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MORPHOLOGY OF THE TEXTURES

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The increased amount of matter so deposited is a danger, glue the threatened membrane to whatever deriation from the law of the texture, and therefore surface may be next it, and so prevent that worst and . phenomenon of disease ; but the sensible or visible universal inflammation of the peritoneum which the effects upon the texture depend upon the times, stages, escape of the contents of the alimentary canal into and forms, of the subsequent morphology, which may that serous bag would infallibly occasion. Inflammaconform to the law of the texture, or deviate from it. tion, limited in extent, and moderate in degree, For example the fibrous textures are not secreting becomes conservative by preventing inflammation textures; they do not evolve a viscid mucus mixed more severe and more widely-spread, which would with cells; this is not the law of their nutrition. be fatal."* These textures are therefore on this account called This being the graphic picture of inflammation by a serous textures. But there are other textures that do practical physician, the question very naturally arises, evolve a viscid mucus, mixed with numerous colour. | what can this inflammation be? less cells, and these are therefore termed mucous In the first place, the answer appears to me to be textures. Now, an unusual amount of nutritive clear upon this point that the inflammation which is matter, deposited upon the walls of the blood-vessels conservative,-closes wounds-repairs fractures--bas of a hbrous texture, and a conformable morphology, healing tendencies and preserves the life of the necessarily give rise to an increased amount of the individual, --must be different from the inflammation eleraents of the texture, which becomes thickened which produces destructive consequences --morbid by abnormal fibres; and if adhesions are contracted phenomena-organic changes-and prematurely extin. between contiguous surfaces, it is by fibres; and the guishes buman life; and therefore, that two very serous fluid which naturally lubricates the texture, is different, nay, opposite and incongruous things, are increased in quantity. On the other hand, an unusual | brought together under the unscientific and silly term amount of nutritive matter, deposited upon the walls of inflammation. The difficulties of the subject obvi. of tbe nutrient vessels of a mucous texture, and a con- ously arise, pot from an oversight of the primary pheformable morphology, give rise to an increased quantity nomenon, the disturbed circulation of the blood, and of macus, mixed with a larger number of colourless the increase of nutritive matter in the vessels of the cells. In either case, an unconformable morphology affected texture, but from an utter neglect of the would produce different forms and qualities-fibrous physiological elements involved, and therefore, necesforms, for instance, upon the mucous textures, and cor- sarily of the conformability or unconformability of the puscular forms upon the fibrous textures.

morphology. A nutritive element that is, an element "INFLAMMATION," says a recent and talented author of growth, nutrition, or secretion, which is conformable “must needs occupy a large share of the attention both and therefore healthy in one texture, is unconformaof the surgeon and the physician ; it is continually the ble, and therefore an element of disease, in another and object of bis treatment and watchful care. It affects different texture. An unusual abundance of colourless all parts that are furnished with blood vessels; and corpuscles or cells and an increased mucous secretion it affects different parts very variously.”—“A great in a inucous texture, may pass under the term inflammajority of all the diseases to which the human frame matory product; but mucus and mucous cells are is liable, begin with inflammation or end in inflamma-conformable products, and an unusual amount denotes tion, or are accompanied by inflammation during some no more than an increased amount of the elements part of their course, or resemble inflammation in their natural to the texture ; whereas, the very same elements symptoms. Most of the organic changes of different in a fibrous or serous texture or in the fluid evolved from parts of the body recognize infamation as their cause, it, are the proof of an unconformable metamorphosis, or lead to it as their effect; in short, a very large because such incoherent forms are not natural to this share of the premature extinction of human life in texture. general is more or less attributable to inflammation.”- If so complex a subject as normal and abnormal “ Again, inflammation is highly interesting, not only nutrition,-of conservative and destructive inflammain its morbid phenomena and destructive consequences, tion-be susceptible of a short definition, it may be said, but in its healing tendencies also. It is by inflamma- that simple healthy inflammation consists of an increased tion that wounds are closed, and fractures repaired, amount of protoplasma with a conformable morphology: that parts adhere together when their adhesion is and destructive unhealthy inflammation, of an increased essential to the preservation of the individual, -and amount of protoplasma with an unconformable more that foreign and hurtful matters are conveyed safely phology. The terms conformable and unconformable, out of the body. A cut finger, a deep sabre-wound, referring to the law which governs and determines the alike require inflammation to re-unite the divided physiological form and function of the texture in parts. Does ulceration occur in the stomach or intes-, health, and which must be known before the pature of tipes, and threaten to penetrate through them! Inflam

