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IMPORTANCE OF METEOROLOGY TO MEDICINE.

Jiver, and internal organs; and this opinion was rendered more certain by the effects of the treatment, for Professor Piorry has proved, from observations made upon a great number of cases, that the heart and liver, when engorged and congested, will diminish under the effects of a full bleeding, just as the spleen is observed to contract on the administration of quinine. But what was the primary cause of this engorgement? Injury of the pneumogastric nerves. We know that the effects of

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was quite contraindicated, and that the best method of relieving the bowels was the friction over the abdomen with olive oil, and the employment of purging enemata,-the means so much insisted upon by the French physicians in almost every case where there is no imflammation of the viscera. Paris, April 3, 1847.

PROVINCIAL

injury of a nerve are partial paralysis, or "anervismie," Medical & Surgical Journal.

cramp, and congestion of the parts supplied by that nerve, and this we find to have been the case here; the terminating branches of the right pair being injured, the stomach is first affected, and becomes filled with gas; by reflex action the effects are carried to the heart, its force is lessened, and its energy diminished, and thus being unable to entirely empty itself at each systole, it becomes gradually more and more distended; as the distension goes on, the muscular fibres loose in a great measure their power of contracting; the blood not being propelled onwards, accumulates in the lungs, venous system, and liver. By lessening the amount

of the circulating fluid, the heart is emptied, and the blood soon again flows freely through the lungs and liver; and the heart, although its force is still considerably diminished, is again enabled to contract upon and propel this smaller quantity of fluid. But it cannot be expected, that after this enormous distension it will at once recover its former tone; it must have time to regain its lost energy; before this can occur the blood again accumulates in its interior, and embarrasses its action, thus requiring another large abstraction of blood; after which we find it was not only enabled to regain its normal condition, but having now sufficient time to recover its lost force, it continues to act freely and regularly upon the diminished quantity of circulating fluid.

Again, what was the cause of the symptoms of intermittent fever, and exalted nervous sensibility or "bypernervismie"? Injury of the sympathetic nerves. Thus, no doubt, the solar plexus is injured, its sensibility exalted, radiates to the phrenic nerves, causing pain in the epigastrium, to the intercostal spinal nerves, inducing pain in the spine and intercostal neuralgia, so that the patient could not elevate her ribs nor depress the diaphragm without great pain, and thus producing symptoms greatly resembling those of angina pectoris. Again, radiating to the splenic nerves, inducing symptoms of intermittent fever, and determining the periodicity of the neuralgic attacks, for Professor Piorry affirms, that, we almost never have lesion of the spleen or the nerves which supply it, without some symptoms, more or less marked, of intermittent fever or periodic neuralgia; and this opinion is strengthened by the effects of the treatment, for we find that the attack was immediately cut short by a large dose of quinine, and the patient completely cured by its continued employment.

It may appear strange to the English practitioner, that in this case, the colon was not at once emptied by a brisk purgative, but on considering the condition of the stomach, which was filled with gas, and partially paralysed, it will be seen that the use of purgatives

WEDNESDAY, APRIL 21, 1847.

The popular inclination to remark and speculate upon the weather and its effects, as manifested in our daily salutations and conversation, is singularly at variance with the actual state of knowledge on the subject. We are all more or less disposed to comment on atmospheric variations,-to anticipate their occurrence and nature,-to give due credence to every busy foretel a coming change, and to draw from such weather-prophet who believes himself able to predictions, conclusions of future weal or woe; but there are few who follow the course of careful observation, and still fewer who avail themselves of recorded facts, or attempt in a philosophical spirit to deduce the laws on which this part of the system of nature is governed, with a certainty and precision as unerring as those which regulate the motions of the heavenly bodies.

There are various reasons for this neglect of genuine philosophical investigation on a subject in which all the world professes to be, and is, hourly and deeply interested. The problem to be solved involves many conditions, requires multiplied observations carefully followed out for long periods of time, which must be made by stanced as to locality, and these observations different individuals differently circummany must be accurately comparable together. The limits of error are therefore necessarily wide, and the intricacies of the subject such perhaps as not to be included within their influence. We are not however, here, to enter upon a treatise of meteorology; nor is it intended to develope the causes why the meteorologist has hitherto failed to detect the laws which regulate atmospheric changes. The medical philosopher is not called upon to take upon himself to supply the short-comings of a science, which would require for its elucidation the devotion of a whole life. It is, however, within his province to make use of such meteorological details as admit of ready observation, and to endeavour to trace the effects of the varying conditions of the atmosphere in which we live, on the human constitution, and their relations with disease.

