The four canine; 5. The last four molars. M. Trousseau persists in affirming that the canines appear after the first molars. On this point he is undoubtedly correct. The order of appearance of the teeth is governed by the wants of the animal throughout the mammalian class. The soft food first given to the infant requires cutting by the incisor teeth, then grinding by the molar teeth; but the digestive organs are not for some months fitted for the former kinds of food requiring laceration, for which the canine teeth are intended. PATHOLOGY AND PRACTICE OF PHYSIC. MR MARSTON'S CASE OF DIARRHEA ADIPOSA, CONFIRMATIVE OF BERNARD'S VIEWS. This case was that of a man, a labourer, aged 35, who had frequent purging of a very peculiar fatty-looking substance. No tenderness, swelling, or tumour, could be detected, except a slight enlargement of the liver. "His appetite was good, and he had a great desire for saccharine matters, fat meat, and hydro-carbons generally. Urine was passed in abnormal quantity, pale in colour, with very slight reaction on litmus sp. gr. 1030: under the microscope it presented a few epithelial scales, and a number of oil globules; on evaporating a portion, and treating it with ether, these globules were dissolved; there was less than a normal amount of urea and lithic acid, and no albumen; but Trommer's test, yeast, and oxide of silver, indicated the presence of sugar, and the skin was harsh and dry though he did not complain at all of these diabetic symptoms, all of which disappeared some time before death. Tongue was slightly furred; gums and inside of lips were pale and flabby; pulse 100, but it varied during treatment from 90 to 120. No cancer, phthisis, or cardiac affection, could be traced in any of his family, which had been generally healthy. The matters passed from the bowels presented a very fatty, tenacious, and peculiarly slimy appearance, deficient in bile, and altogether different from fæces; on raising a portion on the point of a knife it appeared in greasy masses; under the microscope numerous epithelial scales, with mucus and a substance laden with oil globules, in every respect similar to fat, were observed; their fatty nature was rendered more evident by their being soluble in ether, and with liq; potassæ forming a semi-opaque gelatinous mass exactly resembling soft soap.' The treatment consisted of abstinence from "farinaceous and saccharine articles of food. Diaphoretics succeeded, though with difficulty, in producing diaphoresis; the sweat had no acid reaction on litmus. Olive oil, instead of being beneficial, only increased the discharge of fatty matter and deranged the stomach. Purgatives, mercurials, and counter-irritants, with small doses of iodide of potassium and ung, iodin. to region of liver, and a variety of other -remedies failing to produce relief, at last all medical treatment was discontinued. His appetite continued good, but the adipose diarrhoea (four or five stools per diem upon the average) continuing, he gradually sank, and died apparently from asthenia, after having been under medical treatment altogether thirteen to fourteen months." On dissection the duodenum was "quite healthy, but the head of pancreas appeared to be converted into a hard schirroid tumour, which did not press upon the ductus communis choledochus, as in most of the similar recorded cases, whilst the body and other parts of gland were atrophied, and its duct was found perfectly obliterated and degenerated into an impervious cord." Mr Marston concludes some excellent observations on this case with the following remarks:—“ Mialhe, adopting Bernard's views, explains the action of the pancreatic juice upon the fats by the principle of fermentation. More recently another set of physiologists, of whom Frierichs and Lenz appear to be the most prominent, have published a series of experiments to prove that its absence in the intestine does not prevent the digestion and assimilation of fat. They experimented upon cats, and found the usual amount of fatty mat ter in the chyle, after ligature of the pancreatic duct. Here, then, exists a division between two leading sects of physiologists; for Bernard still adheres to his views. The question comes, does this case in any way fill up the gap? It has been advanced by Bouchardat and Sandras, that the free alkali of the juice, or serum of the blood, would be sufficient to dissolve the fat; and adopting Plattner's theory, the soda of the bile may be almost vicarious of the action of the pancreatic juice, in separating the fatty ingesta by saponification with its acids; but whether this could continue long is not evident, and what appears to be the real root of the question