use should be commenced by taking a very small quantity, either alone or mixed with common water, and increasing it gradually until the bowels are opened, but it should never be drunk to such an extent as to produce really purgative effects. The aperient result is a certain method of ascertaining the limits of the quantity to be taken. By combining the internal use of this water with bathing, the efficacy of sea-water baths would be much increased, and great advantages would be obtained in all respects.

QUARTERLY REPORT ON PATHOLOGY AND MEDICINE.
By EDWARD H. SIEVEKING, M.D.,

Fellow of the Royal College of Physicians, Physician to, and Lecturer on
Materia Medica at, St. Mary's Hospital.

I. DISEASES OF THE NERVOUS SYSTEM.

A Case of New Formation of Grey Cerebral Matter. By Dr. C. TüNGEL, of Hamburgh. (Archiv für pathol. Anat., &c., Band xvi., hefte 1, 2.)

A female, aged thirty-one, was brought into the Hamburgh Hospital on the 26th November, 1858, in a state of sopor; she only gave short replies when repeatedly questioned, and without having understood the questions; she occasionally uttered brief exclamations. When attempts were made to open the eyes, she closed them convulsively; attempts at moving any of the limbs were resisted, but this was easily overcome, except the spasmodic contraction of the right hand. There was a dislocation of the right arm inwards. Respiration was accelerated, but no disease could be discovered in the lungs. As the patient was considered to be moribund, no treatment was adopted, except the application of a blister to the chest. She died six hours later, and it was afterwards ascertained that she had been subject to dislocation of the arm, that she had been indisposed and peculiar in her manner for four weeks previously, during which time she had been seen only once by a medical man, who considered her hysterical. There were various rickety distortions in the trunk and lower extremities. The vessels of the dura mater and pia mater and the cerebral tissue contained much blood; the arachnoid was not opaque, and there was a considerable amount of reddish watery exudation under it. The lateral ventricles contained a little fluid of the same kind. At the point where the upper wall of the lateral ventricle bends down, there were, on the outer side, between the middle and end of the posterior horn, several hemispherical tumours projecting into the cavity, varying in size, and on section apparently identical in hue and consistency with grey cerebral matter. These deposits extended into the medullary tissue, so as to form circular tumours, which were separated from one another by intervals of white matter. The deposit was greatest at the end of the posterior horn, and here the consistency of the brain was most developed. Both lateral ventricles presented the same appearances. There was no other abnormity in the brain. The microscopic examination of the new formation exhibited a fine granular mass with granular cells; nerve tubes were not seen. From the remainder of the autopsy, we merely note that the uterus was divided into two compartments by a septum, that there were two cervices and two vaginæ, with a single circular hymen.

On Diphtheritic Paralysis. By Dr. MAINGAULT. (Archives Générales de

Médecine, October, 1859.)

Various French authors have drawn attention to the fact that paralytic affections occur as sequela of diphtheria, or rather of the disease to which Bretonneau has given the name diphthérite. Dr. Maingault discusses the subject

fully, and adduces numerous cases in illustration of his remarks. The following is a brief summary of the account which he gives:-Two or three weeks after all throat affection has disappeared, the first symptoms of paralysis show themselves; they are developed slowly; the patients may even have made considerable progress towards recovery before they occur. The first thing noticed is a para lytic affection of the soft palate, characterized by a difficulty of deglutition and a nasal speech-phenomena that may entirely disappear when the general mus cular weakness shows itself. In some patients there is sudden emaciation. Vision becomes imperfect, and even complete blindness may supervene. The strength fails gradually; formication occurs in the extremities, accompanied by more or less severe pains in the joints. Walking becomes more and more painful, until the upright position is impossible. The paraplegia is then complete. The upper extremities partake in this weakness, the head becomes too heavy and sinks on the chest, the muscles of the trunk are incapable of sustaining the weight of the body. Strabismus, distortions of the face, dribbling, defective articulation, and paralysis of the bladder and rectum also supervene. There is an entire absence of fever, the pulse is small, and is reduced even to fifty, at the same time the heart's action is tumultuous, and there are anæmic murmurs. With these and other symptoms of defective innervation, the intellect remains intact, but the mental powers are sluggish. The disease may proceed to a fatal termination, or if it terminates favourably, the patient's strength returns gradually, and a cure is effected in a period varying from two to eight months.