Certain of these effects are, it is presumed,

of Paris, published in the Gazette Médicale, for 1846, it would seem to be established that the weight and temperature of the atmosphere, whether considered absolutely or in reference to their variations, do not appear to exercise any appreciable influence on health. The degree of humidity of the atmosphere, and the direction of the winds, on the contrary, seem to exert a well-marked influence. Yet if we attempt to trace the effects of temperature and pressure in their extremes, as recorded by various travellers in the arctic regions, in tropical countries, and on the heights of the Andes or Himalaya range, we shall find that both exercise an immediate and direct influence, and it is therefore not an unfounded presumption that a minor effect must be produced by both, within the limits of such variations as occur in our own country and under our own observation.

well-known; the prevalence of pulmonary ca- the admirable reports on the sanatory condition tarrhal affections in the seasons of winter and early spring, and of dysentery, diarrhoea, and cholera at the close of summer and in autumn, is among the established facts of medicine, and has long been attributed to atmospheric changes. Very loose ideas, however, have been entertained of the relation which the condition of the atmosphere in respect to its weight, temperature, moisture, electric state, &c., bears to the prevalence of disease. How far the influence of these physical agents may be primary or secondary, or whether other conditions, which may be termed concomitant, are not concerned, does not always appear. To take an instance, the autumnal gastrointestinal affections have long been popularly attributed, and be it remembered that the popular opinion of one age is very generally the expression of the experience, or presumed experience, of past ages,-to the ingestion of certain fruits; the plum season has been termed the doctor's harvest, and an abundant supply of stone-fruit has very commonly been considered the source of much professional emolument. But the experience of last year shews that the consumption of abundance of plums and the presence of intestinal fluxes, however generally they may be concomitant, in respect of time, are not always to be looked upon in the relation of cause and effect. With a very scanty supply of stone-fruit, we had the usual autumnal bowel complaints most extensively prevalent throughout the country, and unusually We may dismiss, therefore, the popular opinion on this point as a popular error, while we must look elsewhere for a cause of the prevalence of intestinal affections in summer and autumn, than to the use of a superabundance of vegetable productions.

severe.

The question will then recur, whether the unusual heat and dryness of the preceding summer season were not, one or other, or both, the direct cause of the prevalence of intestinal affections, and consequently, whether these conditions may not always be more or less influential in the production of the same effects in the plum season, whatever may be the supply of that fruit. This is a point for meteorological

research.

The real agent, whether cold, humidity, rapid changes of temperature, or other atmospheric condition, in the production of the catarrhal affections of winter, is another subject which requires investigation on similar principles. These affections have been very prevalent and severe during the severe season now drawing to its close, but they have been also prevalent in other seasons of less actual severity. From

These, then, are the questions which the medical meteorologist has to determine. Observations are required to attain this desirable end, and we rejoice to see the attention of several of the members of the Provincial Association directed to this point. To appreciate the effects of any one morbific agent on the public health, it becomes necessary, as far as practicable, to isolate it from all others; this can only be partially accomplished, but the end may be attained with much more effect than has hitherto been done. Meteorological observations, with a view of ascertaining the influence of atmospheric changes on the health ought to be carried on in the healthier districts, altogether removed from the influence of such causes of disease as result from over-crowding of the population,—from the accumulation of animal or vegetable miasmata,-from the exercise of arts or manufactures, known to be injurious to health and longevity. The locale must, therefore, be far removed from the influence of the great-town system, and the observations should be carried on chiefly in agricultural districts. With a view of estimating the effects of temperature and pressure, they should be instituted in different localities, some of which may be on the general level, in the most northern and most southern parts of the country, others on different levels; some inland, some maritime. In this manner we may hope to be able to isolate, to a certain extent, even the more general physical agents; and by recording also the diseases amongst the denizens and cultivators of the soil, readily ascertainable from the records of the union medical officers, to estimate their effects.

REVIEW.

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Review.

warns the reader, that in inexperienced hands this instrument is not devoid of danger, and that violent (Jack-inflammation may be occasioned by its use.

On Tumours of the Uterus and its Appendages,
sonian Prize Dissertation.) By THOMAS SAFFORD
LEE, Esq., M.R.C.S.E., &c., &c. London, Svo,
Pp. 274.

