
of the inflammation, I felt justified in adhering to the deter¬
mination with which 1 had set out, viz. to reduce the inflam¬
matory diathesis by resolution.

No cough having hitherto appeared, I was emboldened to
pursue this principle, and, accordingly, twelve ounces more of
blood were taken, and, removing the blister that had been
applied at eight o’clock, I covered the surface of it with
pulvis cantharidis, and again applied it to the sternum.

Medicines the same.

This evening, before I left him, I flattered myself I per¬
ceived an abatement of symptoms.

14th, eight o’clock, A. M. An accession of all the pre¬
vious symptoms. At four this morning the pain returned
with increased violence; his skin is hot and dry; tongue
parched and considerably furred ; respiration more oppressed
than I had seen it before ; his eyes assumed a peculiar ex¬
pression, evidently indicative of the extreme anguish he
laboured under by the distressing urgency of symptoms.

The same motive that actuated me to bleed largely in the
first instance, seemed equally, .if not more pressing now ; a
constant and copious action was kept up on the bowels, and
every effort was excited by antimonials and saline medicines
to produce a determination to the skin, which was accom¬
plished.

The situation of my patient urged the necessity of prompti¬
tude in the application of my remedy. I now, therefore, again
took twelve ounces of blood.

Deliquum followed, and half an hour elapsed ere my
patient recognised his attendants.

On recovering, he expressed himself much relieved, yet
exceedingly debilitated : conceiving it impossible to survive,
he wished to die.

Half an hour after the operation I administered the
following : —

R Haustiis Salini,- f. §iss.

Extracti Hyoscyami, ^ss. — M.

Statim sumendiis, et 6tis horis repetendus.

280

Ormna I Communications.

During the whole of this day he appeared better; his pulse
was now 90 and ; he took, occasionally, tea and barley
water ; the blister discharged copiously.

Four o’clock. Slight evacuations ; bis debility was now so
great that it was necessary to relieve him by the slightest
movement: tow'ards evening his pulse increased; his coun¬
tenance became flushed; and the febrile symptoms resumed
their sway after having remitted during the day.

Twelve o’clock. Worse; the pulse increased to 110, and
my poor patient appeared to be rapidly dying. I left him in
the full conviction of his speedy dissolution : however, in the
morning, at six o’clock, I w^as called tohim at his request: on
my arrival I found him in a deplorable state indeed ; his
voice only extended to a whisper, and that was rendered
almost unintelligible by the hurried respiration : [ could
with difficulty distinguish that he wished to be bled : at his
request, therefore, I again bled him to the amount of twelve
ounces ; this last evacuation reduced the pulse to 50 ;
deliquum did not supervene ; his countenance recovered
after the operation, and he felt himself considerably relieved ;
shortly after a copious loose dejection follow ed, highly impreg¬
nated with the hyosciamus.

Sudden exhaustion succeeded, and he sunk into complete
insensibility, which terminated in profound sleep. I remained
with him, closely watching the progress of these highly in¬
teresting moments, nearly two hours, and experienced the
pleasure of perceiving a sensible alteration for the better ; his
pulse assumed a fuller and softer character, and remained
steady during the day ; towards evening it increased to 75.

The hyosciamus was exhibited every six hours in doses of
a scruple each : he took barley water and tea, as before : this
was on the 15th.

Twelve o’clock, P. M. He had remained six hours asleep,
and awaked quite refreshed, and (to use his own expression)
quite a new man, with a moist skin, having perspired profusely
during his sleep, with a full, regular pulse, at 75. The blister
has continued to discharge freely, and I desired it might be
kept open, which was done for a week, and then, as it became
no longer necessary, it was healed.

The hyosciamus was continued in one scruple doses until
the 19th, when, having advanced into convalescence, I
afforded him light nutritious diet, obviating costiveness,
with occasionally small doses of mag. sulph. He continued
to advance in his recovery, gaining strength rapidly; the paiii
of the hypochondria gradually left him, and, with an increasing
appetite, he continued to amend until he left the place per¬
fectly restored, 1 have not seen or heard of liim since®

Clemot’s Cases of Lithotomy,

281

III.

Tzco Cases of Lithotomy in Females^ with Remarks. By
M. Clemot, Professor of Anatomy at Rochefort.

[Communicated by the Author.]

In the month of March, 1814, a girl of twenty-four 3’^ears
of age was brought to me by M, Guignard, for the purpose
of having a stone extracted from the bladder, symptoms of
which had been felt for nearl}^ six years. By passing the

sound the existence of the stone was made sufficiently

evident, and upon introducing the finger into the vagina it
was felt through the vesico-vaginal division: it appeared to
be about the magnitude of a duck’s egg.

If Surgeons are pretty well agreed respecting the most
eligible mode of performing lithotomy in the male, there
is still some room for variety of opinion on this head as it
respects the female : the comparative shortness of the urethral
canal, and the very narrow space which surrounds it at the
upper part of the vagina, leave one in doubt whether to

attempt the dilatation of the urethra, or to divide the canal on

the superior part on both sides, or on the left side only.

If we operate laterally, the vagina brings us too near the
ramus of the ischium, and to the pudic artery, and is itself
liable to be wounded in different places, as, indeed, has often
happened. By the upper division sufficient space is not
allowed, and depression is occasioned should the calculus turn
out to be large. This serious inconve'nience, to which sufficient
attention has not perhaps been paid, is common to instruments
which divide on both sides. The urethra being placed at the
upper part of a triangle, the section which the instrument
makes being transverse, the sudden retraction of the parts
tends to draw them to the centre of the triangle, the sides
of which are fixed and bony, and, consequently, to remove
them from those which they ought to approach, in order to
leave the organs in a state to perform their functions.

Thus the frequent incontinences of urine which follow all
those methods in which the division of the urethra is adopted
for the passage of the stone have induced many Surgeons to
prefer and adopt the high operation, which is always attended
with difficulty and danger, and is, indeed, sometimes im¬
practicable.

Applying these considerations to the case immediately
before me, my first determination was in favour of the operation
of Celsus, which is more generally applicable to the female
than to the male, in consequence of the less thickness of the

VOL. XI. — NO. 64. 2 0

282

• Original Communications,

parts to be divided, and the greater facility of introducing
the fingers in parts, the extension of which is always less
than that of which they will admit, and which are not
affected in their ulterior functions by any degree of temporary-
distension ; circumstances wliich do not apply to the male.
If w'e are allowed to examine by the rectum and by the
urethra, no valid reason can be given against examining^ by
the vagina also in a disease of so much importance as stone
in the bladder.

The only ground upon w'hich I hesitated was the fear
raised by some Practitioners respecting the occurrence of
urinary fistulas into the vagina ; but these disorders having
their origin in the urethra, one should expect women to be
less obnoxious to them than men, which, indeed, is verified by
observation. The difficulty which is found to attend the
management of intestinal fistulae in men occurring after the
operation of fistula, arises from the continued passage of
excrement, and the case is therefore verv different from that
of urinary fistulae communicating with the vagina. The
thick parietes of this passage, as well as of the bladder, and
the quantity of intermediate cellular tissue, appear to furnish
sufficient freedom for the inflammatory and cicatrizing pro¬
cesses necessary for the reunion of parts. Indeed, an
example was before me of the correctness of this reasoning in
a female, from whose bladder had been spontaneously’^ expelled
two calculi by an erosion of the parts in question. These
considerations, then, I repeat, induced me to operate upon
the vagina.

Determined as to this point, it only remained to fix upon
the plan. I have already said that 1 had thought of that of
Celsus, according to which my intention was to carry the twm
first fingers of the left hand into the vagina, at the upper
part of the stone, to make it prominent without. I should,
with the back of the same hand, have strongly depressed the
fork so as to admit the light into the vagina, and to allow me
to cut between my fingers upon the stones, which I should
have extracted by continuing to push it, or by using the
forceps or the lever.

But being well aware that reasoning which appears very
applicable and conclusive prior to the commencement of
an operation, is often found to fail in its course ; and know¬
ing that the merit of a Surgeon consists mainly in varying
his views and practices according to circumstances, I took
care to be provided with instruments necessary for another
method, vv’hich I employed before Mr. J. L. Allame Repey,
and many other naval Surgeons.

The subject of the operation being placed in the common

283

Clemot’s Cases of Lithotomy,

position, I found it not practicable to reach the upper part of
the stone, and change its position by drawing it forward : I
therefore introduced through the urethra into the bladder, a
grooved catheter with which 1 had provided myself. I'hen I intro¬
duced into the vagina a wooden gorget employed in the ope¬
ration for fistula in ano, I rested these instruments one upon
the other, through the parietes of the bladder and of the
vagina, making them form an angle at the point at which I
intended to finish my incision in the vagina. Trusting the
catheter to an assistant, I laid hold of the handle of the
gorget with the left hand, with which, at the same time, I
depressed the fork, and threw the light into the vagina so as
to expose the anterior upper part, confined and fixed by the
"'catheter ; then taking a straight bistory in the right hand,

I carried it like a pen into the groove of the catheter, through
the parietes of the vagina and bladder, the neck of which I
laid open behind the canal of the urethra, which I left un¬
touched. I withdrew the gorget, and introduced a finger
into the wound, in order to ascertain the size of the wound
and of the stone. I withdrew the catheter and replaced my
finger by the forceps, with which I conducted the stone into
the vagina, when, finding some difficulty, I finished the
extraction b}’^ a scoop in the shape of a lever.

The operation was not followed by any untoward symp¬
toms, with the exception of a colicky pain, with which the
subject of it w^as attacked on the eighth day, and which I
attributed to the discharge of a small quantity of blood that I
conceived to be menstrual ; she had no fever at any period :
on the fifteenth day she began to perceive her urine pass by
the urethra ; at the end of the month she was capable of
retaining it for some time, and fifteen days after she was
discharged, and returned to her home quite recovered ; where,
notwithstanding that she has been occupied in hard labour,
she has acquired her wmnted strength and complexion, and
the ability to retain her urine for a great length of time.

The adult age of this girl, the great size of the stone,
which, as before remarked, \vas as large as the egg of a duck,
the pain and the straining of the perineum wdiich it had
produced, had disposed the parts favourably for the opera¬
tion ; so that I left to experience to determine the propriety
of its application to less favourable cases ; one of which
occurred to me in November last, 1815.

A landowner of St. Jean d’Angely brought to me, at Saints,
where I then was attending the assizes, his daughter, twelve
years of age, afflicted with stone in the bladder. I soon detected
its presence with the sound. In attempting to examine per
vaginam, I found an opening which would only admit the

284

Original Commiinicatious,

end of the little finger: on introducing this with care, and
without giving much pain, 1 found the hymen yielded without
rupturing. Reflecting on my method of operating, I sub¬
stituted the fore finger, and introduced that also without
rupturing the hymen. I ascertained the capacity of the
vagina, which is known to bear no proportion to the narrow¬
ness of the entrance. The os lincte was felt by the extremity
of the finger : I perceived, therefore, that it was possible to
operate in the same way that had been so successful before.

I performed this operation in the presence of some brother
Practitioners, Messrs. Chaslom, naval Physician, Viand, and
Trosoan, Physicians at Saints. The open catheter was
introduced into the bladder; the gorget of wood, well lubri¬
cated, was introduced into the vagina. Though the interior
fold of the fossa navicularis presented so as almost to block
up the vagina ; the gorget easily stretched this without
wounding it, and exposed the interior surface of the vagina,
which I divided as I have described in the case of the
girl de Vendre. Having introduced my finger into the
bladder, and withdrawn the catheter, I easily found a rough
stone, of the size of a walnut, which I extracted without
difficulty or much pain. Having substituted a pair of straight
forceps for the crooked ones, my success was greater this time
than on the former occasion. It was with some difficulty that
the child was kept on low diet for two days. On the fifth
day the urine began to pass by the urethra; the sixth and
seventh day she was able to retain it for a short time; the
eighth she left the house to go to the court of law for two
hours, during which time she found no inconvenience from the
urine: she continued to go abroad till the twelfth day, when
she went home in spite of my efforts, where her recovery was
soon complete.

M. Dupuytren, a fellow student of mine at FEcole de la
Sant6, who honours me with his friendship, and to whom I
communicated the success of my first operation, on the occa¬
sion of a journey to Paris which 1 made in August, 1814,
pointed out to me a similar case, communicated by M. Plobert,
of Rouen; which, being joined 'to those I have just men¬
tioned, will, I hope, be sufficient to do away the fear of
cutting into the bladder from the vagina: I trust that they
confirm also the reasoning wdiich 1 have thought sufficiently
clear to w'arrant the employment of this method of operating,
at once more easy of execution, and less dangerous in its
consequences.

REFLECTIONS.

Sabatier mentions, in his work on Surgery, that Toilet
extracted many stones from a bladder, dragged down by a

2S5

Case of F ulmonary Disease.

prolapsed uterus, the subject of which perfectly recovered :
lie adds that, if in this operation we had only to fear a urinary
fistula, such an accident would be easily guarded against.

If these fears arise from the danger of wounding the
uterus, or of getting into the cavity of the abdomen, we know'
that the facility \vith which the tissue of the bladder yields,
renders it unnecessary to carry the incision to tlie top ; and
that it is to stop at the junction of the two instruments. In
the method which I have employed, the posterior part of the
vagina and the rectum are always defended by the gorget.
There is no danger of wounding the ureters, or the larger '
vessels, as the incision keeps the mid-way. Can Sabatier be
kept back by the scruple of introducing the finger into the
vagina? He has said above, in speaking of the method of
Louis and of Fleurent, that it is necessary to introduce two
fingers into that canal, in order to keep off the anterior
parietes, by acting upon the two sides. If he pleads for
modesty and virginity, these find their best defence in the
necessity of the case, whilst both reason and religion lead us
to seek for relief to our sufferings. If any other objections
should arise, they could only have place in cases occurring
in young subjects, in which the high operation might be em¬
ployed with less difficulty, in consequence of the bladder
rising much higher out of the pelvis.

AUTHENTICATED CASES,

OBSERVATIONS and DISSECTIONS.

' LXIX.

Miss Vincent died on Sunday, February 14th, aged
twenty-four; about three years and a half since she w'as
first affected with a pulmonary disorder, brought on by a
severe cold. She took medicine consisting principally of
digitalis, under the use of which she appeared to lose strength.
The menses became obstructed. She continued in this state
for about five months, after wdiich she gradually got better.
In the course of about twelve months from the first attack she
W'as again exposed to cold, and the pulmonary disturbance
recurred. Her expectoration at this time did not appear
purulent, but was of a tough, gluey consistence. The
attendant fever did not assume a hectic character: she again
gradually recovered, and w'ent into the country ; but still
there were appearances of something constitutionally wrong
in the frame ; a difficulty of breathing was easily induced
by slight irregularities or exposures to cold, and, indeed,

286

j4 iiihenticated Cases.

respiration never, at the best, appeared free and iinin»
terrupted.

About twelve months prior to death, menstruation returned,
after having been for a considerable time suspended. Ti'here
now appeared indications of hepatic disease; a little hardness
was discovered in the region of the liver ; and the alvine dis¬
charges became somewhat irregular. Under the occasional,
and, indeed, pretty frequent exhibition of two grains of calo¬
mel, together with saline medicines, the patient appeared for
some time to be in an improving state; and the expectora¬
tion did not become decidedly purulent until about a fort¬
night previous to her death. On the day of her decease she
w'as suddenly seized with a very urgent difficulty of
breathing, and died in about three hours, apparently suffo¬
cated by a copious pulmonary excretion.

At different times she was in the practice of inhaling
hydrogen, by holding her mouth over a basin in which zinc
and sulphuric acid were mixed so as to produce the hydro¬
genous fumes. This practice almost invariably gave her
temporary relief.

Dissection by Mr, Taunton, in the presence of Dr. Uwins,
Mr. Varley, and Mr. Whitmore. — In the abdomen was
found about a gallon of fluid ; but there were no marks of
inflammation or increased vascularity in the peritonsBum.
f The stomach, spleen, pancreas, and kidneys, were natural in
their structure, but remarkably pale, and the three last organs
rather anasarcous in their investing membranes. The liver
was somewhat enlarged, and of a harder consistence than
usual ; It was grarmlated through the whole of its paren¬
chyma, and there was a considerable adhesion between its
surface and the diaphragm. Neither the uterus nor ovaria
exhibited the slightest marks of disease. There was no evi¬
dence of increased vascularity in any portion of the intesti¬
nal canal.

Upon laying open the thoracic cavity, the pleura was
found every where adhering to the surface of the lungs, and
the lungs themselves were, throughout, studded with tu- *
bercles ; in some places considerable abscesses had formed
from the suppuration of these tubercles. The whole of the
upper and anterior portion of each lung was, indeed, destroyed,
leaving but a small portion by which respiration could
be carried on. The heart was in a natural state, but the peri¬
cardium contained more than its ordinary quantity of fluid.

Rema7ks, — Ihe absence of hectic symptoms would appear
in this case worthy of notice. Was not a sort of phthisical
asthma, if we may so express it, in the first instance formed,
by mechanical obstrueiion, to the air cells of the lungs,

287

Of Generation in Impeifect Plants*

caused by the great number of tubercular bodies ? And is
not the non-appearance of hectic, till towards the last stages
of the disease, to be attributed to the circumstance of these
tubercles not having run into a state of suppuration ? The
expectoration, it will be recollected, was not purulent till
about a fortnight before death.

It is thought and stated by many, especially at the present
time, that effusion into cavities never occurs, but in conse¬
quence of membranous inflammation. J3ut what was the
vascular irritation in the present instance which produced the
ascitic deposit.^ The whole contents of the abdomen, the
liver excepted, were remarkably pallid. Did then the effu¬
sion arise from impeded circulation through the vena-portae,
or might it not more properly be attributed to a torpor of the
abdominal lymphatics ?

Tlie healthy appearance of the uterine system would serve
to show that a disease of action may consist for a long period
with unchanged structure.

DEPARTMENT OF NATURAL HISTORY^

- -

On the Mode of continuing the Species in the Imperfect Plants ;
and first of the Algae* By Mr. Gray.

— — -

Although it had been known by cultivators from the
earliest times, that certain plants, as the date tree, were fur¬
nished with flowers of different sexes, and that the presence
of the male flowers was necessary to the fertility of the female
ones ; yet it was not until the time of Camerarius that this
idea of the existence of sexes in plants was extended to all
vegetables. From his tune to within a few years the doc¬
trine has met with little opposition, and numerous facts show
• that in a large number of species it may be considered as true.

As animals which have a near affinity to one another will
breed together ; such as the horse and the ass ; the dog and
the wolf; the linnet and canary bird : so will also plants in
which a similar affinity exists, as the red and common poppy.
Some of these mixt breeds are continuable, others not; the
female individuals, or organs, being only imperfectly formed ;
at least in cold climates, for many mules will breed in warm
countries, which are barren in cold ones.

It is this mixture of different original species that appears
to be the cause of the vast number of species in some families
of plants, as brassica, saxifraga, hieracium, geranium, ixia,
erica, mesembryanthemum, and protea : as also the numerous
varieties of frails and flowers in our gardens ; the multipl icily

288

Oriiiinal Co m municat io n s .

<• J ,

of species in some families of insects, as the lady-birds, is
ascribed to the same cause.

Adanson was so struck with this idea of the formation of
new species by mixture of different pre-existent species, that
he was led to affirm the whole vegetable kingdom was in
a state of perpetual change; that new species were continually
formed, and some of the old ones were constantly disappear¬
ing ; that the whole number of species went on increasing as
the world increased in age ; and that the old botanists men¬
tioning only a small number of plants was occasioned by their
being really fewer in number in ancient times,

Linnseus took, nominally, the other side of the question; he
affirmed that the species now existing are the same in number
as they were on the day of the creation of plants ; but after¬
wards he retracted this opinion, and said he did not dare to
affirm positively that there were not now in Europe new
species produced within the last 150 years, i. e. since the
Pinax of C. Bauhin was published. Indeed he went farther
than Adanson, and imagined that plants of very different na¬
tural families might mix and produce fertile races : thus he
conceived the saponaria hybrida to be a mule between the
common saponaria and some species of gentian; the white
actaea spicata to arise from the black actsea spicata and the
rhus toxicodendron. This contrariety of opinions is expressed ,
in different parts of the very same work, so that his partizans
may produce his dictum, let whatever opinion become pre¬
valent.

In those plants where the distinction of sex is most evi¬
dent, it is not yet demonstrated that fecundation is absolutely
necessary for producing perfect seeds. Spallanzani has made
experiments on spinage and gourds, which seem to show that
these plants will produce fertile seeds when the male flowers
have been carefully taken away : doubts, however, still remain,
because the pollen is carried to considerable distance by the air,
and male flowers are sometimes to be found on female plants.
Fresh experiments are therefore wanted before this anomaly
can be allowed; and it must also be recollected that in the
aphides, or plant lice, the impregnation of the great great
grand-dam is sufficient to render all her female descendants
fruitful to the fifth generation, although kept from communi¬
cation with any males.

But there exists also a great number of plants in which the
common organs of sex, as seen in the perfect plants, are not
discernible, and the cqntinuation of the species in these has
become disputable. Linnmus and his followers maintain that
all organized beings are necessarily produced from eggs, or, as
they are called in plants, from seeds; that eggs require fecun-

289

Of Generation in Imperfect Plants*

dation, and that of course all organized beings possess sexual
organs, although their small size may prevent us from per¬
ceiving them: but at present a number of botanists are of
opinion that instead of dividing plants into two grand classes
only, the phenogamous and cryptogamous, they ought to be
divided into three: 1. Phenogamous plants, in which the
sexual organs are very distinct. 2. Cryptogamous, in which
their existence is enveloped in some obscurity. 3. Agamous,
in which even the existence of the sexual organs is denied :
the speeies is continued in these two last classes by turiones,
biilbilles, seminules, and propagules : the two former of these
modes are also known in phenogamous plants.

Of the nature of turiones, we have a familiar example in
the common propagation of the potatoe, by pieces of the root
to which a turion, or eye, is attached.

Bulbilles differ only from turiones by their place of growth
not being on the roots, but in the axilla of the leaves, as in
the bulb-bearing lily or the ovaries, in which last case the
plant is perfectly analogous to a viviparous animal ; thus gar-
lick bears heads of bulbilles, known by the name of rocam¬
bole : but the most striking example is the agave fsetida,
where the beautiful head of flowers is succeeded by one or
young green plants.

Seminules appear to differ only from seeds by their minute¬
ness. The above modes of continuing the species is common
to the cryptogamous and agamous plants. The seminules of
cryptogamous plants are produced in ovaries to which
stigmas are attached ; but those of agamous plants are con¬
tained in a sort of ovarv, to which no stigma being attached,
they are distinguished by the peculiar name of conceptacles,
either loose, or, as in some plants, in small cases called elytrse,
the conceptacle itself then performing the office of an invo-
lucrum. The ferns are familiar examples of this mode of
continuing the species.

Propagules are peculiar to agamous plants; they appear
* like a powder upon the surface of the plant, and are never
conflned in true or false ovaries. It has been supposed, and it
is probably the case, that they are only fragments of the ex¬
ternal surface of the plant. The lichens are the most fami¬
liar example that can be adduced of the propagule.

After this general review of the modes of continuing the
species in plants, it must be observed that so great are the
difficulties in respect to the determination of the division to
which a number of these imperfect plants belong, that it may
be truly said, that the arrangement of the whole is involved in
doubts. Of the nine orders which were included by Linnaeus
in his class of cryptogamia, four are supposed to be more

VOL, XI. — NO. 64. 2 p

(

200 Original Communications,

properly agamous, namely, the algae, fungi, hypoxyli, and
lichenesr The external appearance of these is very different
from that of perfect plants ; they are composed of a cellular
tissue only, and none, except the algae, have any appearance
of leaves or green herb. The other five orders, namely, the
hepaticae, musci (mosses), filices (ferns), lycopodacese, sal-
viniae (rhizospermae of Decandolle), and the equisetaceae
(horsetails), throw out leaves or herbaceous expansions of a
similar nature, and have a vascular structure analogous to that
of phenogamous plants.

In respect to the first order, or algae, a difficulty presents
itself, which is, to determine the exact limits between the
plants of this order, andghe animals belonging to the order of
polypi vaginati, a difficulty perhaps the greatest in the whole
circuit^ of natural history. The corals, corallines, and
sponges, formerly ranked as vegetables, are now considered
as compound animals; but it is probable the two latter will
soon re-enter the vegetable kingdom.

Two tribes of plants are united by modern botanists under
the general name of algae. The first are those commonly
called sea weeds, but which are called, by scientific botanists,
thalassiophytes, which is only the substitution of a name of
Greek derivation for one of Saxon origin. These generally
grow in the sea or salt water creeks; although a few plants,
whose structure is perfectly analogous, grow in fresh water
like those of the second division, which are called confervae,
or in vulgar language, without any distinction, the green
matter of stagnant water. Some, how’ever, are found in run¬
ning water; and it is even doubted by Mirbel whether others
of this second division may not be found in the sea. The
structure of the whole tribe is such that they do not grow
unless they are in v/ater, from which if they are withdrawn, they
dry up; but many of them will revive upon being plunged
again into wmter, unless they have been kept so long in a dry
state, as to have undergone some other alteration besides mere
exsiccation.

The thalassiophytes are propagated by seminules, which
are usually contained in elytrae. The elytra3 are either lodged
in the cells of the cellular tissue, or in conceptacles which
are in some species closed originally, and split open in due
time ; or they have at their top a small cbamiel, through which
the elytrae pass, and which opens on the surface of the frond,
thus bearing a strong analogy to the uterus and vagina of
viviparous animals: in some algae, as theclaiidea, both sorts of
conceptacles are found. The seminules are surrounded with
a mucilage which favours their development : although not
acted upon by salt water, this mucilage is dissolved by fresh.

Multiplicaliou of the Algiz,

291

and when the seminules are deprived of it they are no longer
fertile. Mr. Lamouronx observes that they do not germinate
on every sort of substance; some grow only when they fall on
sand, others only on limestone rocks, &c. : hence he concludes
that the seeming root of thalassiophytes is a real one, and ex¬
tracts the juices necessaiy for the increase of the plant from
the substance on which it grows, and is not, as is generally
thought, a kind of sucker merely serving to moor the plant
that it may not be carried off by the waves : but the above
circumstance does not necessarily require that this consequence
should be drawn from it.

Reaumur called the hairs which sometimes cover the sur¬
face of the plant, stamens ; whence some, forgetting that he
denied the existence of the sexes in plants, have supposed
tl it he considered them as the male organs. Others, as
Li'nnseus, have placed these organs on the threads found in the
bladders, which serve more probably to float the plant than to
contain the sexual organs; and which to other eyes appear
only to be the fragments of the internal cellular tissue of those
bladders. Later authors, driven from this opinion, and yet
unwdlling to believe in agamous propagation, consider the
mucilaginous substance in which the seminules are Immersed
as the real seminal liquor, and that the seminules are impreg¬
nated without any intermedium, in the same manner as some
zoologists suppose to be the case w ith oysters and muscles.

As to the confervas, or fresh water algae, many preserve the
species in the same manner as the thalassiophytes. Other
split either longitudinally or across, and each part becomes a
new plant. But the most curious phenomenon in vegetation
is afforded by the conjugate confervae. These plants are
composed of tubes quite simple, without any branches, and
contain small grains spirally arranged in cells. As long as
they continue at a distance from one another, they grow, but
do not multiply. When two or more come close together
an excrescence grows out of each approximated cell, which
unite into a tube of communication, by means of which the
grains of one cell in one of the plants passes into the cell of
the other plant, wdth which a communication has been formed,
and mixing with them form a roundish mass ; the cell then
bursts, the roundish mass set free opens into two lobes, and
emits a slender filament which soon assumes the characters of
the parent plants. There seems to be no certainty in regard
to w'jiich of the plants will emit the grains into the other, as it
often happens that one cell is emptied, while the next to it on
the same plant is filled. The structure of these confervm is so
j)erfectlv similar to the other, that they seem to belong un¬
doubtedly to the same order; and yet this mode of conli-

29^

Original Communkatiom.

nuing the species is nearly allied to that of animals, and so
remote from that of other plants, that we can scarcely con¬
sider them as vegetables. The whole must be left to the
sagacity of future observers, and to them a rich harvest of
discoveries is promised.

Monthly Calendar of Natural History for the Neighbour¬
hood of London. 1819-
— . ■ -

' Jan. 26th.— The cuckoo (cuculus canorus) was this morning
distinctly heard at Bushy Heath, in Middlesex. A circum¬
stance very unusual at this time of the year. No less un¬
common w^as the premature developeraent of the spring foliage
on the lime trees in Wanstead Forest, Essex. A Swallow
was likewise observed the last week in January. All these
circumstances mark a very unusually early season.

Feb. 4th. — The Snowdrop (ga/anthus fnvalis) in bloom.
The Thrush {tardus musicus) and the Blackbird {merula nigra)
singing.

20lh. — The dr aha verna in flower.

March 1st. — The Crocus {crocus vernus) in flower.

6th.' — The W'c\gtoi\{motacilla first seen near Denham.

Qth. — Asparagus first cut ; and the polyanthus in flower.
The maximum of the thermometer at mid-day was 47®. The
Cirrus or Curlcloud was prevalent all day. The pulmonaria
already in bloom ; also tussilago farfara.

10th. — The veronica agrestis came into flower this morn¬
ing. The common garden Daffodil {narcissus jyseudonarcissm)
in full bloom.

O rith.^ — This was a fine warm day for March, and the
vegetation advanced. The wind NW.

12th.- — Fair day ; and while riding in the lanes near Leyton,
in Essex, I observed a vast quantity of small flies, the first I
have observed this spring, INarcissi blow in the open
ground.

1.3th. — Sitta Europea seen in the garden. The copulatio
ranarum first observed.

15th. — Fair spring day: vegetation advances but slowly.

This spri ng has been erroneously considered by some per¬
sons to be a very early one. Having by me journals of the
weather, and of natural history, as far back as the year 1780,
I am enabled to compare the phenomena of a succession of
seasons ; and though there have certainly been, in the early
part of this year, some very unusual anticipations of verdure,
yet on the whole, at present, the season is far from being for¬
ward. The flow'er of the elm, for instance, is rather late than
otherwise, and many of the early spring flowers are not yet in

‘293

Yeats 0)1 Hych'encephalm.

bloom. In short, it is an error, though a very common one,
to expect a forward spring after a mild winter, as a reference
to former journals enables me to say decidedly. It seems
that the excitability of vegetables, like that of animals, varies
inversely as the application of the stimulus; and that tlie
suspension of all vegetable functions during frost and cold, so
enables the susceptibility to increase, that on a sudden remis¬
sion of the cold in spring, the march of vegetation is propor¬
tionally rapid.

On a similar principle I can account for the luxuriant
appearance of fungi after dry summers : the first autumnal
rains operate with more effect on them, in consequence of the
accumulation of susceptibility during the preceding drought,
I shall endeavour to illustrate further this principle in a sepa¬
rate paper.

T. FORSTER.

March iblh, 18 Ip.

1 [To be continued to the \5th of every month, in the neighbourhood of

Tunbridge W ells, the Author s residence?^

PART II.

ANALYTICAL REVIEW.

A)i Appendix to the Pamphlet on the early Symptorns of Wafer
in the Brain, containing Cases successfully treated, with
Practical Illustrations of the Doctrines therein inculcated,
and some Observations on the Functions of the hitestines as
connected with a Morbid Action of the Digestive Organs.
By G. D. Yeats, M.D., Fellow of the Royal College of
Physicians, London; of the Royal Medical Society, Edin¬
burgh ; Honorary Member of the Dublin Society, and of
the Historical Society of New York ; late Physician to the
Lunatic Asylum and Infirmary of the County, and Physi¬
cian to his Grace the Duke of Bedford.

It will have been perceived that from the commencement
of our labours as critical reviewers, we have ever been careful
to oppose ourselves to extravagant notions and exclusive
views, whether of a chylopoietic, cephalic, or hepatic nature ;
and we are not sure whether the respectable author now
before our bar of judgment will see with much pleasure tne
announcement on the cover of the liErosiTORY, that Iiis tract

^94

Aiialylical Mevkzv.

is among the number of noticed books. Supposing us not so
fundamentally orthodox as he could desire, he may anticipate
in the present instance censure in place of praise, and imagine
that we take up his pamphlet merely for the opportunity it
afford us of further criticising the intestinal mania of
modern medicine.

Such, however, we can assure Dr. Yeats, is not the motive
by which we are actuated in reviewing this Appendi.x to his
former Tract on Hydrocephalus. We may, indeed, be dis¬
posed to consider that our author is rather too deeply imbued
with digestive notions in his pathology of hydrocephalic pro¬
duction ; and somewhat too little disposed to admit that
hydrencephalic derangement, whether more decided, or more
obscure, more acute or more chronic, may and does often
originate in and about the bead itself, the disturbance in the
alimentary canal being rather consecutive and consequent,
than primary and producing; yet we conceive at the same
time that a considerable degree of credit is due to him for
having opposed himself to the vague assumptions of some
hepatic theorists, and stamped a character of more decision
and dehnitiveness upon an enunciation which is too often
used with such a laxity of signification as almost to amount
to plain no meaning,” viz. ‘‘ a disorder of the digestive
organs.”

it w'as our good fortune to he present during the very inte¬
resting and instructive lectures which Dr. Yeats delivered
before the College of Physicians (or rather in their rooms), on
the topic of duodaenal affections ; and we were particularly
gratified by the pathological view's which the Lecturer took of
derangements connected especially with the locality and
functions of this and other important portions of the intestinal
tube, more particularly -with the distinctions which he was
careful to point out, as necessary to recognise not only in
theory but in practice between actual and mere apparent and
secondary disorders of the liver and stomach. We shall hope
to see these discourses, or the substance of them, made more
public at some future time, when an opportunity will be
afforded us of calling our readers' attention more closely to
these subjects : for the present w e shall be excused for just
hinting, backed as we are by the respectable authority of our
author himself, that calomel and hepatic excitants are often
administered under an empirical and superficial notion of liver
derangement, when the actual disease is both in its scat and
nature different from the suspected one ; and when purga¬
tives, if they are useful, prove so, upon prindples that are
not exactly the same as is often conceived by their exhi¬
bitors.

295

Yeats on Htjdr'enccphaliis.

Calomei, we verily believe to be, when judiciously admi¬
nistered, the most beneficial medicine that pharmacy has
supplied to the Physician ; but that it is many times admi¬
nistered in too indiscriminate and empirical a manner is like¬
wise in our judgment an unequivocal truth ; and to such
Practitioners as consider it' endowed with cathohcon virtues,
as well as on all occasions freely admissible both in chronic
and acute malady, we recommend a due consideration of the
following very sensible remarks and strictures of Dr. Yeats : —

“ When the digestive organs are oppressed by an accumulated
load of faeces, and a consequent inactive state of the colon, purgatives
are usuallyadministered,and occasionally repeated when thisoppressed
state, arising from the same cause, occurs ; and from the immediate
and sensible relief obtained by unloading the lower intestines, no
object is looked for, other than this effect,- 'i'his is a delusive secu¬
rity, and it is the error to which I wish much to awaken attention :
for it is not enough to have relieved the intestines of an unusual load;
diseased secretions^ to which constipation and irregular intestinal
actions have given rise, must be altered ; the intestines must be gra¬
dually and healthily excited^ otherwise the morbid condition, relieved
by the operation of the purgative, particularly under improper diet,
soon recurs, and that dangerous irritation of the digestive organs, so
much to be deprecated, supervenes.

“ The very operation of the purgative too, particularly when
active, is calculated to produce this quiescent condition of the intes¬
tines, as every one knows who has ever taken a purgative, from the
costive state which most commonly ensues. An actite dose of calo¬
mel, the medicine usually had recourse to, produces this consequence
more than any other medicine, as far as my experience goes, 'fhe
immediate effects are, undoubtedly, more lively spirits, with salutary
sensations ; but these continue only for a day or two, while the mov¬
ing impression remains upon the intestines, and while the secretions
temporarily excited are poured into them ; the torpid state soon re¬
curs with the glandular quiescence resulting from the previous preter-
naturally excited state, and languor and lassitude prevail.

“ A purgative dose of calomel has appeared to me, very frequently,
to produce this semi-paralytic state of the abdominal viscera; it is
then repeated at intervals to remove this uneasy languor, till their
tone is materially affected. I am satisfied from facts which have oc¬
curred to me in practice, that in certain irritated states of the digestive
organs, calomel has caused a very unfriendly impression on the nerves
of the intestines, so as morbidly to affect, and prove painfully inju¬
rious to the brain. The kind of purgative becomes therefore a
matter of importance in many morbid conditions of the digestive
organs.”

We cannot find room for any of Dr. Yeats’s cases, or we
.should gladly transcribe one or more of them : they all go to
the establishment of his favourite principle, that a tor()id state
and irregular aetlon of the first passages, il suflered lo exist

29G

Analyiicai Review.

for a long time without interruption, vyIU be likely to lay the
foundation for that kind of syinpathetic irritation in the mem¬
branes and substance of the brain which eventually, and often
without prior suspicion, breaks out into that formidable and
frightful condition of this organ or its meninges, which authors
have agreed to call h)’dro or hydrencephalus : a position and
principle which, if not carried too far, we are equally ready
with our author to subscribe to, heart and hand. But we must
be permitted to repeat our convictions, that the encephalic
affection is often the primary link in the chain of perturbed
functions, and that constipation and its consequences are in
very many instances the first to be noticed, while they are
th e second to exist.

Dr. Yeats will not be displeased to see his name coupled
with a Physician who lias recently acquired much celebrity :
we shall not, therefore, apologize for closing the present
article with an extract from Dr. Armstrong on puerperal
fever, that contains some matter bearing upon the present
subject, which, liowever obvious, is sometimes overlooked,
when the optics and understanding are dazzled and warped
by favourite principles and particular practices.

“ Erasistratus confidently maintained, that most purgatives altered
the nature and colour of the alvine evacuations; and though this
remarkable fact has been disregarded in modern publications, where
purgatives are constantly recommended, yet it is familiar even to
nurses. Calomel often changes the stools to a greenish or dark
brown colour, and in fever not unfrequently produces , those glary,
oily dijections, which some have erroneously supposed to be pathog¬
nomonic of hydrocephalus when they occur in children: indeed the
nature and colour of the feces are so varied by calomel, as to render
it highly probable that some portion of it is decomposed in the bowels,
either by the bile, or by other secreted fluids. The sulphate of mag-r
nesia tends to darken the stools, as likewise all prescriptions which
contain sulphur: the infusion of senna, too, has a similar effect, and
even aloes when given in solution; but rhubarb renders the stools of
a deeper red than natural, and castor oil generally shows them as they
really- are, while magnesia makes them lighter. These few hints are
only given in illustration of the doctrine which might be supported by
many others ; and if it were necessary, it also might be easily proved,
that drinks and diets contribute in like manner to give peculiar tinges
to the stools, which, even when passed in a natural state, are dark¬
ened by exposuie to the air. Now that purgative medicines are so
much resorted to in almost all diseases, whether acute or chronical,
these suggestions are only thrown out to caution the inexperienced
against their indiscriminate continuance : for it has almost become an
admitted principle in therapeutics, that we shotild continue to purge
less or more while the stools remain unnatural ; and yet it will be
readily understood how erroneous that principle may be, since the very
medicines exhibited may be the cause of the morbid evacuations,”

Thoinson’s Lo}tdon Dispensaton/, 297

We shall only add, that the cases contained in Dr. Yeats’s
tract are recited with much clearness and candour, and prove
their reporter to possess much of both pathological discern¬
ment and therapeutical tact.

The London Dispensatory, By Anthony Todd Thomson,

F.L.S., Member of the Royal College of Surgeons, &c. 8cc.

Second Edition, London, 1818. 8vo. pp. 820.

The original compilers of pharmacopoeias and dispensa¬
tories have been actuated by two very different motives. One
being the mutual convenience of the retailers of medicine and
of the Physicians, or to speak more correctly, the prescribing
Practitioners, so that the former may always have ready in his
apotheca or shop, the drugs and those compound medicines
that require time for their preparation, which the latter may
be likely to order. The other motive which has led to the
publication of pharmacopoeias has been that fondness for
municipal regulations, and minute rather than general legis¬
lation that is so prevalent in Germany, and from thence de¬
rived to other nations descended from the German stock. In
pursuance of this spirit of legal interference in every action,
the colleges or archiaters who have published those pharma¬
copoeias have considered themselves invested with a legisla¬
tive character, and have in consequence thereof admitted
articles into them, rejected others, and ordered certain
methods to be followed in the preparations and compositions,
as to their judgment has appeared proper; and willed that
the other Practitioners should abide by their judgment, and
use only the articles they prescribe, or take the consequences
of their disobedience, by being prohibited future practice
within the bounds of their jurisdiction.

The Pharmacopoeias published by the College of Physi¬
cians of London, at least until the year 1745, were certainly
written upon the first idea, that of convenience. In 1745,
that College imitated their brethren at Edinburgh in greatly
curtailing the number of the drugs and compounds, and in
altering the preparation of the latter. It does not, however,
appear by any documents or traditions that have reached us,
that the London College itself meant to hinder the free exer¬
cise of the Practitioner’s skill and judgment in using other
medicines for the cure of the diseases that fell under they:
care. The translators of the subsequent Pharmacopoeias,
and the commentators on them, have indeed endeavoured to
inculcate this opinion by oblique insinuations, and the denial
of any virtues to those substances which have been omitted

VOL. XJ. — NO. 64. 2o

298 Analytical lietnezi\

in the successive revisions and alterations which the Phaiina-’
copoeia has since undergone.

These translators and commentators who have thus endea¬
voured to inculcate that idea which the liberality of the Lon¬
don College itself would probably reject as dishonourable to
themselves and to their Fellow-practitioners, have not ad¬
verted to the difference between practising in commercial
cities and in rural villages. Merchants import foreign drugs
into the former, and use all the arts of trade to promote their
sale, to the prejudice of the native productions. The pre¬
scribing Physicians are led to order them because thCy are
more certain of their being found in the compounders* shops
than the others ; and this preference, in like manner, leads
the dispensing Practitioner to employ them as having them at
hand for use in their quality of compounders : until in com¬
mercial cities, the indigenous productions are left entirely to
the use of the amateur or self-practitioners, who are unbiassed
in their judgment by any consideration of convenience ; or a
few professional Practitioners who have studied the old au¬
thors, and acquired a fondness for their modes of practice.

Th is preference for foreign drugs naturally passes into the
Pharmacopoeias published in the commercial cities; and
although they serve as inventories of the resources of the
medical art which are most usually to be found in the cities
where the Pharmacopoeia is published, yet the country Prac¬
titioner who should neglect the medical productions of his
neighbourhood which obtrude themselves upon his view, nay,
perhaps, even give him trouble to eradicate from his grounds,
would be justly accused of ill husbandry, and a lamentable
want of economy. It is to be feared, however, from the neg¬
lect of medical botany among those students who frequent
the medical schools established in cities, that this is too often
the case, and that the country Practitioner frequently pur¬
chases at a dear rate a foreign drug, adulterated perhaps to
half its weight of some inert article, the operation of which
may be produced by some rampant weed which overruns his
garden.

This work, then, of Mr. A. T. Thomson, as it contains only
the articles mentioned by the London, Dublin, and Edin¬
burgh Colleges, is, of course, adapted only for dispensing
Practitioners in those cities, (who are not at the same time
engaged in the retail sale of medicines, which would oblige
' them to keep many articles not mentioned by him): for these
it seems a complete work. Being intended as a book of
reference, it can scarcely be expected that a reviewer should
read it completely over; but from a perusal of such articles
as appeared likely to yield a fair specimen of the whole, it

Mac Keiizie on Lachrymal Diseases, 299

seems to be executed with sufficient care. If we except the
general idea that the College lists contain the whole resources
of the medical art, and the admixture of the compositions of
the thr ee Colleges, which is the fertile source of confusion,
the only other fault that might be found with the work, taken
in general, is that of redundancy ; under which head may be
ranked the botanical description of the plants which yield
many of the foreign roots, barks, &c., but which are not, nor
never can be naturalized in these islands, especially as the
drugs as sold to the apothecaries are frequently a mixture of
the produce of several different plants ; the detail of the mi¬
nerals from whence the metallic substances whose compounds
are used in pharmacy are extracted ; and the substitution of
descriptions for characters in respect to the few indigenous
plants that are noticed. When we consider how frequently a
work of this kind forms the entire medical library of a dis¬
pensing Practitioner, we are not disposed to criticise a fault
of this kind too severely ; although this very redundancy, by
increasing the price of these works, may be one cause that
these Practitioners, contenting themselves with their own
experience and a dispensatory, neglect the acquisition of
pathological and therapeutic works; the want of which, how¬
ever, can never be properly supplied by any others.

—

Essay on the Diseases of the Excreting Parts of the La--
chrymal Organs. By William Mac Kenzie, Member
of the Royal College of Surgeons, of the Medical and
Chirurgicai Society, and Lecturer on the Anatomy and
Diseases of the Eye,

Fistula lachrymalis, like white swelling of the knee-joint,
is often made use of as an empirical watch-word to conceal
ignorance or save the trouble of further inquiry ; and we
verily believe that much mischief has often been occasioned,
especially in country districts and situations remote from
professed oculists, by students from our hospitals and medical
schools thinking it only necessary to take with them into
service and practice some very general and outline notions
on the subject of lachrymal diseases. We are pleased to see
a change in the tenor and complexion of modern teaching in
reference to these particulars, part of which may be attributed
to foreign influence ; for by the greater facility with which
continental communication is now effected, the double ad¬
vantage is afforded us at once of witnessing what our neigh¬
bours are doing in the way of minute anatomy and surgery.

300

Analytical Review.

and of being stimulated by their example and success into
the same or greater exertions.

The writer of the tract, the title-page of which we have
just transcribed, has, as before noticed, remarked, that “as far
as England is above France in a knowledge of this department
of surgery (the diseases of the eye), so far at the present is
Germany above England*.^’ Whether Mr, Mac Kenzie shall
make good this assumption remains to be shown ; but at any
rate the position itself is a sufficient proof that our German
brethren have not been idle.

The present small volume is avowedly “ the first of a series
of Essays upon the principal diseases of the eye, in wffiich the
author proposes to present to the reader an abstract of the
most valuable works which have lately appeared abroad, and
especially in Germany, upon that subject, together (he adds)
with such observations as reflection upon what he has seen
in practice may suggest.”

We must confess, that as far as the present specimen goes,
w^e do not discover a great deal more than what Pott and
Ware, and others of our own countrymen had already taught
us : as, however, the distinctions pointed out between “ dis¬
eases of the excreting parts of the lachrymal organs” are con¬
fessedly important; and, as but just now hinted, too little
attended to in practice, we shall aim at abridging the abridg¬
ment before us; pledging ourselves to a continuation of the
same proceeding in reference to the future volumes which our
editorial and annotating author may, from time to time, send
forth into the world.

Mr. M. treats of lachr3unal diseases in the following order:
— 1st, Of wmunds of the lachrymal canals. £d, Erysipela¬
tous inflammation of parts covering the lachrymal sac. 3d,
Acute inflammation of the excreting parts of the lachrymal
organs. 4th, Blenorrhoea of these parts. 5th, Stillicidium
urinse. 6th, Fistula of the sac. 7th, Caries of the os unguis.
8th, Relaxation of the sac. Qth, Mucocele of this part.
10th, Obstruction of the canals. 11th, Obstruction of the
nasal duct.

FVe shall just remark previous to giving a slender analysis
of the several chapters under the above arrangement, that we
think Mr. Mac Kenzie and his German prototypes are, like
other systematics, a little too much disposed to abstract divi¬
sions. We do not question that each and every one of the
above affections may exist exclusively of any other; but that
one or more of the states ma}^ be combined, is a fact that

Sec our General Review, Vol. X. page 505.

301

M ac Kt'nzie on Liachrijtnai Diseases.

ought to be especially recognised by those who take upon
themselves the task of delineating occurrences as nature pre¬
sents them.

Under the first head, viz. wounds of the lachrymal
canals,” our author, after alluding to the dubious prognosis
which must he given in lacerated wounds of these parts, states^
that Professor Schmidt had the good fortune to cure in eight
days, without the slightest stillicidium or ectropium a
wound in the nasal angle of the eye, in which the patient

had the under eyelid torn away to the length of half an inch
from the upper.” The indications of treatment in these cases
are obviously to bring the separated parts into opposition,
and then to keep them so.” The latter is somewhat difficult.
The patient is to be directed to shut his eyelid as seldom
as possible during the first four-and-twenty hours, and
the slip of adhesive plaster employed to keep the parts in
contact, must be applied by one end to the cheek or temple,
and by the other to the forehead or nose : this length being
requisite in order to insure against its displacement.

An inflammation of the cellular membrane covering the
sac, IS too apt, by superficial observers, to be mistaken for a
complaint originating and existing in the sac itself. In the
first stage this must be distinguished from other disorders by
the erysipelatous and diffusive character of the disorder.
Erysipelatous inflam ihation is especially apt to extend
itself to the upper eyelid, and sometimes over the whole of
the face.

In the second stage, this inflammation seldom comes to a
distinct suppuration. The redness of the part increases, but
the heat and pain diminish, and an oozing fluid renders the
skin moist and slippery. When the inflammation has been
more than commonly severe, the lachrymal sac at the com¬
mencement of the second stage, becomes completely filled
with mucus, which can always be discharged by pressure ; a
real suppuration takes place, and the matter collecting be¬
tween the integuments, at length makes its way outwardly.
Now it is that the appearance of the parts is apt to impose
upon a superficial observer; and the sac has been sometimes
opened under the notion of a real fistula lachrymalis. Occa¬
sionally, indeed, this exit of matter is by the way of the sac
itself; but it is still of much importance to distinguish the
case from one in which the purulent matter that fills the sac
is the result of inflammation, or the lining membrane of the
sac itself.

The mode of ascertaining in the case before us whether the
purulent matter has actually penetrated the sac, is to press
very slightly with the finger upon the upper part of the sac,

302

Analytical Review,

which will produce a discharge from the external opening,
not of pure pus, but of pus mixed with mucus, and also with
tears, if the lachrymal canals have recommenced their func¬
tions. When an abscess has thus formed after erysipelas,
there is always more or less danger of the case terminating
unpleasantly^ The suppuration may include the canals, and
either entirely destroy them, or render them unfit for perform¬
ing their function. The consequence will be an incurable
stillicidium. The suppuration may destroy the ligamentous
layer of the lower eyelid, penetrate into the sac, and even
disorganize it to such a degree, that after the parts have
healed, its cavity shall have entirely disappeared. Even when
the sac is left entire, its sides, if the canals have been de¬
stroyed, must be made to adhere by artificial means, in order
to prevent the formation of a mucocele.’^

Cold applications, purgatives, and if the inflammation be
very severe, blood-letting from the arm, constitute the treat¬
ment of the first stage. Our author also recommends an
emetic of the tartrate of antimony in some cases of severity^
W armth, gentle diaphoretics, and a dry linen compress, are to
be had recourse to at the commencement of the suppurative
stage. A warm poultice of bread and milk ought to be ap¬
plied if there are symptoms of a subcutaneous abscess ; and
w^hen that becomes decided and pointing no time must be
lost in opening it, lest the matter make its way into the sac.
When this last has happened, tepid water, mixed with a little
vinous tincture of opium, is to be gently injected through the
fistula once a dayq and a small quantity of lint, dipped in
this tincture, to be introduced into the abscess, but not pushed
so far as to enter the sac.”

The third affection, or acute inflammation of the excreting
parts, is marked by a swelling having the shape of a bean in
the situation of the lachrymal sac : it is, instead of being as in
the former case undefined and diffused, distinct, hard, and
circumscribed : a stillicidium is occasioned from the stoppage
of the natural passage of the tears. The nostril soon becomes
dry from the inflammation extending through the duct to the
mucous membrane of the nose ; and this extending likewise
in the other direction, the whole eye and its appendages be¬
come affected ; but still the circumscribed swelling of the sac
is to be recognised as the primary and principal feature of
this disease, which is constituted by an inflammation of the
mucous membrane lining the sac and the whole excreting
organs. This tumor, if the inflammation be not made to
subside, increases ; and at length a fluctuation becomes dis¬
tinct, and the swelling pointing in the middle, the matter
works its way through the orbicularis palpebrarum, and forms

Mac Kenzie on Lachrymal Diseases. 303

a true fistula lachrymalls. The stillicidium will now often
cease, as the inflammation has left the lachrymal canals, the
functions of which become restored, and the tears then make
their way through the external opening with the pus. In
treating this affection during the first stage, we are to be
guided by the general principles of subduing inflammation.
Cold and saturnine applications are to be used ; and in this
instance, rather than in the erysipelatous external inflamma¬
tion, leeches may be applied. When suppuration becomes
evident, the eold lotions should give wmy to warm poultices ;
and if still the disorder grows upon us, the tumor becoming
discoloured and pointing, we must open the sac in the direc¬
tion of the long diameter of the tumor. In the course of a
few days, when the matter has been evacuated, and the sac
continues hard, a poultice of hemlock and camphor must be
applied, or, what Mr. Mac Kenzie says is preferable, a roasted
onion. The hardness thus being made to disappear, ‘‘ the
wound is to be filled with a small quantity of soft lint, dipped
in the vinous tincture of opium, and the whole covered with
a piece of adhesive plaster.” If the secretion still continues
in an indolent habitual kind of manner, the lint is at length to
be covered with an ointment composed of red precipitate and
tutty (1), which should be inserted daily; and into the nasal
angle of the eye may now be dropped a little stimulant solu-^
tion (2), some of which is also to be injected through the
w’ound into the sac. When the secretion shall have sub-
sided, and the canals and nasaTductof themselves become
permeable, the external wound is to be closed, and the cure
will be effected.

The next affection of which our author treats is of a
chronic, indolent, and most commonly strumous character.
The inflammation is seldom marked or considerable in the
first stages ; but the bean-shaped tumor is here observed,
which being pressed upon, forces a muco-purulent matter
into the eye through the puncta, which are not, as in the last
case, obstructed. By giving our pressure a downward direc¬
tion, however, we shall not so frequently succeed in forcing
this matter through the nasal duct, as the permeability of this
last is more commonly suspended by the tumefaction of its
mucous membrane. This affection is one often of very long
standing ; it will sometimes almost disappear during warm and
dry weather, but returns when the atmosphere becomes cold
and wet. Our prognosis in chronic blennorrhoea must be
formed partly from the nature and degree of constitutional
affection which accompanies it. When it occasions repeated
attacks of inflammation, and a fistula of the sac is formed,
very little hopes are to be entertained of a cure. Local treat-

304

raent most, in this case especially, be accompanied by consti-.
tutional ; the digestive organs aie to be assiduously attended
to; and in some cases of much scrofulous weakness small quan¬
tities of steel will prove highly beneficial.

In respect to the local treatment it will be recollected, in
the first place, that the integrity of the puncta lachrymalia
generally remains, so that dropping fluid into the lacus lachry-
marura will answer all the purposes without the inconvenience
and probable mischief of injection. After the sac has been
emptied as much as it can be by pressure (and if this can be
effected in a downward direction so much the better), a small
quantity of a very weak solution of corrosive sublimate (3) is
to be dropped into the lacus, the patient lying upon his back
horizontally : he is to remain in this position for a quarter of
an hour, and then rise. After another quarter of an hour the
eyelids are to be carefully dried, and a little of Janin’s oint¬
ment (4) applied, with a camel-hair pencil, to the caruncula
lachrymalis and the edges of the eyelids. These operations
are to be repeated twice a day. Professor Schmidt recom¬
mends as a collyrium the undermentioned (5); and when there
is a chronic inflammation of the Meibomium glands, the sur¬
face of the eyelids must be penciled with the diluted citrin
ointment (6).

Stillicidium (the subject of the Fifth Chapter) is neces¬
sarily the result of disease in other parts, and is therefore
a mere symptom of either increased secretion from the
lachrymal gland, or of obstructed passage through the
lachrymal conduits; “ but the stillicidium now to be con¬
sidered is most frequently a sequela of inflammation, con¬
tinuing after all the other symptoms have disappeared, and is
to be regarded as a curable disease.” One cause of this is
the extreme tumefaction and relaxation of the semilunar mem¬
brane, by which the tears are prevented from reaching the
puncta ; but the most usual source of it is a sort of exhausted
and paralyzed state of the canals themselves. It will some¬
times spontaneously cease upon the setting in of warm and dry
weather, or it may be removed by the careful employment of
astringents ; solutions of one or another of which are to be
dropped into the nasal angle of the eye several times a day ;
the patient lying on his back for some minutes after the
application.

‘‘ Of Fistula of the Sac.” This also is most usually (as
may be gathered from what has been said) a consequence of
neglect or mismanagement of inflammation. While em¬
ploying the term fistula, let us not forget any part of its
import: let us recollect that it implies a narrow canal with a
small opening, the circumference of which is hard and callous.”

S05

/ Mac Kenzie ofi Lachrijmal Diseases.

The opening- in the integuments does not very often cor¬
respond exactly with the opening from the sac, but what is
termed a complicated fistula most usually occurs. If
fistula be allowed to continue for a great length of time
unremedied, contraction or even obliteration of the nasal
duct from disuse is an unavoidable consequence.” When
the fistula is complicated, the direction of the sinuses is to be
ascertained by a careful examination with a whalebone
probe ; if they are superficial, they are to be laid open with a
small bistoury quite up to the sac; if deep seated, we must
content ourselves with enlarging the fistulous opening;

after which we pass a common silver probe along the
sinus to its commencement in the sac, and then divide the
integuments immediately over the end of the probe, so as to
form a counter opening to the sinus,” through which diluted
vinous tincture of opium is daily to be injected. The sac
itself is to be treated in the manner formerly described.

Caries of the os unguis is much less frequent than was
once imagined, and it very seldom indeed takes place unless
when the constitution is embued with syphilis or scrofula; it
can only be radically combated by constitutional remedies.

The disorder occasioned by mere relaxation of the lachry¬
mal sac, presents the bean-shaped tumor formerly mentioned
in inflammation ; but it is small and not painful, and yields
easily to pressure. The cure of this disease consists in the
combination of pressure, with the application, externally and
internally, of an astringent fluid. The compression must be
carefully applied, constantly continued, and gradually in¬
creased.” Machines invented for this purpose will not apply
with effect. Graduated compresses are then to be preferred;
over these a firm leather pad, of a proper form, is to be
placed, and the whole is to be supported by a narrow roller
passing round the head.” These compresses are to be con¬
stantly kept moist by an astringent solution ; a small quantity
of the same fluid is likewise to b6 dropped into the corner of
the eyej so as to be absorbed by the puncta. All , injecting
and probing is to be carefully avoided.

By the term “ mucocele” Mr. Mackenzie means to desig¬
nate that state of the sac which is sometimes occasioned by a
Surgeon precipitately healing an abscess, without ascertaining
whether the canals and nasal duct are properly pervious.
Should an obstruction remain in these, what will be the con¬
sequence? The natural secretion of the mucus from the
internal surface of the sac will go on ; but as it can neither be
diluted by the tears discharged into the nose, nor completely
reabsorbed by the mucous membrane which secretes it, it will
accumulate, and the anterior part of the sac will be again
' VOL. XI, — NO. 64. 2 R

306

ylnal^tkal Review.

gradually distended into a tumor.” in this case the tumor
after a time becomes exceedingly large, and of <i bluish
colour, and it has been considered, by ignorant Practitioners,
to be of a cancerous nature. Its cure is to be accomphsned
opening the sac, and clearing out the accumulated mucus
by injections, by the introduction of a small pair of forceps
and a whalebone probe moved about^ in the sac, should the
mucus be so inspissated as to require these forcible methods
of dislodgement. Having emptied the sac, a small quantity
of soft lint is now to be placed within the lips of the wound,
arid covered with a piece of court plaster. On the next day
an examination must take place as to the degree and kind of
obstruction in the canals or duct.

The lachrymal canals may be obstructed from the pre¬
sence of inspissated mucus, from tumefaction of their lining
membrane, or from absolute obliteration in a part, or
throughout the whole of their extent. Anel’s probe is to be
used in the examination, and if we can pass it freely into the
sac, through the canals, there is sufficient evidence that they
are not obliterated. If there be mucus in the canals, the
probe will dislodge it, and restore the passage into the sac;
but when the obstruction arises from tumefaction of tiie
mucous membrane, the temporary dilatation immediately
ceases upon withdrawing the probe. Here we must be very
w^ary of using the probe, lest we increase the evil it is our
aim to remove. Sometimes doubt as to the real state of the
canals still exists, in which case it will be expedient to drop
a coloured fluid into the corner of the eye, and this, if the
passage is free, will not fall down the cheek, but will imme¬
diately be seen at the opening of the sac. Some authors talk
of making new puncta and canals in case of complete oblitera¬
tion of the natural passage, and consequentincurable stillicidium :
these, however, are mere pen and ink operations, and are safer
upon paper than upon the patient. In these cases mucocele
of the sac is to be obviated by applying lunar caustic to the
lining membrane of the sac, so as to excite a degree of in¬
flammation, and then, by moderate compression, endeavour to
secure the obliteration of its cavity.

“ Of Obstruction of the Nasal Duct.” The examination
of the nasal duct, equally with that of the lachrymal canals, is
to be instituted before healing up any artificial opening or
fistula of the sac ; it is also to be instituted on the day after a
mucocele has been laid open.” A whalebone probe is the
best instrument for this purpose ; and it must not be con¬
cluded that there is complete obliteration of the duct merely
because this meets with resistance : a diseased state of the
mucous membrane may prevent the passage of the whalebone^

S07

Mac Keiizie on Lachnpnal Diseases.

and then a small silver probe may be attempted to be passed.
1 he duct may be obstructed at three points ; first, at its very
commencement from the sac; secondly, in the middle; and,
thirdly, at the termination of the conduit into the nostril.
When we have succeeded in passing the whalebone or silver
probe, the next object is to restore the duct gradually and
progressively to its natural caliber. Our author supposes
three states of an obstructed duct, after attempts at passing
the silver or whalebone probe ; first, that in which the object
has been easily affected ; secondly, that in wdiich it is still
possible by perseverance to effect it; and, thirdly, that in
which it is impossible to pass the probe through the natural
caliber of the duct. In the first case, a nail-headed silver style,
of about an inch and a half long, is to be introduced, which
is to be followed by others progressively increased in thick¬
ness, or by catgut : when the latter is used, five or six inches
are to be introduced, so as it may be drawn forward through
the nose by the patient himself ; the superior part being
coiled up, enclosed in a piece of linen, and fastened under
the hair of the forehead. Into. the opening of the sac a little
lint is laid, and over that a piece of court plaster applied.
After two hours the patient is to try to bring the inferior end
out of the nose, with the blunt end of a knitting needle ; he is
to shut his mouth and the opposite nostril, and cause the air
to descend through the affected part. Having succeeded in
obtaining the end of the catgut, he is to draw it out of the
nostril, and turning up its extremity by the side of the nose,
then fix it by a slip of court plaster. On the following day
the lint is to be removed from the sac, and a solution injected
by the side of the catgut. The coil is now to be loosened
from the forehead, a fresh portion undone, and being besmeared
with an ointment, it is to be drawm into the duct. The
inferior portion answering it to be cut away, and this pro¬
cess repeated daily until the catgut is consumed. Another
piece of catgut is now to be introduced, but before that is
done, the permeability of the duct must be ascertained by the
injection of a coloured fluid, and the processes must be con¬
tinued until the passing of the injection in a full stream.
The besmearing ointments and injections are to be more or
less stimulating, according to the nature and degree of
obstruction. If styles are preferred for restoring the nasal
duct, the process is to be conducted very gradually, and the
instrument continued for several months. Our author does
not consider the patient quite safe till a coloured injection
flows in a full stream through the duct for fourteen days suc¬
cessively. Then, and not till then, the external wound is to
be closed.

S08 Analyikal Review^

In the second case, that of not being able to pass the probe,
it is to be left sticking in the passage till the next <3ay, fasten¬
ing it to the forehead by a proper bandage, and closing the
opening with lint and court plaster. Gentle pressure is then
to be used daily for a week, turning the instrument on its axis
at every trial.

Should the case after all turn out to be of the last order;
namely, that of total and invincible obstruction, perforation is
to be had recourse to, and on this head we shall conclude our
analysis, by presenting our author’s directions in his own
words : —

If in our examination of the nasal duct we have discovered that
part of its extent is obliterated, recourse is to be had to perforation by
means of a small triangular or trocar-shaped probe. If the extent of
the obliteration be inconsiderable, and consequently be placed near
the opening of the duct into the nose, this perforation may be per¬
formed with confident hope of success. The sharp point of the probe
is to be covered with a little bit of bees* wax, that it may not injure
the duct before it reaches the obliteration. A few drops of blood flow
from the nose as soon as the perforation is completed. We imme¬
diately withdraw the probe, and introduce a small silver style. This
remains for a day or two, and then we commence the very gradual
dilatation of the duct which has already been described.

If a considerable portion of the duct, or even its whole extent be
obliterated, we ought to perform the same operation ; and we do this
with at least equal hopes of success as if we perforated the os unguis.
It is true, that Nature, constantly tending to destroy every thing
contrary to the organic system which she has adopted, would pro¬
bably close the new passage, after our dilating instruments were laid
aside. This is the only case, then, in which the introduction of a
metallic tube into the duct, to be left for life, is at all defensible. A
gold or silver tube, not more than an inch in length, and presenting an
elevated ring surrounding the middle of its external surface, is to be
pushed down into the dilated passage which we have formed. The
surrounding substance will contract upon this tube, so that it will be
much less liable to be displaced than when a similar instrument is
passed into the natural caliber of the duct."

The following are the formulae used and referred to by Mr.
Mac Kenzie, He suggests that the common citrin ointment
is improperly prepared, and he proposes a subnitrate of
mercury in powder mixed with common white ointment in
lieu of it.

FORMULA.

No. 1. — Unguentnm e Mercimo Prtedpitato Riihro et Tutia.

R Butyri rccentis insulsi, f

Mercurii prajcipitati rubri, gr. x.

TutiiE prcparatjc, gr, vi,— M,

ooo

Hallaran on Insanity.

'No. 2. — Solutip Ijapidis Divini.

R Aeruginis,

Nitri puri,

Aluminis, utriusque,

Pulverisata llquefiantiii vase vitreo in balneo arenas. LIquefactis adde
Camphor® trit®, 3ils. — M.

Refrigerata massa servetur sub nomine Lapidis Divini.

R Lapidis Divini, gr. x — xx.

Aqu® Distillat®,

Solve, et colo. Colato adde
Vini Opii, 3i — 3ii.

Aqu® Rosarum, ^iv. — M.

No. 3. — Solutio Mercurii Sublimati Corrosivi.

R Aqu® Rosarum, ^iv.

Mercurii sublimati corrosivi, gr. R, — gr. i, _

Mucilaginis purissim®, 3i.

Vini Opii, 9i. — M.

No. 4. — Unguentum Janini,

R Butyri recentis insulsi, 3R.

Mercurii precipitati albi, gr. xv.

Boli albi, 9i, — M.

This ointment may be increased in activity by the red bole, or by
the Armenian.

No. 5. — Collyriiim Acidi Nitricl,

R Aquee Rosarum, 3vi.

Acidi Nitrici, 9i.

Alcoholis, 3i. — M.

IV.

Practical Observations on the Causes and Cure of Insanity,
By William Saunders Hallaran, M.D., Physician to
the Lunatic Asylum of Cork, &c. Second Edition, ma-
' terially enlarged and amended. 1818.

We take up this book rather with a view to recommend
its perusal than to analyze its contents. In every page are
found indications of much good sense, discriminating judg¬
ment, and candid feeling. Whether the former edition of
this volume may have come under the critical cognizance of
our predecessors in the editorial management of the R epo¬
sitory, we have not just now the means of ascertaining, nor
do we know any thing with respect to the quantum and kind
of additional matter which the present edition possesses : it is
for us, then, to speak of the book merely as we find it, and it
would be gratifying to our best feelings for us often to meet
in medical works with so little to censure, and so much to
praise.

With respect to Dr. Hallaran’s distinction of insanity into
mental and bodily, we do indeed feel a little hesitation in
allowing the correctness of his inferences. Ear be it ever

310

Analytical Review.

from us to allow the legitimacy of those assumptions which
resolve every thing into matter and consequent necessity ;
which tend to the destruction altogether of moral responsi¬
bility; which make virtue to consist of an harmonious cor¬
respondence between nerve and blood vessel, and crime to be
constituted of a hurried circulation^.” But still we think it
may be made out almost with the force of absolute demon¬
stration, that in every state of mental hallucination lliere must
be some bodily change either original or induced: indeed
Avhen the aberration of mental feeling more obviously pro¬
ceeds from what I3r. IL would deem mental causes, such
causes could not per se possess the powder of thus deranging
the understanding, were they not met as it were, and assisted
by the prior condition of the bodily organization. But we
must not give reins to our disposition to pursue this theme,
more especially as we have just declared off from a regular
critique of the volume now under review. We shall merely,
therefore, point out briefly one or two of its prominent fea¬
tures, and refer to the book itself for more ample particulars.

Dr. tlallaran very justly animadverts on the inconsistency
of allowing a hereditary' predisposition to insanity, and at the
same time denying that it is absolutely an hereditary dis¬
order. Disposition to disease is, in fact, disease ; since the
latter can in no case be absolutely induced without exciting
sources. When treating of the prognosis, our author evinces
much acumen and observation. We shall extract one or two
remarks on this head. “ In all cases of insanity,” says Dr. H.,
‘‘ strictly so called,, w'here the first accession had been abrupt,
and equally so in its departure, a renewal within three or four
weeks at the furthest may be confidently expected, A per¬
fect recovery from insanity is never to be expected when the
symptoms have suddenly given way. Should catalepsy follow
upon insane paroxysms, the complaint is most commonly
fixed for life. Females (Dr. H. says) appear to be exclu¬
sively liable to catalepsy.” In this particular our observation
does not entirely coincide with that of Dr. H. : a melancholy
case of a male subject is now fresh in our recollection, in
which catalepsy, or at least a state very nearly allied to it,
was one of the most conspicuous characteristics of the malady.
Epilepsy and paralysis ushering in the disorder, or alternating
with it, invariably mark an extreme ujalignity. Where this
connexion is established, the Practitioner will effect but little
to his purpose.”

“ There is no general proof more indicatory of stability in a per¬
son recently recovered from a paroxysm of insanity than his running

Quarterly Review, article insanity and Madhouses.

311

Hallaraii on Itisanilij,

rapidly into a state of corpulency; nor is tlicre any appearance less
encouraging than groat emaciation in the paroxysm, and the conti¬
nuance of it during the interval. A voracious appetite usually ac¬
companies this state of emaciation, and for the most part attends those
patients who degenerate into dementia or idiotism.”

When treating on the pathology of insanity, oiir author
very properly objects to those principles which assume that
increased circulation of blood through the vessels of the head
is invariably present, or that when existent snch inordinate
impetus explains the whole of the phenomena connected with
mental aberration. Many opportunities (says ])r. H.) we
have of observing the existence of mania entirely independent
of increased action of the heart and arteries in any direction^
and occasions of unusual impetus in the circulation do fre¬
quently occur, even towards the head, without producing any
of the calamities here referred to.^’ Let the vascular Patlio-
logist look well to these remarks. Our author, however, is
not, we think, quite so happy in his own assumptions as he is .
in objecting to those of others. I have long (he says) en¬
tertained the opinion that in whatever degree the arterial
action is exerted, there follow's, at the same time, a torpor of
the venous system, effecting a diminution of the equilibrium
of the circulation so essential to the preservation of health.’’
Dr. 11. ought to have recollected that this want of balance
between the arterial and venous sj^stem of vessels, as w'ell as
increased activity of the former, often occurs without bring¬
ing with it any marks of deranged intellect ; and that there¬
fore such state cannot with propriety be predicated as pathog¬
nomic of the insane state.

Venesection, as a general remedy in maniacal affections,
our author objects to ; ^Mt is (he says) not often called for,
and, unless under the most urgent circumstances, is^^not even
admissible.” While perusing this part of the volume we had
marked down an omission in the author in not noticing, as
one of the arguments against copious, ^and indiscriminate
blood-lettiiia: in these cases, that the blood when drawn
does not display the inflammatory crust. This particular,
however, we find pointed out in a subsequent page, wlicre
Dr. H. again insists upon the importance of recollecting
both in pathology and practice, that insanity is not phre-
nitis.” Emetics Dr. H, highly approves of, but cautions
against expecting too much from them. He prefers the tar-
tarized antimony to all others, “ as being tasteless, more
soluble in water, and most certain in its effects.” Purga¬
tives are recommended, either in conjunction with emetics, or
alone; and very often, he tells us, the propriety of a smart

.112

Analytical Revienh

purge full}" indicates itself, previously to any attempt to affect
the stomach by emetics. The circulating swung, we are told in
the practice of Dr. H., has occasionally produced very essential
benefits, and the foxglove is lauded as possessed of very high
powers in some cases of insanity; the. utility of which, in our
author’s opinion, is referrible not to its sedative, but to its
stimulant operation, The singular benefit to be obtained
from a judicious use of digitalis, in real maniacal cases, has
become so fully established in my mind (says Dr. H.), that
where they do occur, properly adapted to its application, I am
encouraged to proceed with as much confidence in the hope
of recovery, as I would in cases of lues from the mercurial
influence. In the latter, however, we are occasionally
baffled, as well as frequently in the former, in which no
human power could supply a remedy.” We are disposed to
suspect, in reference to this medicine, a little favouritism on
the part of its encomiast. If foxglove were as antimaniacal
as mercury is antivenereal, it would surely by this time have
come into more general use, both in public and private
practice. Opium is spoken of with commendation: in the
perfectly quiescent state of insanity, where all febrile heat
and turgescency of countenance have been subdued, opium will
be found, separately or combined, of infinite utility, particu¬
larly where the mind remains defective through debility, and
is prone to dwell on real or imaginary misfortunes.” Cam¬
phor, Dr. H. has not much confidence in : as a palliative,
however, (he says) it may be entitled to some credit.” When
blisters are applied, it ought to be after the febrile excitement
is subdued, and they are better, in our author’s judgment,
placed at some distance from the head, than upon the scalp.
Of mercury Dr. H. speaks in the following terms : — Al¬
though I cannot decide favourably on the specific properties
of mercury in this disease, I am far from limiting them to its
purgative quality : the equable and general stimulus which it
affords to the system at large, by an evident action on the
absorbents, has taught me to entertain a high opinion of its
utility as a preparative for digitalis.” The warm-bath is
spoken of as, in the general w^ay, more applicable to the state
of convalescence than during the actual presence of the dis- '
order ; on the contrary, cold affusion and the shower-bath are
more appropriate in the first stage of mania.

Here, however, we must stop ; insensibly have we been led
beyond the intentions with which we commenced the present
article. The subject of insanity we may probably find occa¬
sion at a future time to take up, in a more general and
enlarged manner, and vve may then have to refer to Dr. Hal- .

313

Braude on the early Symptoms of Graveh

Jaran’s, in conjunction with some other treatises on the very
interesting topic of mental hallucination. We now, there¬
fore, bid farewell to the present intelligent and candid writer,
with every feeling of respect and admiration.

PART IIL

SELECTIONS.

Observations on the Medico-Chemical Treatment of Calculous

Disorders. By W. T. Brande, Sec. R.S., &c.

- -

{From the Quarterly Journal of Science and Arts.)

[Continued from page 233.] '

Having now considered the nature of the white sand, and
the mode of treatment to be adopted in regard to it, we may
advert to the composition of the red sand or gravel, and to the
means which are most effectual for its prevention and cure.
Here> as in the former case, distinction must be made between
those cases in which the sand is actually voidedyOiiid in which
it is deposited, after some hours, by the urine, w'hich at first
w as clear. The appearance of the red sand, in the former case^
is an alarming indication of a tendency to form calculi; in the
latter, it is often a temporary symptom, of indigestion; but yet,
if it frequently occurs, means should be strenuously adopted
for its prevention.

Since the discovery that the red sand consists of uric acid,
more or less pure, and of the solubility of that acid in the
caustic fixed alkalis, these substances have been in vogue as
solvents. The important fact, however, was soon made out,
that the alkaline subcarbonates and carbonates, were equally
effectual, and less apt to disagree with the stomach than the
pure alkalis ; and as in them the uric acid is not soluble, it
became pretty evident that the benefit of alkaline medicines
w'as not rationally referrible to their solvent powers. Indeed,
where the caustic alkalis are taken, they could never reach the
urine in a caustic state, but would naturally combine with the
carbonic or other acids of that secretion.

