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will be brought to composition and resolution ere it reaches the joint, and therefore muscular force will alone remain, and will produce a feeling of vigour and strength in proportion to the amount of muscular contraction plus over the gravitation. The careful weighing of a book in the hand, and afterwards, with the same book in the hand, rigidly extending the arm and hand, will make apparent what is here desired to be understood. In weighing the book little muscular force is used to counterpoise gravity, and weight is the feeling induced ; but when much muscular force is used, a feeling of vigour or strength follows, from the muscular force being considerably plus over the gravitating force. Of course the lines of direction in the two different feelings experienced—weight and resistance, will be in conformity with those maintained for the respective feelings at the commencement of this paper.
If very great muscular exertion is used to overcome gravitation, with a considerable plus of muscular force, there is a feeling or sensation over and above that of mere vigour, namely, a feeling of violent exertion distinct from either mere resistance or weight; this sensation arises in all probability from some other sentient impression than that of force only.
Having thus feebly finished the task I allotted to myself at the commencement of this paper, it is not becoming in me here to make any general remarks upon the application of the sense here advanced; for that would be premature whilst it is, as yet, suh judice. Moreover, this paper has only reference to the distribution of this sense to synovial membranes, but the writer is disposed to think that this sense has other seats of distribution besides that of synovial membranes, which will require a very careful examination in connection with several collateral subjects, which bear a nearer or more remote relation to the sense discussed.
The only thing the writer can with propriety at present refer to, is the testy subject of the substratum of matter; or, that there is something pertaining to matter of which neither sight, touch, nor smell, etc., can give us any information, these having relation to the superficies, yet it is evident that these are so many indications of its existence—the feel, colour, angles, etc., but not the substance; yet the fact that we are sure that these are the superficies, and not the substance of the same, arises from our consciousness of its possessing weight. And how? Because, though we cannot touch it, hear it, see it, smell it, or taste it, yet we can feel weight. And how do we feel it? Not, surely, because it is unrecognisable by any of our senses, or else how should we feel it? And if we feel it, and yet none of the recognised senses inform us of the presence of this said substratum, it remains, therefore, that a sense yet unrecognised gives us that assurance which the rest have failed to detect, and that that sense must embrace within its function the ability to detect weight. This, certainly, always assures us of the presence and amount of matter, or of its untouchable substarice, or substratum,
which none of the orthodox senses have been able to detect, neither can they.
But, it will be said, that the philosophers and metaphysists do not affirm weight to be that elemental property in matter which gives to the examiner the conviction of the existence of a substratum which the orthodox senses cannot recognise. This I freely admit; yet I am disposed to think that the usual mode in which the subject is argued and referred to implies a conviction, arising from some impression matter gives to the philosopher distinct from the five recognised senses, and not having wherewith to express his inward impressions of the same, has recognised that conviction by the term substratum, which weight would have expressed equally as well and more concisely. Nevertheless, let it be granted that that elemental property in matter, called weight, does not include all that is implied by the term substratum (I mean when the term is used correctly), yet, if we had no sense capable of recognising weight and resistance in matter, those very characters, as weight and resistance, as distinct from roughness and smoothness, which above all others assure us of its presence and mechanical properties, would leave us in a perfect chaos of ignorance, both as how to use and apply matter, and whence it was governed, and what laws it obeyed, — direct revelation being in such case necessary for our subsistence and guidance.