If we were called upon to name the department of pathology, in which the most solid advance has of late years been made, we should without hesitation point to the diseases of the female organs of reproduction. Although we have not exactly grown grey in the practice of our profession, we can, nevertheless, remember the time, when all but the more palpable forms of uterine disease were a dead letter to the majority of practitioners, and to those who pretended to some skill in such matters, the finger was their best agent in diagnosis, and astringent injections their chief means of cure. This reproach, however, cannot now attach either to the multitude, or the individual medical practitioner, excepting by his or their own culpability, for the more general use of the speculum vaginæ, and the publication of such works as the present, have operated in introducing into the study of uterine diseases, a precision, both of diagnosis and treatment, which is only equalled in the diseases of the eye.

Mr. Lee's volume is one of a class of which we would fain see more frequent examples, and we think that the College of Surgeons has displayed a sound judgment in according to it the Jacksonian Prize. It is not like too many practical treatises, a mere com. pilation, full of crude speculations and hasty generalization, but one which is characterized by so patient an examination of the subjects discussed, and such an evident desire on the part of the author not to move one step in advance of his facts, that it will not fail, we are assured, in impressing the reader with an entire confidence in the writer's truthfulness and capacity for

correct observation.

In reference to the operation for the removal of uterine polypi, the author is at variance with Dr. Montgomery and others as to the dangers of incision. He finds, and we may be sure that in an essay like the present, every available source of information has been searched, that there are at most but two cases on record in which the patient has died from hemorrhage consequent upon excision of a polypus. The fears of the surgeon have been, we believe, most unnecessarily excited in reference to this operation, and we regard Mr. Lee's statement as well calculated to restore his confidence.

We could easily, and with much satisfaction to ourselves, lengthen the notice of this valuable essay, by the mention of many other subjects treated of in the first part, but as we wish more particularly to direct the reader's attention to the chapter on ovariotomy, we shall here merely state that the diagnosis of uterine polypus, the description of the various modes of operating for their removal, and the chapter on cauliflower excrescence, are particularly worthy of perusal.

The diseases of the ovary occupy the second part of the work, and as the subject is one which has recently been invested with peculiar interest, we shall allude to the author's well-digested opinions on its different bearings at some length. It is a common opinion that encysted dropsy of the ovary attacks females indiscriminately, whether single or married. Mr. Lee finds, on the contrary, that the married are the more liable of the two; of 136 cases, 88 were married, .11 were widows, and only 37 single. These results are certainly opposed to our previous impression, but as we have chapter and verse for this, as for all Mr. Lee's

assertions, we are bound to receive them with respect. Another very general opinion exists, that ovarian dropsy

The matter contained in the volume is distributed affects the left ovary more than the right. This under three divisions. opinion is also reversed by Mr. Lee's investigations.

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The pathology of ovarian tumours, the anatomical details connected with the structure of the cyst, the symptoms, diagnosis, and treatment of the disease, are so many points upon which we might with advantage dilate; our space is, however, too limite to allow of our noticing them at the length they eserve, we shall, therefore, devote what space remains to the consideration of two very important subjects connected with the treatment of the disease-namely, the operation of tapping and that of ovariotomy. On both these sub

3. Tumours of the vagina and external organs. Under the first division the author gives us a very complete history of the various benign and malignant growths to which this important organ is subject, commencing with the fibrous tumour, and taking in succession polypoid tumours, soft polypi, cauliflower excrescence, and encephaloid. As a means of diag-jects Mr. Lee speaks ex cathedra, and it is but common nosis of all forms of uterine tumour, he speaks favourably of Dr. Simpson's uterine sound, by means of which he states that the important question of the attachment of the growth to the fundus, and of the adhesion or non-adhesion of the organ to the neighbouring parts, may be satisfactorily determined. He however,

justice to him to admit that the pros and cons of each operation are most clearly laid down.

The operation of tapping is shewn to be but at best a palliative of very doubtful value, and to be, moreover, in many cases, surrounded by positive and immediate dangers. The consequences, too, of the operation,

form part of the library of every man who is desirous of improving his professional knowledge. We could wish that this class were more numerous, for it is really

are not more favourable, for Mr. Lee finds, that out of a given number, one half died within the space of four months, and that of the latter, half were only tapped The cause of death is attributed to inflamma.painful to meet such numbers of soi-disant practical tion of the sac or peritoneum. These results are exhibited in a table at page 177.

once.

We now come to the operation of excision of the ovary as a curative measure, and here we find Mr. Lee's information to be both extensive and accurate. We must, however, refer the reader to the original for the greatest portion of the details on various matters connected with the operation, contenting ourselves with the following list of conclusions, to which the author has been led by a candid review of the subject:

"1. That from the difficulty arising in the cure of this disease, the operation of extraction of the cyst has been proposed and performed 114 times, of which number 74 have recovered and 40 died, making the average mortality one in three nearly.