Experience having sufficiently shown the efficacy of the
alkalis and alkaline carbonates in preventing an increased
secretion of uric acid, the first question that arises is, as to the
kind of alkali to be preferred, and the state in which it should
be exhibited.

Soda seems by common consent to be preferred to potash ;
and there can be little doubt that, although it will be most

VOL. XI.— ^NO. f)4, 2 s

314

Sdeetions,

effectual in a pure form, it is most priifleiit to use it in its
hishlv carbonated state, as it is sold under the name of soda
water; for it may be longer persevered in, and is less apt to
injure the digestive organs in that state than in any other. It
deserves remark, however, that much of what is sold under
the name of soda zoater, contains scarcely any soda, but is
merely water impregnated with fixed air ; and further, that it
is very apt to be contaminated by copper, zinc, or lead,
arising from the vessels in w'hich the condensation is carried
on. These contaminations, which are very easily discovered
by proper tests, have been adverted to by Mr. Pepys, in
his Description of an improved Apparatus for the Manu¬
facture of Soda Water, published in the Fourth Volume
of this Journal.

But, though soda water is in most cases very effectual, in
others it is certainly less so than a similar solution of potash;
and I have seen cases in which the latter alkali has dispelled
^mptoms that withstood the operation of the former. This
fact has been adverted to by Sir Gilbert Blane, in his paper on
the Effects of large doses of the Vegetable Alkali in Gravel.
(Transactions of a Society for Improving Medical and Chirur^
gical Knowledge.) He has there also proposed the convenient
method of partly saturating the alkali with lemon-juice or citric
acid, and has dwelt upon the advantages of combining opium
with it, which are certainly great, in cases attended by irritation,
or other symptoms calling for the use of sedatives.

Ammonia^ and suh^carbonate of ammonia , are alkaline reme¬
dies of considerable use in many cases of red gravel : they may
be resorted to with advantage where symptoms of indigestion
are brought on by the other alkalis; and appear to be of great
use in that form of red gravel w hich is connected with gout,
and which, in gouty patients, often alternates with fits of the
disease; the joints and the kidneys appearing to be affected
by turns.

In a paper which I communicated to the Society for the
Improvement of Animal Chemistry, in the year 1809, and
which has a place in the Philosophical Transactions for 1810,
1 have detailed the advantages 6^ magnesia as a preventive of
uric gravel ; and subsequent experience, which has been pretty
ample, completely justifies the character 1 have there given it.
I do not mean to propose it as excluding the alkalis; it is,
indeed, improper in many cases where they may be properly
employed ; but where potash and soda have been so long em¬
ployed as to disagree with the stomach, to create nausea,
flatulency, a sense of weight, pain, and other^ symptoms of in¬
digestion, magnesia may be adopted with the greatest chance
of success.

SIS

Brande o}i the earh/ Sj/mptoms oj' Gravel,

The doses of the different alkal ine remedies that have been
enumerated, and the modes of exhibiting them, may next be
briefly noticed. ^

The caustic alkalis are best taken in any mucilaginous
vegetable infusion, barley water, or water gruel, for instance ;
, and their nauseous flavour is much covered by liquorice. From
five to sixty drops of the liquor potassoi of the London Pharr
iiiacopoeia has been called a dose. From ten to twenty drops
may be considered an average dose, taken night and morning,
or thrice a day in a glass of barley water. A drachm of the
carbonate of potash, as advised by Sir Gilbert Blane, or of the
carbonate of soda, may be dissolved in two ounces of watery
sweetened with honey, and taken, during the effervescence
occasioned by the addition of half an ounce of lemon-juice,
twice or three times daily.

Soda water should be kept in the shops, single, double, and
treble; the first should contain one, the second two, and the
third, three drachms of the cry’staliized subcarbonate in the
pint ; and from one to three half pints of either may be taken
daily, as it proves agreeable or efficacious. A portion of tfie
.alkali in the strongest may be conveniently neutralized by
.adding a table-spoonful of lemon-juice to each half pint
tumbler, which renders it more palatable.

From half a drachm to two drachms of the solution of
ammonia of the pharmacopoeia may be taken in a suflicient
quantity of w^ater, but the sub-carbonate is as effectual, and
has the advantage of being administrable in the form of pills,
in which it may be united with some bitter extract; none
better than that of camomile. Twenty grains of the alkaline
sub-carbonate, and a drachm of the extract, may be made
into twenty-four pills, two or three for a dose, twice or
thrice a day.

Magnesia may either be calcined, or the sub-carbonate; the
latter is generally preferable, except where the stomach is
distended by wind, and in that case calcined magnesia should
be used. I'he dose is from ten to thirty grains of the calcined,
and from tw'enty to forty or fifty of the sub-carbonate, or, as it
is often called, common magnesia. This remedy is particularly
commendable, where tl^e alkalis have been employed for a
long time, where they excite flatulency and indigestion, or
disagree with the bowels, or where the red sand continues to
be formed even during tlieir copious use. As rnagnesia some¬
times collects in and clogs the bowels, their state sliould be
attended to during its use, and any accumulation which may
have occurred, occasionally moved off by a mild aperient, or
by tlie occasional use of acids, where they are admissible.
The case described by rny brother, in the First Volume ol this

310 Sehctioiis,

Journal, will give an idea of this effect, and point out the
requisite caution in the use of rnagnesiaf.

The ne:?ct subject of inquiry is the mode in which the alkalis
operate,

That it is not by any solvent power upon the gravel after it
is formed, is evinced by the action of the carbonates, and by
that of magnesia, which, though incapable of dissolving urip
acid, are as effectual in checking its formation as the caustic
alkalis. ^ It would appear, then, that the benefit derived from
these medicines must be principally ascribed to their action
upon the digestive organs, where, by preventing the formation
pf, or neutralizing and combining with, acid matter, it is pro^
bable that they prevent its secretion in the kidneys. Never*
theless, the alkalis undoubtedly do pass off by urine ; and in a
paper already quoted (Philosophical Transactions, 1810), 1
have detailed some experiments illustrative of this subject, the
results of which are extremely important, as connected with
the treatment of calculous disorders, for they show the danger
of administering alkaline remedies where there is a tendency
to the production of the phosphates, and the likelihood of
jprodiicing the deposition of white sand, by improperly per¬
severing in their use after the formation of the red sand has
been checked.

The above are the principal observations which have oc¬
curred to me, connected with the symptoms and treatment of
the white and red sand : the first object should be to ascertain
the nature of the matter voided ; the next, to select the most
appropriate acid or alkali, and in either case to watch care¬
fully over their effects, since the acids, after having removed
the superabundance of the phosphates, will sometimes induce
the excess of uric acid ; and nothing is more common than
the appearance of white sand during the use of alkaline
medicines.

Cases are by no means unfrequent, in which the sabulus
deposit of the urine consists of a mixture of uric acid with the
phosphates: as far as my analysis has gone, the sediment of
inflammatory disorders is usually of this kind ; it is very fre¬
quent in the urine of those persons who habitually indulge in
excess of wine ; and not uncommon in jaundice and other
affections of the liver, where a large quantity of albuminous
mucus often accompanies it. This form of the disorder
is generally alleviated by general, rather than particular treat-

* Magnesia may be dissolved in excess of carbonic acid, and
administered in the form of magnesia water, which is an excellent
substitute for soda water. Some years ago, Mr. Schwcppe, at my.
r€(piest, prepared it in this form.

317

Brande on the early Symptoms of Gravel,

nient; I mean by particular attention to the state of the sto¬
mach and bowels, by purges and by tonics. I have heard
nitric acid recommended, upon the principle of its dissolving
both uric acid and the phosphates ; and in some cases which
were under Dr. Pemberton’s care in St. George’s Hospital,
and of which'! have preserved notes, it appeared particularly
efficacious. I am, however, induced to refer its efficacy
rather to its tonic, than its solvent powers. Indeed, it cannot
be too often repeated, that in all cases of urinary sand and
gravel it is necessary to pay particular attention to the general
state of the patient’s health, and along with the medicines
usually called solvents, to pursue a tonic and invigorating plan
in respect to the stomach.

The best diet for those who suffer from excess of uric acid,
jand who form red gravel, has been a subject of discussion with
most writers upon this disorder, and animal and vegetable food
has been alternately extolled and recommended. 1 should not
hesitate in these cases to recommend the adoption of a
vegetable diet, for, independently of the valuable observations
of Dr. Wollaston, connected with the subject, (Philos. Trans.
IB 10)* I have known a week’s abstinence only from animal
food relieve a fit of uric gravel,, where the alkalis were of
little avail ; and in other cases the same plan has been most
successfully adopted : at the same time it must be remembered,
that if flatulency and other stomach symptoms arise from the
want of usual animal diet, mischief will in most instances
result.

The observations which I have now' made are intended to
refer to those cases of sand and gravel which are independent
of the formation of calculi, and unconnected with any sabulous
accumulation in the kidneys or bladder. In these cases new
questions and difficulties arise, to which it will next be pro¬
per to advert.

(To he Continued,)

* In this paper, Dr. Wollaston has alluded to the quantity of uric
acid contained in the excrement of birds feeding solely upon animal
matter. The following is a curious analogous fact. Mr. Barrow
lately put into my hands for examination, a red matter, which tinges
the snow in high latitudes, collected by Capt. Franklin, in the late
Polar expedition. It was supposed to be the seeds of a lichen, but I
found it to contain uric acid, separable by potash, and precipitable
from its alkaline solution by muriatic acid, in the form of a yellow
powder. The uric acid is mixed with what appears a modification of
the same substance, having many of the'properties of what Dr. Mar-
cet has called xanthk oxide.

318

Foreuxn Medical Scimce and JLitej^ature.

PART IV.

- ^

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

PATHOLOGY (INCLUDING MORBID ANATOMY) AND
PRACTICE OF MEDICINE. ^

I. Apoplexy. — In our February Number we transcribed an
interesting paper by l)r. Series*, elucidating the process
whereby cysts, formed by extravasation of blood in the sub¬
stance of the brain, are sometimes obliterated, and the para¬
lysis, dependent upon it, consequently removed. In two
cases just published by Dr. Patissiert, are exlFibited very
striking examples of the apoplectic cyst in its more recent
state.

First Case. -T- A woman, aged twenty-five, of robust consti¬
tution, short neck, extremely irascible, and who had long
suffered from domestic troubles, fell down senseless in a fit of
passion on the 6th of January, 1816. An emetic was admi¬
nistered without relief; and on the 8th she was conveyed to
I’Hotel Dieu with the following appearances : coma ; closure
of the left eye, caused by paralysis of the levator palpebrae
superioris ; loss of movement and sensation in the left arm ;
incapability of replying to questions ; deviation of the point
of the tangue to the right; pulse slow and small ; respiration
free. A blister to the nucha, sinapisms to the legs, a simple
injection, antispasmodics, and a solution of tartrite of anti¬
mony in veal broth, were prescribed. About the tenth day
the patient began to make signs for food, and expressed great
satisfaction at friction of the left arm, which still continued
paralytic. An infusion of arnica (ieopaixUs bane) was given
as a ptisan. On the sixteenth day articulation commenced ;
but the woman could only express her wdshes by the mono¬
syllable tu, and this language was continued to the close of
life. In the fourth month, with a view of restoring the power
of speech, mastication of the leaves of the cochlearia and pyre-
thrum was uselessly directed. The employment of tbe nux
vomica was equally unavailing, although administered in doses
of sixty grains. The menses were irregular ; and the appli¬
cation of leeches every month to the vulva, while subduing
some ephemeral symptoms, effected no considerable change.

See Repository, page 154 of the present volume.

t Bulletin de rAlhenee de IMedeciiie de raris, Bibliolhccpie
Mcdicale.

.119

Patissier on tUe Apoplectic Cyijd.

Under the influence of her misfortunes, the young woman at
length became gloomy, headstrong, and capricious; and ex¬
tremely sensible to ridicule or reproach. On the 12th of
October great depression of strength, with oedema of the
extremities, took place, and w'as followed by death on
the l6th.

Dissection. — 1st; The vessels of the brain were somewhat
gorged. 2dly; On cutting into its right- middle lobe, in
which there w'as a slight softening, a cavity was discovered,
wholly distinct from the lateral ventricle, containing a little
coagulated and yellowish blood, and lined by a perfectly dis¬
tinct and smoothish membrane; which was the more readily
detached, from being in several points united to the cerebral
substance by filaments of a cellular appearance. 3dly ; The
thoracic organs were sound; as, 4thly, those of the abdomen,
with the exception of the stomach, which exhibited some red
patches'^.

, Second Case. — A labourer, aged sixty-two, of small stature,
short neck and face habitually red, w^as stricken with apoplexy
in April, 1816. The consequent paralysis and embarrassment
of the tongue not yielding to venesection and an emetic, the
man was conveyed to THotel Dieu on the 15th of June. He
had then hemiplegia of the right side, and such an embarrass¬
ment of the tongue as allowed only of the articulation of the
monosyllable tu. A blister w^as applied to the nucha, and
leeches repeatedly to the neck. The use of the right supe¬
rior and inferior limb was gradually^ recovered; but without
any amendment of speech. The patient was extremely iras¬
cible, and evinced violent anger on being interrogated respect¬
ing his health, or denied the ordinary allowance of food.
Repeated attacks of indigestion were succeeded by asthenic
symptoms ; and he died on the 2d of May, 1817*

Dissection. — The middle and left lobes of the brain were
in a state of very decided softening ; and on being cut into
exhibited, at the depth of an inch from the surface, a cavity
comprehending nearly the whole extent of the middle lobe,
perfectly isolated from the lateral ventricle, and lined by a
very distinct membrane, which w'as in some points continuous
w’ith the pia mater, dipping down between the cerebral con¬
volutions. The substance of the brain, in the vicinity ol the
cyst, displayed a yellowish colour. The other portions ol the

* We cannot agree with Dr. Patissier in regarding as “ remark¬
able” the occurrence of apoplexy at the age of twenty-four; because,
although more especially affeciing, it is not peculiar to advanced
life; nor the failure oirmx vomica in paralysis while the cerebral cyst
upon which it depended remained wholly or in great measure un-
obl iterated. — Edit.

320

Foreign Medical Science and Literature,

, enceplialon were sound ; the thorax and abdomen not ex¬
amined.

Dr. Patissier concludes by stating a pathological fact,
which he has repeatedly noticed, and of which the cause yet
remains to be discovered: in hemiplegia, the inferior limbs
almost invariably recover their mobility and feeling sooner
than the superior.

II. QLdematous Angina of the Larynx. — -We hasten to
present to our.readers a most important Memoir on CEdema
of the Glottis; or, Q^dematous i\nginaof the Larynx,’^ which
has just made its appearance in France*. The author of it
is M. Bayle, a writer of well-known talent and celebrity ; and
none of whose productions we have ever yet perused without
great interest and advantage.

The sudden and unexpected death of different individuals,
who had previously exhibited no alarming symptoms, first
excited the attention of M. Bayle to this subject : and in the
prosecution of his researches on the dead body, he found
obstruction of the larynx from various diseases to be a more
frequent source of such fatalities than has commonly been
suspected. By pathological writers, are recorded numerous
instances of sudden death, consequent on diverse lesions of
the larymx. Among these, that which appears to be most
frequent, most invariably fatal, and least perfectly described,
is an oedematous swelling of the borders of the glottis. And
this, as leading, when unopposed, to certain destruction, yet
frequently yielding to early and decisive treatment, possesses
a powerful claim upon our attention.

Although no where clearly defined, the disease in question
admits of easy description ; and the characteristic symptoms
are so strongly marked, that error in its diagnosis is almost
impossible. During the last six years it has many times
fallen under the observation of M. Bayle; and the long
promised notice of it has only been delayed in the hope of
rendering more perfect the history, particularly as regards the
diagnosis and prognosis of the affection. ' The term adema-
tous laryngeal angina may with propriety be applied to it,
inasmuch as it consists merely in a serous infiltration of the
membrane lining the larynx ; and all the symptoms wdiich it
exhibits are the effects of this state.

The affection is characterized by a constant tightness of
respiration arising from the oedematous sw elling of the borders
of the glottis. This oedema is not usually complicated with
fever. It renders inspiration difficult and zeheezing, while ex¬
piration continues unaffected; and induces, from time to tim^,

* Nouveau Journal de Medccine, Janvier, 1 Sip,

321

Bayle on (Edematous Angina of the Larynx,

paroxysms of suffocation, during wliich inspiration becomes
very sonorous and almost obstructed, although expiration is
invariably free.

This brief exposition of the seat, nature, and pathognomic
symptoms of CEdematous laryngeal angina will suffice to dis¬
tinguish it from all those affections possessing any features of
resemblance; and contains the signs which all the subjects
affected with the disease have constantly presented. It differs,
for instance, completely in its seat, symptoms, and termina¬
tion, from the aqueous angina of Boerhaave, which is an affec¬
tion occupying especially the velum palati, amygdalae, and
pharynx ; while the oedema of the glottis is essentially seated
in the larynx, 'bhe latter, moreover, is almost invariably
fatal; the former usually much less formidable; and conse¬
quently often terminates in recovery.

There are some other diseases, which resemble in their cha¬
racters oedema of the glottis. These are, 1st, convulsive
asthma; 2dly, the acute asthma of Millar ; Sdl^q angina pec¬
toris; 4thly, laryngeal inflammation; and, othly, sometimes
aortic aneurism: but with these, the assemblage of symptoms
characterizing oedema of the glottis, prevents us from con¬
founding it. In convulsive asthma the suffocation commences
suddenly, and is not preceded by a sensation of uneasiness in
the larynx ; after the paroxysm there is no constriction in the
summit of the trachea, and even when the dyspnoea has not
wholly subsided, it consists in stricture of the thorax, and is
not referred by the patient to the region of the larynx. The
suffocation in the acute asthma of Millar depends also on
spasm of the thorax ; and the convulsive stricture of the
larynx, when occurring, is not preceded by any painful sensa¬
tions in this part. In angina pectoris the suffocation, which
takes place suddenly, arises from constriction not of the glot¬
tis, but of the thorax : and in both the latter affections, on the
cessation of the paroxysm, respiration becomes perfectly free,
and neither stricture nor pain of the larynx is experienced.
Again, in aneurism of the aorta, compressing the trachea, re¬
spiration is performed with a hissing sound, and there are
occasional attacks of suffocation ; but the pain of the larynx
is inconstant ; and error will be commonly avoided by minute
observation of the progress of the disease. And, lastly, the
joedematous laryngeal angina, cannot be confounded acute
infammation (f the larynx. The.violent fever attendant on
jthe latter disease, and its absence in the former, suffice to dis¬
tinguish these affections, which, moreover, materially differ in
their progress.

The affection, termed angina sicca by Boerhaave and-pre-

VOL. XI. — NO. 64. 2t

5^^ Foreign Medical Science and Literature,

ceding writers, which supervenes on other diseases, and
proves almost invariably fatal, does not appear, from the im¬
perfect description given of it, at all to resemble oedema of
the glottis. In the former, according to Boerhaave, there
exists no trace of tumor external or internal : and as no vestige
of it remains after death, it would seem to be merely a ner¬
vous affection.

After having pointed out the pathognomic signs of the
cedematous laryngeal angina, and the charapters which dis¬
tinguish it from other analogous affections, M. Bayle pro¬
poses to trace, in detail, its varieties, causes, progress, effects,
and the treatment which it requires ; and, lastly, to record some
cases illustrative of the disease in its simple state, and differ¬
ent complications.

F arieties,— The disease is either primitive and essential, as
when resulting from no other local malady ; or consecutive
and symptomatic, when consequent on some affection of the
larynx or adjacent parts. In either case, however, it pursues
the same course ; and when symptomatic, produces death in
persons whose primitive disease might otherwise have termi¬
nated favourably. In its complication with other diseases,
the angina ought probably to be regarded as the principal^
affection, since against it the curative plan should mainly be
directed. When primitive, it appears to depend on a catar¬
rhal or inflammatory affection of the larynx ; but when con¬
secutive, it may be the consequence either of an abscess
formed in the larynx or its vicinity ; of ulceration of the organ,
with or without caries; of laryngeal phthisis, simple or com¬
plicated ; or of other acute or chronic disease, which has pro¬
duced, by irritation, oedema of the borders of the glottis.

The causes of the symptomatic varieties of this angina are
as various as the diseases of which it is the symptom. When
it results from abscess of the larynx consequent on pyrexiae,
the deposit may be considered as the crisis of the disease.
As to the primitive form of the angina, it most commonly
arises during convalescence from severe fevers of the asthenic
or putrid type. But both in these cases, and in those wherein
it attacks a previously healthy subject, its occasional causes
appear to be little understood. They are in general those of
inflammatory and catarrhal diseases, operating upon indivi¬
duals predisposed to laryngeal irritation. But the nature of
this predisposition, and the means whereby it may be distin¬
guished before the invasion of the disease, and obviated, are
utterly unknown. In almost all the cases observed by M,
Bayle, nothing occurred to announce the impending attack
till the moment of its developement.

323

Bajle on (Edematous Angina of the Lari/nx*

Progress of the Disease, — It may commence by snffocation
with pain in the region of the larynx ; but usually its invasion
is less formidable. There is at first merely a sense of uneasi¬
ness in the larynx. The patient endeavours for relief to
expel the obstructing mucus by a deep and sonorous expira¬
tion. The hand is frequently directed to the part with a
complaint rather of constriction and uneasiness than of pain.
The voice is somewhat hoarse ; but there is neither fever nor
general derangement. At the end of from one to four days
the disease, however, is aggravated. The efforts to clear the
larynx are more frequent; and a glairy fluid is at times ex^
pectorated. The voice grows hoarser, sometimes extinct.
Respiration is at intervals for a short while embarrassed. In¬
sensibly it becomes sonorous, and as it were rattling. Yet
the voluntary shocks impressed on the larynx by the efforts at
expiration, produce the discharge of glairy mucus; and then
a dry and peculiar sound accompanies inspiration. The pulse
and appetite yet continue unchanged ; and the patient feels
no alarm at his situation. Speedily, in some cases^ there
supervenes a slight and infrequent cough ; and the dyspncDsa,
although slight for whole hours together, is habitual. But,
after the lapse of days, or even weeks, the patient is suddenly
seized with suffocation, of from five to fifteen minutes’ or
sometimes longer continuance. During this paroxysm inspi¬
ration is difficult and loud ; expiration unembarrassed. At
the close respiration is sometimes fully, sometimes imper¬
fectly, restored to its pristine freedom. The patient regains
his ordinary state, and passes some hours, occasionally even a
week or more, without experiencing a fresh attack. After a
while they return, gradually increasing in violence and* fre¬
quency. In the interval respiration grows progressively more
tight and sonorous, particularly during sleep. Sometimes it
is again relieved for a few hours; and the voice is imper¬
fectly recovered.. Fi’esh paroxysms, commonly occurring in
sleeps induce a return of suffering. The appetite is impaired ;
but seldom wholly fails. The pulse becomes irregular. Yet,
unless to an experienced observer, no pressing danger is
apparent.

During the more violent paroxysms of suffocation, the
patient experiences excessive tightness of respiration. The
shoulders are elevated, and the whole thorax in motion.
Inspiration is difficult and noisy ; expiration invariably free.
Suffocation seems impending. The face is sometimes pale,
shrunk, and expressive of alarm ; sometimes red, turgid, and
wild. The suffering is extreme. Some patients entreat ear¬
nestly to be relieved by incision of the larynx ; ofhers with
frantic expressions of terror and despair, attempt suicide.

324 Foreign Medical Science and Literature,

Evea ill the more moderate attacks, the pulse becomes
unequal, irregular, and sometimes intermittent.

On the decline of the paroxysm, respiration becomes
tolerably free ; but slight inequality and even intermission
of the pulse sometimes remain. Frequently, after a short
time, the patient is destroyed by a fresh attack. Most com¬
monly, however, death takes place in the interval, at the
moment when relief might be expected from the free admis¬
sion of air into the thorax.

The disease is almost invariably fatal. Of seventeen cases
observed by M. Bayle, during the last six years, one only has
terminated in recovery. In general, its duration is very inde¬
terminate. Some of its victims are carried off from the third
to the fifth day ; others, after struggling against it for a month,
have eventually sunk, although the early paroxysms were
slight, and of rare occurrence. Individuals*have occasionally
died in the first paroxysm of the disease.

Results of dissection.— ^Having examined the bodies of all
those whom he had seen die of it, M. Bayle has found that,
in the victims of this disease, the vital warmth has been almost
invariably long preserved, and the limbs have retained their
flexibility. The blood contained in the heart has, in most
instances, scarcely coagulated after twenty-four hours ; and
polypiforra concretions, when existing, have in general pos¬
sessed but little tenacity.— The muscular parts are brown
or red, but never resemble those of subjects destroyed by
chronic disease. No remarkable serous or saneuineous con-
gestion has been discovered in the brain. The borders of the
glottis are constantly swollen, thickened, white, and, as it
were, tremulous ^ They form a ridge more or less prominent,
and injected by serum which escapes with difficulty, even on
compression between the fingers, after repeated incisions of
the membrane. A loose but extremely dense cellular struc¬
ture retains the liquid in a compact net-work, the cells of
which do not communicate with each other. The swollen
borders of the glottis are so disposed, that every impulse
communicated from the pharynx inverts them into the rima
glottidis, which they more or less completely close; and every
impulse arising from the trachea, repels them upon the sides
of the glottis, the orifice of which then becomes unimpeded.
In the larynx there is sometimes only a slight and uniform
oedematous swelling ; at other times, red spots and injected
blood-vessels are perceptible. A morbid alteration, varying
in extent, may also exist on the chordae vocaies, in the ven¬
tricles, or at the base of the cricoid cartilage. In other cases,
there is an abscess in or near the larynx, and sometimes
caries of its cartilages. The epiglottis is seldom sound; its

325

Bayle on (Edematous Angina of the Larynx,

borders are frequently much swollen. The lungs are com¬
monly somewhat gorged with blood posteriorly, although
crepitous and flaccid in their anterior portion*.

Although the symptoms of oedema of the glottis have been
nowhere described by authors, still its eflects, and the con¬
sequent state of the larynx, have been correctly detailed, par¬
ticularly in the writings of Morgagni and Bichai'f'.

The fatal event appears in this disease to have been fre¬
quently determined by the cessation of the functions of the
lungs, the exercise of which, the repeated spasmodic state
has so much impaired, that, even when the air is admitted

* When in the aqueous angina of Boerhaave, and even in some
violent erysipelatous affections of the face and neck, the patient dies
suffocated, no symptoms of the oedematous laryngeal angina are ob¬
served. The infiltration of the epiglottis and glottis, when taking
place, occupies rather the surface than the margin of this latter part.

And the serum, which forms the infiltration, flows out much more
readily than in cases of the oedema of the glottis, expressly constituting
the subject of this memoir.

^ t Bichat (Anat. Descript, tomeii. p. 399^) describes the serous con¬
gestion of the membrane of the larynx; and adds, that patients, suffer- ^
ing from this affection, frequently die suffocated in a short time. He
speaks of a dog destroyed by angina, of a precisely analogous cha¬
racter, which had been produced by making an incision between the
os hyoides and thyroid cartilages, and tying the epiglottis with pack¬
thread. By Morgagni, also, the serous congestion of the membrane
investing the laryngeal cartilages has been correctly described. He
well knew the severity of the lesions of this organ, and regarded apo¬
plexy as a frequent consequence of them, from the circumstance of
several persons affected with oedema of the glottis having died
suddenly in the first paroxysms of suffocation ; and considered the
apoplectic seizure to have resulted from the convulsive affection, of
which the tumefaction of the glottis was the cause. In his fourth
Epistle, Art. 24 and 2b, he speaks of two persons who had died sud¬
denly, and in whom the membrane of the larynx was much swollen.

In one of them the borders of the glottis, white and thickened, were
much more closed than usual. He moreover states (Epist. XXH.,

Art. 24 and 25,) that a Physician, after becoming hoarse, and having
sustained occasional attacks of suffocation, died suddenly. The state •

of the larynx was not examined ; but Valsalva ascribed the fatal
event to a lesion of this organ, from having witnessed the sudden and
unexpected death of twm persons ; in one of whom there was an ulcer,
and in the other carcimona of the larynx. In Epist. XLIV., Art. 13,
is mentioned the case of a man who died suddenly on the third day of '
acute laryngeal angina, and in whom the membrane of the cartilages
of the larynx was swollen and thickened, and exhibited two excres¬
cences attached to the base of the cricoid cartilage.

S%6 Foreign Medical Sciencg and Literature.

with facility, it can no longer undergo the changes which the
pulmonary organs are destined to operate upon it in respira¬
tion. This assertion may, indeed, be received with doubt,
when it is recollected, that in most of the persons who die
from this disease, the glottis is not so much contracted as to
prevent the admission of air, and that they principally ^ink in
the interval of the paroxysm, when respiration, although dis¬
ordered, is not wholly intercepted. Relatively to the employ¬
ment of curative means, this remark is very important. The
privation of oxygen and superabundance of carbonic acid in
the blood, seem, in this affection, to be very strongly
marked ; for after death it is of a d^ep colour, difficult of
coagulation, and commonly presents no polypiform concre¬
tions ; or, if existing, they have little tenacity. Moreover,
the state of the lungs resembles that which these organs
exhibit in persons who have died from defect of respiration.

Treatment. — Vxe\\o\\^\y to entering on this part of the
subject, M. Bayle thinks it right to remark, that while the
dangerous nature of the disease is announced 'by the almost
invariably fatal termination of every well characterized case
of oedematous angina of the larynx which he has yet seen,
alarming symptoms of a similar character have occasionally
been dissipated in others by active treatment : but, as in
these instances the disease was not decidedly marked, it might
not have eventually proved to be oedema of the glottis. This
observation, however, is important, inasmuch as if after the
employment of revulsives in the laryngeal angina, the favour¬
able termination of the disease be not clearly indicated,
Jaryngotomy should immediately be had recourse to. If
there be delay, the lungs, enfeebled by the paroxysms of suf¬
focation, become affected by dangerous spasm, and hence
incapable of resuming their healthy functions; and the opera¬
tion will then be unavailing.

The treatment presents probabilities which differ according
to the species or variety of the angina. If the disease
depend on laryngeal, complicated with pulmonary phthisis,
slight palliatives are only indicated, because the patient will
be destroyed by the principal malady, even if the infiltration
of the borders of the glottis were removed ; but in other cases
nothing must be neglected ; since, if the disease be primitive,
a cure, spontaneous or artificial, may be looked for, provided
the life of the patient can be sufficiently prolonged by ob¬
viating suffocation.

If the congestion of the glottis have been determined by an
abscess, the disease will be somewhat more severe than if it
were primitive; but it may terminate favourably, particularly

527

Bayk on (Edematous Angina of the Larynx.

if there be no caries of the cartilages. Such caries existing,
the disease will be attended with greater severity and danger ;
yet even then is, perhaps, not invariably fatal.

The following are the general means to be adopted in the
treatment of the oedematous laryngeal angina : — 1. Venesec¬
tion in plethoric subjects, and even in others when not
decidedly contra-indicated ; leeches in the vicinity of the
larynx and around the anus. 2. Vomits, when there is
strength to support their operation. 3. Large sinapisms or
blisters to the throat, arms, or nucha. 4. Antispasmodics,
and sometimes diuretics : but as these means alone have never
sufficed to complete the recovery when the disease has been
well characterized, and the paroxysms frequent and severe,
no decided advantage will result from them, unless they are
promptly followed up by the operation of laryngotomy.

At what period, it may be asked, should this operation be
had recourse to ? Probably as long as suffocation is not
menaced, and the paroxysms continue slight and distant, and
particularly if respiration be free in the interval, the means
already indicated may be pursued : but it may be established
as a general rule, that laryngotomy must be immediately per¬
formed whenever one or more violent paroxysms of orthopnoea
have occurred in a subject whose voice is hoarse, with difficult
inspiration, and constant tightness of breathing even during
sleep. The urgency of the case will be proportionally
greater as the returns of orthopnoea are more frequent, and
respiration is more disordered after them. No one, affected to
this degree, has yet been observed to escape ; and laryngo¬
tomy affords a prospect of cure the less encouraging as it is
longer delayed. The apparent mildness of the disease in a
person who can rise and take his food, might be productive, to
an unexperienced Practitioner, of a fatal illusion.

When the recurrence of the paroxysms has been prevented
by laryngotomy, remedies calculated to remove the infiltration
of the glottis, or its causes, must be sedulously employed.
They must be adapted to the nature of the primitive malady,
but are too well known to require specification.

The HISTORIES about to be detailed have been selected for
the purpose of exposing the condition of the larynx in different
varieties of the disease, and the identity of the characteristic
symptoms which it invariably displays. Several of them
have been observed and recorded by other Physicians ; and,
for obvious reasons, their statements have generally been pre¬
ferred by our author to his own. The history of aortic aneurism,
simulating oedema of the glottis, with which the memoir closes,
is well calculated to show the obscurity in which the diagnosis
of the disease may occasionally be involved, and to inculcate

3£8

Foreim Medical Science and Literature.

the necessity of great vigilance and circumspection in deciding
upon it.

First Case. — CEdema of the Glottis, superuening, without ap¬
parent cause, during convalescence, from Putrid Bilious Fever.
—A tailor, aged twenty- five, of bilio-sanguineous temperament,
was seized on the 17th of November, 1803, when recently but
perfectly convalescent from putrid fevei’, with dry infrequent
cough, hoarseness, and sense of constriction in the larynx.

18th. — Left his bed ; hands constantly directed to the
region of the larynx ; voice hoarse and low.

19th. — At times extreme dyspncea ; inspiration then sono¬
rous and almost intercepted ; expiration free; eyes prominent;
and the patient expressed dread of suffocation. The voice,
for about twenty minutes, was extinct. Two hours after¬
wards the dyspnoea recurred. The night was restless ; the
patient starting up, from suffocation, and being obliged to
pass w'hole hours in the erect posture,

. £0th. — Appeared, at intervals, nearly well; appetite unim¬
paired; no fever; but progressive aggravation of the dysp¬
noea. Pulse soft and^regular during the remission ; concen¬
trated, frequent, and at times intermitting in the paroxysm.
Night again restless; and the patient occasionally much dis¬
tressed by the sense of impending suffocation,

£lst. — He got up and had yet some appetite, but no fever.
Respiration extremely tight and sonorous ; glaring expectora¬
tion from the pharynx ; little cough ; inspiration constantly
difficult, and performed with a loud hoarse noise; expiratiorr
unaffected; paroxysms more infrequent, but severe. Night
more calm.

£2d. — Appetite unchanged ; no fever; thorax every where
sonorous. The patient obliged to sit up all day, during
which two fits of suffocation were experienced, and one very
violent at night ; yet expiration continued easy. The patient,
in despair, exclaimed, at times, that he was suffocated, and
called for a knife, tie then became more calm, and died at
ten o’clock. The body long preserved its warmth.

Dissection. — Encephalon sound. About, tw^o drams of
serum in each lateral ventricle. The orifice of the larynx,
examined from the pharynx, presented the following lesions:
epiglottis thickened, white, oedematous at its borders ; orifice
of the glottis contracted, but not sufficiently to obstruct the
admission of air; its borders thickened, oedematous, and
whitish ; the right forming a loose ridge three lines, and the
left one line higher than the cartilaginous rim of the glottis ;
and both, and particularly the right, completely closing, when
bent inward, the rima glottidis. The tumefaction of these
borders arose from serum contained in their cellular structure.

329

Bayle on Ghdematons Angina of the Ltarynx.

and which escaped with difficulty on incision of them. The
interior of the larynx, smeared with glairy mucus, was here
and there reddened, while the borders of the glottis were quite
pale ; the chordae vocales oedematous ; and the sinuses of the
larynx almost obliterated ; but no other vestige of disease in
the organ. The membrane of the trachea was sound ; the
lungs somewhat gorged, yet soft, crepitous, and unadherent.
The heart contained black blood without coagula or polypus
concretion. The abdominal organs were natural ; and the
descending colon enclosed some formed foeces. The muscles
exhibited a rather deep colour.

Second Case. — CEdema of the Glottis, spontaneously arising
in a subject previously healthy. By Dr. Merat. — A groom,
aged fifty-five, healthy, and of florid countenance, was sud¬
denly seized, on the morning of the 12th of July, 1808, with
pain in the throat, and a sense of suftbcation. Breathing
became hurried and sonorous. Otherwise, there was no
complaint. The pain of the throat was relieved by a pectoral
infusion ; but after a week the habitual dyspnoea was aggra¬
vated, and there were occasional paroxysms of suffocation,
particularly in the night. During these he was obliged to
rise and walk about, After a few minutes they subsided; and
he could again sleep.

Upon admission into la Charite on the 20th, all the func¬
tions, respiration excepted, were natural. Pressure on the
larynx produced pain; and a tremor was communicated to
the hand. Inspiration was difficult and sonorous, particularly
during sleep : expiration natural. The patient frequently
expelled the air abruptly from his lungs, as though with a view
of clearing the larynx from some foreign body ; and a sound
ensued like that which is heard when the passages are ob¬
structed by mucus. Pulse regular but strong; appetite im¬
paired. The voice was hoarse and weak, as it had frequently
been in health after inordinate drinking, or exposure to wet.

Up to the 31st no change. Respiration commonly very
sonorous during night. Leeches were twice applied to the
anus, and anodynes administered. Paroxysms came on at
evening or night. On the morning after, the pulse was fre¬
quent, uneven, sometimes intermittent; inspiration more diffi¬
cult arid sonorous.

From August 1st to 24th, four sinapisms were successively
applied to the middle, sides, and base of the larynx. The
two first excited tumefaction, and redness of the cellular
membrane and skin ; and, although no oedema existed in the
extremities, the inflamed parts became so decidedly loaded
with serum as to pit on pressure. The third and fourth sina¬
pisms produced much less Oedematous swelling.,. The appli-

VOL. XI. — NO. 64. 2u

330 Foreign Medical Science and Literature,

cation of each continued for five hours, was followed by a
diminution of ail the symptoms. On the 24th the voice re¬
mained hoarse; but there had been no paroxysm of suffoca¬
tion for several days. An astringent gargle and purgatives
were prescribed: and on September 12th the patient was
dismissed, completely free from pain of the larynx and dysp¬
noea. Yet the hoarseness continued ; and the inspiration
was wheezing, though not unduly accelerated.

Third Case. — (Edema of the Glottis, determined hy an
Abscess in the Posterior Part of the Larynx, consequent on
Malignant Putrid Fever. A young man, aged eighteen, of
bilio-sanguineous temperament, and who had recently re¬
covered from malignant fever, was seized, on the 22d of July,
with an uneasy and prickling sensation in the larynx, hoarse¬
ness, and difficult inspiration, and infrequent cough. Expi¬
ration continued free. A papular eruption, which had pre¬
viously existed on the back and breast, nearly disappeared.
When admitted, on the 28th, into la Charite, the man was
much enfeebled, and his voice hoarse and weak. Pain in
the larynx severe ; inspiration difficult and sonorous ; cough
strong and frequent, with soreness in the chest, which, how¬
ever, sounded well on percussion. Frequent efforts were
made to expel, by deep expiration, some obstructing substance
from the larynx ; and by these a quantity of mucus, tenacious,
glairy, transparent, and sometimes yellowish or whitish, was
expectorated. There was, moreover, a copious discharge of
very fluid and transparent saliva. The appetite was keen ;
deglutition difficult and painful ; but without any morbid
appearance of the velum palati or pharynx. 29th, Laryngeal
and other symptoms unchanged. Marked emaciation.
Tongue, appetite, excretions, and all the various functions,
natural. Pulse weak, small, not accelerated, but at times in¬
termittent. Patient not confined to bed. 30th, Had slept a
little ; pain of the larynx, cough, and dyspnoea diminished.
Appetite continues. Slst, Sleep less tranquil; expectoration
more copious; one stool; pulse more slow and developed,
August 1st, Extreme agitation during the night; sleepless¬
ness; suffocation urgent; inspiration more sonorous; cough
and pain in the chest and larynx aggravated. Progression
difficult from loss of strength ; pulse small and more frequent,
but excretions good. In the afternoon, in consequence of an
immoderate meal, the bowels became painful, and the pain of
the larynx worse. Many efforts were made to expectorate
by cough a puriform fluid. There was less copious discharge
of saliva, and more sleep during the night; but inspiration
continued to be performed as heretofore with a hoarse sound
audible to a considerable distance. 2d, The dyspnoea worse,
1

331

Bayle on CEdematous Angina of the Larynx.

and inspiration more sonorous than ever, notwithstanding the
decrease of the laryngeal pain. Emaciation sensibly greater;
skin warm ; pulse frequent. The patient was up the whole
day; spoke with facility though faintly; enjoyed his food;
and notwithstanding the dysphagia, could swallow a whole
cherry without mastication. The eye and countenance were
clear; and the eruption of the skin* completely dried. .At
night the patient went to bed uneasy ; and was obliged from
increased dyspnoea to sit up. The sound of his inspiration
W'as heard through the whole ward. About ten o’clock he
was seized with suffocation, and at times suffered so much as
to subdue his reason, and impel him to acts of extravagance
and despair. He could yet articulate. After a while he grew
more calm ; and died without a struggle about eleven o’clock,
during a moment of apparent relief.

Dissection. — Encephalon sound. A little serum in the
lateral ventricles, and at the base of the brain. The pharynx
and oesophagus were healthy. On examining the larynx from,
behind anteriorly, the right border of the glottis was found
thickened, elongated, distended with serum, and capable of
almost closing the rima when pressed inward. The lateral,
ligaments were very soft and lax ; the right one slightly oede-
matous, as was also the left border of the glottis. The mem¬
brane of the larynx displayed neither ulceration, redness, nor
any orifice communicating with the substance of its parietes.
Its sinuses were strongly marked, although the chordae vocales
were slightly thickened and oedematous. The passage of
air was yet quite unobstructed, and could only be excluded
by inversion of the border of the glottis over the rima. In
the substance of the posterior paries of the larynx, between its
membrane and that of the pharynx, was an abscess extending
longitudinally from the superior extremity of the arytenoid
cartilages below the middle of the posterior part of the cri¬
coid, and transversely from one posterior border of the thyroid
to the other. The arytenoid cartilages and superior border
of the cricoid were immersed in pus. The base of the form^
and left superior portion of the latter were partly destroyed.
The remnant of these cartilages w^as white, and nearly natural.
The pus of the abscess was white and thick. The interior of
the trachea and lungs sound. The heart contained fluid
blood. The liver, spleen, pancreas, and other organs, were
healthy. The intestinal canal contained much gas. The
small intestine exhibited in numerous places portions, about'
the size of a nail; somewhat thicker than the surrounding gut.
These portions were produced by an unnatural firmness and
thickening of the mucous membrane, which, in some of them,
was slightly excoriated, granular, and of a red violet colour ;

33Q, Foreign Medical Science and Literature,

but, in others, covered by its mucous epidermis. Below this
transparent .epidermis the membrane appeared, covered by
numerous fleshy bodies, equalling in size the fourth part of
a millet-seed, very close, and more minute in proportion to
their distance from the centre of the thickened patch. The
membrane of the ccecal extremity of the ileum presented this
state in a very remarkable manner, and, in some places, small
excavations, resembling cicactrices of small-pox, but not
so large.* ^ In the coecum were found some healthy feces, and
a whole cherry. The membrane of the large intestine was
completely natural.

Fo URTH Case. — (Edema of the Glottis, from an Abscess
in the Parietes of the Larynx ; by Dr. Lasnnec. — A stu¬
dent in medicine, of strong constitution, bilio-sanguineous
temperament ; tall, with black hair, and powerful voice, had,
with the exception of occasional pains in the bladder, con¬
stantly enjoyed good health till his eighteenth year. In
January 1805, he was attacked, after excessive fatigue, with
violent haemoptysis, succeeded by malignant putrid fever, of
twenty-five days^ continuance; during which he coughed
frequently, and complained, at times, of pain in the throat.
Of the latter he had sustained some attacks previously to the
invasion of the fever. Convalescence advanced rapidly; and,
in a few days, the patient was again abroad with pristine
strength and spirits. After exposure, however, to damp and
cold, his voice grew unusually hoarse and feeble. Respiration
became, at times, embarrassed and even sonorous, with slight
pain in the region of the larynx. Three days afterwards, a
paroxysm of suflbcation occurred ; during which, inspiration
alone was very difficult. It re-appeared, at intervals, the fol¬
lowing days. On its decline the patient felt much relieved ;
but his voice was nearly extinct. He exerted himself greatly
in speaking; and was in vain recommended to observe
silence. A blister, applied to the throat, v/as productive of
much relief. It was replaced by another on the following
day. Yet the symptoms continued. The patient ate well;
but experienced, at the moment of the passage of the food by
the top of the larynx, an urgent sense of suflbcation. About
the sixth day from the invasion of the first paroxysm, all the
symptoms were aggravated. Inspiration became habitually
difficult and sonorous; the voice more hoarse and low.
During the next night he sustained two dreadful attacks of

* These excavations and cicactrices exhibit a return to the healthy
condition of the intestinal mucous membrane ; which is almost in¬
variably ulcerated in malignant putrid fevers, especially when con¬
siderable diarrhoea exists ; or abdominal tension^ with or without
delirium.

53S

Bayle on Q^dematous Angina of the Larynx,

suffocation. M. Laennec and Beelard found him, at one
o clock, in the condition just described; and witnessed two
attacks of suffocation, which were less sensibly felt than the
preceding, on account of the great oppression experienced in
the interval. Antispasmodics procured a transient respite.
But about six o’clock the pulse sank and intermitted, and
suffocation seemed impending. Hence trachaetomy was pro¬
posed, and immediately determined on.

The incision having been made in the ordinary situation,
the patient exclaimed with a suffocative voice that the orifice
was not sufficiently large. Hence the Surgeon decided on
practising laryngotomy. With this view, he introduced a ,
grooved director through the opening made in the trachea,
beneath the thyroid cartilage, and cut upon it. But, even
after this the suffocation continued unabated. The instru¬
ment was now introduced into the larynx, and made to tra¬
verse its cavity. Blood, mixed with frothy mucus, escaped.
The patient yet spoke distinctly with a very low voice. The
rapid progress of the symptoms allowed no time for reflection
on the source of this strange phenomenon. The patient died
in a paroxysm of suffocation about eight minutes after the
operation.

T)issection tzirenty-four hours after death, — The body con¬
siderably emaciated ; lower extremities livid ; face and su¬
perior extremities pale. Cranium not examined. On re^
moving the larynx and trachea, it was discovered that the in¬
cision of the latter had actually penetrated into its cavity, and
was about two lines in breadth ; but that the division of the
larynx had merely interested the thyroid cartilage ; and the
subjacent mucous membrane had been incised only at the
base of the epiglottis, and consequently above the seat of the
obstruction. The' borders of the glottis were oedematous ;
and nearly closed, when depressed, the orifice. Each of them
presented several irregular elevations more considerable an¬
teriorly and posteriorly. All the cellular structure, exterior
to the membrane of the larynx, was also filled with serum ;
and the membrane itself, unusually soft and thickened, had
evidently shared the same affection. The infiltration was par¬
ticularly remarkable in the sinuses of the larynx, and on the
chordae vocales. In the centre of each of the last there arose
a reddish body, of the volume of a small pea, adherent to the
mucous membrane, of which they were evidently an ex¬
crescence. In their structure they exhibited a marked degree
of serous congestion. Their position was such, that, in in¬
spiration, they obstructed, in a great degree, the cavity of
the larynx : while, in expiration, they allowed, by becoming

334 Foreign Medical Science and Literature.

elevated, a free passage to the air. The inferior part of the
larynx was free, although somewhat contracted by the tume¬
faction of its mucous membrane. The posterior paries also
displayed towards its centre considerable tumefaction. On
incision of this tumor, there escaped about four drachms of a
yellow viscid pus. The cyst containing it was situated be¬
tween the mucous membrane of the larynx, the ascending
portion of the cricoid cartilage, and the internal surface of
the posterior borders of the thyroid. None of these cartilages,
although in contact with the pus, exhibited any morbid
change. A small purulent cyst appeared also to have existed
posteriorly between the cricoid cartilage and membrane of
the pharynx. The membrane of the trachea and bronchiae
was sound ; as were the lungs, with the exception of con¬
gestion of blood in their posterior portion. The heart was
healthy. The small intestines displayed, in some parts, an
uniform red tinge equally perceptible on the internal and ex¬
ternal surfaces. The capillary vessels beneath their peri¬
toneal covering were, moreover, somewhat gorged. Neither
ulceration nor cicatrix was discoverable on the mucous mem¬
brane, The small intestine contained in the reddened por¬
tions a mucous blood-red fluid. The remainder of the
intestinal canal and abdominal organs were natural. The
^bladder, empty and contracted, exhibited here and there on
the mucous membrane some blackish red spots, in which
were distinguished capillary vessels gorged with blood.

* Neither ulcer nor cicatrix was visible. The prostate gland
was natural, both in structure and volume*.

* In this case is exposed aU obstacle to the operation of laryngo-
tomy, till now unknown ; and which was obviously insurmountable the
first time of its occurrence ; since, in operating according to the usual
mode, its existence could not have even been suspected. The canida,
instead of passing into the cavity of the larynx, as it would have done
if the parts had been in their natural state, was introduced between
the thyroid cartilage and mucous membrane ; the adhesion of which
to the cartilage had been rendered lax by the oedema. From the
same cause, the membrane, yielding with great facility before the in¬
strument, became applied to the posterior part of the larynx, and thus
induced the operator to believe that the cavity had been opened. It
may be doubted whether, in a case like this, laryngotomy, even if well
performed, would have been productive of benefit. The opening
made in the trachea might have sufficed to prevent strangulation, had
not the powers of life been already exhausted.

The unfortunate issue of this case ought not, in M. Bayle’s opinion,
to discourage the trial of laryngotomy again under similar circum¬
stances. > When the disease is idiopathic, it may probably be dissi¬
pated as any other cedema, if, from its position, it produce not death

335

Bayle on (Edematous Angina of the Larynx.

Fifth Case. — (Edema of the Glottis j arising from Ulcera¬
tion of the Larynx in a phthisical subject, and consequent on
quotidian intermittent Fever ; by M. Cayol. — A man, aged
forty-five, of middle stature, possessing all the exterior cha¬
racters of the bilious temperament, and who, without ever
having suffered from glandular enlargement or hoemoptysis,
and otherwise healthy, had for the last five years been subject
to cough, was seized, in September 1806, with quotidian
fever ; and on the fifth day was received into la Charite. Till
the middle of November the fever preserved the same type.
The fit came on at five o’clock every morning. From the
period of its invasion the cough became more frequent, and
was accompanied by expectoration of limpid mucus, mixed
with striae and minute white and opaque points. The voice
grew gradually more hoarse ; and, in a few days after the
patient’s admission into the hospital, was quite lost. About
the same time a pain was first felt about the sides of the
thyroid cartilage, principally during deglutition or the act of
coughing, which was, moreover, attended by uneasiness in the
epigastrium. Respiration became tight, and at times, during
the day, even difficult.

November 8th. The patient first experienced a paroxysm
of dyspnoea, with sense of suffocation. After a few days it
recurred. — 17th. No rigor. From this day the fever no
longer preserved its type or regularity of accession; — 18th.
Third attack of dyspnoea. On attempting to rise the patient
experienced stupor and excessive difficulty of respiration.
Insensibility ensued, and the muscles of the face and eyes
were convulsed. — £0th. Face yellow, dull, and swelled in the
lower part. Skin universally dry, without being unduly
warm. Pulse frequent, small, but regular. No trace of
oedema in trunk or extremities. Abdomen slightly tense,

before the absorption of the fluid constituting it can be accomplished ;
or if, by obstructing respiration, it do not diminish the action of the
circulating system, and consequently that of the absorbent vessels.
Laryngotomy might evidently remove this obstacle to recovery, even
in a case where, as in this, the oedema of the glottis was but the effect
of an abscess situated in the parietes of the larynx, thd disease may
not be beyond the efforts of nature and art. All the cases resulting
from abscess yet recorded concur to prove that the collection in¬
variably takes place in the posterior paries of the larynx, either
between its membrane and the cricoid cartilage, or the two sides of
the same cartilage. In the latter case, the disease is perhaps fatal
from its nature ; but in the former, opening the collection might
possibly save the patient, particularly if the cartilages were sound,
and no considerable exfoliation took place. It would only be neces¬
sary to keep open the larynx for a somewhat longer time.

33C) Foreign Medical Science and Literature,

without congestion. Inspiration was long, difficult, and ac¬
companied by a hissing sound, and horrible grimace, resulting
principally from depression of the angle of the lips, and
excessive dilatation of the alas nasi ; but expiration continued
natural. The breath exhaled a sickly and offensive odour.
The voice was lost irrevocably. A sense rather of constriction
than of pain was felt in the laryi>x. But, during the act of
coughing, pain was experienced both in this organ and in the
epigastrium ; yet the thorax was free, and sounded well on
percussion. The appetite was good, although the tongue
yellowish : the feces natural; and urine frequent and copious.
To the 12th of December the symptoms continued, with the
addition, soon afterwards, of diarrhoea. Thenceforth emacia¬
tion and debility rapidly advanced. During sleep, respiration
was particularly disordered. In each inspiration a hoarse
guttural noise was heard, 'and the thorax much elevated ; and
several times the dread of suffocation was expressed. The
cough invariably frequent. About the close of November,
some yellow opaque points, of the size of a lentil, had first
been seen in the expectoration. Many white strias, in a
transparent, colourless, and ropy fluid, were also perceptible.

About nine o’clock in the morning of the 12th of Decem¬
ber, the patient lay in a supine posture ; the head bent back¬
ward, and eyes fixed, but objectless ; the teeth grinding at
intervals; and pulse very small. Yet the pupils were but
little dilated ; and the patient apparently retained his intel¬
lectual faculties. He died in one hour after.

Dissection tzsjenty hours after death, — The body was ex¬
tremely emaciated, without the slightest oedema. The orifice
of the glottis was not much contracted ; but its borders were
filled with a limpid serum, which increased their thickness at
least fourfold. On bringing them together by slight pressure
between the fingers, the rima glottidis was completely ob¬
structed. The serum oozed from them with difficulty, on
incision, and was apparently contained in a close cellular
structure. The epiglottis was remarkable only from its ex¬
traordinary volume. In the interior of the larynx, at the
posterior part of each sinus, was observed a deep ulceration,
with a bottom of a blackish colour, somewhat resembling that
of dead bone. That of the left side might contain a small
pea ; and had destroyed a portion of the superior chorda
vocalis, nearly the whole base of the arytenoid cartilage, and
part of the articular surface of the cricoid. The ulcer of the
right side took the same direction ; but was not larger than a
lentil. It had only just corroded the superior chorda vocalis,
and the crico-arytenoid articulation. On neither of the
ulcers was there any appearance of pus. The lungs adhered

337

Aneurism of the Aorta,

strongly to the ribs, and yet more so to the mediastinum ;
and were blackish, dense, and heavy. On incision in different
directions, their whole substance was found filled with len¬
ticular tubercles, most of which had suppurated, and formed
small cysts ; the least, capable of containing a lentil ; and the
largest, one or two peas. These tubercles, in different states,
were very closely set, and only separated by points, some of
which of a bluish black colour appeared to be formed by the
compressed pulmonary substance ; and the others of a deeper
black, probably by a structure described under the name of
melanosis, by Dr. Laennec. These points were larger as they
approached the inferior part of the lungs, where consequently
the tubercles were less numerous. No sound portion was
visible in either lung. The liver was of a blackish colour ;
but its structure appeared to be healthy, as was that of the
gall-bladder, stomach, spleen, and pancreas. The mucous
membrane of the large intestine exhibited two large ulcera¬
tions. The one about the size of a crown-piece, with elevated
and uneven borders, and its bottom smeared with a blackish
pus, occupied the lower part of the caecum : the other, much
more deep and extensive than the preceding, the transverse
colon. It had completely destroyed the mucous membrane ;
but its margin was not elevated. The small intestine was
much contracted, and somew'hat reddened externally. The
brain and cerebellum presented nothing remarkable. There
were about five drachms of serum in each lateral ventricle.

Sixth Case. — Aneurism of the Aorta simulating (Edema
of the Glottis; by M. Cayol. — A cart-wright, aged forty-
eight, of tall stature and healthy complexion, with strongly-
marked muscles, pale face, and dark-brown beard and hair,
was received into la Charite, November 29, 1808. He had
then, according to his own report, been ill six months, from
suppressed perspiration. He coughed and expectorated much
ropy and glairy fluid. His voice \vas hoarse; respiration
tight and sonorous. On each inspiration was heard a sort of
hissing, or rather peculiar sound, which, if somewhat more
acute, might have been compared to that produced by inflat¬
ing strongly the reed of a hautboy. Expiration was not
affected. I'here w'as frequently slight pain in the larynx.
The slightest exercise aggravated the dyspnoea, without, how^-
ever, inducing palpitation of the heart. The pulse was regu¬
lar in the left arm, but imperceptible in the right. This was
^t^onsidered as a natural peculiarity by the patient. The di¬
gestive functions were undisturbed ; the bulk little diminished ;
the flesh firm, and free from oedematous swelling. Six weeks
previously to the man’s admission a seton had been inserted
in the nucha, and seemed to have somewhat relieved the

VOL. X ! . — N o . G4. 2 x

358 Foreign Medical Science and Literature.

dyspncea and hoarseness, [n December it was withdrawn.
Aperients and anodynes only were prescribed.

About the middle of January the cough and expectoration
were evidently relieved, as well as the respiration. The
patient walked in the hospital court during the day, without
greatly aggravating his dyspnoea, and ate voraciously ; yet
emaciation slowly advanced. There was no increased heat ;
but constriction, and sometimes slight pain in the larynx, was
constantly felt, —Jan. £Oth. Slight pain in the throat, with
redness about the velum palati and larynx. On being ques¬
tioned, the patient confessed that he had heretofore repeatedly’^
contracted syphilis. Hence a mercurial gargle was prescribed,
but without effect. — 26th. Shortly after dining as usual, the
patient was seized with a violent fit of orthopnoea; and could
only^ respire while sitting, bent forward, with his arms ex¬
tended to the side of the bed. In this Sftate the sound pro¬
duced by each inspiration was much louder than common;
the countenance of a red colour, bordering on violet; pulse
hard, slow, and unequal. At nine in the evening a large
blister was laid upon the throat. About midnight the respira¬
tion was relieved ; and, on the morning visit, the man was
found in his ordinary state, reclining upon his right side, and
respiring without much difficulty, but constantly with the
same hissing sound qn every inspiration. Towards night
another and much more violent attack of orthopnoea, which
Iiad not subsided on the morning of the 28th. I’he violet hue
of the countenance and extreme smallness of the pulse, an¬
nounced impending death. Three grains of tartrite of anti¬
mony were administered, and a fresh blister was applied on the
throat, the part having been previously irritated by ammonia.
No vomiting ensued ; but there were several scanty discharges
from the bowels. The patient died in an hour after the in¬
gestion of the emetic.

Dissection twenty hours after death. — The larynx, to the
astonishment of all present, was found in the natural state ;
as were also the pharynx and fauces. The inferior part of the
trachea was compressed and flattened from before posteriorly^
by an aneurismal tumor, larger than the adult fist, and of a
founded figure. This tumor v/as formed by a considerable
dilatation of the aorta, from about an inch above its origin, to
the point of its entrance between the pleurae. The deveiope-
inent of the artery had principally taken place in its posterior
paries, so that the tumor, although voluminous, came in
contact neither with the ribs nor sternum, but bore upon the
vertebral column, and compressed the trachea, to which it
adhered intimately in a portion of its surface, about the size
of a penny-piece. The cavity of the sac contained much

Aneurism of the Aorta, Ssc. 339

blood, partly coagulated. Its parietes were strengthened
by a layer of fibrine, in some places more than an inch thick ;
but very thin and almost worn away about the centre of the
posterior paries, at the point of adhesion of the sac to the
trachea. In this part all the coats of the artery w^ere destroyed ;
even the surface of the trachea corroded ; and several of its
cartilaginous rings denuded, and, as it were, dissected, were
seen projecting into the interior of the aheurismal sac. Thus
the mucous membrane was the only barrier which prevented
the irruption of the blood into the trachea ; and this accident,
had not death intervened, must have speedily occurred; for
the membrane already presented a' dark red circumscribed
spot, which appeared to be the commencement of an eschar.
The rest of the internal surface of the sac, after separation of
the fibrine, exhibited the same aspect as the interior of a
sound aorta. The internal membrane was every where natural :
yet a small and thin ossification, about the size of the little
finger-nail, was Cbserved at the point where the sac suddenly
contracted to form the contini’ation of the aorta. Five or six
nearly similar patches of ossification were dispersed here and
there on the internal surface of the thoracic and abdominal
aorta. The vessel had throughout a caliber larger than
natural. The arteria inominata, left carotid, and subclavian,
arose from the very centre of the aneurismal sac. The trunk
of the inominata had nearly disappeared ; so that, on a first
view, the right carotid and subclavian seemed to arise sepa¬
rately, at the distance of more than an inch from each other.
The right subclavian took, at its origin, an oblique direction
in the substance of the parietes of the sac, rjearly in the same
manner as the ureter traverses the membranes of the bladder.
3Iy this peculiar disposition, the passage pf the blood into the
right subclavian must have been more or less completely in¬
tercepted when the sac was distended.^ The artery, dissected
with care, in its passage to the arm, displayed neither sensible
contraction, nor any other morbid change.

The heart, and principal arteries of the trunk and ex¬
tremities were natural. The lungs soft, inelastic, but other¬
wise healthy. The left bronchia, principally compressed by
the aneurismal tumor, was gorged to its minutest ramifica¬
tions, with thick, ropy, frothy mucus. The interior of the

* This disposition satisfactorily explains the absence of pulsation
in the radial artery of the right arm. But how,’" asks M. Bayle,
“ was the unimpaired nutrition of the limb in this case supported ?”
The answer, we think, is obvious. Does not the same phenomenon
arise in several diseases of the arteries and nerves, without any sign of
defective nutrition ? May not pressure be applied by the tourniquet
on an artery, so as to suppress its pulsation, without obstructing the
current of its contained blood ? — Editor.

340 Foreign Medical Science and Literature.

right bronchia was but slightly smeared with it. All the
abdominal viscera were in a sound state. The dmentum and
all the reflections of peritoneum contained a quantity of
healthy fat. The muscles were still strongly marked and red ;
the flesh every wmere Arm, and without any trace of oede-
matous swelling.

SURGERY.

Ill, — Removal of the first Metacarpal JBo/ze. The im¬
portance of using every precaution to prevent unnecessary
mutilation in the various surgical operations upon the hand,
particularly in persons dependent for their subsistence on
manual labour^ requires, we would hope, to be pointed out to
very few Surgeons of this country; distinguished, as they in
general are, for reflection and humanity. Yet it may be well
occasionally to obtrude such truths on their notice and recol¬
lection; lest, in the anxiety and alarm attendant on wounds
and accidents, they may be forgotten, or only remembered
w'hen the mischief which tlrey are calculated to obviate is no
longer reparable. With this view we shall transcribe a case of
successful precaution of this kind, lately communicated by the
French Surgeon, M. Roux, to one of the Paris Journals.*

A young tailor was admitted into la Charite, April 6, 1818.
The first metacarpal bone of the right hand, attacked by
osteo-sarcoma, formed a large tumor, covered by a reddish,
thin, and ulcerated skin. The disease was of three years'
standing ; but, till within the' last six months, had been con¬
fined to simple enlargement of the bone. Since then all
mobility of the thumb was lost. Amputation was evidently
the only resource ; but objected to by the man, as the loss of
the thumb would involve that of his trade. Hence, as the
disease was confined to the first metacarpal bone, it was
determined to remove that only, and to remedy, by mechani¬
cal means, the defect of the organ consequent on the inevitable
division of its extensor tendons.

On the l^th of April the operation w^as performed. The
bone, extremely fragile, broke into several pieces; but w^as
readily extracted by the forceps; and care taken, by touch¬
ing the articular surfaces of the trapezium and first phalanx
of the thumb, that no portion was left behind. The wound
was filled with rolls of charpie, supported by compress and
bandage. Tiie cicatrization, though tardy, was uninterrupted.
And the success ol’the operation surpassed the hopes which
had been formed of it ; for the thumb retained a power of
flexion and extension sufficient to allow the exercise of the
man’s calling : and it was very little shorter than that of the
other hand.

* Nouveau Journal de M^decine, Octobre, 1818.

Fracture of the Femur by muscular contraction, S4i

IV. Fracture of the Femur by muscular contraction, _ Ah

though cases of this description are by no means of unfrequent
occurrence, vve never recollect having met with any correct
detail of the appearances presented on dissection of the frac¬
tured limb in these injuries. Hence the ensuing statement
by Dr. Rostan* will, we imagine, be read with interest.

In August, 1817, a woman, aged fifty, who from infancy
had been subject to epilepsy, and suffered for several years
with cancer of the breast, received such injuries from repeated
falls in the epileptic paroxysm, as confined her during six
weeks to her room at la Salpetriere. Her complaints in¬
creasing, she, in September, was admitted into the Infirmary
of that establishment. On this occasion she walked un sup-
ported o> distance of S or 400 paces. In the night she expe¬
rienced sev'eral violent fits of epilepsy, but without falling.
The day after she complained generally of the cancer and
fits. Palliatives were administered ; and at night the epilepsy
recurred with extreme violence : yet the woman \vas so well
secured that she did not fall from the bed. On the next
morning, however, she complained of severe pain in the right
thigh. The limb when uncovered was found much disfigured.
Curved anteriorly and externally it presented the appearance
of an articulation slightly bent. Considerable tumefaction
rendered the limb the more voluminous, as it was much
shortened. The right knee was four inches above that
of the opposite side ; the point of the foot directed outward ;
and the heel below the inner portion of the gastrocnemius.
This disposition left no doubt as to the existence of fracture,
notwithstanding the absence of its ordinary causes. Professor
Lallement, having informed himself of the circumstances of
the case, judged that the epileptic seizures would frustrate the
objects of any apparatus, and merely applied a common band¬
age. The convulsions, in fact, soon returned with increased
violence and frequency ; and all confinement of the limb be¬
came impracticable. Symptomatic fever supervened, with
oedema at first restricted to the fractured limb, but shortly
becoming general, severe and continual pains and marasmus.
The woman died on the 22d of January, 1818.

Dissection. — The right thigh was shortened nearly five
inches ; the knee turned outward ; and the heel below the
calf. The fragments of the bone were still moveable. On
the removal of the oedematous integuments and superficial
muscles, the triceps adductor cruris exhibited a remarkable
consistence. It was filled with a cartilaginous substance,

* Nouveau Journal de Medecine. Fevrier, 1818.

S42

Medical and Physical Intelligence,

which became more compact on approaching the fragments
of the bone. The superior fragment was placed in front of,
and externally to, the inferior. Both were enclosed in a real
capsule of fibro cartilaginous structure. On opening this the
fractured extremities appeared rugose, and wholly deprived of
their external table. The right mammary gland was de¬
stroyed by cancer. The bones ly*oke with great facility.
Nothing particular was observed in the other organs.

PART V.

- - . .

MEDICAL AND PHYSICAL
INTELLIGENCE.

On Monday, the 8th of March, was held the Anniversary of the
London Medical Society, in Bolt Court, when an excellent Oration
was delivered, to a numerous assembly, by Mr. Pettigrew, on the
subject of Medical Jurisprudence, more particularly in reference to
the effects, mode of operating,, and symptoms of poisons.

In our next Number we purpose to give an abstract of this Oration ;
in the mean-time we have to announce ihe following as the list of
Officers elected for the present year : —

Fresidenl, — Dr. Clutterbuck.

Vice-Presidefits. — Dr. Haighton, Dr. Uwins, Mr. T. Whateley,
and Mr. Norris.

Treasurer. — Mr. Andree.

librarian. — Dr. Hancock.

Secretaries. — Dr. Uwins and Mr. H. Blegborough.

Registrar. — Mr. T. Bartlett.

Dr. Merriman to deliver the Annual Oration, 1820.

PYROLA UMBELLATA.

Our Readers will probably recollect that in fiie fifth volume pf the
Medico-Chirurgical Transactions, Dr. Somerville published an ac¬
count of the diuretic effects of the American plant, pyrola umhellata,
and of the beneficial effects that had been found from its use in
dropsy, even when elaterium, digitalis, and cremor tartari had been
tried without effect. This plant has an advantage over digitalis and
cremor tartari, in that it has not the narcotic effects of the former, nor
the griping quality of the latter: a strong infusion, or a decoction of
^ijj warm water infused for some time, and then boiled to
strain a pint, is an agreeable bitter, and has a remarkable effect in
increasing not only the urine, but also the appetite. Unfortunately
the Practitioners of this country have been prevented from using it on

Medical and Physical Intelligence,

343

account of its extreme scarcity, as Dr. Somerville was only able to
md a single plant in the nurseries about London ; but we are happy
to inform the Profession that a large quantity of it has been just im¬
ported, and may be procured in London, so that they have now an
opportunity to try its effects.

Its virtues are known to the Indians of North America : on a
coloured plate of the plant being shown to an Indian, he knew it, and
said, “ good medicine,’^ and sent his son into the woods, who returned
immediately with a handful. It is called in the Chippawa language,
IVeesuccabuck, or Weenesebuk-Nebesh, meaning medicine leaves.

Royal Society. — The annual meeting for the election of officers
for the ensuing year took place on Nov. 30, when the following noble¬
men and gentlemen were elected : —

President. — Right Hon. Sir Joseph Banks, Bart. G.C.B., See,

Secretaries, — W. T. Brande, Esq. and Taylor Combe, Esq.

Treasurer. — Samuel Lysons, Esq.

There remained of the old Council, Right Hon. Sir J. Banks, Bart.;
VV. T. Brande, Esq.; Lord Bishop of Carlisle; Taylor Combe, Esq. ;
Sir H. Davy, Bart. ; Sir E, Home, Bart. ; S. Lysons, Esq. ; George,
Earl of Morton; John Pond, Esq.; W. H. Wollaston, M.D. ; T.
Young, M.D.

There were elected into the Council, J. P. Auriol, Esq. ; R. Bingley,
Esq.; Sir T. G. Cullam, Bart.; John, Earl of Darnley; S. Davis,
Esq.; Sylvester, Lord Glenbervie; Major-Gen. Sir J. W. Gordon,
K.C.B. Sir A. Johnston, Knight; Rev. R. Nares ; Sir G* T. Staun¬
ton, Bart,

Ja7i. 14. — A paper, by Sir E. Plome, was read, on the Corpora
Lutea. The texture of the ovarium before puberty is loose and open,
and contains globular cells. After puberty, the corpora lutea are
found in the substance of the ovarium. In the cow, they form a mass
of convolutions, which Sir E. compared to those of the brain. The
ova are formed in the corpora lutea; and, according to our author,
exist previously to, and independently of, sexual intercourse; and
when the ova are formed, the corpora lutea are destroyed by absorp¬
tion, whether the contained ova are impregnated or not. Sir E,
thinks that impregnation is necessary to the expulsion of the ova, and
that the corpus luteum is burst by extravasated blood, its cavity, after
the escape of the ovum, being found distended with blood in a coagu¬
lated state. When impregnation does not take place, the oVum
remains in the cavity of the corpus luteum. Hence the author thinks
it probable that the ovum is impregnated in the ovarium itself.

Beautiful drawings, illustrative of these points, accompanied the
paper, founded chiefly on the observations of Mr. Bauer, who assisted
Sir Everard in the present inquiry.

Feb. 12. A paper was read, communicated by Dr. Leach, from
Mr. Thomas Say of Philadelphia, containing a scientific description
of a new species of the genus Ocythoe discovered on the American
coasts.

Academy of Scieistces, Paris.— At the sitting of 5th of October
last, was'Tcad by IM. Thenard a Series of observations on the Oxy-

.S44 Medical and Physical Intelligence,

genized Acids and Oxides*, which, the author observed, embrace facts
so singular that they will excite some surprise. They are as follow :

I, The oxygenized nitric and muriatic acids dissolve the hydrate
of the deutoxide of mercury without eifervescence; but if an excess
of alkali be afterwards poured into the solution, a considerable disen-
t gugement of oxygen ensues, and the. oxide of mercury, which at first
re-appears of a yellow colour, is quickly reduced.

n. When this hydrate is brought in contact with the oxygenized
nitrate or muriate of potash, it is reduced with equal facility. It
passes from yellow to gray, giving off at the same time much oxygen.

III. Oxide of gold, obtained from the muriate by means of
barytes, and containing such a small portion of the base as gave it a
greenish hue, being put, while in a gelatinous state, into oxygenized
muriatic acid, a strong effervescence instantly followed, occasioned by
a disengagement of oxygen. The oxide assumed a purple tint, and
was, soon after, completely reduced.

IV. Oxygenized sulphuric, nitric and phosphoric acids, like
the oxygenized muriatic acid, cause the oxide of gold to assume at
first a purple hue ; but instead of assuming afterwards the appearance
of gold that has been precipitated by sulphate of iron, it becomes dark
brown. These experiments have a tendency to prove the existence of
a purple oxide of this metal.

V. If oxygenized nitric acid be poured on oxide of silver, a
strong effervescence ensues, occasioned, as in the preceding cases, by
a liberation of oxygen. One portion of the oxide is dissolved. The
other is first reduced, and afterwards is dissolved, if a sufficiency of
acid be present. If potash be gradually added to the solution when
completed, a fresh effervescence follows, and a dark violet-coloured
precipitate is thrown down (such, at least, is always the colour of the
first deposit), which is insoluble in ammonia, and, to all appearance,
a protoxide of silver, similar to what was observed by an English che¬
mist while examining the action of ammonia on the oxide of silver.

VI. Oxygenized sulphuric and phosphoric acids likewise reduce
partially the oxide of silver, with a strong effervescence.

VII. Having already noticed that the oxide of silver and oxy¬
genized muriatic acid, by their mutual action, produce water, disen¬
gaging oxygen gas and chloride of silver, I now remark that this
chloride is of a violet colour; but violet chloride, however obtained,
always leaves a metallic residue when treated with ammonia. This
phaenomenon was observed by M. Gay-Lussac, respecting white
chloride turned to violet by the action of light. From this it follows,
that when oxygenized muriatic acid is treated with oxide of silver, a
small portion of the liberated oxygen is furnished by the oxide itself;
therefore, to determine by the process pointed out in my last paper,
by means of this oxide, the quantity of oxygen in muriatic acid, we
must take into the account the oxygen furnished by the oxide; in
order to which a second experiment must be made, in which the

* See M. Thenard’s paper in the Philosophical Magazine for Ja¬
nuary; also his paper on the acids and oxides in the present Num¬
ber, p. 109.

Medical and Physical Intelligence, 345

chloride of silver, produced and mixed with oxide of silver, must be
collected. This mixture being treated with ammonia gives, as a
residuum, the portion of the metal that had been reduced; the quan.
tity of which informs us respecting the quantity of oxygen we are in
quest of. — With respect to the chloride of silver, it probably corre¬
sponds with protoxide of silver.

Vlir. When a tube containing oxide of silver is dipped into a
solution of oxygenized nitrate of potash, a violent effervescence ensues ;
the oxide is reduced, the silver is precipitated, all the oxygen of the
oxygenized nitrate is liberated along with that of the oxide; and the
solution, containing merely common nitrate of potash, remains neutral,
if it was in that' state at first.

- IX. Oxide of silver produces the same effects on oxygenized
muriate of potash as on the oxygenized nitrate.

X. When silver in a state of minute division is put into oxygenized
nitrate or muriate of potash, all the oxygen of the salt is instantly
liberated. The silver is not affected, and the salt remains neutral as
before. The action is much less lively when the silver is in a less
divided state ; and the action is always less violent with the muriate
than with the nitrate.

XI. Iron, zinc, copper, bismuth, lead and platinum, possess, like
silver, the property of separating the oxygen of the oxygenized nitrate
and muriate of potash. Iron and zinc are oxidized, while oxygen is
involved; the others are not sensibly oxidized. — They were ail used
in the state of filings.

The action of gold and of tin was likewise tried. They produced
no sensible action on the neutral solutions; or, utmost, only a few
bubbles were liberated, and these at intervals.

XII. The peroxide of manganese and that of lead are also capable
of decomposing the oxygenized nitrate and muriate of potash. Only
a small quantity of these oxides is required to expel the whole of the
oxygen from the solution. The effervescence is brisk. I believe that
the peroxide of manganeseundergoes no alteration. It is not impossible
that the peroxide of lead may be reduced to a lower degree of oxi¬
dation.