Dr. Bouillon-Lagrange, in one of a series of articles on angine couenneuse, contained in the Gazette Hebdomadaire,'* also draws attention to diphtheritic paralysis, of which he adduces four cases. He regards it as a complication occurring mainly in the adult, that its duration is from two to three months, that the effect of treatment is very doubtful, and that it depends upon a serious alteration of the blood, the restoration of which is essential to recovery. Dr. Bouillon-Lagrange asks why this important complication has scarcely been noticed in previous epidemics, and is inclined to attribute it to the modifications in the epidemics of 1857 and 1858 by the continued dryness of the atmosphere which accompanied their development and progress.

II. DISEASES OF THE VASCULAR AND RESPIRATORY SYSTEM. Tubercle in the Heart. By Dr. F. v. RECKLINGHAUSEN. (Archiv für pathol. Anat., Band xvi., hefte 1 and 2.)

This is probably a unique case of miliary tubercle under the endocardium, occurring in a person aged twenty, who died of arachnitis, and exhibited acute miliary tuberculosis in the lungs, pleura, liver, spleen, kidneys, thyroid, and prostate. About twenty small, opaque, circular or elliptic nodules were found under the auricular and ventricular endocardium, embedded in the muscular tissue, and varying from one to one and a-half line in diameter. Under the microscrope they were found to consist of moderate-sized corpuscles, generally with a granular nucleus, and a dark, finely granular substance. The adjoining muscular fibres were atrophied.

On the Position of the Heart in Emphysema of the Lungs. By Dr. J. KLOB. (Zeitschrift der Gesellsch. der Aerzte zu Wien, 1859, No. 6.)

In a paper in which Dr. Klob discusses the opinion that in emphysema the apex of the heart is felt at the epigastrium, owing to the organ being pushed into the middle line, he makes some remarks on the post-mortem changes in the position of this viscus which deserve notice, not only because they appear to

* Gazette Hebdomadaire, 24 Juin, 1859.

vitiate conclusions arrived at in reference to the heart by pathological anatomists, but also because they are suggestive of the necessity of caution in regard to similar questions affecting other viscera.

The rigor mortis fixes the muscles in the position which they occupied in the corpse; but long before the extremities have lost their rigidity, the thin diaphragm has become flabby, and owing to the early distension of the intestines, is pushed upwards, so as to induce a change in the heart's position. In order to determine this point more accurately, Dr. Klob percussed the heart of numerous corpses three hours after death, and then inserted a long needle into the apex, while the rigor mortis was still well marked. Before the rigor appeared to diminish in the muscles of the face or of the extremities, the position of the needle was altered, the external end of the needle moving downwards, and distinctly towards the right, so that in some cases Dr. Klob inferred a movement of the heart's apex of from one and a-half to two inches. He therefore concludes that in every corpse the upward movement of the diaphragm causes the heart to assume a horizontal position at a very early period, and before other phenomena of putrefaction occur.

*

Dr. Klob does not deny that emphysema may induce a horizontal position of the heart, and that the epigastric pulsation felt in these cases may be due to the impulse of the right ventricle; but he does not consider the fact to be proved by autopsies, on the ground above-mentioned. In the cases of emphysema which have fallen under his notice, he has found that the heart occupied a horizontal position, so that the right wall of the right ventricle was in contact with the anterior wall of the thorax in the triangular space of the anterior mediastinum. But where he had marked the point of maximum impulse of the heart during life, he found at the autopsy neither the apex nor the right ventricle; but the latter above, the former to the left of the point that had been marked.

Inquiry into Sweating of Blood+ and Neuropathic Hemorrhages. By Dr. JULES PARROT. (Gaz. Hebdom., Nos. xl., xli., xliii.)