"2. That of these 114 operations, in 24, or rather less than one in five, the operation was obliged to be abandoned, either from extent of adhesions, from the tumour being an uterine or omental one, or from there being no tumour at all, proving indisputably the diffi. culties of the diagnosis.

"3. That in the 90 cases where the tumour was removed, nearly one died to three recoveries.

"4. That the diagnosis of ovarian tumours is very obscure as regards adhesions and the character of the tumour; thus adhesions existed in 46 of the 81 cases where the fact is mentioned.

"5. That where adhesions existed, the mortality was greater, being one death in 24.

"6. That the principal recorded causes of death, where it took place soon after the operation, are bæmorrhage and peritonitis.

"7. When death takes place in consequence of the operation it is very rapid. Of 30 patients 14 died within 36 hours, and 25 within a week.

"8. That the character of the disease is of importance with regard to its mortality. In the case of hard tumours the mortality was more than one in two. Of the 16, 9 were cured, 7 died. In 5 the tumour was not removed. When the tumour was composed partly of fluid and partly of solid matter-viz., in 65 cases, 44 were cured, 21 died, and in 14 the tumour was not extracted, making the mortality less than one in three. So that encysted dropsy is more favourable for the operation than hard tumours of the organ.

"9. That as regards the mortality of the two operations, in 85 cases where the major operation was performed, 50 were cured and 35 died, making the mortality 1 to 2; in 23 where the minor operation was performed, 19 were cured and 4 died, making a mortality of one in six.

"10. That in one of the cases operated upon the tumour was malignant, but that encysted dropsy is not malignant in the ordinary sense of the word."

men, who not only do not read, but who make it their silly boast that they do not, hoping, no doubt, that such gasconading may lead to the impression of their own wonderful and innate sagacity.

Lecture, introductory to a Course of Clinical Medicine delivered in the Theatre of Queen's College, Birmingham, on Tuesday, December the First, 1846. By SAMUEL WRIGHT, M.D., Edin., Physician to the Queen's Hospital, and Professor of Clinical Medicine in Queen's College, Birmingham, &c., &c. London. 8vo., pp. 23.

We are induced to notice this lecture by the Clinical Professor of Queen's College, Birmingham, chiefly because it emanates from one of our Provincial

Schools. The observations of its author are highly judicious, and embrace a brief summary of what is expected and required of those entering into the medical profession, to render themselves competent to the serious duties on which they are about to embark. "There is no nobler profession than ours," observes Dr. Wright, in his concluding remarks, "and there is none more responsible. There is something awful in having to take charge of human life: it tells us that we have both a moral and a medical duty to perform to our patients. Never look to the worldly condition of individuals, to know how much professional attention you are to pay them, and what claims they are to have upon your sympathy with their sufferings and anxiety for their welfare." We regret we have not space for the entire passage; it is replete with the highest principles of medical ethics, and happy will it be for the students of the school if such principles seek deep into their minds, and become those on which they shall hereafter be guided in the exercise of their professional calling.

Proceedings of Societies.

BATH AND BRISTOL BRANCH OF THE
PROVINCIAL MEDICAL AND SURGICAL
ASSOCIATION.

Quarterly Meeting held at Bristol, Tuesday, March 23,
1847, Mr. ORMOND in the chair.

There was a very full attendance, amounting to nearly fifty members and visitors.

Dr. Kay, having expressed his extreme regret at the loss the Society had lately experienced in the death of Dr. Bompas, proposed Mr. Nathaniel Smith as PresidentElect, to supply the vacant office. Mr. Estlin seconded the proposition, which was carried unanimously. ON THE RESPIRATORY FUNCTIONS: USE OF THE

SPIROMETER.

We now take leave of our author, with a strong conviction that he has written upon a subject which Mr. Hutchinson, of London, having kindly offered he thoroughly understands, no mean qualification in to make some remarks in illustration of his paper "On the present days of medical scribbling; and we most the Capacity of the Lungs and on the Respiratory cordially recommend his work as one which should | Functions," and to explain the use of the Spirometer,

BATH AND BRISTOL BRANCH ASSOCIATION.

then gave a very interesting lecture, illustrated by numerous tables and diagrams, on the respiratory functions, of which the following is an epitome :—

Nothing was correctly known upon the functions of respiration previously to the discovery of the circulation of the blood, the pressure, and composition of the atmosphere, so that our present knowledge upon this subject is comparatively of modern date.