• "Lectures on the Principles and Practice of Physhe," mation will often anticipate and provide against the in the Medical Gazette,) Dr. Watson.

the diseases can be understood. It is not necessary to he was siezed with rigor and pain in the right side, this definition of simple healthy inflammation, that all succeeded by slight cough, at first dry, subsequently the nutritive elements furnished by the blood should

with some expectoration. He attributed his illness undergo a conforunable metamorphosis ; it is sufficient

to drinking a pint of very cold water from a spring,

| when greatly heated by hay making. that they do so within a reasonable time, to the extent

The symptoms on admission were thus noted : of restoring the irritated, wounded, or inflamed texture

ed, or inflamed texture Complexion muddy; tongue tolerably clean; bowels to its normal state and function.*

regular ; urine natural; pulse 80, of good strength ; Practical medicine is based upon the recognition cougl not very urgent; expectoration muco-purulent, and appreciation of visible or sensible signs: the phy | having a peculiarly unpleasant sickening odour. sician cannot treat diseases ascertainable only by the Physical signs.- Inspection : Evident bulging of the microscope; but if this instrument carries our analysis

antero-inferior region of the right side of the chest, of change of texture into hitherto unknown regions,

from between the third and fourth ribs downwards,

the affected portions rising en masse ; vocal and tussive the medical practitioner must be prepared to accept or

vibration not particularly noted.-Percussion; Com. reject its testimony in toto. There can be no halting plete dulness over the anterior and lower part of the between the microscope and the eye--interpreting one | right side in front; normal sonorosity behind; the left part of physiology and pathology by the vision of side healthy.- Auscultation: Total absence of breathnature, and another by the improved vision of art. sound over the lower-third of the right lung in front;. If the microscope is to be relied on as an analytical slightly exaggerated in the antero-superior region of the means, then not only is every post-mortem examination same side; fistulous breathing audible between the fourth imperfect and the majority useless without it, but we and fifth ribs ; respiration natural over the back; no must no longer speak of vessels or ducts secreting.

abnormal rhonchi; resonance of voice and cough

unaffected ; left lung healthy. Vessels convey or transmit incoherent corpuscular

These phenomena continued for about a week, with forms, and are the means of their accumulation ; and

but little variation, the pulse remaining at 80, soft, ducts convey them away out of the body. Transforma

and of inoderate strength; tongue clean ; appetite tions of matter are effected, or secretions formed, excellent, and bowels regular. At this period the within the cells.

patient became suddenly worse ; he had a rigor; the

skin was hot; the cough greatly increased; expectora• The phenomena of inflammation, although very multi- tion purulent, the odour from wbich was now scarcely todinous, may in fact be resolved into the morphology of the contents of individual cells, the conformability or un.

bearable ; he had nocturnal perspirations, and evidently conformability of the product being dependent upon the

emaciated; the pulse, however, remained steadily at normal or physiological type of the elements of the texture, 80, of fair tone, and the appetite continued tolerably and the form resulting from the last stage of the inflam

good. There was occasional vomiting, which was matory metamorphosis. This is shewn by the phenomena of inflammation in the several textures of the lung,-pleurisy

justly attributed to the horrible fætor of the expectora. (fibres,) bronchitis (cells and mucus,) and pneumonia (a tion. On examining the chest, the respiratory murmur mixed product.) I would beg to suggest to Mr. Hassall the was now feebly audible over portions of the affected benefit he would confer on physiology and pathology, by

region, on the right side in front, in which it had extending bis “ Microscopical Anatomy," so as to include the elements of the various parenchymala, and the struc.

hitherto been extinct; the fistulous breathing had tore of their putrient vessels in the embryo and in the disappeared, and about two inches to the outer side adalt, viewed with a power of 600 or 700. If these were

of the right nipple, and a little above that projection, correctly established, the phenomena of scrofulous diseases

there now obtained, in addition to a modified amphoric and inflammation would be rendered easy.

stroke sound, cavernous breathing, loud bronchophony, (To be continued.)

and slight gurgling, clearly indicative of a pulmonary abscess. The vesicular murmur immediately around

this spot was healthy. CASES AND NOTES FROM HOSPITAL AND

Treatment. This consisted of counter-irritation by PRIVATE PRACTICE.

means of two successive blisters to the side, followed By C. M, DURRANT, M.D.,

by antimonial pustulation, mercury (Hydrarg. cum Physician to the East Suffolk and Ipswich Hospital.