XIII. Though nitric acid, as is known, has no action on the pe¬
roxide of manganese and of lead, the oxygenized nitric acid dissolves
both of them with facility, accompanied by a great disengagement of
oxygen gas. Potash produces in the manganese solution a black
flocky precipitate; and in that of lead, a brick-coloured precipitate.
The latter is less oxidized than peroxide of lead ; for, treated w'ith
nitric acid, it yields nitrate of lead and a flea-coloured residuum. On
adding the potash there is instantly a strong effervescence.

XIV. The oxygenized sulphates, phosphates, and fluates, exhibit
with the oxide of silver, with silyer, and probably with other bodies,
the sam^ phaenomena as the" oxygenized nitrate and muriate of pot¬
ash ; and the greater number of the oxygenized alkaline salts pos¬
sesses the same properties as the oxygenized salts of potash. The
cause of the phaenomena we shall hereafter attempt to resolve.

Vf)!,. XI. — NO. 64, 2 Y

346

Medical and Physical Intelligence.

With this view, let us recollect the phasnomena exhibited by oxide
of silver, and silver, with the neutral oxygenized nitrate of potash.
Silver in fine powder rapidly liberates the oxygen of this salt. It
undergoes, itself, no alteration ; while the oxygenized nitrate is re¬
duced to the state of simple nitrate. — The oxide of silver liberates
the oxygen of the oxygenized nitrate still more rapidly than does the
silver ; is itself decomposed, reduced, and the silver entirely precipi¬
tated : and in the liquid only common neutral nitrate of potash is
found. In these decompositions the chemical action is evidently null.
We must therefore ascribe them to a physical cause; but they depend
neither on heat nor light. It follows then, that probably they are
owing to electricity. I will endeavour to ascertain this — likewise
whether the cause, be it what it may, cannot be produced by bring¬
ing into contact two liquids, or even two gases ; from which, perhaps,
we shall derive means for explaining a great variety of ph^enomena.

BETHLEM HOSPITAL.

On Wednesday, the 24th, came on at Bridewell, the election of
Apothecary and Superintendant to this Hospital: at three o’clock
the glasses were closed, and the numbers were, for — Dr. Wright,
47; Mr. Wansbrough, 39 ; Mr. Bridgeman, 30; Mr. Propech, 13.

Iv^OTICES OF LECTURES.

Mr. Gray’s Lectures on Botany have just commenced ; and his
Excursions for Practical Botany will begin in the middle of April,
and continue to the beginning of June.

Dr. Davis will commence a Course of his Lectures on the Theory
and Practice of Midwifery, and on the Diseases of Women and Chil¬
dren, at his House, No. 29, George Street, Hanover Square, on
Monday, the 12th of April, at half-past Ten o’Clock in the forenoon;
and on Tuesday, the 13th of April, at Six o’Clock in the evening, at
Mr. Taunton’s Theatre, Platton Garden.

Mr. Curtis, Aurist to His Royal Highness the Prince Regent, and
Surgeon to the Royal Dispensary for Diseases of the Ear, will com¬
mence his Spring Course of Lectures on the Anatomy, Physiology,
and Pathology of the Ear, on Thursday, April Sth, at the Royal
Dispensary, Carlisle Street, For particulars, apply to Mr. C., at his
House, No. 2, Soho Square.

LITERARY NOTICES.

In the press, and speedily will be published, in Svo., illustrated
with Five Plates, an Inquiry, illustrating the Nature of Tuberculated
Accretions of Serous Membranes; and the Origin of Tubercles and
Tumors in different Textures of the Body. By John Baron, M.D.,
Physician to the General Infirmary at Gloucester.

Dr. Dickson, of Clifton, is about to publish “ Observations on
the Prevailing Epidemic Fever, and on the Utility of Forming Sepa¬
rate Receptacles for Patients I.abouring under the Disease,”

547

A METEOROLOGICAL TABLE,

From the 2\st of FEBRUARY to the ^Oth of MARCH, I819.

KEPT AT RICHMOND, YORKSHIRE.

Baroi

Max.

neter.

Min.

Max

erm.

Min.

Rain

Gauge.

Winds.

Weather.

SE.NE.,

1 Rain. 2 Sun..&Sh. 4 R..

NW..

1 Sun... 3 Cloud.. 4 Rain.

WNW..

1 Sun...

NW..

1 Sun... 3 Snow... 4 Starl....

NW..

1 Sun...

NW. SW. SE.

1 Sun..

SE. ♦

1 Snow.,..

1 Cloud.. .&Sh.ofS.4Starl...

NE.

1 Show. ofSnow. and Sun..

NE..

1 Sun.. and Show. ofSnow..

EbN..

1 Sun., and Show. ofSnow.

NE..

1 Sun,.

NW..

1 Sun..

NW.NbE.

1 Cloud...

NE.

1 Cloud.. .2Sun.3Rain.4M.

WbN.

1 Sun..

WbS..

1 Cloud.. 2 Sun..

vvsw..

1 Sun...

WNW..

1 Sun... 3 Cloud.. 4 Moon...

WbN.

1 Sun...

WbN..

1 Cloud..

WSW.

1 Cloud..

SW..

14 Cloud... 23 Sun..

SW...

1 Show, and Sun..

WbN...

1 Cloud.. 2 Sun..

SW..

1 Sun....2Cloud..4R.. &Sn.

w...

1 Sun..&Shs. ofR..&Snow.

NW...

1 Sun.. & Shows, of Rain.

The quantity of rain during the month of February was 3 inches 75-lOOths.

Observations on Diseases at Richmond.

The disorders under treatment were Convulsio, Cynanche tonsillaris,
Delirium tremens, Diarrhoea, Fehris catnrrhalis, Febris simplex, Gastrouynia,
Lumbago, Obstipatio, Rheumatismus acutus, ‘^cables. b’s, Vaccinia,

and Vbi.'iceli !

348

THE METEOROLOGICAL JOURNAL,

From the 20th of FEBRUARY to the \^th of MARCH ^ 1819>

By Messrs. HARRIS and Co.

Mathematical Instrument Mahers, 50, High Holborn.

Rain

Therm.

Barom,

De Luc’s

Dry.

Hygrom.

Damp.

Winds.

Atmo

Fine

WSW

Wva.

Fine

tine

Clo.

WNW

Fine

SSW

SSE

Clo.

SSE

Rain

R&S

,28

Rain

,11

Clo.

,08

ENE

Fine

,02

NNE

Clo.

ENE

Rain

Clo.

Fine

Clo.

SSE

Fine

30^

Fine

NNE

Fine

,02

Wva.

Fine

,08

Rain

Rain Clo.
Rain Clo.
Fine
Clo.

Clo.

Rain

Clo.

Fine

Rain

Clo.

Rain

The quantity of rain fallen in the month of February is 1 inch

and 52-lOOths.

349

A REGISTER OF DISEASES

■

Between FEBRUARY 20tk and MARCH I9M, I8I9.

Total.

DISEASES.

Abortio .

Abscessio . .

Amaurosis .

Amenorrhoea .

Amentia .

Anasarca .

Aphtha lactentium •

Apoplexia'* . .

Ascites .

Asthenia .

Asthma • . . .

Asphyxia (from dro wni

Atrophia • . . .

Bronchitis acuta • • .

‘ ■ . chronica •

Calculus . .

Cancer . .

Carbunculus . .

Cardialgia • • • . . .

Catarrh us . .

Cephalalgia . .

Cephalaea . -

Chlorosis . .

Chorea .

Cholera .

Colica .

- - Fictonum • • • <

Convulsio .

Cystitis . .

Cynanche Tonsillaris

- - maligna • • •

- Farotidea

Dolor latent ......

Diarrhcea .

Dysenteria .

Dyspepsia .

Dyspnoea .

Dystocia .

Dysuria .

Ecthyma .

Eczema .

Eneuris .

Enteritis .

Entrodynia .

Epilepsia .

Epistaxis .

Erysipelas .

Erythema nodosum
Febris Intermittent
- catarrhalis- •

• • • •

« • • •

-1

DISEASES.

Febris Typhus mitior • •

- Typhus grav. • • • •

■ - Synochus

- Fuerpera .

- Remit. Infant. • •

Fistula ' • .

Gastritis • • . .

Gastrodynia .

Gonorrhoea pura .

Hasmatemesis .

Haemoptbe . . • • .

Haemorrhois .

Hemiplegia . .

Hepatalgia .

Hepatitis .

Hernia .

Herpes Zoster .

- lahialis* .

- prceputialis ••••

Hydrocele • • • . .

Hydrocephalus .

Hydrothorax .

Hypochondriasis .

Hysteria .

Icterus . . .

Impetigo jigurata .

■ - sparsa • • .

Ischias .

Ischuria .

Lepra .

Leucorrhoea .

Lichen simplex ........

Mania .

Melancholia .

Menorrhagia . f * .

Morbi Infantiles* .

- Biliosi'^ .

Nephralgia . * • •

Nephritis* • • . . • •

Obstipatio • .

Odontalgia .

Ophthalmia .

Otalgia .

Palpitatio . .

Paralysis .

Paronychia .

Pemphigus .

Peripneumonia .

Peritonitis . .

Pertussis .

S50

Observations on Prevaihng Diseases,

Total.

i Fatal.

DISEASES.

Total.

Fatal.

Scorbutus .

Scrofula*

Spasmi . .

Strictura .

Strophulus interiinctus •

- confertus • • • •

Sycosis menti • • * .

Syphilis .

I'abes Meseuterica .

Tussis * .

Vaccinia . .

Varicella .

V ariola * • * .

Vermes . .

Vertigo . .

113

1 ft 1

JL V..I v/CA.! kA A y j i-., 1 S

DISEASES.

Phlogosis .

Phrenitis • • • . .

Phthisis Pulmonalis

Pleuritis .

Pieurodyiie

Pneumonia .

Podagra .

Porrigo larvalis • • •
-favosa .

Prolapsus
Psoriasis ••••

Purpura hamorrhagia

Rheuma acutus .

- - — chronicus' • • •

Rubeola .

Scabies . • •

Scarlatina simplex - • • •

- — . - — maligna • •

Scirrhus . • •

* Morbi Infantiles is meant to cornprise those Disorders principaily arising from den¬
tition or indigestion, and which may be too trivial to enter under any distinct head; Morbi
Biliosi, such Complaints as are popularly termed bilious, but cannot be accurately classed.

Observations on Prevailing Diseases.

Of the cases of purpura haemorrh. it may be observed that one terminated
in death, after an illness of upwards of nine months. The bleedings were
chiefly from the gums, and were profuse. It was, however, believed that
bleeding also took place from the internal surface of the stomach, although no
blood was vomited or seen in the stools. May not blood in its passage from
the stomach through the intestines, suffering all those alterations which other
dead animal matter undergoes, become so changed in its foscal form as not
to evince any marks by which its original state may be manifested The
other case was a pauper found in the street in an exhausted state : he,
though aided by every nourishment and comfort, died within eighteen hours.
On inspection the internal surface of the stomach was found beset with seve¬
ral discoloured spots ; and to some of these extravasated blood was still
adherent.

Several cases of fever have again occurred. They cannot all be traced to
infection by communication ; but analogy leads to the referring of them all
to such origin. For those advanced in years little hopes of recovery can be
entertained : such aids being required, in the progress of the disease, as can
seldom be obtained. The young and middle aged have all recovered, under
every disadvantage and privation of their miserable state. The Reporter
takes the liberty to remark, as, perhaps, a useful fact, that he has observed
great and constant advantages by keeping such patients, after the first two
or three days, as much as possible out of bed, and exposed to the fresh air :
and whilst i\\ bed, by keeping them in a sitting posture. Perhaps when the

351

Monthly Catalogue of Books.

surcharge of the vessels of the brain, &,c. is considered, it will be admitted
that this measure is not always sufficiently attended to. Having said thus
much, he must add, that the concurrent treatment of the patient is the clean¬
sing the bowels, preserving them in rather an open state, and perseverance in
very small doses of tartarized antimony until the state of collapse occurs.’'

The above are remarks with which we are favoured by an intelligent Cor¬
respondent in the north-east district of London. As far as our observation
goes, general fever seems to be much upon the decline : in one particular
district, viz. the neighbourhood of Drury Lane, it has occurred to us to wit¬
ness several cases of scarlatina, some mild and others malignant. In the
house of a medical friend, two instances presented themselves of disease
apparently the result of the same contagion. The one individual, the master
of the family, had the disorder with so little of malignity in its character as
scarcely to prevent him from partaking of a single meal. The second, an
apprentice, was seized with such dreadful force that life became extinguished
in not many more than fifty hours from the attack. He was playing at cards
on Wednesday night, and was a corpse on Saturday morning. The fauces
and pharynx seemed to be the principal points of the disorder’s attack : from
first to last there was not that degree of delirium which would a priori have
been expected from such a severe affection.

We should be glad to receive cases of, and remarks upon, the treatment of
scarlatina and cynanche maligna from any of our Correspondents ; the most
momentous point, as it appears to us, in the rationale and management of
these maladies, is to determine, as to the time and quantum of depletion and
stimulation.

MONTHLY CATALOGUE OF BOOKS.

An Essay on the Diseases of the Excreting Parts of the Lachrymal
Organs. By William Mac Kenzie, Member of the Royal College of
Surgeons, of the Medical and Chirurgical Society of London, and
Lecturer on the Anatomy and Surgery of the Eye. 8vo,

Aphorisms, illustrating Natural and Difficult Cases of Labour;
Uterine Hemorrhage ; and Puerperal Peritonitis ; adapted to the use
of Students. By Andrew Blake, M.D., Member of the Royal Col¬
lege of Surgeons, London. 8vo.

The Quarterly Journal of Foreign Medicine and Surgery, and of
the Sciences connected with them. No. II., for February, I8I9.

Observations on Contagion, as it relates to the Plague and other
Epidemical Diseases; and refers to the Regulations of Quarantine.
By a Physician. 8vo.

An Essay on the Diagnosis between Erysipelas, Phlegmon, and
Erythema; with an Appendix touching the probable Nature of Puer¬
peral Fever. By George Hume Weatherhead, M.D., Member of the
Medical and Chirurgical Society of London. 8vo.

Cursory Remarks on Legislative Regulations of the Insane, and
its Probable Influence on their Physical and Moral Condition ; with

)

352 Notices to Correspondents.

Observations on some Defects on the Present System, By George
Man Burrows, M.D., F.L.S., &c. 8vo.

Additional Experiments on the Arteries of Warm Blood Animals:
together with a Brief Examination of certain Arguments which have
been advanced against the Doctrines advanced by the Author of
“ Experimental Inquiry, &c.^’ By Charles Henry Parry, M.D.,
F.R.S., &c. 8yo,

Observations on the Internal Use of the Flydro-Cyanic (Prussic)
Acid in Pulmonary Complaints^ &c. &c. By A. B. Granville,
M.D., F.R.S., &c. &c. 8vo.

Memoir on the Formation and Connexions of the Crural Arch,
and other Parts concerned in Inguinal and Femoral Hernia. By
Robert Liston, Member of the Colleges of Surgeons of London and
Edinburgh. 4to.

^ Dickinson^s Observations on the Inflammatory Endemic, commonly
called the Yellow Fever. 8vo.

The Elements of Natural Philosophy ; illustrated throughout by
Experiments, &c. 12mo.

Lectures on Physiology, Zoology^ and the Natural Flistory of Man.
By William Lawrence, F.R.S., Professor of Anatomy and Surgery to
the College, Assistant-Surgeon to St. Bartholomew's Hospital, &c.
&c. 8vo. Plates.

Essay on the Application of the Organology of the Brain to Educa¬
tion. 8vo.

Medical Botany, No. IIL, illustrated with Six Coloured En¬
gravings. 8vo.

Remarks on the Treatment of some of the most Prevalent Varieties
of Inflammation of the Eye ; with Cases. By Thomas Whately,
Member of the Royal College of Surgeons. 8vo.

NOTICES TO CORRESPONDENTS.

Communicutions have been received this month from Mr. Forster, Mr.
Furnivall, and Mr. Wansbrough.

Several Books have been received for review^ all of which shall be noticed
as speedily as possible. We have come to the determination qf' aiming to
give shorter and more concentrated Analyses than we have hitherto done,
so that four or five volumes may be reviewed in each Number ; otherwise we
find that it will not he possible to do justice to all the Works which are
issued from the Press worthy notice. We of course hold ourselves at liberty
occasionally to deviate from this plan; and in the Number immediately suc¬
ceeding the present, it is our intention to collect together the several works
on Fever that have been forwarded to us, and give a general review of the
whole.

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

LONDON MEDICAL

II' E P O S I T O 11 Y.

No. 65. MAY 1, 1819. Vol. XL

PART I.

. . — ■ ‘

ORIGINAL CO M M U N I C AT I O N S .

Remarks on the Opinions of Mr. Abernethy and Mn.
^.Lawrence, on the Subject of Life. By James VV^ood-
HAM, Medical Surgeon^ London.

The attention of the medical public has been of late much
excited by the discussion which has taken place between two
of the most eminent Surgeons of this metropolis. It is scarcely
necessary to mention the names of Mr. Abernethy and Mr.
Lawrence, both men of splendid talents, and at the head of
their profession. As the subject on which they have been
engaged is in itself interesting, and as erroneous views of it
may lead to consequences the most important, it is my inten¬
tion to submit a few remarks on th^r respective opinions.

Mr. Abernethy, in his two first anatomical lectures at the
Royal College of Surgeons, in 1814, maintained that life (the
principle of life) is something of an invisible and active
nature, superadded to organization; that mind is superadded
to life, as life is to structure ; and that mind and matter reci¬
procally operate on each other by means of an intervening
substance, the living principle. He moreover considered as
-natural to man, the belief, that, in addition to his bodily
structure, he possessed a sensitive, intelligent, and independent
mind.

That the opinions of Mr, Abernethy are congenial to man,
there cannot, 1 believe, be any doubt; and their basis, I con¬
ceive, will be found to be that of reason and truth. I'he phe¬
nomena expressed by the term life, can. only be explained

VOL. XI, — NO. 6.'>. 2 z

354

Original Comm unications.

satisfactorily by admitting what is termed a living principle ;
neither can our intellectual faculties, or, more correctly
speaking, the operation of our intellect, except we allow that
mind is something different from that substance we call brain ;
the Nng, the and the Xo/ao. of the ancients,' therefore,

must be recognised upon every principle of a sound and just
philosophy. On the opinions of Mr. Lawrence it will be
necessary to enter more at large.

Mr. Lawrence in his introductory lectures to comparative
anatomy and physiology, which followed those of Mr. Aber-
nethy, and in those on physiology, zoology, and the natural
history of man, ridicules the idea of a living principle, and
considers man as wholly material. Life,” he says, “ or the
assemblage of all the functions, is immediately dependent on
organization. Life — is merely the active state of the animal
structure. It includes the notion of sensation, motion, and
those ordinary attributes of living beings, which are obvious
to common observation.” This definition of life, not to say any
thing of its including the mental faculty^ of sensation, is evi¬
dently incorrect : for life may exist as in the seed, and in the
egg, and in cases of apparent death, though not any actions
are going on, or have for a time ceased. Vitality, 1 would
define a susceptibility to the impression of stimuli, and is
occasioned, I conceive, by something interwoven with the
organization, and binding, if I may so/ speak, the whole
together. When this, whatever it be, is gone, the body,
as when it has been too long under water from submersion,
is no longer susceptible of the impression of stimuli, its or¬
ganization loses its firm and compact texture, and the action
of the surrounding elements speedily’^ produces a state of pu¬
trefaction. The same lakes place with the egg, and with the
seed. The former will not produce a chick, nor will the
latter germinate : the one becomes what is termed addled, the
other rots.

Again : To call life,” says Mr. Lawrence, a property

of organization, would be unmeaning — it would be non¬
sense. The primary or elementary animal structures are
endued with vital properties; their combinations compose
the animal organs, in which, by means of the vital properties
of the component elementary structures, the animal functions
are carried on.” If the whole be made up of parts, and those
parts possess certain properties, then the properties of the
whole must be the same as those of the parts. Therefore, if
the primary or elementary animal structures are endued
with vital properties, and those structures form the organi¬
zation, life must be a property of organization. Mr. Law¬
rence continues : ‘‘ The same kind of facts, the same rea-

Woodliam’s Remarks, on Abeniethy and Lawrence. 555

soning, the same sort of evidence altogether, which sliow’
<ligestion to be the iunction of the alimentary canal, motion
of the muscles, the various secretions of their respective
glands, prove that sensation, perception, memory, judgment,
reasoning, thought, in a word, all the manifestations called
mental or intellectual are the animal functions of their appro¬
priate organic apparatus, the central organ of the nervous
system.’’ —

“ Shall I be told that thought is inconsistent with matter;
that we cannot conceive how medullary substance can per¬
ceive, remember, judge, reason ^ I acknowledge that we are
entirely ignorant how the parts of the brain accomplish these
purposes — as we are how the liver secretes bile, how the
muscles contract, or how any other living purpose is effected.”
That sensation, perception, &c. as functions of the brain, rest
upon the same sort of evidence, and the same kind of reason¬
ing and facts, as those which show digestion to be a function
of the alimentary canal, motion of the muscles, &c. few but
Mr. Lawrence, and the French physiologists, will, I imagine,
be disposed to allow\ Between the secretion of the fluid
found in the ventricles of the brain, of gastric juice by
the stomach, or any other secretion, there may be some
resemblance of function, however ignorant we may be of the
mode by which each is performed ; but not any between those
and perception, memory, &c. It is as unphilosophical,
therefore, to suppose that perception, memory, &c. are mere
motions of the medullary matter of the brain (for the function,
as it is termed, of that organ resolves itself into this), as it
would be to explain chemical phenomena, by asserting that
the subjects of such phenomena were endowed with thought
and volition. That the brain is necessary for the faculties or
operations of the mind, there cannot be a question; but it
does not from thence follow that a function or motion of the
brain is the mind. The mind is one being, which perceives,
thinks, wills, and judges through the medium of its organ, the
brain : but however close the connexion, it is carefully to be
remembered,” as Mr. Rennell, the Christian advocate, has
well observed in his Remarks on Scepticism, that connexion
is not identity.” If the intellectual phenomena of man,”
says Mr. Lawnence, require an immaterial principle super-
added to the brain, we must equally concede it to those more
rational animals, which exhibit manifestations differing from
some of the human only in degree. If we grant it to these,
we cannot refuse it to the next in order, and so on in succes-
sion, &c.”

With the author before mentioned I do concede it, but
think with him, that though immaterial, it is not of necessity

556 Original Cornmunicaliom.

iriuiiortal, and that those facts and reasoning, from which w^e
infer the immortality of the human soul, fail when applied to
the sentient principle of the brute creation. After the man¬
ner of the celebrated author of the Diversions of Purley,’’
Mr. Lawrence etymologizes the word spirit, and attributes the
origin of what he terms metaphysical puzzles, to the Latin
spiritus a spiro. The answer to this shall be in the words of
the first intellectual philosopher of his age and country.

This figurative language,” as it undoubtedly is, with
respect to mind, has been considered by some as a convincing
proof that the doctrine of its materiality is agreeable to general
belief, and that the opposite hypothesis has originated in the
blunder of confounding what is very minute with what is
immaterial. To me it appears to lead to a conclusion
directly opposite. For whence this disposition to attenuate
and subtilize to the very verge of existence, the atoms or
elements supposed to produce the phenomena of thought and
volition, but from the repugnance of materialism to our
natural apprehensions?” Mr. Lawrence thinks that no ana¬
tomical or physiological research has any connexion or influ¬
ence onnhese great truths, the immortality of the soul, and a
future state of rewards and punishments, if Mr. Lawrence
means such researches as that mind is a function, a motion, or
action of the brain, as the secretion of bile is a function or
action of the liver, f am strongly inclined to think that there
is a connexion, and that they ha've and must have a very
powerful influence. Will not that have an influence on the
proof or belief of those great truths which at once annihilates
them ? Who that gives credence to the opinion, that the soul
or mind is only a function of the brain, can at the same time
believe in the immortalitv of the soul and its future state of
reward or punishme'nt ? — If he embrace the one, he must of
necessity relinquish the other; to hold the two is an impossi¬
bility. It is said that truth cannot do any injury ; that if
doctrines or opinions have their foundation in truth, their
tendency cannot be injurious: but this furnishes a strong and
additional argument against mateiialism ; its tendency is
injurious, and of consequence it has not truth for its founda-'
tion. If, says an able philosopher of the last century, in dis¬
cussing with a friend the doctrine of materialism, if that
7nass of matter which we call the brainy may be that sentient
and intelligent being we call the mind, then that mass of cor¬
poreal substances which we call the zvorld, may be God; and
it must be unphilosophical to search farther than itself iov its
cause. You, 1 know, are far from being sensible of this ; but*
such indeed is the tendency of your principles, and such their
a t Ii eis t i ca 1 c o n elusion.”

Essaj/s 0)1 Medical Ij/iprovement,

557

11.

s on Medical Improvement, By a Physician.

No. I.

It is a desideratum on the part of the most enlightened
members of the medical profession, that it should become an
object of more general attention ; that men of liberal pursuits
would direct their inquiries to the principles and philosophy
of physical science, as connected with the well-being of the
human frame. I'he result would be generally advantageous
to society, and very particularly so to the profession. Nor
can thei^ be any reasonable ground upon wdiich to apprehend
injurious consequences to individual interest. We do not
even imagine that the result of such investigations would, in
any sensible degree, augment the number of medical Prac¬
titioners. The duties of one profession, if rightly attended
to, are amply sufficient for one man ; and perhaps, when
viewed abstractly, the practical duties of ours are not the
most seductive. It may be added, that no extent of human
life is sufficiently long, or degree of talent sufficiently great, to
obtain in one individual the knowledge of all the facts that
are at least desirable, if not necessary, to the perfect attain¬
ment of any science ; and while we stop short of perfection
we ought not to sit down contented, \ et, should it be other¬
wise, granting that thd result of general attention to medical
science would be the conversion of every well educated man
into a Physician or a Surgeon, and consequent diminution of
income to those who consider the art as no more than a
husinesSj by which to obtain wealth — he must, indeed, be
unworthy the name of philosopher, who does not consider
emolument as an inferior object. If there are any who
esteem it the summum bonum medicum, the sooner such are
driven to other methods of gaining a livelihood the better.

To those who take a similar view of the subject, an at¬
tempt to point out certain obstacles to the object desired,
wall not be vain. Of these it may be said, and with some
truth, that a few are of such a nature, that the profession can
exercise no control over them. To place them in rather a
different point of view will be part of our business in these
essays. There are others which depend unquestionably upon
ourselves, and the removal of which is strictly our own affair.
To animadvert upon these obstacles, wdth a view to the general
improvement of medicine, rather than the mere attainment of
the object above pointed out, and to enumerate the advan¬
tages that may be expected to result from their removal, w'ill
furnish ample employment lor subseejuent lucubrations. On

35S

Origina 1 Commanicatlom.

the present occasion we shall confine ourselves to a few*
general remarks, which may serve as an introduction.

Notwithstanding man has in ail ages, and in all countries,
been the subject of disease, and the victim of death,, it is but
too true that medicine has never administered to his necessi¬
ties, in proportion as the other arts have done in their several
departments. Setting aside the plea, that the eyiis it is called
upon to combat are invincible ; that death, at least, if not
disease, must inevitably and speedily overtake the healthy as
well as the infirm; if we reject, as visionary, the supposition
that any discoveries we might make, would banish disease
from among us, much less insure any long protraction of
existence; nay, if we even give up the hope of ever ascertain¬
ing the immediate principles of diseases, (researches a^er, and
reasonings upon which, under the indefinable term proximate
cause, have done such injury to medical improvement) still
must we confess that, compared with other arts, medicine has
even yet made but small progress tow'ards maturityo This
is neither idle declamation, nor an attempt to depreciate the
divine art of alleviating human misery. It will not be by
flattering ourselves that all is right, or by attempting to dis¬
prove the truth of these allegations, that any good can be done.
If we shot our eyes to glaring defects, or deny their exist¬
ence, when it is matter of notoriety, we prove ourselves to be,
at least, very dangerous depositaries of the important charge
of the lives and health of our fellow-citizens.

It is a pleasing consideration, however, that the most illus¬
trious members, and especially the teachers of the profession
in the present day, are those who, having most thoroughly
reviewed the subject, are most fully aware of the disadvan¬
tages under which we labour. They candidly and unre-.
servedly admit them, and carefully point them out. They
exert themselves to the utmost in the good cause of reforma¬
tion ; and though their success has been, and will be distin¬
guished, they alone cannot accomplish all that is necessary.
This will never be done until the profession shall rise eii masse,
and by a reformation as general as the abuses of which we
are about to complain, divest themselves of those incum¬
brances which must ever impede the due success of the most
brilliant discoveries, and unhappily give too much cause for
the obloquy cast upon a profession, that, of all others, might
and ought to be least exposed to it.

To' do something towards this, is the duty of every mem¬
ber. It is true, that on the one hand a numerous portion
of the medical community* may conceive it sufficient to

* This term is here meant to include the educated, the approved,
or the regular profession only, as well as all other terms of the same

Essai/s on Medical Inipro-cement,

pursue the beaten track, and to do as others do. They may
be persuaded that they have neither opportunity nor ability to
step aside from the great road of professional pursuit. We
shall prove to these that such conduct is not required of them ;
and that it will be sufficient for them to pursue their former
path, if it be done rightly. On the other hand, there are
many who will, after all our laudable endeavours to improve
our own state by improving that of the res medica, exert them¬
selves to take advantage of the credulity and imperfections of
mankind, and to establish their fortune and their reputation
on the rftins of those of their more honourable brethren, ft
will be part of our business to point out, that on this score
there should be no ground for apprehension ; and that such
men will bid fair to be exiled from among us, not merely by
our own verdict, but by that of society at large.

The task to which we would urge our brethren, though
difficult, is by no means desperate. There are certain aids
we may ever reckon upon, provided we are inclined to call
them in. The sum and substance of what we propose to
contend for is, in a vulgar but appropriate phrase, to give
medicine yhg'r play; to divest it of incumbrances that other
liberal arts and sciences do not labour under : to take esnecial

/ i

care that we do not ourselves clog the wheels of progress, so
that we may with the better grace and the greater effect
attempt the removal of whatever does. This being accom¬
plished, the career will become more encouraging and more
brilliant than it has ever yet beciij and the result will be ad¬
vantageous to all, and particularly so to us.

It may here be proper to signify more explicitly that our
intention is to lay before the professional world, from time to
time, the imperfections, the errors, and disadvantages of the
present state of medicine ; and to submit such hints for their
remedy as, we trust, will neither be considered visionary nor
presuiffptuous. The ffeld is wide ; and for greater conveni¬
ence and liberty of discussion we enter on it without any fixed
plan, or rather wuthout any arranged concatenation of topics.
We apprehend that subjects will occasionally present them¬
selves, arising out of future occurrences, that may call for
prompt consideration, so as thereby to render the suspension
or interruption of a projected method expedient. Our aim
will be to raise the Profession to a due height in its own esti¬
mation, and consequently in that of the world ; a level which
we are too sadly persuaded it has not yet attained. For tlie

nature which we may occasionally make use of. We shall have to
handle the subject of quackery among those which will call for de¬
tailed investigation.

.joO On<;^i)ial Comminiications.

distinctioi!, eiiiploy meiu, and ronseqiieiit vvealtli of a few iii-
dividtiais cannot be credited to the Profession at large. We
do not propose to accomplish this by entering into the mi-
niitiaj of local eveiUs, or indulgiog in technical gossip; but
by keeping iiie more dignified course of philosopliical inves¬
tigation, and applying it to practical purposes.

And now it may be asked, cui bono'( It may be objected,
that the evils it is supposed we mean to complain of, are in
the nature of things ; that medical Practitioners are but too
sensible of the disadvantages under which they labour; and
that enough has already been said, and even written ^.pon the
subject. We have admitted that there are, if not evils, at
least obstacles in the nature of things ; but factitious evils
have crept into the Profession. We very readily allow that
all Practitioners /ke/ the disadvantages of their present situa¬
tion, but we deny that all are az^are of them. The last objection
is more specious. Mucli has been written on the subjects
that lie before us. Nevertheless we humbly hope to add a
little to the former mass, as well as to place some things that
have been already, and perhaps repeatedly treated of, in a
different point of view. On many topics that may fall within
our province, we have been so fully anticipated as to render
it superfluous to do more than refer. The great argument,
however, in answer to the objection, is, that much of what has
hitherto been done lias evidently been done in vain. Another
trial, therefore, should be made, and we enter upon it in the
hope of drawing the attention of our readers to certain matters
which ought not to be considered altogether indifferent.

We have already stated that we have not projected any
particular plan. But in order to enter upon details with more
advantage, it is our intention in the next Essay to offer a few
remarks on the obstacles that have hitherto stood in the way
of medical improvement; after which we shall be prepared
to discuss those that still exist.

III.

Case of Pneumonia. By W. Furnivall, Surgeon, &c.

1 WAS recpiested some short time since to visit a person
who was described to be labouring under pain in the side.
On arriving at the house, I was introduced to a female, about
thirty-six, who said she had been seized six days before with
a pain in the region of the left hypochondria, which was at¬
tended with great sickness, and for which an emetic and saline
medicines, with a blister to the part affected, were prescribed :
these afforded but little relief, and upon inquiry she com-

3()1

Furnivall’s Case of Pneumonia,

plained of great thirst, increased pain, and every symptom of
approaching active inflammation ; her pulse at that time was
beating about seventy-eight in a minute. Sixteen ounces of
blood were directly drawn from the arm, and another blister
applied to the scrobiculus cordis : two drams of the sulphate
of magnesia were prescribed, to be taken every third hour.
On the following day she was greatly relieved ; pain not quite
gone ; pulse about eighty-two ; blood not in the least buffed or
cupped. On Saturday I was again called, in consequence of
rapid aggravation of the symptoms; the pain was so violent
as to cause her to cry out every four or five minutes, especially
on the attack of a slight cough, which occasionally disturbed
her ; pulse very full, and not more than eighty ; thirst very
great ; skin dry and hot ; bowels very open : sixteen ounces
of blood were again abstracted ; purgatives as before. Sun¬
day morning, ten A.M., no better; pain equally great; blood
not cupped or buffed : the lancet was again used, and the
blood allowed to flow till nearly thirty ounces were evacuated,'
w'hen she complained of giddiness in the head, and great dis¬
position to faint. Five P.M., rather better; the pain quite
gone for about two hours, but now felt again slightly in the
region of the epigastrium and right hypochondria ; pulse
ninety-six, and full. Twelve P.M., the symptoms much in¬
creased; the blood drawn in the morning very much cupped
and buflfed : sixteen ounces of blood again taken, the purga¬
tives continued. Monday, ten A.M., had two hours sleep,
and free from pain immediately after the bleeding ; but pain
now rapidly returning, thirst very great, furred tongue, with a
burning heat through the whole region of the stomach, great
sickness and inclination to vomit; pulse upwards of 100, and
still full : twelve ounces of blood immediately taken, which
caused her to faint. Five A.M., rather better, but the pain
not yet gone, and pulse full, still above 100; the purgative
acting very freely on the bowels; cold water the only drink
desired. Eleven P.M., symptoms again so much increased
as to require further abstraction of blood, which was done to
about ten ounces, wdien she again fainted. Tuesday very
much relieved, passed the night without pain, but complained
of slight headach : the aperient continued, and saline draughts,
with xij m of tinct. digitalis every four hours. Wednesday
the pulse again became full, and the general febrile symptoms
much increased ; ten ounces of blood were again taken in
three cups ; after which, the pain complained of ceased ; the
blood at this time was not buffed in the first cup filled, rather
so in the second, and not at all in the third. Thursday very
much better, the tongue moist and clearer, with gentle per-
voL. XI. — NO. 65. 3 a

362 . Oriohml Communications,

spiration over the whole surface of the body ; bowels very lax ;
the medicines as usual. Friday, complains of very dreadful
pain in the head, sickness ; pulse ninety-eight, rather full; and
great aversion to light ; pupil of the eye a little contracted ;
the head shaved, and the cold evaporating lotion constantly
applied : the medicines continued. Saturday (this day), much
relieved ; lotion, &c. continued, and a blister to the nape of
the neck. Nine P.M., much better, and every appearance of
doing well ; the menses having appeared, and caused great
reduction in the pulse, as well as an alleviation of every dan¬
gerous symptom. The peculiarities in this case of the pulse
not being quick, and the non-appearance of the usual cha¬
racteristics of inflammation (the blood being neither cupped
nor buffed) in the earlier stages, with the great evacuations of
blood every morning and evening, procuring but momentary
relief, may be worthy of remark ; and it might be right to
suppose, that had a copious venesection, on the following
morning after Wednesday, the first time of bleeding, when
the symptoms were relieved, been employed, according to the
practice of that skilful Physician, Dr. Clutterbuck, who
observes, that he always repeats bleeding for the very reason
that others often do not (the patient being better) ; this con¬
tinued evacuation of blood would have been saved, and the
cure much expedited.

Case of Scarlatina,

IV.

By T. W. Wansborough, of
Fulham.

Eliza Cornish, aged 15, was in perfect health on the even¬
ing of the 3d of December, and at three o'clock on the morn¬
ing of the 4th was attacked with rigor, vertigo, and nausea, at¬
tended with vomiting: she threw up some bile. At one o’clock
I saw her; pulse 166 ; vertigo still continues; considerable
pain in the head, principally over the eyes ; vessels of the con¬
junctiva tinged ; great prostration of strength ; soreness of the
throat, attended with difficult deglutition ; tonsils swollen ;
mouth parched and clammy ; teeth feel furred ; tongue
covered with thick brown crust; excessive thirst; bowels
relaxed ; temperature much increased, with dyspnoea.

R Pulv. Jalapse, ^ss.

Hydr. Sub. gr. vj. — Ft. pulv.

Statim, ex quovis vehiculo crasso, sumend.

Six o’clock, — The powder was retained on the stomach ten
minutes, when it was returned with violent retching : symp-

56’3

Wansboro lights Case of Scarlatina,

toms described in the morning still existing. Since my visit
slight wanderings have supervened, not amounting to deli¬
rium; coma; pulse 150, hard and full.

E sectione venae basilicae sanguinis uncias sedecim mitte.

The pain in the head and vertigo were somewhat relieved
by the bleeding for about half an hour, when my patient sank
on her pillow apparently exhausted; pulse 100, full and

HARD.

Emplastrum Lyttae Nuchae admoveatur.

R Mist. Camphorae, Jiij.

Tinct. Valerianae, ^iss. — Ft. Mistura.

R Hydr. Subm. gr. x.

Opii in Pulvere, gr. iss. Conserv. Rosar.

Q. S. Ft. massa, in pilulas octo dividenda, quarum sumat unam
qu^que hor4, atque misturee sumat cyath. 2d. qq. hor.

I directed the patient to be sponged all over the body with
tepid decoction of garlic in vinegar, and ordered barley water
as drink, with occasionally the juice of oranges, to allay
thirst. I directed a domestic gargle to be used frequently,
composed of equal parts, (half a pound) decoction of sage in
vinegar, and Port wine, with one ounce of Cinchona hark.

5tii. — Eight o’clock, A.M.— Has had a tolerable night, with
some sleep ; blood drawn exhibits sizy serum, but not huffy ;
pulse 120, full and soft. The pills have procured three
copious alvine evacuations ; the first of a healthy appearance,
the second and third black, slimy, and exceedingly offen¬
sive : the pain in the head is considerably relieved; the
gargle has thrown off a great deal of thick phlegm from the
throat during the night. This morning the tonsils and uvula
exhibit a dark brown colour, extending nearly to the apex of
the tongue in a brown crust ; the whole surface of the body
has assumed a deep scarlet hue ; the heat of surface is not so
great as last night.

Medicamenta 4tis horis continuentur.

I applied a small blister on each side of the throat, imme¬
diately upon the seat of the submaxillary glands, and directed
the gargle to be repeatedly used, with half a capsicum bruised
and infused therein.

Vespere. — Three more foetid evacuations, with considerable
abatement of symptoms. 1 had forgotten to mention that the
swollen state of the tonsils threatened suffocation to my
patient in the morning ; but now, since the use of the gargle,
she has thrown off several small sloughs, and is thereby re¬
lieved. The ablution of tepid vinegar only with a sponge, (no
garlick being attainable) affords sensible refreshment, and she
voluntarily bathes her hands.

364

Original Communications*

(3th. — Has had a good night, five or six hours’ sound sleep ;
pulse 100, full and soft; eyes clear; pain of the head quite
removed ; has had two evacuations, far less offensive than the
former, containing much recent bile since last night, and this
morning several large sloughs have been thrown off from the
tonsils ; these parts appear now of a florid colour ; tongue
clean and red ; the blisters to the throat have risen well ;
slight ptyalism : in short, I now pronounce my patient con¬
valescent; and as her pulse indicates debility, 1 have directed
light nourishing food and porter, with a glass or two of
Port wine to be taken during the day : deglutition easily per¬
formed.

Pilulse ut ante continuentur 6tis q. horis.

R Mist. Camph. ^vj,

Pulv. Cinch. 5 ss.

R. Valerianae, ^ss. — M*

Cujus cyath. hora tertia post pilulam sumend.

Vespere. — The scarlet hue upon the surface of the body
has disappeared this evening.

7th.-— My patient continues to improve; she is able to
sit up ; pulse 80, full and soft. I have put her on a moderate
diet, and directed the medicines to be continued, a pill and a
glass full of the mixture twice a-day.

The following is the formula used for the mist, camph,
which, as it differs from the Pharmacopoeia, I transmit,

R Camphorse, ^ss.

Sacch. ^iij. tereben^ in mortario, et adde

Pulv. Tragac. c. p.

Aq. bullientis, f vj.' — M.

The water to be added in small quantities until the mixture
becomes smooth • then add the remainder.

Animadversions on Medical Nomenclature^ and a new one pro¬
posed. By T. Parkinson, M.D., Author of Synopsis
Zoo-Nosologise, and Teacher of Medical Science in
London.

1. Anatomical Nomenclature.

%■

1. The abstract solids, or those which compose the exterior
of the body.

1. Artery, Av^Ie^sco, to keep air.

It is unworthy of the highly improved state of the science
of Anatomy to suffer the denominating terms of which its
language chiefly consists, to remain unaltered to the present
day; many of which are not anatomical but physiological;
others are false ; and they are altogether ridiculous.

Parkinson on Medical Nomenclature »

365

Suppose it were the truth that arteries carry air only, which
was the opinion of the inventors of the term; yet then it would
not stand as an anatomical denominator ; because it does not
represent the construction and composition of that solid, but
its function only, or what it does ; and in rendering the term,
a false induction is unavoidable. Keeper of air.

The anatomical denominator should be such as will express
those peculiarities of construction and composition which
distinguish it from all other animal substances. The neces¬
sary inquiry, then, is, What are those peculiarities ?

On examination, what is called an artery is found to be
composed of what is known by elastic ligament, or the lami¬
nated fibre, and it is so constructed as to be thrown into a
tubular form : its composition is the same as the common
elastic fibre; but the peculiar form imposed upon it, makes it
worthy of a distinct generic appellation. Helasmata siphon-
odes, from Exacr/Acc, laminated fibre, and a tube. The

term I have proposed expresses the whole of those charac¬
teristics by which the solid is distinguished; and therefore
it raises the same image in the mind of one man as it does in
that of another, the very essence of nomenclature.

Contrast.

Artery, to keep air.

Helasmata siphonodes, a-icpovj tubulated laminated

fibre.

Question.

Which is the most appropriate, the most determinate, and
the most worthy to be taught and used in anatomical nomen¬
clature

£. Bone, ban, a solid substance.

The term is indeterminate, notwithstanding it will serve to
distinguish this peculiar animal solid from all others, by
emphatically expressing its solidity; yet there are many com¬
paratively solid substances in the animal frame; and as 1
stated respecting a proper denominating term for artery, it
must be such an one as will declare its peculiarities, or those
characteristics by which bone is distinguished from all other
solids, and that by a clear representation of its peculiar con¬
struction and composition. The question, then, is, What are
its peculiarities ?

The basis of what is called bone is membrane, improperly
so called : this membrane secretes its own associate, the phos¬
phate of lime ; and this association constitutes an inflexible
substance, commonl}^ called bone. Membrane is intertexed
fibres, which intertexture renders it nearly inelastic. Bone
then may be happily represented, both as to its distinguishing

366 Original Communicatiom,

characteristics, and as to its composition and construction by
Enyphanta coniodes, from '¥.vv(paiva} to intertex, and novia lime,
signifying membrane associated with lime.

Please to make the contrast, and ask the question.

3. Cartilage, caro, flesh, from a supposed resemblance of
cartilage to flesh. Is not such resemblance too remote to
govern the appellation of cartilage ? Is it not ridiculous ?
The basis of cartilage is enyphanta, called membrane. This
membrane secretes its own associate KoKKy\, albumen ; and
this association constitutes that peculiar solid denominated
cartilage.

Enyphanta collodes, Evv(paivco, and albumen, represents

the construction and composition peculiar to this solid ; and,
therefore, becomes the proper technical term by which it
should be denoted.

Contrast and Question,

4. Cellular membrane, cellula a little cell, and a

member, or a limb. The basis of this solid is enyphanta, and
it secretes its own associate fat. But it is not very

clear that the cells in which the fat is deposited are smaller
than those in which are deposited albumen and phosphate of
lime ; therefore, the term cellular membrane is indeterminate
in its import. The exact image of this solid, both as relates
to its construction and composition, is raised by the denomi¬
nating term enyphanta steatodes, signifying the distinguish¬
ing characteristic, an association of membrane with fat.

Contrast and Question.

5. Gland, glans, a nut, a resemblance too remote to govern
a denominating term. ' What is generally understood by
gland is a peculiar modification or construction o^'''EjXa<T[xoda
or elastic fibre. It differs from Helasmata siphonodes in
shape'; the former, that is, gland, is denominated Helasmata
siphogyrodes ’TAacrywa, laminated fibre; ori(poVf a tube; and
yi/fo?, convoluted, such being the anatomical characteristic of
a gland ; whilst the latter, an artery, is simply tubulated
elastic fibre, and is sufficiently represented by the technical
term I have imposed upon it.

But the gland, in addition to a tubular shape given to
elastic fibre, has ramifications, and especially convolutions.
It, therefore, becomes necessary to distinguish it from an
artery by an appropriate appellation. This is happily accom¬
plished in the term helasmata siphogyrodes, giving an exact
representation of the peculiarities of that solid, namely, tubu¬
lated and convoluted elastic fibre.

6. Lateal, lac, milk. However readily the resemblance of
the chyle to milk may be admitted, the term lacteal to repre-

Parkinson on Medical Nomenclature.

367

sent a vessel carrying chyle is not strictly anatomical. It
does not express its peculiarities of construction and compo¬
sition, but its function only ; and, therefore, it is a physiolo¬
gical term.

The anatomical peculiarities of this solid are tubulated
membrane, happily and exactly represented by enyphanta
siphonodes.

Contrast and Question,

7. Ligament, ligo to bind. This term is at once seen to be
physiological only, and that it is not eligible to a place in the
anatomical nomenclature.

The substance meant to be understood by the term liga¬
ment is merely a modification of Enyphanta or membrane,
and needs no distinct appellation, except that of platynodes
broad, Enyphanta platynodes, 'Evv(pav]a intertexed fibre, and
•7r"Koilug broad, signifying simple or broad membrane, or not
tubulated.

Contrast and Question.

8. Lymphatic, Xu/x<py], a pellucid fluid, intended to denote a
vessel carrying a pellucid fluid. But pellucidity is not pecu¬
liar to the lymph ; therefore the term, as applicable to it, is
indeterminate ; and when extended to represent the vessel
which carries lymph, it is not strictly anatomical, but physio¬
logical ; therefore it cannot be retained in the anatomical
nomenclature.

The anatomical characteristic of this solid is enyphanta
siphonodes, or tubulated membrane ; and it is properly and
explicitly designated by the term enyphanta siphonodes.

Contrast and Question.

Q. Membrane, a member or a limb. It is indetermi¬

nate in its import, and leads to false deductions.

The term membrane is designed to denote simple unasso¬
ciated enyphanta platynodes, or the broad or extended
intertexed fibre ; and such being the characteristic by which
it is distinguished from all other solids, its denominator should
be expressive of such characteristic; and is fully compre¬
hended in Ihe term enyphanta platynodes, Evuipcnilcc intertexed
fibre, and TrXodvg broad.

Contrast and Question,

10. Muscle, (Mug, a mouse. A resemblance too remote to
govern its denominator; and so ridiculous as to demand ex¬
clusion altogether.

It is intended to represent the moving solid, the charac¬
teristic of which is hsemeuthytona, aiiAdf blood ; zv^ug^ straight
fibres. Straight fibres with blood.

368

Original Communications,

Contrast and Question,

11. Nerve, vbuo^, to extend. This term is at variance alto¬
gether with the solid ; it is employed to represent, both as
regards the anatomical characteristics and the physiological
capabilities of that solid ; extension, or even extensibility of
what is called a nerve is not a property belonging to it;
neither is the nerve capable of enduring extension to any
considerable degree, without suffering injury. The term, then,
leads to false conclusions, and ought to be rejected.

The anatomical characteristics of the nerve are mycleu-
thytona, or straight fibres, wdth the medullary substance ; and
those characteristics are fully comprehended in the term
the substance of the brain, and EvOug straight fibres.
But mycleuthytona is necessarily divided into two genera,
dependent upon associations : it is demanded, therefore, that
these distinct genera be provided with distinguishing appella¬
tions. The characteristic of the first genus is an association
of the medullary substance, with muscular fibres : it compre¬
hends ail the immediate organs of sense, and the brain within
the head ; and it is clearly and beautifully distinguished from
the second genus by a qualifying adjective htemeuthytodes,
mycleuthytona haemeuthytodes, and aT/xa, suQvgy

strikingly illustrative of the peculiarity of the association of
brain with muscle.

The second genus has for its characteristic an association of
brain with membrane, and it is limited to the nerve or nervous
cord. In this genus there are no muscular fibres ; but the
medullary substance with straight fibres is so closely'^ asso¬
ciated wdth membrane as to be enclosed by it through its
whole extent; and it is eligibly distinguished from the first
genus by a qualifying adjective, enyphantodes, mycleuthytona
enyphantodes, [xuBKog EvQvg, and £vu(pavlo^y^g, strikingly illustrative
of the association of brain with membrane.

12. Periosteum, oglEov, about bone. This term is inde¬
terminate: what is intended to be denoted by it is something
which is placed immediately upon bone, and attached to bone.
Now, inquiring into its real character, let me ask. What is
it ? — I answer, it is a modification of muscle ; and belongs to
ha3meuthytona, as strictly as tendon. There needs not any
further argument to prove the validity of this opinion than
what will be elicited to every man’s mind by a solitary expe¬
riment; namely, in macerating or boiling, the periosteum
quits the bone, and keeps its connexion with the muscle or
tendon. I w’ould, then, consider a tendon and periosteum
only modifications of fnuscle.

13. Tendon, to extend. The term is at variance with
the substance represented. It is not a property of tendon

Parkinson on Medical Nomenclature. 369

to admit of extension; such quality being imposed upon
it, would defeat its physiology. I’endon appears notliing
more than a modification of a muscle, and therefore does not
require any distinct appellation.

14. Vein, venio, to come, because veins bring the refluent
blood to the heart. But the term is not anatomical, denoting
the construction and composition of the solid; but it is
physiological, denoting function, and even for that purpose
is so indeterminate as to demand exclusion.

A vein is tubulated membrane, as an artery is tubulated
elastic fibre, and that is its distinguishing characteristic. The
denominating term ought to be such as represents this charac¬
ter. Eny phanta siphonodes answers the purpose fully, £vv(pocvla,
intertexed fibre, and cripov^ a tube.

2. Compound Solids, and those vchich may he considered

visceral.

It has already been observed, that the abstract solids of

the animal frame are necessarilv divided into genera, and that

• • • • ^ ^

this division depends upon three circumstances: — 1. The
association of one abstract solid with another. — 2. Peculiarity
of form or shape.- — 3. The association of membrane with a
substance which itself secretes.

Certain of these genera have been noticed, which I men¬
tion again, and refer to their respective numbers ; and then
proceed with such as remain ; —

1. Artery, No. 1. Helasmata siphonodes.

5. Bone, No. 2. Enyphanta conoides.

3. Cartilage, No. 3. Enyphanta collodes.

4. Cellular membrane, No. 4. Enyphanta steatodes.

5. Gland, No. 5. Helasmata siphogyrodes.

6. Lacteal, No. 6. Enyphanta siphonodes.

7. Ligament, No. 7* Enyphanta platynodes.

8. Lymphatic, No. 8. Enyphanta siphonodes.
g. Membrane, No. g. Enyphanta platynodes.

10. Muscle, No. 10. Heerneuthytona.

11. Nerve, No. 11. Myeleuthytona.

12. Periosteum, No. 12. Heerneuthytona.

13. Tendon, No. 13. Heerneuthytona.

14. Vein, No. 14. Enyphanta siphonodes.

It remains, only to consider the following genera of
solids : —

\ 1. Enyphanta haemeuthytodes.

2. Enyphanta helasmatodes.

3. Enyphanta siphogyrodes,

4. Enyphanta siphocollodes.

5. Enyphanta siphoconiodes.

6. Heerneuthytona antrodes.

— NO. 65. 3 B

VOL. XI.

370

Orig:inal Communications,

15. Enyphanta bcemeuthytodes is instanced in the whole
of the intestinal canal in the bladder, and in the uterus of
women; but there is no distinguishing appellation by which
the anatomical characteristics are denoted.

This solid is an association of membrane with muscle, and
the precise nature of it is expressed in the term Evu^avhx inter-
texed fibre, aifjLEvMco^ng muscular.

16. Enyphanta helasmatodes is instanced in the substance
of the lungs, and in the corpora penis ; but there is no distin¬
guishing appellation for this solid w'hich expresses its ana¬
tomical characteristic, or even its function. Such a term is
wanted, and it becomes necessary to provide one.

This genus is governed by the association of membrane
with elastic fibre; and the precise nature of it is expressed
in the term enyphanta lielasmatodes, enyphanta, Evu(pavla, inter-
texed fibre, and laminated, signifying the associa¬

tion of membrane with elastic fibre. Whoever will give him¬
self the trouble to examine the substance of the lungs, will
find that the anatomical character I have given it is suffi¬
ciently correct, and that the representation given by the deno¬
mination agrees with its character. Nor will the examiner be
jess surprised to find that the auricles of the heart do not turn
out to be what is commonly taught and understood, or rather
believed. I ask, is the substance which constitutes the
auricle of the heart purely muscular? If not, what is it?
Then give it a name worthy of its construction and composi¬
tion. 1 am prepared with one, but am inclined to withhold
it, for reasons which 1 may explain some future day. 1 have,
however, thrown out the suggestion, that others may* make
their examinations and their observations on the subject,
before I bring forth my denominator.

17- Enyphanta siphogyrodes, instanced only in the sub¬
stance of the liver. It has no name descriptive of its ana¬
tomical construction and composition. It is, however, a
similar distribution and convolution of a vein to form a
venous gland, as the distribution and convolution of an artery
to form an arterious gland; the only difference is, one is
elasmata siphogyrodes, tubulated and convoluted elastic fibre;
the other enyphanta siphogyrodes, tubulated and convoluted
membrane, Evvcpavla, cri(poVj yu^og,

18. Enyphanta siphocoliodes. This is a genus of eny¬
phanta, dependent upon association and form ; for its
dependence on association, see 2, No. 3. ; and the tubulated
form which constitutes the present genus is instanced very
conspicuously in the annular cartilages of the trachea and
bronchia, and in the bony meatus or the ear. It is fully and
clearly represented by enyphanta siphocoliodes, cn^oy,

hoxm.

Parkinson on Medical Nornenclatiu'e.

371

19. Enyphanta siphoconlodes. This genus, also, of eny-
pbanta, like the one preceding, is dependent upon two
circumstances; the first upon association, see No. 2, and
the second upon form or shape. The form or shape imposed
upon it is tubular; and it is instanced in the large bones of
the extremities, and in the bony meatus of the ear. This
genus is fully represented by enyphanta siphoconiodes,
svu(pcx,v]<Xj aKpov, kovicc.

20. Haemeuthytona anlrodes. This genus is dependent
upon form or shape, and the form is chambered. Jt is
instanced only in the muscles of the heart, and is sufficiently
distinguished from the first genus of Haemeuthytona, see
No. 10, by the addition of the qualifying adjective, antrodes,
making the term Haemeuthytona anlrodes, aiu£u9ulova avl^ov.

Having given the etymology, import, and application of
the new nomenclatura anatoiuica, so far as relates to the
classes and genera of all the solids which enter into the com¬
position of the human body, it now becomes necessary to
do the same with respect to the fluids.

I'he fluids are necessarily divided into classes, genera,
varieties, and species, in order that they may be clearly
distinguished, and that the etj^mology, import, and applica¬
tion of the terms by which they are each designated, may be
taught logically and radically ; for without such arrangement
it would be impossible to avoid the confusion and consequent
misconception, inseparable from the present method of teach¬
ing the doctrine of the animal fluids.

Classes denote existing states of fluids, and are two in
number: — 1. Perirrotica, or those which are circulating in
vessels. And, 2. Lymnetica, or those which are not circu¬
lating in vessels.

1. Arterious blood, distinguished from venous blood

chiefly by its florid colour. It is found only in the substance
of the lungs, in the pulmonary blood-vessels which carry it
to the left side of the heart, in the left chambers of the heart,
and in the arteries. It is the onl}^ perfect blood, possessing
all the elements of every solid and fluid in the animal system;
and it is therefore the only fluid entitled to the dignified appel¬
lation, blood. The term by which it may be distinguished
from all other fluids, is haema, pure or perfect blood.

2. Venous blood, distinguished chiefly from arterious
blood by its darker colour. It is found only in the substance
of the lungs, the pulmonary blood-vessels which carry it to
the lungs, the right side of the heart, and in the veins. It h

37^

Original Communications.

not perfect blood, because it lias been deprived of some of
its elements which it has imparted, in its arterious tour, for
the supply of the solids and fluids individually and collectively
which they respectively stand in need of, to repair the loss
they sustain in the exercise of their natural functions.
Nevertheless, in point of value, it stands next to haema,
because without a considerable quantity of it haema cannot
be formed. Having, however, lost part of its elements, it
cannot stand so high in the catalogue of fluids as h^ma, and
is distinguished from it and all other animal fluids by the
term haeniatodes, bloody.

3. Lymph, a fluid circulating in vessels, but deprived
of the colouring particles of the blood, consequently of more
of its elements than haematodes ; it is therefore of less value
than h^matodes; nevertheless, it is essential in the formation
of arterious and of venous blood, and serves as their men¬
struum and vehicle. It is distinguished from other fluids
circulating in vessels, by the term diaphanodes, ^ia(pg,voi'^n^
limpid.

4. Chyle, a fluid separated from the food, proceeding
towards the heart, on vessels for the nourishment of haema.
This fluid has never passed the tour of circulation ; is not
animalized, but animalizing ; therefore its value is not so great
as diaphanodes ; it is, nevertheless, essential to the continua¬
tion of a formation and regular supply of hoema, and is dis-*
tinguished from the fluids before mentioned by the term
galatodes, yaXalco^yig, milky.

These are all the fluids which can be said strictly to be
circulating in vessels; they therefore constitute the first class.

The second class of fluids comprehends ail other animal
fluids not yet mentioned. Not being circulating in vessels,
the whole tribe is denominated lymnetica. It is requisite
here to observe, that this class is divided into genera and
varieties.

Genera .

The first genus is denominated phylacteria ; (^uXaa-aoij to
imprison, because they are kept in cysts or reservoirs till
wanted in the animal economy, or for the purpose of con*
venience ; consequently this genus comprehends, and yet is
limited to those fluids which are encysted.

The second genus is denominated diakosia, to dis¬

perse, because they are not strictly imprisoned, but dispersed
into communicating cells ; and are commonly called in*
terstitial.

The third genus is denominated exothism, sioQsco, to expel,
fluids thrown out of the body.

373

Gray on ihe Metamorphoses of Insects

But these genera are subdivided into varieties, and the
varieties demand their respective denominating terms,

Gen. 1. — 1. Cholodes, XoXri, bile.

2. Coprodes, Kott^o?, dung, fluids of the intestines,

3. Ophthalmodes, O(p0aA//of, the eye, ocular.

4. Spermatodes, semen.

5. Urodes, unne.

The whole of these varieties are understood by their appel¬
lations, which need not any further explanations.

Gen, II. — 1. Hydatodes, water.

2. Blennodes, BXswoc,, mucus.

Gen. III. ■ — 1. Hydatodes, water.

2. Blennodes, BXswa, mucus.

These are all the terms necessary in the Anatomical No¬
menclature: it requires, however, to be well understood, as it
is the basis of the Nosological Nomenclature, both in form
and in substance. Species relate to situations only, in every
department of Medical Nomenclature.

(The Thysiologicaly Nosological, and Therapeutical Nomenclature in our

nexty and succeeding Numbers.)

DEPARTMENT OF NATURAL HISTORY, &c.

■

On the Metamorphoses which Insects undergo during their

Growth. By Mr. Gray.

Among the various phenomena of animal life there is
none that is so remarkable as the change of form, and the
acquisition of new parts during the growth of an insect. The
changes are so wonderful, that it would appear to us, if the
phenomena wmre not common, that the animal died and came
again to life in another form. Indeed, this appeared actually
the case to the first observers, and accordingly the priests of the
heathen religion chose this change to represent symbolically,
according to the spirit of that religion, the state of the dead,
and of the soul reviving again in a form superior to that with
w^hich it was formerly invested : and the phrases derived from
it may be traced by an accurate and unprejudiced observer in
our own.

This change is not found to take place in any of those
animals whose vital fluid does not circulate, except in insects,
properly so called, that is to say in the winged insects, and
pulex of Linnaeus; each of the great families (or orders as

374

Original Communicatiom*

they are called) into which the proper insects are divided^
having something peculiar in regard to their metamorphoses:
and these metamorphoses are not confined to tlie external
appearance of the insect, but extend even to the most important
internal organs. 1 hey are in reality either successive altera¬
tions of parts already developed, or they are the formation of
new additional organs which \yere not before visible.

No naturalist has paid more attention to the study of the
changes undergone by insects during their growth than
Lamarck ; and in his large work on invertebral animals, he
has treated the subject with that care that it demands ; and
has shown its analogy with certain crises in the growth of the
larger and vertebral animals. Some naturalists have even
used the metamorphosis as the foundation of their division
and arrangement of these animals ; but to ibis use being
made of it, at least as a primary character, there occurs the
very considerable objection, that they are not permanent cha¬
racters existing in the insects, even when dead, but temporary
circumstances arising in the course of their life, and requiring
for their discovery a continual attention to the living insect,
from its first being hatched. As secondary characters their
use is certainly necessary, for we may well suppose that the
insects of each large family or order ought to agree in their
metamorphosis, if the division be founded upon nature.

The change of form, in regard to its extent, is either general
or partial ; each of which has some peculiarities in their first
and second states, or those of the inlancy and adolescence of
the insect.

The insects which undergo a general metamorphosis,
undergo such a complete change, that their form, when first
hatched, is quite different from what they afterwards acquire;
none of their external parts being the same in their full-grown
and infant state.

In the larva or infant state of these insects, they have
in general a soft tender skin, except on the head, and they
are destitute of reticulated eyes ; by which marks they may
be known.

In the second state of those insects which undergo a com¬
plete metamorphosis, they are immoveable, take of course no
nourishment, and appear dead.

On the other hand, in the partial metamorphosis there
is no change takes place in the general form of the insect, but
it only acquires some new external parts, which it did not
possess in its infancy.

These insects are furnished at their birth with net-work
eyes, and a leathery or horny skin ; and their mode of feeding
is the same as in their adult state.

375

Gray on the Metamorphoses of Insects.

In the adolescent or half-grown state of these insects, they
are more or less active, and feed the same as usual.

It was established as an axiom by many physiologists who
have confined their attention to the more perfect classes of
animals and plants, that every living being originates from an
j egg ; but further researches show the futility of this hypo-
: thesis ; and as there are many tribes of animals and plants, in

which no traces of any sexual organs, whether fecundating or
fecLindable, can be discovered, so there are many modes of
j multiplication, by division of parts, buds, and bulbs, in which
fecundation is not necessary.

Insects in general are oviparous ; and the eggs require no
! other heat than that of the atmosphere, or at most, of the
nest or hive for their being hatched. The aphides, or plant-
lice, have, however, this peculiarity, that they are viviparous
in the summer, and in the autumn lay eggs, which are not
hatched until the next season ; by which means only the
species is preserved, as the insects themselves are too tender
to survive through the winter, although the eggs can bear the
cold.

Larva State.

The state of an insect when first hatched, is called the larva
state : as their form varies very much, they are sometimes
called worms, sometimes larvae ; and those of lepidopterous
insects are called caterpillars.

The larvae of the insects w’hich have only two clear wings
in their adult state, and many of those which have four clear
wings, have no feet; hence their name of worms. These
have the skin always of a soft nature.

Other larvae have six or more feet. The six fore-feet are
jointed, hard, and have claws to them ; their situation coin¬
cides with those of the adult insect. The other feet are soft,
not jointed, and have no claws : two of these are usually
separated at a distance from the rest, and are called caudal
feet.

Although these larvae, which differ entirely from the adult
insect, are without large net-work eyes, they have sometimes
■ small smooth eyes, or stemmata.

It is in this state that the insect takes the whole, or the
principal part of its nourishment and its growth ; and during
this state it changes its skin several times. This change of
! skin, which is, however, not peculiar to insects, is in them a

j crisis of a very serious nature, and they prepare for it by

I abstinence from food: during this mew, they remain immove-
I able, become of a pale livid colour, appear diseased, and fre-
i quently perish. Some suppose that those larvse which have
i no feet do not change their skins.

76 Original Communications,

The nymphf or chrysalis state.

A few days after the last time of changing their skins, the
larvae of insects pass into the nymph or chrysalis state. This
state is very different from that of the larvae, for although
some insects in this second or adolescent state move and eat
the same as in their form of larvae, and merely differ by pos¬
sessing new parts, a considerable portion of insects remain
immoveable, and do not take any food ; some being hidden in
an opake coccoon, others covered with a fine ^membrane, and
others without any covering.

Insects which undergo a complete metamorphosis, chan ge
in their second state either into a chrysalis or a mumia. The
chrysalis is shut up in an opake coccoon, which has no mouth,
eyes, antennae, nor feet, and it does not move, unless it be
touched. It breathes, however, by stigmata, which are some¬
times placed on the tip of certain eminences, like small horns,
or tubular threads.

The chrysalides of lepidopterous insects are rather oval,
pointed at one end, and obtuse at the other, with impressions
in relievo, which show the form of the parts under them;
Those of butterflies are hung to a wall or tree by a thread ;
most of those of moths are enveloped in a coccoon of a silky
nature; and those of the hawk-moths are concealed under
ground, surrounded by earth, &c. held together bj^ silky
threads.

The chrysalides of the insects which have two clear wings
are rather hard, of a rather oval form, partly encircled with
remains of rings, and not showing the impressions of the parts
underneath. This chrj^salis is formed of the skin of the
insect, which is not changed, but merely contracted and har¬
dened : it has at one end a kind of door, by which the full-
growm insect escapes from his confinement.

There are two sorts of mumise. Those of the beetles and
the hymenopterae become inactive, take no nourishment, and
are covered with a fine and generally transparent mem¬
brane, which permits their form to be seen, or which envelopes
the parts separately. These mumiae are soft, whitish, and
merely stir when pressed.

Another sort of mumias is that of the phryganeae, and some
few other insects, and called a cadis worm, by anglers : it is
inactive, and takes no nourishment, naked, rather contracted,
and enclosed in general in a sheath formed by itself.

Those insects which undergo only a partial metamorphosis,
preserve the same parts which they had on their first being
hatched, and only acquire some new parts in their second
state ; but neither lose their activity, nor cease to take food.

377

Gray on the Metamorphoses of Insects.

The second state of these insects is called a nymph. Tt
has the same eyes, antennse, feet, and skin as the larva, and
nearly the same form, but it has the rudiinents of the wings
which it is to have fully developed in its adult state. 'This
metamorphosis is undergone by the orthopterous, hemipterous,
and many neuropterous insects.

The thirds or pey feet state.

This state is the only one in which insects have perfect
wings ; and for the most part, in which they increase and
multiply, ft appears, however, that a few insects breed in
their nymph state. Their life is in this state usually very
short, as the males perish almost immediately upon their
having met with the females, and the females pe.rish in the
act of laying their eggs, or very soon after.

The cause of the metamorphoses of insects has been gene¬
rally considered, not only as one of the most curious and most
interesting in natural history, but also as one of the most
difficult. I ^amarck considers the changes as depending
upon two circumstances; first, the horny nature of the integu¬
ments of insects in their perfect state ; and, secondly, the
crisis which takes place in all animals (and even plants) fur¬
nished with sexual organs at the age of puberty.

From the horny nature of the integuments of insects, their
growth would have been impeded, if this consistence of their
skin had ahvays been preserved; but by the skin of the larva
being soft and flexible, the insect is allowed to increase freely
in size, and when this increase is no longer required, the inte¬
guments take their proper consistence.

Jn respect to the crisis taking place in organic bodies at
certain periods, nature, although prodigal of the means of
continuing the species in the lower classes of them, is yet
economical in not developing, at least fully, the necessary
organs until the time in which they are wanted, but bestows
her whole attention upon the acceleration of the growth.
'J'he crises and developments are more remarkable in insects
and sexual plants than in other organic beings, because their
sexual organs are fitted only' for a single fecundation, after
which the insects and annual plants perish entirely, while in
perennial plants the organs and part only of the plant perishes,
the remainder survives, and the next year new sets of sexual
organs are produced. The changes, however, are more or
less visible in other animals, even in man himself. In the
infant state the physiognomical expression of the different
sexes are not very visible ; the teeth and much of the voice
arew'anting; by degrees these are developed, and the coun-

\ O I. . XI. — NO. 60 . 3 c

Onoinal Communications,

tenance takes a more decided character ; but the most
decisive change takes place on the approach to puberty ; the
voice in the male entirely changes, and many organic altera¬
tions take place, which it were needless to rehearse.

Calendar of Natural History from the \Qth of March to the

Wth of April, 1819.

March l6th. — Cloudy morning; fair afternoon. The
thermometer rose as high as 60® of Fahrenheit. The Titssilago
Farfara was in flower beside Lea river. Daisies also bloomed.
I found the Peziza Scutelata var. (of Sowerby, Feb, 24th,) on
cow dung to-day in the marshes. The Tussilago Petasitis in
bloom in the garden.

18th. — Fair day^, but cold. The Beilis ptrennis every
where in flovver; and the Ficaria verna, or Pilewort, here
and there.

19th. — The flrst day of spring showers, the wind changing
at|ten A.M. from SW. to IN W., and blowing a gale at times,
with rain and hail in showers. Grape Hyacinth and the Blue
Hepatica in flower.

23d. — The Rooks and Daws building their nests. Stel-
laria media in flower.

24th.— I’his was a fine spring day, with west wund and
mild air. The Cumulus cloud as usual prevailed, but there
was a fine display of Cirrus and Cirrostratus in mottled
rows up in a higher region. I noticed the Leontodon Taraxa¬
cum in flower. The wdllow's are in catkin every where ; and
the leaves of the Eglantine budding. The birds sung till past
seven in the evening, when the Scarabceusfimetarius was on
the wing.

25th. — Fine warm day, with westerly wind and Cirrus
clouds. We had a smart thunder shower, with hail, at about
noon ; and slight showers followed. The Larch trees are
budding, and the Elms in full flower. Tumaria tuberosa in
bloom : also Fiola odorata,

26th, — Fine west wind, with slight flying showers. The
Carabus hortensis first appeared to-day. The Horse Chesnut
trees began to put forth leaves. The Anemone hortensis, the
Marigold, and several other early plants in flower in the
garden.

27th. — Strong wind from W. and troublesome dust ushered
in rain.

28th. — Fine small rain and warm air; vegetation begins to
advance rapidly.

29th. — Fine day, with showers. I saw the Veronica arven-

Calendar of Natural History. syg

sis* in blow on a wall at Woodford. Several kinds of Narcissi
(exutici) came into flower in the garden. The Trcmella deli-
quescens (of some authors) is still abundant on the sear wood
of an old paling.

^lOth. — Cardamine hirsuta in flower to-day. Some of our
vernal songsters are already arrived, and fill the groves with
their music.

31st. — To-day came into flower the Cowslip Primula
V eris, the Dead Nettle, Lamium 'purpureum, the Veronica
agrestis^ and V eronica hederifolia. Clouded, warm, still day,
SW. wind, and thermometer barely reached 60° of Fahren¬
heit. Pilewort is now plentiful in the meadows. I have not
yet seen the Marsh Marigold; but as this plant flowered by
unseasonable anticipation in December last, it may not, per¬
haps, have flowered a second time }^et.

April 1. — Fine warm weather, wind WSW., and thermo¬
meter 62°. The Garden Spiders and the Earwig first seen.
The Wallflower in bloom, and also Lamium amplexicaule on
the w^alls. The Bees begin to abound.

2d. — Callha palustris at length coming into flower: fine
warm weather.

3d. — The temperature above 60°, with clear Welkin, and
red Sunset. 1 first noticed to-day the Least Willow
Wren (Sylvia Hippolais) and the Blackcap (Ciirruca Atrica-
pilla). '1 he Bat was flying about in the evening. The yellow
and brown Butterflies first appeared ; and the Auricula,
Sweet William, Hyacinth, and Narcissi Odori in blow.

4th, — 1 he Redstart (Phccnicuriis lluficilla) first appeared.
Anchusa sempervirens in bloom in the garden F*

6‘th. — Cold east wind ; but fine day.

7lh. — Fine day; wind SE., with Cirrus cloud, 8ic. The
Anemone nemorosa, Erysimum Bajharea, and Oxalis Aceiosa
in flower on Hainhault Forest. The Pettychaps became fre¬
quent on the Larch and Pine trees in the garden. Various
species of Staphilynus come forth.

8th. — Rainy day. The lesser Petty chaps already frequents
the Larches.

9th. — -The female Redstart seen.

* Botanists should avoid confounding this Veronica with the V*
agrestis, which it much resembles; the latter grows usually on the
ground ; the former generally on walls, in company often with the
dr aba verna.

t The flowers of Veronica Chamaedris, when growing wild, are of
a lively blue colour, and so like those of Anchusa sempervirens, that
only the slightest shade of difference can in general be found by com¬
parison.

380

Analytical ReDku\

10th. — Fine and warm SW. wind in the evening. The
Wryneck {Jyrix Torquilla) heard at Walthamstow.

11th. — 1 he Cuckoo (Cuculas Canorus) at North Mims.
Plants in flower, Populus nigra^ Primula elatior, Ribes Alpina^
Vinca major ^ and V , minor. Scilia nutans and S. lialicus in
the garden. Luzuia pilosuSj L. Forsteri, and L. campestns.
Pulrnonaria ojjicinalisy and P. Longifoiia^ Narcissus pbeticus^
N. Pseudonarcissus, N. majors N, odorus, N. incomparabilisy
N. tenuis, and N. Italicus, (in open ground in the garden,)
Ca/tha radicansy Ranunculus aquatilisy Lamium Ga.rganicumy
and Anemone ranunculoides.

Vegetation rapidly advances ; the fields begin to be spangled
every where with pilewort, daisies, and dandelions. A few
instances are still afforded of the production of unseasonable
phenomena, with which these last two years have abounded ;
among others the Bundlefungus, Agaricus fascicu laris, is
growing abundantly at Upton, in Essex.

Mr. T. F. Forster, of Clapton, discovered, at North Mims,
on the 1 1th, a variety of the Primula Vulgarisy with bright
saffron coloured yellow flowers.

T. FORSTER,

[This journal is to he continued in the neighbourhood of

Tunbridge Wells. '\

PART II.

ANALYTICAL REVIEW.

Obsertations on the Prevention and Treatment of the Epidemic
Fever y at present prevailing in this Metropolis and most
parts of the United Kingdom. To which are added. Re¬
marks on some of the Opinions of Dr. Bateman and others,
on the same subject. By Henry Clutterbuck, M.D.,
Licentiate of the Royal College of Physicians, and one of
the Physicians to the General Dispensary, Longman,
pp. 299. 1819.