Physiological experiments upon respiration have been so limited, that the student is perplexed with views differing from each other. Two circumstances should be considered before he can correctly draw a conclusion from any research, at least of a pathological or physiological nature:-First, with reference to the number of experiments; and second, with reference to collateral observations upon the human frame. One where the investigation demands for its solution a multitude of experiments; another where a very limited number at once establishes the point. The chemist, by one experiment, determines the presence of carbonic acid gas in the breath; but the physiologist requires thousands of experiments to determine the quantity of respired air.

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the quantity of respired air is also modified or diminished by disease, so that having determined the healthy quantity, the presence and extent of pulmonary disease can be measured by the difference, and that probably earlier than by any other means.

The subject of this research resolves itself under the following heads:-1st. The quantity of air expelled from the lungs, in connection with other physical observations on the human frame. 2nd. The absolute capacity of the thorax, with cubic, snperficial, and longitudinal measurements. 3rd. The respiratory movements and mobility of the chest. 4th. The inspiratory and expiratory muscular power. 5th. The elasticity of the ribs and estimate of the voluntary muscular power. 6th. The effect of decussating, diametric, and oblique power, in reference to the function of the intercostal muscles. 7th. General and practical deductions, to detect disease by the spirometer, with the method of its application. In this abstract the first and last heads only are touched upon.

In determining the healthy standard of respiration, upwards of 2000 men, from 20 different occupations in life, have been examined as follows:-The number of cubic inches given by a full expiration, here denominated the VITAL CAPACITY-the power of the inspiratory and expiratory muscles-circumference of the chest over the nipples-the height and weight-the pulse and number of respirations (sitting)-the age-tem

With reference to collateral observations, our comprehension of time, space, and weight, is relative; no isolated observations in nature, if strictly considered, can be of much value, because a combination of circumstances is precluded. The medical man feels the pulse, auscultates the chest, examines the tongue,perature of the expired air,—and, lastly, general observes the countenance, desires to know whether the remarks on the vocation and appearance. secreting organs are acting in excess or in deficiency, the sleep natural, the appetite good, &c.; and upon combining these data, he grounds his opinion, and the more numerons his collateral observations, the better he is able to venture his diagnosis. An isolated

observation upon two men, touching the quantity of air expelled at one expiration, varied from 80 to 461 cubic inches; this observation, when viewed alone, is

of little use, but the matter is more comprehensible when we add the collateral observations of their height and weight, for by arithmetically reducing one man to the size of the other, the shorter man breathed within one cubic inch of what was determined by calculation from the collateral observations. The physician, the pathologist, or the physiologist, will gain little knowledge by weighing and measuring the different organs, if he, at the same time, omit taking the height and weight of the body from whence these organs were taken. The development of man is regulated by some certain and constant capacity or measure of his digestive system, therefore to weigh the constituent parts and omit measuring the whole human frame, is like storing up the measurement of doors and windows without reference to the size of the edifice from whence such observations have been made.

Respiration resolves itself into two grand heads, Chemical and Mechanical; our attention is here to be directed to the latter.

The object of this research is to detect pulmonary disease in as early a stage as possible. That the sounds of respiration are modified by disease is now generally believed; it may also be demonstrated that

VITAL CAPACITY.

Of the quantity of Air expelled from the Lungs.— Man at rest breathes a very limited quantity of air, but by the deepest expiration immediately fol lowing the deepest inspiration a very considerable quantity can be expelled. To this quantity we affix the term vital capacity. To determine this, an instrument,

the spirometer, has been constructed, and also a convenient form of scale and standard for taking the Height and weight.

To measure the vital capacity, the person must stand perfectly erect, with the head thrown well back, slowly and effectually fill the chest, then as slowly and effectually expel all the air he can into the spirometer,

where it is measured.

The vital capacity in man is a constant quantity, and is modified by four circumstances,-by HEIGHT, by WEIGHT, by AGE, and by DISEASE.

Effect of Height.-The standing height, and the vital capacity, bear a strict relation, so that by measuring the height of a person, the quantity of air can be determined that should be breathed as necessary to health. "For every inch of height, (from 5ft. to 6ft.,) eight cubic additional inches of air at 60o are given out by a forced expiration." In measuring the height, no allowance is made for the shoe-heel, nor in weighing, for the weight of the clothes. Let the observation for measuring the vital capacity be made three times, and the greatest noted as the quantity sought for. When an air-bag is used instead of the spirometer, then the mean for the three observations must be taken.

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