Medico-Chirurgical Transactions. ART. II. Published by the Royal Medical and -London, 1848. 8vo, pp. 522. With Seven Plates. WE continue, from our last Number, our analysis of this volume; the interesting nature of whose contents gives occasion to this unusually lengthened notice of them. XVI. Contributions to the statistics of valvular disease of the heart; by A. Whyte Barclay, M.D., Physician to the Chelsea, Belgrave, and Brompton Dispensary, and Medical Registrar of St. George's Hospital. The present paper neither contains, nor professes to contain, any suggestions for the improvement of diagnosis, except in as far as a priori probabilities may be available, nor does it hint at any novel principle for the guidance of practice. It consists of a tabulated statement of the necroscopic appearances of 79 bodies in which more or less valvular disease was discovered, and of the sex, age, and cause of death of the sufferers, preceded by some remarks which may be considered as a running commentary upon the whole. Much patient industry is required for the collection and arrangement of the materials of such a record of facts, which is calculated to throw great light upon the history and relations of the particular disease under discussion. We cannot pretend to give an adequate sketch or analysis of a memoir of this kind, but shall content ourselves with extracting some of the more striking facts and inferences that are deducible from the numerous observations here detailed. Out of 419 cases occurring during two years at St. George's Hospital, in which the condition of the organs of circulation was ascertained, 79 detailed in the table were found to present various modifications of valvular disease: so that 18.8 per cent. is the proportion in which we may expect to meet with these lesions in persons dying of all diseases. As regards the frequency with which the different valves were affected, it appears that in 36, or 45 per cent. the aortic and mitral were so simultaneously, in 26, or 33 per cent. the aortic alone, and in 17, or 22 per cent. the mitral alone. The age of the patient seems to have a marked influence upon the production of fibrinous deposit, since in the first 18 cases in which the age varied from 12 years to 34, it occurred 16 times, while it is only mentioned 5 times in the remaining 51, in which the age ranged from 34 to 79 years. Atheroma, on the contrary, is more abundantly developed as life advances. Of 113 instances out of the 419, in which it was met with on the valves or at the origin of the aorta, the numbers falling in different decades of age give, as compared with the whole numbers of deaths in the corresponding decades 12 per cent. as the rate of its occurrence between 20 and 30; Valvular disease is superadded in about two fifths of the cases of atheroma, but in little more than half of these is the valve found in a condition of atheromatous degeneration; and it does not appear from Dr. Barclay's researches that the mitral valves are more liable to atheromatous disease than the aorta, though a contrary statement has been made by several pathologists. The frequency with which the aortic and mitral valves are simultaneously affected in connexion with rheumatic fever is very remarkable. Of 15 cases traced to this disease, out of the 79, there were 13 in which both valves thus suffered together; and of another series of 35 cases similarly circumstanced, there were 28 in which both were implicated. In the few remaining cases in which either valve was separately diseased, it appeared that there was no distinction between them as to the frequency of this occurrence. Hypertrophy, dilatation, and atrophy are equally found as consequences of severe lesion of the aortic and of the mitral valves, and of adherent pericardium, and sometimes would seem to exist in a considerable degree of development, with a condition of valves in no way proportionate to the muscular changes. Deviations from the healthy and normal condition of the kidney are noticed forty-one times in the table. In 28 cases the disease was granular degeneration; in 5 the kidney was large and mottled. It is remarkable that, while of 61 cases of atrophied kidney, 29 are coincident with valvular disease, only 5 cases out of 21 of those in which the kidney was large and mottled present examples of endocardial affections; very nearly 50 per cent. in the one condition, and scarcely 25 per cent. in the other. And in comparing these two forms of disease, we find that, while contraction with thickening of the valve exists in numerous cases of granular degeneration, only one ambiguous instance is recorded as coincident with a large and mottled kidney; a result which agrees with the fact that endocarditis occurs in the former without complications, and is not found in the latter, except under such conditions as would seem to develope it where the kidneys were healthy. "Were I," writes the author, some pages farther on, to allow myself to speculate on blood-poison as a cause of endocarditis, of which acute rheumatism and granular degeneration are supposed to furnish us with examples, I might inquire why it is that in the one the inflammatory action is so liable to extend to both sets of valves, while the other does not exhibit any marked deviation from the ordinary statistics which I have obtained for all forms of cardiac lesion together? whence the liability to a recurrence of endocarditis is derived, when no subsequent affection