Practical Observations on the Treatment, Pathology , and Pre¬
vention of Typhus Fever. By Edward Percival, M.B,,
M.R.I.A., &,c. Longman, pp. 156. 1819.

Practical Observations on Continued Fever, especially that
form at present existing as an Fpidemic. M ith some Re¬
marks on the most efficient Plans for its Suppression. By
Robert Graham, M.D,, Regius Professor of Botany in

Treatises on Epidemic Fever* 581

the University of Glasgow, 8cc. &c. Smith and Son, Glas-

, govv; Constable and Co,, Edinburgh; Longman, Under¬
wood, and Cox, London; pp. 84. 1818.

Statements relative to the present Prevalence of Epidemic
lever among the Poorer Classes of Glasgow ; together with,
some Suggestions, both for affording more adequate Assist¬
ance to the Sick, and for checking the farther Progress of
the Contagion, in a Letter addressed to the Hon. the Lord
Provost of Glasgow. By Richard Millar, Lecturer
on the Materia Medica in the University of Glasgow, 8cc.
&c. Smith, Constable, Longman, Underwood, and Cox,
pp. 48. 1818.

Remarks on the Causes, Prevention, and Management of the
present Prevailing Fupidemic,commonlp called Ti/phus Fever,
for the use and benefit of the People. By W. O. Porter,
M.D., one of the Physicians to the Bristol Infirmary, &c.
&,c. 8cc, London, Baldwin and Co., pp. 53. 18)9-

Observations on the Necessity of Parochial Fever Wards, with
Remarks on the present extensive spread of Fever. By
James Parkinson, Member of the Royal College of
Surgeons. Sherwood and Co., pp. 20. 1818.

Observations on the Prevalence of Fever in various Parts of the
United Kingdom, and on the eminent Utility of Houses of
Recovery, exhibiting the great Advantages that zvould result
from such an Institution for the Reception of the Sick Poor
of Bristol and Clifton. By D. J. H. Dickson, M.D.,
F.R.S., Ed. and L., &c. &c, Bristol.

An Attempt to estimate the Pozcer of Medicine in Cordrolling
Fever. By William Brown, M.D., Fellow of the Royal
College of Surgeons, and Emeritus Professor of the Royal
Infirmary, Edinburgh. Whyte, Black, Longman, Under¬
wood, and Anderson and Chase, pp. 05. 1818.

The term epidemic, in its application to disease, implies
visitation ; and when it is designed to predicate the existence
and prevalence of any particular malady, its employment sup¬
poses that the occurrence of such malady has reference to
causes that are in some measure extrinsic ; or, at least, not
in constant operation. What is the precise nature, and what
the modus operandi of such causes ? are questions then
w'hich naturally suggest themselves to the thinking mind when
an epidemic affection makes its appearance ; and accordingly
we find such an event to be invariably followed by a multi¬
tude of conjectures and reasonings, and assumptions and

58^ Analytical Revim,

inferences, upon the origin and essence of the induced
disorder.

The investigations that are thus set on foot soon branch
out into collateral and dependent inquiries, and so become of a
more complicated nature than might at first be supposed ; and
as their object is not merely the satisfaction of speculative
curiosity, but is of high practical moment, the most efFectual
method both of preventing the evil and mitigating its influence,
forms necessarily a part of the inquiry.

That a certain state of morbid being, to which in a very
vague manner is applied the generic term of fever, has recently
been prevalent in a more than ordinary measure, is scarcely
disputed ; and that the activity of the medical profession has
been excited to a scrutiny of the particulars above alluded to,
is sufficiently evidenced by the long list of publications, the
title-pages of which have been just transcribed. The main
questions which may be regarded as involved in the present
inquiries, are, first, whether the epidemic of the present day is
the same with the low nervous or typhoid fevers of preceding
authors; and if not, w'hether the diversity is attributable to
the exciting source of the distemper, or to the constitutional
peculiarity of the times ? Secondly, fever having established
itself in an individual, is the induced deviation from health
necessarily and ab or?gine, a topical disturbance, or are the
local affections which occur mere consequences of the pri¬
mary and radical derangement ? In the third and last place,
how is the complaint most effectually to be guarded against,
or most efficiently combated ?

That these are still unsettled and debatable points we need
no further proof than is furnished us by the several publica¬
tions of the day; and in the documents immediately before
us for review, we see how different are the inferences of sen¬
sible speculatists from precisely the same premises. By some
accredited Practitioners of the present period it is asserted,
that in assuming the identity of the now prevailing fever, with
that of twenty or thirty years since, we commence our inves¬
tigation by a petitio principii, and therefore stumble at the
very outset of our inquiry. Other instruction, likewise of
high authority, teaches us to regard idiopathic fever as virtu¬
ally the same in kind, however it may incidentally and indi¬
vidually differ in degree: it goes onto say that the disease
itself is nothing more nor less than a certain condition of the
blood-vessels in the brain, known by the name of inflammation.
This doctrine, both of the identical nature and “ local habita-
tion’"* of all fevers, is denied and derided by many, who look
upon the derangement to be of a more general origin and
diversified chp'acter : and with respect both to prevention

Treatises on Epidemic Fever. 583

and treatment, we meet, as might naturally be expected, with
an equal discrepancy of feeling and opinion. To dash cold
water upon the surface of the body, to take blood from the
veins, to administer an emetic, to excite nausea, to produce
sweat, and smartly to evacuate the contents of the intestinal
canal, have all been lauded in their turns as measures, if early
and judiciously had recourse to, sufficient often in se to pre¬
vent the establishment and full formation of fever; while the
very principle itself of thus meeting and subduing the enemy,
has met from one respectable quarter with formidable opposi¬
tion; it being maintained that we possess no absolutely curative
power over fever, and all that medicine is capable of etfecting,
from first to last, is to palliate or to mitigate the severity of
accidental symptoms. Lastly; neither are the means of pre¬
vention absolutely decided upon; and while fever houses and
fever wards are recommended, and earnestly insisted on as
absolutely necessary, by the majority; others, who from their
demonstrated talent and presumed sincerity, deserve at least
to be heard, laugh at such plans of prevention as the devices
of either mistaken benevolence or jobbing expediency.

In considering this extensive subject, the first suggestion
that presented itself to our minds was to endeavour at the
formation of a general essay on fever from the materials fur¬
nished us by the respective writers who have favoured us
with their works for notice It will, however, be more con¬
sistent with our professed plan of analytical reviewing, to dis¬
cuss the prominent particulars of each of the volumes and
pamphlets before us, interspersing such notice with occasional
remarks of a critical nature; and if we find time and space
at the end of the paper, we intend to close the whole with a
few aphoristic corollaries.

Dr. Ciutterbuck. This is a name that can never be pro¬
nounced without respectful feelings : and when we speak of
the candour and ability of this author, we merely echo the
general voice of the profession. If the point for which he
strenuously contends be not made out to the satisfaction of
others, the failure must be sought for in the defect of the
principle itself, and not in the deficiency of talent by which
it is supported. And if his volumes are closed by his readers
with sentiments short of conversion, such readers, neverthe¬
less, will always be instructed by the matter, and pleased witli
the manner of the author. >

The following passages w'e extract at length, as expressive
of Dr. Clutterbuck’s notions on the contested point of identity
or variety in fevers; and from which we imagine it will be
inferred, that he contends for a sameness of essence in all

384

Analytical Review.

febrile disorders that are not symptomatic of local irritation,
the diversities being merely circumstantial, and not properly
referrible either to their exciting source, or proximate charac¬
teristic.

“ Fever in general is subject to be so much varied by circum¬
stances, many of them of a very trivial kind, without any essential
alteration in its nature or treatment, as almost to defy description, if
we allow ourselves to descend to all the minuticc which present them¬
selves in ditferent individuals. Situation, mode of life, occupation, in¬
dividual constitution, sex, and age, are, all of them, circumstances
capable of considerably modifying the character of the disease, so as
to give minute shades of difference to it in appearance; — to say
nothing of the effect of medical treatment, and the general manage¬
ment of the patient while under cure.

“ That this is really the case, any one may satisfy himself, who will
be at the pains of comparing together the histories given by different
writers, of the present epidemic, as it has appeared in London, Dub¬
lin, Cork, Glasgow, and other places. In each, a variety of feature
may be discovered, though a yhwzi/y likeness prevails throughout the
whole. I have now lying before me a history of more than fifty cases
of the prevailing fever in my own practice, as it has appeared in this
city, and of which I noted down the symptoms with the greatest mi¬
nuteness at the bed-side of the sick, generally once, and often twice,
in the twenty-four hours throughout the disease. Upon a revision of
these cases, I find that no two of them correspond in the minuter
points; though they all agree in the essential one, that is, in a mani¬
fest affection of the brain and its functions ; v^:v ’ious in degree, and
probably in extent; with numerous, but accidental, complications
from the affection of other organs.

‘‘ Independent, however, of the circumstances above mentioned, epi¬
demic diseases are subject to considerable diversity, from causes that
are as unknown as those which originally produce them. This wm
learn from the works of Sydenham, one of the most acute observers
and faithful narrators of what he saw. In tracing the history of epi¬
demic fever for five successive years, he describes each as marked by
considerable peculiarities; and so, no doubt, it would be found at any
other period ; new varieties springing up every day with every change
of circumstances. -

“ This serves to shew, that an affectation of extreme minuteness,
in the description of diseases that are liable to be varied by a number
of trivial circumstances, can answer no pathological purpose. The
nature of fever must be deduced from more general views of the dis¬
ease, and not from the laboured descriptions that have been often
given ; which, though they prove the industry of their authors, serve
only to confuse the subject, by confounding the essential with the
adventitious circumstances of the disease. Were it otherwise, indeed,
we should not, at the present day, be so continually disputing about
the essence of fever, and as to its seat in the body ; for accurate ob¬
servers and minute describers of diseases have abounded in different

S85

Treatises on Tpidemic Fever,

ages, quite down to the period of the present epidemic; without, how¬
ever, having either settled the pathology of the disease, or agreed upon
the [)roper method of cure.”

To the practical inference which is deduced by Dr. Clutter-
buck from this principle of essential similarity in all fevers,
we shall shortly have to advert. We shall now present our
readers with another extract, by which the author’s senti¬
ments on the local origin of the malady will be more fully
exhibited. After mentioning the general feelings and symp¬
toms of falling off from health which usually usher in fever,
Dr. Clutterbuck goes on to observe : —

“ There is as yet no remarkable general disorder of system, nothing
that in strictness entitles it to the appellation oi fever. Yet such
symptoms constitute, indubitably, the incipient state of the disease,
and which it is of great practical importance to be aware of ; for the
entire and almost immediate suppression of it, is now greatly in our
power. It is this stage, however, that is always the most neglected,
“ The disease hitherto is merely locals and confined to the brain
and its immediate or proper functions. In many instances it proceeds
no further, the symptoms gradually declining again. This is the
case where the disposition to fever is naturally but little ; or where an
indisposition has been acquired by habitual exposure to contagion;
and also where prompt and active means of cure have been applied.

“ But if the disease is about to pursue its course, the general vas¬
cular system becomes affected precisely as in other inflammations.
Rigors, in greater or less degree, take place, and are succeeded, as
usual, by increase of heat, frequency of pulse, thirst, and foulness of the
tongue; in a word, by the concourse of symptoms, technically called
pyrexia: and now it is that the disease literally merits the name of
fever. This is the confirmed state of the disease. It may terminate
in two or three days, sometimes spontaneously, but especially by the
active treatment of inflammation being applied to it; or it may be
protracted to one, two, or three weeks, and even longer.

If it terminate early, and especially when the solution has been
effected by blood-letting, the termination is generally rapid, and by
sweating, which seems to be critical. But if, on the contrary, the
disease is prolonged to the extent of three weeks or more, it then de¬
clines gradually ; both the general symptoms, and the local affection
of the brain, subsiding by slow degrees.”

The remaining portion of this section is devoted to an an¬
nouncement and description of varieties of form, and to
detailing the manner in wdiich the disorder becomes confirmed
when not stopped short in limine.

In respect to the exciting causes of fever, Dr. Clutterbuck
professes his dissent from the opinion of Dr. Bateman, that
unquestionably epidemic fever is generated, in the first in¬
stance, by defective nutriment.” All that a deficient supply
of necessary aliment is capable of effecting, is, according to
vox., XI. — NO. 65. 3 D

S86

Analytical Review^

Dr. C., merely that of rendering the individual more sus¬
ceptible of the actual exciting sources; and he suggests,
whether the atmospherica! or other circumstances occasioning
scarcity by affecting the vegetable creation, may not, at the
same time, exert a somewhat similar influence upon animal
life, so as to excite a more than ordinary disposition to disease.
This we conceive to be a very fair supposition; but the fact
is, as we observed in our remarks on Dr. Bateman’s book,
that epidemic affections frequently break out without the
operation of any causes that are at all cognizable either by
sense or by science : and poverty, distress, cold, filth, and
famine, are often quite as abundant where no particular
malady is present, as during the existence of a distemper
which we are too prone, from our desire to pry into causation,
to attribute, in a wholesale manner, to these sources. ‘‘ Even
the present fever of the metropolis, as we have before re¬
marked, did not make its first appearance at the time when
suffering from scarcity was at its height; but it broke out
with the greatest virulence in the year subsequent to that in
which large numbers of our manufacturing community fell
into unexpected and deplorable poverty.” Some, indeed, we
are aware, have traced its origin in this metropolis from the
visits of Irish paupers, who, either in their clothes or their
bodies, conveyed the poison to London. We are disposed,
however, to think that the whole history of the recent epi¬
demic justifies the presumption, to say the least, that a some¬
thing beside transferred contagion has been operative in its
generation and spread. We do not carry our scepticism so
far as to deny the communicable nature of the engendered
poison ; but we cannot help thinking, that were contagion the
sole source of epidemic fevers, a crowded population like
London could never be free from their visits. Typhus, if we
are allowed the employment of the term, as expressive of the
complaint, would be rather an etidemic than an epidemic of
great cities. We are not quite sure whether certain condi¬
tions of the atmosphere, the nature of which has hitherto
eluded all scrutiny, may not be necessary to the easy propa¬
gation and extensive spread of even the specific contagions,
as they have been termed ; for the origin, course, and decline
of those diseases, which result from decidedly contagious
poisons, often present- peculiarities which are quite inconsist¬
ent with the presumed independence of such poisons upon
what is passing about us. Indeed, the more we inquire into
the law's of infectious and contagious disorders, the firmer
becomes our conviction that a considerable degree of ob¬
scurity still involves the subject, and that a great deal has
been inferred respecting them upon premises by far too

Treatises on Epidemic Fever, 387

slender. A professor and practitioner of celebrity recently
asserted, in a large assembly, that he had not seen a case of
true typhus for the last twenty years. What did he mean by
this assertion ? Are we to understand by the proposition,
all owing its truth, that the poison creative of true typhus” is
in se and absolutely different from that which gives birth to
the present fever, in the same manner that measles differ from
small-pox ? Or does the avowal merely go to the assump¬
tion of a different state of the individual recipient? Here
lies all the difficulty of the determination. But it appears to
us that writers and teachers talk too much about identity and
diversity in disease, without sufficiently recognising the ne¬
cessity of the radical distinctions now referred to; distinctions
which are not merely nominal and speculative, but upon
which must hang a considerable weight of decision, as it
refers to the controversy now carried on respecting the com¬
municability or contagious nature of different distempers. It
has been asserted that typhus fever would become plague,
could an individual affected with the virus of the former be
conveyed, while the disease was upon him, to Constantinople
during the prevalence in that city of plague ; but that, if the
same speedy conveyance could be effected of a person in
small-pox, the latter disease would, in spite of the prevailing
atmosphere, retain its specific peculiarities. Now, could
these positions be substantiated, they would go far to prove
that the differences in fever of which we talk are rather inci¬
dental than absolute; and the fact would further justify the
conclusion that, without denying the contagious nature of
either plague or typhus, we might divest our minds of a con¬
siderably degree of that apprehension which would otherwise
follow an abolition of quarantine enactments. It will not be
understood that we mean to say such is actually the case :
indeed the facts which are upon record, if they can be de¬
pended on, respecting the origin of plague in different parts
of the world, from single individuals having transported
thither the contagion, are at variance with the supposition now
alluded to: certain, however, it seems, that susceptibility to
infectious distempers is governed by somewhat different laws
from that of the specific contagions. These hints, it is re¬
peated, are merely thrown out for the consideration of those
who, in our judgment, are too much inclined to confound pre¬
disposing with exciting causes when discussing the question
of identity in disease.

I’he following quotation from Dr. Clutterbuck, with regard
to the mode in which the present epidemic may be propa¬
gated, it will be seen, leaves the great question undetermined,
respecting the independent origin of contagion: but the

388 Analytical Review.

extract, we think, is too much in the spirit of those theorists
who think that fever must, in ail cases, be either contagious
or not. Does it not appear to be more in harmony with
observation to infer, that the distemper is at once contagious
and not contagious ; or that neglect of cleanliness and venlila- ,
tion may, under favouring circumstances in the recipient, be
equal to the production of a fever, which, in its course, shall
engender a poisonous virus, that may be imparted to another
io the same way that the specific contagions are received ?

“ Whether the virus producing the disease be generated, like that
of small-pox, in the bodies of the sick, and thrown otf from thesn by
exhalation or excretion ; or whether, as some have imagined, the mere
crowding together of numerous individuals, with neglect of cleanliness
and ventilation, is sufficient for its production, without the actual
existence of the disease previously, is a question that is more difficult
to be determined. The decision is of some importance, undoubtedly,
in regard to the means of prevention to be employed : for if the cause
of the fever be extrinsic to the body, and merely the result of the ac¬
cumulated exhalations and excretions taking place from it, prevention
becomes an easier task, and will depend almost solely upon cleanli¬
ness and ventilation. In the other case, such means will of course be
less effectual. I must however pass by this point for the present,
having no means of deciding it satisfactorily.”

It wdll not be necessary to follow our author through his
directions on the head of preventive measures, which are all,
like those contained in most of the other works before us,
grounded upon- the three important principles, separation ^
ventilation^ and cleanliness, 1st, I'he speedy removal of the
sick from his family and friends.” ^:d, “ The destruction of
contagion in the places from which the sick have been
removed,” by airing, white-washing, and fumigation ; and,
3dly, The correction of the evils which arise from confined
and filthy habitations, by opening the confined courts and
narrow' alleys in the most crowded parts of the town ; or rather
by removing altogether the most objectionable of them, and
erecting in their stead straight and sufficiently wide streets,
the elevation of which should be always proportioned to their
breadth.” On the disputed subject of fortifying the body
against the influence of contagion, Dr. Clutterbuck expresses
his scepticism wdth respect to the alleged power of the
Peruvian bark in eflecting this purpose. “ The analogy,” he
tells us, “ is, perhaps, too much strained, in imagining that
because the bark prevents the recurrence of a paroxy sm of
intermitting fever, it will, upon a similar principle, prevent
the accession of fever of a continued form.” And even allow¬
ing that ‘‘ a generous mode oL Jiving, with a moderate
quantity of wine,” may guard the body in some degree against

S89 •

Treatises on Epidemic Fever,

contagiony as it does against cold ; we are likely, according to
onr author, to lose, by adopting it, as much as ue gain; since
when fever does attack the generous liver, “ the disease is at¬
tended with more danger than in feeble habits.” Might not,
however, an occasional and moderate use of the fV^ruvian
bark, under some circumstances of necessary exposure, be
calculated to insure the good wdthout the risk of the evil ? —
The virtues of this drug, both preventive and curative, were at
one time lauded far beyond desert; but it is questionable
whether we are not altogether abandoning it, in the present
day, too much in the spirit of disgust with which an old lover
regards the object.ol’ his former unreasonable attachment.

When discoursing on the treatment of the present epidemic.
Dr. Cluiterbuck takes occasion further to enlarge on his
favourite principle of the local, inflammatorj^ and identical
nature ot fever, under whatever form or degree it may appear.

Contagion,” he tells us, “ first excites active disease in the
brain; and the variety observed in the general symptoms, is
owing to the different degrees and extent to which this organ
is affected.” But, on this head, we must make room for an
extract of considerable length : —

“ To understand this, it is necessary to advert to the peculiar con¬
stitution of the brain, in regard to its circulation, in which it differs
from all other organs.

“ The brain, it is to be considered, is included in an unyielding
case of bone, which defends it from all immediate pressure of the sur¬
rounding atmosphere. The skull, like the other camties (as we call
them), is always completely tilled by its contents, namely the brain,
with its membranes and vessels, and the blood contained within
them : there is no vacuity, all the surfaces being in perfect apposition,
when no fluid happens to be interposed between them. These con¬
tents are all in their nature incompressibley at least by any force that
can possibly be supposed to be applied to them during life.

“ It follows from this construction, that neither can the brain itself
suffer any immediate alteration in its bulk, from pressure of any kind
being made upon it; nor, upon the simplest hydraulic principles, can
the whole quantity of blood in its vessels vary, from one time to
another, in any sensible degree. A difference in theyorce and velocity
with which the blood moves in them, or in the relative distribution of
this fluid, is all that can possibly take place. To one or other of
these must be referred the changes that are observed in the state of its
functions when suffering under active disease.

“ From the peculiarities mentioned, an increased action of arteries in
the brain will often produce effects widely different from those which
take place in other organs, not similarly circumstanced.

“ '1 he arteries of the brain, as well as others, may have their actions
increased in a certain degree, and at the same time preserve their
diameters unchanged, or nearly so. When this happens, the force

S90

Auahjtical Reviez^h

and velocity of the circulation in the brain will be increased, and the
functions of the organ be carried on with augmented energy. A state
of excitement in the general system will succeed, with or without dis¬
order, accordins; to the degree of increased vascular action in the
brain, and according as it is accompanied with inflammation, or
otherwise.

“ After a time, however, and sooner or later in different instances,
from the continuance of increased action, the diameters of the arteries
will be increased; and these, by occupying a disproportionate space
within the skull, will compress the veins, which, in this case, are the
only parts capable of yielding to pressure. The circulation through
the brain will, in consequence, be interrupted in greater or less degree,
and the functions of the organ be proportionally impeded, with a di¬
minution of energy throughout the whole system. Thus the same
cause, increased xascular actim^ may produce the most opposite
effects.

“ This serves to explain what takes place in fever. At the o-utset of
the disease, while the inflammatory action is moderate, the functions
of the brain are carried on in an excited, but unequal and disordered
manner; accompanied with that general disorder of system, {pyrexia
or the febrile state) which inflammation, wherever seated, so commonly
induces.

“ In an advanced stage of the disease (and, in unfavourable cases,
even in the beginning) the arterial system Of the brain becomes
distended, the veins are compressed, and the circulation through the
organ more or less interrupted; and its functions, consequently, im¬
perfectly performed. This may take place, up to the degree of com¬
plete apoplexy, or total insensibility; but still with more or less of dis¬
order in the functions, owing to the nature of the disease (inflamma¬
tion), and the unequal affection of the organ.

When we consider the variety of structure in the brain; that, in all
probability, each part has its destined office, and is connected with,
and influences, a different part of the system ; and further, that the
disease may affect one or more of these parts, and that unequally and
in different degrees, we need be at no loss to account for the great di¬
versity observed in the character of fever at different times, inde¬
pendent of that which proceeds from climate, constitution, and other
causes.

‘‘ From these physiological considerations in regard to the brain,
I conclude that the oppressed state of functions, observed in violent or
rnalignant states of fever, is not the result of the sedative operation of
contagion, upon either the pozeer, or vital principle ; but pro¬

ceeds from interrupted circulation in the brain, the consequence of
increased arterial action taking place there, and producing its eflect in
the manner stated. The use of such vague terms as debility, exhaus¬
tion, collapse, venous congestion, and the like, in order to explain the
phenomena, appear to me to be quite unnecessary.'^

Now the theory which the above positions involve, respect¬
ing the incompressibility of the brain, appears to our concep-

391

Treathes on EpuletJiic Fever.

tion to be totally void of foundation ; and this we venture to
assert, notwithstanding the avowal exposes us to the charge
of differing from Dr. Monro, who, as Dr. Clutterbuck tells
us, taught the doctrine many years since. It seems surprising
that any pathologist can maintain the opinion, who recollects
the large quantity of fluid which is often poured out into the
ventricles of the brain, so as to distend these cavities to an
enormous degree, without producing any alteration in the
dimensions of the containing parts. When such deposition is
gradually effected. Dr. Clutterbuck and Dr. Monro would
tell us, that there has been a corresponding absorption in the
actual matter of the brain : but, beside that this is a doubtful
point, and, if Gall’s principles of brainular construction^ are
correct, an absolutely untrue assumption; it will be recollected
that the effusion is often so suddenly made, as to render the
supposition of proportionate absorption, to say the least,
highly improbable. From every view, indeed, that we find
ourselves able to take of the case, our conclusions would be
precisely the reverse of those now referred to; and we should
say, that if there be any part of animal organization more com¬
pressible than another, it is the brain ; and it seems thus con¬
stituted on account of the unyielding nature of its bony
investments. Dr. Clutterbuck surely recollects, that it is not
in this organ alone where we find all surfaces in perfect
apposition,” but that the very same 7iatural position of parts
is even found in what is erroneously called the abdominal
cavity, which is capable, nevertheless, of becoming enlarged
by disease to an enormous extent. Indeed, every tyro in
physiology, knows that there is no such thing as a cavity,
strictly speaking, in any part of the body.

Dr. Clutterbuck admits that there may be a difference in the
relative distribution of blood in the brain; but it seems strange
that he should, in the very face of this admission, talk in
terms of contumely of that doctrine, which is altogether
founded upon this principle, and should ridicule Dr. Arm¬
strong’s notion of congestive states as inconsistent with a
sound pathology. The great source of failure, as it appears to
us, of Dr. Clutterbuck’s theory of fever, consists in his
neglecting to recognise the primary link in the chain of causa¬
tion. A something is applied to the body, say contagion,
which proves sufficiently forcible to derange the whole system,
and the impulse of w^hich is first felt upon the sentient
and moving powers of the body: the brain then, as the great
organ of sensation, especially feels the influence of the
deranging power ; its circulation becomes, by consequence,
irregular ; vascular congestions take place from the induced
irregularity in the balance of circulatory movements ; and thus

39^

Jnalyt ical Review^

is the original affection of the head (an affection, which we
conceive to l)e prior to any vascular change,) rendered more
urgent and conspicuous, ddie occurrence of positive inflam-
niaiion within the cavity of the cranium, we conceive to be
infrequent, unless in those instances in which the fever termi¬
nates fatall}^ ; and it appears to us, that mere irregularity in
the distribution of the blood, and consequent congestion, are
not sufficientiv distinguished from inflammation by authors
in general, when they are endeavouring to ascertain the
conditions that accompany or characterize fever. Not long
since, the body of an individual was opened, who died
from the first shock of fever virus, in a state of collapse, as
Dr. Armstrong would term it; or, to use the almost exploded
language of the Cullenian school, prior to the reaction, which,
had the individual survived, would soon have become esta¬
blished. Now, in the encephalon of thrs man was found
exactly that state of vessels which would have been a priori
expected ; the venous system was throughout actually gorged,
w’hile the arteries were even more empty than usual. Had
the first shock been survived, the brain would necessarily
have become the seat of much vascular irregularity before the
circulatory balance could have been readjusted : but still, it is
conceivable that the disorder might have run its course, and
have terminated in health, without the induction at all of the
real inflammatory state of parts ; which, as above hinted, we
should be glad to see more accurately defined by those
authors, who insist so much upon inflammation being but
another name for fever.*

But we must still further urge upon our readers the prac¬
tical errors which may be likely to arise from the indiscrimi¬
nate reception of these general and simplifying notions of fever’s
production. In Dr. CliUterbuck’s own hands, we believe that
fever patients would be always safe, since we could hardly
name any individual who has come forw'ard upon the world as
a declared theorist, with so little disposition to make every
fact bend to such theory ; but we are apprehensive that the
tenets he inculcates, respecting the identical and necessarily
inflammatory nature of all fevers, is calculated to lead to
a practice too indiscriminately depletory. Sydenham him¬
self, it W'ill be recollected j observed a marked dift'erence in

* A sick headacb, as it is erroneously termed, is a minor degree of the
febrile state ; and it is attended, not caused, by an irregular conges¬
tive state of the encephalic vessels, in the same manner as it is accom¬
panied, not occasioned, by faulty action in the digestive organs; but
it would certainly be improper to apply the term inflammation to the
condition of vessels here present.

Treatises on Epidemic Fever, 393

what is called the type of fevers in different years; and even
allowing that the majority of cases we meet w'ith of the pre¬
sent epidemic may bear bleeding very well, it is more than
possible that, long before l)r. Clutterbuck’s volumes lose their
popularity, an epidemic may visit us which shall be charac¬
terized by different features, and demand a different treatment.
We have just received a letter from an intelligent corres¬
pondent, (Mr. Woodham=^), which want of room prevents us
from inserting at length, containing an account of a fever that
prevailed at the depot for prisoners of war at Norman Cross,
in Huntingdonshire, from 1797 to 1802, during which time
the writer was Physician’s assistant at that place. From
1797 to 1799,” says Mr.' W., the fever principally was that
denominated by Huxham the low nervous fever; whereas from
the latter date to the period of 1802, it was the putrid malig¬
nant fever of the same author, chiefly characterized by
extreme prostration of strength, feeble pulse, and a dry
mahogany tongue.” With respect to these last, our corres¬
pondent goes on to state, “ the head and contents of the
thorax were the parts which chiefly suffered; and it is worthy
of notice, that we invariably lost our patients when the lungs
were seriously affected, but seldom or never when the head
was so.” The treatment w'as, by the exhibition of an
emetic, if the strength w'ould admit, followed by a gentle
aperient,” with columbo and aromatics to give tone to the de¬
bilitated stomach, with wane, from four ounces to a pint
during the 24 hours.” Now let us submit, as a respectful
query to authors and readers, whether these patients would
have fared better under a treatment directed by the dashing,
inflammatory doctrines of the present day; or whether even
Brunonian stimulation might not have been nearly as safe an
expedient as bold depletion. At any rate, we feel fully con¬
vinced, that both the type and treatment of fever must
be judged of and regulated with reference to something
further than mere vascular conditions ; and, on this score, if
on no other, should we object to that simplification of its
essence and management, which meets, we think, with too
much encouragement from Dr. Clutterbuck’s views. It is
inflammation,” he tells us, that we are,to treat, whether the
brain alone suffers, as in the simplest forms of the disease, or
other organs are affected at the same time along with the
brain — it is still inflammation,’ and our remedies are essentially
the same. The proper adaptation of them to the different
circumstances of the case, is the only point of difficulty.”

* The writer of a paper in the present Number of the Repo¬
sitory.

VOL. XI, — NO. 65. 3 E

S94 Analytical Reviezv.

Dr. C. divides the prevailing fever with a view to prac¬
tice merely’^ into three different stages ; the first, or incipient;
the second, or active stage in which the disorder is fidly
formed ; and the third, or stage of oppression, which,- when
strongly marked, approaches in its characters to the apoplectic
state.'* He tells us, that blood-letting employed in the inci¬
pient stage of fever, wnll generally bring the disease to an
almost immediate termination.” He admits, however, that
vomiting and purging used at this period will rarely fail to
answer the intended purpose. Stimulation may occasion¬
ally also succeed ; but in case of failure, it is well calculated
to confirm the disease,” Of the cold affusion he has had no
experience. In the second stage, blood-letting ought to be
the first measure resorted to,” if the Practitioner be called
within three days of its complete formation. Single large
bleedings, as from twenty to thirty ounces, are generally
preferable to repeated small ones : when the latter are
employed, it is sometimes necessary to take from eighty to
one hundred ounces before the object is fully effected.
Blood should be drawn from the patient while he is in a
recumbent position, in order to insure a sufficient loss of
blood, and at the same time to avoid fainting.” The follow¬
ing remark, in regard to bleeding in the advanced stages of
fever, we insert as, in our minds, exceedingly important,
feeling as we do, that the full and bounding pulse” is by
far too indiscriminate!}^ set down as a mark of strength ; it is,
on the contrary, often an index of a state of the circulation in
which weakness is exceedingly urgent. The full and
bounding pulse appears to me to be much more equivocal, as
a reason for bleeding, than a small and contracted state of it.”
Purging and digitalis are the principal remedies of a general
kind, which Dr. C. uses as adjuncts to bleeding in the active
stage of fever. Blistering, our author objects to as a general
practice, both in the first and second stage of the disease.
Of antimonials he has not much to say. It may be remarked
by the wa}^ how much the fashion of medicine has changed,
in respect to this last medicine : at one time it was lauded as
a febrifuge, nearly in the same terms of encomium that
blood-letting is at present spoken of; and now, an advo¬
cate for its employment is a sort of phenomenon in the
medical horizon. Such an advocate has, however, recently
appeared in Dr. Balfour, who tells us that tartar-emetic
might, if properly employed, be made, in a very great
measure, to supersede the lancet, both in fevers, inflamma¬
tions, and even in affections menacing apoplexy. Dr. Clutter-
buck concludes his section on the treatment of the confirmed
stage of fever by some very just observations, in respect to

S95

Treatises on Epidemic Fever,

the propriety of occasionally supporting the system by nou¬
rishing diet to a moderate extent, in inflammatory states,
even when we are pursuing the remedial plan of depletion.
There is, however, we conceive,"much more propriety in such
a pri nciple, as applied to inflammation, than true febrile
complaints; and the vulgar adage of feeding a cold, (which is
an inflammation) and starving^of fever, is not altogether
without foundation*.

When, on the treatment of the third stage of fever. Dr. C.
takes occasion to ridicule the doctrine propounded by Arm¬
strong, respecting venous congestion, and says he is at a loss
to conceive how such a state should take place, combined
(as Dr. A. contends) with a deficiency of arterial action.’’
For ourselves we should say, that in no other way but want
of propelling power in the vessels, can this congestion have
place: such propulsion being in one moment suspended,
and in the next restored, constitutes, indeed, as we have
before hinted, the principal peculiarity of fever, as far as
mere vascular states are concerned. Dr. C. himself admits
that this oppressed or apoplectic stage of fever, con¬
sists in a partially interrupted state of circulation in the
brain and that “ the object to be aimed at in the cure, is
the restoration of the circulation to its natural state and

the small bleedings” which are recommended in these
circumstances, followed b}^ a moderate use of cordials
and stimulants,” are quite in harmony wdth the notion of
relieving congested vessels, and urging on the circulatory
energy, in such sort as to obviate re-accumulations. The
practice of blistering. Dr. C. does not seem to be very partial
to, even in this stage of the disease ; but he recommends,
W'hen the oppression is urgent, small quantities of wine, of
spices, of ammonia, and, if there be much restlessness, six
drops of the tincture of opium at night, or even once or twice
in the day.”

We must now take leave of our ingenious author, merely
adding, that the cases which he has recorded as an appendix
to the present volume, are drawn up wuth a great deal of
candour ; and were it not that other cases likewise of different
and still successful treatment in the present fever might be
adduced, we should say that they might be considered as
almost absolute demonstration, if not of the correctness of his
principles, at least of the propriety of his practice. It has,
however, lately fallen to our own lot to notice, upon a pretty
extensive scale, the effects of remedies in the early stages of

* As in moral, so in medical science, we often find the trite axioms
that are circulated among the vulgar, to be in accordance with coirect
principles.

396 Analytical Review.

fever; and we have generally found reason to be satisfied
with insuring a free discharge from the intestinal canal, and
using blood-letting both general and topical, rather inci¬
dentally, in order to meet the occasional urgency of unfa¬
vourable symptoms, than absolutely, invariably, and, in fact,

as a febrifuge, in the way that Dr. Clutterbuck recommends.

■ —

Dr. Percival. — The volume now^ to be noticed we have
read with considerable interest and pleasure, and we are
sorry that our restricted time and room will prevent us from
doing justice to its contents : it opens with some general
remarks on the origin of infectious fever, and on the means of
restraining its threatened prevalence in England. With Dr.
Clutterbuck, and almost all other writers. Dr. P. considers
that much is in our power, in the way of prevention, by the
use of the three important measures, — separation, cleanliness,
and ventilation. What are the positive means of controlling
the future progress of contagion throughout the country ?’^
I answer in the terms which have been repeated and con¬
firmed by almost every individual authority, from the time of
Dr. Lind, separation, cleanliness, and ventilation.

With respect to the dose of poison w'hich is requisite to
produce fever. Dr. P. remarks, that it varies, first, according
to the state or degree of fever in the person who emits the
miasma ; secondly, according to the degree of its concen¬
tration ; and, thirdly, according to the bodily and mental
condition of the recipient.’’ He further notices another law
respecting contagious influence, namely, the curious fact, that
exposure for a length of time to a fever atmosphere, renders
the person less obnoxious to the poison producing fever.
Hence the immunity of nurses and other attendants on fever
hospitals. Does this fact explain the infrequent attacks of
medical Practitioners, compared with what might be a priori
supposed? Dr. Percival believes in the spontaneous origin
of typhus fever, contrary to the tenets of those who maintain
the absolute necessity in all instances for the application of
contagion. There are, indeed,” he says, those who deny
the influence of contagion ; and the same incredulity seems to
have led others to deny the spontaneous origin of typhus
fever.”

The following remarks we present to the reader at full
length, as bearing upon the disputed point of our means of
controlling contagion.

“ The contagious property of the plague was not discovered
earlier than the fifteenth century. The horrors of that disease
induced the Venetian Government, in the year 1478, to appoint
officers of health for the protection of the public ; and this appoint¬
ment may be considered as the origin of medical police. These

397

Treatises on Epidemic Fever.

officers soon discovered the necessity of preventing all communication
between the healthy and diseased. Hence arose lazarettos and
quarantines: and these institutions, which were the first fruits of
medical police, have banished the plague from the greater part of
Europe. The medical police of Malta, under the direction of a
board of health, kept the garrison absolutely free from the plague
which lately ravaged that island. Only seven soldiers died of the
pestilence ; while of the inhabitants, who were not under medical
police, there perished 3348.

“ I'wenty years ago, a zealous and benevolent Physician in
Chester, demonstrated that small-pox might be extinguished by
means that were successfully practised for some time in that city.
Had there then existed a national board of health, co-operating with
provincial branches, it is scarcely to be doubted that small-pox
would have been eradicated from these kingdoms, though the efficacy
of vaccination had never been discovered.

“ The same intelligent Physician has pronounced very sanguine
expectations, that a similar plan adopted in reference to typhus
would banish that pestilence also from the empire.’^

In noticing the opinions of the present author, we mean
rather to be analytical than critical, otherwise the several par¬
ticulars which the anticontagionist would oppose to these
anticipations of our author, on the efficacy of preventive mea¬
sures in contagious and infectious diseases, might here fall
under discussion. We must just allow’ ourselves to remark, that
Dr, Percival, in another part of his book, admits, that con¬
tagious influence is modified or graduated by causes, many
of which are beyond our discernment; and that fevers have
their periods of prevalence or declension independently of the
interference of huma7i artd^

Dr. Percival presents us with some very interesting remarks
on the head of difference of susceptibility to fever, from age
and sex, and rank in life. While, according to his owm
observations, the proportion of females which fall with fever
are larger than of men, the mortality, on the other hand, is
reversed ; and this he very justly ascribes to the difference in
organic integrity, so to express it, between the sexes. “ It is
obvious,” he says, that the lower classes of men are more
exposed to violence and hardships, and more addicted to in¬
temperance and excess of all kinds, than women of the same
rank ; and in broken subjects, febrile actions, from whatever
cause they originate, fall upon the diseased organs with pecu¬
liar force, and not only augment, but complicate the fever.”
But farther: the rank in life is an important circumstance in
modifying the nature of fever, as to the individual affected :
and Dr. P. tells us, that while among the poor, the mortality
from this disorder does not exceed, in ordinary circum¬
stances of medical care, one in fifteen ; and in peculiarly

398

Analytical Review*

auspicious circumstances, perhaps one in twenty one
fatal case in five has been given as the ratio among the higher
orders. This striking disparity our author ascribes — 1st. To
the artificial habits of the higher orders, which render them
more prone to severer congestive and inflammatory affections
than the lower classes. 2d. All the cerebral functions, so pe¬
culiarly implicated in fever, are in the former much more
susceptible of excitement and disorder. 3d. The intelligent
sensorium, through which so much energy is distributed or
misplaced in the system, is, in the poor man when laid on his
sick bed, a dormant faculty ; but in the rich man, under the
same circumstances, is the busiest instrument imaginable, of
hopes and fears, provisions and anxieties, recollections and
anticipations.’^

Th ese circumstances of difference are, we think, exceedingly
well conceived, and admirably expressed. We should be
glad, did our limits allow us, to lengthen the quotation.

The following we extract, as expressing our author’s sen¬
timents on the nomenclature and classification of Typhus.

Substantially,” he says, the arrangements, both of Dr.
Bateman and Dr. Armstrong, correspond with my own. It
has been our common object to dispose a family of fevers,
which have hitherto boasted of more than twenty names,
under the simplest generic denomination and the most obvious
specifical divisions. The genus then may be denominated
Typhus; the speczes, gravior, mitior, mitissimus, or febricula ;
artd the individual may be characterized in each species by
the organ more peculiarly engaged with congestion or inflam¬
mation, as cephalic, pulmonic, enteric, &.c.”

One remark shall suffice here, in addition to those which
w^e have had occasion often to make on the absolute error
even of the attempt to class diseased production according to
the principles of arrangement in other departments of phi¬
losophy. In the above division it will be perceived that a
slight febricula from cold, or irregularity in diet, is set down
as a Typhus fever, and thus are all the disputes at once
settled as to the specific or more general character of the dis¬
order under notice. We do not mean to assert that such is
not the case ; all that we wish to point out, is the incorrectness
of assuming the fact in nomenclature until opinion is unani¬
mous with respect to the fact itself.

Morbid Characters and Indications of Typhus.” This
division of the volume is opened by the following statement; —

“ The leading features of Epidemic and Contagious Fevers are,
rapid prostration of strength, with sanguineous determination to the
head or other principal organ, attended with frequent pulse, increased
heat, partial or general, and disordered secretions. The strong

Treatises on Epidemic Fever, ' SQQ

analogy, prevailing amongst all fevers of this description, indicates a
community of generic character. They differ from fevers arising
from simple local inflammation, in many important particulars ; but
in none more remarkably than the sudden failure of mental and
voluntary power, the tendency to perform a certain cycle of morbid
changes in definite periods, and the power of propagating their kind
in healthy subjects by contagion.^^

Dr. Percival then goes on to trace the general history
of the complaint, remarking upon the pulse, the tongue, the
temperature of the body, &c. : on the disputed point of critical
days, he announces his agreement with the facts observed by
Hippocrates; and, with respect to appearances after death,
we meet with the following statements: —

“ I have superintended numerous dissections of patients who have
died in typhous fever. The examination has been almost invariably
made within twenty-four hours after death. In typhus gravior, at¬
tended with low muttering delirium, and coma, the brain usually
exhibited evidence both of venous and arterious congestion. These
were not less observed in cases that had run a short course, than in
those which were more protracted. On removing the upper part of
the cranium, blood was frequently effused. The vessels of the pia
mater and plexus choroides were often turgid, and portions of the
serous membrane opaque. A glairy fluid, sometimes tinged with
blood, was interposed between this membrane and the arachnoid
tunic. Globules of air appeared often in great abundance in the
vessels of the pia mater, which were easily ruptured in their small
branches. More or less of limpid fluid was found in the ventricles ;
yet seldom in any considerable volume. The substance of the brain
was in some cases firmer, in others softer, than the common standard.
On dividing its substance, numerous bloody points usually presented
themselves on the surface of the separated parts. No case of abscess
of the brain (as described by Pringle and others) occurred to my
observation,

“ The phenomena here specified are in strict correspondence with
the symptoms of typhus gravior, especially towards its decline; and
elucidate the common termination of the disease in the manner of
coma. In many fatal cases of petechial fever, however, the brain
exhibits very slight evidence of sanguineous congestion. But these
cases are not distinguished in their progress by acute cerebral
affections.

“ In almost every case that comes under dissection, whether of mild
or malignant typhus, one or other of the following organs is found
engaged with disease ; namely, the lungs, the pleura, the liver, the
peritonaeum, the mucous and villous texture of the intestinal canal.

** The morbid appearances of the lungs, in such cases as have ante-
cedentlys hown symptoms of pulmonic inflammation, resemble those
which are observed after peripneumonia notha, viz. sanguineous con¬
gestion of one or more entire lobes, with mucous and purulent en¬
gorgement of the bronchiae, a florid hue of the pleura of one or both

400 ' Analytical Review.

cavities, \vith serous effusion, coagula, and membranous adhesions.
Sometimes the lungs are found studded with abscesses, or tubercles in
various stages of advancement to suppuration.

The liver is found diseased, especially among paupers broken
by habits of intoxication. That organ is sometimes found shrunk in
its dimensions, hard, or knotted ; sometimes preternaturally enlarged,
soft, and rotten in its texture; gorged with blood, and grumous
rather than bilious secretion. Sometimes its investing membrane is
inflamed, with adhesions to the neighbouring parts. The gall bladder
is in some cases distended with green or black bile ; in others it is
found empty.

The peritoiiceum, in cases of antecedent tympany, exhibits a dif¬
fused blush of preternatural redness. The intestinal portion of it, in
some enteritic cases, is marked with circumscribed patches, of a livid
hue, accompanied with adhesions more or less extensive throughout
the viscera. The abdominal sac, under these circumstances, always
contains some serous fluid, from the quantity of a pint to that of two
or three quarts, with filmy coagula. The inner coat of the. intestinal
canal is found variously diseased, from the mucous tissue of the
fauces to the opposite alvine extremity. Portions of florid congestion,
or livid patches, are not unfrequently discovered. Sometimes the
membrane is invested with tenacious mucus ; in other instances it is
preternaturally denuded of it. When dysenteric symptoms have pre¬
vailed, the surface of the membrane is partially or generally florid,
with sero-puriform secretion, and scattered spots of darker hue, with
separation of texture. Ulcerations, however, are seldom observed,
except in cases of confirmed dysentery

The above account of the appearances on dissection, refers
principally to what Dr, Percival calls typhus gravior. Typhus
initior is, he says, much seldomer fatal than typhus gravior ;
but when death has taken place among his patients in the
former, he has very often found, upon examining the brain,
no deviation from the due or ordinary condition of that
viscLis;” and, on a careful dissection of three persons who died
suddenly, in appearance just recovering from mild fever,
neither the brain nor any other organ showed the probable
cause of these sudden deaths ; and there was no ground to
impute them to errors or excess of diet.”

Our inflammatory theorists will, perhaps, urge that these
were anomalies, for the explanation of which they are not ac¬
countable. To us, however, the occurrences seem rather in
too large a number to be e.xplained away by any evasive
remarks of this kind ; and we must be allowed to contend, that
they make strongly and strikingly against that theory which
we have all along opposed, viz. That an inflammatory condi¬
tion of the cranial contents, is identical with true fever.

Here, however, we must reluctantly break off, as the admis¬
sion of other articles, which are already corapo.sed for the

401

Medical Hotany,

present Number, will be inconsistent with the lengthening of
the present. In the next Number, then, we shall resume the
subject, and finish the consideration of the works that remain
to be noticed.

II.

Medical Botany y or History of the Plants in the Materia

Medica, illustrative of the LondoUy Edinburghy and Dublin

Pharmacopoeias y arranged according to the Linncean System,

This work is published in monthly numbers, each contain¬
ing six plates, and is evidently an imitation of Dr. Wood-
ville’s Medical Botany, but far inferior in execution. The
advertisement is signed T. T. and dated from Cambridge ;
but the author is not known to us.

As a periodical work of this kind, well executed, would be
agreeable to many young Practitioners, to whom the purchase
of Dr. Woodville’s book might be inconvenient, we should
be happy if it w'ere in our power to praise the present work,
but our duty to the public forbids this proceeding. In the
first number, the generic character is either omitted, or, as in
rosemary, blended with the specific difference,* but this is
altered afterwards : the language of the whole, however, is
very careless: the figures are as indifferent, and do not agree
with the descriptions ; that of the olive-tree is very bad, and
two varieties of the fruit appear on the same branch. The
black pepper is represented with the flower of a polygonum,
coloured yellow, yet described as w'hite, although authors
unanimously agree it has neither calyx nor corolla ; and the
fruit is equally incorrect. The sugar-cane would scarcely be
recognised by a West Indian ; the two upper leaves are also
represented as opposite. Although the leaves of madder are
said to grow in whorls of four or five, they are represented in
the figure in a whorl of three. As apothecaries usually pur¬
chase their jalap, &c. in the form of powder, their apprentices
are, on examination, frequently at a loss to recognise the roots,
&c. in mass : the representation of a root of jalap here given
will certainly be of no assistance. In the figure of datura
stramonium the capsule is represented with a four-leaved
calyx adhering to it; yet the author himself says the calyx is
deciduous ; and w'e do not know what authority he can
adduce for constantly writing strammonium.’’ The flowers
of atropa belladonna are represented of three different
shapes, the leaves wrongly placed ; and we neither under^
stand the figure of the berry, nor the use of figuring the root.
But we are tired of having nothing to do but to find fault. The

VOL. XI. — NO. 65. 3f

402 Analytical Review,

figures adding so much to the expense of the work, they
should in return be correct; but almost any old herbal, with
wood-cuts, would give the student a better idea of the plants.

III.

A Treatise on Midwifery ; developing New Principles, zvhich
tend materially to lessen the Sufferings of the Patient, and
shorten the Duration of Labour, By John Power,
Accoucheur, &c. Member of the Royal Medical Society
of Edinburgh,

A WORK, the title-page of which promises so much as

materially to lessen the sufferings of the patient, and
shorten the duration of labour,” could not fail to attract the
attention of those, among whom w^e profess ourselves to be
the most forward, who are anxious to alleviate the afflictions
of parturient women. Whether the author has formed too
sanguine expectations of the success of his peculiar method of
practice, or has, indeed, chalked out a new path of usefulness
to the cultivators of the obstetric art, we shall now^ proceed to
inquire.

The work is divided into two parts: the first contains the
doctrines of parturition the second practical observations
relative to parturition and there is an appendix of illustra¬
tive eases.

We shall not be detained long by the doctrinal part of this
w'ork, w’hich might have been abridged at least one half, with
great advantage ; yet we marked, as we read, a passage on
which we feel inclined to offer a few comments.

The passage in question is at page 24, where the author
announces a new method of trying a pain, without putting the
patient to the inconvenience and unpleasantness of submitting
to an examination per vaginam,

“ We now turn to such effects of the parturient paroxysm as are
detected by the attention of the accoucheur.

‘‘ On applying the hand to the abdomen of the patient, previous to
the approach of the paroxysm, the uterus will be found in a flaccid
state; the parts of the child, and other abdominal contents may,
indeed, be felt presenting harder masses through its parietes, but its
general feel will offer an easy compressibility ; the paroxysm now
commences; it immediately becomes evident, even before the patient
has a perception of it, that a change is taking place ; the compressi¬
bility gradually diminishes, until it is entirely lost, and the abdominal
tumor is rendered so hard and tense, that a difficulty is found in pro¬
ducing the slightest indentation, so that it may be said, to speak
emphatically, to become hard and solid as a board.

Power^s Treatise on Midwifery. 403

As the paroxysm recedes, the contraction and incompressibility
gradually go off, and the softness and flaccidity return.

It may not be improper here to deviate, in some degree, from the
subject before us, to notice the very delicate and excellent mode of
trying a pain, which the above state of uterine contraction, as
evinced through the abdominal parietes, affords ; the information it
gives is most important, and uniformly correct ; no genuine parturient
action is without it, and, when perfect, no false or unprofitable action
is ever found co-existent with it, its presence evidencing the existence,
and its absence the want, of the true energetic uterine principle, by
which it unfortunately happens, that the most distressing states of par¬
turition are often, for a length of time, totally unaccompanied, ft is
true, that it will not indicate the state of presentation, or the degree of
progress ; but when those points are ascertained to be favourable, the*
necessity of frequent examination per vaginam, which is always dis¬
tressing to female delicacy, will be obviated by its use : the informa¬
tion it is capable of affording, might even be acquired through the
dress of the patient, without trouble, or much appearance of inter¬
ference; its most decided importance must, however, rest upon the
ready opportunity it gives of becoming satisfied that the state of the
parturient energy is correct ; a point which will be found to require a
regular attention, and to involve the most interesting consequences.'^

The method here recommended, if implicit reliance may be
placed upon it, promises to be ver}^ useful under certain con¬
ditions of labour. It cannot, however, supersede the necessity
of an examination per ^vaginam, at the time, of all others,
when such an examination is most unpleasant to the female,
the commencement of labour.

But we conceive that this mode of examination may be ad¬
vantageously called into use, in order to determine a ques¬
tion, which we have found even skilful Practitioners at a loss
to resolve ; viz. whether pains, apparently very strong, after
many hours of labour, were uterine or not. We were called
some time since on a Monday to a woman of forty, in labour
of her first child. Upwards of tw’enty-four hours elapsed
before any considerable impression was made on the os uteri.
On the Wednesday, however, the os uteri being well dilated,
a termination of the labour was looked for ; but the head of
the child had not passed through the superior aperture on the
Thursday. The advice of a very eminent accoucheur was
therefore requested, w'ho, finding the patient suffering frequent
and apparently strong pains, gave it as his opinion that there
was no necessity for the interference of art. We objected,
that though the pains were apparently strong, yet that they
were in reality inefficacious ; the consulting Practitioner
thought they were rather spasmodic than uterine, and he
attributed them to commencing inflammation either of the

404 Analytical Review,

uterus or peritonaeum, and not to healthy uterine efforts ; and
he alleged, in proof of this position, the extreme tenderness of
the abdomen on pressure. The arguments that he used were
not considered satisfactory, and it was determined to leave the
case longer to nature. The next day, however, demonstrated
the necessity of proceeding to artificial delivery. The per-
forater was employed, but not in sufficient time to save the
life of the mother, who died in a few days, of what w^as called
puerperal fever. Now if the criterion that this author pro¬
poses can be made available in such a case as this, he will
have conferred a very great boon upon his brethren of the
profession by giving it publicity.

At the end of the first part, the author has given a kind of
nosological view of the varieties of the parturient state, which
exhibits great research and precision.

Having thus given a very brief account of the first part of
Mr. Power’s book, we hasten to the second, containing his

practical observations relative to parturition.”

After some preliminary observations, the author enters upon
the consideration of his first class of labours, (Eutocia)
Natural Parturition, which he defines to be labour with-
out painful action ; and he adds, the case terminates favour¬
ably within six hours.”

“ The happy state of parturition, which is described in the
above definitions, is, unfortunately, under the present state of
society, to be regarded as almost an ideal or imaginary pro¬
cess.” We w'ould ask, Under what state of society did
this happy state of parturition” ever exist The oldest
records we possess uniformly speak of childbirth as a process
full of pain, anguish, and woe.

The second class, (Dystocia) Unnatural Parturition,
is divided into three orders and twenty-three genera ; but the
author treats only of the first order, unnatural labour arising
from derangement of the parturient principle.”

This order of labours is subdivided into the following
genera: — 1. Labour with painful uterine action. (Oxytocesis).
— -2. Labour with partial uterine action. (Merergasis). ' — 3,
Labour with metastatic determination to muscular parts.
(Myopathia). — 4. Labour with metastatic determination to
the arterial system. (Angiosmus). — 5. Labour with dimi¬
nished production of the parturient energy. (Apenergesis).
— - 6. Labour with exhaustion of the parturient energy.
(Asotia.) — 7. Labour with defective irritation of the os
uteri. (Anerithismus).

Though each of these states of labour obtains some atten¬
tion from the author, yet the object which he has principally

405

Power’s Treatise on Midwifery,

in view is to discuss the subject of metastatic determination, to
which he attributes the difficulty of the labour in a great ma¬
jority of instances.

It will not be in our power to follow the author through
the long, and rather verbose disquisition which he has entered
into upon metastatic determinations: he first gives a history
of the general symptoms,” then of the specific varieties
next he treats of “ the causes of metastatic determination to
muscular parts,” under the different heads of the proximate
cause, the pre-disposing causes, and the exciting causes.”
Afterwards he directs us how to form a prognosis and a diag¬
nosis, and at length comes to the more important subject, the
treatment of metastatic determination to muscular parts.”

“ Admitting that most of the protracted cases of parturition, which
have been characterized in the doctrines of the obstetric art, as occu¬
pying a longer period than twenty-four hours, depend upon the exist¬
ence of metastatic determination, it will follow that the consideration
of those measures which are best capable of removing it, must con¬
stitute a_subject of the highest importance.

“ This importance is not a little enhanced when it is also found
that a considerable portion of the more favourable cases, occupying
a less portion of time than twenty-four hours, are also referable to
the same cause, since it has been attempted to be established, that a
casd of labour of the natural class should arrive at its termination
within six; and of labour, with painful uterine action, within twelve
hours from the commencement of the process.

“ Whenever the case is protracted beyond these periods of suffer¬
ing, it is most probable that it will be found, so far as it is referable
to the nervous order, to be affected more or less by metastatic action
of the muscular kind.

The indications of treatment, which naturally present themselves,
are threefold : —

“ 1. To effect the removal of the causes of the metastatic state.

“ 2. To obviate the effects of those causes ; or, in other words, to
relieve the spasmodic affections which are excited by them.

“ 3. If the above indications should be disappointed, to produce
a temporary suspension of the case, in expectation that the ensuing
efforts may be of the proper uterine kind.”

For the removal of the metastatic determinations, the
author proposes two sets of remedies : — A. Internal antispas-
modics. B. External antispasmodics.

By internal antispasmodics he means such as are admi¬
nistered by the stomach, or that operate generally on the
nervous system by external topical applications.

The internal antispasmodics most deserving of notice are :
— 1. ^ther, — 2. Ammonia. — 3. Wine and spirituous fluids,
— 4. Camphor. — 5. Opium. — 6. Abstraction of blood.

The three first of these are, he thinks, rarely admissible,

406

Analytical Review,

since they are likely to increase the resisting powers nearly
in the same proportion that they increase the propelling
efforts.

Camphor is not much objected to ; but its beneficial effects
are doubtful, in such doses as prudence would authorize the
use of.

Opium is recommended in doses of thirty to forty drops,
under certain conditions; but we are judiciously cautioned
not to induce suspension of the parturient action by its im¬
proper exhibition.

Abstraction of Bloody though introduced under the head of
anlispasmodics, is said to be hardly entitled to such an appel¬
lation. The author thinks it may be of advantage by pro¬
ducing relaxation in a rigid state of the parts ; but he rightly
objects, that in proportion as it increases the disposition to
relax, it diminishes the power of propulsion. The author on
the wdiole believes that it will be seldom necessary, and says
that he has never found occasion to resort to it. One dis¬
advantage attends it, that it is a formidable operation in the
opinion of the patient, and may be productive of much
mental emotion.’’

This objection to blood-letting during parturition is again
strongly insisted upon in another part of the work, and we
cannot avoid saying is an objection that ought not to be men¬
tioned. To omit a useful means of giving relief, solely
because the opinion of the patient is adverse to it, can never
be a justifiable reason. We can remember when the same
objection was urged to bleeding in the state of childbed ; and to
this deference to the weak opinions of the attendants in the
lying-in room, may be attributed the death of many women
in puerperal fever.

The other objection to blood-letting, that it tends to weaken
the propelling powers, is very deserving of consideration : we
feel assured that we have witnessed this effect lately, in a poor
woman from whom the quantity of blood taken was certainly
much greater than the case demanded. This, however, is the
abuse of an excellent remedy, not the warrantable use of it.

The externcA antispasmodics recommended by the author,
are : ■ —

“ 1. Embrocations. — 2. Fomentations. — 3. Injections. — 4.
Warmth.-— .5. Pressure. — 6. Frictions.

Bmbrocations are supposed to be principally beneficial by
supplying warmth and friction.

Fomentations are useful by imparting warmth and moisture
to different parts : they are said to be particularly serviceable
in painful affections of the pubic region, pudenda, and peri-
naeum : our own experience strongly supports this opinion.

Power’s Treatise on Midwifery. 407

Injections are deservedly commended ; but the author seems
to use them only into the rectum. — Mild injections have been
recommended to be thrown into the vagina and uterus. Of
their use during labour, we can say but little; but we have
found them abundantly beneficial when employed after all
kinds of artificial delivery.

Warmth, applied in a dry state, is often of service.

‘‘ Pressure. — It is well known that supporting a muscular part
which is acting spasmodically, will assist materially in preventing or
relieving that spasmodic state; this is instanced in various cases of
cramps and pains, and in midwifery is familiarly illustrated by the
anxiety the patient so commonly expresses, to have her back sup¬
ported under the paroxysm of pain.

« The same assistance, where it is possible to give it, may be
advantageously extended, during parturition, to every part affected
with spasmodic pain, but more particularly to the abdomen, back,
hips, thighs, sacrum, and perinasum. It may be effected by the pres¬
sure of one or more hands ; and it seems proper to continue the sup¬
port during the interval, as well as the paroxysm. An excellent
mode of adhibiting it will be found in the application of a napkin
expanded about the abdomen, and tied tightly round the back: this
may be tightened at pleasure by an attendant placed behind, so that
a regular and uniform pressure may be kept up to any degree.’'

Friction. The greatest novelty'in the work, and that for
which the author claims to himself the merit of originality, is
the introduction of friction, as a powerful means of relieving
the metastatic determination of the parturient energy.

Friction is, without doubt, beneficial, by exciting warmth in the
part rubbed, and also in affording it pressure and support ; it is pro¬
bable also that it possesses a peculiar ratio operandi dependent upon
a stimulating action produced amongst the nervous rami of the mus¬
cular fibres, by their consequent agitation or concussion, and by
which their local or innate irritability {vis insitd) may become so far
exhausted, or changed in its quantity, or susceptibility of receiving
nervous impressions, as to give rise to diminished action or quiescence
of the moving fibres, with correspondent cessation or diminution of
painful sensation. The nervous energy being thus prevented from
being expended upon the part affected metastatically, is determined
to the proper seat of its action, the uterine muscles.^

“ It has been advanced that the present genus is characterized by
the existence of spasmodic pain of the muscles affected, and soreness
on pressure continuing through the interval; the above state of pain,
although it occasionally and partially continues or lingers through
the interval, is more particularly attendant upon the paroxysm. The
application of friction will be found to alleviate or disperse both these
symptoms, so that the spasmodic pain will often be entirely removed,
the subsequent paroxysms being simply attended by the efforts of ex¬
pulsion, conjoined more or less with the pains necessarily arising

408

Analytical Review.

from the dilatation of sensible parts or spasmodic uterine action 5 the
state of soreness will totally be done away with, so that the patient
who, at the commencement of the friction, could scarcely bear the
slightest touch, will now suffer the roughest pressure without incon¬
venience.

This sense of soreness occasionally produces a strong objection
on the part of the patient to the use of the friction ; and she will, in
consequence of the distress accompanying its commencement, earnestly
entreat its discontinuance. Her wishes must, however, on no account
be complied with, and she ought to be encouraged to support the
operation with resolution and patience, under the full assurance (an
assurance which will not be disappointed) that the inconvenience of
which she complains will speedily vanish under its use: the objection,
in reality, constitutes the strongest reason for perseverance, as being
a certain evidence of the existence of metastasis, the removal of which
is necessary for her welfare, and which the friction will, if persisted
in, be almost certain to remove.

The application of friction will, however, rarely be found a pain¬
ful operation to the patient: on the contrary, if artfully commenced;
the relief and comfort experienced from it will both surprise and
gratify her, although this happy effect may prove not a little trouble¬
some to the accoucheur himself : the author has occasionally been
compelled to keep up his friction, even with both hands at once, for
one or two hours without intermission, in consequence of the urgent
entreaties or commands of his patient, whose relief from it has been
so great, that she would on no account allow him to desist or quit
her for a moment.

“ The length of time required to produce the desired effect will be
found different in different cases, according to the nature of the ex¬
citing causes : in some the improper action will be removed almost
instantly, and^as it were by a miracle, so that a case which has been
protracted for the greater part of a week under the most intense suf¬
fering, without the least progress, has been happily terminated in
fifteen or twenty minutes from the first commencement of the friction;
in other cases a longer period will be requisite, before any evidence
can be gained of its good effects; but it may in general be expected
that the paroxysm following the commencement will be combined
with uterine efforts, and the pain and soreness which had previously
existed, materially lessened.

“ The spasmodic actions of the part affected may be taken off
without the metastatic action being removed ; which action will then
be determined to a new set of muscles : for instance, if it has previ¬
ously existed in the abdominal muscles, it may, on being expelled
from thence, fix itself upon the lumbar ones : in this case particular
attention should be paid to the exciting causes, which may be consi¬
dered as powerfully exerting their actions; but the use of friction is
not to be relaxed from ; on the contrary, a more vigorous application
will become necessary, and the back must be rubbed in its turn. The
spasmodic pain may now possibly revert to the abdomen, and may
be thus made to oscillate at pleasure from one to the other: it will

409

Power's Treatise on Midwifery,

now be requisite to apply the friction to both parts at once, each hand
being brought into action, and occasionally a third or fourth may
become desirable: this want may be imperfectly supplied by an
assistant, who can, if unable to supply the friction, at least keep up
warmth and pressure.

In the above case, the operation always requiring much exertion
from the Practitioner, becomes peculiarly laborious, at least until he
is habituated to it; if, however, it multiplies his exertions, and ex¬
hausts a portion of his strength, he will find himself amply recom¬
pensed by the saving of time, and the satisfaction of having afforded
real good to his patient. The old adage, that “ practice makes per¬
fect,'*' will eventually operate in his favour, and neutralize his exer¬
tions : the author has, from practice, acquired so much facility, as to
be able to use both hands at the same time for one or two hours
without intermission, and with little fatigue.

“ It is a feature of no small importance in the effects of friction,
that those patients with whom it has been used have, in almost every
instance, recovered with remarkable celerity, although in previous
and protracted parturitions, where it was not employed, they had
sustained much subsequent illness, and deferred recoveries : in short,
in the practice of the author, puerperal diseases are comparatively
unknown/’

Respecting the manner of applying the friction, we ^re
told by the author, that

“ Experience has proved that it is not so efficacious when applied
with the palm or flat part of the hand ; the friction is then not so
regular, the warmth and glow attending it less excited, and the exer¬
tions of the operator are materially increased ; nor will its good effect
be so decided.

“ The better mode of applying it is with the ends of the fingers,
applied together so as to form the segment of a circle, and moved
over the part to' be rubbed, in much the same way as the sound is
elicited from a tambourine: this must, however, be done with great
celerity, making from 130 to 150 motions of the hand in a minute,
and, at the same time, with such degree of pressure as will produce
considerable warmth and glowing feel in the part. The application
should be made to the skin itself, and not through the medium of
clothing, and must be vigorously kept up in the above described
manner, and extended with rapidity over the part affected ; and if the
spasmodic action should be found to vary its situation, it must in¬
stantly follow it.

“ Notwithstanding it may appear to have produced its full and
decided effect, the friction must be persisted in for some time, as it
will not iinfrequently happen, that, when discontinued, the metastatic
action w'ill return ; at least it must be occasionally repeated, particu¬
larly if any variation in the nature or seat of the pain is observed.

“ If the state of soreness is considerable, the friction must be cau¬
tiously commenced, only a slight degree of pressure being at first
used, according to the sensations of the patient : this must gradually

VOL, XI. — NO. 65. 3 G

410

Analytical Review,

be increased ; and it will be found, that, in proportion as it proceeds,
the soreness will be diminished, until its full force can be sustained
without inconvenience.

“ In order to perform the operation with comfort to the accoucheur,
the bedclothes and dress of the patient should be arranged so as to
offer the least possible impediment; for it is singular, how imme¬
diately the arm tires if any obstacle is opposed to it ; the position of
the patient must be regulated by the part requiring assistance, and
will generally be obvious : to make the application to the abdomen,
she will conveniently lie on the back, but the usual position on the
left side will generally be found most convenient. It may be re¬
marked as an useful fact, that the part on which the patient lies is
very rarely affected by the spasmodic state, in consequence of the
pressure and support given to it.’^

Of the use of friction, as a means of giving relief, in pro¬
tracted labours, we can really say nothing, for though we may
occasionally have partially employed it, yet it has never been
tried in our practice so perseveringly, or with the same
motive, as by Mr. Power: but that it may sometimes *he
beneficial, is very probable. We regret to observe, however,
that even in the author’s practice it has not been so success¬
ful as his juvenile ardour induced him to expect: so unfor¬
tunately do our too sanguine hopes end in disappointment.

The author with praiseworthy candour admits : — -

“ For a length of time his success was so decided as to encourage
in him the flattering expectation, that the ^ practice afforded an almost
certain means of overcoming every case of difficulty, which a pro¬
tracted case of what was termed natural parturition could present;
experience has now corrected his Juvenile ardour, by evincing that, in
many instances, the causes of the protraction are various, and the
spasmodic affections too obstinate to be subdued by its use, as well
as their seat too remote to be affected by its application. Yet he
still believes, that in a majority of cases the eulogium, which his first
experience suggested as due to it, is fully merited.”

Upon the whole, we must acknowledge that this book
contains much sound practical information, drawn up by a
man of experience, skilfulness, and learning. Its great
defect is an exuberance of words, and a highly reprehensible
substitution of new terms for novel principles : the reader is
fatigued with the ornaments that are heaped about the sense :
he is cloyed with the sw'eets, before he can make himself
master of the substantial matter. A judicious use of the
pruning knife might render it a work of standard reputation.

Opinions of the Ancients respecting Contagion. 4il

PART HI.

SELECTIONS.

Some Observations on the Opinions of the Ancients respecting
Contagion. By G. D. Yeats, M.D., Fellow of ihe Royal
College of Physicians, 8cc. &c.

{From the Quarterly Journal of Science and Arts.)

An opinion having been promulgated that the ancients dis¬
believed in the doctrine that fevers were contagious, that is,
that the disease was propagated from one individual to another
by contact, it appeared to me a matter, at least, of curious, if
not of useful, research, to inquire how far this opinion was
founded in truth. They who will take the trouble to turn
over the pages of the ancient historians and poets, will soon
find that the description of fevers, both by medical and historic
writers, clearly shows that it was the generally received opi¬
nion, that human bodies conveyed to each other febrile infec¬
tion of a highly malignant nature; and further, it is stated,
that diseases were propagated by contagion and infection from
brutes to the human race. It would be^a matter of gramma¬
tical liypercriticism to give the etymology of the word conta¬
gion, which, of itself, as so closely connected with its Latin
derivation, is sufficient to show what was the idea entertained
of the mode by which some diseases were conveyed from one
individual to another. It will not be necessary to look into
histories more early than that of Thucydides ; although it is
related that, after the destruction of Troy, a pestilential dis¬
ease raged in Greece and the neighbouring countries of Asia ;
and Herodotus attributes it to the miseries consequent to, and
connected with, the Trojan w^ar.

In the second year of the Peloponnesian war, which
scourged Greece for twenty-seven years, and which com¬
menced about four hundred years before the Christian aera, a
raging pestilence broke out in Athens; an invading army of
sixty thousand men covered the beautiful plains of Attica, and
compelled thousands of the inhabitants to seek protection
within the walls of the already populous and crowded cities ;
thus generating and increasing, by a pollution of the air in
confined habitations, pestilential disease ; accordingly, as
Thucydides says, n voaos sTTEvAixaTo h "AOvvag /^sv fxaXira, tTrsLTct
xai Twv aXAwv ra ttoT^u av^^cdTrorara. — Thitcj/did, Mist,

lib. ii. p. 134. Francofurti, 1594.

Selections.

This pestilent disease raged chiefly at Athens, and also in
other places where the inhabitants were the most crowded.
Diodorus Siculus, in his account of the same pestilence, de¬
clares the opinion that the disease arose in consequence of the
unusual crowded state of Athens — 0/ A'OnvaToi 7ra^aTa^aa9ai

{X£V OVK B'TOT'.fAaV, (Ti;j/£%0//£V0i ^^SVTOg TCOV TEi^WV, kvETTEG'QV dq ?^0l/JAZriV

•^Eplracriv. 7ro7\XH ya^ TrXYi^oug kcu TravTO^aTTov cruv£^pumoTog Eig tyiV

TTOXlV, hd TYIV TEVOX^^ioLV EV’hOJO^g £ig VOG'OVg ETTlTTTOVj £?^H.ovr£g Ct£^a

^EcpSa^fAEvov. Lib. xii. p. 101. The Athenians, not daring
to meet the Peloponnesians in open battle on the plain, re¬
mained cooped up wnthin their walls, and caused pestilential
effluvia ; for great multitudes of people from all quarters con¬
gregating in the city, very readily generated disease by
breathing a corrupted air.” — The eloquent and animated de¬
scription which Thucydides gives of the symptoms, clearly
describes a fever of the most violent kind. It was attended
with such violent thirst and evolution of animal heat, that the
miserable sufferers threw themselves into the sea, into ponds;'
and even into the w^ells, to quench their thirst and raging heat.
The art of the Physicians not only was of no avail, but they
themselves, and all wdio approached the sick, were cut off by
the contagion — dx?C dvroi /Lidxira eQvyio-kov o(tco kou TTpocr--

YiEcrav. P. i£9. — Such was the dread created by thus catch¬
ing the contagion, that people were unwilling to attend the
sick ; there w'as a mutual fear of visiting each other, and
whole families perished in consequence of want of assistance;
and they who braved the danger, from a principle of virtuous
affection in attending their sick friends, perished in heaps —
K(xi on ETEpog ete^h OEpETTEiag avaTTipL'si'Kd.fMEVOiy coaTTEp ra Tr^o^ara
sdunerzov' uki rov 7r?^£igov (pQo^ov tSto evetto'iei. ei'te yd^ /xn SbXoiev
^E^iOTEg dXT^vXOig TTpoaiEvai, aTroiT^KvvTO E^vpioi, nai olmou ttoKKou
EKEvi^YidOiV aTTOpiOi T« OE^a'UJEVCQVTOgj EITE, '^pOCTlOlEV, di£(p9£!p0VT0,

p. 132. Thus, then, it appears clearly from the account of
Thucydides that the contagion not only spread from one indi¬
vidual to another, but what is very remarkable, as showing
the belief of the virulence of the disease caught in this way,
be adds, that the greatest part of the mortality was produced
by this communication of the contagion — rov ^>.£irov
(p^opov raro EVErsoiEij and in the popular clamour which was
raised against Pericles for involving his country in the destruc¬
tive Peloponnesian war, he wms accused, says Plutarch, of
giving more violence to the pestilence which raged at Athens,
by keeping the people cooped up like herds of cattle to be
infected with contagion from one another ecov coq-'^e^

^oa-HYiixara KaOsi^yf^hoig, dva'Sjlf/.'mXao'Qui ^Oo^dg a'm ' ah^n^ojv.
Plutarch, vita Periclis.

413

Opinions of the Ancients respecting Contagion,

Aristotle, the son of a Physician, has in one or two of his
- problems, proposed questions for reasons why diseases should
be propagated from a diseased person to a sound one who
approaches him. So prevalent was the opinion of the con¬
tagious nature of pestilential diseases, that he puts it down as
a problem — Ai^ n ttote o xoifog fMovn tuv vcocruv /xccXira rsg
TTXyicriai^ovTag roTg ^ oti (jLovy) tcov

vojcrojv KOiv^ ETiv ct'znacriv' ure ha tuto 'macriv E'nyKps^si rov Xoi/uou, ocroi
(pauXcog ExovTEg 'ss^ou'siapx^o'i, kou yap ha ro v'vu'mEHKavfjLa T^g voan
TYig 'siapa tcov OEpa'srsuo/xEycov yEivofAEvy^g^ vtito th UpaypLarog

axla-KOvrai. Sect. 1, Prob. vii.

From what cause does it happen that the plague alone '
of all diseases especially infects those who approach the per¬
sons labouring under it? Whether is it that, of all diseases,
mankind are more susceptible of it ? Therefore, on this ac¬
count, the plague attacks all who, being of a bad habit, are
tirst seized with it ; fora fomes of the disease being generated
in those labouring under it, others are quickly infected
with it.”