Creta,) to affect the gums, the influence of which was

prolonged, salinés ; subsequently the iodide of potas(Continued from page 547, of last Volume.)

sium, creosote internally, and by inhalation; and Case XVII.

lastly, quinine and nitric acid, with the syrup of the CIRCUMSCRIBED EMPYEMA, COMMUNICATING WITH

iodide of iron. The diet, with the exception of the THE BRONCHI: ABSCESS OF THE LUNG: PHYSICAL

first few days after admission, and the period of the 'SIGNS : TREATMENT : RECOVERY.

rigor, was "full" throughout-viz., meat daily, with a J. M- , aged 27, a labourer, admitted into the pint of porter. Under the abore treatment the Ipswich Hospital, September 3rd, 1846, under the patient rapidly gained desh and strength, the cough care of my colleague, Dr. Beck, who being prevented subsided, the expectoration becameless, with diminished visiting the hospital at the time, the case in part fell fotor, and the progress of the case towards recovery, under my observation.

although slow, was uninterrupted. He was discharged He stated, that seven weeks prior to his admission, 'perfectly well, the respirations being fairly audible

CASES AND NOTES FROM HOSPITAL AND PRIVATE PRACTICE.

121

orer the entire lung, with but comparatively slight, and, as reported by his wife, considerable delifalling in of the lower ribs.

rium. On the occurrence of the pain in the body, the Remarks. The phenomena of the preceding case, rbeumatic pain of the joints became greatly lessened. although full of practical interest, are so clearly The patient stated that on different occasions, uncondeveloped both by the general symptoms, and also by nected with the present attack, be had expectorated the physical signs, that it sufficiently elucidates itself; large quantities of blood, amounting altogether to still a passing remark upon one or two points may not between one and two gallons. Of the accuracy of be deemed superfluous.

this statement I am sceptical, although the patient That the patient was correct in ascribing bis illness adheres most rigidly to the circumstance of the blood to the draught of cold water taken when heated, there being ejected by cough and expectoration, and not by cannot be a question. In our agricultural districts vomiting. On his admission his general appearance during hot weather this dangerous practice becomes, I was strongly that of advanced phthisis, so much so believe, not unfrequently a rife cause of internal dis- that I confess that before making an investigation of ease among the labouring classes.

his case, I was fully prepared to find extensive tuberThe history of the case, the aspect of the sufferer, culous disorganization of the lungs. the cough, and the peculiar expectoration, at once His countenance was anxions and exsanguine; eye. aroused suspicion of some formidable chest affection. balls prominent; tongue coated; total anorexia; That such existed was most unequivocally revealed by bowels sluggish. He complained of a violent sharp burathe stethoscopic examination; indeed I do not remembering pain, with great tension and constriction across to have seen any case in which the phenoinena described the lower part of the thorax, extending between the in the report were so clearly developed. The bulging hypochondria and beneath the sternum, and stretching of the lower ribs, the circumscribed dulness, with cor. to the loins, and which was greatly aggravated by responding absence of respiration strictly limited to coughing, sneezing, and deep inspiration. Pressure this spot, at once bespoke the presence of a fluid, between the lower ribs, over the epigastrium or hypoenclosed by pleuritic adhesions; while the co-existence chondriac regions, and more especially pressure on of fistulous breathing with the fætid expectoration, tbe abdomen upwards, towards the diaphragm, caused fartber indicated that nature had already formed an inost acute suffering. Respirations short and hurried, exit for the discharge of the foreign matter.