is, whether, under long continuance, this would not be incompatible with existence. In the case before us it is possible that the choleate of soda of the bile, and the alkalis of the serum did supply an alkali to the fat, thus saponifying it, and that the choleic acid, if Plattner's views be correct, taking albumen as its base, the resulting compound, which is the product of so highly an organised gland as the liver, on the one hand, and the chemical and antiseptic action of the gastric secretion, which is doubtless itself not a mere chemical combination, but a definite semi-organised material, on the other, might give rise to the fatty albuminous molecular base of the chyle; but that this continuing, these alkalis were not only insufficient in quantity to the digestion of the fatty ingesta, but an imperfectly organised material was formed, from which an imperfect chyle resulted. "The presence of sugar in the urine in this case is difficult of explanation; but be it remarked that this was a transitory symptom, existing most when the patient partook largely of amylaceous matters, which are easily capable of being resolved into sugar, and ultimately ceasing altogether long prior to death. It might be that a larger than normal amount of fatty matter was presented to and absorbed by the tributary branches of the vena porta, and that through the intermediate action of the liver (if Bernard's views be correct) this was resolved into sugar and carried by the hepatic vein into the general circulation; and being more than normal in quantity, did not altogether undergo decomposition in the lungs (as it is conceived to do) but was excreted by the kidneys. Again, the deposit of fatty matter in the viscera generally may admit of a similar explanation; for, I apprehend, we must regard the fatty degeneration of the liver not as a primary affection, but as a secondary disease, resulting from the actual deposition of fat from the blood, it being found in a similar condition in almost all diseases attended by much emaciation. Perhaps the fatty ingesta in this case, not having been subjected to the vital and chemical action of the pancreatic secretion, had never reached a sufficiently organised state to undergo the necessary changes, prior to assimilation or secondary combustion. "Looking at the case in all its bearings, it certainly appears to support Bernard's views, which I cannot consider entirely overthrown by the experiments before quoted."-Glasgow Medical Journal. [This is a valuable addition to the six cases of Bright, Elliotson, Lloyd, and Gould, and supports from the result of pathological observation, the experimental researches of Bernard, with regard to the functions of the Pancreas. In a Memoir published in the last number of the Prague Vierteljahrschrift by Dr Eisenmann, a seventh case is quoted by Lussanna in the Giornale Veneto di. Sc. Med. T. ii. 766, and an eighth case of his own is given. In the two last instances, however, the individuals recovered, the principal symptom having been discharge of fatty matters by stool.] SULPHATE OF MANGANESE IN HYPERTROPHY OF THE SPLEEN. Prof. Gintrac recommends this salt as a substitute for and adjuvant of chalybeate remedies, for improving the condition of the blood in anæmic patients. He relates an instance of ascites, where oedema, with great splenic enlargement, formed the sequelae of intermittent fever, in which 14 grs. (0·10 gramm) of this drug, given twice daily in the form of pill, produced a complete cure.L'Union Medicale, lxix. 1853. 1854.] PATHOLOGY AND PRACTICE OF PHYSIC. HYPERTROPHY OF THE SPLEEN. Professor Christiansen of Copenhagen considers splenic enlargement to be caused by such mechanical obstacles as impede the return of the venous blood to the heart, and by such dyscrasic states of the blood as give a tendency to hyperæmia. He has frequently met with it in cases where there was hypertrophy of the right ventricle of the heart. In these circumstances, he says, so called "infarctions," or capillary apoplexies, are not uncommon, presenting, in its substance, clots which, at first, are firm with well-defined borders, and afterwards become decolourized and softened. Hypertrophy of the spleen also occurs in cases where there exists any impediment to the circulation through the vena cava; where there is constriction or impermeability of the vena portæ: and where there has been suppression of the menstrual or hemorrhoidal evacuations. In the blood-diseases as typhus, cholera, pyæmia, and delirium is frequently not only enlarged, but also altered in the organ he tremens, says structure. He has never seen enlargement from intermittent fever, as this He has frequently observed