No doubt can possibly be entertained here of the opinion
respecting the contagious nature of plague ; on the contrary,
the opinion is so established and believed, that it is asked,
why it should be so ? It is also not a little curious, that
Aristotle should state, that the plague first commences in
those who are of a bad habit of body ; or, to speak in modern
language, he conceived a predisposition of the constitution
rendered the body more susceptible. The constitution, being
thus impregnated with disease, generated a fomes, wdiicii
readily communicated the contagion to another. I take
vTu^EKKauixa to be very expressive in this way. Thus we have
the complete modern doctrine explicit and clear in a single
problem of Aristotle, the susceptible predisposition of the
body in taking infection, the generation of a fomes, or infec¬
tious principle, readily communicating the disease to others
contact. In the eighth problem of the seventh section
are some more explanations on this point ; in which he
observes, all are easily affected with such diseases as arise
from a corrupted source, such as pestilences, for they wlio
approach such are immediately infected, o hs 's^xiga-ia^uv toihtov

avd'ZiTTEl,

(To be Continued in our next Nmnher,)

414

Foreign Medical Science and Literature.

PART IK

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

PHYSIOLOGY.

I. Condition of the Stomach during the act of vomiting. —
Professor Magendie, it will be recollected, in the year 1812
presented to the French Institute a memoir, intended to
prove, by a long series of experiments, that the stomach is
not the principal agent in vomiting, but the pressure exer¬
cised by the abdominal muscles on the gastric organ during
this act. Messrs. Cuvier, Pinel, Humboldt, and Percy, wer^
commissioned to inquire into the correctness of the facts
and opinions thus advanced ; and, after having witnessed
tile repetition of all the Professor^s experiments on this sub¬
ject, declared themselves perfectly satisfied with his new
theory of vomiting. These experiments have also been
shown annually by the Professor in his lectures, and re¬
peated in different parts of Europe, without, he asserts, in
any known instance, invalidating the doctrine which they
w^ere intended to establish.

Nevertheless, a memoir, in which these experiments were
contradicted, subsequently appeared from the hand of Dr.
Maingault, who, how^ever, did not assert that he had seen the
stomach contract in vomiting, but cited facts, in his opinion,
inexplicable by the theory of Professor Magendie. Thus he
had seen a dog, while stretched on his back, and in whom
the abdominal muscles, and even diaphragm, had been
divided, in some cases reject the liquid contained in the
stomach. This work was presented to the Societe de I’Ecole
de Medecine ; and Legallois and Bedard appointed to exa¬
mine it; but as these gentlemen did not find the facts ad¬
vanced by Dr. Maingault contradictory to the results stated
by the Professor, the former withdrew his memoir in a pique,
and printed it previously to the report of the committee.-
Th is, however, did not prevent Legallois and Bedard from
publishing the results of the experimental inquiries instituted
by them on the occasion ; and which, completely substan¬
tiating the theory of Magendie, were inserted in one of the
bulletins of the society for 1813*.

^ Bulletin dc la Socide de I’Kcole de Medecine. 1813. No. X.

415

Condition of the Stomach in Comiting ?

In October of the same year, Magendie presented to the
Institute another memoir, wherein he examined, by fresh
experiments, the influence of the oesophagus upon vomiting,
and described, and explained, in harmony with his own
theory of that operation, the phenomenon observed by Main-
gault*. This, in conjunction with the report of Legailois
and Bedard, seemed to have destroyed all the objections
advanced against the doctrine, and to have silenced in every
respectable quarter the spirit of controversy respecting it.

Under these circumstances has appeared a memoir of
Professor Portalf, wherein he proposes to re-establish, on
the ruins of Magendie’s theory, the ancient doctrine, which
regards the stomach as the principal agent in vomiting, and
the contraction of the abdominal muscles as merely an
accessary. Such being his object, he ought clearly to have
shown that the stomach contracts at the moment of vomiting.
This, however, he has not done; and, if the experiments of
Magendie and his partizans be not utterly deceptive, could
not do; since, according to them, the gastric organ does
not contract during the act; but on the contrary becomes
distended, and filled with air. Professor Portal has therefore
adopted a different and much less conclusive mode of reason¬
ing. After rapidly tracing the various opinions of authors
upon vomiting, and particularly those of Professor Bayle, of
Thoulousej, who, in 1621, first started the doctrine so ably
advocated in our own days by Magendie, he formally decides
for the contraction of the stomach, and advances in proof of
it: — 1st, The experiments of Maingault, already alluded to.
2dly\ Two experiments made by himself in 1771. And,
Sdly. Inferences deduced from pathological observations.

]. The experiments of Maingault, which go to prove that
vomiting takes place in the stomach of living animals, not
onl}^ after the division of the phrenic nerves, but even after
destruction of the diaphragm, and transverse section of the
abdominal muscles, have. Portal asserts, been repeated in the
presence of Chaussier, Desormaux, and Muigrier.

2. The experiments upon vomiting, instituted by Professor
Portal, are the following: — A certain dose of arsenic was
given to one dog ; and to another, a large quantity of paste,
prepared with nux vomica. The first dog was speedily
attacked with vomiting, hiccup, and convulsion. The abdo^
men was then opened, and the recti muscles, as well as the
aponeuroses of the obliqui and Iransversales, were cut across;

* Bulletin de la Societe Philomatique, Annee 1813.

t Journal Universel des Sciences Medicates. Avril, 1818, ■

J Dissert. Physicne Sex. Tolosae, l6'31.

416

Foreign Medical Science and Literature.

yet the vomiting continued, and the stomach was observed to
relax and contract alternately with force, and invariably
during expiration, when the diaphragm was elevated towards
the thorax. The stomach, full of alimentary matter, was
several times compressed during the contraction of the
diaphragm, with a view of causing its contents to regurgitate
into the oesophagus and excite vomiting. But these attempts
were unavailing, as the irderior extremity of the oesophagus
was strongly constricted by the diaphragm while contracting.
The dog which had swallowed the nux vomica, continued
to experience violent vomiting, although its abdomen had
been likewise opened.

3. Professor Portal does not deny that in the healthy state
the stomach may derive powerful assistance from the abdo¬
minal muscles in the act of vomiting, particularly from the
transversales, the principal office of which is to contract the ab¬
dominal cavity; in doing which they invariably impel the spleen
and liver against the stomach, and consequently compress^t
in a lateral direction, while by the aponeuroses, the anterior
surface of the organ, when distended with aliment, is thrust
backwards against the spine, and down towards the navel.
Hence results a change in the situation of the stomach, which
so signally favours vomiting, that it may almost take place
from this cause alone, with little or no assistance from the
contractions of the organ itself.

This will be more clearly understood on recollecting the
observation of Vv'inslow, that in the empty state of the
stomach, one of its surfaces is placed anteriorly, the other
posteriorly; that one of its curvatures is superior, the
other inferior, and both situated on the same plane; and that
its large or cardiac extremity is situated superiorly with
respect to the pyloric. Under these circumstances, adds
Portal, the oesophagus opens directly into the stomach,
without forming any bend by which it can be contracted at
the point of insertion into the organ ; while the duodenum,
contained in its sheath of peritoneum, and unadherent in its
superior third part, except by a loose cellular structure, forms
two or three very remarkable curvatures. On being dis¬
tended by aliment, however, the situation of the stomach
undergoes a considerable change. Its anterior surface then
becomes nearly superior, and its posterior inferior ; while the
smaller curvature is carried backward, and its larger raised
anteriorly, and applied against the anterior sheet of peri¬
toneum, immediately behind the abdominal muscles, so as to
project visibly, and render sensible, particularly in weak and
irritable subjects, the pulsation of its inferior coronary, or right
gastro-epipioic artery. When the stomach is thus elevated,

CondUio7i oj the Stomach in P'^omlting'i 417

its left extremity is, by the contraction of the transvcrsales
muscles, thrown somewhat inward with the spleen against
the diaphragm, while the pyloric is raised and carried ante¬
riorly : whence result such a bend in the lower part of tlie
oesophagus, and extreme contraction of the cardia, as
effectually oppose the reflux of alimentary substaiices from
the stomach into this canal. Meanwhile, the superior flexure
of the duodenum diminishes or disappears; iience necessarily
facilitating the passage of the food into the commencement
of the small intestines, where it the more readily descends, as
the duodenum possesses a muscular structure much stronger
than that of the jejunum and ileum. This circumstance,
joined to its excess of capacity, has caused the intestine in
question to be regarded in man as a second stomach. Of
these views, considered only by Winslow in their relation to
the natural condition of the organs. Professor Portal makes
the application to the state of disease.

The regurgitation of food into the oesophagus, and conse¬
quently vomiting, is, he observes, singularly favoured, if
the bend of that canal disappears while the curvatures of the
duodenum are again forming ; and this constantly takes place
when the stomach is thrust backward and downward by the
abdominal muscles. An idea of the effects of their action
may be formed by exercising pressure anteriorly on the full
stomach of a living animal, after having opened the abdomen,
or on that organ in the dead subject, when it has been pre¬
viously filled with water. These physiological notions
explain how it happens that even a small tuoior, situated in
the great curvature of the stomach, or an enlargement of the
left lobe of the liver, exercising compression on its lesser
curvature and superior surface, excites frequent vomiting, as
also elongation of the spleen towards the umbilicus, and
congestion of the omentum ; and why an hypogastric ban¬
dage, or the horizontal posture, will, in the last case, by
obviating the mechanical effect of the enlarged omentum on
the gastric organ, cut off the source of irritation. Two
successful cases, illustrative of this practice, are detailed, lii
one of these the omentum, in the other the spleen was thought
by Dr. Portal to be enlarged, and thus to have incommoded
by weight in the first instance, and by pressure in the latter,
the digestive viscus.

Invariably in vomiting, concludes the veteran Professor,
the stomach is in a state of convulsion, which is subsequently
communicated to the abdominal' muscles ; for every th ing
announces that the contractions of the latter are, at least most
commonly, but consecutive; and by admitting these opinions
w'e combine physiological knowledge with that of pathology,

VOL. XI. — NO. 65. 3 H

418 Foreign Medical Science and Literature.

and confirm the ^doctrine of idiopathic and symptomatic
vomiting; the first an effect of contraction, from irritation
operating directly on the stomach; the other consequent on
some affection of the nerves of the different parts, communi¬
cating with those of the gastric organ.

To this m'emoir Professor Magendie has published a
spirited, and, in our opinion, tolerably satisfactory reply.
The present article has, however, already so far exceeded its
prescribed limits, that w^e can only allow ourselves to notice
the refutations of the arguments advanced by Portal in the
three preceding paragraphs.

1. With regard to the experiments of Maingault, we have
already, in tracing the grounds and origin of the controversy,
stated the objections of Magendie. Portal also, it seems,
acted somewhat disingenuously in not citing, with those of
Maingault, the experiments and conclusions of Legaliois
and Bedard.

2. No one who is an advocate for precision in experiments
can admit, as conclusive, those which have been detailed by
Portal. In fact, after the division of the recti and aponeurosis
of the other abdominal muscles, vomiting may continue,
since the fleshy part of these muscles which remains will act
on the basis of the thorax, compress the stomach, and support
this viscus when pressed by the contraction of the diaphragm.
The alternate dilatation and contraction of the stomach,
Magendie formally denies ; having in vain sought for the
phenomenon in experiments on more than one hundred
animals ; and he offers at any time to demonstrate to Portal,
the passage of the contents of the stomach (into the oesopha¬
gus) at the moment of the depression of the diaphragm, and,
consequently, during inspiration.

3. In the reasonings deduced from pathological facts,
Portal admits as positive the contraction of the stomach in
vomiting never witnessed by Magendie ; and the latter con¬
siders the attempt at refutation useless ; as, dissenting so
much on the principle, they cannot fail to differ on the conse¬
quences. Magendie then concludes by declaring that, in
the face of Portal’s authority, he regards it as demonstrated,
that the contractions of the abdominal muscles and diaphragm
principally determine vomiting, by the pressure which they
exercise on the stomach*.

* Nouveau Journal de Medecine, Avril, 1818. — We shall notice,
in our next Number, a memoir, by M. Bourdon, on vomiting, the
object of which is to invalidate the theory of Dr. Magendie.— Edit.

419

1 ransposition of the Viscera.

PATHOLOGY (INCLUDING MORBID ANATOMY) AND
PRACTICE OF MEDICINE.

II. — General transposition of the Viscera. — The importance
of cases of this nature to the physiologist and practical
Physician may not, on a first view of the subject, appear very
obvious; but when it is considered that they are probably
more frequent in occurrence than has commonly been
imagined; and that, minutely and philosophically examined,
they are calculated not only to elucidate unknown points in
physiological, and explain extraordinary phenomena in patho¬
logical science, but to inculcate extreme caution in the
diagnosis, where such phenomena present themselves, we
really think that their value has been in general greatly under¬
rated*. In this comprehensive view of the subject, every
well-authenticated case of unusual disposition of the internal
organs acquires an aspect of considerable interest, and par¬
ticularly when, as rarely happens in such instances, the
previous history of the individual has been duly observed
and recorded. By these considerations we have been induced
to notice a communication on a general transposition of the
viscera, which M. Rostan has lately published in the French
Journal edited by himself, in conjunction with several other
gentlemenf.

*■ In examining a patient, whose heart constantly pulsated in the
right region of the thorax, or who presented tumor or induration of
the right hypochondrium, attended with a very slight or contradictory
train of constitutional symptoms, the Physician might be betrayed
into very serious and discreditable error of opinion, if he bore not in
mind the possibility of the existence of transposition of the viscera. —
Edit.

t Nouveau Journal de Medecine. Mai, 1818. It may perhaps
be interesting to our readers to enter cursorily into the history of this
curious variety of malformation. Perrault is said to have once
presented to the Academy of Sciences, of which he was a member, an
example of general transposition of the viscera; but this fact rests
upon no very solid foundation. Bartholine (llistoire Anatomiqiie,
liv.^ 29. cent. 2.) cites the instance of a thief, in whom Guy Patin had
discovered a similar disposition of the internal organs. An analogous
fact had also been communicated to him by Petrus Servius, the
Roman Physician. Skenkius, in his compilation (liv. 2. obs. 188.)
reports a like instance. Roemer (Syllog. Opusc. Ilal. Ease. 1), the
Acta Curios. Naturae, Vol. IV. observat. 132, and the Journal de
Medecine, Tom. XXXllI and LXXV, furnish various examples of it.
Sabatier, in his fine Traite d’Anatomie, merely observes, that the
phenomenon is not uncommon; but Bichat has left in his works a, well
known instance of the malformation in question. Since that time, it
has been repeatedly observed by French pathologists. The hospital of

4^0

Foreign Medical Science and Literature,

A woman, aged sixty-seven, of robust constitution, pre¬
viously quite healthy, and the mother of twelve children,
inhabited a low and damp situation, when in \i8ll she
experienced tightness of respiration, and palpitations of the
heart in the right thoracic region. By these palpitations,
which she frequently pointed out to her husband, the wx)maii
was greatly incommoded. In 1814 she became gradually
hemiplegic on the right side, and shortly afterwards lost her
sight and hearing. It may be worth while- to remark, that
this woman habitually employed her right hand.

April 8th, 1818. — She was admitted into the infirmary of
la Salpetricre, after having on the day before sustained a
violent shivering fit, succeeded by heat and pain in the side.
She had long, from the report of her attendants, been subject
to palpitations and dyspnoea; but as she was completely
deaf and blind, no satisfactory information could be obtained
from herself. It was, however, remarked, that immediately
after the shivering, there arose round the neck considerable
heat, redness, and tumefaction, which disappeared with the
paroxysm. The face was flushed and swollen; respiration
tight and rattling; cough frequent; expectoration scanty,
difficult, but not mixed with blood. There was pain in the
right side of the thorax, increased by percussion. This
region, moreover, sounded obscurely, and imparted to the
hand a sense of tumultuous pulsation, scarcely perceptible on
the left side. This phenomenon, rendering probable the
existence of an iinusual position of the heart, did not very
strongly attract M. Rostan’s attention. Four jmars pre¬
viously he had attended a plumber, who for a long time had
experienced pulsations in the right region of the cliest, with¬
out any on the left side ; and hence supposed to arise from
transposition of the viscera. On dissection of the body,
however, there was discovered an enormous aneurism of the
descending aorta, which had projected into the right cavity of

a la Charite alone has, within a few years, offered three cases of it ;
and Bedard, in 1816, (Bulletins de la Societe Medicale d’Emulation,
for December,) published an example, the third of this description
which he has met with. Others also may be seen in the Memoirs de
I’Academie Royale des Sciences, 7'om. X. and in one of the German
Journals (Journal der Practischen Heilkunde), for December 1817>
two cases of transposition are cursorily noticed; the subject of one, a
young man who had died of hydrocephalus ; that of the other, an
unmarried woman, aged 36, and commonly healthy. 1 he case ob¬
served by Mr. Abernethy, the peculiarities which it displayed in the
distribution of the hepatic vessels, and the important physiological
inferences naturally resulting from this peculiarity, are too well known
and obvious to require particularization here.— Edit.

421

Transposition of the Plscera.

the thorax, and therein burst. He moreover recollected that
Lancisi had observed, in the same family, four persons
affected with palpitation in the right thoracic region; and
tliat this phenomenon, on dissection of three of the subjects,
was found to have originated from dilatation of the pulmonary
auricle of the heart, which had encroached considerably on
the right cavity of the thorax*, d'hese examples he con¬
sidered as quite sufficient to render him very circumspect in
the diagnosis of transposition of the viscera. I'he symptoms
were hence regarded as indicating an affection of the heart.

During the night the suffocation had been very urgent.
The pulse was soft and irregular; tongue of a yellowish
white colour; appetite lost; thirst intense; and deglutition
difficult, and effected only drop by drop. Slight diarrhoea
existed. The paroxysm took place at two o’clock in the
afternoon. JSo important change occurred till the 12th of
April, when a fresh pain attacked the left side of the thorax,
Relieved by the application of a blister, it attacked the
opposite region, and continued till death, ^s'o answer could
be obtained from the patient, who was now reduced to a state
of merely automatic existence.

16th. — T bngue brown, and subsequently black ; counte¬
nance altered; weakness increasing; faeces passed involun¬
tarily; and neck constantly red and swollen during the
paroxysms. Death on the morning of the 19th.

Dissection. — Anatomical disposition. — External appearances.
Nothing remarkable. Thorax. — The right cavity contained

* For the information of the student and young Practitioner, it may
not be amiss to review the causes of preternatural pulsation in the
right thoracic region as far as they are at present known. They may
be principally arranged under the five following heads: — 1. Mal¬
formation, as exhibited in the case now under review. — 2. Dilatation
of the pulmonary cavities of the heart, as exemplified in the dissec¬
tions from Lancisi. — 3. Aneurism of the descending aorta, as observed
bv Rostan ; of the arteria inominata ; of the internal mammary
artery ? — 4. Copious extravasation of pus or serum into the left sac
of the pleura. Of this we have ourselves seen a memorable instance.

— And, lastly, Some obscure and inexplicable derangement of the
thoracic organs, not always producing a permanent change in the site
of the heart’s pulsation, nor invariably fatal in its termination. Of
this a curious example may be seen in the New Medical and Physical
Journal, Vol. IX. page I92. The boy, who forms the subject of it,
after having enjoyed good health for more than two years, died in the
spring of 1817, of phthisis, consequent on severe pneumonia. The
pulsation in the right region of the thorax, however, did not again
show itself. Leave to examine the body could not be obtained.

— Edit.

422

Foreign Medical Science ' and Literature o

the lung with only two lobes, and the heart in an inverted
situation, so that ilie pulmonary auricle and ventricle were
turned to the left, and the opposite cavities to the right. The
oesophagus, trachea, and aorta, descended on the right ol the
vertebral column, which here preserved its ordinary curve.
Tile left lung, wdth three lobes, occupied the whole cor¬
responding cavity of the thorax. Abdomen,— -'The cardiac
portion of the stomach was situated tow^ards the right; the
pyloric to the left. i\ll the intestinal convolutions were in an
inverted position. The ccecum and its appendix occupied
the left iliac fossa; the sigmoid flexure the right. The liver
and spleen respectively the lel’t and right hypochondriac
regions. The kidneys, bladder, and uterus, would obviously
{iresent no remarkable disposition. Morbid appearances, —
Heart voluminous ; both ventricles, particularly the right,
thickened. Aorta in several points ossified. Slight con-
gestion of the left lung; right lung hepatized^ and reddened.
The internal structure of the other organs was not examined.

In M. Rostan’s “ reflections’^ on the preceding case, he
observes, that in order to ascertain whether the peculiarity of
conformation w'ere, in this instance, as sometimes happens,
hereditary, he examined the only one of the two surviving
children of the deceased to whom he had access, and found
her siilfering from symptoms of a morbid affection of the
heart; but the palpitations were on the left side of the
thorax. He farther infers, from the history and dissection
which have just been recorded, that the preference universally
given to tiie right arm in all the common occupations of life,
does not depend on the anatomical disposition of the large
blood-vessels destined to supply the superior extremities.

\\l.—-~B.uptureofa Sound Heart.-— instances of
sudden death from rupture of the parietes of the heart, where
the organ has exhibited no vestige of previous disease, are to
be found on record. Of this the author of the following
case, Dr. Fischer, whose attention has, for six or eight years
past, been especially directed to the pathology of the heart,
appears not to be ignorant. Yet the history to which we
advert presents, in his opinion, some characters so uncommon,
and even peculiar, as to render it wmrthy of minute and
elaborate description

A gentleman, aged sixty-eight, stoutly made, and ap¬
parently possessing every claim to longevity, was, after'
having spent many years at court, compelled to quit it, and
retire to a country residence, 'i bis trying reverse of fortune
was sustained with great apparent fortitude; and every one,

* Journal der Practischcn Ihiikunde. Dec. 1817.

423

Rupture of the Heart,

with the exception of his fafiiily and Physician, considered
him as indifferent, or at least perfectly resigned to his fate.
In his retirement too, the complaints almost invariably itici-
dent on a court-life, and with which he had previously suf¬
fered, as indigestion, derangement of the biliary secretions,
catarrh, nervous affections, and slight and irregular gout,
ceased nearly to persecute him, except at the changes of the
seasons : and daring the last ten years he had very rarely
been confined by the gouty affection of the lower extremities,
and then but for a few days. Towards the close of life, his atten¬
tion was occupied by an unpleasant business, which, as inter¬
fering w'ith the indulgence of his propensity for solitude, had
the effect of aggravating his melancholy. With the exception *
of this,' there was nothing in his mode of life which could
pr ove at all detrimental to his health.

On the l6th of October he was seized, while walkins',
with violent pain, which he supposed to be cramp at the
stomach ; and, after having reached with great difficulty the
place of his destination, distant about half an hour’s walk from
his own abode, sank faint and almost breathless into a chair.
On the administration of some of Hoffnian’s anodyne, he
speedily recovered ; and remained in company without farther
complaint, till fetched home in the carriage by his daughter.

17th. — After having passed a good night, Mr. V. K.
found himself so triflingly' indisposed, that he repaired, in bis
carriage, to the house which he had visited on the preceding
day; held a family conference; and returned home on foot,
accompanied by his coachman. But scarcely had he walked
a third part of the way, wffien he sustained another attack of
pain, so violent, that he was more than an hour in reaching
home, supported by the servant. Arrived here, he soon
recovered, ate his supper, and slept as usual.

On the morning of the 18th he wrote to Dr. Fischer, com¬
municating the particulars of the indisposition, which has
just been described, and requesting his advice. He repre¬
sented his appetite and digestion as being unimpaired, and
bow'els regular; and, from the momentary relief invariably
following eructation, attributed the affection of his stomach to
the accumulation of flatus. The doctor, however, disposed
rather to refer the complaint to a disturbance of the cutaneous
functions consequent on cold, prescribed a diaphoretic mix¬
ture, and prohibited exposure to the weather. Under this
plan, the remainder of the day and succeeding night were
passed very comfortably; and, on the IQth, he went to church,
and exerted himself in singing aloud with the congregation.
Immediately on his return home he sat down to his writing-
desk ; but scarcely had he written a few lines, when he ex-

4^24 Foreign Medical Science and Literature,

perieiiced a general rigor, with spasmodic contraction of the
extremities, and dreadful pain in the region of the stomach.
Strong infusion of chamomile, tepid pediluvia, and warmth to
the affected part, were instantly applied : and Dr, Fischer,
who arrived in about an hour and a half^ found that the
paroxysm had completely subsided, witlf the exception of
some pain in the pit of the stomach. The sensations of the
patient indicated the existence of induration in this region ;
but none vvas apparent on examination. The abdomen, from
the umbilicus to the scrobiculus cordis, was sensible to the
slightest pressure, but without tension, hardness, or tumefac¬
tion ; and its temperature, like that of the somewhat flushed
countenance, perfectly natural. The extremities were yet
■very cold; the skin dry and rough; and the pulse regular,
except that, at times, it was, for two or three strokes together,
somewhat contracted. The patient had just eaten some
soup; and, but for the fear of obstructing the operation af the
medicine, wmuld have taken other food. A remed}^ capable
of dispersing the wind, would, he declared, completely restore
him. Yet Dr. Fischer felt confirmed in the idea that the
complaint arose from cold, and disturbance in the crisis of an
arthritic affection. Hence he prescribed confinement to bed,
diaphoretics, an anodyne embrocation, and, occasionally,
antispasmodic injections. In the afternoon there was an
apparent amendment; and, at night, the patient felt himself
so well, with the exception of the flatulence, that he ex¬
pressed a wish to quit his bed, and join the family at table ;
but this was not allowed.

Early on the 20th, Dr. Fischer learnt that his patient had
passed a partially good night. The first injection had
brought away some indurated feces, and a few drops of blood,
followed by such violent pain in the rectum, that he would not
submit to a repetition of the remedy. The frictions also had
been found to aggravate his suffering. In other respects
the patient felt himself somewhat better than on the preceding
day. The skin, without perspiration, was naturally warm and
moist. At his own particular request, a saline aperient was
now prescribed, with the direction to discontinue it if pro¬
ductive of any aggravation of the pain. After sending off the
messenger, the patient had quitted his bed, smoked a pipe,
and walked about ; whereby a scanty evacuation from the
bow'els was induced. Tlie pain instantly returned ; and on
the receipt of the medicine, a dose was administered. With
the rapidit}^ of lightning, a paroxysm, more violent than that
of the preceding day, ensued ; and Dr. Fischer was imme¬
diately summoned.

On his arrival about ten, A, M. the paroxysm had again

425

Rupture of the Heart,

declined; but the pains yet continued so severe that the pa¬
tient predicted with groans and exclamations his approaching
end. After minute examination, nothing at all inHammatory
was discovered in the case ; but, in addition to the previously
existing symptoms, there was now felt a numbness of the left
arm, extending to the finger-ends. With a view to excite
sweating, warm fomentations, as requiring less time for pre¬
paration than a bath, were employed; and, about half past
eleven. Dr. Fischer left his patient tolerably composed. Two
hours afterwards, how'ever, he received intelligence that con¬
siderable vomiting of bile and mucus had taken place, and
been succeeded by relief. And scarcely had Dr. Fischer
written a prescription to be had recourse to in the event of a
return of the vomiting, when he was again summoned in
haste. On this occasion he arrived in time to witness the
paroxysm ; and never, he adds, can forget the horrible scene
which it presented. Two strong men led, or rather dragged
the patient about his chamber. Despair was marked upon
his countenance ; and he roared aloud for relief or death.
The agitation and agony, whether induced by the vehemence
of the pain, or an effect resulting from the same cause, were
extreme. With some difficulty he was prevailed upon to go
to bed : a combination of ammonia, with opium, and strong
chamomile infusion, were administered ; and poultices of
conium, hyoscyamus and belladonna, applied. Hereupon the
skin speedily became moist; the pain decreased; transient
sensations of prickling were felt sometimes in the great toes;
sometimes in the right or left shoulder; and then the pain at
the stomach seemed to have momentarily subsided. Asafoetida,
given alternately with the medicine above mentioned, pro¬
duced several eructations, with evident relief. The stomach
was now no longer the seat of complaint; but the pain
seemed to have extended generally over the body. At first,
after the paroxysm, the patient was cold and shivering; the
pulse small, spasmodic, and intermittent ; but, as the body
regained warmth, it became more free: and, on the eruption
of a sweat, full, soft, regular, and scarcely more frequent than
in the healthy state. The cutaneous discharge was profuse.
Pain was, however, again felt in the stomach ; but the patient
remained tranquil. In this state Dr. Fischer again left him,
indulging the hope of a more decided and permanent amelio¬
ration; but, next morning, received the unexpected intelli¬
gence of his patient’s death, by a sudden seizure, in its
appearance resemblitig apoplexy.

In about an hour after the departure of Dr. Fischer, the
patient, although still perspiring abundantly, had, it seems,
complained of increased pain ; but begged that his daughter

VOL. XI. - NO. 65. 3 I

426 Foreign Medical Science and Literature*

might not be distressed by the intelligence. Soon afterwards
he suddenly sprang upright in bed ; and, with a look of wild-
ness, seized his attendant by the neck, as though intending to
strangle him ; and, with a loud exclamation, entreated that
his head might be sustained. In this posture he lay com¬
posed for more than half an hour. Shortly afterwards, hav¬
ing turned first on his left, and then on his right side, he
expired without a struggle.

Dissection^ eighteen hours after Death. — The body, in con¬
sequence of having lain in a warm situation, w'as yet flexible,
and not quite cold. The whole back of it, from the neck to
the heels, was of an uniformly bright red colour. On opening
the abdomen, the different viscera were found buried in a con¬
siderable quantity of adipose substance, but displayed ex-
ternall}^ no morbid appearance. The cardiac orifice of the
stomach was regularly situated : but, on tracing it front, this
point, the organ ascended tow^ards the left, under the arch of
the diaphragm, so as to be situated very high up, and wholly
on the left side. The colon rose upwards, at an obtuse angle
from the coecum to the epigastric region ; proceeded from
thence below the stomach, and in a direction parallel to it,
and formed, in its descent, an acute angle. The thorax was
now opened, and the sternum removed : and here also every
thing seemed, on a first view, natural. The heart w^as nearly
covered by the healthy lungs; and upon the pericardium
there was a layer of fat. On the cautious removal of this,
a crackling noise proceeded from the air contained in the
adipose structure, which was of a w^hiter colour than else¬
where, Upon puncturing the pericardium, which had the
appearance of being distended by a substance of a dark blue
colour, a quantity of reddish fluid escaped, and afterwards
florid blood to the amount of two or three pounds. The
membrane was then slit up, and the heart seen surrounded
by a coagulum more than three pounds in weight. This
being cleared aw^ay, a rupture was discovered in the aortic
ventricle ; and not far from it, at the apex of the heart, a dark
blue, somewhat elevated round spot, about two lines in dia¬
meter, and apparently formed by small varicose vessels. For
the purpose of more minute examination, the heart, wdth its
large blood-vessels, was now removed from the thorax. It
was somewhat whiter than natural; surrounded with fat at
the upper part; and, like the whole body, softer than dead
muscle is usually found. The rupture extended upwards
from the apex, about an inch and a half, on the external sur¬
face. Its borders were fringed, but in accurate contact except
in the middle, where, for about half an inch, they were sepa¬
rated by intervening coagulum. Upon opening the ventricle.

427

Rupture of the Heart.

“N

the internal wound was found but about half an inch in length,
and its lips at least as wide again asunder as those of the ex¬
ternal breach. 'I’he blackish speck before described was
readily detached by the scalpel, and seemed to consist of a
thin bluish membrane. Beneath it the substance of the heart
was healthy. This organ and its vessels contained not a drop
ol blood. Yet they, as well as the other thoracic and ab¬
dominal viscera, presented not the slightest deviation from
the natural state, except that the aorta seemed to be every
where little less capacious than the pulmonary artery. The
cranium it was not deemed necessary to examine.

Should nothing more important meanwhile present itself,
we shall, in our next Number, review the comments and con¬
clusions of Dr. Fischer on this instructive case.

IV. — Rupture of the Heart consequent on Chronic Inf am-
mation. — Since the preceding paragraph has been concluded
we have received one of the foreign journals for the present
month*, wherein is detailed a case of ruptured heart, which
presents so fine a contrast with the history just traced, that
we cannot resist the temptation of transcribing it. In this
instance a morbid change of the parietes of the heart,
probably the consequence of intemperate habits, had preceded
the fatal rupture; in the production of which, a profound
moral affection may evidently be regarded as the direct agent.

The subject of the case to which we have adverted was a
robust and plethoric female, aged 22, and long addicted to
dissolute and intemperate habits. For some time previously
to her decease she had complained only of slight and ap-
^parently rheumatic pains: but, within a day or two of the^
fatal event, she had been deserted by a man to whom she was
engaged in marriage. In consequence of this her mind be
came very deeply affected. After having supped on the
preceding night, she retired to rest as usual ; and, in the
morning, was found dead in bed. She lay in a bent position
on the left side ; and was hence supposed at first to be in a
profound sleep. Neither the countenance nor limbs were at
all contorted.

On dissection, the sac of the pericardium was found filled
with about ten ounces of coagulated blood, and two of serum.
The heart, on all sides covered by it, was of the ordinary
volume, but much loaded with fat. At the summit of the
aortic ventricle was discovered the breach from which the
effused blood bad issued. It was irregularly lacerated, and

* Journal Universel des Sciences Medicates. Avril, I8I9. The
case was originally published in the “ Transactions of the Physico-
Medical Society of New York.’’

428

Foreign Medical Science and Literature.

measured about half inch in diameter. The parietes of the
ventricle around the rupture were much thicker than in the
natural state ; and, on close examination, a very sensible
fluctuation was distinguished, to the extent of an inch on one
side of it. From this, floccuii of a cheese-like substance were
discharged on pressure. The pericardium presented traces
of inflammation in the part opposite to *the rupture, and a
little above it had becojme adherent to the heart, 'i’hat por¬
tion of the aorta which is invested by the pericardium, ex¬
hibited also externally some appearances ol’ indamrnatory
action. The abdominal viscera were perfectly sound, with the
exception of the liver, which was enlarged, paler than com¬
mon, and had acquired an adhesion to the peritonaeum.

V. — Cardiac Syncope.- — About ten years since, Mr. Che¬
valier published some cases of death from an affection of the
heart, before unnoticed by writers on medicine, and to vrhicb
he has given the title of Asphyxia idiopathica*. Weliave
ourselves seen in practice several accidents bearing a very
close resemblance to these; but in all of them the privilege
of dissection after death has been denied. A case, recorded
by Dr. Ozanarnf, appears to be of a nearly similar description:
and as few dissections, elucidating the nature of this affection,
are upon record, and very erroneous notions commonly pre¬
vail respecting it, we shall offer a brief transcript of the his¬
tory in question J.

A midwife, belonging to the Milan Hospital, aged forty-
two, rickety, and with a spine so curved from right to left
as to form an angle of nearly thirty-five degrees, had, in con¬
sequence of her deformity, and repeated attacks of pulmonary
inflammation, become subject to habitual dyspnoea. On the

* Medico-Chirurgical Transactions, Vol. I. p. 15/.

t Recueil Periodique de la Societe de Medccine de Paris, Tom.
LXI. p. 87.

I It is very probable that the sudden death, frequently succeeding
the more important surgical operations, and parturition, where neither
haemorrhage, nor other obvious cause, explanatory of the event, has
occurred, results from the affection of the heart here described.
About twelve years ago, an aged, but apparently very heahhy man,
suffered amputation of the hand in consequence of a morbid affection
of the tarsal bones. He sustained the operation with uncommon
firmness, and very little blood was lost; but immediately on being
removed to his bed, he sank into a fit of syncope, and expired, with¬
out any apparent struggle, except a transient convulsion of the facial
muscles. The body was opened, and death attributed to “ collapse
of the lungs F a stale which we cannot comprehend where no breach
of the thoracic parietes has existed. The condition of the heart was
not mentioned. — Editor.

429

Case of Diabetes.

5th of J Lily, 1 815, in returning from the city, she was overtaken
by a shower; in her haste to seek shelter from which she
re-eniered her room almost breathless. Scarcely had she sat
down, when she fell against the bed, and instantly expired.
On dissection, forty-eigiit hours afterwards, the body exhibited
no trace of apoplexy or coniusion; and exhaled not the
slightest offensive smell, although it had lain exposed to a
very high temperature. The condition of tlie brain was per¬
fectly natural. I’he left cavity of the thorax was found so
much contracted by the curvature of the spine, that there re¬
mained tlie space of only an inch and a half between the
dorsal vertebra? and the ribs. The lungs had acquired ad¬
hesions to the pleura. The heart, and all the large blood¬
vessels, as well arterial as venous, were in a state of most ex¬
treme flaccid ity. The aorta, at its exit from the heart, was
slightly ossified, and somewhat changed in structure at the
point opposite to the acute angle formed by the spinal column.
Idle fatal event is, in this instance, attributed by Dr. Ozanani
to obstructed circulation from embarrassment of the lunsfs,
the result of unduly accelerated progression.

1 he influence of pain and terror in producing sudden ex¬
tinction of life, is, moreover, illustrated by reference to the
case of a middle-aged criminal, who, having throughout
evinced extreme weakness and depression, expired on his way
to the scaffold. The body was completely cold and stiff ere
it reached the place of execution, distant about eight miles
from the spot where the man died ; and a few^ drops of blood
only stained the instrument by which the lifeless head was
severed from the bodv.

VI. — Diabetes. — A man, aged thirty-two, of small sta¬
ture, and healthy, but somewhat full habit, in a few weeks
after, having got wet in a storm of rain, first perceived that
the functions of his stomach were impaired. Considerable
diminution had also taken place in his bulk and strength; and
his sight was particularly weakened. On his arrival in Paris
to consult Dr. Demours, no defect w'as perceptible in the eye,
except a slight dilatation of the pupils. The iris performed
its functions in a nearly natural manner; yet the patient
could no longer see to read, and with difficulty found his way
alone. The general depression of the vital powers seemed to
affect in a particular and more decided manner the optic
nerves. In fact, the case was one of incomplete amaurosis
from asthenia. The patient exhibited all the symptoms which
characterize diabetes mellitus. The disease, of about five
months’ standing, and now in its second stage, had come on
simultaneously with the weakness of vision, and never been

430

Foreign Medical Science and Literature .

steadily opposed by judicious treatment. The urine, on
being mixed with tincture of litmus, became of a red-violet
colour ; and the chemical analysis of it, made by Thenard,
left no doubt as to the nature of the case.

In a consultation, on the 8th of November, 1817, it was
agreed that only two pints of chalybeate water should be
allowed a day ; that bread, and all vegetable substances,
should be prohibited in the diet, which was to consist of
animal food, as beef and bacon. Business prevented the
immediate adoption of this plan ; and on the 9th the man
died suddenly, at noon. The final struggle was slight and
transient. On dissection, neither the optic nerve, brain, kid¬
neys, nor any of the other organs, presented the slightest
apparent change of structure.

2. — A Dutch general, aged forty-five, of robust constitu¬
tion and sanguine temperament, consulted Dr. Demoujs, in
October last. He was suffering from chronic inflammation
of the margins of the eyelids, evidently consequent on di¬
minished secretion of the lachrymal fluid. Dryness of the
mouth; general lassitude, particularly on waking; and marked
though gradual reduction of the vital powers. His thirst was
constant and insatiable; his bow^els habitually constipated.
He had lost much flesh; and the sound of his voice was
greatly altered, from defective moisture of the membrane of
the pharynx and brqnchiae. The urea had totally disappeared
from the urine, which contained a saccharine matter, evident
to the taste: it was perfectly clear and inodorous, and voided,
in twenty-four hours, to the amount of between sixteen and
twenty pounds; while, in the same period, not more than
half that quantity of fluid was usually drank. The diet had
consisted of vegetables, wdth only a small proportion of animal
food. He had been in the habit of taking warm tea very
largely every night and morning ; and the water which he had
employed previously to his arrival in Paris was of a very bad
quality. The disease appeared to be yet in its first stage.

The treatment was commenced by large doses of an antL
scorbutic syrup, which speedily brought out an eruption of
small boils on the surface. The employment of tea was, at
the same time, forbidden, and small quantities of wine substi¬
tuted for it. A diet, consisting, almost exclusively, of animal
food, was, moreover, enjoined. On the third day from the
adoption of this plan, the urine had regained a faint yellovV
colour, and some smell. Its sweet flavour was also less per¬
ceptible. All the symptoms rapidly declined: the lachrymal
secretion increased in proportion as the morbid excess of the
urine was reduced ; the different functions were gradually re-

Case of Diabetes. 431

established ; and the patient was, in less than three months,
completely well.

The preceding cases* have been transcribed with a view of
showing the similarity of the results obtained in France, on
the dissection of subjects destroyed by diabetes, to those
w'hich British pathologists have recorded; and to expose the
practice of the French in this unmanageable disease t. In
an instance of it recorded by Dupuytren and Thenard, several
strongly-marked morbid appearances were exhibited on dis¬
section ; and, as anatomical examinations of the diabetic
subject rarely occur, a description of that to which we have
just adverted, cannot fail to prove interesting : nothing un¬
natural was observed in the fauces, pharynx, or oesophagus.
The stomach w'as extremely voluminous ; and displayed, on its
internal surface, a reddish net-work, formed by dilated blood¬
vessels : it moreover contained a considerable quantity of un¬
inflammable gas ; and some greyish fluid, on the surface of
which were floating seven or eight small, yellow, soft, round
bodies, of an adipose nature. The duodenum and commence¬
ment of the jejunum and coecum were more thick, and of a
redder colour than natural. The other portion of the intes¬
tinal canal was sound ; as were the structures of the liver,
spleen, and pancreas. The gall-bladder contained a little
healthy bile. The kidneys were at least one-third larger than
ordinary ; but their structure, although soft and greyish, was
not more readily penetrable by injection than that of the
organ in a healthy condition. In other respects they, with
all the other organs of the urinary system, were free from
disease. The bladder was very small: the abdominal lym¬
phatics and thoracic duct were unduly developed. The
arterial and venous systems presented no alteration. The
lungs adhered to the parietes of the thorax by a loose cellular

* Journal Universel des Sciences Medicales. Avril, 18 Ip.
f The following are the medicinal articles enumerated by Re-
nauldin, (Diet, des Sciences M6d. Tom. IX. Art. Diabetes) as appli¬
cable to the treatment of Diabetes, in conjunction with a strictly
animal diet: — venesection, sometimes in the commencement; opium,
combined with musk or cinchona, and phosphate of soda to obviate
constipation ; ammonia, or phosphorous acid, largely diluted, for
common beverage ; frictions of the lower extremities with unctious
substances ; aromatics ; camphor ; catechu ; chalybeate waters ; asa-
feetida with valerian ; the tincture of lytta; Dover's powder; Iceland-
moss; lime-water; purgatives; sulphur; sulphate of alumina ; cold
baths ; mercury ; and blisters to the sacral region. — From some
recent experiments of our own, we are led to believe that the solution
oi pure potash y and consequently that of pure soda also ^ will prove a
most valuable remedy in diabetes mellitus. — Editor.

432 Medical and Physical Intelligence^

substance : the right, moreover, contained several small col¬
lections of pus ; and the left, some cysts, with thin parietes,
analogous to those of serous cvsts, and merely tilled with an
elastic fluid. The muscles were pale and wasted, as com¬
monly happens in chronic diseases; but there existed no ap¬
parent change in their organization.

The article from which the preceding description has been
taken* is terminated by an observation too important, and, at
the same time, too little known to be passed over in silence,
M essrs. Dupuytren and Thenard have noticed, that, towards
the favourable close of diabetes, the urine presents, at first, an
albuminous matter; the quantity of which, for some days, goes
on increasing, and afterwards gradually disappears ; that then
the kidney begins to secrete urea, the uric (and doubtless also
the acetic) acid; and the urine again resembles that of the
healthy subject.

[Some interesting articles on Surgery, Midwifery, and Botany, which
were transmitted for the present Number, are postponed to the
next, for want of room. — D. U.]

PART V.

MEDICAL AND PHYSICAL
INTELLIGENCE.

" A Society has been established in London bearing the designa¬
tion of “ d'he 11 unterian Society.^’ It professes the most friendly
feeling towards all similar existing Institutions, and is founded prin¬
cipally, but not exclusively, for the accommodation and benefit of
medical men residing in the eastern parts of the mcti'opolis.

Its objects are to contentrate the zeal and experience of a large
number of respectable Practitioners, whose places of residence are at
a distance from Professional Associations already existing, and to re¬
ceive and discuss communications on Medical, Chirurgical, and all
other subjects connected with Medicine. It aims particularly at the
cultivation of a spirit of liberal and fric'ndly intercourse among the
members of the Profession within the sphere of its influence.

It consists of honorary, corresponding, and ordinary members, and
already the Society is honoured by the names of a considerable num¬
ber of men of character and talent. The following is the list of the
Officers and Council for the present year: — *

President. — Sir William Blizard, F.R.S.

Dictionnaire des Sciences Medicales, Art. Diabetes.

43.1

Medical a)id Phyucai Intelligence^

Vice-Presidents. — James Hamilton, M.D.; George Vaux, Esq. ;
John Meyer, M.D.; and Lewis Leese, Esq,

Treasurer. — Benjamin Robinson, M.D.

Secretaries. — John T. Conquest, M.D., F.L.S. ; Thomas J. Ar-
miger, Esq.

Council. — Thomas Addison, M.D. ; Thomas Bell, Esq. F.L.S,;
Flenry James Cholmley, M.D. ; Thomas Calloway, Esq. ; William
' Cooke, Esq. ; George Edwards, Esq. ; James Alexander Gordon,
M.D. ; William Kingdon, Esq.; Benjamin Pierce, M.D. ; James
]'arkinson. Esq.; Henry Richard Salmon, Esq.; and Frederick
Tyrrell, Esq.

d'he Flunterian Society holds its meetings every alternate Wed¬
nesday evening throughout the year, at No. 10, Saint Mary Axe,
where communications on any department of medical science, ad¬
dressed to the Secretaries, will be thankfully received.

Method of determining the Specific Gravity of the Gases.

The apparatus necessary for taking the specific gravities of gases
by the following method, consists of a delicate balance, or rather
beam, so constructed that two bulky vessels of exactly the same size
and weight may be conveniently suspended from its extremities. One
of these vessels may be a globe, or flask, furnished with a stop-cock as
usual, and of any convenient size. The other must be cylindrical, so
as to admit of being graduated ; say, into 1000 equal parts ; and must
be likewise furnished with a stop-cock, having an extremely minute
aperture.

The two vessels, as before stated, must be exactly of the same size
and w'eight, so that, when filled with atmospheric air and suspended,
the index of the beam shall stand at 0, and these easy adjustments are
the whole that are required. When used, the globe or flask is to be
filled with the gas, whose specific gravity is to be determined in the
usual manner, and the cylindrical vessel is then to be so far exhausted
as to be rendered lighter than the globe or flask, thus filled. Both
vessels being now suspended, one at each extremity of the beam, the
stop-cock of the cylindrical vessel is to be opened, and so much air be
permitted to enter, by the minute aperture above mentioned, as shall
be requisite to bring the two vessels in the same exact equilibrium as
at the commencement of the experiment. The cylindrical vessel is
then to be removed from the beam, and its stop-cock opened under
mercury, and thus the precise hulk of air contained in it to be accu¬
rately measured, which bulk (if the whole vessel has been graduated
to 1000 parts) represents the specific gravity of the gas weighed, com¬
mon air being 1000. Thus, suppose hydrogen to be the subject of
experiment, and it be found that 69*44 parts of common air be equal
in weight to 1000 parts of hydrogen, the specific gravity of hydrogen
.will be ’O6944 common air by LOOO, or it is 14'4 times lighter than
common air.

VOL. XI. — NO. 6.5. S K

454

Medical and Phi/sical Jritelligence.

The above form of the apparatus is more particularly adapted for
determining the specific gravity of gases lighter ih.2iX\ common air ;
but it is obvious that the principle upon which the method is founded
is equally applicable to gases header than air, by a little modification
in the apparatus. 'I'he advantages of the method are many and im¬
portant. Besides the greater general accuracy attainable by measuring
than uoeighing gases, the use of weights, as well as the necessity of
ascertaining the bulk and weight of the apparatus, as in the common
mode of determining the specific gravity of gases, are entirely super¬
seded ; nor are errors likely to arise from any change in the atmo¬
spheric temperature, or pressure occurring during the performance of
the experiment.

NOTICES OF LECTURES.

Dr. Davis vvill commence his next Course of Lectures on the
Theory and Practice of Midwifery, and pn the Diseases of Women
and Children, on Saturday, May 22d, at Six o’Clock''in the
evening.

Mr. Taunton will commence his next Course of Lectures oft
Anatomy, Physiology, Pathology, and Surgery, on Saturday,
May 22d.

Dr. Clutterbuck will begin his Summer Course of Lectures on the
Theory and Practice of Physic, Materia Medica, and Chemistry, on
'I’uesday, the 1st of June, at Ten o’Clock in the morning, at the General
Dispensary, Aldersgate Street; where farther particulars may be
had, and at his House, No. 1, in the Crescent, New Bridge Street. —
Elementary Lectures on Botany, with an Exhibition of the most im¬
portant Medicinal Plants of indigenous growth, will be given during
the Summer to the Pupils attending this Class and those of the
Dispensary.

LITERARY NOTICES.

Mr. J. G. Mansford, author of a Treatise on Consumption, will
shortly publish Ptesearches into the Nature and Causes of Epilepsy,
as connected with the Physiology of Animal Life and Muscular
Motion; with Cases illustrative of a new and successful method of
Treatment.

Dr. Bateman is preparing for the press. Reports on the Weather
and Diseases of London, from 1804 to 181(J inclusive; comprising
Practical Remarks on their Causes and Treatment, and preceded by
an Historical View of the State of Health and Disease in the Metro¬
polis in former times, in which the extraordinary improvement in
point of Salubrity which it has undergone, the Changes in the Cha¬
racter of the Seasons in this respect, and the Causes of these, are
traced to the present time.

Dr, John Reid^s Treatise on Hypochondriasis and Nervous Dis-
«ases has been translated into German.

4S5

A METEOROLOGICAL TABLE,

From the 2\st of MARCH to the 2Qih of APRIL, 1819,

KP:PT at RICHMOND, YORKSHIRE.

Baron

Max.

leter.

Min.

The

Max

rm.

Min

Rain

xlauge

Wiiuis.

Weather.

4 c

N'bVV..

1 Sun. 2 Cloud... 4 Starl...

SbW.. WbS..

1 Sun..

SVV. SbE.

1 Cloud.. 4 Rain.,

W...

1 Sun...

WbS..

1 Sun., and Show.

vVSW^..

1 Sun., and Show..

-9

W'SVV... sw

1 Show.. 2 Sun...

sw..

13 Show. 2 Sljn.. 4 Starl..

svv....

1 Sun.... 2 Show..

29.

vVSW.. sw....

1 Sun..

SW..SW...

1 Sun..3 Cloud... 4 Moon..

sw,.

1 Sun..

Fble.

1 Sun. 3 Rain.

vV. NE.

1 Sun.... 2 Cloud...

SE. W.

1 Cloud... 2 Sun.. 4 M....

NW. NE.

i Sun....

SE..

1 Sun.... 3 Cloud..

^E..

134 Cloud.. 2 Sun..

SE. NW.

1 Sun.. & Sh. 4 Moon....

W’bN..

1 Sun...

SW..

; 1 Sun..

wsw..

1 Sun.. & Show. 3 Sun....

>JE... N..

1 Sun.. 3 Cloud... 4 R....

M.. W..

1 Mist... 3 Showers....

SW..

1 Sun...

SSW. W.

1 Sun.. 3 Cloud.. 4 Starl..

NE. SE.SW...

134 Cloud... 2 Rain....

>E.. S.

1 Show. & Sun.. 3 Thun..

SW...

13 Sun.. 2 ( loud... 4 Rain.

sw..

13 Sun.. 2 Cloud..

i29

sw. E. NE.

1 Cloud... 2 Rain....

The quantity of rain during the month of March was 1 inch &. 24-lOOths.

Ohsermt ions on .Diseases at Richmond.

Tlie disorders under treatment were Cephalalgia, C olica, Cynanche
tonsillaris. Diarrhoea, Dyspepsia, Febris catarrlialis, lebris simplex, Gastro-
dynia, Obstipatio, Podagta, Rhcumatismus acutus, and Sphacelus.

436

THE METEOROLOGICAL JOURNAL,

From the 20th of MARCH to the I'^th of AFRIL^ IS 19?

By Messrs. HARRIS and Co.

Mathematical Instrument Makers^ 50, High Holhorn.

1 Moon

lerm.

Barom.

Oe Luc’s
Dry.

lygrom.

Damp.

Winds.

Atmo

NNW

Rain

,05

Fine

Wva.

Fine i

SSE

Clo. i

wsw

Rain

,05

Wva.

Rain

,04

Fine

,03

siv

Wva.

Fine

,24

Rain

wsw

Wva.

;^4ne

,03

Wva.

Rain

,12

WNW'

WSW

Clo.

WNW

Rne

({

Mne

:'’ine

lOSE

Fine

SEva.

Fine

SSE

Fine

Fog

Fine

,32

Fine

WSW

Fine

Clo.

,26

ESE

SSW

Fog

,19

4;,

Clo.

,23

WSW

Sho.

,09

Sho.

,1£

.48

Sho.

,17

4£

WSW

Fine

,31

Fine

CIo. I -

IClo.

Fine

Rain

Fine

Stor.

Sho.

Fine

Rain

Clo.

Sho.

Clo.

Rain

The quantity of rain fallen in March is 1 inch and 15-lOOths.

457

A REGISTER OF DISEASES
Betueen MARCH 20th and APRIL I8I9.

DISEASES.

Abortio .

Abscessio • . .

Amenorrhoea

Amentia .

Anasarca . . . . . .

Aneiirisina .

Aphtha lactentium • •

Apoplexia . * * i t .

Ascites .

Asthenia .

Asthma .

Atrophia • • . .

Bronchitis acuta • • • -

— - ■ chronica • <

Calculus .

Cancer . . . .

Carbunculus .

Cardialgia .

Carditis .

Catarrh us .

Cephalalgia .

Cephalaea .

Chlorosis .

Chorea .

Cholera .

Coiica .

Convulsio .

Coryza • • • . .

Cynanche Torisil laris

- - - Tracheal is

• - Parutidca' •

- - Laryngea> ■

Delirium Tremens* • ■

Diarrhoea .

Dysenteria .

Dyspepsia .

Dyspnoea .

Dysuria .

Ecthyma .

Eczema .

Enteritis .

Entrodynia .

Epilepsia . . • •

Epistaxis . .

Erysipelas .

Erythema nodosum •
Febris Litermittent •

- catarrhalis- • •

- Synocha . • • • •

- Typhus rnitior

•«>>

‘ 5

rv I

DISEASES.

Febris Typhus grav. • •

- - Synochus • • • •

- Puerpera .

- - - Remit. Infant.

Fistula • * •
Furunculus • • * •
Gastrodynia * • • .
Gonorrhoea

Haemoptbe . . .

HtEinorrhois * • . .
Hemiplegia . • . «
Hepatalgia* * • * ♦ •

Hepatitis .

Hernia .

Herpes Zoster • •

• - labialis' •

Hydrocephalus ••
Hydrothorax . ♦ • •
Hypochondriasis

Hysteria .

Hysteritis .

Icterus .

Impetigo erysipel.

Ischuria .

Lepra .

Leucorrhoea • • • •
Lichen simplex • •

Lithiasis .

Mania . ♦ •

Menorrhagia • • • •
Morbi Infantiles^
- BiliosB" • •

Nephritis* • • .

Neuralgia .

Obstipatio * . .

Odontalgia .

Ophthalmia . . •

Otalgia . . *

Palpitatio .

Paracusis .

Paralysis .

Paronychia .

Pemphigus .

Pericarditis .

Peripneumonia • • • •

Peritonitis .

Pertussis .

Phlogosis .

Phthisis Piilmonalis
plethora .

Total.

Fatal.}

438

Oh nervations on Prevailing Diseases.

DISEASES.

Pleuritis • •
Pleurodyne
Pneumonia

Podagra .

Porrigo decalvans'

- favosa • • • '

Prolapsus .

Prurigo mitis . • ♦ • ■

- - formica 7is

- senilis - • • ■

Psoriasis guttata • •

- inveterata

Pyrosis .

Rheuma acutus- • • •

- chronicus- •

Rubeola .

Scabies .

Total.

Fatal.

DISEASES.

Total.

*5 j

^ !

Scarlatina simplex .

- - anginosa ••••

Scrofula .

Spasmi .

Strictura . .

i Sycosis menti . . •

1 Syphilis . * • •

2.5

1 1 abes iVlesenterica .

Vaccinia .

1 Varicella . .

1 Variola . . .

Vermes .

Vertigo . . *

Urticariaye6ri/is‘ ■ .....

14'

—

Total of Cases .

1358

140

Total of Deaths .

^ . . .

* Morbi Infantiles is meant to comprise those Disorders principdiy arisinic from den¬
tition or indigestion, and which may be too trivial to enter under any distinct head; Morbi
Dillosi, such Complaints as are popularly termed bilious, but cannot be accnrat - Iv classed. 1

Observations on Prevailing Diseases.

Inflammatory disorders of different parts of the pulmonary organs have
been, as might have been expected, from the great vicissitudes of the wea¬
ther, exceedingly prevalent.

Under the heads of asthma, catarrh, catarrhal fever, morbi infantiles, and
phthisis pulmonalis, it will be seen the cases are considerable in number.
At the west end of the town especially, catarrhal affections have appeared
so generally as to constitute a kind of influenza ; and children have been
particularly liable to pulmonaiy inflammations, which have, in many
cases, assumed an aspect of much severity.

The late epidemic fever is in most districts of the town decidedly
on the decline. Our reporter from a north-east district of great extent,
appends the following account to his table of diseases ; —

“ Fever, except in two or three cases, lias been milder. It was more
frequent in the beginning of the month ; but is now evidently declining.
There are no patients now but such as are convalescing, except one who was
attacked with fever, after having been for two months labouring under short¬
ness of breathing, cough, &c., and reduced extremely low for want of nou¬
rishment. The fever soon subsided, although accompanied v.ith petecbije,
but the pulmonary affections still continue.’^

Monthly Catalogue of Books.

439

MONTHLY CATALOGUE OF BOOKS.

The Hunterian Oration for the year 1819, delivered before the
Royal College of Surgeons in London. By John Abernethy, F.R.S.,
&CC. See. Sec. 8vo.

JMedical Botany, No. IV.

On the Mechanism and Motion of the Human Foot and Leg. By
John Cross, M.D. 8vo.

A Letter to the Rev. Thomas Rennell, concerning his Remarks on
Scepticism : from a Graduate in Medicine of the University of Ox¬
ford. 8vo.

Index Botanicus sistens omnes Fungorum Species in D. C. H.
Persoonii Synopsi Melhodica Fungorum enumeratas und cum Varie-
talibus et Synonymis. Confectus a D. G. H. L. 8vo.

Thomas’s Modern Practice of Physic. Sixth Edition. 8vo.
enlarged.

Cursory Observations upon the Lectures on Physiology, Zoology,
and the Natural History of Man; delivered at the Royal College of
Surgeons, by Vyilliam Lawrance, F.R.S., &c., in a Series of Letters
addressed to that Gentleman : with a Coiicluding Letter to his Pupils,
by one of the people called Christians. 8vo.

Wildenow’s Botany, 4 vols. 8vo. a New Edition.

A Manual of Chemistry; containing the Principal Facts of the
Science, arranged in the order in which they are discussed, and illus¬
trated in the Lectures at the Royal Institution of Great Britain. By
W. T. Brande, F.R.S., Sec. Sec. See.

Armstrong’s Practical Illustrations of Typhus Fever. 8vo, New
Edition.

440

'Notices to Correspondents*

NOTICES TO CORRESPONDENTS.

Communications have beeti received this month from Dr. R. Smitf.%
Dr. G. Smith, Dr. Parkinson, Mr. Cooke, Mr. Fosbrooke, and Mr. G. H.
Davis.

A 7nost interesting Paper was read before the London Medical Society at
their last meetings on Elateidwjif written byDc. Ciutterbuck. — We are
happy to announce that we have the writer s permission to publish it in the
Repository ; it willy therefore, appear in the nexty or in an early
Number.

The continuation of Mr. Fosbrooke’s Paper on f 'accination we have been
obliged to postpone till the next Number. By the delayy hozcevery the
Essay will have been considerably increased in vaiuCy as the writer has re¬
cently obtained some 7iew infor7nationfro7n Dr. Jenner and other sources.

A highly respectable individual has sent us a letter for publicationy coin-
plaining of the injustice, as he considers it, done to Sir Gilbert Blane in our
recent Peview of that author's work. We shall be excused for reminding the
writer of what, indeed, he must be aware, that to publish appeals of this
kmd would serve to weaken the cathedra authority of the reviewbig
department .

We shall be happy to receive the Paper on Puerperal Convulsions.

We have been prevented from fulfilling our engagement of giving in this
Number an abstract o/'Mr. Pettigrew’s Oration, at the Medical Society, on
Toxicology, This shall certainly be done in the ensuing Number.

Dr. G. Smith has requested us to notice the following Erratum in his
Paper on Hernia of the Stomach, published in the Number for last March,
page 185, line 3d,_/br “ opposition,’’ read apposition:” and we are con¬
cerned to have the same task imposed upon us to a more considerable extent,
by Mr. Fosbrooke : as an excuse for appareiit neglect in this instance, we
must plead the exceeding obscurity of many words in the manuscript.
Page 267, line 6th, for “ important,” read “ impotent;” 23d line, insert
“ in” before “ which 24th line, dele “ in.” Page 268, dele “ note of in-
terrogatibn.” Page 271, line 9th, “ as it is,” read “as they are;”

12th line, insert “ as” before “ an;” 19th line, (fter “ excite,” read
“ doubt.” Page 273, line 8th, substitute the word “ account” for “ part.”
Insert the” between “ of” and “ danger.”

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

THE

LONDON MEDICAL

REPOSITORY.

" ' - — - - 'jtl . . ' ' .lyi

No. 66.

JUNE 1, 1819.

VoL. XL

PART I.

— ^ ...

Vr.->

ORIGINAL COMMUNICATIONS^

c - „..„.„4..^._....

I. ygo^^,

[In order to accommodate the Writer of this most interesting Paper, anil in- ’
deed to meet our own wishes of presenting it in an undivided form, we
have given an additional half sheet to the present Number of the Repo¬
sitory. — We think our able Correspondent deserves well of the Profes-
4 sion for calling the attention of the medical public to the pathology of a
disease which has, perhaps, hitherto been either too indiscriminately
ranked with inflammatory affections, or treated of, as to the immediate
■ circumstances of its product4on, in a vague unsatisfactory manner. — It
will be of course understood that as well in this, as in all other instances
of “ Original Communications,^’ the responsibility in respect of theory or
opinion rests with the authors of the respective Papers, and that the pages
of the Repository' are always open to candid and liberal discussion on,

* debatable points. — Edit.] '

Cases and Observations on Hydrocephalus Acutus.
William Cooke, of Great Prescot Street, Member of
the London College of Surgeons,

Notwithstanding the great attention which of late has
been directed to this disease, some of the most important
desiderata for the early diagnosis and successful treatment
are yet to be supplied. - , > ,

Various authors, indeed, have done much towards discri«r
minating it; yet there are cases of frequent occurrence vvhere
the charactepistics on which their chief reliance is placed do
not exist; and Practitioners the most competent to appre- ^
ciate the diagnostic' symptoms of disease, fail in detecting
this until it has attained an incurable stage, or until an oppor--
tunity of post mortem inspection is afforded.

In elucidation of this circumstance I might. refer to an.
interesting case, by Dr, Wm. Heberden, published in the
YOL. XI, — NO‘. 66. 3 L

442

Orisinal Communications-

fifth volume of Transactions of the College of Physicians.
The patient was an old man, who had been deaf many years.
His last illness was fever, expectoration, and transient giddi¬
ness. Some time afterwards, indeed, he had a fit, but soon
recovered from it; and he continued tolerably well until
within twelve hours of his death.

The dura mater was found strongly adherent to the calva¬
rium ; tunica arachnoides thickened ; the cellular structure of
the pia mater contained about four ounces of fluid, and the
ventricles about eight ounces. The internal carotid and
basilar arteries were ossified. The abdominal viscera were
healthy.

Here was a case of very extensive effusion, with organic
disease, unattended by^ its usual symptoms.

Dr. Abercrombie, in his valuable Paper on Chronic In¬
flammation of the Brain and Membranes, says, VVe have
reason to believe that we have no certain mark by wliich we
can ascertain the presence of hydrocephalus ; but that all the
usual symptoms of it may exist in connexion with a disorder
of the brain, which, if allowed to go on, would probably lead
to hydrocephalus ; but which, if treated with decision in its
early stage, holds out a fair prospect of being able to arrest
its progress.*’

Dr. Folhergiii attached some importance to the dejections
being of a dark greenish colour, with an oiliness or glossy
bile : but both he and Whytt considered the more general
symptoms as common to this disease, and other causes of
irritation, as worms, dentition, etc.

Dr. Cheyne, indeed, considered the oily-looking, or glazed
dark green stools, as peculiar to hydrocephalus, but not con¬
stantly attending it : upon this point, however, my experience
accords very much with that of Dr. Porter ; for I have never
seen this appearance of the stools occur until after the admi¬
nistration of calomel, and it has generally ceased to appear
when the employment of this medicine has either been sus¬
pended or reduced to extremely minute doses. I have not,^
indeed, observed these peculiarly glossy stools in other cases
than hydrocephalus, after the employment of calomel, except
on one occasion ; and although the youth is now living, I had
fears at one period of a protracted indisposition, that he was
a subject of water in the head ; but this appearance of the
stools was never exhibited after other purgatives. Even in
small doses, his constitution was uniformly much disordered
by calomel, which more particularly affected the hepatic
secretion, suspended digestion, and gave to the undigested
aliment, passed as excrement, the resemblance of boiled
spinage, with an oily surface.

^ Dr« Coindet has directed attention to a particular aspect

443

Cooke’s Observations on Hydrocephalus,

of the urine; especially to a micaceous deposition like crystals
of boracic acid, and which he believes to be ure. This ap¬
pearance, he says, is almost peculiar to hydrocephalus, and
takes place in the second stage.

1 have not had an opportunity to appreciate this observa¬
tion ; and although it would be uncandid to prejudge it, many
doubts will arise as to the safety of relying for pathognomic
symptoms upon the adventitious appearance of a secretion so
liable as urine to be modified by a variety of combinations*.

Diverse opinions have likewise been entertained respecting
the origin of the disease. Many able writers have contended
that it generally originates in organs remote from the brain,
especially the chylopoietic viscera. Dr. Yeats seems to
have been pretty generally understood to maintain almost ex¬
clusively the remote origin, but he has recently declared his
sentiments more explicitly on this topic. I beg to repeat,”
says he, that I by no means intend to deny that a diseased
action does occur not unfrequently in the brain, per se, inde¬
pendent of previous disease in any other organ.”

On the otlier hand it has been maintained, that the disease
very frequently exists in the head, without being attended
with any very manifest derangement of the abdominal viscera,
and without any trace of disease being discoverable in those
organs after death. Dr. Spurzheim, whose opportunities of
inquiry must have been extremely numerous, admits that
often the first disorders take place in the abdomen, and the
greater determination of blood to the head is the result.

Yet (says he) anatomical dissections have convinced me
that in the greater number of cases, the morbid appearances
of the abdomen are secondary symptoms of the affection of
the head.”

To rely upon the non-discovery of organic lesion in remote’
organs, after death, would certainly be extremely equivocal ;
and inconsistent with pathology.

Diseased action may exist without a change of structure;
yet it does unquestionably induce it. Whether that morbid
action be primary or sympathetic, in most cases it will pro¬
duce a change in the organization of the affected part: and,
therefore, although not so universal as to justify the inference
that all disease must be discernible after death ; yet it is per¬
fectly accordant with pathological phenomena to expect some
chan2:e in structure, when the functions of those parts on
which structure itself depends, have long been deranged.

Dr. Yeats has referred to the retrocession of rheumatism

* May not this “ micaceous deposition’^ be the same as the
“ branny sediment” so frequently mentioned by Dr. Blackall, in his
cases of dropsy, not only in the head, but in other parts of the body

444

Original Communications.

to the heart, of gout to the stomach, and of er3^sipe]as to the
brain: no mark,” sa^^s he, of tijese diseases shall appear

after retrocession, although sufficiently apparent and severe
before it, when the brain, the heart, and the stomach, shall
be found diseased upon dissection, but shall have exhibited no
symptom of disease, until such retrocession took place.”
Cherishing a high degree of respect for the talents of this
distinguished Physician and author, it is with considerable
deference I submit that nothing could be less conclusive
than this reasoning, as it merely shows that certain parts,
previously diseased, had regained a health}? state prior to
death, and the circumstances are not parallel with those phe¬
nomena they were intended to explain.

So far as my experience and inquiry have enabled me to
form a judgment, 1 should regard hydrocephalus a disease of
the head, as independent as most other diseases f riable to
arise from circumstances exterior to the body, as well as
from derangement in the’ functions of some other organ, by
which the balance of circulation throughout the body might be
disturbed ; and exciting, like most affections of the head,^very
considerable sympathetic influence over the digestive func¬
tions, especially those of the stomach and liver.

Individual cases of disease have been so multiplied, and the
phenomena of this disease so long investigated by the analytic
process, that it seems specious enough now to demand atten¬
tion to the synthetic, to the combination of the accumulated
facts, and to a deduction from them of principles to direct
the treatment; — to the discovery of some more efficient method
than is at present known of averting the catastrophe in which
it generally issues. Plausible, however, as some Practitioners
render this sentiment, and truly important as it is, we cannot
admit that the period has yet arrived when we may sit down
and quietl}? contemplate the past, and cease to pursue
individual inquiries for the future. So much obscurity
still envelopes anatomical and physiological science, and
so tributar}? have zealous pursuits of morbid anatomy
proved, to elucidate disease, and to impart efficiency to
curative indications, that 1 persuade mj^self every individual
case of disease, in which the interposition of medicine has
been effectual ; every fatal case, in which inspection of the
body after death shall have been subservient to the illustration
of preceding symptoms, and especially an aggregation of such
case?, will never cease to be acceptabie to this society*.

* This Paper, with others by Dr. Robinson and Lewis Leese, Esq.
was presented, and partially read, at the first meeting for medical
discussion, of the Hunterian Society, held on the 2lst of April last.
The institution of this society has been already announced through
ffie medium of the Medical Repositoky, and other periodical

445

Cooke’s Ohserroations on Hydrocephalus,

I shall then proceed to detail four cases of this formidable
disease, affixing to each the result of careful inspeclion after
death, and shall presuine, in the sequel, to make such obstTva-
tions on the treatment, as these and a variety of other cases
have appeared to justify; in hope of eliciting much useful in¬
formation from gentlemen of more extended experience and
accurate observation, many such being enrolled in this
societ}".

The cases are not adduced to establish any favourite svstein
or opinion ; they rather tend to show that the designatory
phenomenon of water in the head exists under the greatest
diversity of combination and symptom ; and that some¬
times the fluid exists without having manifested itself bv
any cognizable sign; whilst at others (although such cases
never fell under my inspection) the ordinary symptoms of it
occur, without the fact which those symptoms usually re¬
present ; and which seems to justify the inference that
water in the head is but a consequence of other disease
in that organ, and that the state of the patient would not
be amended were the fluid absorbed without that state being
altered in which the efl'usion oriarinated.

Case First. — On the 28th of October, I was requested
to see Ann Graves, ^tat. ten. She had been a very healthy
girl; and allhougli her parents w'ere poor, 1 should infer, from
the healthful countenances of numerous children, that they
were well fed.

She was reported to have been ill during the preceding
fortnight, though to an extent scarcely perceptible. The
symptoms appeared to have been those of mild pyrexia, with
constipation. Various gentle aperients had been admi¬
nistered, without any permanent advantage, and disease had
thus been stealing on insidiously, till it had assumed a some¬
what marked character.

1 found her sitting by the fire, supporting her head upon
her hands and knees. Her countenance was distressed.
She was impatient of society, continually seeking after
solitude. She had no appetite; was dull and fretful; and
almost perpetually moaning.

journals. It originated in local objects, but it embraces the culti¬
vation of medical and physical science in general. It therefore identi¬
fies with it Practitioners in every part of this country or abroad, as
corresponding members, from whom a quarterly communication, but
no fees, are required. Whilst its laws protect it from the admission of
unworthy candidates, the terms of admission to respectable men are
made peculiarly cas}^ I'he continued accession of distinguished
Practitioners, in each department of the Profession, renders its com¬
mencement auspicious.

44^ Original Communications »

I directed two grains of calomel to be administered imme¬
diately, and repeated occasionally, and the same quantity of
pulvis antimonialis every six hours,

31sl. — General symptoms the same as before recited.
The medicines had effected but little change in the bowels.

Habeat Hydra. Subm. gr. iij.

P. Jalapcfi, gr. x. — Statim.

And one ounce of a saline mixture, with tartarized antimony, every
six hours.

Nov. £. — The opening powder has induced but little
effect. The general symptoms are much the same.

Habeat Hydr. Subm. gr. iij.

P. Jalapoe, 3j. — Statim.

Contr. mist, salina.

3d. — The bowels were freely acted upon yesterday ; the
dejections offensive, and, for the first time, reported to be
very dark coloured.

The symptoms are unabated. The head is particularly
distinguished as the seat of pain; no pain or tenderness about
the abdomen. The night was passed without sleep, in almost
ceaseless meanings, and incoherent exclamation. The tongue
is white, but there is no thirst ; pulse very quick and rather
bard ; light irksome ; the pupils much dilated ; skin of
moderate temperature.

1 directed the application of four leeches to the temples;
to continue the saline mixture, with an addition of two drops
of tincture of digitalis to each dose ; and to apply cold lotions
to the head.

4th. — The same symptoms continue. The pupils are
much dilated, and scarcely diminish on the approach of a
strong light to the eyes, but the light of the room annoys her
much. She had strabismus in the right eye; but is sensible
when spoken to.

The application of four leeches I again directed ; likewise
a blister between the shoulders ; the opening powder and
saline mixture, with digitalis as before.

3th. — She has passed a most distressing night, vociferating
throughout for victuals and other things, which when brought
to her, were rejected. Only one leech had been applied
effectually. The powder had operated copiously four times.
The pupils are dilated, and the eye almost insensible to light;
the pulse very quick, and skin cool. She is sensible when
spoken to, but wanders when her attention is not arrested.

1 directed for her half a grain of calomel, and one of pulvis
antimonialis, every four hours ; and that the cold lotionp be
continued.

447

Cooke’s Observations on liijdrocephalus,

6th. — Had rather a better night; symptoms a little abated ;
headach the same; pupil rather more susceptible to light;
pulse less frequent. She moans constantly. At eight in the
evening 1 saw her again. The bowels had been freely
opened during the day. Stools very dark coloured. The
calomel to be omitted from the next three powders.

7th. — She has had a most restless night, screaming and
talking incoherently without ceasing. This morning the
pulse is very small and quick, but firm. Eyes look dull;
pupils exceedingly dilated, and nearly insusceptible to light;
the right eye drawn towards the nose. The bowels have been
very open, and stools offensive.

As there appeared no prospect of relieving the head from
its oppression except by withdrawing blood, and the pulse
remaining firm, I determined to open the temporal arteiy, in
the execution of which the constant action of the temporal
muscles in the act of "rinding the teeth occasioned much
difficulty. The radial artery progressively expanded under
the flow of blood, which induced me to abstract nearly eight
ounces, when syncope ensued, and considerable diarrhcsa
supervened.

The digitalis to be continued, and mercurial inunctions
employed, with the use of cold lotions to the head.

Sth. — She has had a quiet night. Pulse not so quick ;
pupil considerably smaller, and more sensible to light; she
is able to give a rational reply, although she talks inco¬
herently to herself, and imagines apparitions and insects in
the room. She still complains of pain across the top of tlie
head. During this day, at intervals, she conversed very
rationally, but continued progressively sinking until two
o’clock on the following day, when she died.

Inspectio cadaveris, — - There were patches of diseased
glands beneath the scalp.

The vessels of the pia mater were turgid. The lateral
ventricles were distended, and contained about two ounces
of fluid. The choroid plexus was very pale.

The abdominal viscera did not present any morbid appear¬
ances, except a circumscribed opaque spot on the surface of
the liver.

Case Second. — Mk. Hill, the subject of this case, was
always rather delicate. His character was amiable ; his
habits temperate ; and his mind very susceptible of generous
sentiment. He had attained about his thirtieth year.