of the joints has been observed? or why, in the last stages of granular degeneration, when epilepsy or coma marks the transmission of the poison to the brain, recent inflammation is so rarely found, and evidence of previous disease is of such constant occurrence? But for the present it must suffice to point out these as inferences which may be fairly drawn from the statistics now presented." (p. 203.) It results from the author's investigations that acute rheumatism has some, but no great, influence in developing atheroma, since he found that all the cases of diseased heart gave a proportion of 45 per cent. of atheroma in general, and 25 per cent. of atheroma of the valves; while diseased hearts, connected with rheumatic fever, give, as the corresponding proportions, 53 and 27 per cent. We here terminate our notice of a paper which must be consulted in the original, in order to form a just estimate of its merits, and which will always be referred to by those who wish for a complete knowledge of the subjects of which it treats. XVII. On the anatomy and physiology of the cysticercus tenuicollis; by C. B. Rose, F.R.C.S., F.G.S., &c. We candidly admit that we are not prepared to treat this paper critically. We do not profess entire ignorance of the subject, but the field selected by Mr. Rose is a peculiar one, and it requires the devotion of considerable time and careful attention for the successful cultivation of such a science as helminthology. We certainly consider that the author has made a step in advance, in the account which his investigations have enabled him to give us of this interesting hydatid, about which much has been already written. We pass by the historical notice with which the original observations in the paper are introduced, and will briefly point out the chief novelties it contains, without professing to have verified them by personal examination. After describing the structure of the vesicular, transparent body of this entozoon, which he regards as consisting of an external fibrous, and an internal granular lamina, the author proceeds to speak of its proboscis, and the corpuscles with which it is beset, and which he has satisfied himself are not ova, but what Mr. Gulliver has demonstrated them to be, viz. "oval bodies possessing a granular texture, with a calcareous shell." He considers their function to be protective. The circlet of hooks attached to this organ the author considers to be capable of free movement, and that their function is to act as a mechanical irritant, "wherewith to scratch the interior of the vascular cyst, for the purpose of exciting it to secrete a pabulum for the sustenance of its tenant." He regards the absorbent property of the suctorial cups to be entirely exploded, and that they in reality afford no channel to the interior of the hydatid; that, in short, they are purely suctorial. This opinion he holds in common with other naturalists of the present day. We now come to a point of, we believe, entire novelty. On opening the vesicular body of the hydatid by a crucial incision, and turning back the anterior flaps, a transparent filament is seen hanging from the interior of the vesicle where the proboscis commences, and which may be traced high up within the proboscis. The length of this organ increases with the growth and age of the hydatid, and it is very strong and elastic. The author was fortunate enough once to discover "a cluster of young ones sprouting from the upper part of the pendulous body" in question. From this he infers that it is a special reproductive organ, and denominates it accordingly the "Gemmarium." Mr. Rose believes, however, that there is still much to learn with respect to the reproduction or propagation of this in common with other cystic entozoa, and certainly we are quite in the dark as to how they can be disseminated; so that, as the author remarks, the difficulty does not consist in the question of whether they are generated by ova or gemmæ, but in the mode of escape from their incarcerated position. He is inclined, however, to think that they may propagate by ova as well as gemmæ. As regards the nutrition of this parasite, Mr. Rose regards the fluid contained in the cyst as the source whence it derives its nourishment; and considers that the thickened cyst seen surrounding this entozoon when found dead, results from the excess of irritation by its armed proboscis in its demand for food. The lithographed illustrations which accompany this paper are well worthy of it. They are extremely well executed, and must, we apprehend, faithfully delineate the objects described by the author. XVIII. Description of the dissection of a brain, in which the corpus callosum, fornix, and septum lucidum were imperfectly developed; by Mitchell Henry, House Surgeon to St. Bartholomew's Hospital. Communicated by James Paget, Esq. ་ The readers of the Medico-Chirurgical Transactions' will recollect that a brain, presenting an analogous imperfection of development to that noticed in the subject of the present paper, is described by Mr. Paget in the 29th volume. Both the physiologist and psychologist are interested in the multiplication of such instances, where a faithful and trustworthy record is given of the post-mortem appearances, associated with any mental, moral, or other functional peculiarity. That we are still far, very far, from possessing any satisfactory data for generalizing on the metaphysical functions of the great nervous