disease is extremely rare in Copenhagen, but he believes it to be due to the repeated hyperemic condition of the organ. splenic hypertrophy occurring in cases of Bright's disease, so that the organ weighed from 3xvi. to 3xx. Its condition, in these cases, resembles that observed in it by Rokitansky after intermittent; i. e. it is so hard and brittle that it can easily be cut into thin slices or broken into fragments. It presents on section a coarse granular structure, nodules the size of pepper-corns being embedded in its substance: it is also of a bluish red or dark violet colour, which becomes bright red on exposure to the air. Its form is somewhat changed, the inner border being broader and firmer than ordinary. The fibrous capsule is not firmer than usual, and there are no morbid adhesions to the peritoneum, although these conditions frequently are found in the enlargement following intermittent. The author thinks this condition of the spleen arises from a deposition of albumen in the substance of the organ; and surmises that, after the absorption of the watery elements, the albumen remains behind in the Malpighian bodies, in a solid form, occasioning, by their dilatation, the granular structure alluded to. Prof. Christiansen has found many pathological lesions of the thoracic and DR E. H. ECKER OF UTRECHT, ON THE ENLARGEMENT OF THE BLOOD-VESSELS IN The cerebral substance assumes a marbled appearance when its minute bloodvessels, which contain little or no blood, become distended with that fluid. These vessels are so small, (measuring from 0.0005-0001 mill.), that in health only one or two blood-globules occasionaly pass through them; and so numerous are they, that when, in congestion, they are filled with blood, they nearly obscure the whitish colour of the cerebral matter by their rosy colour. Nor is this sanguineous distension confined to them alone, it occurs also in the larger vessels, so that when congestion is present, the whole of the brain is enve loped in a fine vascular net-work. If the congestion proceed to inflammation, the meshes of the net-work become more closely approximated, and in the vessels themselves irregular enlargements occur. These enlargements are often so great that the diameter of the vessels is six-fold increased; while, in some places, the swellings are almost aneurismal in their character. Ecker records in detail the examinations of the capillary vessels of the brain in three lunatics, who died maniacal, and in whom chronic meningitis had previously existed, accompanied by more or less imbecility. In all of these cases he found the vessels greatly enlarged; and he has tabulated their measurements, showing that they greatly exceed those found in the normal condition of the parts, measuring from 0.275 to 0.310 mmtr., while in health they average only about 0.152 mill. The capillary vessels were largest and most numerous in the corpus striatum, and their enlargement was more conspicuous in the cerebellum than in the cortical substance of the brain. He observed that, in their expansion, their texture became atrophied, and that the tubular nerve fibres of the cerebrum were compressed by the vascular enlargements, just as happens in the case of an apoplectic extravasation. It may not be uninteresting to the reader to mention the method adopted by Schröder van der Kolk, for the examination of the cerebral vessels. Having cut a very thin slice, (1 mill.) of the cerebral substance, before its vessels have become empty, he spreads it upon a piece of glass, and allows it to dry for a day or two. As it is then capable of being cut without tearing, he carefully thins it still further till it is about mill. in thickness, and transparent when placed under the microscope. It is then moistened with Canada balsam, and enclosed between glasses in the usual manner.-Deutsche Klinik. 26. 1853. BIGNON. TUBERCULAR PERFORATION OF THE STOMACH IN A BOY-FATAL At the Hôpital des Enfans, a boy æt. 61, extremely emaciated and scrofulous, was under treatment for extensive ulcerations in the neck, and died suddenly from vomiting of blood. At the autopsy, numerous tubercular deposits were found, particularly around the ulcers in the neck, and in the peritoneum. The stomach was filled with blood which had escaped from a circular perforation, about the size of a groat, placed at the large tuberosity on the great curvature, exactly in the situation of the gastro-epiploic vessels. The erosion of these vessels could not be discovered, although doubtless the source of the hemorrhage. The perforation was not surrounded by inflammation or ulceration: close beside it a crude tubercle was found under the mucous membrane, and another tubercle, surrounded by sanguineous infiltration and tubercular granulations, occurred on the posterior surface of the stomach From the specimens it appeared that the tubercles were first developed under the peritoneum, and destroyed the coats of the stomach progressively from without inwards. Examples of tubercle and tubercular perforation of the stomach in children, are among the rarest facts in pathology.