Without observing any remarkable circumstances attending
the changes which his constitution underwent, he thought that
during about twelve or sixteen months prior to my visits, he
had experienced a progressive increase of indisposition.

44B

Origin a I Communications.

Tile chief character of the disease during the year had been
idolent headachsj with derangement of function in the chylo-
poietic viscera.

His stomach and bowels in general were extremely irritable,
the former retaining but little food, and the latter being
excited to frequent dejections by the most trivial alterations
of diet, or changes of atmosphere. His appetite was often
rather voracious, and probably he did not always resist this
propensity, though he knew that very soon after indulging it
the food must be rejected.

During tlie fortnight immediately preceding my attend¬
ance, having become worse, he had been under the care of an
eminent Physician. His symptoms were chiefly indicative
of abdominal aflTection ; and although the head was extremely
painful, it was considered as sympathetic, rather than primary;
and not the cause of that disorder in organs, the integrity of
whose functions peculiarly depends upon the condition of the
brain and nervous system. Within the latter few days he had
frequent startings, a disposition to coma, and very severe
headach ; his bowels being freely open.

On the SOth of September he appeared worse, to the
family ; but his Physician did not apprehend that any exten¬
sion of disease had really taken place. He was taking
effervescing draughts, with a view to quiet the stomach.

At nine o’clock in the evening he became completely
comatose ; and at eleven, by the request of the Physician, 1
was called to bleed him, and was desired by the family to
continue in attendance.

His pulse was about 1£0, and strong ; pupils rather dilated,
but contracted by a strong light; temperature moderate; face
not flushed.

He was sensible of the puncture, and made violent efforts
to disengage his arm, yet he was perfectly incoherent, and
unable to articulate, llie Physician regulated the quantity
of blood abstracted by keeping his finger on the pulse, and
when about eight or ten ounces were withdrawn, he suggested
the propriety of closing the orifice.

A blister was applied to the back; but an enema, and
powder with scammony and calomel, which were ordered for
him, could not be administered.

On the following day, October 1st, the patient continued in
nearly the same condition, but was considerably weaker. He
was, indeed, not truly comatose ; but after passing some time
in a state of mental and corporeal torpitude, one of furious
inquietude ensued, during which, he violently resisted the
administration of food and medicine. The blood was
buffed and cupped.

Cooke’s Observations on Hydrocephalus. 449

It was directed that his head should be kept cool by
vinegar and water, and that he should take two grains of
calomel every four hours, with a draught containing tw'O
drams of Epsom salt,

Oct. 2d. — He has had a very restless night; the vascular
system has become more active.

V. Sectio, ad. ^

His friends had only been able to administer one dose of
the medicine ; but now five grains of calomel, with a saline
draught, were given him.

Blisters were applied behind the ears.

Sd. — The blood drawn yesterday was unusually dense, but
exhibited no buff coat. Whilst bleeding him on both these
occasions, the blood was as florid as arterial, and flowed in a
strong current, even when syncope had decidedly occurred.

Is it probable, that the circulation of this highly oxydized
blood contributed to keep up an inflammatory diathesis

Saline aperients were ordered for him, and the lowest diet
enjoined.

On the 4th he was much the same. Four leeches were
applied to the temples.

On the 5th there was little variation.

V. Sectio, ad.

10th. — The blood last drawn was buflf and firmly cupped ;
but the proportion of coagulable to the serous part was very
small. He has been slightly improving since the last report.

He complains of violent pulsation in the head, and has a
very firm pulse.

His nutriment has chiefly consisted of tea and gruel, and
■ his medicines saline and mercurial purgatives, with digitalis.

The following week the stomach continued extremel}'
irritable, seldom retaining fluids; and as the active part of
disease had subsided, a mineral tonic, w^ith some infusion
of calumba, w'as prescribed for him, but the stomach did not
retain it. Much difficulty has been experienced in regulating
his diet, from the capricious state of his stomach.

Epistaxis has several times occurred, and has uniformly
relieved him.

On the 19th, he complained that the cerebral pulsation had
much increased, and that he had some confusion of intellect,
and dulness of hearing ; notwithstanding this, he was eating
chicken and French beans when I called.

The nasal hemorrhage had not taken place since yesterday.
Stools copious and offensive.

Habeat Hydr, Subm. gr. vi. immediately, and every six hours an
aperient draught, and let six leeches be applied to the temples.

VOL. XI. — NO. 66. 3 M

450 Original Communications,

His nurse called in the evening to say that the nose had
bled freely, and his head was relieved. The deafness also
had left him.

On account of the occurrence of hemorrhage, the leeches
had not been applied ; but I requested their application,
unless the relief of the head were decisive.

Habeat Hydr. Suhm. gr. ij. h. s.

21st. — Yesterday he voided some dark bilious stools in
large quantity. The stools of to-day are better, and he is
more comfortable.

He is directed to continue the draughts and pills ; all
animal food is interdicted ; and the head to be shaved and
blistered.

The appetite is extremely capricious, and is observed to be
greatly influenced by the state of mind.

Slst.^ — It was reported to me, that during the whole
illness, and even previously thereto, Mr. HilFhas been liable
to hemorrhage from the nose, and had derived advantage
from it; for whenever excessive action supervened in the rami¬
fications of the carotid arteries, manifesting itself by headach,
dulness of intellect, and violent pulsation, this discharge
invariably quieted it, and thus proved critical. Towards the
close of his illness, however, it frequently ensued profusely,
when we would gladly have prevented it. Upon one occa¬
sion I plugged, by passing a roll of lint along the floor of the
nostril, by which the bleeding was arrested ; but the patient
was so irritated by the sensation, that I was constrained
to withdraw it.

Sometimes when ,tiiG hemorrhagic action had a little
subsided, the snuffing up of a strong solution of sulphate of
zinc appeared to shorten the duration.

On Sunday, the 27th, he lost at least six or eight ounces
before he tried the solution ; it then put an immediate stop
to it.

Notwithstanding the debilitating tendency of this adven¬
titious bleeding, his health improved; his intellects were
clear ; and the head in general but slightly painful. He
frequently sat up, and lively hopes were entertained of his
final restoration.

On Tuesday evening, the 29th, the hemorrhage again
occurred, and continued through the night. The solution did
not avail, nor was the circumstance communicated to me
until my usual visit, when it had ceased spontaneously.
Having been a very susceptible man, even in health, he was
always greatly annoyed whenever coagula formed in the nasal
cavities, as well as by the irritation of turgid vessels, and

451

Cooke’s Observations on Hydrocephalus »

under these events was habituated to rub his nose violently;
nor was it possible to restrain him from this practice, even
during the continuance of hemorrhage.

He could not have lost less than a pint, and j)robably the
quantity exceeded this estimate; for at times he brought up
by sickness, clots which must have been the coagulable part
of several ounces, independently of the quantity which
escaped from the nostrils.

1 begged him to allow the clots to remain undisturbed in
the nostrils; to keep the face cool; to avoid all exertion,
especially on going to stool, on which occasions he has been
accustomed to use much straining.

His condition was greatly altered by this last hemorrhage,'
and, indeed, presented a hopeless and melancholy aspect.
He could not rise in bed without fainting. There was much
subsultus tendinum ; the tongue was apparently ex sanguis;
stools bloody (from that which had passed into the stomach) ;
the pulse was 90, small and soft. From tliis period there
was no possibility of renovation ; he gradually sunk, and
died on the first of I^ovember, two days afterwards.

Inspectio cadaveris. — On the following day I inspected the
body. It looked natural, and possessed considerable
point.

On opening the head we found the calvarium very thick,
and the dura mater morbidly adherent, although not so firmly
as to require removal with the bone. The diploe of the
cranium was much developed. The brain felt very firm
before the dura mater was raised, and imparted a sense' of
fluctuation, clearly indicating that fluid existed underneath.

The vessels of the dura mater were nearly empty. After
having raised and reflected this membrane, the tunica arach-
noides was very conspicuous, being opaque, and raised from
the pia mater by a considerable quantity of serous fluid.
The vessels of the pia mater were nearly destitute of blood.
The substance of the brain was perfectly natural.

The roof of the right ventricle was more elevated than the
left; they contained together about four ounces of fluid.
By making slight pressure, fluid poured out from the for.
com. anterius, and after the removal of the cerebrum, it was
seen escaping from the cerebellum. By a careful estimate,
the fluid did not amount to less than six ounces.

Each plexus choroides had a little tumor upon it. So
uniformly do these parts undergo similar morbid changes,
that on seeing one of them thus circumstanced, it was anti¬
cipated the same would be observed on the other side*.

* This was quite different from the knotty appearance which the
tortuous vessels often present.

452

Original Communications,

There was a large quantity of adipose substance on the
abdominal muscles, and the muscles themselves were fine and
florid.

The whole abdominal viscera were natural. The liver w^as
free from the slightest indication of morbid lesion, or con¬
gestion. The gall-bladder did not contain much bile; but
what it did contain was of healthy colour.

The mucous coat of the stomach and pyloric orifice were
perfectly natural. ®

The thoracic viscera likewise were in a healthy condition;
there were not even adhesions betwixt the pleurte, so com¬
monly detected ; but on feeling into the left cavity I dis¬
covered about twelve ounces of serous fluid.

The heart felt remarkably firm, and the parietes of the left
ventricle were at least one-third thicker than ordinary, yet
without an appearance of disease. It might arise ^s a query,
whether this thickened state of the ventricle may be considered
as accounting for the impetuous flow of blood from the vein,
even under fainting; or whether it was an adaptation of the
ventricle to the diminished quantity of blood in circulation.

Before concluding this case, it should be observed, that
during this last illness there existed no symptom indicative of
hyd rothorax ; but previously to it the patient’s respiration had
been somewhat impeded ; by using a little exercise he suffered
palpitation of the heart, and needed two or three pillows at
night. He^ had voided large quantities of pale urine, and
during the whole illness there w^as no defect in the quantity
of this secretion.

In comparison with his w'onted accuracy, the state of his
books intimated that he had not enjoyed full exercise of his
faculties during tw o years.

He afforded during this period an example of the influence
exerted by the brain' and mind upon the abdominal viscera.
Sometimes his appetite was voracious ; at others, it was sus¬
pended by only naming food ; and inquiries respecting the
state of his stomach, would often produce immediate nausea
and vomiting. The same influence was also observable upon
the hepatic secretion; so that upon the communication of any
unwelcome intelligence, or the accession of any particular
affection of the head, he could anticipate the colour and
appearance of his motions. Diarrhoea often succeeded
transient mental agitation. The same causes likewise exerted
some influence over the renal functions, but these w^ere not
so constant.

It seems unquestionable, that the bleeding, by inducing a
temporary depletion of the cerebral vessels, contributed to
prolong life and reason, but did not avail to ensure any per¬
manent advantage. From the experiments of Dr. Seeds,

Cookers Observatiom on Hydrocephalus, 453

indeed, we might be induced to believe, that towards the close
of the disease it had rather led to an increase of elfusion.
From his experiments Dr.--S. reports, that in every instance of
animals bled to death, there is an overwhelmins; effusion of
water in the ventricles and between tlie membranes.

Case Third. — I was requested to see Master B. in the
middle of March. He was about six years of age, and had
been indisposed about four months. He had chiefly com¬
plained, during that period, of occasional pain in the abdo¬
men ; his bowels were constipated; and stools pale: he had
evening paroxysms of fever. His tongue white ; and he
extremely listless.

His parents informed me that he had not been under regu¬
lar medical attendance; hut that an eminent Surgeon had
occasionally prescribed for him. They informed me likewise
that he had frequently taken small doses of calomel; but that
he was invariably worse afterw^ards.

When I first saw' him he appeared to be labouring under
a sub-acute form of hepatitis. After taking saline aperients
during a week, his stools became of a tolerably healthy colour,
which had never been the case after calomel ; and he seemed
altogether in a state of amendment, except that some affec¬
tion of the head, which hitherto had appeared subordinate,
developed itself more acutely.

Four leeches were applied to the abdomen, and afterwards
a blister, with good effect.

On the 21st his father told me he had been a child of con¬
siderable precocity of intellect, and was very successful in his
youthful studies : but during several months he had not the
same facility of receiving instruction, and his temper became
more irritable. ^

He had often complained that the light annoyed him.
For some time these complaints were disregarded, and young
as he was, no remission of learning was allowed. He was,
indeed, often corrected for his peevishness and complaints.

The affection of the head had now rather suddenly aug¬
mented. Light was very irksome: he had pain over the fore¬
head ; tongue darkish coloured ; teeth covered with sordes.
He takes little notice ; eats nothing; and drinks but seldom.
His respiration is rather quick in general, but frequently
whilst sleeping he is seized with very great oppression, lasting
above half a minute. His mind is extremely irritable ; his
pulse small and quick : he took some Epsom salts and infu¬
sion of senna, which operated freely.

He passed the night very restlessly ; and at six the follow¬
ing morning (22d) i was called to him. He was screaming
violently; knitting his eyebrows; greatly agitated when

454

Original Communicatiom.

light was thrown upon the eyes, although it was not very
powerful. Pulse 140, rather tense, and slightly irregular: he
kept his head low in bed; seemed to have pain when the
belly was touched ; the teeth covered with sordes; skin mo¬
derately cool. His bowels had not been opened during
the night, but on being opened, he became more tranquil and
rational.

1 ordered the application of four leeches to the temples ;
two grains of submuriate of mercury to be taken immediately,
and the purgative mixture continued.

23d. — He has passed a composed night. This morning
he has been distressed by frequent attacks of convulsive respi¬
ration, lasting about a minute ; bow'^els once opened since last
night, the dejection dark coloured and loose. He is rational;
pulse small, 130, irregular; skin cool; tongue not so dark
coloured. He is less irritable, and less annoyed' by light.
Some tinct. of digitalis was added to his former medicines,
and cold lotions to the head.

During some days he has been considered as labouring
under hydrocephalus; and on the 24lh Dr. Farre was re¬
quested to meet in consultation. He considered the case
nearly ho[)eless; but requested that, with a continuance of his
present medicines, his head might be blistered ; and, if possible,
brought to extensive suppuration. He thought he had suc¬
ceeded in one or two cases, where the symptoms of hydroce¬
phalus existed, by this means. He said it had been carried
on to extensive suppuration, so that one child retained large
cicatrices on the scalp.

With very slight variation he became increasingly coma¬
tose ; the pulse varied somewhat in irregularity, and so did
the degree of insensibility.

On the 25th he had convulsions ; the pupils were more
dilated, and less susceptible to light ; pulse almost incal¬
culable.

On the 27th the pulse was 130, strong and irregular; and
he expressed pain on pressing the abdomen.

On the 28th he lost the power of deglutition; but regained
it on the 29th.

He died in the evening of the 30th.

Inspectio cadaveris. — The vessels of the pia mater were
turgid ; and in the substance of the brain they appeared more
conspicuous than usual.

When the cerebrum had been dissected down to the roof
of the right ventricle, fluctuation was perceptible. On punc¬
turing it, about two ounces oi perfectly limpid fluid ran out.
When the other ventricle was opened, more fluid escaped;
but as there was free communication between the two ven-

455

Cookers Observations on Hydrocephalus,

tricles, part had escaped when the opposite ventricle was
opened. On the exterior of this ventricle an abscess was cut
into, and when the finger was introduced, it was found to
pass into a large cell, which occupied nearly the whole ante¬
rior lobe, and communicated with the ventricle.

The point at which it corresponded with the ventricle felt
callous; almost like cartilage; which on subsequent minute
examination appeared to arise from depositions of lymph
around the cell. '

The liver was natural in size, and the gall-bladder contained
healthy bile; but upon the surface was a small opaque spot,
and a few minute tubercles, about the size of pins’ heads.
The mesenteric glands were very slightly enlarged. The
thoracic viscera were healthy.

Case Fourth. — On the £5th of March I was consulted

respecting the child of Mr. Y - , of Lemon Street, two

years and a half old ; a very fine and intelligent boy, who
had enjoyed almost uninterrupted health.

I transcribe from my journal the following memoranda: —
The child has been ill about two days : he complains of head-
ach; the pulse is quick and strong; eyes red; and skin hot,

Habeat Calomel, gr. ss.

Pulv. Antim. gr. i.

Quarta quaque hoiA.

£6lh. — Bowels have not been freely opened; continuentur
pulveres.

Habeat Mist. Salin. Purg.

Four leeches I directed to be applied to the temples; and
cold lotions to the head.

27th. — The bowels freely opened. Pie seems consider¬
ably reduced by the leeches: the face, which before was
florid, has become pale. The stools are of a good colour.

29th. — Less pyrexia; but still complains of his head ; the
eyes are less red. He is quite sensible. Pulse not above
90, reg ular; tongue brown and furred. He often starts when
asleep. Two leeches to the temples.

30th. — In all respects better; and having been called to
the house in the evening in consequence of an accident, it
was reported to me that he continued comfortable.

31st. — Early this morning 1 was informed he was much
worse. He had been restless through the night ; incoherent;
and insensible. I found his eyes nearly insensible to light;
pupils not very much dilated. He lay sometimes in a coma¬
tose state, at others reaches after something in the air. On
being roused he seemed to have momentary intelligence, and
swallowed a little barley water ; belly soft and open ; pulse

456

Original Communications,

86; extremely irregular. He "moans occasionally. I di¬
rected a blister between the shoulders ; the calomel and anti¬
mony, and saline aperients to be continued. The head
shaved and kept cool with lotions. In the evening the coma
was more profound ; there was likewise strabismus.

At)ril 1st. — Much the same. He has just passed faeces of
good colour. His power of swallowing is impaired by an
apparent want of control over the tongue. He has aphtha.
Changes of countenance very sudden. Some digitalis added
to his medicines, and blisters applied behind the ears.
Raising him from the bed seems to distress him very much.

2d. — -Pulse 96, soft, and irregular; no strabismus; pupils
rather large, but more susceptible to light than yesterday;
and, although not capable of speaking, he seems more intelli¬
gent. He appears conscious of the pain of the blisters. His
power of deglutition has improved. , His bowels being rather
constipated, 1 gave him a dose of calomel and scammony, of
each two grains, which after a few hours caused the evacua¬
tion of a dull dark green stool.

As his bowels were rather torpid, I directed him some pills
containing of calomel, scammony, antimony, and digitalis
aa i grain, every three hours.

At night he was more intelligent ; sight a little improved.
He frequently attempts to raise his left arm to his face, but
with much difficulty and tremor. He was observed to sigh
very frequently ; and has subsultus tendinum.

From this period there was no material change : his pulse
and respiration continued very irregular ; he remained coma¬
tose until the evening of the 4th, when he died ; only twelve
days from the first appearance of indisposition.

Inspectio cadaveris, — April 5th. — On reflecting the scalp I
observed a red line in the course of the coronal suture, exhi¬
biting peculiar vascularity, extending also along the sagittal.
The bones were not compact at the sutures. The dura mater
adhered very closely to the cranium, but perhaps not much
more so than is usual at this age. There was an appearance
of granulation in lines corresponding with the sutures, which
seemed to give to them their vascularity, and perhaps desig¬
nated the process by which nature effects the ossific union.
The tunica arachnoides w'as raised by much subjacent fluid,
and the vessels of the pia mater were very turgid. The sub¬
stance of the brain did not seem more, vascular than ordinary,
Eaoh of the lateral ventricles contained upwards of an ounce
of limpid fluid; and after the, cerebrum was removed, the
cerebellum and basis cranii w^ere likewise found to contain a
considerable quantity : making in the wffiole about three
ounces. . u

467

Cookers Observations on Hydrocephalus.

On examining the substance carefully, I found an abscess
occupying the right corpus striatum, spreading to the extent
of a walnut. The substance was not quite so soft as it often

is, but sufficiently broken down and circumscribed to define

it. The contents had a reddish tinge. The other parts were
healthy. The medullary substance of the cerebrum was firm,
but that of the cerebellum extremely soft and loose in its.
texture. There was nothing like acute inflammation in the
membranes or brain. The mesenteric glands were a little
enlarged, one as large as a Spanish nut, many as large as
hazel nuts. The liver was healthy. The gall-bladder con¬
tained some bile, of rather a dark colour. The thoracic
viscera were quite healthy.

Notwithstanding the successful achievements of some
comparatively recent physiologists, b}^ which the progress of
medical science has been surprisingly accelerated, yet there
are many phenomena in disease so'involved in obscurity, that
the treatment is still conjectural. The interest of humanity,
as well as the honour of the Profession, present most power¬
ful incentives to the utmost diligence and perseverance in
those investigations which have been found most effectual in
developing the nature of diseases to which the body is incident.
The progress of science may be imperceptible, and the agents
' in it subordinate; yet as it is by a careful collection of facts,
and a deduction of legitimate inferences from them, that ad¬
vancement is most likely to be insured, I shall not hesitate to
communicate (though it be with diffidence) those principles
which my own experience and observation have suggested
respecting hydrocephalus. Whilst, then, I maintain, that
although often co-existent with disease in remote organs,
it seldom originates from them, 1 cannot cherish the opinion
which many highly respectable Practitioners have adopted,
that it is inflammation, either of the membranes of the brain,
of the brain itself, or of the delicate investing membrane of
the ventricles.

Sometimes the symptoms at the onset are so acute, as to
conceal the real points of distinction betwixt hydrocephalus
and phrenitis. The progress will generally exhibit discri¬
minating characters; and the morbid appearances after death
seem to me decidedl}' unlike those presented after inflamma¬
tion in the membranes of the brain. I'he tunica arachnoides,
indeed, is often rendered opaque ; but the increased vascu¬
larity of the pia mater consists chiefly in venous congestion;
and the dura mater has been but slightly or not at all affected
in the cases 1 have examined; whilst it must be conceded, that

VOL. XI. - NO.G6. 3 N

458

Original Communications*

as in many diseases in which inflammation, though not the
chief agent, is accessary, so there are cases of hydrocephalus
in which high arterial excitement is a very prominent
feature.

If we suppose an inflammatory condition of the membrane
of the ventricles to constitute the cause of the disease, I am
apprehensive we shall be unable to account for all the phe¬
nomena which happen too frequently to be considered merely
fortuitous, and from the peculiar structure of the brain, it is
probable they exist more frequently than is discoverable.

The dull and clouded, or more distinctly vascular aspect of
this membrane is not constant, and, so far as I have observed,
the choroid plexuses (from which, as well as the membrane,
secretion is supposed to take place) are generally paler than
natural. \

We cannot by it account for effusion between the tunica
arachnoides and pia mater, except, indeed, by admitting that
the membrane of the ventricles is a continuation of the arach¬
noid coat, which has been rendered extremely probable ;
in that case, however, the disease should be designated inflam¬
mation of the tunica arachnoides. Neither can we explain the
frequent occurrence of abscesses in the substance of the brain,
nor changes in the texture itself, where the nature of the
change may be scarcely appreciable. The characters of the
fluid itself likewise differ considerably, in general, from the
fluids of other inflamed serous membranes. It is generally
limpid, as pure water, and is believed to approximate the
natural state more than any other morbid efliision.

Of those cases in which there appeared unequivocal symp¬
toms of hydrocephalus, but in which no effusion was found
after death, no instances have occurred to me; they are so
well authenticated, however, that I cannot doubt their occa¬
sional existence, but apprehend that a state of inflammation
of this membrane would by no means induce that series of
symptoms which are usually supposed to denote this disease.

Is the disease then an inflammatory condition of the substance
of the brain ? The frequent formation of abscess ; the deposition
of jyrpph ; the manifestly increased vascularity in most cases,
concur, with the acuteness of the symptoms, to indicate an
inflammatory state of the cerebral structure ; but a variety of
cases immediately present themselves to our view in which
there was no other prominent feature than a softened and
apparently disorganized condition of some part of the brain,
quite distinct from that ensuing after death, as was seen in
No. 4, of the preceding cases, from which w e must infer that
inflammation does not constitute an essential cause or quality
of the disease.

I am rather disposed to consider it a peculiar organic

459

Cooke's Observatiojis on Hydrocephalus,

disease of the whole brain, affecting the substance and mem*
branes in common, generally attended with a sub-acute form
of arterial excitement, but more conspicuously, with some
obstruction to tlie return of blood from the head, inducing the
state of venous congestion. Of this condition effusion is a
very common, but not inevitable consequence. From the
variable state of vascular excitement, the distinctions into
more and less acute forms have arisen ; but this symptom
often affords very inconclusive evidence of the state of the
affected organ, probably deriving some modification from the
peculiar connexion of the brain and nervous system with the
heart and arteries, which, hitherto, it may not have been
practicable to develope.

What the real nature of this disease is, I am not prepared
to exhibit, but think it presents many points of analogy with
scrofula. Their alliance derives some confirmation from the
frequently hereditary nature of hydrocephalus, its frequent
co-existence with other scrofulous diseases, and from the
greater liability of children to it, in whom there is a remark¬
ably early or energetic developement of the intellectual facul¬
ties, which, if 1 do not mistake, is often the case in youths
predisposed to true phthisis pulmonalis.

That a tendency to the disease may often be counteracted,
I have not the smallest doubt; and that in certain states of
the disease itself, medical agency may be interposed wdth
effect, there are cases enough to justify an expectation. If,
indeed, the disease consisted merely of inflammation, and we
had only to subdue this, and afterwards to promote absorption,
the treatment w^ould be greatly simplified : but, believing
that it is more complicated than this, our reliance must, 1
conceive, be placed on plans adopted anterior to that period at
which we have been accustomed to view it ; at which per¬
haps only presumptive evidence may exist of the disease
having really commenced, or of its being imminently
threatened.

Parents are often extremely culpable in disregarding the
inactive forms of juvenile complaints; but even in the present
highly cultivated state of medical science, the most sagacious
Practitioners will often fail to prognosticate formidable dis¬
eases, to which early and perhaps slight derangements of
function often tend, and which, at that period, might have
been averted.

In a large proportion of cases of hydrocephalus, the com¬
mencement and early progress are extremely insidious;
the departure from health appearing to consist merely in
torpor or irregularity of the digestive or excretive function, or
slight deterioration of temper or disposition, no anxiety is

460 Original Communicatiom,

created. Too much solicitude, however, never can be
exercised in the most trivial chronic disease, to which children
especially are liable, and an increase of fretfulness (and,
indeed, sometimes of vivacity,) should be considered as truly
symptomatic of disease, as any character which the functions
of the body can present, and as legitimately to claim the inter¬
position of medical, as well as moral treatment. The wanton
infliction of corporeal punishment under these circumstances,
cannot be too strongly reprobated.

A disposition to the disease may often be known by the
circumstance that other children in the family have been
affected ; and in some instances not only have parents been
able from personal resemblance to select the individuals .most
liable to be invaded, but likewise to predict the time about
which the attack shall take place.

There are states of constitution in which a morbid diathesis
seems to prevail, rendering the individual peculiarly sus¬
ceptible of the influence of adventitious circumstances, and
yet no particular disease shall be apparent until the applica¬
tion of some local excitement. Many such children are
delicate almost from birth ; and as they pass through the years
of childhood, often appear particularly amiable, and have an
unusual aptitude in the acquisition of elementary knowledge.
These pleasing qualities may not only be admired, but
fostered ; and under inordinate anxiety to cultivate the
mind, morbid actions have been cherished in the brain;
whilst the functions of other organs, essential both to health
and life, have been disregarded.

Whether the earliest morbid changes connected with hydro¬
cephalus take place in that texture of the brain in imme¬
diate relation with the nervous system or not, we find, at a
very early period, that the functions of the digestive organs
are disordered ; and if any secretions are peculiarly subject
to nervous influence, those of the abdominal viscera must be
distinguished.

The unnatural appearance of the stools, or the irregularity
of the excretion, mav be the first token of disease which
distinctly arrests the observation of parents ; and if domestic
remedies are unavailing, medical advice may be solicited,
and the Practitioner’s attention almost exclusively directed to
this point.

The great influence which derangements in these organs
exert upon the general health, and the surprising efficacy of
remedies tending to induce salutary actions in them, in curing
many diseases of distant organs, will plead strongly in ex¬
tenuation of an occasional error in considering their derange¬
ments as primary, when they may be consecutive.

4Gl

Cooke’s Observations on Hjydrocephalus.

Whatever benefit may be derived from calomel and
scammony, and other stimulating and exciting purgatives ia
certain diseases of these organs, I am persuaded, in that to
which we are now adverting, they often do essential mischief;
and that the organic affections of the liver, enlargement of the
mesenteric glands, affection of the mucous membrane of the
intestines, and the intus-susceptions, are often occasioned
by them.

Where there is suspended hepatic secretion, it seems
extremely rational to administer mercurial remedies. If
calomel be adopted in these chronic cases, an eighth of a
grain, steadily employed, will render more service than a
larger quantity ; yet I think an unirritating dose of the blue
pill, or of the hydrargyrus cum creta, far preferable. In
many instances, however, in which persevering employment
of the most varied and guarded mercurial treatment did not
avail, the secretion was established by a steady adoption of
some mild aperient. In counteracting a disposition to hydro¬
cephalus, there is much to be avoided, as well as much to be
done ; the mind should be. cultivated very cautiously, and
efforts of memory must be relinquished, whilst encouragement
is given to active amusement. The diet must be nutritive
and unstiniulating. As an aperient, a few grams of the
sulphate of magnesia are very suitable. Mineral acid, I
think, is often useful ; either the nitric, or, as I have recently
employed it (but whether entitled to preference, I am not
quite satisfied), the nitric and muriatic in combination. On
one occasion, where the symptoms were very threatening, I
successfully employed this acid with the extract of taraxa¬
cum, keeping the bowels gently open with the Epsom salt,
and enjoining residence in the country.

Had I not already greatly exceeded the extent which pro¬
priety suggests in this essay, I should have considered the evils
arising from an indiscriminate administration of calomel and
stimulating purgatives worthy of much further consideration,
and might have corroborated my opinion by a diversity of
cases, illustrative of the morbid actions which these drugs in¬
duce and keep up ; and of the greater efficacy of mild aperients
in exciting hepatic secretion in some conditions of the liver in
relation to other organs ; and I might have corroborated my
sentiments by reference to Practitioners, whose long expe¬
rience and accurate observation entitle them to the highest
respect. 1 shall only. cite the opinion of Dr. Blackall upon
the former particular, who, I recollect, in speaking of a child
to whom calomel had been improperly administered, de¬
scribed the stools as black and liquid, such as are not only
brought off by mercury, but often entirely caused by it.”

462

Original Communications,

Nevertheless, 1 am persuaded that mercurial remedies in
chronic indispositions, and even in forms threatening hydro¬
cephalus, cannot be wholly abandoned. An unirritating dose
of a mild mercurial preparation, repeated every other or
third night, during a week or ten day^s, will often prove of
signal utility ; and although calomel does not appear equally
adapted with other preparations of mercury, to the purpose
in view, it is an agent of great ejdicacy under some other
circumstances of morbid action.

As to the treatment of the disease itself, much must be
determined by accidental combinations.

When the disease assumes a very active form, blood¬
letting is indispensable, but must not be carried to an extent
equal to that which inflammation of the brain demands, and
which even the strength of arterial action and Appearance
of the blood seem to justify. Wherever bleeding had been
carried to a large extent, although it temporarily improved
the patient’s condition, unfolded reason, or removed some
degree of coma, yet a proportionately larger quantity of fluid
was effused. The case of Mr. Hill is interesting in this
respect. Had the disease consisted of inflammation, he, in all
probability, would have recovered ; but as haemorrhage
continued to recur, the quantity of fluid appeared to increase.

I therefore prefer the abstraction of blood by leeches, in cases
of children ; and three or four ounces taken from adults will
often subdue arterial excitement, in a degree equivalent to
a much larger quantity, in cases of inflammation.

As morbid actions are often created or kept up in the
brain by unnatural secretion or accumulation in the intestines^
it is not incompatible with the preceding observations on
calomel and stimulating purgatives, to recommend the ad¬
ministration of a dose, in the first instance, adequate to
their removal ; and so speedy an amendment of cerebral
functions occasionally results, that we admit the derangement
was but sympathetic. To other sources of irritation attention
must be directed, especially^ dentition.

During the state of greatest excitement, cold applications
to the head are often useful. To apply them efficiently the
head should be shaved, or the hair cut off very closely.

In phrenitis, and other cases of determination to the head,
these evaporating lotions ought to supersede blisters to the
head ; but in hydrocephalus, early and extensive vesication
upon the scalp seems highly expedient.

The medical treatment which has been most useful in my
practice, has consisted of a combination of mercurial pill (in
a very minute dose), with antimony and digitalis, keeping the
bowels gently open by a neutral aperient salt. Under such

403

Fosbrooke’s Remarks on Variola^ ^c.

management as this, modified a little by circumstances, cases
which seemed to be incipient forms of this disease have
recovered; but from the uncertainty of the diagnosis, I
am fully sensible how equivocal these instances must appear.
Had I not already obtruded too much on the lime of the
Society, and encroached rather too greatly on duties claiming
my attention, I should have candidly submitted some of
them to the judgment of my hearers.

Under every form of management great disappointments
will arise. There is no disease, however, which excites more
commiseration towards parents and their offspring than this ;
nor any that creates more solicitude, or prompts to greater
efforts in order to avert a fatal termination. Discouraged, and
almost despairing, as we at times may feel, the extent of injury
which the brain will sometimes endure, and of reparation it will
occasionally effect, should animate us to unceasing researches
into the cause, the progress, and consequences of this
formidable malady, or rather into the origin of that train
of morbid actions, and the change of texture they endure,
upon the elucidation of which, correct principles, which
impart efficiency to practice, can alone be securely established.

I am quite aware how unsatisfactory and incongruous this
essay is likely to appear. It has been written amidst cease¬
less interruptions; and whilst it has embraced topics which
claim extended discussions, its specific object circumscribed
me with reference to time and matter. If, however, in its
present imperfect form, any benefit should accrue, either
from the diffusion of my own experience, or by eliciting the
experience and opinions of others, or should my professional
brethren afford me the privilege of uniting with them in their
examinations of morbid structure, in this or other diseases, 1
shall be most amply compensated.

II.

Some Remarks upon the late Epidemic Eruptive Diseases^
supervening on Fariola and Vaccinia^ and upon Professor
Thomson’s Theory of the Identity of Modified Small-pox
and Chicken-pox; with some Contributions to Diagnosis-
By Mr. Fosbrooke, a Member of the Profession.

[Continued from page 277.]

I SHALL now enter into the particulars of some of the most
authentic cases on record of secondary small-pox, to deter¬
mine whether they differ from the primary, and in the next

464 Orwinal Commurikations,

place after vaccination ; and whether, subsequent to either,
they undergo a similar modification ; for if it does not appear
that there is any general diagnostic difference of the latter
kind from the earliest accounts, it will be rather inauspicious
for this section of the theory which refers to the reciprocal
modification. As for the term spurious small-pock being
formerly used, it is mere catching at straws to trust for evi¬
dence to appellations, for nothing could be move commeilfaut
than to name a strange distemper from its resemblance to one
more familiar, and not ascertained by every body to originate
from a different poison. Small-pox derived its name from a
predecessor very dissimilar. Heberden, it seems, once con¬
ceived varicella to be a mild genuine small-pox. Longford’s
case in the fourth volume of the Memoirs of the Medical
Society is well knov/n; his countenance was strongly indica¬
tive of the malignity of the distemper : he had a bad confluent
small-pox a second time, and died. Four persons, of whom
one died, caught it, and fully satisfied the country w^ith regard
to the nature of this disease, which nothing short of this
would have done. It is singular, says Dr. Jenner (First In¬
quiry ), that in most cases of this kiridy the disease in the first
instance has been confluent. In Dr. Pearce Dod’s cases,
published in 1746, an instance is mentioned of secondary
small-pox, in which there came out between two and
three hundred pustules, which miasmated and scabbed like¬
wise, and went through the same stages, and in the same
manner that the former did, only the subject w?^as worse
before the eruption, but when that was completed he had no
manner of disorder. A case of secondary small-pox, with
the usual symptoms of the distinct disease, is given by Dr.
Bateman, in the Reports of the Carey Street Dispensary, Vol.
VI. Edin. Med. Journal. The case given by Mr. Dunning,
of Plymouth, of secondary small-pox, occurred in the family
of Dr. Stew'art. His daughter was inoculated when very
young, and had about two hundred pustules of distinct small¬
pox. Six years afterwards the doctor inoculated her a second
time. She suffered more from the second than from the
first inoculation. She wms many days severely indisposed,
and had a considerable number of variolous eruptions dis¬
tributed over the body. Dr. Coxe, of Philadelphia, gives three
cases without unusual symptoms. I myself have knowm one
of secondary distinct, and another of secondary confluent: the
history of one of these will be published hereafter. I have
been inclined to form an opinion that many of these events
have originated in too implicit a confidence in the regular
gradations of topical appearances, and often when there has
been a temporary disposition of the system (not of the skin),

465

Fosbrooke’s Remarks on rariola,

to reject it by inoculation in the first place*. Sometimes,
ns a pertinent observer remarks, ‘‘ this disposition con¬
tinues through life; at other times it affords only a temporary
protectionf.” This obtains in vaccination, and has led to
multifarious failures. 1 must here remark the laudable mode
in which the Broad Street establishment have always con¬
ducted their vaccinations, testing after the regular course
with variolous matter. How many of these failures would
by this m'lans have been avoided, where the epidemic is
purely varioloid. Among the cases of small-pox after small¬
pox, in Jenner’s Inquiry, p. 80, variolation was attended with
the most fallacious and regular appearances : four took the
small-pox afterwards in the natural way, one of whom died,
three recovered, and the others (five altogether), being cau¬
tioned by me to avoid as much as possible the chance of
catching it, escaped from the disease through life.'^ In
addition to these, a second instance occurred where the
children took the small-pox from this second inoculation, and
had a very full burthen.” It is probable matter ,was taken
from a varioloid pustule at an improper period, or preserved
in an improper manner. Wilson quotes some experiments
of inoculation with crude matter, though small-pox was pro¬
duced, but being doubted, a second inoculation was made
with well formed matter, and all of them had the small-pox
in the common form. See article Small-pox for other cases
of severe secondary small-pox, in Rees’s Cyclop.

Dr. Jenner has personally favoured me, since this article
was first written, wdth some ingenious and original additions.
Among the rest are the following anecdotes of secondary
smali-pox ; — When I was at Gloucester assizes, three years
ago, Mr. Justice Holroyd, at an hour of disengagement,
requested to speak to me : after a few compliments he said,
you must observe how universall}^ my countenance is in¬
dented ; people have been absurd enough to say smali-pox
cannot be taken twice; 1 had the disease when a little boy,
with others ; I went, when twelve years old, into a house

* See my former communication to the Repository, V ol. X. 1818.
t All that has been discovered in the progress of vaccination is a
parallelism with small-pox inoculation throughout. The report of
vaccination in France for 1815, by the central committee, con¬
tains instances from the second to the seventh vaccination with final
success. Un Praticien avoit deja remarque que quelques enfans
des carapagnes, vaccines aux bras, sans succes, avoient ensuite con-
tracte la vaccine par Tinoculation qui leur en avoit etc pratique aux
cuisses.” A vaccine pustule near any cuticular affection may fail
repeatedly. — F.

VOL. XT. — NO. 66. 3 o

465 Original Communications »

where small-pox was, 1 took it a second time, and this was
the consequence. — The Marquis of Hertford told me his
father had been inoculated by Sir Caesar Hawkins, and from
the eminence of Sir Caesar, when a boy he went with him in a
tour to France; at Rheims he took the small-pox, and died*
This circumstance threw such a damp over France, that it
gave a further check to the practice, which was alw^ays
distrusted there. Mr. Bromfield, a celebrated surgeon in
London, inoculated with small-pox Miss Pappendeck, the
Duke of Clarence, and Prince Ernest. Miss Pappendeck
afterw^ards went to play at Kensington with the little
branches of the royal family, caught secondary small-pox
and was pitted. Dr. Jenner cautioned the others who
had been inoculated from the same thread, but they had
resisted it after frequent exposure. Blomberg so often
failed, that he gave up small-pox inoculation. A Mrs. G., a
solicitors wife, at Cheltenham, had small-pox five times.
Mr. Chamberlayne, surgeon-apothecary, Clerkenwell, has had
small-pox twice. Colonel Brysac twice severely. Two
persons in Mr. J. Angerstein’s family. The poet Campbell
gave Dr. J. two cases in one family. The grandfather of
Mr. J. Nicholls the publisher, is a case. Lord George
Cavendish an instance of congenital small-pox severe. (I
have read of several cases. F). Sir Wm. Rowley’s son a
case of secondary small-pox. Mr. Bagster’s child, near
Somerset House, inoculated by Sutton, died of secondary
small-pox. Seventeen cases were enumerated among the
nobility. Van Swieten says, that a servant maid, who had
had small-pox twenty years before, was delivered of a child
under true small-pox. The case was observed by Dr.
Watson, an eminent Physician of London. After mentioning
the cases of Forrestus, he gives Dobrzensky’s case of a boy
twice taken with small-pox, from fright, at seeing a subject
who died of the disease. F.

Dr. Adams says, that small-pox has appeared in two
different forms after vaccination. In by far the most
numerous instances the small-pox, after the cow-pock, have
appeared so mild and deficient in the true variolous character,
(turning on the fifth or eighth day), as to excite doubt of the
reality of the disease ; hut its identity has been proved by
inoculation from it. In a very few cases the small-pox
which occurred subsequent to the vaccine pock, were severe
as usual ; in one or two instances, fatal. Dr. W^illan’s obser¬
vations on secondary small-pox, are almost literally the same.
See some continental cases in confirmation, by A. F. Schutz,
Muhry, &c. &c. Ed. Med. Journal, No. L. p. 160. Dr.
Adams, in some further account of vesicular small-pox after

Fosbrooke's Remarks on Variola, 4’c* 467

vaccination, says, Their figure is somewhat elliptic, and
though the pustules preserve a regularity in the manner
in which they succeed each other in different parts of the
6ody, yet the whole processes completed two or three days
sooner than the mildest of the regular distinct small-pox.
Nothing but the progressive hardness of the pustules w’ould
mark the disease in some of these cases, and that would have
been insufficient if the insertion from them had not produced
true small-pbx.”

The minutes of the Broad Street Institution, in 1805,
are deserving of reference, as they relate an unfavourable
state of vaccination, as at the present time, and a similar
ambiguous kind of eruptive disease, presumed to be small¬
pox. In Goldson's cases of small-pox after vaccination, the
pustules were few in number, and horny, and counteracted
the avowed purpose for which they were published. In
Dr. Pearson’s Reports of 1806, (vide Lond. Med. Rev.) the
cases of small-pox after vaccination were irregular, but
exhibited nothing novel: the number of pustules in most
cases were few. Some other cases, are from the minutes
of the Broad Street Institution. In many of these cases, the
miniature size of the eruptions suggested the idea of an
independent disease. In two cases given by Dr. Wonden, of
supervening variola (Vol. XII. Rev.) the disease was not
anomalous. With these we may class Mr. Hallen’s and
Mr. Granger’s cases, Vol. VIII. Edin. Med. and Surg.
Journal. Mr. Burn’s cases, Vol. III. Ed. Journal. Dr.
Adams’ on the small-pox hospital, morbid poisons, Vol. XII.
Lond. Med. Rev. without pustular modifications, with the
exception of diminutive size, mildness of the disease, and the
duration not always deviating from that of the distinct small¬
pox. In several cases recorded in the Lond. Med. Rev.
for 1807, the pock was perfectly regular. Dr. Winterbottom
(Vol. VII. Bradley’s Med. Phys. Journal), gives some cases'
of four children vaccinated when exposed to the contagion of
small-pox. Though one of the four was covered three days
afterwards with a copious eruption of variolous pustules,
they proceeded very small and clustered, continued very
small, and became confluent on many parts, particularly on
the face. Not the least appearance of efflorescence round the
base. In one of three others, inoculated under similar circum¬
stances, on the tenth day twenty or thirty pustules, resembling
varicella, appeared on the face and neck, which, after con¬
tinuing out four or five days, fell off. In another child
a trifling eruption of hard dry spots appeared about the
tenth day, and soon disappeared. These may be considered
as good specimens of modified small-pox. Ivvo cases by Dr.

4,68

Original Communications.

Jeiiner, p. ]08 of his Inquiry, “ The one had the disease
in the slightest manner, a very few eruptions appearing^
two or three of which only maturated.” In cases of vario¬
lation after vaccination, according to extracts from the
minutes of Broad Street Institution, small discrete
pimples, with vesicles here and there on their apices, have
appeared.” In the two fatal cases of supervening variola
here related, the pustules were in every respect resem¬
bling small-pox, though of a small size.” In some other
cases, it resembled eruptions of pimples, but in instances
communicated regular small-pox, Baron Humboldt relates
that in New Spain, a marked kind of small-pox succeeded
to vaccination^ which, whoever had passed through the disease
mildly, this may be noticed as a proof of the irregularity
of the contagion >of the Edinburgh diseases. Some writer
has observed, that where these two diseases have gone
together, they have produced a very favourable small¬
pox.” It is a singular exception, that these two diseased
actions, wben synchronous, co-operate, in fact, blend
together, topically and constitutionally, producing a mild
anomaly*. Thus was formed the pearl-pock of the late
Dr. Adams.

Dr. Thomson mentions inconsequently the horny character
of the scab in this disease ; yet surely I may ask, is this a pecu¬
liarity usual in chicken-pock, or does it only occur from
vesicles containing lymph, indurating before maturation
Dr. Bateman names the horny, a severe variety of small-pox.
It occurs in modified small-pock, after vaccination, ac¬
cording to Adams ; by others I believe it is regarded as a
peculiar disease, and in cases of secondary small-pox we
find no mention of it at all. Mr. Bryce considers this
epidemic horn-pock. Ed. Journ. for October.

The accounts of this disease being mostly traditional, I know
very little of them. Willan says, (Reports on the Diseases
in London, from 1796 to 1800,) When the small-pox and
vaccine disease had been inoculated at the same time, the
eruptions were, in all cases I saw at the hospital, of the
species vulgarly termed horn-pock, being hard, and semi¬
transparent. They contained little fluid, and though of
long duration, did not maturate or break by suppuration.”
This rather confirms the experiments of Adams, though both
classify the disease differently'', and somewhat differ in descrip-

* This has been said to be inistated by Dr. Adams, but I by no
means deem it to have been refuted. It was even said by his saga¬
cious reviewers, that he must have dipped the point of his lancet by
mistake in vaccine lymph.— -See Willan^s Remarks, cit. loc.

Fosbrooke^s Remarks on Variola j S^c. 46Q

tion. I am inclined to think that the integrity of small-pox
and all its varieties is broken by the vaccine and modified ;
if this is true, horn-pock is a fact} t ions disorder. Van Swieten,
who had seen the natural, says, I have observed three
kinds of the bastard small- pox, generally occurring at the
close oj the genuine. At the firsr sight they do not appear
different from the genuine small-pox. They are generally
preceded by a slight fever, sometimes only by a little faint¬
ness, and a spontaneous lassitude : then prominent red
pimples break out here and there on the skin, sometimes the
first day, and sometimes not till the second or third, and
sometimes immediately harden, (never suppurate, cit. loc.)
dry up, and fall- off. These pimples, the common people
of this country generally call the Stein-pocken. Sometimes
they seem distended wdth a thin lymph, especially at the
first: these two immediately, however, dry up, and fall off:
they are called the water-pocken. Sometimes that lymph
is wanting, and nothing appears but empty vesicles, but
distended, notwithstanding : these are called wind-pocken,’^
Sect. 1381. Query, Whether the two former be not varice-
loid, the latter horn-pock ? F.

As to the problem that chicken-pock does not occur ge¬
nerally in persons who have undergone either of the two
diseases, I am at this moment witness of a case of une¬
quivocal chicken-pock, long after vaccination. The learned
Professor, aw'are of the difficulty of accounting for the
fatal cases by this theory of identity, endeavours to establish
it as a sine qua noriy that small-pox must always accompany^
chicken-pock ; but, even admrtting that these diseases were
all derived from a mild, very mild disorder, at least according
to Mr. Hennen, the contrary is scarcely possible ; it may,
perhaps, be more difficult to prove that they never co-exist,
but with the contagion of mild small-pox, because most
of the exanthemata become epidemic at the same time ;
yet I do not perceive that this must necessarily imply their
identity. Measles, as well as scarlatina, co-exist with variola
as well as chicken-pock ; yet no one would assert that they
are the same diseases on no solider foundation. A chicken-
pock, ascertained ta be genuine, in as far as descriptions
could dejfine it, spread in a town, in the south of England, in
1815, and attacked indiscriminately children who had not,
and who had been vaccinated, and where no variola did then,
or had existed. Whether variola and varicella modify each
other ; if their contagions mingle, it may be probable they
may ; but when they ensue by specific contagion, distinctly
in the same subject, the like supersedure or suspension, as in
the concurrence of all exanthemata, probably takes place, or

470

Original Comm unications*

otherwise a spurious disease is produced. What could be
a better test of the certain relations of one disease to the
other, than inoculating with the matter of both contempo¬
raneously * ? '

The milder epidemics of small-pock have always been
considered prophylactic. There are certainly more forms
than one, (says Dr. Jenner, with his usual foresight, p. 40
Inquiry,) without considering the common variation between
the confluent and distinct, in which small-pox appears in
what may be called the natural way. He mentions an
epidemic which prevailed in Gloucestershire, of so mild a
nature, that a fatal instance was scarcely ever heard of,
and consequently so little dreaded by the lower orders of
the community, that they scrupled not to hold the same
intercourse with each other, as if no infectious disease had
been present among them. I consider this a variety of the
small-pox.’^ Mr. Fry, surgeon, of Dunley, further says,
this was called by the common people the swine-pock^ not
one of zchom received the small-pox Dr. Hicks, the con¬
temporary Physician, promised a history of this epidemic ;
he left an accumulation of MS., which are not, however,
forthcoming. Dr. Jenner has favoured me with the following
information:—^' Dr. Hicks never published his account of
the mild epidemic ; it prevailed for two years, raged with
severity on the Cotswold, and was finally extinguished on
the confines of Berkshire.” Mr. Taylor, of Wotton-under-
Edge, a Surgeon of eminence, in consequence of inoculating
my eldest son, sent me an urgent message to be cautious,
for he had found a patient or two who had had secondary
small-pox ; but instances of this nature were solitary. Mr.
Hans, Surgeon at Berkeley, found two under it, who had had
small-pox before. Van Swieten, who gives an excellent
history of variola, says, " The small-pox has been sometimes
observed to prevail epidemically, but that in so mild a
manner, as to be attended wdth very few pimples, and to suf¬
fer almost all those who had it to escape.” Sect. 1382. He

» I must here enter what should have come under varicella
in initio. Dr. Underwood seems to think, in his " Diseases of
Children/' that varicella is frequently as severe as small-pox, espe¬
cially in that variety, the hives or swine-pock. “ I have known the
head and face as much swollen as I have seen them in any distinct
small-pox, however full, and the pustules containing a yellow matter,
with highly inflamed bases, and exceedingly sore." He says it could
not he small-pox, for one died of that disease afterwards, Vol. II.
p. 299* Dr. Jenner has seen marks left by the chicken-pox, not to
be distinguished from the cicatrices of the small-pock.

471

Fosbrooke’s Remarks on Variola, 4c.

mentions a mild sporadic kind, 1387 : also another epidemic
of a very benignant kind : and gives a case of a young
gentleman, being obliged to take to his bed, amusing himself
the whole time with music, and the company of his friends,
Sect. 1739. What is inoculated small-pox but mild
small-pox ? yet its preventive effects are infallible to a great
extent. And, again. Dr. Adams’ pearl-pock, which w’as a
disease of a neutral gender, between small-pock and vaccinia,
W'as preservative.

But I have lingered on this subject already with too fond
a delay,” and must hasten to a conclusion. To recapitu¬
late what I have in some measure endeavoured to advance,
not unsupported by facts, there appear strong reasons to
question whether these secondary eruptive diseases are in
reality purely varicelloid or varioloid; that in the milder
cases there are many remarkable discrepancies, that from the
circumstance of the disease produced in the inoculated
children, differing in many points from the true variolous
character, it is still more warranted, that there are certain
diagnostic marks of distinction between these varicella, and
modified small-pox, wdiich still remain to be ascertained^.
That no analogy of cases of secondary small-pox proves the
pre-exisfence of these eruptive diseases; that they tend to
show that the disease was mostly severe, if not fatal, and
small- pox, after vaccination, was very irregular in its action,
not possessing any specific morbid character, with the ex¬
ception of that of mildness ; that these eruptive diseases
have recurred twice in the same individual ; that mild
epidemics, of variolous character, have afforded security,
which chicken-pock does not ; thence we think that the
arguments for the identity of these two diseases cannot be
established by the apposition of past experience, or testimo¬
nies. Finall}^, when we reflect that the mass of collected
cases only prove that secondary small-pox was always casual,
so much so as not to occur within the observation of
inoculators of immense experience, cases probably many
times obscure and fortuitous ; and when we reflect that
Dr, de Cairo observed, when the regular small-pox raged at

* The Edinburgh Reviewers say (in Vol. XV. on vaccination),
with their usual good sense, “ The diagnosis of regular constitutional
small-pox is, indeed, abundantly easy ; and if we were to refuse that
name to every eruption which had not the nosological character, or
did not correspond with the best systematic descriptions, we should
hear very seldom of small-pox after vaccination. Since the introduc¬
tion of vaccination, eruptive diseases, of a very different natqre, have
been confounded with small-pox.”

472 Original Communications »

Vienna, There never was perhaps such a disastrous epi¬
demic at Vienna as that we have now ; it is certainly owing to
it, that people think so much now of the cow-pock, against
which they have been exceeding incredulous.” That Dr.
Marshall vaccinated, according to his evidence on the first
inquiry of the House of Commons, 1000 who were exposed
every possible way to variola, and even at that time 2,000,000
experiments had been made, in India and elsewhere, in which
regular small-pox had had no effect. I am disposed to think that
this epidemic is an anomaly of an independent kind, essentially
dift'erent in its nosological nature from small-pox or varicella,
but so strictly assimilated to each in its varied character, to
sanction the probability that it is an union of many conta¬
gions, operating as novel, and, hitherto, undefined disease.
Such an hypothesis is at any rate as good as any.

I find a few rays to light me on the way in this dark and
delicate question. A peculiar anomaly seems to attend every
extended epidemic of small-pox. Van Swieten,Sect. 138 1, says,
that he had heard a thousand times people speak of having
had the small-pox twice, thrice, and even four times : but he
says he has seen the spurious small~pox break out, on the
ceasing of the true kind, which had prevailed epidemically
for a long time, and seize both the young and old, and in
great numbers. Afterwards he mentions Diembroeck’s cases
of persons scarcely recovered, having it twice and three times
within the space of six months ; yet, though the latter was a
sedulous observer of diseases, I must own (says Swieten) I
cannot help suspecting a little, that he had confounded the
spurious wdth the genuine small-pox; and with the others
he indulges the opinion, that the disease was spurious in the
first and sometimes in the second occurrence. See Sect. 1381.
The genuine small-pox, he elsewhere says, sometimes happens
to be very mild, as causing very little disorder in the body,
bringing with it very few, and those very slight, symptoms,
and soon drying up and falling off. It cannot appear strange
that the ignorant should confound the two kinds one with
another; the spurious sort often attacks the person two or
three times. Dr, Jenner, from whose mind new lights of
genius seem to emanate, whenever he is willing to call them
forth, says, that he can produce a variety of small-pox, or
vaccine at will, by means of herpes, which variety may
be perpetuated ; thus we see how, by an accidental inatten¬
tion to an existing disorder, a partially secure disease may
be formed and communicated unconsciously in the first
instance, and followed by spurious small-pox in the next.
He says, I have considered the small-pox as a variety of the
cow-pox, or rather of the equine. It springs from a species

473

Fosbrooke's Remarks on Variola,

of herpetic eruption on the skin of the horse. We see then?
if my theory be accepted, why it happens that these three
diseases are capable of modifying each other; 1 mean the
equine-pok:, the small-pox, and that species of eruption
which has its origin in the secretion or exudation of a
peculiar fluid, that has obtained the name of herpes, and
which seems to be entangled, more or less, with every kind
of spontaneous cuticular disease, or nearly the whole. This
we knotv for a certainty, that the herpetic fluid of the human
subject, and the vaccine (equine), act reciprocally on each
other ; and we know, too, or ought to know, for 1 have
explained it fourteen years ago, that we are apt to produce a
'Variety, and not the genuine characteristic vesicle, when
we insert the vaccine lymph in the skin of a subject whose
constitution is at the same time under the influence of the
herpetic lymph.” He has named the case of a boy. Church,
who had small-pox subsequent to small-pox connected with
herpes. Dr. Jenner has favoured me wdth these remarks,
orally and in writing, wFich he purposes giving more at large,
with facts relating to herpes, and the singular phenomenon
of some acute diseases, e. g, catarrhal fever subsiding on the
appearance of an herpetic vesicle on the lip, as also of a
vaccine vesicle. The vaccine, too, succeeds after spurious
small-pox : it has long been my opinion, that the pocks are
all varieties of the herpetic class, of wdiich each has a certain
duration. I must add a history from. Dr. J. which bears on
the point of the possible transformation of one variety of
disease into the other. Mrs. Carnegie, a lady in Scotland,
w'ho ranked high among the benevolent, vaccinated with
lymph procured from the Broad Street Institution ; her patients
were exhausted, and she was at a loss for matter; previously
to sending for more, she thought proper to test with variola,
and found they resisted it ; she applied to me at Cheltenham
for vaccine lymph ; her practice was renewed, and after
going forward to a certain extent, she wrote to me at Chelten¬
ham to say she was fearful that her new set was not under
the same protection as the former, because no regular vesicle
followed the process ; for in the first instance it almost in¬
variably happened that small pustules with watery heads,
appeared on her patients : here, then, the vaccine matter
had undergone that deviation which brought it one step
nearer to small-pox.” A Mr. Read gave Dr. J. four cases
in one family of vaccine, modified by herpes ; and I have
somewhere in my readings found variola thus modified.
Mr. Hennen queries whether they have any, or what con¬
nexion with the reigning epidemic.” I think sufficient
authorities may be quoted to prove that simple contagions
VOL. XI. — NO. G6. 3 V

4,74

Original Communications.

may become compound, and affect with augmented malignity
the infected subject. Two very old Practitioners, from
inquiry made by me, as I was aware they had particular
opportunities, said, They had seen no cases of regular or
definable small-pox, after vaccination ; but that they had
seen anomalous diseases, which could only, in their minds,
be accounted for by the supposition of a mixture of conta¬
gious matter, and the state of seasons, when many diseases
had been epidemic, predisposing the human constitution in a
greater degree. In February, 1818, when I was on the banks
of the Wye, in the County of Hereford, in a climate celebrated
for its general salubriousness, mildness, and purity, typhus,
measles, and small-pox, were at once raging, in which the
two latter were topically exhibited, and terminated fatally in
more than one instance*. But the coincidence of contagions
may, I conceive, produce a very different constitutional
disorder from the coincidence of diseases. In my opinion,
all diseases of the same genera, as I have observed previously,
modify each other ; and to this principle we may attribute
the action of herpes, and other excrementitious eruptions of
that class on cow-pock, and even on variola in some instances :
it tends to mitigate malignancy in acute distempers, in others
to increase it. The illustrious discoverer of cow-pock makes
a very excellent remark upon contagious diseases acquiring
progressive increment of virulence, from concurrence of
different contagions. He says of small-pox, after appro¬
priating to it a mild origin, May it not be reasonably con¬
jectured, that incidental circumstances may have again and
again arisen, still working new changes upon it, until it has
acquired the contagious and malignant form, under w'hich we
commonly see it making its devastations among us And
from a consideration of the change which the infectious
matter undergoes from producing a disease in the cow, may
we not conceive, that many contagious diseases now pre¬
valent among us, may owe their present appearance not
to a simple, but to a compound origin ? For example, is it
difficult to imagine that the measles, the scarlet fever, and
the ulcerous sore throat, with a spotted skin, have all sprung
from the same sources, assuming some variety in their
forms, according to the nature of their new combinations ?
The same question will apply respecting the origin of many

* I am persuaded that there is a very common deception, when
there happens to be synchronous measles and smali-pox. The roseola
variolosa of Willan, and such appearances of erythema as are de¬
scribed in more than one of Mr. Hennen's cases, are mistaken for
coincidences.

475

Fosbrooke’s Remarks on k\iriola, S^c,

other contagious diseasesj which bear a strong analogy to
this.” I may also add to this theory of combinations,' that
some diseases may.be temporarily influenced by vicissitudes
of climate, difference of employment, and, consequently, of
temperament and susceptibility of the subject. Local causes
certainly produce decided variation in the action of diseases,
perhaps by the atmospheric communication, through the
medium of the lungs, {conjoined zoith personal habits: zohat a
conductor of disease is the skin!) The vaccine in London,
under Dr. Woodville’s practice, was attended with maturating
erysipelatous inflammation, very different from that of rural
situations. Mr. Russell’s cases of coincidence of measles

and small-pox, in the London Society, Vol. II. p. 9*2, show
that either of these diseases may succeed each other, without
operating any difference of quality. A mild distinct small¬
pox was often observed to follow the worst kind of measles,
and vice versa. Hoffman, in his Essay on Fevers, p. 130,
states, he had often seen the epidemic fever coincide in
the same patient with the small-pox.” He quotes the
malignant epidemics of 1740, 1, and 5, as observing a fatal
kind of smalj-pox, breaking out with the symptoms of such
malignant fever ; at the same time those who had no com¬
munion with the febrile patients, had a si^all-pox of the most
gentle kind. Thus Dr. Jenner: A family in the parish of
Berkeley, living in a small cottage, had typhus, the epidemic
of the day; the whole, consisting of five, had eruptions, the
appearance of which was midway between small-pox and*
chicken-pock. Mr. H. J. who attended them became
infected, and had the disease with great severity. In a
week eruptions began to appear on the face, and spread over
the body and limbs, possessing the same character.” Among
miscellaneous observations bearing some relation to the pre¬
sent subject, may be included the following. In Sydenham’s
Account of the Epidemic of 1()70, in which measles and
small-pox prevailed, The variolous pustules were of a
small round size.” Mr. Maurice has proved (Vol. IX.
Bradley,) that cow-pock and rubeola, though ‘coincident,

cannot be communicated bv inoculation. Dr. Percival

(Vol. V. Med. Observ. and Inquiries,) remarks, that in
particular seasons of the year, small-pox might be com¬
plicated with thrush, diarrhoea, gripes, and other divers
fevers, convulsions, &c. Grant on fevers (1779> Vol. 1 1,
p. 82,) says, describing variola, which is the course of
natural small-pox, so long as there is no other disease
complicated with it.” Wilson observes : “ During a con¬
tagious epidemic, almost every disease which appears is
sometimes more or less influenced by it.” Though the

476 Original Communications*

writer of the article small-pox (Rees’s Cyclop.) thinks that
the nature of the original contagion has no influence io
modifying the disease which it inflicts, and makes the causes
of severe small-pox idiosyncranous and personal, yet he
advises shunning the concurrence of other diseases.”

Such is a disease of which every Protean variety, like the
feigned chameleon, may elicit a medley of hypothesis, and I
should not have hazarded any ideas of ray own, if not involved
by a difference of opinion, resulting from a laborious research.
1 am aware that all hypothesis is of easy construction, and
of easy disintegration ; but we are much more inclined to
deceive ourselves, than rest in indecision ; and 1 am
aware, also, it may be said, that what is here advanced is
merely collateral ; but 1 repeat, that Dr. Thomson’s theory
must stand or fall, as accurate descriptions of the disease
in question, or connected diseases, tend to explain that there
is evidently a deficiency of circumstantial accounts, either of
modified or any similar epidemic to confirm or refute it
in toto. I think that the arguments, as well as facts, which
are urged against it, justify the observation, that identifying
diseases excited by different poisons, is a propensity of modern
ambition. 1 have witnessed one or two deplorable mishaps
from an abandonment to the new fangled paradox of
the non-existence of syphilis : it is the character of the pre¬
sent daring age, to overturn and transpose the doctrines
of former experience. 1 by no means, however, plead
guilty to an obstinate prejudice in favour of what 1 have
urged, or devote to it implicit faith : it will perhaps be
said, what consolation does it afford, that we have a new
and enigmatical contagious malady, not cognizable in the
nosology, and for the same reason so much further re¬
moved from any power of arrest, and which is almost
equal with that to which it is related ? But may we not
•infer that its existence is merely contingent? And if it cannot
be eliminated by any means, what a triumphant certainty
is afforded, that its energy is extenuated by vaccination to
a trifling indisposition, and that variolation affords so slight
a security, that any man of the meanest understanding,
or most vulgar infatuation, who would undertake to decide
from proofs, would have but one alternative. In the mean¬
while, I wish Mr. Hennen and Dr. Thomson still greater
success in their liberal inquiries, which, conducted without
too much bias to the exclusion of established opinions, will
ten,d still more to satisfactory discriminations and the establish¬
ment of important truths.

Two Cases of Morbid Dissection,

All

III.

Two Cases of Morbid Dissection,

[Communicated by Gordon Smith, M.D.]

Among a few scraps that have been preserved from the
wreck of many papers of some importance, I find two
memoranda of morbid dissections at which I was present
some years ago. The appearances, post mortem, are nearly
the whole of what I can communicate ; but if they are
deemed of sufficient importance to be put on record, they may
not be without their use. I would take advantage of this
opportunity to suggest, that notwithstanding the little ex¬
planation we can sometimes offer on points of morbid
anatomy, and the many obstacles in the way of making
draughts or preparations of parts extensively deranged, and
which come in the w^ay of every zealous Practitioner who
supplies (to the medical wwld) the failure of remedies by the
research of the scalpel, yet accurate verbal descriptions of
extraordinary appearances are of the very highest im¬
portance. I fear that many interesting articles of this
nature have been laid up in other Repositories than such as '
that for which I am now writing, from a mistaken notion
that they did not merit publication. Let diffident observers
of phenomena remind themselves that/hc^s are the founda¬
tion of improvement ; and the acquisition of one fact is of
more importance to science than the construction of a
hundred theories.

The authenticity of the subjoined statements does not rest
upon my simple testimony. The appearances described
were seen by Physicians of excellence and eminence; but
some of them being at present in distant countries, I have not
quote'd their names.

Case I. — In the summer of ISIS, at Santarem, in Portugal,

I had an opportunity of seeing a soldier"^ who had been long
labouring under chronic dysentery, and whose death was
preceded by frequent attacks of vomiting, which, for the last
day or two, amounted to copious pouring out of faeculent
fluid. This horrible symptom, which appeared to supersede
all the others, was excited by the slightest bodily movement,
but more particularly by any attempt to swallow. No relief
whatever could be afforded. According to custom the body
w'as opened after death, and I happened to be present at the
dissection. The contents of the abdomen were completely
hid by a dark coloured membranous-looking body that pre-

In the British General Hospital.

478-

Original Commiinicatiom,

sented itself to view, and whieh was found to be the stotnacii
in this state of extension, apparently carried as far as the
containing parts of the abdominal cavity would admit. It
descended into the cavity of the pelvis, and pushed the
diaphragm considerably upwards on the left side. It con¬
tained a' great quantity of such fluid as had been vomited by
the unfortunate patient before his death,

I am not able to state that a rupture in the Dalvula coli was
discovered ; but I think there can be no unwarrantable stretch
of hypothesis in concluding that this must have existed.

Case II, — The following summer I w'^as appointed to
assist Dr. S. in assuming the duties of the General Hospital
for French prisoners at Lisboiij which had been under the
management of some Portuguese medical gentlemen. Among
a few English patients we found a person employed in the
Commissariat,, who, according to the account redeived, had
long laboured under dysentery. His principal, and, indeed,
only known disorder now v/as hypochondriacism, in w^hich he
was sunk so low, that w^e could not get a single word from
him, although his sensibility seemed little, if at all impaired.
The medical attendants turned down the bed-clothes, and
showed us a remarkable elevation in the centre of the abdo¬
men, the appearance of which was as if the parietes were (as
he lay continually on his back) stretched over a globe of con¬
siderable size. This, according to account, had suddenly
appeared one night about six weeks before. The patient was
evidently in the last stage of existence, and died in a day or.
two afterwards.

The dissection was made under disadvantageous circum^
stances, and the‘re may be some particulars that I have now for¬
gotten ; but this tumor was occasioned by the urinary bladder,
which we found enormously enlarged, without rupture or any
remarkable thickening of the coats.

IV,

Animad'Oersions on Medical ISlomenclature, and a nezo one pro¬
posed, By T. Parkinson, M.D., Author of Synopsis
Zoo-Nosologiae, and Teacher of Medical Science ia
London.

[Continued from page 373.]

2. Physiological ISomenclature,

The Physiological Nomenclature consists of such techni¬
cal terms as represent the offlcial capacities and modes of
function, of abstract solids, and fluids, and in their various
associations and configurations, but limited to health ; and

Parkinson on Medical Nomenclature,

479

u perspicuous view of physiology will be afforded by running
the Physiological Nomenclature in parallel lines with that of
anatomy.

1. Physiology of abstract solids.

1. Mycleuthytona synesthesis, cruv aicrOntrig. This is the
general physiology of the nervous system ; but it is divided
into two genera : —

1. Mycleuthytona haemeuthytodes, aesthesis, aia-^no-ig, per¬
ception ; the function is limited to the immediate organs of
sense, and the brain within the head, and consists of sensa¬
tion and motion. It is a compound function, arising out of
the association of two abstract solids, the function of one
of which is sensation only, and that of the other motion only,
and such an association is essential to the physiological
product, aesthesis, or perception.

2. Mycleuthytona enyphantodes, sesthephoresis, cacrQna-ig
ipo^eco, the carriers of perception ; the function is limited to
the nervous cords, and the function arises out of the organi¬
zation. The nervous cord, as before stated, is not a per¬
ceiving organ, it is merely a conveyor of the perceptions
obtained by the organs of sense to the dDrain, that such
perceptions may be elaborated into mind, and also the carrier
of volition to the other solids which are acknowledged to
inherit the eapability of obeying the commands of the brain
to all the genera of solids, but most obvious in the moving
solid, haemeuthytona, or the muscular solid, by whose actions
the judgments or the volitions of men are manifested, that
is to say, not what a man wishes to be done, but what he
doeth, declares his volition or Tiis mind. But it is not to
the solids which are destined to perform voluntary actions
only that aesthephonesis is applicable ; it attaches to all living
animal functions — to all those which are not at all influenced
by the will — every solid in the whole animal system, so long
as it possesses life, must be supplied with all the attributes
of life, that is, with sensibility, circulation, motion, and
caloric, in order to preserve life, and to perform their
respective functions. Examples are as numerous as the
genera of solids. Membrane, though not acting in obedience
to volition, has obviouslv the whole of the attributes of life
within its own sphere, otherwise it would cease to be a living
substance, and would of course be, and act as an extraneous
material — not only so, membranes are secreting organs,
and without the exercise of all the attributes of life, secretion
could not be produced by them. Again, the muscles of the
heart are in perpetual action without the influence of the
will; but this subject will be more fully illustrated hereafter;
suffice it for the present to say, that all parts of the body

480

Original Communications,

are supplied with nerves, therefore action, whether voluntary
or involuntary, is necessarily attributed to each of them. I
do not mean to say that muscular action, kinesis, is inherent
in membrane ; I deny it; circulation and caloric are ^essential
to its life and function, though the moving power does not
reside in it. It contains arteries, veins, nerves, &c., and
all that is wanted to fill up the integrity of life is kinesis,
direct or positive action, and that is derived from the left
ventricle of the heart ; apokinesis from the tubulated elastic
fibre, helasmata siphonodes ; and caloric is the product of
these functions. But it is time to proceed to the next class.

S. H^meuthytona kinesis, jiivsco, to move ; kinesis, direct or
positive action, is the only function haemeuthytona possesses ;
it is not capable of apokinesis or reaction ; hence the necessity
and almost universality of antagonist muscles, action and rest,
function, and absence of it, are all that can be discovered in
the capability of muscle ; and it will, it must remain at rest
till called into action through the influence of the brain
transmitted by the nerves.

Haemeuthytona is divided into two genera, and conse¬
quently two distinguished modes of function,

1. H^meuthytona stereoses. Kinesis,

2. Hsemeuthytona antrodes. Antrokinesis.

3. Helasmata apokinesis, utto klveci}. The only capability
ascribable to this abstract solid is reaction, or a return to its
place of rest, after having been displaced by some foreign
impulse. It does not possess the capability of performing
kinesis.

It is necessarily divided into three genera, and consequently
three distinguishable modes of function.

1. Helasmata stereoses. Apokiiies.

2. Helasmata siphonodes. Siphapokinesis.

3. Helasmata siphogyrodes. Eccrisis.

4. Enyphanta parenthesis, Tra^EvliOniAi, The only capability
ascribed to this abstract solid, is that of interposing between
one thing and another, to keep them distinct or separate.

It does not possess the power of kinesis, or of apokinesis,
as an abstract solid : but it is necessarily divided into ten
genera, and consequently ten distinguishable modes of
function.

1. Enyphanta platinodes. Parenthesis,

2. Enyphanta siphonodes. Siphoparenthesis.

3. Enyphanta haemeuthytodes. Parenthisystolesis.

4. Enyphanta collodes. Diastolesis.

5. Enyphanta siplocollodes. Siphodiastolesis,

6. Enyphanta coniodes. Acamptosis.

Parkinson o?i Medical Nomenclature,

481

7» Enyphanta siphoconiodes. Siphacamptosis.

8. Enyphanta helasmatodes. Parenthapokinesis.

9. Enyphanta steatodes. Morphosis.

10. Enyphanta siphogyrodes. Eccrisis.

Now the functions of these genera of enyphanta arise
out of, and are the inevitable consequences of their associa¬
tions, and of the forms imposed upon them.

The first genus has no associate ; its form is broad, or
simply extended ; it has, therefore, only a simple function,
that of interposing between one solid and another solid.
Parenthesis.

‘ The second genus has no associate ; but the form or shape
it assumes entitles it to a distinct appellation, declaratory of
its genus, consequently of its function also. Siphoparenthesis,
(Ti(pov7ra^£v9y]o-ig, interposing between solids and fluids; and
it appears to me not to possess any other faculty.

The third genus is clearly an association of one abstract
solid with another abstract solid ; consequently it possesses
a compound function, the inevitable consequence of such
association. The association is manifestly membrane with
muscular fibres ; accordingly the compound function is denoted
by parenthisystolesis, interposition and constriction, Tra^evSscngf
insertion, and a-vnycho), to contract.

The fourth genus is an association of membrane with albu¬
men, enyphanta collodes : its function is to keep parts at
proper distances, diastolesis, haroM) dilatation or distinction.

The fifth genus is similar to the fourth, excepting in form,
on which account its function is so different as to constitute
it a distinct genus, enyphanta siphocollodes, membrane
associated with albumen tubulated : its function is to keep
tubes perpetually open, siphodiastolesis, aicjiovj a tube, ^iccroy,yi,
dilatation.

The sixth genus is an association of membrane with
phosphate of lime, enyphanta coniodes : its function is
inflexibility, acamptosis, ana/ATrlo;, inflexible.

The seventh genus differs from the sixth only in form,
being tubulated : its function is that of inflexibility in tubu¬
lated bones, siphacamptosis, a-npov, a tube, anai/^Tflog, inflexible.

The eighth genus is an association of membrane with
elastic fibre, enyphanta helasmatodes ; its physiology arises
out of the association, namely, interposition and reaction,
parenthapokinesis, Tra^svSecng, interposition, aTTomvsco, to react.

The ninth genus is an association of membrane with fat,
enyphanta steatodes : its function is chiefly that of giving
form or beauty to the fabric, morphosis, fxo^(poco^ to shape.

The tenth genus is a peculiar form or shape of membrane,

VOL. XI. — NO. 66. So

4S2

Original Communications,

enyphanta slphogyrodes : its function is secretion, eccrisis,
mK^ivci), to secrete.

It remains now only to show the physiology of the fluids ;
having done that, we shall have completed the Phy^siological
Nomenclature.

It will, I trust, be thought sufficiently explicit, if the
Physiological Nomenclature be made to run parallel with
that of anatomy, and at the same time giving the exact
meaning of the physiological terms : —

I. Haema, stereotrophisis, solid, nourishment;

nourishment of solids.

Haematodes, haBmathemeleosis, blood, 0£fjt,EXico(rig^

foundation ; the basis of haema.

3. Diaphanodes, haemaleptosis, ai/jLcCf blood, to

attenuate; the dilution and vehicle of blood.