ARTICLE III.—On a Simple Method of performing the Operation for
Fistula Lacrymalis. By E. R. BICKERSTETH, Surgeon,
Liverpool. As far as I am aware it has hitherto been considered essential to the success of the operation for fistula lacrymalis, that the point of the knife should pass into, and be carried along, the lacrymal canal before attempting to introduce the style. As this is a proceeding which required some tact and minute anatomical information, it has at all times received from surgical authors considerable attention, and long and complicated directions are common, describing the method to be adopted to secure its ready and safe performance. The French writers have, as usual, surpassed the English in the minuteness of their description. Thus we have the steps of this little operation divided into the “Premier temps," the “Deuxième temps," and the “ Troisième temps," and half a page or more devoted to the discussion of each. Desmarres, in his work on eye diseases, when speaking of the “premier temps," says:— . . . “Et je lui recommande de tirer l'angle externe des paupière pour tendre les parties ; et surtout pour faire saillir le tendon de l'orbiculaire. Ce tendon représente alors une ligne horizontale formant le côté supérieur d'un triangle dont le côté inférieur légèrement courbe est tracé par l'orbite. Partant du sommet du triangle, je compte de
NEW SERIES.—NO. IV. APRIL 1855.
du triangle dont y ayant pas plus de 5 lop je tire une ligne
thinnal, by plow the ten, directly whe
dedans en dehors 4 à 5 milli-mètres, et là, je tire une ligne verticale dont la hauteur n'ayant pas plus de 5 milli-mètres, mesure la base du triangle dont je viens de parler. Je partage cette ligne en trois parties égales, et c'est à la réunion du deuxième tiers inférieur avec le tiers supérieur que la ponction sera faite—Ces dispositions prises," etc., etc., etc.
The utter futility of such a complicated plan for finding the proper point to open the lacrymal sac, must be obvious to all practical surgeons, for in the vast majority of cases requiring this operation, the swelling and tumefaction are such as to render it altogether impossible to make these dispositions. And when there is little or no alteration of the external parts, and the operation is desirable, nothing can be more simple or effectual than to feel the orifice of the canal, by pressing the nail of the forefinger deeply downwards immediately below the tendo-palpebrarum, and to introduce the knife, guided upon the nail, directly into the passage. This, in fact, is the proper method of proceeding whenever it can be adopted, but generally it is impracticable from the cause just mentioned. " To pass the knife directly into the canal must then be more or less a matter of guess-work.
Until a recent period I was in the habit of judging its position by observing precisely its relative situation on the unaffected side, and then bearing this in mind, I was generally able to direct my bistoury at once into the obstructed passage. However, a case occurred last September, in which, owing to the almost horizontal direction of the canal, I signally failed, although after a good deal of poking about with the probe I succeeded in finding the passage, and then in introducing a style which passed without unusual resistance. The patient quickly recovered, but after the first few days a good deal of trouble was experienced in keeping the style from falling out, when she bent the head forwards.
This case naturally led to reflection regarding the pathological nature of obstruction in the lacrymal canal. It is no doubt various in different cases. It may arise from tumours occluding either extremity; it may be caused by necrosis of the bony textures entering into the formation of the tube, and this is by no means uncommon in children of a strumous habit; but by far the most frequent cause is from the extension of inflammation from the lacrymal sac to the lining membrane of the canal. Swelling takes place, and as an almost inevitable consequence the passage is choked up by secretion, and by the tumid state of its mucous membrane. When once produced, this state of matters may continue indefinitely, unless remedied by mechanical means ; but I am not aware of any reason for believing that the canal ever becomes so completely filled up by densely organized material that the passage is obliterated, and a necessity created for using the knife in order to establish a new canal. Certainly, if such cases do exist, they form the exception to the general rule.
With this view of the subject I have ceased to operate as before, and now content myself by making a simple puncture into the abscess or lacrymal sac; and then introducing the style, guide it to the orifice of the canal, and with gentle pressure pass it along the tube. The ease and simplicity of this method of procedure is surprising as compared with the usual plan, and I believe it will be found very generally practicable, and equally efficacious in restoring the canal to a healthy condition. During the last five months I have adopted this simple means in six consecutive cases of confirmed fistula lacrymalis, with results at least as satisfactory as by the former system. In one case the fistula was of eighteen months' duration, yet the style passed without difficulty, and the patient made a rapid and complete recovery. In another case, the patient-a nervous and excitable female--could not bear the idea of being cut, I therefore insinuated the style along a fistulous opening, which fortunately happened to be nearly over the duct, and succeeded in passing it into the canal without trouble and without pain. She also made an excellent recovery, but an ugly scar remained from ulceration caused by the pressure of the style against the fistulous orifice, which was not quite over the canal.