-Gaz. des Hôpitaux, Sept. 20. VIGLA. CEREBRAL COMPLICATIONS IN ACUTE ARTICULAR RHEUMATISM. These important complications have been hitherto mostly overlooked in pathological treatises: they are not, however, extremely rare; for in three months M. Vigla has met with 5 cases, 2 of which recovered and 3 proved fatal. Out of 65 cases, this complication was observed in the proportion of 1 in 13. The cerebral affection is perhaps the most important and dangerous complication in rheumatic fever. It varies, however, in character and intensity in different cases. The different kinds have been classified as follows by M. Vigla : 1st. Simple delirium, similar to the sympathetic or nervous delirium which occurs in many acute febrile diseases, whether of idiopathic or traumatic origin; in short, rheumatism complicated with delirium. 1854.] SURGERY. 2d. Delirium, accompanied by most of the symptoms, and probably also the lesions of meningitis, or the rheumatic meningitis of authors. 3d. Sudden and unexpected ataxic condition, quickly succeeded by fatal collapse or coma, the rheumatic apoplexy of Stoll and some other authors.Arch. Gen. de Medicine. BOUCHUT. CUTANEOUS PULMONARY FISTULE. The author gives this name to perforations of the lung, which communicate, by means of a fistulous tract, with the subcutaneous cellular tissue of the thorax, and secondarily with the external air, when the skin is destroyed by ulceration. From several rare cases which he has observed, M. Bouchut draws the conclusions: 1st. We must admit the existence of pulmonary pistulæ. 2d. Some of them are completely open on the surface of the skin where it is in contact with the lung adhering to the thoracic walls. 3d. Sometimes the fistula, open externally, communicates first with the pleural cavity, which is filled with air and pus, and consecutively with the perforated lung, which is more or less distant from the thoracic walls. 4th. Other pulmonary fistulæ are incomplete, opening under the skin, and forming soft elastic fluctuating tumours: these are subcutaneous pulmonary fistulæ. 5th. All these fistulæ are the results either of abscess caused by foreign bodies, or of empyema, or of pulmonary gangrene, abscess, hydatids, or tubercles. 6th. The cutaneous pulmonary fistula are characterised by the fistulous opening of the skin, through which air is continually escaping during expiration and cough. 7th. Subcutaneous pulmonary fistule are characterised by a soft, elastic, fluctuating tumour, more or less reducible, with gurgling under the finger or The tumour, sometimes dilated during inspiration, is particularly expansive in expiration and cough. to the ear. 8th. The subcutaneous fistulæ, forming a tumour, may be easily confounded with intra-thoracic abscesses, and herniæ of the lung. 9th. The cutaneous pulmonary fistula may give rise to general emphysema of the cellular tissue. 10th. These fistulæ form generally a dangerous complication of pulmonary disease; but sometimes they are a salutary measure instituted by nature to bring about a cure.-Gaz. des Hôp., Oct. 27. SURGERY. ON INJECTIONS OF PERCHLORIDE OF IRON APPLIED TO THE TREATMENT OF ANEURISMS. Since the meeting of the French Academy of Medicine at which M. Malgaigne's paper on the above subject was read, several discussions have taken place on the same question, and some additional facts have been published. We propose at present to give a short account of what took place at the meetings of the Academy, as well as to lay before our readers the substance of the most important communications which have been laid before the profession. Discussions in the Academy of Medicine.-M. Malgaigne's paper was read, it will be remembered, on the 8th November, but the subsequent discussion occupied the greater part of the three following meetings. M. Velpeau stated that having observed that in certain vessels coagulation of the blood had taken place around portions of membrane floating in them, the idea had long ago occurred to him to attempt the cure of aneurisms by the With a view to make introduction of a foreign body. Accordingly he tried acupuncture, but his experiments were unsuccessful both on animals and man. this method more effectual, M. Pravaz added galvanism to the acupuncture. NEW SERIES.—NO. XLIX. JANUARY 1854. I |