4. Galatodes, haematrophisis, ouf/,a, blood, nourish¬
ment; the nourishment of haema. ^

5. Urodes, akrestophoresis, ctx^nrog, useless, f to carry ;
carrier away of useless things.

6. Cholodes, pepsis, digestion.

7. Spermatodes, paraphusis, Tra^acpva-ig^ propagation.

8. Ophthalmodes, diastolesis, haroM, dilatation ; to keep
parts of the eye at proper distances.

9. Coprodes, akrestophoresis, noxious things,

to carry ; carrier away of noxious things.

10. Hydatodes, hygrosis, vy^aivo), to moisten ; moistening.

II. Blenodes, blennosis ; lubrication.

By a careful look over the Anatomical and Physiological
Nomenclature as I have arranged them, it will be seen that
they are in exact concordance with each other ; that the
physiology arises as an inevitable consequence of organiza¬
tion ; and that, of course, the laws which govern the economy
of health must be inflexible and immutable.

It may be urged, that the terms at present in use have
been long employed, and are well understood ; the latter,
however, must be denied, and be laid sufficiently open to
animadversion and ridicule, if it should be deemed necessary.
Every branch of natural science is rendered more easy of
being taught, and is the more systematical in proportion as
the Nomenclature is determinate and condensed.

A popular cry will probably be raised against any form of
nomenclature, hov/ever simple and appropriate it be in its
nature; and it will be stigmatized with the greatest acrimony,
by those who will not condescend to revert to elementary

Parkinson on Medical Nomenclature.

483

studies ; they will deem it an innovation, and strive to hunt
it down : but such treatment will not serve them as a pro¬
tection against the imputation of ignorance and idleness ; nor
will it loosen the attachment of those who have examined for
themselves, and have declared themselves favourable to the
Nomenclature 1 have proposed.

It will probably be deemed difficult to be understood, and
on that account be objected to; but this objection is removed
by an impartial examination of it; for it will be found very
easy to be understood, and that it cannot be misunderstood;
whilst all those Nomenclatures which have preceded it are
not capable of being understood. Moreover, the present
Nomenclature is true to itself, in all the departments of
medical science.

The technical terms in anatomy and physiology being
understood, those in nosology and therapeutics cannot be
mistaken, because their radicals are the same; the anatomical
governing the appellations for the identities of diseases, and
the physiological the appellations for the evidences by which
they are distinguished, and for the indications of treatment.

I'he example has been the Chemical Nomenclature,

It has been already promulgated among so many who are
competent to decide on its merits, and who will ably advocate
it, that I feel persuaded there remains little more for me to
do than to commence, and steadily persevere in, my intended
lectures on zoo-nosologia, or on the elements of medical
science ; and of this I shall publicly give early notice.

I now proceed to the Nosological Nomenclature.

Part II. Nosological Nomenclature.

The nomenclature of nosology is divided into two parts,
the first from the anatomical tables representing the identities
of diseases ; the latter from the physiological tables, repre¬
senting the symptoms by which diseases are distinguished.

The technical terms used in the first, or the anatomico-
nosological nomenclature are called cletics, from KMcru^y a
denomination or a proper name fora disease; those in the
second, or the physio-nosological nomenclature, are called
phanerics, from (pavEpoco, to make manliest.

Were the merits of the proposed Nosological Nomencla¬
ture to rest alone on the certainty with which it separates
idiopathic from symptomatic affections, it would be worthy of
adoption. But it does much more, it raises the image of each
individual disease, to which the human frame is liable, in the
minds of those who understand the meanings of the terms, by
which they are respectively denoted.

484 Original Communications.

I would ask, How is it possible to prevent misconception
and confusion in teaching medical science from any of the
present Nomenclaturee, which include in one confused jumble
idiopathic diseases and mere symptoms .without distinction ?

For example, Cullen’s adipsia, agheustia, anaphrodisia,
anorexia, anosmia, apoplexia, asthma, atrophy, bulima, catar-
rhus, chlorosis, cholera, chorea,- continum febres, contractura,
convulsio, cynanche, and more than fifty other technical terms
for diseases, have not the most distant reference to their

identities. Those which I have ahead v mentioned are all

•/

symptomatic only, or the evidences by which diseases are
known. Adipsia, agheustia, and so on, including anosmia,
are not diseases ; they are symptomatic of a diseased state of
some certain definable part, and the consequent disturbance
of its function. Apoplexia, aTTOTTMa-a-oi, to knock down ; now
what reference does the term apoplexy bear to ihe intrinsic
quality of the disease ? God forbid that knocking down
should always and necessarily comprehend those derangements
of the brain which the term apoplexy is intended to denote,
but which it in no measure expresses. But the proper ques¬
tion to be answered is. What is the identity- of the disease
usually called apoplexy ? Not knocking down surely. It is
ansestliesis encephalica, or impaired function of the brain
within the head, a resulting consequence of one or another
of those genera w^hich are found under the second class of
diseases ; and, let me add, it cannot have existence otherwise.
It is referred, therefore, to the fourth class of diseases, when
the defunction of the brain continues after the parent of it has
ceased to be. But while the cause remains, and the form of
that cause is understood, it is properly placed under the
second class.

' The genera of the second class are: —

1. Merotome, division, or partial division.

2. Ectopesis, displacement, or partial displacement,

3. Platynesis, distention, or over action.

Now the cletic term for the disease called apoplexy, when
it is known to be the consequence of a division of the brain by
violence, must be merotome encephalica, such being the iden¬
tity of the disease ; but the phaneric tertn must be ansesthe-
sis encephalica, such term comprehending the symptoms by
which division of the brain is distinguished.

The cletic term for apoplexy, when it is attributed to pres¬
sure upon the brain, either from a depression of the skull, or
from extravasated blood within the head, or from efiusioo,
or, indeed, from whatever cause adventitious pressure is pro¬
duced, must be ectopesis encephalica; because a portion of

Parkinson on Medical Nomenclature.

485

the brain is displaced by that pressure, and is rendered unable
to perform its natural function. But the phaneric term must
remain anaesthesis encephalica, such term comprehending the
symptoms by which pressure on the brain is discovered and
distinguished.

The cletic term for apoplexy, when it is attributed to too
strong or too sudden exercise of the brain, as sudden and
great excitements of the mind, intense study, excruciating
pain, and whatever is capable of exciting the brain beyond
the limits of health, as opium, wine, alcohol, &c. leaving the
brain partly exhausted by excessive excitement, must be
platynesis encephalica, such being identically the disease.
But the phaneric term must remain anaesthesis encephalica,
such term comprehending the symptoms by which exhaustion
is known to exist. 1 have dwelt at some length on the dis¬
ease, called apoplexia, by Dr. Cullen, to show that it is merely
symptomatic according to his term ; and, that, being an
idiopathic disease, it demands a cletic appellation, declaratory
of its identity.

I would ask. What is to be understood by Cullen’s term
epilepsia, from ETrtXafxQavco, to seize upon suddenly?

Does it refer to the identity of an idiopathic disease, disor¬
dered state of the brain, productive of, and known by a tem¬
porary dereliction of function, or temporary anaesthesis ence-
phaliea ? Epilepsy’^ differs from apoplexy only in intensity and
duration ; they are different types of the same identical affec¬
tion, the former transitory and intermittent \ the latter per¬
manent and progressive.

I have chosen apoplexia and epilepsia of Cullen, for no
other reason than because they first present themselves in the
alphabetieal arrangement of his technical terms, to evince
that they are instanees of the terms denoting symptoms in¬
stead of identities ; and to prove that they are not the only
instances, I shall take the liberty of bringing to light others
equally palpable.

Asthma, atrophia, bulimia, before mentioned; and were I to
enumerate all the terms he has appointed, 1 should not fail to
make manifest the accomplishment of the first object 1 had in
view, that of distinguishing between identical diseases, and
their symptoms, or those evidences by which their real cha¬
racters are to be known.

I am sorry to have trespassed so long upon the reader’s time
and patience ; but I deemed it highly necessary ; and, even now',
cannot reconcile to myself the neglect of going through the
remainder of the terms adopted by Dr. Cullen, to represent
identical diseases; but which, in truth, only denote the symp¬
toms by wEich they are detected.

Original Communications,

Caligo, caligo darkness,
Catarrhus,

Chlorosis,

Cholera,

Colica,

Continuae febres,
Contractura,

Convulsio,

Diabetes,

Diarrhoea,

Dysenteria,

Dyseccea,

Dysorexia,

Dyspepsia,

Dyspnoea,

Dysphagia,

Dysuria,

Dyspermatismus,

Ecchymoma,

Elephantiasis,

Ephidrosis,

Epiphora,

Erysipelas,

Ganglion,

Gonorrhoea,

Haemoptysis,

Haemorrhagia,

Hectica,

Hsemorrhois,

Hernia,

Herpes,

Hydarthrus,

Hydatis,

Hydrocele,

Hydrocephalus,

Hydrometra,

Hydrophobia,

Hydrothorax,

Hypocondriasis,

Hysteria,

Hysteritis,

Icterus,

Intermittentes,

Ischuria,

Lepra,

Luxatio,

Mania,

Melancholia,

Menorrhagia,

Miliaria,

Anaesthesis Oplith.

Parenthitis mycter.

Aparenthisystolesis gon.

Eccrisitis enteron.

Parenthisystolitis enter.

Proscollesis.

iEsthephoritis.

Eccrisitis.

Parenthisvstolitis enter.
Parenthisystolitis enter.

Anaesthesis oton.

Aparenthisystolesis ent.
Aparenthisystolesis ent.
Aparenthapokinesis thor.

Akinesis oesoph.

Siphoparenthitis gon. 1
Aneccrisis gon.

Symptomatic of merotome.

Parenthitis exot eleph. ^

Eccrisitis ophth.

Parenthitis exot.

A parenthesis exot.

Eccrisitis gon.

Parenthapokinitis thor.

Symptomatic of merotome.
Symptomatic local inflammatio spher.
Symptomatic of merotome.

Ectopesis.

Parenthitis exot.

Aparenthesi§ exot.

Aparenthesis.

Aparenthesis gon.

Aparenthesis encep.

Aparenthesis gon.

Ai,sthephoritis canin.

Aparenthesis thorac.
Aparenthisystolesis enter.
Parenthisystolitis gon.

Parenthisystolitis gon.

Symptomatic of biliary obstruction.
Symptomatic of inflammatio ditfus.
Symptomatic of obstruction of the urine.
Parenthitis lepros.

Ectopesis.
xEsthesitis enceph.

Anassthesis enceph.

Parenthisystolitis gon.

Parenthitis miliiar.

Parkinson on Medical Nomenclature,

487

Nymphomania,

Obstipatio,

Odontalgia,

Oneirodynia,

Palpitatio,

Paralysis,

Pemphigus,

Pertussis,

Pestica,

Pneumatosis,

Pneumonia,

Podagra,

Prolapsus,

Psora,

Ptyalismus,

Pyrexise,

Pyrosis,

Quartana,

Quotidiana,

Rachitis,

Raphania,

Rheumatismus,

Rubeola,

Satyriasis,

Scarlatina,

Scirrhus,

Scorbutus,

Scrophula,

Syncope,

Synocha,

Synochus,

Syphilis,

Tertiana,

Tetanus,

Tinea,

Trichoma,

Trismus,

Tympanitis,

Typhus,

Ulcus,

Urticaria,

Variola,

Varicella,

Varix,

Verruca,

Vulnus,

^sthephoritis gon.
Aparenthisystolesis ent.
Acamptositis stomat,
Anantrokinesis.

Antrokinesitis.

Akinesis.

Parenthitis exot.

Parenthapokinitis thorac.
Parenthitis pestic.

Aparenthesis.

Apurenthapokinesis.

Parenthitis exot.

Ectopesis.

Parenthitis psor.

Eccrisilis stom.

Symptomatic of local inflammation.
Parenthitis oesoph.

Symptomatic of inflammatio diflfus.
Symptomatic of inflammatio ditfus.
Acamptositis exot.

Symptomatic of local inflammation.
Kinesitis.

Parenthitis rubeol.

-(Esthephoritis gon.

Parenthitis scarlat.

Symphylakesis.

Parenthitis.

Phylakesis.

Anantrokinesis.

Symptomatic of inflammatio spher.
Symptomatic of inflammatio corap.
Parenthitis syphil.

Symptomatic of inflammatio diff.
iEsthephoritis exot.

Parenthitis tineos.

Parenthitis trie.

Eisthephoritis exot.

Aparenthesis enter.

Symptomatic of inflammatio diffus.
Merotome.

Parenthitis urtic.

Parenthitis yariol,

Parenthitis varic.
Asiphoparenthesis.

Metamorphosis.

Merotome,

There are yet some other terms used in Cullen’s Nosology
which require our notice, and which ought to be expelled
from Nosological Nomenclature.

488 ^ Original Communications.

Amaurosis, ai^au^oco, to darken ; indeterminate altogether :
the proper appellation for this disease is anaesthesis ophthal-
mica, or the cletic platynesis myeleuthica hsemeuthytodes
ophthalmica.

Anasarca, ava. amongst the flesh. Is this indicative

of anjr idiopathic disease? What the term is intended to re¬
present is C. prokeosis, P. aparenthesis.

Aneurisma, avsv^vycoj to dilate much ; indeterminate : C. pla¬
tynesis helasmica siphonodes, P. asiphapokinesis.

Aphtha, awlcoj to inflame. C. enyphantitis platynodes sto-
matica, P. parenthitis stomatica.

Ascites, acTHog, a bottle ; ridiculous. C. prokeusis entero-
nica, P. aparenthesis enteronica.

Cancer, a crabfish. C. symphylakesis.

Caries, to abrade. C. merotome enyphantica coni-

odes, P. acamptitis.

Carditis, cystitis, enteritis, gastritis, hepatiti^s, hysteritis,
nephritis, peritonitis, phrenitis, and splenitis are to denote
what they are intended to do; but, they are objected to be¬
cause they do not raise in the mind either the anatomical con¬
struction of the part inflamed, or the derangement of function.
The heart is a muscle; its function is antrokinesis, excess of
its function then is P. antrokinitis, C. hsemeuthitis antrodes,
cystitis, enteritis, gastritis, and hysteritis are all associations of
membrane with muscle, whose function is parenthisystolesis,
consequently the excess of function must be P. parenthisys-
tolitis, C. enyphantitis haemeuthytodes.

Hepatitis is inflammation of a venous gland, whose func¬
tion is eccrisis; consequently excess of function will be P.
eccrisitis, C. enyphantitis siphogyrodes.

Nephritis and splenitis, inflammation of arterious glands,
whose functions are eccrisis in excess, P. eccrisitis, C. helas-
mitis siphogyrodes.

Peritonitis, phrenitis, pleuritis, are inflammation of mem¬
branes, whose functions are parenthesis, in excess P. paren¬
thitis, C. enyphantitis platynodes.

I shall conclude by observing, that this Nomenclatura
Medica agrees with itself in every department of the science.
It gives wonderful facility to study, as well as fixes solid and
just principles; and it affords rules of syntax, exhibiting the
concord of the classes, genera, orders, species, varieties,
and types of diseases, in a climax of harmonious medical
language.

Gray on Indigenous Plants. -489

DEPARTMENT OF NATURAL HISTORY', &c.

Pnumeration of those Indigenous Plants zehich have an Pmetic

Effect. By Mr. Gray.

Of the several medicines, advised by the London College
of Physicians to be kept in the shops of that city, and
its neighbourhood, as being in common use amongst their
members, there are no less than four which are frequently
employed as emetics, namely, emetic tartar, white vitriol,
ipecacuanha, and oxymel of squills. It may therefore seem
to some superfluous to recall to the memory of Practitioners,
the existence of others which grow wild in England, and,
although now neglected by most regular Practitioners, have
been, and still are by some employed as emetics in the cure
of diseases.

Those, however, who pay attention to the secondary and
even third actions of medicines, after the cessation of tlieir
primary effect, must know that those whose primary actions
are the same frequently vary in other respects. Thus in the
class of medicines now under consideration, what Practitioner
is not aware of the difference between the after-actions of
tartar emetic and ipecacuanha, so that although when the
simple evacuation of the , Bents of the stomach is the sole
object in view, it is inctcp^^ent which of these medicines is
employed ; yet in other cases when a further and secondary
action is required, then each has its appropriate use, and
cannot be employed in the other’s place. JNow, as this
difference is well known in these two medicines, which are of
daily use at present, we have every reason to suppose that
every medicine has its peculiar, and in some respects specific
action; and hence the superiority of one Practitioner over
another, in point of medical practice, will depend very much
upon the greater number of medicines their superior reading
or experience will allow them to employ.

A real friend to the medical Profession sees, with regret,
many patients who have tried the routine of the ordinary
medicines in the College List, who afterwards apply to
persons educated in foreign countries, or hard students in
the old authors, and receive that relief which they could
not obtain from our simple hospital practice. And with still
greater regret he sees the majority of Practitioners, instead
of endeavouring to extend their knowledge of the materia
medica, and acquiring the mode of using the nostrums of
their occasionally more successful brethren, contenting them¬
selves Yvith the common shop medicines.

VOL. XI. - NO. 66. 3 11

490

Original Vommuiticaiions .

With a view to enable Practitioners, especially those in the
country, to increase the number of their resources, the follow¬
ing collective view of such emetic vegetables as grow wild in
England, or are usually cultivated in private gardens, has
been drawn up.

Although an infusion of three to six asarabacca leaves in
whey was the most common mild vomit before the introduc¬
tion of ipecacuanha, yet authors differ much in respect to the
other actions of this plant. Some say thirty to forty grains of
the powdered root excites violent vomiting: while others say
it works milder than the leaves. It would appear that
neither the root nor leaves ought to be given in substance,
but in infusion ; namely, one to two drams of the leaves, or
one to three drams of the root.

The roots of betony, betonica officinalis, are emetic, but
very violent, and must therefore be given in small doses.

The roots of horseradish, cochlearia armoraciaj are emetic,
especially the rind ; it may be given either in substance, or
still better in infusion, which should be made very strong ; it
is very serviceable in cases where the stomach is loaded with
thick phlegm, as being incisive. An infusion of the seeds is
also used for the same purpose.

The expressed juice of the root of common garden radishes,
given warm, is considered by some as a good emetic ; or a
strong infusion made by expres^)/*u of three drams of the
seed bruised.

The roots of asphodel lily and narcissus, have been used
as emetics.

The juice, or a decoction of groundsel, senecio

vulgaris, has been much used as an emetic; in doses of one
to two ounces : it acts violently, and is also vermifuge.

Although spinach is not itself emetic, our old botanical
writers recommend it as an adjuvant, as tending to facilitate
the action of emetics, by inducing a disposition to vomit, and
it may therefore be serviceable in a fev/ cases where it is
wished to empty the stomach with as little exertion as
possible.

The juice of wall-pepper, or stone-crop, sedum acre, is
strongly emetic, and has been used as such; it is also anti¬
scorbutic. A handful boiled in a pint of stale beer to an half,
and two or three ounces of the strained liquor drank warm,
fasting, was used with success in the Swedish army, in
scurvy. Its immediate action was emetic. The juice taken
with vinegar is used by some to cure obstinate agues.

The dried roots of primroses, primula veris, taken up; in
autumn, in doses of one dram and a half, operate as a strong,
but safe emetic; it is therefore probable, that it might be

Gray 07i Indigenous Plants. 49]

substituted for ipecacuanha, in the usual dose of that foreign
root.

The fresh root of bryony, or wild vine, bryonia dioica, in
doses of one dram, has been used in dropsical cases, as an
emetic and hydragogue cathartic ; also the expressed juice in
doses of two drams to half an ounce. With a view to render
its operation milder, the slices of the fresh root have been
infused in wine, and then dried.

Spurge olive, daphne mezereum, although an English plant,
is admitted a place in the pharmacopoeia. The berries
have been attempted to be used as an emetic ; but their
acrimony is so great, that they are to be regarded rather
as poisons than as potent but manageable remedies; twelve
grains produced almost immediate death : but spurge laurel,
daphne laureola, although not in the pharmacopoeia, is really
the plant which produces the twigs sold in the shops for
those of daphne mezereon ; that plant being very scarce,
and not to be found about London.

The leaves of buckbean, menyanthes trifoliata, in doses of
one dram, not only vomit, but also act as cathartics ; and the
seeds are also said to be emetic.

The emetic action of camomile flowers is too well known
to need any further notice, especially as they still continue a
shop medicine.

An infusion of a handful of water hemp agrimony, eupa-
torium cannabinum, vomits smartly, and, moreover, acts as a
purge ; as also a decoction of one ounce of the root.

the roots of herb Paris, or one berry, Paris quadrifolia,
are said to act very similarly to those of ipecacuanha ; but they
must be given in a larger dose.

An infusion of broad leaved pepper-wort, lepidium latifo-
lium, is emetic.

The distilled water of less spear- wort, ranunculus flammula,
has the most instantaneous action of any emetic yet known,
operating the. moment it is swallowed, without exciting that
contraction in the upper part of the stomach which the
sulphas zinci sometimes occasions, and by which its afction is
defeated; the juice has been said to have the same effect;
but it seems too acrid to be given inteTnally. •

Besides the above, other plants common in England have
an emetic effect, as the dried inner rind of the walnut tree,
a decoction of ash keys, the seeds and bark of the elder tree.

From this recapitulation it appears that the country Prac¬
titioner has an ample resource, in case of his wishing to try
thel.effect of indigenous remedies, when the foreign or chemical
•ones fail.

492

Original Communications.

Calendar of Flora and Fauna, kept at Hartwell, hy Tunbridge

Wells, Sussex, by Dr. T. Forster, from the I5th of

April to the \ 5th of May, 1819, inclusive,

April 15th. — The Swallow {Hirundo rustica) first made
its appearance in the neighbourhood of Lingfield. The Tur¬
nip is now in full flower every where, and the Moorhen
(Fulica chloropus) is building. The seeds of Papaver somni~
ferum coming up, which were sown only a week ago. Vipers
and Snakes out a considerable time.

17th. — Cool showery weather, and westerly wind. The
Cowslip and Pagel every where in flower hereabouts. Pile-
wort still flowering abundantly, and Cardamine pratensis in
all the meadows.

18th. — Orchis mascula in flower under a hedge facing the
South. The Kidlock {Sinapis arvensis) plentifully in flower
in the corn-fields near Cowden and elsewhere. Specimens
appear here and there in marshy ground of the Agaricus glu-
tinosus,

19th. — A thorough rainy day. A few Swallows were
flying about at Hartfield. 1 had not seen this bird before since
the 15th,'^ and they are not common yet. Allium ursinum
in flower.

20th. — Rainy morning. Stitchwort (Stellaria Holostea)
in flower under the hedges between Hartfield and Withyham.

2lst. — Showery; but fair evening. Tussilago Farfara in
seed at Lankington Green.

22d. — Wind got to Northward, and cooler.

23d. — Rains in gentle showers, and cool. Ranunculus
hulbosus came into flower. Swallows as yet but few. ikfer-
curialis perennis in blow.

24th, — Rainy cold day. From a Correspondent I learn
that Thlapsi Bursa Fastoris^ Fritillaria Meleagris, Draba
muralis, and the Great Leopard’s Bane {Doronicum Farda--
Hunches) are in bloom at Walthamstow.

25th. — The Wryneck first heard at Hartwell; cold day.
The House Martin {Hirundo urbica) seen. Swallows be¬
come more frequent. Agaricus glutinosus still found in the
fields ; but the pileus of it is lighter coloured than that of the
same plant in autumn. The Tremelia mesenterica growing
on some sear trunks. ,

27th. — Clear cold day; wind easterly. JLy coper don Fpi~
dendrum found flourishing. The Nightingale {Sylvia JLusci-
nia) first heard singing, notwithstanding the coldness of the
night.

28tb. — Ranunculus acris iw flower here and there.

493

Calendar of Natural History.

oOth. — Ranunculus arvensis in bloom.

May 2d. — Warmer weather to-day, and a fine shower at
night; the Cirri and Waneclouds, which appeared all day and
yesterday, were a sure indication of a change. The Kidlock
or Charlock is still abundantly in llower every where*.

3d. — The C^noglossum, so remarkable for its brilliant
blue flowers, still in bloom t*

3th. — A line warm spring day, after a night of rain.
Schoenic/us arundinaceus observed. Swallows and Martlets
become common. Orchis Morio in flower.

6th. — The following plants nowin full flower: — Ranuncu¬
lus bulbosus, R, acrisy Fragaria sterilisj Erysimum ylUiariay
F eronica Charnccdrys^ V, serpyllifolia, V . agrestis, F. arvensis,
and V. hederifolia, Anthoxanthum odoratum. F aleriana dioica,
and V, Locusta, Phleum pratense. Alopecurus pratensis, Briza
major, Poa annua, P. trivialis, and P. pratensis. Galium cru-
ciatum, Alchemitla arvensis^ Sagina erecta, Myosotis arvensis,
M. versicolor, and M. umbrata. Borago officinalis, Primula
elatior, and P. veils. Anagallis arvensis, B iola tricolor, and
F. Tonbrigensis (supposed a variety), Sanicula Europcca,
Caucalis Anthriscus, Scandix Pecten Feneris, Fiburnum Lan-
tana, Narcissus bijiorus, Allium ursinum, Scilla campanulata,
Faccinium Myrlillus, Acer Pseudoplatanus, and A. carnpes-
tris. Chrysosplenium alternifolium (wild), Arenaria trinervia.
Lychnis dioica purpurea, and L. dioica alba, Cerastium vulga-
tum, Euphorbia amygdaloides, Mespilus Oxyacantha, Pyrus
Malus, and P. Aria. Adonis autumnalis{m T. F. F'orster’s
garden); Ranunculus auricornus in the corn fields.

12. — The Charlock {Raphanns Raphanistrum) ; also
Sinapis nigra. The S. arvensis still abounds.

The weather continues warm and still, and the foliage

* This plant {Sinapis arvensis) should be carefully distinguished
from the other, called also Charlock, viz. Raphamis Raphanistrum,
which much resembles it; but which in this district is not near so
common. The former is a noxious and irradicable weed in corn ;
and its seeds, when deeply buried by ploughing, work their way by
degrees up to the surface, and grow again. This circumstance,
which is common to many plants, leads us to inquire by what means
seeds possess this ascending power, when buried, of regaining the
surface of the earth?

t There are three plants in our gardens noted for the brilliancy of
their light blue flowers. The Cynoglossum is the purest fine ultra¬
marine colour; the Veronica chamaedrys has a very slight lint of the
red in its composition; and the Anchusa sempervirens (the third I
allude to) has a tind of greenish. The blue of the Cynoglossum being
the only perfect blue.

494

Original Communications*

advances. There is every appearance of spring. The banks
are covered with Viola canina^ and the fields here gilded with
Ranunculi j there blue with Scilla nutans.

T. FORSTER.

Journal is to be continued in the neighbourhood of
Tunbridge Wells. 1

PART IT.

ANALYTICAL REVIEW.

Treatises on Epidemic Fever. ^

(Concluded from page 401.)

It will be recollected, that the chain of our critical disquisi¬
tion on this topic was broken by our.limits just at the point
in which inferences were made against the absolute necessity
of inflammation in levers, from the occasional post mortem
appearances, as faithfully delineated by Dr. Percival. This
able author cominences the fifth section of his work by the
following remarks on the pathology of the febrile state,
remarks which 'We have great pleasure in quoting, since they
entirely accord with our own sentiments on the subject ; and
it is impossible that the positions they are designed to
establish could be put into more concentrated or more com¬
prehensive language.

The science of disease is hardly yet sufficiently advanced to com¬
pass the pathology of fever. Much collective light has been thrown
upon it by the humoral theories of the older writers ; the vascular
spasm of Hoffman ; the doctrine of morbid associations by Darwin ;
of local inflammation by PloucqueP; and of morbid temperature by
Currie. That the labours of these, and of other distinguished men,
have furnished many solid and some highly wrought materials for the
structure of febrile pathology, cannot be questioned; nor will the
Physician, who is at all versed in the difficulties of the task, refuse the
tribute of his admiration to each of these scientific artists. Yet to
select, assemble, and give cohesion to the valuable parts of their several
Tabrics; to supply radical deficiencies; and render the whole con-

* We are not pleased to see so studied an omission of even the
name of Clutterbuck, by Dr. Percival ; and we are sick of that kind
of cant which would deprive ingenuity of its due award, because there
have happened to be priorities or coincidences in the statement of
opinions.

Treatises on Epidemic Fever. 495

sistent and symmetrical, may demand still higher powers of scientific
genius.

What has hitherto retarded the advancement of this work, has
been not so much a propensity to generalize, which belongs to all
philosophic minds, as an eagerness to abandon old doctrines, when¬
ever new ones have been projected, and to rely too exclusively upon
each, for a solution of all the various phenomena of fever. 1 hus the
humoral pathologists slighted the Hippocratic doctrine concerning
morbid temperature ; and, in turn, the humoral theory, though preg¬
nant with the most important doctrines of the econom^^ of secretion,
was rejected for neurological hypotheses of debility and spasm.
Organic disease was thus in a great measure overlooked ; until the
doctrines of morbid heat, of local congestion or inflammation, again
brought this important feature into notice. But there is now danger,
lest, in discarding the cycles and the epicycles of fever, delineated by
Cullen or Darwin, the doctrines cf morbid catenation, or associate actions
of disease, will be at the same time fatally overlooked.^'

Dr. Percival then goes on to develop, with the same
masterly precision, the connexion of sensorial disturbance
with vascular irregularity, as occurring in different grades and
proportions, under the various circumstances of fever, and
concludes by observing : —

“ That genuine acute inflammation does not always, or perhaps
even in the majority of cases, attend typhus, (as it has appeared epi¬
demically in these islands,) may, I think, be fairly maintained. Yet,
in most of the worst cases, and, by consequence, in most of those
which come under posthumous examination, there are unequivocal
evidences of genuine inflammation, accompanied with those appear¬
ances of venous congestion, which frequently distinguisli these dis¬
eases from the proper phlegmasiie."

Our author then adverts to the disordered condition of the
secerning and secreting organs in fever; alluding to the
circumstance of febrile heat as having hitherto been but
imperfectly explained,” since under apparently similar
circumstances of respiration and circulation, the temperature
of the body is found to vary considerably,’^ he suggests
whether the disturbed balance or economy of the secerning
organs does not require to be taken more into consideration
than has hitherto been done, in reference to this particular.'
There cannot be a doubt that the ' pulmonary theory of
animal heat, if we may so name it, leaves unexplained several
points connected with fever heat, which would certainly
seem to have more connexion with the peculiar actions going
on in the body under this state of morbid being, than with
the respiratory process. Breathing a condensed and oxy¬
genated air, which would add to the quantity of sensible
heat in a healthy subject, every thing besides being favour-

496

Analytical Review.

able, will often serve to diminish the temperature of fever,
by abating the virulence of the disorder, or by reducing
morbid excitement.

Dr. Percival concludes this section of his treatise by
referring his readers to Dr. Cheyne’s comparative tables
of pulse, respiration, and temperature, in his last clinical
report from the Hardwick Hospital.

At the commencement of the last chapter, which com¬
prehends the curative treatment of typhous fever/’ our
author alludes to those sceptical notions which slight the
comparative pretensions of dissimilar modes of management ;
and in reply to those statements, which are grounded upon
such scepticism, he remarks, it has appeared from the bills
of mortality, that in places where this disease has been
suffered to commit its ravages with little or no control
from medical treatment, one-fourth, and even_ one-third of
those afflicted by it have died ; whereas, the registers of
different fever hospitals show, that under due remedial
management, one-tenth, and sometimes one-twentieth only
of the cases terminate fatally.” Dr. Percival then goes on to
compliment Sydenham as the founder of correct principles
of treatment in the fevers of this country, and concludes by
stating the result of his own observations and experience, with a
very brief abstract of which we shall conclude what we have to
say on the present interesting little volume. The first point
to be attended to is a plentiful supply of cool and fresh air.
The next is suitable evacuation, and primarily that of blood¬
letting, “ the safest and best period for which is undoubtedly at
the commencement of the disease.” This remedy is espe¬
cially called for when bronchial irritation is present, “ w’hen
cough is suppressed, and mucous secretion suspended*,”
and it must be repeated till the dyspnoea is relieved, and
mucous secretion restored. Such inflammatory state of the
pulmonary organs must, however, be carefully discriminated
from that in which hurried circulation, with great debility, are
the true causes of scanty and oppressed respiration.” T his
pseudo-peripneumony may be distinguished from inflam¬
matory irritation, (when the case is doubtful) by respiration
being accompanied by a certain degree of elevation in the
chest, as well as depression of the diaphragm, and by the

^ These symptoms are exceedingly frequent accompaniments of
fever, especially at the vernal season. By the kindness of Dr. Arm¬
strong, we were yesterday allowed to go through his wards of the
London Fever Institution; and we remarked that pulmonary and
bronchial affections were very general in that atlmirably conducted
establishment. — Rev.

Treatises on Epidemic Fever, 497

patient being able to take a slow and full inspiration, without
inducing cough or pain. In the cephalic form of typhus/’
bleeding is often called for, but the benefit derived from it
has appeared considerably more precarious than in the
pneumonic species.” Leeches, or opening the temporal
artery, are occasionally requisite ; but assiduously sponging
the shaven scalp with cold vinegar, or moistening it with
ether, at the same time fomenting the patient’s legs for
several successive hours, has proved in general less objec¬
tionable and more efficacious. After free catharsis, and
other depletion, blisters should be applied to the nucha and
between the scapulae.” Blood-letting may, perhaps, with
its usual accompaniment, a dose of purgative medicine, occa¬
sionally succeed in extinguishing some incipient efforts at
fever.” The afternoon or evening is in general the best time
for bleeding. The cold affusion, although probably too
highly lauded by Dr. Currie, is an admirable remedy under
due restrictions. Free catharsis is in all cases desirable ; but
violent purging at the commencement of fever, has often been
carried to an injurious extent. Calomel, used to the extent
of inflaming the mouth, has been tried without decisive
benefit, and sometimes with aggravation of the patient’s
sufferings. Heating diaphoretics are to be avoided, and
antimony has only appeared serviceable as it proved emetic or
purgative. Vomits, when given early, may cut short ephe¬
meral and mitigate the severity of other fevers; but their
exhibition has formed no part of Dr. Percival’s stated or ordi¬
nary practice. Cold water is to be given freely, with Currie’s
restrictions. Of the mineral acids our author has not had
much experience. Peruvian bark is only to be administered
during convalescence, when no inflammatory irritation is pre¬
sent. It may then be mixed with elixir of vitriol or tartrite of
antimony, or kali and lemon juice. When cordials are
required, diluted wine is the best ; and the best time and
occasion for the exhibition of these is when the limbs are
cold and clammy while the trunk preserves its morbid heat.
When much restlessness is present, small doses of opium may
be used with benefit, due evacuations having been premised.
With respect to diet ; before crisis the aliment should be
fluid, and of the simplest kind, and meat should not be allowed
for some days or weeks after the crisis. Warmth of clothing,
and due ventilation, are necessary in convalescence; and gesta¬
tion in slow recoveries appears sometimes more beneficial
than any other means.

Dr. Graham. — The duty of reviewers is arduous, from the
circumstance of their engagements involving the necessity of
often wading through what is jejune in substance, and dull in

VOL. XI, — NO. 66. 3 s

498 Analytical Review,

style ; but were the manner and matter of all authors like the
one now before us, the irksomeness of criticism would be very
considerably diminished. Dr. Graham is not only a sensible,
but a masterly writer. The following extract will at once
serve as proof of our position, and give the reader an earnest
of what he is to expect from the perusal of this very able
tract : —

“ I may premise, by way of caution, that with respect to fever I
have been able to draw no general rule, excepting that generalizing
is nearly impossible in that disease. Much must always be left to^
the pro re nata discernment of the Physician ; and if he allows him¬
self to be guided by preconceived notions, rather than by reflection on
the circumstances of the case, and the symptoms which it presents, it
would have been well for his patient if he had intrusted himself to the
m medicatrix naturct alone. So far am I from thinking, with some
people to whom I have already alluded, that the causes, and the
history, and the cure of fever are perfectly known, arrd as well under¬
stood, that I believe the ignorance of every one of us on all these par¬
ticulars is very great ; and I have the fullest conviction that we are
only to become wiser by a repeated and more careful investigation of
its phenomena, by contrasting symptoms and circumstances; the
many futile attempts at theory, show that we are not yet ripe for
giving a plausible rationale of the disease.”

Dr. Grab am then proceeds to a detail of the general symp¬
toms of the Glasgow fever, as they occurred in his own prac¬
tice, and remarks, that as far as topical inflammation is
concerned, the head, the spinal canal, the thorax, the
abdomen, and the external cellular substance, have each af
different times been its seat. With respect to the cephalic
condition. Dr. Graham candidly acknowledges that he has
seen many cases where it was extremely difficult to determine
from the symptoms whether there was active inflammation
within the head, or a state the very reverse of this. Delirium,
(he very properly, in our judgment, remarks) taken by itself,
can never be considered as a symptom of inflammation. It
often arises froih a modification of nervous energy, inde-
pendenj; of the existence of either inflammation or congestion,
and is removed either by an effort of the patient himself, or
by the application of a stimulus.’^ To this very important
point we wish especially to call the attention of our readers,
convinced as w^e are that the present-day pathology has in it
too' much of tendency to confound nervous with inflammatory
‘ action, or to suppose that sentient and vascular excitation are
invariably coincident and commensurate. Let it be remem¬
bered, that the above caution as to the liecessity of the
distinction alluded to, comes from one who tells us in the
same page, that when the eye is more or less suffused, and

Treatises on Epidemic Fever,

49y

sparkles wildly, with a sliarp contraction of the pupil, con¬
nected with headach and a jarring pulse, or delirium, or even
without this last symptom, he never hesitates in declaring
there is inflammation witliin the head, or at least, never
delays for an instant the abstraction of blood, either generally
or topically, and the other means which are calculated to save
life when the brain is inflamed.

Inflammation of the spinal chord. Dr. G. suspects has
been too much overlooked in the aeteology of fever, and
those pains about the neck which characterize it have been
too indiscriminately regarded as rheumatic. For this hint he
confesses himself indebted to the clerks of the infirmary.

In the doctrine of critical days Dr. G. is not so firm a
believer as Dr. Percival : in general, he says, he has found the
period and manner of t:onvalescence remarkably ill defined.
‘‘In repeated instances the patient has lingered for several
weeks, the symptoms sometimes subsiding a little, giving
promise of a speedy recovery; but by and by again becoming
rather more prominent, suspended the patient between hope
and fear, and either gradually overcame his strength, or left
him to creep slowly back into the world again.”

In alluding to the proportion of deaths, he refers to a table
which he gives at the end of his pamphlet, of the number of
patients dismissed from the Edinburgh Infirmary during
fourteen months, beginning with January, 1817, b}" which
it appears that the average proportion of deaths during that
time w’as one in 15^. Of his own patients he tells us that
the proportions of deaths w^ere rather more than one in nine
males, and about in 16| females. The mortality, too, he, with
Dr. Percival and others, states to be greater among the rich
than the poor.

When discoursing on the treatment of fever. Dr G.
tells us, that the greater number of cases “ require little
or no treatment at all.” In common and slight cases, “ the
practice of giving an emetic at the onset, and following
it up by a purgative, has often been attended with marked
advantage.” The lancet Dr. G. never uses, excepting when its
employment is indicated by “ local disease;” but wEen such
is the case, he tells us he “ cannot too strongly recommend it,
and that too without reference to the period of the fever
when these symptoms occur.” He often, he says, bleeds in
the third week of the fever, when inflammatory symptoms
present themselves. Those bronchial affections which we
noticed when reviewing Dr. Percival’s volume, our present
author likewise adverts to as attended often with much
danger. He never, he tells us, neglects the employment of
blisters in these cases. Cold applications to the head Dr. G.

500 Analytical Revierv*

is very partial to; they are often of infinite advantage,
and are most grateful to the feelings of the patient/' The
state of the surface has seldom been such as to justify cold
affusion ; but sponging both with cold and tepid water, we
are told, formed part of Dr. G.’s practice. Active purges
are useful ; but they tend very materially to increase debility
in typhoid cases." The virtues of calomel and opium, as
recommended by some in fever, Dr. G. does not rate very
high. In cases of typhoid sinking, when stimulus are re¬
quired, it must often be pushed in very great quantities."
Wine has been given occasionally ad libitum^ and alcohol,
ether, and camphor, in such doses as the patient could
be made to swallow, and in some cases, he has doubtless
owed his life to this treatment."

As to the means of preventing the propagation of fever.
Dr. Graham’s principles and views are virtually the same
with the four authors that stand next in succession in the list
which we have placed at the head of the present article.
These authors are Dr. Millar, Dr. Porter, Mr. Parkinson, and
Dr. Dickson, all of whom assume the contagious quality of
the febrifacient virus, and urge, as measures necessary for
its extinction, the establishment of houses of recovery;
the separation of the sick from the well ; and the adopting
every possible expedient for ensuring to individuals and
families as much ventilation and cleanliness as is consistent
with town residence, and poverty of circumstances.

We had marked down several forcible passages from each
of these pamphlets with an intention to extract one or more
of them in the present article ; but as they have all pretty
much the same bearing, and as we have extended our critique
on this subject to perhaps already an unwarrantable length,
we must content ourselves with merely saying, that the
particular cause espoused finds an able advocate in each
of the writers before us. The pamphlet of Dr. Porter is
avowedly of a popular cast, and by his self-imposed restriction
the writer is prevented from philosophically engaging in the
pathology of the febrile state, although he treats of the
origin and course of fever : since, however, the former part
of the present paper was written, we have met with some
incidental observations of Dr. P’s, in another publication,
which so entirely coincide with our own sentiments on the
essence and seteology of fever, and are so well expressed, that
we cannot resist the temptation of transcribing the passage
which contains them : —

“ Ill typhoid fever, the cranial and spinal brains are primarily
affected in their sensorial and locomotive function, by the direct
influence of contagion, and some other acknowledged remote causes,

501

Treatises on Epidemic Fever.

antecedent to vascular commotion ; but in a subsequent stage of the
disease, those organs not unfrequently suffer a further derangement, in
common with many other parts of the body; having an increased
liability, somewhat in the ratio of their more abundant vascularity ;
and here the essential cause of cauma rises up in typhus ; and if I am
not mistaken, this last stage of obvious cerebral lesion has been con¬
founded with its less manifest primary derangement; and on these
distinct conditions of cerebral disorders, contending pathologists have
fixed their eye, when disputing on the efficient cause of idiopathic
fever/’

Dr. Brown. — The different inferences that are drawn by
different persons from precisely the same premises, is a very
curious fact in the history of medicine. Some, as it has
already been said, deny the specific nature and communicable
property of fever, while others conceive such peculiarity and
quality to be established with the force of almost absolute
demonstration. Some talk with familiarity, and as a matter
of every-day occurrence, respecting cutting short and pre¬
venting fever; while others, as in the instance before us, call
in question the power of either doing one or the other. Of
the three alleged sources of fever, says Dr. Brown, namely,
a particular constitution of the material world, the vapour that
is produced by heat and moisture, and a matter which is
usually called contagion, our present ignorance is such as to
prevent our controlling them ; and with regard to the last
principle, namely, contagion, it must be remarked that the
knowledge of its source has been of late attacked in such a
way as to lead us to entertain doubts whether our notions
concerning it were correct. We are, then, rather thrown -
back in this matter, and made to hesitate whether we really
possess that degree of power of preventing contagion which
we thought we had acquired.” Contagious fever, continues
Dr. B., has been conceived to be diminished by the establish¬
ment of hospitals to ensure the separation of the sick from the
well; and the advantages of separation are so evident that it
would be absurd to deny their existence ; but to ascribe the
cessation of epidemics to these sources, seems at the very
least a questionable principle ; nay, in every instance (he
says) on record or within our own memory, fever has ceased,
although no fever-houses were provided, nor any extraor¬
dinary means employed.” Dr. B. goes on to question whe¬
ther a great deal may not have been taken for granted in the
way of preventive measures, in reference to fumigation, airing
apartments, Sec. ; and then enters upon the main object of
the pamphlet, namely, to inquire whether we have just reason
for giving credence to the doctrine of the curable nature of
fever. His investigations have led him to a sceptical con¬
clusion; and he presents his readers with several documents

502

Analytical Review,

ill order to prove that, in the long run, it is of little conse¬
quence whether we use cold affusion, blood-letting, purging,
or any other supposed agent in the cure of the disease, since
they are ail equally inefficacious to accomplish the object.
We must assent, he says, for example, to the truth of the
assertions, that the sick specified by the numerous advocates
of blood-letting w'ere relieved by this operation, and on that
account we cannot withhold our assent to the usefulness of
the practice of taking away blood in certain cases of fever.
But the testimony carries us no further. The same witness
brings evidence, which appears also irresistible, to convince
us that the efficacy of this remedy is of very limited extent.
They assure us that in a great many cases it did no good.
One urtsuccessful case counterbalances a considerable plura¬
lity of others, inasmuch as we know most assuredly that fever
often disappears without the aid of venesection, or without
the aid of medicine at all ; nay, even under the~application of
remedies which the patronizers of venesection consider as
certainly pernicious.”

Dr. Brown, in order to establish bis assumption that all
imaginary curative measures stand upon the same footi ng in
point of efficacy, presents his readers with several tables, in
which the days of termination in fever are remarkably uni¬
form, under a treatment considerably different; and he then
concludes his pamphlet by the following remarks : —

“ If these observations be just, the knowledge of them gives us very
important advantages. While it does not oppose any obstacle to the
farther investigation of the disease, or to the invention of more power¬
ful means of cure, it teaches us to employ the means of lelief which
we do possess more extensively, with more certainty and more uni¬
formity for the advantage of the sick. It binders us from fixing our
attention on one single view of the nature of the disease, the justness
of which we must hesitate to acknowledge, and calls us to contem¬
plate symptoms with more earnestness, and to direct our endeavours
principally to the removal of uneasy sensations, and restoration of
disordered functions. Hence we may be delivered from the fear of
moderate blood-letting in diseases called putrid ; of the prudent use
of wine in those termed inflammatory; of the cautious employment
of opium in ail cases where its soothing operation can allay uneasy
feeling; of heat, where the comfort of the patient is increased by it;
and of cold, where it brings agreeable sensation along with it. Nor
need we dread the stimulant and putrescent properties usually attri¬
buted to different kinds of food. In this respect we may safely aban¬
don the patient, if not under delirium, to his own experience, or
direct him more according to the principles of common observation,
than according to rules of an uncertain philosophy.'’

For our proposed concluding remarks an extremely limited
space is left.

First, then, as to the specific nature and Identity of fever.

505

Treatises on Epidemic Fever.

It appears to our judgment by no means satisfactorily made
out that the disease we call typhus acknowledges any positive
or exclusive cause; and it is, at the least, probable that dif¬
ferent modifications of cold, that impure air, irregularities of
diet, and even mental affections, may, under some circum¬
stances of the recipient, prove equal to the production of
genuine fever*

The fever thus engendered shall be communicable to ano¬
ther, exterior and internal circumstances being favourable to
its production ; but this power of communication is, compa¬
ratively with what has place in the specific contagions, so feeble,
that febrile affections w^ould never from such source be spread
among a community v/ithout the aid of conjunctive influ¬
ences : such influences being either an epidemic constitution
of the air, acting exclusively, or in combination with deficient
ventilation and cleanliness, irregularities in living, or mental
anxieties.

Secondly, all theories hitherto proposed respecting the
modus operandi of febri-facient matter in bringing about its
particular effects, fail in satisfactorily accounting for the
phenomena which fever exhibits; certain it is that in every
case of idiopathic disease, the sensorial functions are espe¬
cially and peculiarly affected; but in what consists the essen¬
tial and primary derangement in the organs subservient to
such functions, is at present among the arcana of nature.

Inflammation, whether encephalic, visceral, organic, or
cutaneous, is an exceedingly common concomitant of fever;
but however speedily it may be engendered, it is invariably
subsequent to the first shock, and is by no means absolutely
essential to the disease.

Thirdly, as there is reason to doubt the specific nature of
typhus, so may we fairly presume upon the uncertainty of
the doctrine of critical days; or at least it may be supposed
that mere fever does not necessarily commence, decline, and
disappear with the same regularity of period, as those febrile
derangements that are obviously and always excited by a
specific virus, such as small-pox and measles.

Fourthly, it is probable that curative attempts of a vigor¬
ous nature, applied before the cycle of actions is completely
established, may occasionally prevent their full formation, or,
in other words, cut short fever. But this principle is not fixed
with a force beyond what probability is capable of imparting
to it. It seems, however, next to certain that both death and a
protraction of ailments may at times be obviated by a judicious
employment of remedial measures to counteract the severity of
incidental symptoms. These measures are blood-letting,
topical and general, purging more active or more lenient,
emetics or nauseating doses of emetic substances, the partial

504

Selections*

and general use of cold externally in a variety of forms ; re-
'^frigerant, diuretic, sudorific, anodyne, and stimulant articles of
medicine and di^; and the application of heat and other
excitants to various parts of the external surface.

Lastly, much may be effected in the way of preventing
the spread of fever, by checking indiscriminate intercourse
between the sick and the well ; by an assiduous attention to
individual cleanliness, and by ensuring as free a ventilation as
possible in the apartment of the sufferer. There are never¬
theless certain epidemic visitatisns which occasionally make
their inroads in spite of precautionary measures, and which
have hitherto proved invincible by the energies of man. It
would seem, moreover, that efforts to guard against these
irruptions of our physical enemies must, to be efficacious, pro¬
ceed upon different principles from those which regulate the
prevention of the absolute or specific contagions: the commu¬
nicability of typhus, and perhaps of plague,'T)eing governed
by somewhat different laws from that of measles and small-pox.

PART ILL

SELECTIONS.

Some Observations on the Opinions of the Ancients respecting

Contagion. By G. _D. Yeats, M.D., Fellow of the Royal

College of Physicians, &c. Sec.

- -

{From the Quarterly Journal of Science and Arts.)

[Continued from page 413.]

In various parts of Diodorus’s history, we find accounts of
pestilential diseases as they occurred in different parts of the
world, particularly among multitudes of people collected to¬
gether for the purposes of w^ar. A contagious pestilence
broke out at Carthage at the time it was invaded by Dionysius,
the tyrant of Syracuse. Diodorus, in his account of this pes¬
tilence, the S3'mptoms of which he has described, particularly
points out the infection and fatality produced by approaching
the sick : — ixETa raorcc te to <7rM9og rm veu^cov nai to roi/g
vocrone/xouvTag vtto th voVa ov^slg EToXfjta TJ^ocriEvai roTg

Xoi/XV0i(Tl.

As the mortality caused by the disease was great, and as
the attendants upon the sick were cut off by it, no one dared
to approach the infected.— Again :

Kcat ot tok TtoipB^psvovrsg sveTriTTTov slg roy voaov •jroc.yrtg

wfB ^Bivriv sivon rnv Tuv u^^Ufovvruv, GsAovTog iTrtpiTBiv

roXg arv^ovcTiv, 6v ycx,^ ol •jr^oavjtiovrBg aT^T^yihovg iyKaTiT^imovy aTCh,

f&v (piXot ra? crvvv^itg vyoHjicc^orro TrpoUcr&ttt hoi Tffs>

vvrtq avTup (poQov.

506

Opinions of the Ancients respecting Contagion.

** For all took the disease who had close communication
with the sick, so that wretched indeed was the condition of
those who were diseased ; every one being unwilling to assist
them, for not only they, who were not bound by any tie of
relationship, deserted each other, but brothers and friends
were compelled to neglect their nearest relatives and com¬
panions, on account of their dread of the contagion.”

In various parts of the history of the Romans, by the Hali-
carnassian historian, we find accounts of pestilential fevers
which spread havoc and destruction around ; and we not only
can discover that these fevers were infectious, by the manner
in whicli they spread, but Dionysius expressly tells us, that
they who touched, or lived with, persons so diseased, became
infected. In the 451st year before the Christian aera, and
about 300 after the building of the city, a contagious fever
broke out in Rome — Aoifum vocrog elg tyiv (a£-

yiTYi TOiV EH. m TTpOTE^d IJLVY\(Jl.OVEUQlJ(.EVOiV Yig 01 (AEV

oxlya £^£y}crav a'sroiVTEg a'sroXEtrdaij ruv rsg

v/XKTEig /j,a>,ig(x ^lEtpSccpnaav, »T£ rcov larpuv apHiiVTOiV etl ^o-hQeTv
Toig Ha/icdroig, ste oIheiuv ^ <plxm rd vayndiix v'^HYipEmvTm ol
E'SjiKHpEiv rdig krEpoov ^hXo/^evoi voiroig, aTHTO/xEvot re HafA.ixTV}pci3V
a-o/bcocTcov, HiZi cruvhaiTdpLEYOi rug auTug EHEivolg vocnsg (jt,£T£X(Xf/.^cxvQVi
Dionpsii Halicarnassensis Historia. Oxoniae, 1704. p. 645.'

“ The most pestilential disease ever remembered, brought
destruction upon the city, by which almost all those affording
assistance were cut off, and nearly one half of the other citi¬
zens were destroyed; neither were the Physicians able to at¬
tend effectually the sick ; nor the friends and domestics to
administer the necessaries; for they, who willingly attended
others, by touching their diseased bodies, or dwelling with
them, were seized with the same malady.”

Here we have both contagion and infection clearly stated ;
the former communicated by touching the diseased bodies,
the latter giving disease to those w^ho came within the con¬
centrated sphere of its action. The miserable condition of
the city during the ravages of this pestilence is pathetically
described by Dionysius. — The stench from the unburied dead
bodies, which were cast into the sew^ers, on the highways, and
into the river, and again thrown by the tide upon its banks,
contributed to maintain the disease by spreading the infection;
for such was the desolation, that whole houses were deprived
of their inhabitants by death. The contagion was carried into
the country, where numbers perished; and the ^qui, the
Volsci, and the Sabines, enemies of Rome, desirous of taking
advantage of the distresses of the city, by invading it, received
the infection, and carried destruction into their own habita-

voi.. XI. — NO. 66. 3t

S06

Selections,

tions. The yeomanry of the country were either destroyed,
or paralyzed by the febrile infection ; the ground remained
untilled, and famine was added to pestilence.

Interspersed in various parts of Livy will be found histories
of pestilential fevers, the infection of which, it is expressly
slated, was spread by contact. About the year 389; A. U. C.,
a fever of this kind broke out in Rome.

“ Grave tempus et forte annum pestilens erat,’’ says Livy,

urbi agrisque nechominibus magis quam pecori; et auxere
vim morbi terrores populationis, pecoribus agrestibusque in
Urbem acceptis. Ea colluvies mistorum omnis generis ani-
mantium et odore dnsolito urbanos et agrestem conferiim in
arcta tecta aestu ac vigiliis angebat, ministeriaque invicem et
contagio ipsa vulgabant morbos.’^ Lib. 3. c. vi. p. 47.

Again, in the account which Livy gives of the fever which
broke out among the soldiers during the siege of Syracuse, a
siege ever remarkable by the death of Archimedes, it is clearly
stated, that contact of the sick propagated the disease.

Accessit et pestilentia, commune malum, quod facile
utrorumque animos averteret a belli consiliis, nam tempore
autumni et locis natur^ gravibus, multo tamen magis extra
urbem quam in urbe intoleranda vis aestus per utraque castra
omnium ferine corpora movit, et primo temporis ac loci vitio
et segri erant et moriebantur, postea curatio ipsa et contactus
aegrorum vulgabat morbos ; ut aut neglecti desertiqiie, qui
incidissent, moriuntur aut assidentes curantesque e^dem vi
morbi repletos secura traherent.’^ Lib. 25. c. xxvi. Cartha¬
ginians, Romans, Sicilians, all fell victims to the disease.

So prevalent indeed was the opinion of the contagious na¬
ture of pestilential fever or plague, that we find in medical
writings, when the authors wish to represent the infectious
nature of disease, they compare, it to the plague. Thus Are-
taeus, one of our best and most accurate professional writers,
in giving an account of the nature of Elephantiasis, and wish¬
ing strongly to impress on his readers the idea of its highly
contagious nature, says, — arefTTEg iuev hcci ^oQe^ov^ ya^
d'Eog ^E ^v(J(.Qi^vte nai ^vv'^iai'vaaOaiy a /ueTov v XoiiJiu' avaTTVOvg ya^ eg

ftETu^ocriVy — 0Epa7rEia ^XE<pavT0g.

I “ It is a terrible and unsightly disease, putting on the ap¬
pearance of the beast : there is great danger too in taking food
with one so diseased, as much as w ith one afflicted \Vith the
plague, for the infection is readily caught by a reciprocity in
respiration.”

, Galen, too, in his first book, chapter iii. i)e not

only alludes to, but directly asserts, the contagious nature of
the plague; for -he says, in strong language, there are none,
possessing any understanding, who do not know that a pesli-

507

Opinions oj the jlncients respecting Contagion.

lential condition ot the air will produce fevers, as also that it
is very imprudent to have any direct communication with
those afflicted with the plague, on account of the danger of
catching it, in like manner as in the itch, or inflammation of

» 0(p9ccXf/,i(Xi;.

It may not be incurious to remark here, that ophthalmia is
said to be contagious ; and Aristotle asserts the same thing in
the eighth problem of the seventh section. What is the
reason, he says, that they who have close intercourse with
persons labouring under the itch or ophthalmia, are seized
with it? — Aia t/ octto <pQl<jzco(; kcci 6(pQ(X'K[JLi<x^ Kai oi 7r>^Yi(Ti(X-

^ovTsg aXidHOVTai ;

The public are well acquainted with the discussion which
has taken place respecting the contagion of that species of
ophthalmia, which so sorely afflicted our army in Egypt.

In the sixth chapter of the fourteenth book of the history
of Animianus Marcel Lin us, where he describes the vices of the
people of Rome, he alludes to a disease of a highly infectious
nature, at a period of time about three hundred and fifty-three
years after the birth of our Saviour. It appears to me to be
almost impossible to say what the disease was, but it is suf¬
ficient to state that the account describes it to be so exceed¬
ingly infectious, that the servants sent to inquire after those
who were ill, were ordered to undergo purification before they
returned home. Et quoniam apud eos, ut in capite mundi,
morborum acerbitates Celsius dominantur; ad quos vel
sedandos omnis professio medendi torpescit : excogitatum est
adminiculum sospitale, ne quis, amicum perferentem similia,
videat ; additumque est cautionibus paucis remediuin aliud
satis validum, ut famulos percoutatum missos quemadmoduni
valeant noti hac aegritudine conligati, non ante recipiant dopii,
quam lavacro purgaverint corpus. Ita etiam alienis pculis
visa metuitur labes.” Here vve haye not only the dread of
contagion being communicated frorn one individual to ano¬
ther, but precautions were taken to prevent the infection
being carried by the clothes or person of a second individual
to a, third. Whatever particular condition or nature of dis¬
ease labes” may be supposed to mean, it is, nevertheless,
perfectly clear that an infectious principle, communicable
through the medium of another, was feared and avoided.
Animianus, however, in the fourth chapter of the ninth book,
describing a pestilence v/hich raged at Armida in Mesopo¬
tamia, when it w as besieged by Sapor, king of Persia, A. D.
359; and in giving the different opinions which were held re-

508

Selections,

specting the origin of pestilential dieases, makes the following
observations, in which lakes” is evidently used as disease.
Adfirniant etiam aliqui, terrarum halitu densiore crassatiini
aera emittendis corporis spiraminibus resistenlem, necare non-
nullos : qua causa animalia prseter homines cmtera jugiter
prona, Homero auctore, et experimentis deioceps multis cum
talis incesserit lakes, ante novimus interire.”

To the facts, which have been adduced from medical and
historical writers respecting contagion, may be added the
descriptions and opinions of the poets. The classical reader
will feel a pleasing interest in bringing to his recollection the
readings of his earlier days ; and will, therefore, be gratified
by the perusal of quotations from the writings of those authors
whom he has probably often had in his hand. In the beau¬
tiful description from the first eclogue of Virgil, where he
characterizes himself under the name of Tityrus, and the
Mantuans under that of Melibceus, (who hadH^een spoiled of
their lands to enrich the followers of Augustus) the latter thus
addresses him : —

Non insueta graves tentabunt pabula foetas

Nec mala vicini ‘pecoris contagia iaedent.

Thus, as on a subject well known, Meliboeos congratulates
Tityrus that his cattle will not be exposed to the contagion of
a neighbouring herd, as by the interest he had, through Me-
caenas, wdth Augustus, he was permitted to retain his Mantuan
property, and was not, therefore, obliged to remove his flocks
to other and untried pasturage. In the third book of the
Georgies, Virgil is still more explicit and clear respecting the
contagious nature of disease in cattle, for he describes the
symptoms of one becoming ill, and desires it may be imme¬
diately attended to.

- . — Priusquam •

Dira per incautum serpant contagia vulgus.

The other Roman poets of nearly the same period are
equally descriptive and explicit in their accounts of pestilen¬
tial diseases, as propagated by contagion, as we read in the
pages of Lucretius, Ovid, Lucan, and Silius Italicus. I can¬
not avoid the pleasure of quoting, from the two former at
least, their highly poetical descriptions. Lucretius, ip his
beautiful account of pestilential fever, unquestionably taken
from the historical statement of Thucydides, evidently de¬
scribes its infectious nature. Its malignancy and rapid pro¬
pagation from one individual to another, by contagion, are
unequivocally stated.

Quippe cum nullo cessabunt tempore apisci
Ex aiiis alios avidi contagia morbi

509

Opinions of the Ancients respecting Contagion.

Lanigeros tanquam pecudes et hucera secla;

Nam quicunque suos fugitabant visere ad aegros,

Vital nimium cupidi mortisque timentes
Poenibat paullo post turpi morte malaque,

Desertos ope expertes Incuria rnactans,

Qtii fuerant autem prajsto contagibus ibant.

Ovid, in the seventh book of his Metamorphoses, gives an
animated and highly poetical account of the plague which
raged in the island of ^gina; and we hnd the symptoms and
calamitous circumstances attending the disease similar to those
as described by the masterly pen of 'riiucydides ; we must
therefore conclude that it is either a fiction of the poet’s, as a
copyist, or an account of a disease, similar to the Athenian
pestilence, as it occurred in an island of the Grecian Archi¬
pelago. However that may be, the idea of the contagious
nature of the pestilence is determined and unequivocal, clearly
showing that the poet is stating an opinion generallj' received
in his and the preceding times. Alter describing the cala¬
mitous havoc caused by the spreading of the disease, the fields
and roads being strewed with the bodies of the dead, the air
corrupted with the eihuvia of the putrefaction, he adds, the
contagion is thus spread far and wide:

- — * dilapsa liquescunt

Afflatuque nocent et agunt contagia latb.

H uman aid is of no avail, for the faithful attendant, in his
solicitous care of the sick, by a near approach catches the
contagion, and is thereby hastily hurried to his grave.

Nec moderator adest inque ipsos sseva medentes
Erumpit clades, obsuntque autoribus artes;

Quo proprior quisque est, versitque fidelius gegro /

In partem lethi citius venit.

Instead, then, of having any doubts on the opinions of the
ancients respecting the propagation of disease by contagion
and infection, we have ample proof from the writings of their
philosophers, physicians, and poets, not only of the existence
of such an opinion, but of precautions taken to prevent the
spreading of the infection. In the reading, however, which I
have gone through, I do not recollect to have met with a pasr
sage describing any strictly precautionary means except in
Ammianus Marcellinus. 1 am, nevertheless, inclined to be¬
lieve, that by a deeper perusal of the ancient Greek and
Roman authors, we should tind that methods were adopted
for preventing the communication of contagious miasma ; not,
however, with that philosophical accuracy and success which
the improvements in modern science have produced. Many

* Scilicet Corpora.

510 Foreifyn Medical Science and Literature.

works, besides those I have read, remain to be examined, as
well as a more critical perusal of them ; but what I did read
was so much to the point, and so satisfactory, that it was un¬
necessary to proceed further.

, PART IK

FOREIGN MEDICAL SCIENCE AND

LITERATURE.

SURGERY,

I. — Itiflammation of the Tunica Arachnoidea from ex¬
ternal injury. — A well-marked case of arachnitis, complicated
wdth fracture of the cranium, has recently been described by
Dr. Martinet^. The following is a succinct statement of its
history.

A puvior, aged forty- three, received, on the night of the 6tb
of September, 18i8, a blow from a stick upon the left posterior
inferior part of the head; which was followed by a momentary
loss of consciousness, and a discharge of blood from the left
ear. Various other contusions were also inliicted. — 7th. Pain
very severe in the injured part, abdomen, and limbs; great
thirst; nausea. — 8th. Pain in the head continues. Sixteen
leeches applied to each side of its posterior region. — 9th.
Loss of consciousness. Evening, limbs agitated; pain in the
head constant. — 10th. Profound coma; diminution of the
sensibility of both sides ; momentary agitation of the lips and
both superior extremities, with more decided contraction of
the left ; eyelids paralyzed ; trismus ; stiffness of the neck,
which was drawn backwards; pulse small and not accelerated ;
heat natural ; respiration easy ; tongue dry ; abdomen free
from pain; face not flushed; forehead warm; eyes bleary;
extremities cold. Twenty leeches, with cupping-glasses, be¬
hind each ear. Antimonials ; sinapisms to the feet at night.

— 12th. Coma more profound; sensibility farther diminished ;
superior limbs much less agitated, but beginning to fail;
deglutition impracticable; pulse very frequent and feeble ;
heat augmented; respiration hurried and stertorous. At
night, sinapisms to the calves; death. — Dissection : Cranium.

— ]. No trace of contusion on the hairy scalp; but ecchymoses
about the left side of the occipital bone, sinciput, and right
temporal, each several inches in extent.^ — - 2. Separation of

* Bulletin (le I’Alhence dc ]M6decine do Paris; Bibliolheqiie
iM6diGale, Fevrier, 18ip.

511

Wound of the Thor' ax.

the occipito-temporal sutures, particularly the left, where, for
SQme inches, it had taken place to the distance of a line and a
half; simulating, at first sight, the appearance of a fracture, — -
S. Fissure of the base of the left petrous portion of the tem¬
poral bone, with rupture of one of the veins which traverse
its internal surface. — 4lh. Fracture of the internal table of the
squamous portion of the left temporal bone, near its union
with the mastoid process. — 5th. Effusion of coagulated
blood, to the extent of some fingers’ breadth, occupying the
left inferior occipital depression, between the bone and de¬
tached dura mater. — 6th. The sinuses and vessels of the _
arachnoid gorged with blood. — 7th. The arachnoid mem¬
brane of the brain loaded with pus in the whole anterior su¬
perior region, and thickening of the membrane, which was
yellowish, and formed a kind of cap : its posterior portion red,
and covered with blood : drops of blood among the cerebral
convolutions. The arachnoid of the base of the brain, of the
cerebellum, and the portion investing the tuber annulare,
Toaded with pus, which escaped on pressure. Thickening of
all these parts, and especially of the portion of membrane in
the vicinity of the commissure of the optic nerves. — 8th.
Lateral ventricles filled with a yellowish limpid serum. About
a spoonful of purulent serum on the section of the tuber an¬
nulare. Brain itself sound. Thorax and abdomen in the
natural state.

11. — Wound of the Thorax. — Baron Larrey, on the 14th
of January last, presented to the Faculty of Medicine*, the
thorax of a soldier, who had died in consequence of a wound
received in a duel ; and which had completely traversed the
cavity. The instrument had penetrated into the left region of
the chest, between the first and second ribs, near the sternum, ,
and had made its way out behind, in the vicinity of the
cervical (posterior superior) angle of the scapula, between the
second and third ribs. The sword, in its course, had divided
the internal mammary artery ; perforated the superior lobe of
the lung; and cut, at its exit, the intercostal artery. Baron
Larrey had, on the 9th day, been under the necessity of per¬
forming the operation of paracantesis ; when about eight pints
of a fluid, resembling wine-lees, were evacuated from the
thorax. The man was progressively recovering, when, in the
fourth month from the period of the accident, he died in
consequence of a violent fit of anger, and the immoderate
abuse of spirituous liquors. On dissection, were discovered
inflammation of the heart and pericardium, and evident traces
of the injuries above described.

^ Bulletin de la Faculty de Medecine de Paris, No. I. 1819-

51^ loreign Medical Science and Literature,

Wl.—^Hupture of the Fensc Cavce. — ^^Tii a late Number of our
Journal^, vve noticed a case wherein the swallowing of a bone,
followed by a violent inflammatory affection of the throat,
and vomiting of blood, had produced death, and, on dissection,
the oesophagus and corresponding part of the aorta w^ere
found perforated. A fact somew'hat analogous to this, and
equally interesting, has lately been recorded in another of the
foreign journals t. A man, aged forty, experienced a very
violent attack of angina, accompanied with cough and severe
pains in the breast, in consequence of having swallowed a
bone ; the deglutition of which was effected with great diffi¬
culty. Ten days afterwards, he was seized with vomiting of
blood, and died. On dissection, both of the venae cavae were
found ruptured.

IV. Hydatids contained in an abscess, consequent on chronic
rheumatism.^ A French physician. Dr. Farradesche Chau-
basse|, has detailed a case wherein a tumoc'^as formed by
a collection of hydatids in the substance of the abdominal
parietes, betw^een the crest of the left ilium, the vertebral
column, and inferior false rib. Inflammation spontaneously
came on : the tumor burst, and gave issue to an enormous
quantity of pus, succeeded by about six hundred hydatids of
various sizes. After this the wmund cicatrized, and the
rheumatic pains completely disappeared.

V. — Case of Lymphatic Tumor in the Inguinal Region^ .
— A man, aged forty, employed as a servant in the naval
hospital at Cherbourg, was bald, of a brown complexion, and
bilious temperament, much addicted to spirituous potation,
and had two years before suffered amputation of the left leg,
for a caries of the ankle-joint, consequent on reiterated and
neglected sprains. In December 1817, this man first per¬
ceived a tumor of the volume and figure of a nut, situated on
the course of the femoral arterv, about one-third from the
summit of the left thigh. The tumor was hard, indolent, but
little moveable ; irreducible, and without pulsation, it w'as
attributed to the pressure exercised by part of the apparatus
connected with the wooden leg. Repose was directed, but
not rigidly observed ; and topical emollients and resolvents
were alternately applied.

The swelling continued for three months to make a slow
progress. It induced pain in the subjacent parts; assumed

* Repository, VoL X. page 335.

t 'Journal complcmentaire des Sciences Medicales, cap. 1.

J Recueil periodique de la Societe de Medecine de Paris. Sep-
tembre, 1818.

j| Journal Universel des Sciences Medicales. Mai, 1819.

513

Extraordinary Case of Inguinal Tumor,

an oval and lobulated form ; retained its hardness ; and in¬
creased particularly in the superior direction. The employ¬
ment of emollients was continued with the addition of
narcotics.

On the 6th of June, when the patient was admitted into the
hospital, the tumor had increased in every direction to the
volume of two fists ; involved the inferior lymphatic glands
of the groin; was softened; and displayed an evident fluctu¬
ation. None of the indurated base, which commonly sur¬
rounds abscess, was here observed ; nor did there exist any
sign which could lead to a suspicion of aneurism. Soon
afterwards the skin became thin, rose to a point, and menaced
rupture. An incision now made in it gave issue to about ten
ounces of limpid yellow serum, without smell or consistence.
The parietes of the cyst never came together again. Its
interior had a smooth aspect, and was divided into several
cells. After three days, the discharge, which was poured out
in abundance, contracted, notwithstanding the frequency of
the dressing, a strong urinous odour : vvliile the borders of the
orifice became livid, and fell, with the subjacent cellular
structure, into gangrene. From hence resulted a vast putrid
chasm which gave issue very copiously to a fluid resembling
urine, spontaneously decomposed. This cavity soon ex¬
tended beyond the crural arch into the abdomen. The
patient even asserted that he felt the fluctuation of a liquid
contained in an interior cavity. Yet there existed no altera¬
tion in the alvine discharges, nor any phenomenon, local or
sympathetic, indicating lesion of the urinary organs. The
diseased thigh was scarcely increased in volume. The cir¬
culation and sensibility were unimpaired.

Still, in August, the general health was farther deranged.
The thirst became urgent and habitual ; and hectic fever was
developed. Marasmus, meanwhile, made rapid strides, and
some lancinating pains only were felt. Notwithstanding the
greatest attention to cleanliness, the sanies excited in the
integuments around the sore a violent smarting. The cyst
filled from fifteen to twenty times a day; and at its external
part the femoral vessels were seen denuded. The pulsations
of the artery menaced every moment the eruption of fatal
haemorrhage : and the uncertainty respecting the condition of
the^external iliac was opposed to the only operation capable
of preventing such an issue ; the application of a ligature to
that vessel.

About midnight on the 6th of September, the patient
awoke weltering in his blood. The haemorrhage was arrested
by pressure; but the man was so completely exhausted by itj
that he died in four hours after the accident,

VOL. XI. — NO. 66. Su

514 Foreign Medical Science and Literature.

Dissection of the body did not justify the suspicions which
had been entertained respecting a disease of the urinary organs.
The kidneys, and other abdominal viscera, were healthy.
The mesenter}^ displayed but some very small glands in a
state of congestion. I’he sinus, which extended beneath the
crural arch, was not more than two or three inches deep, and
arose from the suppuration of the lymphatic glands of this
region. The surface of the sore was granulated, and allowed
the projections of the muscles, vessels, and nerves, to be seen.
All these parts were covered with a substance resembling, in
colour and consistence, the cortical portion of the brain, or
the matter which is found upon wounds affected with hospital
gangrene. Some hours after death, a sweetish, and, as it were,
ethereal odour, exhaled from it. The femoral artery was
whole; but had lost one-third of its diameter; and its pa-
rietes were thickened. The vein was in a very singular state.
Two inches below the tumor it was contracted, and filled with
a brown, dense, and fibrous substance. In all its parts cor¬
responding to the ulcer, the parietes of the vessel were thick¬
ened, softened, and covered with grey matter. Several
longitudinal ulcerations, in the form of fissures, opened a
communication between the sanious cyst and the cavity of the
vein, which, in the corresponding places, had the same aspect
as the surface of the cyst. Above, the vein, very considerably
contracted, was still filled by the brown fibrous substance
which united the anterior and posterior parietes of the vessel
in the same way that the opposed surfaces of serous mem¬
branes are connected by those of adventitious formation : and,
as far as it is possible to judge from analogy, the adhesion
appeared from its solidity to be of about two months’ date.
This disposition extended to the point of confluence of the
primitive iliac veins, and terminated abruptly. It was propa¬
gated into the principal branches, particularly the hypogastric
vein, sp that the return of blood could only be effected by the
anastomoses of the smaller venous branches with those of the
opposite side in the pelvis, or by the lumbar veins of the same
side. The vessel from which the hmmorrhage had proceeded
was clearly made out to be the arteria profunda femords.

Inquiries relative to the cause of the disease afforded no
satisfactory result. The patient had suffered formerly from
venereal affections, for wdiich he had been methodically
treated, without ever experiencing any relapse. A caustic
issue had been established at the inferior part of the thigh ;
the irritation of which might have been the cause of sympa¬
thetic enlargement of the lymphatic glands ; but could not
have possibly had any share in the production of the other
symptoms.

l)) opsy of the Anuiios.

515

MIDWIFERY.

VI. Dropsy of the Amnios^ requiring premature delivery —
Although facts of this description do not possess the boast of
novelty, the case which we are about to notice will doubtless
be read with interest, as affording an useful contribution to
the materials of the systematic pathologist, and illustrating
the safety and propriety of the treatment, by which it was
brought to a successful issue^. '

A lady, aged ^5, of weak and lymphatic constitution, was
seized, in the seventh month of her sixth pregnancy, with dry
and frequent cough, which disturbed her at night. To this
were added fever, intense thirst, dry skin, scanty and lateritious
urine, oedema of the lower extremities, loss of colour, and
sleeplessness. Soon afterwards, the abdomen became hard,
tense, painful, and much enlarged; and the respiration so
tight and laborious, that the patient could no longer rest in
the horizontal posture. Hiccough, palpitations, almost inces¬
sant vomiting, rending pains in the kidneys, cessation of the
motions of the foetus, anxiety, faintness, and aphonia ensued.
On examination in this deplorable state, Dr. Duclos recog¬
nised excessive distention and elevation of the uterus. This
organ seemed to occupy the whole abdominal cavity. Its
orifice was directed backwards, and towards the base of the
sacrum ; and the fluctuation of a liquid in its cavity was
evident. A consultation was instantly called. The pulse
was then small and weak; the face shrunk and dejected;
respiration short and hurried; and suffocation seemed im¬
pending on any change of position. The nature and peril of
the case were unanimously agreed on by the consultants;
and premature delivery, while acknowdedged to be full of
danger, was indicated as the only resource. Yet some
diversity of opinion, as to the best means of inducing labour,
existed. How, in fact, it was inquired, was the dilatation of
the uterine orifice to be effected, in its present high and
unfavourable situation ? Extraordinary efforts, such as might
prove fatal to the patient in her exhausted state, would be
evidently requisite for this purpose. Hence the attempt was
denounced by Dr. Duclos as imprudent and dangerous until
labour should have commenced ; an event which the extreme
distention of the uterus would probably soon determine. The
consultation was therefore adjourned till the next morning;
and meanwhile small quantities of broth and wine were
frequently administered, but as often rejected by vomiting.