and chiefly performed by the intercostal muscles, with The occurrence of abscess in the lung was an unu- slight short dry cough ; pulse small, quick, and very sual feature in this case, its formation was so rapid as weak, and beating irregularly in the right radial to lead to the probable belief that its origin resulted in artery. the introduction into the venous system of purulent The chest sounded tolerabiy resonant throughout matter, followed, as we see in the liver and other on percussion; respiratory murmur was audible over parenchymatous organs, by suppurative inflammation. both lungs, slightly deficient at the left apex in front; With the exception of a very few days, two most action of the heart weak and irritable, but regular ; favourable circumstances obtained throughout the pro- its sounds unaccompanied by bruit. gress of the case-viz., the continuance of appetite, | Treatment. From the extreme anæmia and general and an upvarying steady pulse, seldom above 80, and weakness of the patient, neither general nor local of moderate strength. When these conditions pre depletion appeared admissable. Two grains of calomel sent, in the absence of tuberculization of the lungs, we with one grain of opium, were given night and mornshall, I think, for the most part be justified in giving a ing; a mixture containing an excess of alkali, with favourable prognosis.

spirit of nitrous æther, and small doses of the tincture Cases of this kind require support almost from the of colchicum, was directed to be taken three times a onset, steadily having recourse, bowever, at the same day, and a blister, encircling one half the body, was time, to repeated counter-irritation. The creosote in applied to the left side. On the mouth becoming sore, this instance was administered both internally and by the opium was continued without the calomel, and inhalation, and as in gangrene of the lung, and other the subsequent progress of the case to convalescence affections in which the expectoration is offensive, with was uninterrupted. On bis discharge from the hosthe result of lessening, and finally removing, the fætor. pital he was perfectly free from pain, bore firm

pressure without complaint, the cough had ceased, CASE XVIII.

but the pulse in the right arm remained irregular, and INFLAMMATION OF THE DIAPHRAGM.

the respiratory murmur in the apex of the left lung, F. S- , aged 34, a tailor, admitted into the although more perfect, yet less prouounced than in Hospital February 18th, 1846. States that he enjoyed that of the corresponding side. good health until about eight years ago, when he bad I have since heard that he has been the subject of an attack of acute rheumatism. From this he recovered, a similar attack, but I have not been able to ascertain but has since been the subject of two or three similar the result. seizures. About eight months since, while labouring 1 Remarks. While inflammation of the serous coverunder a severe attack of rheumatic fever, he was ing of the diaphragm, in connection with its contignous seized with a sudden and severe pain, of a constrictive extension over the pleura and liver, is by no means character, extending completely across the body from uncommon, inflammation of its musculo-tendinous one hypochondrium to the other, accompanied by great structure is, I apprehend, decidedly rare. In the tenderness on pressure, dyspnea, cough, palpitation, I foregoing case, the affection was associated with

rheumatism, the extension or repression of which rheumatism, the best effects result from opiates ; but disease is, perhaps, one of its most frequently exciting in this disease, as in pleurisy, I believe that more benefit On ises.

will be derived from administering opium in full The symptoms from the first were well marked, and doses at night, with mercury during the day, instead require no comment. Upon what the permanent of the more common practice of combining the two irregularity of the pulse in the right radial artery remedies. In croup also, in lymphatic children, after the depended, I am not prepared to say, the stethoscope urgency of the symptoms have abated, opium to predid not indicate either cardiac or arterial disease; it vent spasm is often imperatively called for. In arobe, in all probability, from local pressure upon the peritonitis, enteritis, diarrhea, and dysentery, opium artery, but in what part of its course this obtained, l judiciously used is invaluable. repeated examination failed to elicit.