The occurrence of hæmorrhage on the surface of the body without solution of continuity and from internal causes, is so rare that a well-authenticated case deserves all the attention and analysis that Dr. Parrot has bestowed upon the one that has fallen under his observation. The following are its prominent features: -Mad. X., born in 1832, when seven years old was affected with scrofulous ulcers of the righth and, which cicatrized after two years' treatment; later on, the cicatrices were the seat of a sanguinolent exudation, occurring without pain, and often without appreciable cause. One day, under the influence of severe grief, her tears were coloured with blood, and from this time the knees, thighs, chest, and the margin of the inferior eyelids, exhibited the bloody sweat at irregular intervals. At times the blood suddenly inundated the face, so that the patient looked as if she had been assassinated. The menses occurred at the age of eleven years, and for a time the symptoms were in abeyance, but soon returned with increased force. The hemorrhage was commonly due to mental emotion, and was associated with a temporary loss of motor and sensory power. She married at fifteen years of age; but the attacks became more severe, lasting at times one or two hours. They disappeared during the first pregnancy, and for a year after. Mad. X. appeared to be improving at the beginning of 1858; but after the severe illness of her child, she was seized, on the Ist of April, with

This evidently means to the right of the observer.

For an account of most of what is known on this subject the reader is referred to Dr. Copland's Dictionary, vol. ii. p. 72; Gendrin, Traité Philosophique de Médecine, vol. i. p. 276; and Grisolle, Traité élémentaire de Pathologie, vol. i. p. 644; and Grandidier, die Hemophilie. Leipzig, 1855.

a severe attack of unconsciousness, and hæmorrhage from the face, from which time Dr. Parrot was called in to attend her. He found her suffering from agonizing pains, alternately affecting the epigastrium, the inguinal and vulvar regions, the thighs, head, and thoracic parietes. On the 25th, the lady came to Paris: her period was somewhat behindhand, and she had lancinating pains in every part of the lumbar region. Towards 4 p.m. they attacked the inguina, thighs, breasts, head, hypochondria, and epigastrium, and on these disappearing under the influence of chloroform, she had three epileptic fits. A circumscribed spot on the scalp then became painful, and Dr. Parrot saw the blood exuding from there, and drying up immediately after; subsequently all the painful points became the seat of bloody sweat. It formed a chaplet round the roots of the hairs, and flowed in sufficient quantity from the lower eyelids to allow of several drops being collected. Both before and after the discharge, the skin presented its normal appearance, not exhibiting any injection or spot. After several bilious vomitings, sleep was induced at 11 p.m. by a full dose of muriate of morphia. The day after the catamenia appeared, and the patient gradually improved, the attacks becoming less frequent, till they disappeared entirely. Four similar attacks, wwere witnessed by the author subsequently to the one just described, on the 28th Sept., 1858, the 17th Nov., 1858, the 25th and 28th January, 1859. During the intervals, the patient enjoyed perfect health, looking well and healthy. Her intellectual faculties continue unimpaired, and even after the severest epileptic seizures she suffers none of that prostration often witnessed after epilepsy.

Dr. Parrot's treatment has been directed towards combating the neuralgia during the seizures, and the strumous and chlorotic diathesis during the intervals. The former object he obtained best by chloroform inhalations, the latter he pursued by the exhibition of preparations of iodine and iron. After detailing the above case, the author goes with some minuteness into the history and pathology of the affection: he concludes with regard to the latter, that it it is truly a secretion of blood from the sweat ducts, as evidenced by microscopic examination of the liquid, and close watching the surface from which the exudation takes place. He quotes several cases, the best and most complete of which is given by Professor Huss. We can only make room for one remark as a warning, that these cases are quite distinct from those known as "bleeders,” and characterized by the occurrence of hæmorrhage, which it is almost impossible to arrest, from any part of the body on the slightest abrasion.

On Congenital Vesicular Malformation of the Lungs, with Remarks on Cyanosis resulting from Pulmonic Disease. By Professor MEYER, in Zurich. (Archiv für pathol. Anat., Band xvi., hefte 1 and 2.)