ARTICLE IV.-On the Epidemic Measles of 1854 in Leith. By
John Brown, L.R.C.S. Edin., H.E.I.Č.S., Hon. Pres. Hunterian Med. Soc., Edin., late House-Surgeon, Leith Hospital.
In the following communication it is my intention to describe the principal features of interest, which have occurred in the cases of measles, attended by me during 1853–4, while that disease was epidemic in the town of Leith.
It is necessary to remark, that these cases can only be held to represent the epidemic as occurring among the poorer classes, and that in consequence they may furnish in their complications and mortality some variations from the cases observed among those in more affuent circumstances; still, this will be found insufficient to explain the variable nature of the results at different periods, while the appreciable modifying causes, particularly at work among the poorer classes, were to a great extent stationary.
The town of Leith is favourably situated for the extension of epidemic influences. Lying low, and ineffectively cleansed and drained, in its centre, an overcrowded churchyard, and bounded on one side by a harbour which receives the vegetable and animal decay of most part of the towns of Edinburgh and Leith, and which, twice in the twenty-four hours, at low tide, gives off, by evaporation, the most offensive emanations. The town, in addition, is very densely inhabited, containing a population of 30,919, the greater majority of whom reside within an area of a few acres, in narrow streets and closes. If we look to the internal appearance of the houses of the
3 and 4
5 and 6
poorer classes, we find that they are generally small and ill-ventilated, over-crowded, and having free communication with each other, and in many instances several families are found living in the same room.
This epidemic may be said to have commenced in December 1853, and to have terminated at the end of June 1854. The cases attended during that period have been 170, of whom 16 died, being 9.7 per cent., or nearly 1 in 10.
The patients affected were generally below the age of five years, -a fact similar to what has been observed in former epidemics of this disease, and which is probably not so much dependent upon the predilection of measles for children, as upon its frequent occurrence as an epidemic, so that few attain that age without being under, and affected by, such an influence.
The following table shows the proportion attacked to the age :Under 1 year, .. ... 12 | Between 7 and 8 years, .. 6 Between 1 and 2 years, '. 24
8 and 95. . 3 2 and 3 . . . . 49
9 and 10 , . . ..
10 and 11 4 and 5 , . . ..
12 and 13 . . ..
13 and 14 „ . . . 2 » 6 and 7
23 and 24 „ . . . 1 This table shows that of these 170 cases, 129 occurred below the age of 5; that the number affected was greatest between the second and third years, and that from this period a gradual decline in the number of attacks is noticeable.
General description of the disease in these 170 cases.—The premonitory symptoms (or period of febrile commotion) were generally mild febrile disturbance, rough cough, with slight dyspnoa, watery eyes and sneezing followed on the 5th day by the appearance of the characteristic eruption, at first on the face, and gradually extending to the extremities. In three cases the eruption was delayed ; in one appearing on the 6th day, in the other two on the 7th. In 3 cases symptoms of cynanche laryngea occurred during this stage; in 2 subsiding on the appearance of the rash; in 1 becoming less severe during its continuance, but again becoming aggravated on its recession. In no instance was the eruption ushered in by conyulsions or cerebral disturbance.
The eruption was generally fully developed for 3 days, on the evening of the third day becoming faint and scarcely perceptible on the 6th ; in none but severe cases was there any cuticular desquamation, and when this occurred the face was the only part distinctly affected.
Irregularity in the persistence of the eruption was observed in 9 cases; in 3 the eruption was ill coloured, and suddenly disappeared on the morning of the third day; in 2 cases, proving fatal in 24 hours by coma, in 1 by typhoid fever (7 days); in the 4th the eruption
* The appearance of eruption on fifth day was also observed by others in Leith.