On the morrow, the situation of the patient being still more

* liulletin de la Faculle dc Medccine de Paris, ISIS, No. IX.

516 Foreign Medical Science and Literature.

desperate, the question of artificial delivery was again dis-^
cussed; and it was decided to wait till the os uteri should
evince a tendency to dilatation. The patient now received
the sacrament, and soon afterwards sank into a state of
syncope; on recovery from which, incipient dilatation of the
uterine orifice was perceptible* Fluctuation, on striking the
abdomen, was distinguished in all its regions. Observing a
return of the suffocation. Dr. Duclos determined on imme¬
diately rupturing the membranes, and evacuating the liquor
amnii at four several times, with an interval of fifteen minutes
between each. With his finger introduced into the os uteri,
he regulated the evacuation ; while the process was seconded
by the pressure of a napkin encircling the abdomen. In this
manner fourteen pounds of fluid were discharged, inde¬
pendently of that which escaped beside the basin. The
vomitings immediately ceased, and respiration was relieved.
D uring five hours of subsequent repose, the strength was
recruited by frequent administration of broth and wine. The
cough and palpitations nearly disappeared ; but as the uterus
seemed to be no longer capable of making an effort, the ter¬
mination of delivery was resolved upon. The uterine orifice^
thin and unresisting, was readily, dilated. On penetrating
into the cavity, the vertex of the child, and umbilical chords
were found above the superior aperture of the pelvis. The
head was small, and placed diagonally, with the forehead
backwards, and to the right of the sacro-vertebral angle.
Thus the head was readily grasped ; engaged diagonally in
the pelvic cavityq and ultimately delivered as in natural
labour. The child, a female, though living, was puny and
feeble, with very slender limbs. Its eye-lids were closed ; and
it uttered a w'eak cry. From the calculation of the mother,
it had nearlj^ attained the seventh month. After having been
fed for some days with sugar and milk, the child was put to
the breast. The alvine discharges were at first scanty : and,
at the end of two years, although lively, she was scarcely so
large as a seventh months’ foetus ; and the process of dentition
had not, at that period, commenced.

Immediately after delivery, the bandage round the patient’s
abdomen was somewhat tightened ; and an attempt made to
excite the action of the uterus by external frictions, and titil-
lations of the orifice of the organ, and occasional exhibition of
broth and wine. These means, however, proving inadequate
to the expulsion of the placenta, it was readily detached by
the hand ; and, except that it was very small in proportion to
the size of the membranes, presented no unusual appearance.
Compresses, moistened with brandy, were now applied to the
abdomen ; and some hours of refreshing sleep sufficed to dis-

517

Analysis of the Memspermum Cocculus.

slpate completely the hiccup and palpitations. The lochia
Were abundant, and almost serous. The flow of urine, on the
following day, copious ; and the fever and cough entirely
gone. On the 3d, the oedema of the extremities had consi¬
derably diminished, and the secretion of milk taken place
favourably. The oedema no longer existed on the 10th ; but
the lochia continued to flow till the 15th. In six weeks the
patient was quite restored. At the end of about two years
she aggin became pregnant, and went through the process of
parturition very favourably.

BOTANY AND CHEMISTKY,

Vll. — Natural and Chemical History of the Indian Berry
(Menispermum Cocculus, of Linnagus). — The shrub which
bears the Indian berry is the Menispermum Cocculus,
belonging to the class Dioecia, and order Dodecandria, of
Linnaeus, and the natural family of the Menispermoides, of
Jussieu. It grows naturally in the sand, among the rocks on
the coast of Malabar, and the island of Ceylon, and other
parts of the east ; and is frequently found twining round the
trunks of large trees, and climbing to their highest branches.
The berry is of a grey or blackish colour, equal in volume to
a large pea, wrinkled, round, or sometimes reniform, with a
fissure on the side, and contains within a tough and ligneous
envelope, a whitish fragile kernel, bilobulated, of a bitter
acrid taste, and nauseous disagreable smell*.

* The Indians employ the whole of the plant to destroy corns and
warts. For application, it is mixed up with ginger and grease ; or
they receive the smoke of it while burning. Its root constitutes with
them the universal panacea. With the berries, gathered yet unripe,
the natives form, by the addition of garlic, pepper, and human excre¬
ments, boles of the size of a cherry, with which they catch fish. The
berry is also used to take various kinds of birds and quadrupeds.
Fish, however, taken by these means, becomes speedily putrid, and
operates as a poison when received into the human stomach, espe¬
cially if kept for some time previously to being cooked. The
elaborate Gmelin, of whose work we have here availed ourselves,
gives a tolerably accurate botanical description of this species of
menispermum, and, after noticing the poisonous effects of the berry
on fishes, birds, and the larger quadrupeds, adds, “ In cats and dogs
its internal employment excites spasms and convulsions, which sooner
or later terminate in death. In the human subject it produces piles,
and sometimes nausea and fainting. But an example of its fatal
effects is not to be found in any reputable writer.” Allgemeine
Geschichte der Pflanzengifte, pp. 513, 514. It is singular that
Orfila, who appears, in many instances, to have copied from the de¬
scriptions of Gmelin, never once makes mention, in his celebrated work,
the General History of Poisons,” of the accurate and laborious
German. — Editor.

518

Forehn Medical Science and Literature.

By some persons the deleterious properties oftlie Indian berries
have been denied ; but, as M. Boullay has judiciously observed,
a substance, so powerful as to destroy the larger animals,
must necessarily possess no inconsiderable activity : and in
1812, at the recommendation of Professor Chaussier, this dis¬
tinguished chemist undertook to determine the nature of the
principles which enter into its composition. From the
analysis then published^, we learn that the seed of the fruit,
separated from the ligneous envelope, in which it is enclosed,
contains : 1st, about half its weight of a fixed concrete oil + ;
2d, a vegeto animal albuminous substance; 3d, a peculiar
colouring matter ; 4th, a bitter principle, crystallizable and
poisonous, to which M. Boullay has given the name of
picrotoxine ; 3th, a fibrous part; 6th, malic acid, probably in
the state of acidulous malate of lime and potash ; 7th, sul¬
phate of potash; 8th, muriate of potash; 5^Lh, phosphate of
lime; and, 10th, a small proportion of iron and silex.

From a comparative examination of picrotoxine and mor-
phium, Boullay observed, that both possess equally the pro¬
perty of combining with acids, and thus forming real salts.
This analogy has induced him to resume his experiments;
and to his labours on this subject the study of the saline
combinations of picrotoxine, and the discovery of a peculiar
acid with which this principle is united, import no common
interest.

The aqueous decoction of the berry of the menispermum
cocculus, treated with acetate of lead, furnishes a copious pre¬
cipitate. On diluting this precipitate with distilled water,
and supersaturating it with sulphureted hydrogen, an acid,
differing from all other known acids, is obtained : and this, it
is proposed to call, from the substance yielding it, and from
the probability of its being found in other species of the
menisperma, menispermic acid. This acid is incrystallizable.
Its characteristic properties are the following : 1st, It does not -
act on a solution of proto-sulphate of iron ; 2d, It instantly
determines in a solution of the deuto-sulphate a very consi¬
derable deep green precipitate ; 3d, It forms a copious pre¬
cipitate with a solution of sulphate of magnesia. The acid
may also be procured by pouring nitrate of barytes into a de-

* Analyse Chimique de la Coque du Levant, Paris, 1812.
f This substance, obtained by bruising the nut, resembles in a cer¬
tain degree the fat of animals; has a bitter taste; and a smell
analogous to that of cantharides.

I Dissertation sur ITIistoire Naturelle et Chimique de la Coque du
Levant (menispermum cocculus); examen de son principe ven^meux,
considere comrae acid vegetal et d’un nouvel acid particulier h cette
substance; par P. F. G. Boullay, Pharmacien, &c.

Characters and Effects of Ficrotoxine. 5ig

coction of the berry. Thus an insoluble menispeniiate is ob¬
tained ; which may afterwards be decomposed by sulphuric
acid.

After the trial of numerous experiments for procuring the
picrotoxine, M. Boiillay has adopted the following process,
which he describes as being the best and most certain, when¬
ever it is an object to collect, at the same time, the menisper-
mic acid. This process consists in boiling in water the seeds,
either previously to or after having separated the concrete oil,
and slowly evaporating it to the consistence of syrup. This
is afterwards to be triturated with a twentieth of its weight of
barytes or pure magnesia. The mixture, after having stood
for twenty-four hours, is to be dissolved, by a gentle heat, in
rectified alcohol. The spirit is then to be evaporated to dry¬
ness, and the product to be redissolved in fresh alcohol.
This, when reduced to a small volume, yields, on cooling, the
greater part of the bitter crystallized principle, more or
less coloured. It may be purified by repeated solutions
in alcohol.

Picrotoxine, when perfectly pure, is inodorous, intolerably
bitter, white, shining, semitransparent, crystallized in needles,
distinguishable by the microscope as real quadrangular prisms.
It is soluble in water and alcohol: its solubility is increased
by warmth. The mineral acids act decidedly on it, only by
the assistance of heat. The salts which it forms, are difficultly
soluble, with the exception of the nitrate, which is, moreover,
extremely bitter. The vegetable acids, particularly the acetic,
dissolve it readily. The salts formed by them are also
soluble. Analysis by fire demonstrates in it no trace of
ammonia.

At the period of his first publication, M. Boullay merely
suspected the presence of a saccharine matter in the Indian
berry. Now, however, he declares himself to be assured of
the existence of this principle, in the following manner :
1st, By treating with nitric acid, part of the extract resulting
from a decoction of the berry deprived of its picrotoxine, he
has obtained the malic acid ; Sd, On diluting with water
another portion of this extract, adding a small quantity of
sugar, and placing the mixture for some days in a stove,
fermentation was manifested; the liquid became turbid, and
covered with scum. Yet, as on distillation, it yielded no
appreciable quantity of alcohol, some reasonable doubts may
be surely entertained as to the existence of any saccharine
principle in the berry of the menispermum cocculus.

We may here, although obviously not quite in place, offer a
cursory sketch of M. Boullay ’s observations on the symptoms,

5‘20 Medical and Physical Intelligence* '

effects, and treatment of poisoning by picrotoxine. Ten grains
of this substance, incorporated with crumb of bread, were
given to a young dog. In twenty-five minutes convulsions
came on, followed by a whirling motion which continued a •
quarter of an hour. The animal then fell upon his side, ex¬
perienced convulsive motions, and died at the end of forty-five
minutes. On dissection, the stomach, which was full of food,
displayed, for the compass of an inch around the oesophageal
orifice, decided traces of inflammation. The membrane of
the stomach was of a red colour*. The treatment, in the
first instance, should be mainly directed to the expulsion ot
the poison from the stomach. After this, such remedies as
will most eflectually obviate or reduce inflammation, may be
advantageously employed.

PART V.

MEDICAL AND PHYSICAL
INTELLIGENCE.

ABSTRACT OF THE ANNIVERSARY ORATION DELIVERED BEFORE

The medical society of London, on the 8th of march

LAST, BY T. J. PETTIGREW, SURGEON.

Mr. Pettigrew commenced his oration by expressing his sur¬
prise, that, considering the frequency of the occasion on which the
Physician or Surgeon is called upon to give evidence in a court of
judicature, and that no less than the life of an individual, the for¬
feiture of his property, or the confinement of his person, are princi¬
pally dependent upon the testimony of the professional witness, so
little attention should have been paid to forensic medicine in this
country. “ There is not,” he observed, “ a single Course of Lec-

* This fact, perfectly accordant with the observations of Dr. Gou-
pii, of Nemours, is contradictory to those of Professor Orfila; who,
in his experiments on animals with picrotoxine, asserts, that he has
never found, after death, any sensible alteration in the membranes of
the stomach. Two facts, when correctly observed, do not, however
different, destroy each other. Yet if picrotoxine do not really induce
inflammation of the gastric mucous membrane, why has it been
classed by Orfila among the narcotico acrid poisons, of which one of
the characters is, according to his own admission, a rubefacient action?
A contradiction, thus glaring, would seem to decide the question in
favour of Boullay. — Journal Universel des Sciences Medicales.
Avril, I8I9.

Medical and Physical Intelligence. 521

tures, either of a public or a private nature, delivered in this metro¬
polis upon this interesting branch of inquiry. Few, very few works
have been written respecting it in our language, and those merely of
an elementary kind: the advocate is entirely at a loss where to seek
for information, by which he may institute such inquiries as are ne¬
cessary to the correct appreciation of the merits or demerits of the
cases in the investigation of which he may be engaged, and to the
determining of the validity or vagueness of the criteria which may be
stated upon medical testimony. The attention of the medical stu¬
dent, not having been directed to this branch of science, unassisted by
those publications which might enable him duly to appreciate its
importance, and correctly to estimate the cogency or insufficiency of
his opinions, is placed in the most embarrassing circumstances when
called upon to give his evidence.

Dr. Haslam has justly observed, that the important duty which
the medical Practitioner has to perform, when he delivers his testi¬
mony before a court of justice, should be clearly defined, conscienti¬
ously felt, and thoroughly understood : his opinions ought to be con¬
veyed in a perspicuous manner ; he should be solemnly impressed
that he speaks upon oath, the most sacred pledge before God between
man and man ; and that the life of a human being depends on the
clearness and truth of his deposition.^' In the first Section of the In¬
troduction to the Commentaries of the Laws of England, Sir W.
Blackstone has expressed an opinion that the study of the law is not
of more importance to medical men than to any other class of so¬
ciety. The learned Judge, Mr. P. conceived, was probably led
to make the above observation in consequence of the exemption of
medical men to serve on juries or inquests; or to undertake paro¬
chial offices : but it w-ill be found that Physicians and Surgeons
are frequently called upon to perform duties which require not only
a knowdedge of the principles of jurisprudence, but of the forms and
regulations adopted in our courts of judicature.

The advice of the medical attendant is occasionally required in
cases of sudden emergency, respecting a last will and testament.
This is admitted by Sir Wm. Blackstone. It is therefore necessary
that the Physician or Surgeon should be acquainted with the laws
relating to the transfer or alienation of property either personal or
real ; with those relating to the incapacity of persons afflicted with
madness, idiotcy, dotage, &c. ; for making bequests and disposing of
their property ; and on this subject they will sometimes be required
to give solemti judicial evidence. They should also be familiar with
the laws relating to nuncupative testaments, or that 'which depends
merely upon oral evidence, being declared by the testator in extremis
before a sufficient number of witnesses, and afterwards reduced to
writing. If it be important, continued Mr. P., for medical men
to possess a certain knowledge of law, its forms and regulations ; it is
no less necessary for the lawyer to obtain some portion of medical
information. To know' the iiealthy from the diseased structure ; to
be acquainted with the several operations of the animal economy;

VOL. XI. — NO. 65. 3 X

522

Medical and Physical Intelligence,

the probable effects of different acts of violence that may be com¬
mitted on the various organs of which the body is composed ; the
morbid appearances produced by the taking of poisons, &c.

To Coroners, in particular, this knowledge is of the greatest conse¬
quence, the possession of it would enable them to make a proper exami¬
nation of the medical witnesses, upon whose judgment the nature of
the verdict almost invariably depends, and it would lead them to
attach a due importance to speculative or practical opinions, and
qualify them for correctly charging a jury. The persons who usually
compose inquests and juries have not, and cannot be supposed to
possess, any acquaintance with the operations of the animal economy:
they are, therefore, necessarily directed by the presiding legal officer^

'i’he Germans and French have paid the greatest share of attention
to forensic medicine, and their Professors have published some valu¬
able treatises on the subject : generally speaking, however, they are
but ill adapted to the jurisprudence of this country. Medical juris¬
prudence, legal or forensic medicine, or, according to the Germans,
state medicine, divides itself into two principal branches. First, That
which relates to judicial cases; and, secondly, That which relates to
the preservation of the health of the community.

The first division (to which Mr. P. confined himself in this ora¬
tion) may be regarded as it relates either to the criminal, civil, or
ecclesiastical courts.

The cases cognizable in the criminal court may be arranged under
the following heads : —

1. Poisons, animal, vegetable, mineral, and gaseous.

2. Wounds and contusions.

3. Apparent death from drowning, hanging, suffocation, intoxica¬
tion, lightning, excessive cold, lethargy or apoplexy, catalepsy, epi¬
lepsy, trances, &c.

4. Abortion.

5. Infanticide, and concealed birth.

6. Rape.

II. Those which belong to the civil court are : —

1. Insanity.

2. Idiotcy.

3. Pretended or assumed diseases.

4. Imputed diseases, consisting of impotence, lues venerea, fits,
insanity, fatuity, pregnancy, pretended and retarded delivery.

III. Those which belong to the ecclesiastical court consist of : —

1. Questions relating to marriage.

2. Impotence.

3. Hermaphrodites.,

That the orator should enter into detail upon a subject involving
so many points for consideration, in the course of time usually allotted
to anniversary orations, could not be expected. He therefore con¬
fined himself to those points which he regarded as some of the prin¬
cipal desiderata relating to this interesting branch of inquiry.

Poisons, Mr. P. remarked, have of late years been much and success-

Medical and Physical Intelligence, 523

fully attended to. The labours of the Naturalist, the Chemist, and the
Physiologist, have been equally exerted to advance this branch of
human knowledge. Certainly there are but few subjects more
worthy the attention of the Philosopher; to which his researches
may be directed with so much advantage to mankind, whether re¬
garded as affording admonitions of danger, as supplying us with the
means of averting or remedying serious disorder, or enabling us to
detect crime of the most heinous description. It is to the laborious
researches of M. Orfila that we are principally indebted for the in¬
formation we possess on this subject. By a well contrived series of
experiments, he has arrived at the most important conclusioi^. He
has described in the most masterly manner the physical and sensible
characters of poisons in their natural state, and has explained the
chemical properties of each of these substances. lie has not only
detailed the phenomena presented by the action of a great variety of
chemical tests, but he has also shown the ditferences which the
poison, when mixed with alimentary matter of various kinds, presents
when examined with the same tests, and the changes effected on the
poisonous substances by its admixture with the biliary and other
secretions. His researches are exceedingly valuable, as they relate to
the antidotes to the deleterious effects of poisonous matters. This
knowledge has been derived from experiments upon animals, in
several instances confirmed in their results by trials on the human
species. He has also pointed out the best methods of detecting the
nature of the poisonous substance, whether in its natural state or mixed
with any extraneous body. To the juridical Physician his labours
are of the highest value, for he has enumerated those symptoms
which distinguish acute poisoning from other diseases, showing the
variations of those symptoms, according as vomiting shall or shall not
have taken place, and determining the degree of confidence which
ought to be attached to the experiments in which animals are made
to swallow the matter vomited by the patient suspected of being
poisoned. He has detailed the manner of proceeding in the opening
of bodies suspected of having been poisoned ; and has shown the im¬
portance that ought to be attributed to the lesions of texture pro¬
duced by the different classes of poisons ; the different states of these
lesions in bodies already corrupted, and in those examined shortly
after death ; whether the poison has been taken during the life of the
person, or has been introduced after death.

From this slight sketch of the objects of M. Orfila, the importance
of his work, in a juridical point of view, will be evident; but, although
much has been effected by this learned Physician, still much, remains
on which it is desirable we should have information.

Poisons are derived either from the animal, vegetable, mineral, or
aerial kingdoms. They may be taken into the stomach by the mouth ;
into the lungs through the medium of the air ; into the bowels in the
form of clyster, or into the circulation by means of the absorbent
system, conveying them from the skin when applied to it in the form
of ointments. They appear to act chemically and mechanically.

<§€4 Medical and Physical Intelligence.

Upon being called to an individual who is said to have taken
poison, the first point of attention should be to ascertain the kind of
poison taken, and the manner and vehicle in which it was taken,
whether before or after a meal. The kind of food last partaken of
should be examined as to whether any mineral, vegetable, or animal
matter of a deleterious nature should be mixed with it; whether it
possesses any peculiarity of taste or smell. It has been recommended
to give a portion of it to a dog, or other animal, to ascertain its
effects ; but this will afford no certain criterion, as that matter which
is poisonous to man, may not be so to brute animals. Goats feed
readily upon hemlock, which to man is poisonous. Corrosive sub¬
limate, which to man is a poison of the most violent kind, when taken
to the extent of a few grains only, may be given to a horse in the
large quantity of an ounce without injury. Dogs are said to be '
capable of bearing, with impunity, a larger quantity of this drug than
man. On the contrary, aloes, which can be taken by the human
species in considerable quantity, when given to dogs and foxes in a
very small portion, speedily proves fatal.

Many symptoms in common with those arising from the taking of
poison, such as vomiting, purging, swelling of the abdomen, griping,
eruptions on different parts of the body, &c. may be produced from
having eaten of bread composed of grain, ergot, mildew, &c. From
peculiar idiosyncracies of constitution, many persons are affected in
a similar manner by eating several species of fruit, &c. All these
symptoms must be distinguished from those which arise from the pre¬
sence of poison. The matter vomited should be preserved for che¬
mical examination ; and should the case terminate fatally, the whole
of the contents of the stomach, and other abdominal viscera, should
be carefully preserved. The stomach in particular should then be
minutely examined ; also the whole of the intestinal canal ; and
should no particular appearances present themselves, the heart and
its large vessels, the brain, and other viscera, should be attentively
examined. It is well observed by Dr. Male, in a late publication of
Forensic Medicine, that “ unless all the different viscera are exa¬
mined, a jury should cautiously decide how far surgical evidence is
to be deemed satisfactory and conclusive. We should be careful not
to give an opinion that a person has been poisoned, without being
able to produce irrefragable proof of the fact.”

When the mucous coat of the stomach detaches itself easily froni
the muscular, so that it and the serous coat remain perfectly isolated,
Hebenstreit and Mahon regard this appearance as an infallible proof
of poison. M. Orfila confirms this remark, as it respects the corro-
sice poisons. These poisons consist of the preparations of mercury,
antimony, copper, tin, zinc, silver, gold, bismuth, the concentrated
acids, the caustic alkalies and their earths, the muriate and car¬
bonate of barytes, and cantharides. They are not all. however,
capable of producing the same train of symptoms. In certain cases,
the poison is absorbed, and carries its fatal action to the brain, the
heart, and other organs. In some instances, it is the corroded mem-

Medical and Physical Intelligence, 5^25

branes of the stomach which act by sympathy on these organs, and
suspend their functions, without any absorption taking place. In
other circumstances, which very rarely occur, death is the conse¬
quence of inflammation of the stomach, irritated by these poisonous
substances. Mr. P. then enumerated the symptoms produced by
this class of poisons. The whole of these, he observed, were not to
be expected in every case of poisoning by corrosive substances.
Excruciating pain is, perhaps, one of the most constant ; yet even this
he has known to be absent in a case to which he was called during
the last year. The subject of it was a young man, nineteen years of
age, who swallowed at least an ounce of the white oxyde of arsenic at
nine o'clock in the morning, and who expired at four in the afternoon.
Sickness; thirst; small and quick pulse; coldness of the body, and
particularly of the limbs, the skin of which was of a violet colour;
great secretion of saliva ; were the symptoms under which belaboured.
He did not complain of any degree of pain, nor did he appear to
experience any upon pressure on the region of the stomach, or on the
abdomen. A few minutes before his death, he placed his hand upon
the scroticulus cordis, and complained of a sensation of heat. His
sensorial functions were not in the least degree disturbed. Upon
examination of the body, the stomach was found in a high state of
inflammation, and the mucous easily separable from the other coats
of the stomach ; it was studded with small particles of the metallic
poison, and was very much altered in its texture, being of a pulpy
nature. The duodenum was also highly inflamed, and different por¬
tions of the intestinal canal. A case of poisoning by arsenic, unat¬
tended with pain, is reported by Dr, Laborde, in the Journal de
Medecine, Tome LXX, p. 89«

Mr. P. regarded it as a great desideratum to be able to point out
the lesions of texture, their seat, extent, and character, especially
attributable to the different kinds of poison. Those produced by
corrosive sublimate are as yet not to be distinguished from such as
result from other species of corrosive poison. The lesions of tex¬
ture produced b}^ arsenic, are generally such as result from inflamma¬
tion of the mouth, oesophagus, stomach, and intestines. The stomach
and duodenum are frequently affected with gangrenous spots, studded
with dark coagula, resembling sloughs (but not really such, as is
shown by Mr. Brodie, in the Phil. Trans. Part I, for 1812), and the
mucous coat of the stomach is reduced to a reddish brown pulp.
Other visera often present marks of inflammation.

The orator then proceeded to notice those lesions of structure attri¬
butable to poisoning wdth the various kinds belonging to the first class,
noticing particularly those arising from antimony, copper, tin, zinc,
silver, gold, bismuth, the concentrated acids, the alkalies, and cantha-
rides. The other classes of poisons were then examined in a similar
way, and the lesions of texture produced by these enumerated. Mr. P.
dwelt thus long on the subject of poisons, because the medical Prac¬
titioner is most frequently called upon to give his testimony respecting
them. A review, he remarked, of what had been said, would
clearly evince the»great difficulty that exists in determining whether

5^6 Medical and Physical Intelligence*

an individual has been poisoned, and if so, to what class the poison
ought to be referred. The symptoms in common to many diseases
are similar to those which arise from the taking of poison. Many

cases on record will justify this assertion. The lesions of texture

found after death, in many cases of indigestion, cholera morbus, and
some other affections, also resemble those witnessed in the examina¬
tion of the bodies of persons poisoned. It is, therefore, of the highest
importance carefully to note every s37mptom, and to compare the same
with the morbid appearances that may afterwards be ascertained to
exist. There is occasion to fear, that for want of this knowledge,
some individuals have been condemned upon insufficient testimony. It
has been shown, bv the celebrated J. Hunter, that the stomach of
persons dying from hunger, or from any other cause, in a very

sudden manner, is frequently found dissolved or eroded in various

parts. Perforations in this organ have been nriet with in cases where
there could not be any reason for attributing them to the having
taken of poison. Thus, (he concluded,) it is evident that by the aid of
chemical means, in order to detect the nature of the substance taken ;
of to examine into and discriminate the character of the
symptoms ; and of ‘pathological anatomy, to trace the connexion
between these and the appearances on dissection, that we can hope to
arrive at any precise or satisfactory knowledge of the subject on
which we may be called upon to deliver a most serious opinion. On
the subject of wounds Mr. P. remarked, that it was not necessary for
him to speak at length, since, happily^, the law looks to the intention,
rather than to the effect produced. He alluded to the difficulty of
establishing criteria to distinguish wounds whether mortal, probably
or accidentally so, or otherwise. The subject of asphyxia, or appa¬
rent death, came next under observation, and the variety of causes
producing this state noted. To distinguish apparent from real
death, numerous methods, he observed, had been contrived ; but
it is now generally admitted, that nothing short of the commencing
appearances of putrefaction can be considered as a satisfactory dis¬
tinction. To ascertain whether the vital spark be extinct, or merely
dormant, is, indeed, a matter of the highest importance : it behoves us
all not to consign to the grave those who appear to have expired
suddenly, until such means as are recommended to be adopted in
these cases have been persevered in for a considerable time. Exa¬
minations of the bodies of persons who have died from the causes
mentioned should in all cases be made; they will lead to the best
result. In cases of the drowned, the heart, and the right side in par¬
ticular, is found loaded with darl^ coloured blood ; the lungs are
livid and distended with dark blood ; there is a frothy effusion often
of a pale red colour in the bronchia. Hebenstreit states, that the
diaphragm in these cases is found bent towards the abdomen: this
cannot possibly be true, as a drowning person continues to expire
some time after he has ceased to inspire. In those who die by a
stroke of lightning, the blood loses its power of coagulating. This, in
a lesser degree, is the case with the drowned.

Infanticide and concealed birth forms one of those unhappy cases
2

✓

527

Medical and Physical Intelligence,

which frequently demands the presence of the medical Practitioner in
a court of justice. Every man of feeling will revere the memory of
Dr. Hunter for having written the paper on this subject, inserted in
the Med. Obs. and Inquiries. That humane Physician possessed
extensive opportunities of knowing intimately the female character.
To use his own words, he had seen the private as well as the public
virtues, the private as well as the more public frailties of women, in
all ranks of life. He had been in their secrets, their counsellor and
adviser in the moments of their greatest distress in body and mind.
He had been a witness to tbeir private conduct, when they were pre¬
paring themselves to meet danger, and had heard their last and most
serious reflections, when they were certain they had but a few hours to
live. That knowledge of women had enabled him to say, though no
doubt their will be many exceptions to the general rule, that women
who are pregnant, without daring to avow their situation, are com¬
monly objects of the greatest compassion; and generally are less
criminal than the world imagine. The evidences of guilt in these
cases should be most circumspectly examined. Those usually stated
as such by medical men can be little depended upon. Prejudice
operates but too generally against the unfortunate. Mr. P. then
adverted to the several inquiries necessary to be made in these cases,
and having shown the extreme vagueness of several of them, Mr. P.
passed on to the consideration of medical jurisprudence, as it relates
to insanity, which belongs to the civil as well as the criminal courts.
On this important head Mr. P. brought forward the opinions of Sir
Matthew Hale, Lord Erskine, Dr. Haslam, and some other eminent
writers, and then concluded the oration with a few remarks on that
branch of police which relates to the establishment of houses for the
reception of the insane, and on the economy of which the probability
of the recovery of the patients confined within their walls must
materially depend.

The late parliamentary investigation, he observed, had brought
to light the existence of numerous abuses shocking to humanity ;
and although it had not hitherto excited a correspondent degree of
activity on the part of the legislature for their removal, yet its results
cannot but be attended with the most beneficial effects.

“ As no greater trust can possibly be reposed in any individual
than that which is confided to the keeper possessing absolute authority
over a fellow-creature deprived of the exercise of his reason, and
unable to state his complaints or obtain redress for his grievances, it
is of the highest importance that great circumspection should be ex¬
ercised in the selection of those individuals to whom the superintend¬
ance of the insane is to be committed. They should be men of
unblemished character, of benevolent disposition, of calm and dispas¬
sionate tempers. They should unite decision of character with gentle¬
ness of manner, to ensure at the same time the respect and fear of those
subjected to their control. Mild and consolatory language will, it is
satisfactorily proved, tend much to the recovery of the insane; whilst
a contrary conduct increases the violence of the disease. If coercive
measures, or, I would rather say, the exercise of force, ought eyer to

.528

Medical and Physical Intelligence,

be employed, it should be directed to its object accompanied with the
least degree of irritation possible. The many fatal accidents which
have from time to time occurred, prove the necessity which exists for
the keeper’s ntmosl circumspection. Every instrument of danger
should i)e removed from the maniacs sight, tSiat no association of
ideas may be created to tempt him to the commission of any act of
violence either on himself, or to those around him.

“ The peculiar feelings and habits of the different maniacs who
are. associated together, should be most carefully examined into.
Lunatics generally retain some of those prejudices and sentiments
which were imbibed previously to the loss of reason. To place a
patient afflicted with deep religious melancholy in the same apart¬
ment with one who makes a sport of religion, or to associate a person
of a timid disposition with an individual of a violent character, is to
commit an act of great cruelty towards on^ of the parties, and highly
prejudicial to the recovery of both.

“ To strike, or otherwise maltreat maniacs for any part of their con¬
duct, however outrageous, is an evident dereliction of the very prin¬
ciple on which alone the right of restraining their persons is founded.
The dictates of law, as well as of reason, pronounce them guiltless, in a
moral view, of every offence they may commit. They are neither held
responsible for their actions, nor are they considered to be susceptible
of reform from the influence of opinion, or the fear of punishment.
When sent to a madhouse, it is not intended that their keepers should
act towards them as judges or as executioners, but as guardians of their
persons, and alleviators as far as possible of the sufferings which Pro¬
vidence has attached to their existence. The unhappy fate of the
confined lunatic should be commiserated, and the rigour of his con¬
finement softened by an unceasing attention to his personal comfort.
The furious and flighty maniac should be gently soothed to reason,
and the melancholic should be roused from the stupor of despair by
encouraging a feeling of his own dignity and importance. By such
means alone can the purposes of lunatic establishments be accom¬
plished. The exercise of severity within their walls is abhorrent to
< very sentiment of humanity, and repugnant to every rule of j udgment.

“ The present mode of licensing houses for the reception of insane
persons he conceived liable to many objections. A defect, and one
of a very serious nature, in the existing laws relating to licenses, is the
circumstance of those being excepted from the necessity of obtaining
them, who take only one lunatic under their charge. Such persons
are also free from the obligation incumbent upon the keepers of
large establishments, of stating the condition of their patients, and
submitting to the visits of an inspector. The dangerous tendency of
these exceptions is so manifest, that it is difficult to conceive upon
what grounds they have been originally suggested. The evils of mis¬
management in public institutions are of trivial consequence, com¬
pared to those which may arise to society from the possibility of any
individual being consigned to solitary and perhaps perpetual seclusion.’^

529

Medical and Physical Intelligence,

The Pupils and Friends of Mr. Astley Cooper and Dr. Kaighton
have an opportunity of furnishing themselves with engraved Portraits
of those celebrated Characters at a very trifling expense, by applica¬
tion to Mr. Cox, Medical Bookseller, St. Thomas’s Street, Borough.

, NOTICE OF LECTURES.

Dr. Merriman, Physician-Accoucheur to the Middlesex Hospital ;
and Dr. Ley, Physician-Accoucheur to the Westminster Lying-in Hos¬
pital ; will commence a Course of Lectures on the Theory and Prac¬
tice of Midwifery, and the Diseases of Women and Children, on Mon¬
day, the 7th of June, at Half-past Ten o’Clock.' — Particulars may be
learnt at Dr. Merriman’s, No. 26, Half-Moon Street, Piccadilly ; at
Dr. Ley’s, 62, South Audley Street ; and at the Middlesex Hospital,
where the Lectures will be given.

LITERARY NOTICES.

The Army Medical Officer’s Manual upon Active Service. By
J. G. V. Miliingen, M.D.

Dr. J. Veitch has in the press, Part I. of a Synopsis of the
Principles and Treatment of the Diseases of the Eye.

Dr. Bateman is preparing for the press. Reports on the Weather
and Diseases of London, from 1804 to 1816 inclusive.

Mr. Murray, the Chemist, is preparing for the press a Translation
of Chaussier on Counter-Poisons, rendered intelligible to those who
have not studied the curative Art; with numerous Notes, the results
of Mr. M.’s own Researches on Poisons.

In the press, and speedily will be published, a short Account of the
Principal Hospitals of France, Italy, Switzerland, and the Nether¬
lands; with Remarks upon the Climate and Diseases of those
Countries. By Plenry William Carter, M.D., F.R.S. Ed. ; one of
Dr. Radcliffe’s travelling Fellows from the University of Oxford.

Dr. Harrington, from whose work all the new and improved
Nautical Tables have been taken, has in the press, and it will be
publislied shortly, an Extension of his Important Theory and
System of Chemistry, elucidating all the Phenomena, without
one single Anomaly,

Preparing for publication, an Essay on the Diagnosis, Morbid Ana¬
tomy, and Treatment of the Diseases of Children. By Marshall Hall,
M.D., F.R.S.E., &c.

The Enemy of Empiricism ; or, a concise Explanation of the Func¬
tions of the Male Organs. By a genuine Disciple of Hippocrates.

In the press. Cases of Hydrophobia. By Dr. Pinckard.

VOL. XI. — NO. 66. 3 Y

530

A ^METEOROLOGICAL TABLE,

From the 2\st of APRIL to the 20M of MAY, 181.9»
KEPT AT RICHMOND, YORKSHIRE.

Baron

Max.

leter. I
Min.

The

Max

rra.

Min

Rain

Gauge

Winds.

Weather.

SW.. NW...

134 Cloud... 2 Sun.

NE.

134 Cloud... 2 Sun.

E..

1 Sun..

EbN.. ^

1 Sun...

ENE..

1 Sun..

EbN.

1 Sun..

O An*

SE..

1 Cloud.. 2 Sun..

SSE..

1 Sun....

SE.

1 Cloud.. 2 Sun..

SE...

1 Cloud.. 2 Sun.. 4 Rain.

SE.. SW..

14 Cloud.. 2 Rain.. 3 Sun..

SE..

1 Sun...

SW.. E..

1 Sun..

NW.. EbN..

1 Sun.. 3 Cloud...

EbN..

1 Sun.. 3 Cloud...

ESE.

1 Cloud... 2 Sun..

SSE..

13 Cloud.. 2 Sun.. 4 Moon..

SE..

13 Sun.. 2 Cloud.. 4 M..

SE.. WSW..

1 Sun.. 2 Rain.. 4 Cloud..

WSW..

1 Sun.. 3 Rain....

SW..

1 Sun..

SW..

1 Sun..

SW.. WbN..

1 Sun.. 4 Star!....

29'

WbN..

1 Sun...

Vble.

1 Sun..

SW.

1 Sun..

SSE..

1 Sun.. 3 Cloud..

SW..

1 Cloud.. 2 Sun..

SE.

1 Cloud... 3 Rain..

NbE..

14 Rain... 23 Cloud....

The quantity of rain during the month of April was 2 inches &. 17-lOOths.

Observations on Diseases at Richmond.

The disorders under treatment were Asthma,' Colica, Cynanche ton¬
sillaris, Diarrhoea, Dyspepsia, Enteritis, Epistaxis, Febris simplex, Gastro-
dynia. Haemoptysis, Hydrocephalus, Marasmus, Obstipatio, Ophthalmia,
Rheumatismus acutus, and Scabies.

^31

THE METEOROLOGICAL JOURNAL,

From the 20th of JPRIL to the 19^^ of MAY, 1819>

By Messrs. HARRIS and Co.

Mathematical Instrument Makers, 60, High Holborn.

Moon

pc;

Therm.

Barom.

De Luc’s

Dr^.

Hygrom.

Damp.

Winds.

‘20

,02

SW E

‘21

,03

wsw

NW 'i

2 ‘2

NE C

‘23

ENE

SE (

E [

,15

ENE

ENE 1

,18

ENE

E E

RSE

E !

,04

,03

SSE

SSW I

WSW

SSE

,15

p:se

,05

SSE

ESE

,88

WSW

SSW

.30

ESE

,12

WNW

NNW

SSE

WSW

,15

Atmo. Variation.

:io.

Rain

liain

Fine

Elain

Fine

Clo.

Fine

Cio.

Fine

Sho. i
Clo. I
Rain I

Fine

Clo.

Fine

Rain

Clo.

The quantity of rain fallen in the month of April is 2 inches and

13-lOOths.

532

A REGISTER OF DISEASES
Between APRIL 20th and MAY 19tK 1819*

DISEASES,

Total.

1 Fatal.

Abortio .

Abscessio .

Acne . .

Amaurosis .

Amenorrhoea .

Amentia . .

•V

Anasarca .

Anorexia . .

Aphtha lactentium » • • •

Apoplexia .

Ascites .

Asthenia .

Asthma .

Bronchitis acuta .

Bronchocele .

Calculus .

Carbunculus .

Cardialgia .

Carditis . . .

Catarrh us .

Cephalalgia .

Cephalcea .

Chlorosis .

Chorea .

Cholera • . . * .

Colica .

Convulsio • • • • * .

Cynanche Tonsillaris • *

- - - maligna • * • •

- Trachealis • •

■ - - Tarotidea^ • • •

- - — Laryngea • • • •

Diarrhoea .

Dolor lateris • • * .

Dysenteria . .

Dyspepsia .

Dyspnoea . . *

Dysuria . *

Ecthyma

Eczema .

Enteritis .

Entrodynia • * .

Epilepsia • • . .

-1

Epistaxis .

Erysipelas • • • . .

Erythema Ice'oe .

_ _ _ — papu latum • • •

Exostosis .

■

DISEASES.

Febris Intermittent
- caiarrhalh' •

« • • • C 9 •

- Synocha . .

- Typhus mitior • •

- - Synocims .

- — ~ Remit . Infant. • '

Fistula . . "

Furuncuius
Gastrodynia
Gonorrhoea pura
Hasmatemesis •
Haiinaturia • • •

Haetnoptbe .

Haeraorrhois • • •
Hepatalgia
Hepatitis
Hernia •

Herpes Zoster • • •

- — circinatus-

- - labialis' • •

prtrputialis

• fi e • • • »

4 • • 9 • •

• • • • • •

Hydrocele
Hydrocephalus •
Hydrothorax • • •
Hypochondriasis
liysteria •••••••*

Hysteritis .

Icterus . . • • •

Impetigo fgurata
Ischias .♦•••••••

Ischuria . . • '

Lepra . .

Leucorrhcea • • • • ■
Lichen simplex • • ■
Lithiasis
Mania
Melancholia

9 • • » • •

• • • • 9

Menorrhagia

Miliaria'

Morbi Infantiles^

- Biliosi* • "

Nephritis* ••••♦*

Neuralgia .

Obstipatio • • • • •

Odontalgia .

Ophthalmia • * • • •

Otalgia .

Palpitatio ••••••

Paralysis .

Paronychia • • ♦ ♦

. 2

, 5

^ 12

. 45

Observations on Prevailing Diseases.

55S

DISEASES.

Pemphigus .

Peripneumonia .

Peritonitis .

Pertussis .

Phlogosis .

Phrenitis . . •

Phthisis Pulmonalis •

Plethora .

Pleuritis . . . . . .

Pleurodyne .

Pneumonia • • . .

Podagra .

Polydipsia .

Pompholyx henignus
Porrigo larvalis • • • •
-favosa .

Prolapsus

Prurigo mitis .

- senilis .

Psoriasis guttata • •

- — gyrata • • •

- inveterata

Purpura simplex • • •

Rosicedo .

Rheuma acutuS' • • •

Total.

Fatal.

1 DISEASES.

Total.

Fatal.

Rheuma chronicus .

Roseola .

Rubeola .

Scabies .

Scarlatina sbnplex .

1 - - - anginosa • • • •

Scorbutus .

' Scrofula . .

1 Spas mi .

' Splenitis .

1 Strictura . . •

Strophulus intertinctus •

1 Syphilis .

' Tabes Mesenterica .

Tussis .

1 Vaccinia .

, Varicella .

Variola .

Vermes .

Vertigo .

Urticaricifebrilis .

Total of Cases .

1222

Total of Deaths .

* Morbi Infantiles is meant to comprise those Disorders principaliy arising from den¬
tition or indigestion, and which may he too trivial to enter under any distinct head; Morbi
Biliosi, such Complaints as are popnlarly termed bilious, hut cannot be accurately classed.

Observations on Frevailing Diseases.

The diseases of the past month have not been marked by any striking
peculiarity, with the exception that pulmonary and bronchial affections have
been very frequent accompaniments of the febrile cases, and in many in¬
stances a more than ordinary susceptibility has been evinced to the induc¬
tion of erysipelatous inflammation, from the application of leeches and
blisters.

** Fever (says one of our Reporters) is much diminishing, and those cases
which are now met with in our district, appear but seldom to arise from con¬
tagion ; in most cases they have been fairly referrible to some error in the
non-naturals, wrong indulgencies in diet, excessive exertion, improper ex¬
posure,

Will any of our correspondents say whether they have employed the pyrola
umbellata, and with what effect ?

5S4

Prices of Substances employed in Pharmacy,

Quarterly Report of Prices of Substances employed in Pharmacy

-a^>>

Acacia Gummi elect.

lb.

Acidum Citricum

- Benzoicum

unc.

- Sulphuricum

P. lb.

- Muriaticum

- Nitricum

- Aceticum

cong.

Alcohol ...

M. lb.

2Ether sulphuricus

- rectificatus

Aloes spicatae extractura

lb.

— vulgaris extractum

Althaea; Radix

A lumen

Ammonias Marias

- Subcarbonas

Amygdalae dulces

Ammoniacum (Gutt.)

- (Lump.)

Anthemidis Flores

• •

Antimonii oxydum

- sulphuretum

Antimonium Tartarizatum

•

Arsenici Oxydum

Asafoetidae Gummi-resina

- lb.

Aurantii Cortex

A.r£tenti Nitras

• unc.

Balsamum Peruvianum

lb.

Balsamum Tolutanum

• •

Benzoinum elect.

Calamina prfeparata

Calumbae Radix elect.

Cambogia

•

Camphora

Canellae Cortex

•

Cardamomi Semina

lb.

Cascarillae Cortex

CastoreuHi . . .

unc.

()

Catechu Extractum

lb.

Cetaceum

Cera alba

•

- flava

Cinchonas cordifolias Cortex (yellow)

- lancifoli® Cortex (quilled)

- oblongifoliae Cortex (red)

Cmnamomi Cortex

Coccus (Coccinella)

unc.

Colocynthidis Pulpa

lb.

Copaiba

(Jolehici Radix

Croci stigmata

unc.

Cupri sulphas

lb.

Cuprum ammoniatum

Cuspariae Cortex

Confectio aromatica

- Aurantiorum

Opii

- - - Rosae canins

- Rosae gallicae

— — Senna;

Emplastrum Lyttas

- Hvdrargyri

Extractum Belladonna

unc.

- - Cinchona

- •

- - Cinchona resinosum

- - Colocynthidis

0 i

- - Colocynthidis comp.

- - Conn

- Elaterii ‘

- - Gentiana

Glycyrrhiza

lb.

Hamatoxyli

11 nc.

- - Huinuli

Hyoscami

unc.

- Jalapa * Is'.

6ii, Res.

- Opii

- Papaveris

- - Rhai

.:!>

- - - Sarsaparilla

„

- - - Taraxaci

.9 !

B'erri subcarbonas - - lb.

— sulphas -

Ferrum ammoniatum

- tartarizatum

Galbani Gummi-resina.

Gentianae Radix elect. . - .

Guaiaci I'esina . . - .

Hydrargyrum purificatum
— — prascipitatum album

- cum creta

Hydrargyri Oxymurias - unc.

- Submurias . - -

- Nitrico-Oxydum

— ^ Oxydum Cmereurn

- Oxydum rubrum - ' -

- Sulphuretum nigitim

- - rubrum

Hellebori nigri Radix lb.

Ipecacuanhae Radix

- Pulvis ...

Jalapse Radix ...

- Pulvis - ...

Kino - - ...

Liquor Plumbi subacetatis M. lb.
— Ammonia; ... -

— Potassas ....
Linimentum Camphorae comp.

- - saponis comp.

Lichen - - - lb.

Lyttas _ - -

Magnesia . . . .

Magnesiae Carbonas

- Sulphas

Manna

— communis

Moschus pod, {60s.) in gr. unc.
Mastiche ... Jb.

MyristiCcC Nuclei
Myrrha . . _

Olibannm - - -

Opopanacis sfummiresina
Opium (Turkey)

Opium (East India)

Oleum Thhereint) - oz.

— Amygdalarum • Ib.

— Anisi ... unc.

— Anthemidis ...
— Cassias
•— Caryophilli

— Cajiiputi ...
— - Carui .....
— Juniperi Ang. ...
— Lavandulje

— I.ini - - cong.

— Menthas piperitas - unc.
— Menthse viridis Ang. -
— Piinenta; - - unc.

— Ricini optim.

— Rosmarini - - unc.

— Succini 2s. 6d. — — rect.

— Sulphuratum - P. lb.

— Terebinthinae ...

— — rectificatum

Olivac Oleum - - cong.

Oliva; Oleum secundum
Papaveris Capsulas - (per 100)

Plumbi subcarbonas - - lb,

— Supcracetas ...

— Oxydum semi-vitrcum

Potassa Fu'sa . . ., unc.

— c\un Calce - •

Potassa; Nitras . - . • lb.

— Acetas ....

— Carbonas ...

— Subcarbonas

— Sulphas

— Sulphuretum •

— Supersulphas

— I'artras ...

— Super tartras ...

5
16

6
9

5
0
0
0
1

6
0
0
3

3
1
6

4
1

3
0
7

7
3

8
6

5
1

6
10

Monthij/ Catalogik of Books.

535

Pilulee HydrargjTri - - unc.

Piilvis Aiitimonialis
— Contrayervae comp.

— Tragacanthae comp.

Resina Flava - - lb.

Rhagi Radix (Russia) ...

— r— (East India) opt. -

RosfB pptala - - -

Sapo (Spanish) ...
Sarsaparillse Radix (Lisbon)
Scammonise Gummi-Resina - unc
Scillas Radix siccat. opt. Ang. lb.
Sen^fe Radix - - -

Sennse Folia - - -

Serpentarise Radix
Simaroubae Cortex
Sodse subboras . . -

— Sulphas - . .

— Carbonas . - -

— Subearbonas
— — exsiccata

Soda tartarizata

Spongia usta - . . -

Spiritus Ammoniae - M. lb.

— - aromaticns

— - foetidus

— - succinatus

— Cinnamomi - . .

— Lavandulae - . -

0 6
0 9

0 4

40 0

10 0
14 0

2 6
0 6

5 6

4 ()

4 0

6 G

7 6

3 6

4 0

0 6
6 6
1 6
4 6

2 6

24 0

4 6

5 0

6 0

5 6

3 6

5 6

Spiritns Myristic® ...

— Pimentae . - .

— Rosmarini - -

— .iDtheris Aromaticus

— — Nitriei

— — Sulphurici

— — Compositus

— Vitii reetificatus - cong.

Syrupus Papaveris - - lb.

Sulphur ...

— Sublimatum

— Lotum - -

— Prascipitatum

Tamarindi Pulpa opt. - - .

Terebinthina Vulgaris

- Canadensis

- Chia

Tinct. Ferri muriatis

Tragacantha Gummi - - -

Valerian® Radix - -

Veratri Radix - -

Unguentum Hydrargyri fortius

- - Nitratis

— - Nitrieo-oxydi -

Uv® Itrsi Folia - - -

Zinci Oxvdum - -

— Sulphas purif. - -

Zingiberis Radix opt. ...

Prices of New Phials per Gross. - 8 oz. 705. — 6 oz. 58s- 4 oz. 475. — 3 oz. 435. — 2 oz. and

lij oz. 365. — 1 02. 305. — half oz. 245.

Prices of second-hand Phials cleaned, and sorted. - 8 oz. 465. — 6 oz. 445. — 4. oz. 33s.

3 oz. 305. — 2 oz. and all below this size, 25s.

MONTHLY CATALOGUE OF BOOKS.

The Medical Topography of Upper Canada. By John Douglas, Surgeon
8th Regiment. 8vo.

An Arrangement of British Plants, according to the latest Improvements
of the Linnaean System ; with an Easy Introduction to the Study of Botany.
Corrected and considerably Enlarged. By W. Withering, Esq., F.L.S,
4 vols. 8vo.

Observations on the History and Treatment of the late Epidemic Dis¬
orders which Prevailed in the North of Ireland. By F. Rogan, M.D.

Medical Botany, No. V. Published in Monthly Numbers, with Plates.
Octavo.

A Practical Treatise in the Instruction and Amusement of the Blind,
calculated to promote their personal Happiness, and enable them to employ
themselves with Profit and Advantage. 8vo.

An Inquiry, illustrating the Nature of Tuberculated Accretions of Serous
Membranes, &c. &c. By John Baron, M.D. 8vo. Plates.

Dr. Parkinson’s Tyrocenium Medicum, New Edition. 12mo.

Transactions of the Geological Societies, Vol. III. Part I.

An Essay on the Diagnosis of Erysipelas ; with an Appendix, touching
the probable Nature of Puerperal Fever. 8vo.

The Quarterly JournaPof Foreign Medicine and Surgery, No. III. Pub¬
lished Quarterly.

Annals of Health and Long Life, with Observations on Diet and Regimen,
&c. &c. By Joseph Taylor. 12mo.

A Report on the Practice of Midwifery at the Westminster General Dis¬
pensary, during 1818: including new Classifications ot Labours and Abor¬
tions, Female Complaints, and the Diseases of Children, &c. &c. By A. B.
Granville, M.D. 8vo.

An Explanation of the Real Process of the “ Spontaneous Evolutions of
the Foetus with some Remarks, intended to induce an Inquiry whether the
Practice of Turning be not too generally had recourse to in Arm Presenta-
tion.s. By J. C. Douglas, M.D., &c. 8vo. Second Edition.

5S6’ Notices to Correspondents*

Accum^s Chemical Amusement, comprehending a Series of. Striking and.
Instructive Experiments, which are easily performed, and unattended by
Danger. ' Fourth Edition. 12mo. ;

Observations on the Prevalence of Fever in various Parts of the United
Kingdom ; and of the eminent Utility of Houses of Recovery. By D. J. H.
Dickson, M.D. 8vo.

A Narrative' of a Voyage to New South Wales, in the year 1816, in the
ship Mariner, describing the Nature of the Accommodations, Stores, Diet,
&c. ; together with an Account of the Medical Treatment, &e. By John
Haslam, juiir Surgeon, Royal Navy. 8vo.

An Essay on the Forces which move the Blood, as distinguished in their
Laws from those of Dead Matter. By Charles Bell. . 12mo.

A Letter to His Majesty's Sheriff Deputes in Scotland, recommending the
Establishment of Four National Asylums for the Reception of Criminal and
Pauper Lunatics. By Andrew Duncan, -sen. M.D. and P. 8vo.

Observations on the Management of Children from their earliest Infancy;
and the Prevention and Treatment of some of their most dangerous Dis¬
orders, &c. By D. Moore, M.D.

Blake's Aphorisms, Nevv Edition. 12rao.

Weatherhead's Remarks on Erysipelas. 8vo. - -

Pearke’s Popular Directions on the Diseases of Sedentary Persons. 8vo.

Phillips’s Elementary Introduction to Mineralogy, New Edition, greatly
Enlarged and Improved. 8vo.

Observations on Hemeralopia; or. Nocturnal Blindness, with Cases and
Practical Illustrations. By Andrew Simpson, Surgeon. 8vo.

An Analysis of the Subject of Extra-Uterine Foetation, and on the Retro¬
version of the Gravid Uterus. By John King, Esq. of South Carolina. 8vo.

NOTICES TO CORRESPONDENTS.

Acknowledgments are due this month to Dr. Maclean, Dr. Hamilton,
Dr. Ciutterbuck, and Mr. 'Andree. ' -

, The notice of Mr, Samuel Young, Swrgeow to the Cancer Institution,
respecting his Lectures, came too late for insertion. We have only room
here to state that his Course will commence on the ist of July next.

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

END OF THE ELEVENTH VOLUME.

J. MOTES, GREVILLE STREET, LONDON.

I N D E X

THE ELEVENTH VOLUME.

Ahernethy on life, Woodhams
remarks on - - 353

Acid, oxalic, case of death from 20

— reumic, on - - - 168

— perchloric - - - ib.

^sculapius’s hospital pupil’s

guide - - “138

^ther sulphuric, mode of pre¬
paring of - - - - 169

Alkali, vegetable, description of
a new one - - - 165

Algae plants. Gray on - - 287

Alum, adulteration of wines with 250
Amputation of the upper arm,
case of - - - - 101

America, sea snake of - - 169

Amnios, dropsy of, case of - 315
Ammonia, its use in some spe¬
cies of gravel - - - 314

Ancients, their opinion on fcon-
tagion . - - 411,504

Anniversary oration, abstract of
Mr. Fettigretd’s before the
Medical Society - - 520

Antimony mixed with wine, how
to detect it - - - 253

Anatomical nomenclature, Par¬
kinson on _ , - 364

Aneurism of the heart, &c. oc¬
casioning asthma - - 149

Animal food, abstinence from,
its effects in gravel - ' - 317

— occasions calculous com¬
plaints - - - - 54

Aorta, case of aneurism of,
simulating oedema of the
glottis - _ - - 337

Apposition common to all sur¬
faces in the body - - 391

Apoplexy, cyst in, examples
of - “ - - -318

— an unphilosophical term in

nomenclature - - _ 484

Arsenic taken without injury - 80

— best counteractives of - 31

Arachnoid, inflammation from
external injury - - - 510

cartilages, diseases

- - - 45

Arm, upper, case of amputation
of - - - - - 101

Arsenious acid mixed with wine,
method of detecting it - 253
Armstrong on puerperal fever,
extract from - - - 395

— his view of fever defended - 392
Aristotle on the plague, extract
from - - ^ - 413

Arteries, intercostal and mam*
mary, divided by a wound in
the thorax - - - 3 1 1

Asphyxia, cases of - - 73

Asthma of aged people, of what

nature is it ? - - - 145

Astringency, a principle in me¬
dicinal agency difficult to ac¬
count for - - - - 125

Azotic principle in aliment, as
leading to calculus - - 53

Pattley on sarsaparilla - - 190

Bayle on oedema of the larynx 320
Balfour on emetic tartar,' refer¬
red to - - - _ 394

Belladona, description of - 210

Blood-letting in fever - - 392

Bladder, urinary, case of enlarge¬
ment of - - - - 478

Blackstone on the legal know¬
ledge required in medical
professors - - - - 521

Blenorrhoea, Mac Kenzie on - 303
Blue, Prussian, its action on
starch - - - - 168

Blane's medical logic, reviewed 216
Books, analytical review
OF Medical. — Brodieon dis¬
eases of the joints, 33. Ma-
gendie on urinary concretions,

50. Morgan on the philoso-

Articulating

VOL, XI. — NO. 66. 3 z

538

INDEX,

phy of life, 115. Hall on the
mimoses, 129. Hospital pu¬
pil’s guide, 138. Orjila on
poisons, 213. Blane on me¬
dical logic, 216. Yeats on
hydrencephalus, 293. Thom¬
son's London Dispensatory,

297. Mac Kenzie on lachry¬
mal diseases, 299. Hallaran
on insanity, 309. Treatises
on epidemic fever, 380, 494.
Medical botany, 401. Pow-
er's treatise of midwifery, 402.
Books, New, monthly catalogue
of - 88, 176, 264, 351, 439, 335
Boerhaave, his opinions and
character alluded to - - 225

Botany, medical, review of - 401
Boullay on the menispernum
cocculus - - - - 517

Brodie on diseases of the joints,
review of - - - - 33

Bronchocele, case of - - 76

Breschet on fistula - - 89, 177

Brande on the nature and treat¬
ment of gravel - 140, 230, 313

Brain, membranous inflamma¬
tion of without fever, fatal
case of - - - - 241

— morbid, dissection of - - 13

— after fever - _ _ 399

— and nerves, their separate

functions - _ , 122

— ' is it capable of compression ? 390
Brandy, adulteration of wines
with - - _ - 252

Brown on fever, reviewed - 381
Burgis's case of amputation of
the upper arm - - - 101

Burns, Orjila on •’ - - 215

Calculus, Magendie on, review^-
ed - - - - - 50

— Brande on - - _ 140

Cayol’s case of aneurism of the

aorta, simulating oedema of
the glottis . _ _ 337

Cardiac syncope, case of - 428
Cartilaginous ulceration, Brodie
on - - - - - 40

Caries of the spine, Brodie on " 48
Canin’s account of a wound in
the trachea - _ « I63

Catalepsy in madness more com¬
mon in females than in males 310
Caesarean operation, case of - 77

Capsicum, description of - 212
2

Calomel too indiscriminately ad¬
ministered - - - 295

Canals, lachrymal, wounds of - 301
Catarrh, how is it produced ? - 124

Chemistry, foreign articles rela¬
tive to - - 165, 517, 519

Chomelon cerebral inflammation
without fever - - - 243

Chalk, adulteration of wines
with _ _ - - 251

Chalybeates often used with ad¬
vantage in combination with
purgatives - - - 137

Cinchona bark, substitute for - 79

Cicatrization of the brain, cases
of - - - - - 154

Classification, physiological, its
object - - - 219

Cluiterbuck's principles in vene¬
section, referred to - - 36.2

Classification, botanical,Grfl3/ on 202
Cloquet on the nervous ganglia
of nasal cu.vities - - - 65

Clutterbuck on fever, review of 380'
Cooke on the venereal disease - 16

CoREESPONDENTS, notices to - 88,

176, 264, 352,440, 536
Contagion, Morgan on -■ 128

— Mitchell on - - - 191

— Yeats on - - 411, 504

Cooke's, TE. cases and remarks

on hydrocephalus - - 441

Colocynth, case of poisoning by 161
Corpulency after recovery from
insanity a good indication - 310
Colour, method of imparting ar¬
tificial colour to - - 252

Copper mixed with wine, how
to detect it - _ _ 253

Corporeal and mental insanity
an unfounded distinction - 309
Corpora lutea. Sir E. Home on 343
Congestion, venous, is it consist¬
ent with deficient action in the
arteries.? - - - - 395

Croup, iecse’s case of - - 26

Cranium, extensive fracture of,
case of ' - - - - 187

Critical days in fever, Percival's
opinion on - _ _ 399

— Graham's ditto - - 499

Croup, often simulated by other

diseases - _ - « 437

Curtis on puriform discharges
from the ear - _ , 403

Cullen's nomenclature objected
to - - - - - 484

INDEX.

659

Cjst, apoplectic, examples of - 318

Delirium tremens, Southern's
case of - - - - 185

Delivery, premature, required
on account of dropsy of the
amnios - - - - 515

Dispensatory, Thomson's, review
of - - - ^ - 297

Dickson on fever, reviewed - 381
Diabetes, cases of - - - 429

Dissections, morbid, two cases of 477
‘ — four cases of, after hydroce¬
phalus - - - - 445

Discharges of pus from the ear 103
Ditrachyceros rudis, Pascal on 238
Digitalis, its use in insanity - 312
Diodorus Siculus on the Athe¬
nian pestilence, extract from 412
Diseases incapable of being clas¬
sified and defined with preci¬
sion ----- 127
Digestion, disorders of, some¬
times productive of white
sand in the urine - - 143

Digestive organs, a term too in¬
discriminately and vaguely ap¬
plied _ - _ _ 294

Diet, vegetable, good in gravel 317
Drugs, foreign, general prefer¬
ence of - - - - 298

Dropsy of the amnios, case of - 515
Duct, thoracic, obstruction of *- 68

Duodaenal diseases, not suffi¬
ciently distinguished from he¬
patic affections - - - 294

Duclos’ case of elongation of the
anterior labium of the uterus 254
Dyacanthos polycephalus, Stie~
bet on - - - - 241

Ear, on puriform discharges from 103
Effusion not always consequent
upon inflammation in hydro¬
cephalus - - - - 458

Emphysema from a wound in the
trachea, case of - - 163

Emetic plants, an enumeration
of, by Gray - - - 489

Emetics in insanity - - 311

Energies,living, Blanc's arrange¬
ment of - - - - 219

Epidemic fever, treatises on, re¬
viewed - - - _ 380

Epilepsy, an erroneous term as
applied to disease - - 485

Erasistratus on purgatives,
quoted by Armstrong - 296

Excretions, colour and appear¬
ance of intestinal, not always
indicative of the state of the
bowels - - - _ 296

Eye, diseases of appendages to,

Mac Kenzie on, reviewed - 292

Foetus in utero, does it respire ? 159
Femur, fracture of, by muscular
contraction - - - 341

Fever, Clutterbuck, Pei'cival,
Gruhem, Millar, Porter, Par¬
kinson, Dickson, and Brown,
on, reviewed _ _ - 380

Fever, is it contagious ? - 191

Female, lithotomy in, Clemot
on - ... - - 283

Field's quarterly report of dis¬
eases in Christ’s Hospital - 107
Fistula lachrymalis, a term used
too vaguely - - - 299

Fosbrooke on the identity of
chicken and modified small¬
pox _ - _ 265, 463

Forstei's calendar of natural
history - - 292,378, 492

Formulae, medical, for affec¬
tions of the eye - - 308

Forensic medicine more culti¬
vated in Germany than in
England - - - . 53^

Franck^s cases of tetanus - 67

Friction to promote parturition,
Power on _ _ _ 407

Fracture of the cranium, case of 187
Furnivall's case of pneumonia 360
Function, vital, ilforgr/w on - 123

— and structure necessary to

distinguish the diseases of the
one from the other - - 129

Gases, how to determine their
specific gravity - - 433

Ganglia, nervous, of nasal cavi¬
ties, Cloquet on - - 65

Generation, equivocal, Morgan
on - - - - - 116

— mode of, in imperfect parts - 287
Germans, their attention to the

minutiae of anatomy and sur¬
gery _ _ - - 299

Glottis, oedema of, cases of - 320
Gland, parotid, case of extirpa¬
tion of - - - - 17

Gray on worms - - 27, 108

— on solanese plants - - 201

— on generation in imperfect

plants - - - - 287

540

INDEX.

Gray on metamorphoses of in¬
sects - - - - 373

— on indigenous emetic plants 489
Gravity, specific of gases, method

of determining - - - 433

Gravel, causes of - - - 52

— kinds of - - - - 140

Habit, Morgaii on - - 124

Hall on the mimoses, reviewed 129
Heart, case of rupture of after
chronic inflammation - 427

Hallaran on insanity, review of 309
Hernia of the stomach, Smithes
case of - - - - 182

Herbiverous animals free from
calculous complaints - - 54

History, natural, calendar of, by
Forster - - 292, 378, 492

Hospital pupil’s guide, reviewed 138
Hospital FOR Small-Pox and
Vaccination, report from - 257
Huddersfield, topography of 93, 109
Plyoscyamus, description of - 207
Hydrops articuli, Brodie on - 35
Hydatids from chronic rheuma¬
tism - . _ - 512

Hydrocephalus, Yeats on, re¬
view of - - - - 293

— Cooke on _ - - 441

Identity in fever, to what does
the assumption amount ? - 387

Improvement, medical, essay
on - - - - - 357

Insanity, Hallaran on, review
of - - - - - 309

— different from phrenitis -313

Insects, metamorphoses of.

Gray on - - - - 373

Indigenous emetic plants, Gray
on - - - - - 489

Inguinal tumor, case of - 512

Inflammation, is it necessary to
hydrocephalus? - - 457

does not always exist in in¬
sanity - - - 311

— erysipelatous, of the lachry¬
mal sac - - - - 301

Intellect superior to organization 126
Indians, their mode of employ¬
ing the menispernium coccu-
lus plant - - - - 517

Iron, its action on water - 167

— of carbonate of " - - 168

Jenner^s cases of small-pox a
second time - - - 465

Joints, diseases of, Brodie on,
reviewed - - - 33

Jurisprudence, medical, several

articles relative to 73, 159, 249

Lachrymal organs, Mackenzie
on diseases of, reviewed - 299
Larynx, oedema of, cases of - 320
Lawrence on life, his opinions
objected to _ _ - 353

Larva state of insects, Gray

on . 375

Larry*s case\ of wound of the
thorax - - - - 511

Leech, fatal case of haemorrhage
from - - - - 23

Leese's case of croup - - 26

— on the application of leeches 1 69
Lead, adulteration of wines
with - _ - . 249

Lesions, organic, the kind and
degree of them occasioned by ‘
poison - - - - 525

Life, philosophy of, Morgan
on, reviewed - - - 115

in what manner its laws
should be investigated - 126
Lithotomy in females, Clemot
on - - - - - 281

LinnwuSf the influence of his
name upon natural science - 203
Lithonthriptics do not act by
virtue of solvent power - 316
Local origin of fever contended
for - - - - - 385

Logic, medical, Blane on, re¬
view of - - - - 216

Lunacy, tenderness required in
treating it - - - 528

Magendie on calculus, review
of - - - - - 50

Mandragora, description of - 209
Magnesia an excellent remedy
in some species of gravel - 315
Matter and mind, how con¬
nected ? - - - - 355

Male on forensic medicine, re¬
ferred to - - - - 524

Madhouses, abuses in the regu¬
lation of - - - - 527

Mania, not always attended
with increased circulation - 3 1 1
Medical intelligencer, its publi¬
cation announced - - 83

Meteorological Journal for
London, monthly 85, 173, 259,

‘348, 436, 531

I N D E X.

541

Meteorological Journal for
Richmond, in Yorkshire,
with a report of diseases 84, 172,
258, 347, 435, 530

Metacarpal bone, removal of
the first - “ - , - 340

Menlspermum cocculus, natural
and chemical history of - 517
Metamorphoses of insects, Gray

on . 373

Melaena, mode of treating it - 135
Mercury, its use in insanity - 312
Mimoses, Hall on, reviewed - 129
Millar on fever, review of - 381
Midwifery, several articles rela¬
tive to - - 77, 254, 515

Mitchell on the contagion of
fever - - - - 191

Morgan on the philosophy of *
life, reviewed - - - 115

Mucocele, Mackenzie on - 305

Nasal cavities, nervous ganglia

of . 65

Nasal duct, of obstructions in 306
Nicotiana, description of - 208

Notices to Correspondents

88, 176, 264, 352, 440, 536
Notices, Literary, 82, 171, 257,

346, 434, 529
— of Lectures, 81, 170, 257,

346, 434, 529

Nomenclature, medical, Pctr-
kinson on - - - 364

Nux vomica, its efficacy in
paralysis - - - - 1

Nymph or chrysalis state of
insects. Gray on - - 376

CEdema of the Larynx, in¬
stances of - - 320

Operation, Cesarean, case of - 77

Opium used with success in
delirium tremens - - 185

Orjila on toxicology, review of 213
Organization and function, how
connected - - - 120

Ossification connected with
asthma _ - . - 146

Oxalic acid, case of death from 20

Oxygenized acids and oxyds.
Thenar d on - - - 343

Paralysis treated with nux vo¬
mica _ - - - 1

Paris on white arsenic - - 144

Palpitation in the right thoracic
cavity, causes of - - 421

Parotid gland, case of extirpa¬
tion of - - - - 75

Paralysis cured by encephalic
cicatrization - - - 155

Patassier on the apoplectic cyst 318
Parkinson on medical nomen¬
clature - - - - 364

— on fever, review of - - 381

Pascal on intestinal worms - 238
Pains, labour, new method of
trying - - _ . 402

Peritonitis, Portal on - - 245

Peritonaeum, not often the seat
of primary inflammation - 244
Percival on fever, review of - 380
Pettigrew^s anniversary oration,
abstract of - - - 520

Periodicity of asthma » - 153

Perspiration, its kind and de¬
gree necessary to attend to
in disease _ _ - 134

Pharmacy, price of substances
employed in, quarterly ac¬
count of - - - 262, 534

Phials, prices of - 263, 535
Physalis, description of - 210
Pharmacopoeias, account of - 297
Picotroxine, Boullay on - 518
Pleurisy, chronic, its connexion
with asthma - - - 1 49

Plutarch, extract from, relative
to the pestilence of Athens - 412
Plants, doctrine of sexes of,
first proposed by Camerarius 287
P Wanshorough’s case

of - - - - * 277

— FurnivalVs case of - - 360

Portal on Peritonitis - - 245

Porter on fever, review of - 381
Power on midwifery, review of 402
Poisoning by oxalic acid, case

of . 20

Porter, bottled, its good effects
in a case of fever - - 105

Potash often preferable to soda
in gravelly complaints - 314
Pregnancy, extra- uterine, case
of - - - - - 254

Prussiate of quicksilver, its use
in syphilis - - - 71

Proximate causes, inquiries
after, have injured medicine 358
Purgatives, often useful to com¬
bine them in one prescription 135
Pyrola umbellata, effects of - 342

Quicksilver, prussiate of, use of
in syphilis - - -71

54<2

INDEX.

Rabid animals, wound from,
Orjila on the - - - 215

Regist ER OF Diseases, month¬
ly, 86, 174, 260, 349, 437, 532
Iiecamier*s case of extra-uterine
pregnancy - - - - 254

Houx’s case of removal of the
first metacarpal bone - - 340

Rose on Paralysis - - 1

Sarsaparilla, Rattley on - 190

Sac, lachrymal, diseases of - 304

Scarlatina, WansborougKs case
of - - - . “362

Scrofula, how far is it con¬
nected with hydrocephalus ? 459
Sea snake of America - - 169

Sensation and re-action, Mor¬
gan on - - - - 123

Serves on diseases of the brain 155
Small-pox modified by vaccina¬
tion, is it the same disease
as varicella ? - - 265, 463

Small-pox, bastard. Van Swie-
teri on - - - - 469

Society, Royal, proceedings
of - - - - 167, 343

— London Medical, anniver¬
sary of - - - - 342

— -Hunterian, commencement

of . 432

SoutharrHs case of delirium tre¬
mens treated by opium - 185
Solanese plants. Gray on - 201
Soda and potash compared as
‘ lithonthriptics - - - 313

Spinal, curvative, different
sources of _ - _ 49

Spine affected in fever - - 499

Spasm, how connected with
vascular irritation - - 125

Stillicidium, Mackenzie on - 304
Study, plan of - - - 140

Stramonium, description of - 209
Stomach, its condition in vo¬
miting ? - - - - 414

— case of hernia of - - 182

Stavely^s case of extensive frac¬
ture of the cranium - - 187

Sulphureous acid gas with sul-
phureted hydrogen gas - 61

Susceptibility to fever regulated
by age and circumstances - 397
Syphilis, Cooke on the coinmu- '
nication of - - - 16

— use of prussiate of quick¬
silver in - - - - 7 1

Syncope, cardiac, case of » 428

Synovial inflammation, Brodie on 38
Tartaric acid, its use in calcu¬

lous disorders - - - 231

Tetanus, case of - - - 67

Thoracic duct, case of obstruc¬
tion of - - - - 68

Thoracic region, right, causes
enumerated of preternatural
pulsation in - - -421

Thorax, wound of - - 511

Thucydides, extract from, rela¬
tive to contagion ' - - 411

Thomson, his opinion of vario¬

loid disorders canvassed 265, 463
Tissue, this word first employed
by the French physiologists - 119
Toddalia, a substitute for Cin¬
chona - - - - 79

Tonic agency in medicine? - 125
Transposition of the viscera,
case of - - - - 419

Trachea, a gunshot wound in
producing emphysema - 163
Tricocephalus, or trichuris,
Pascal on _ _ - 234

Tumor, lymphatic, in the ingui¬
nal region, case of - - 312

Typhus, review of several au¬
thors on - - - - 380

Varicella and modified small¬
pox, are they identical ? 265, 463
Vauqueline, a new vegetable
acid - - _ _ 165

Vascular impetus, not always
present in insanity - - 311

Venereal disease, Cooke on - 16

Venae cavae, rupture of - 512

Venereal disease, danger of
curing it without mercury - 20

Vermes, animals of the class of,
Gray on - - - 27, 108

Verbascum, description of - 206
Venjesection in fevers, remarks
on - - - - - 393

— often used erroneously - 311
Viscera, transposition o^ case of 419
Vis medicatrix, Morgan on - 128
Vincent, Miss, case of - - 285

Vital principle, often difficult
to ascertain whether it have

left the body _ > - 526

Vomiting, what is the condition
of the stomach in ? - - 415

Unguis os, caries of, not so fre¬
quent as has been imagined 305

INDEX.

543

Urinary concretions, Magendie
on, reviewed - - - 50

Uric acid, constituents of - 52

Uterus, case of elongation of its
anterior labium - - 254

— foetus in, does it respire ? - 151

Walker on the topography of
Huddersfield - - 93, 189

Wansborough's case of pneu¬
monia - - - - 277

West India fever, different
kinds of - - - - 226

White on a fatal case of haemor¬
rhage from a leech - - 23

White swellings a vague term 34

— Brodie on - - _ 45

Whitmore on bottled porter in

fever > _ - - 105

Williams on poisoning by oxalic
acid - - - - 20

Wines, adulteration of, Orjila
on - - - - - 249

Worms, intestinal, &c. Gray
on - - - - 27, 108

— Facsal on - _ . 333

Woodham^s remarks on Aber-

nethys and Lawrence's opi¬
nions on life - - _ 353

— letter on fever quoted - 393
Wollaston on abstinence from

animal food referred to - 317

Yeats on Hydrencephalus, re¬
view of - - - - 293

— account of the opinions of
the ancients on contagion - 41 1

Zinc, sulphate of, mode of ap¬
plication of - - r 137

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Full text of "The London medical repository. Volume 11, January - July 1819"

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