The forms which I myself prefer are the crude la the trealment, in addition to the other remedies, opium and the muriate of morphia. I am disposed to attribute a large share of the benefit In reference to the constipating effects of this drug derived to the free use of opium ; and this leads me upon the bowels, I do not regard it as any reason for to allude briefly to the question lately brought before withbolding its use. In enteritis and peritonitis, it the Association, - viz., “The treatment of internal becomes often of paramount importance, while allayinflammation, by opium," an important practical ing pain, to ensure quietude in the intestinal tract; subject, and one which I trust that we shall sooner or and not unfrequently shall we find obstinate constipa. later see discussed in the pages of our Journal, by not tion attended with, and perhaps produced by, spasm, a few only of its many talented members. Without effectually relieved by the free administration of entering upon the theory of the action which opium opium. Witbin the last few weeks, I have witnessed exerts upon healthy and diseased organs, I can most the most decidedly beneficial result obtain from the fully assent to the opinions which have been recently exhibition of opium, in strangulated irreducible hernia, expressed by Drs. Chambers and Ranking, in reference for the relief of which, neither the patient (a female, to its utility in the treatment of many cases of acute aged 64,) nor her friends, would sanction an operation. internal inflammation. The power of allaying pain, | After all other measures had been adopted, by the subduing nervous excitability, and thereby reducing surgeon in attendance, without avail, and repeated the irritability of the heart's action, peculiarly belongs stercoraceous vomiting taking place, a grain of solid : to this drug; and however difficult or impossible it opium was administered every two hours, with the may be to instance, by writing, those particular con effect of not only allaying the vomiting, but also ditions in which its adoption is so generally followed (after half a drachm had been taken,) of inducing free by benefit, still how vividly will the reflecting physician, i and repeated eracuation of the bowels, which function unshackled by bypothetical notions, revert to the had not previously been performed for fourteen days. satisfactory results which in his hands have attended The patient, although relieved from the consequences its use.

i of the hernia, ultimately, sank from exhaustion, the In the selection of the cases most requiring the friends pertinaciously refusing a post-mortem examinaopium treatment, as also the precise period at which tion. this medicine is called for, (and this is all important,) In thus briefly advocating the powers of opium in . medical tact and observant experience can alone direct. the treatment of internal inflammation, I must again

A volume upon the subject would, in inany instances, repeat, that it is clinical observation alone that will utterly fail to indicate the peculiar circumstances suffice to demonstrate, in many instances, the particular requiring opium, but in which to give it is recovery to time and circumstances by which its exhibition must the patient,-to withhold it is probable destruction; / be regulated. When calculated to benefit, the and who cannot call to mind the look of gratitude relief which it affords is often immense, while on the beaming in the countenance of the sufferer relieved, contrary, if given under disadvantageous conditions, If not rendered out of danger, by the timely and its injurious effects inay be irreparable. judicious exhibition of this valuable drug. Independ

(To be continued.) ently of those diseases in the treatment of which opium is commonly prescribed, as delirium tremens and some other nervous affections, there exist others,

A CASE OF DYSMENORRHEA IN WHICH in which at one period or other of their course, the

THE TINCTURE OF CANNABIS INDICA exhibition of opiates is attended with the happiest

WAS EMPLOYED, WITH SOME OBSERVA. results.

TIONS UPON THAT DRUG. In the second stage of pneunomia, if the cough be constant and barassing, the expectoration scanty, and By BENJAMIN BARROW, Fellow of the Royal Medicothe countenance anxious, with an exalted state of

Chirurgical Society, of London. nervous sensibility, full doses of opium at bed-time In offering the following observations to the perusal often act like a charm. In pleurisy, prior to effusion, of the profession, it must not be supposed that I con. sbe same medicine administered at night, giving sider the usual effects of the hemp to be those which mercury per se during the day, is equally valuable. came under my notice in the case in which I employed If effusion obtain, the balance of the circulation is it, but simply that they are some of those which may often so much interfered with, that the propriety of occur and cause much alarm not only to the patient opium, in these cases, becomes questionable. In and friends but also to the medical attendant. It is CANNABIS INDICA IN DYSMENORRHEA.

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my desire in giving these details to put those prac-only been able in any way to alleviate her sufferings, titioners who may not have employed the cannabis by administering very large quantities of opium or opon their guard as to its administration, for my own morphine, both of which remedies had been given in part I shall pot again give it in any case wherein the every form, but had become so obnoxious to my patient, æterus is at fault, knowing as I now do what may inducing excessive nausea and vomiting, which frehappen, and as I shall presently show, how long the quently lasted for many subsequent days, that I deter. QRComfortable and painful sensations about that organ mined to make trial in this instance of the tincture of the may continue after its exhibition.