centre must be readily conceded; and but little hope can we hold out to the student of the abstruse science of the connexion between mind and matter, that the present case will afford him, by parallel, or rather by contrast, with Mr. Paget's, the means of making another step in advance. In Mr. Henry's case, the ventricles were exposed above through the anterior half of their extent, the corpus callosum measuring not more than an inch and a half in length, and bifurcating anteriorly, so as to bound a fissure of a nearly quadrilateral form, in which were seen the contents of the lateral ventricles, and the interval between the optic thalami, toward the third ventricle; the fornix was, therefore, likewise wanting at the same part, and the septum lucidum entirely absent. Our space will not allow us to give a more detailed description of the course and arrangement of the fibres composing the imperfectly developed structures; but we find room first to state that, as the boy from whom the specimen was taken was a foundling, an opportunity was afforded of learning that he was very slow in acquiring knowledge, that he was prone to fall asleep when occupied in reading or writing, and generally bewildered when suddenly questioned. He was, however, shrewd in driving a bargain, and in looking after number one. In Mr. Paget's case, the mental phenomena presented a marked contrast to the above, the girl being vivacious, quick in action, &c.; whilst, as remarked, the boy was cautious and stupid. A well-executed lithograph accompanies this paper. XIX. Report of a case in which gastrotomy was performed for the relief of obstruction of the bowels; by Robert Druitt, F.R.C.S.E. Communicated by Thomas Peregrine, Esq. This case would have served well to illustrate Mr. Phillips's paper, which stands at the head of this review; and it adds another to the instances of failure which he records-not, to all appearance, because the operation was inapplicable in this instance; on the contrary, it seemed to be the only resource; the failure being chiefly attributable to delay in its performance, that most rife cause of the fatal issue of so many operations performed for the relief of intestinal obstructions, whether in the form of ordinary hernia or otherwise. The delicate lad who was the subject of this attack and operation was affected with inflammation of the bowels in February 1848, which yielded to the usual remedies, including injections and purgatives. In April the author was again requested to see him for an apparently similar attack; there were present abdominal pain, vomiting, rapid pulse, scanty urine, &c., and the last full evacuation of the bowels was on March 30th. The belly became gradually tense, but less tender; and the chief pain and tenderness were referred to a spot below and to the right of the navel. The patient's condition varied a little, sometimes better, at others worse; but the most prominent and important features of the case remained unchanged, and the constipation was complete. At the close of a fortnight, the consent of the boy's friends to an operation was obtained, and the abdomen was opened by an incision, four inches in extent, between the umbilicus and pubes; and the cause of obstruction was ascertained to be a dense, glistening band, passing from one fold of intestine to another, and binding down a further portion beneath it. A finger was passed under it, and it was divided. The self-gratulation of the author on the success of this step was unfortunately cut short by the outpouring of fecal matter from the bottom of the peritoneal cavity: a large ulcerated opening was found in the ileum, near to the lower end of the divided band. The patient expired two hours and a half after the operation. An examination of the body discovered traces of bygone peritonitis, which had left behind the evidence of adhesions at various points. The whole of the large intestine was pale and contracted, as was likewise the last twenty-five inches of the ileum: the remainder of this portion of the small intestine, together with the jejunum and duodenum, were enormously distended and reddened; the stomach was also distended. The two ends of the divided band were found attached to different points of the ileum; and there were two or three other ulcerated patches near to that which had given way. The case seems to have been treated judiciously, the author confessing his regret that the operation was not performed earlier; and that the inflammatory symptoms, masking the mechanical obstructing cause of constipation, misled him in the first instance; but the true nature of the patient's condition became apparent when these symptoms were mitigated. XX. Cases illustrative of some consequences of local injury; by Thomas Hodgkin, M.D. The author has arranged the cases here published into two groups, viz.: one in which the effects had more or less the character of common inflammation, though probably not unconnected with the operation of a morbid poison; the other distinguished by the production of an adventitious structure, having the character of malignant disease. first of these groups contains three, the second five examples. The The subject of the first case was a gentleman forty-five years of age, an active and energetic man of business, of spare habit, who, though not robust, had seldom suffered from bad health. It was discovered, but not till after his death, that rather more than two months previously, he had |