This is a description of two preparations contained in the Pathological Museum of Zurich, of a kind not before noticed by recent morbid anatomists. The first was taken from a girl, aged one year, apparently healthy to her fifth month; then she presented symptoms of asphyxia, with sibilant respiration, irregular and tumultuous action of the heart, aggravated by lying on the right side, and accompanied by blueness of the face and hands. The attacks occurred in paroxysms with increased frequency and violence, in one of which the child died. The discoloration of the skin remained during the intervals. The heart was found to be normal, the ductus arteriosus closed, but the foramen ovale sufficiently open to permit the passage of a bristle. The right lung presented the usual lobar divisions. On the inner surface towards the heart some large vesicles projected above the surface, varying in size from a hempseed to a pea. The left lung presented two main divisions into lobes; the lower one conHémophilie, cas de maladies rares, etc. Archives Générales de Médecine, Août, 1857,

p. 165.

sisted of three tongue-shaped lobules, their parenchyma being throughout pervious to air. The upper part of the left lung formed a large fibrous sac, with very thin parietes, the pulmonary tissue being cut off abruptly at its margin. The sac was full of air, lined with a smooth mucous membrane, which presented full and prominent folds; the largest folds were found near the root of the lung, where they were found to overlay the orifices of the bronchi. There was some chalky deposit on the posterior wall of the sac. The sac measured vertically 111 millimetres, transversely 93 millimetres (4.36 by 3.65 inches). The second case occurred in a fœtus of 5-6 months, and presented a similar malformation, though in a less degree.

The author regards these cases as resulting from a vicious development, though he will not determine whether this be attributable to an arrest or to a morbid process occurring in the fœtus. Among the older authors, Professor Meyer has only succeeded in finding one case which truly resembles his own, and is given by Bartholinus in a paper entitled "De Pulmonum Substantia et motu Diatribe," which in its turn is contained in the works of Malpighi. (Leyden edition, 1687, vol. ii., pp. 3 and 9.)

III. DISEASES OF THE ORGANS OF DIGESTION.

A Case of Pancreatitis. By TIMOTEO RIBOLI. (Schmidt's Jahrbücher, Band 102, No. 5; and Gazz. Sarda, 11, 1858.*)

A robust female, aged fifty-four, came under the writer's observation, suffering from gastric disturbance, emaciation, loss of appetite and strength, horripilations, slight catarrh, eructations in the morning, with vomiting of a thin, sometimes viscid fluid of a saline taste, with a white tongue, and night sweats. The exhibition of magnesia and bismuth restored the patient so that she was able to go into the country for the harvest. On returning to town she again complained of her former symptoms. The epigastrium now proved to be distended, inducing a supposition that the disease was a circumscribed inflammation of the left lobe of the liver, which was supported by the presence of slight icterus, and a dull, deep-seated pain. Numerous remedies were tried successively and in vain; death ensued at last from gradual exhaustion of the vital powers from arrest of nutrition. The autopsy showed the pancreas to be in a state of complete suppuration; the gall-bladder was turgid with bile, the liver was gorged with black blood, the spleen normal, the intestines anæmic, the uterus and its appurtenances atrophic, the heart and lungs healthy, the surface generally pale and icteric. The case was observed in 1837, but not published earlier because the author wished to collect more cases of a similar kind. Of all his colleagues who were consulted about the above case, Tommasini alone had made a correct diagnosis.

On Fatal Steatosis of the Liver and Kidneys. By Professor ROKITANSKY. (Zeitschr. der Gesellsch, der Aerzte zu Wien, 1859, No. 32.)

This paper is published by the learned Professor to prove the existence of a form of fatty kidney which he regards as consecutive upon fatty degeneration of the liver, and as distinct from that which is commonly set down as one variety of Bright's disease. Death occurs suddenly in these cases, with symptoms of uræmic poisoning. After analysing three cases in detail, which Professor Rokitansky brings forward in illustration of his views, he sums up thus:-In subjects who are inclined to an excessive formation of fat, we meet with fatty degeneration of the liver, with which, sooner or later, fatty degeneration of the kidneys is associated; both, gradually and imperceptibly, attain so high a degree • See also Gazette Hebdomadaire, Sept. 2, 1859, where a few similar cases are quoted.