Cannabis Indica, my attention having been directed to The Cannabis Indica, being one of those drags, this remedy and its use recommended, by a much valued the use of which has been, I believe, very limited, and and professional friend. I therefore immediately gare of which little is known, it may be interesting to some five drops for a first dose; in two hours the same quantity and useful to others of our profession to have a few was again given, and in three hours five additional; particulars of the plant and preparation laid before so that in the course of fire hours not more than them, as also a brief outline of the experience of those fifteen drops were taken. That this quantity was not who have employed it as a medicinal remedy. I find exceeded I am certain, since I took the precaution of that Dr. Pereira, to whose able work on Materia myself dropping the doses into separate glasses before Medica I may refer for full information, represents I quitted the patient. Some ease was experienced the Cannabis Indica as possessing no specific quali. after the last dose, and I found my patient tolerably ties different from the Cannabis sativa, which is, as comfortable in the afternoon, but somewhat drowsy, of of course all know, the common hemp. Some which I took no particular notice, knowing she had botanists have, however, stated that there are certain passed but a restless night. slight differences in the growth and flowering of the She rose at five o'clock, and went down stairs to plants. The ordinary dose of the tincture prepared dinner at six, at which meal she ate about as usual, from these plants appears to be from len to twenty and drank one glass of wine. A degree of incoherence drops; in some cases eren as much as a drachm has of manner and speech was observed by her family been given, and without producing effects of any kind. during the meal, and almost immediately afterwards Dr. Pereira, as well as others, has experimented with she became violently sick and vomited, being at the the drug, and witnessed various effects in different same time altogether unconscious; the extremities and individuals, but none exactly similar to those which body became cold, and when I saw her she was perfectly were present in the case I shall directly relate. The pulseless, the eyes wide open and staring, the pupils Indian hemp is mentioned as causing a very agreeable somewhat contracted and quite insensible to the kind of delirium, augmented appetite, venereal excite- strongest light, with strong convulsions of the whole ment, and impaired volition, followed by insensibility, frame, and involuntary twitchings of the muscles, which during which the patient retains any position in symptoms remained for a day or two whether awake or which he may be placed ; its effects, therefore, simu. asleep. This state of complete insensibility, I might late catalepsy. Dr. W. B. O'Shaughnessy, of Calcutta, almost say of lifelessness, lasted for about a quarter of an has written upon this subject, and his observations hour. Warm brands and water, sal volatile, and warmth upon these preparations may be consulted with advan.to the extremities and abdomen had the effect of tage. He has described their effects on the animal sys. recalling the circulation, and allaying the other formid. tem in health, and their utility in the treatment of teta. able symptoms, but there remained during the whole Dos and other convulsive disorders. Dr. J. Clepdinning night a partial state of unconsciousness, as also the gives & farourable account of the drug, and says " its other symptoms in a milder degree. The pulse, which exhibition was followed with remarkably few excep. | varied from 100 to 140 or 150 was extremely feeble, and tions by manifest effects as a soporific or hypnotic in intermitted from time to time during the following conciliating sleep, as an anodyne in lulling irritation, two days. as an antispasmodic in checking cough and cramp, and It is unnecessary to say more of the case, than that as & nervine stimulant in removing languor and the recovery went on progressively under the careful anxiety. These effects were observed in both acute and adıninistration of stimulants, although the pains and chronic affections, and in patients of all ages and both uncomfortable sensations about the uterus and its sexes. It had also the advantage of not producing the appendages continued for a fortnight or longer, which iDjurious effects of opium. The following is a faithful | I can only attribute to the medicine, as she had never record of the circumslances which attended the case suffered in a similar way at the termination of any which came lately ander my care :

former menstrual period. Warm baths and opium A married lady, twenty-six years of age, of a thin plaster over the hypogastric region, with occasional spare habit, of a naturally feeble constitution, and who small doses of hyoscyamus with camphor mixture, had suffered for some years from dysmenorrhea, the tended to relieve these last remaining symptoms. pain at these periods being of a more than ordinary There are a few observations which it may be useful severe character, requested my attendance in conse to make before concluding, but which I shall say in quence of the extreme suffering with which the last as few words as possible. period was ushored in. On previous occasions, I had The subject of the above case had never suffered at

any time of her life from any description of fit or • The" Botanical Magazine," Vol. II , N.S., gives a full

cerebral affection, and her heart, so far as external description of these plants, by Dr. Hooker.

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