peculiar

Dr. Glover says,-" Scrofula is a"modification of inflammation, whereby the usual, or, as they may be termed, the normal products of this process are not evolved; but instead of them, other

Chapter III. is devoted to the consideration of the scrofulous diathesis, on which the author makes the following judicious introductory remark :-" A careful distinction should be made between the scrofulous diathesis, or predisposing constitution, and the actual processes of the disease; between the ens in potentia, and the ens in actu." This chapter, like the preceding, deserves a careful perusal, as in it are given, what are called the characters of the diathesis. Without agreeing in all which it contains, it displays a minute acquintance with the opinions of others, and the capabilities of the author to discriminate and apply them. Here we have the questio vexata of complexion discussed, which from long experience we regard as of little moment in a practical point of view, although it is our conviction, that scrofulous disease is most common in the lymphatic temperament, and that this latter is most frequently associated with light colour. Towards the conclusion of the chapter we meet with the following paragraph :—“ We agree entirely with Mr. Phillips in assigning the Strumous Dyspepsia' of Dr. Todd, when present, rather to the actual disease than to the diathesis. Neither are these symptoms of dyspepsia confined to cases of tubercular deposit." Our reason for noticing this statement is, that we have been long convinced of the influence exerted by derangement of the digestive functions in absolutely inducing scrofula in children, who had, previously to the operation of such cause, possesessd not merely the appearance of a sound and healthy constitution, but enjoyed even robust health. This remark applies with peculiar force to the dyspepsia which is so constant a concomitant of teething, and which is but too frequently aggravated by the medical treatment adopted for its relief, more especially by the unnecessary exhibition of calomel. To this source of scrofulous disease we think our author hardly attaches the importance which it fairly claims

Chapter V. is devoted to the "Identity of Scrofulous and Tubercular Diseases." Into the examination of this our limits forbid us to enter, in a manner at all commensurate with the importance of the question, and therefore we are obliged to pass on to Chapter VI., which treats of the "Essential Nature of Scrofula." After objecting to various definitions of the disease,

and which constitute the substance already described under the name of scrofulous or tuberculous matter. The peculiarities of this formation, and the continuance of the scrofulous diathesis, are the causes of the characters assumed by the various after-processes which result from the existence of tubercle." This definition is, we conceive, to say the least of it, open to very great discussion. As however constant a degree of inflammation may be as an attendant on scrofula, we can hardly see the grounds upon which such action is to be regarded even as an essential element of the disease. Dr. Glover ably discusses this question, but, after a careful perusal of his arguments, we are still inclined to question the inflammatory origin and nature of scrofula. When this remark is made, it is right to state, that we are perfectly aware of the fact, that both scrofulous disease and tubercle of the lungs do frequently arise as a consequence of inflammation, and that both are very generally accompanied by it, in one form or other, in their progress to maturity; this however, does not, in our estimation, in any measure warrant the conclusion, that either scrofula or tubercle is of necessity essentially inflammatory in its origin. In confirmatiou of his views on this question, Dr. Glover quotes Dr. Bennett's ideas on inflammation. We do not, however, consider the light thrown upon the subject, either by microscopic examination or chemical analysis, sufficiently powerful to overthrow all that has been so long received, and it may be said sanctioned, by careful physiological and pathological observers. As we have already said, chemical analysis and the minute structure developed by the microscope, make us acquainted with results, but the cause of these is not demonstrable, either by one or other of these agents. If confirmation of this be required, reference may be made to the analyses of both the blood and urine, as given in the work before us, from which it will be seen that literally nothing is proved at all peculiar either to scrofula or tubercle; the changes or deviations from the healthy state of these fluids, being met with in cases. of disease, and conditions of the system, in nowise allied either to tubercle or scrofula.

Chapter VII is devoted to the "Etiology of Scrofula." In it the question of hereditary influence is fully and ably discussed by our author, who has given several cases in illustration of the subject, and which decidediy favour the generally-received opinions on this point. Dr. Glover has not contented himself with merely examining into the history of the parents, but has extended his inquiries to the collateral branches of their families. From these cases it appears, that even

the abdomen, and the fixed state and position of the uterus, and the existence of a small body upon its posterior surface, lead somewhat to the conclusion that the tumour was attached to the uterus. The application of iodine externally and internally was the treatment employed, and attending to the general health.

About three weeks afterwards, the patient beginning to get thinner and increasing in size in the abdomen, by an examination, instead of one single tumour being found, it appeared to have split into several, which lay in two masses on either side of the median line,-that on the right extending up towards the liver, that on the left not quite so much external, but larger than the other. An examination per vaginam detected the uterus itself in the same state, but higher up in its natural position, and not fixed; it moved freely by pressure of the finger. It was now quite evident that the tumours were ovarian, and that the uterus was not greatly implicated in the disease.

The patient from this time got rapidly worse, emaciation and debility increased, and the tumours rapidly grew larger. That on the right side could be felt knotty and hard, and extended up to the right hypochondrium, so that in a month after the last examination described, when Mr. Hodgson kindly saw the case, it was impossible from examination, to say that the tumours were not connected with the liver. The tumour on the left side seemed to extend more laterally and not quite so high as that on the right, and was felt in hard lumps all over the left side of the abdomen. Anteriorly and below, between the lumpy projections, fluctuation could be detected; and in the upper part and in the lumbar regions the sound was tympanitic upon percussion. Mr. Hodgson recommended iodine to be pushed even more extensively than it had been, which was continued for some time.

The future state of the patient can only be described as getting worse and worse; emaciation went on without interruption; the tumours increased in size. At times there was difficulty in passing motions or urine; at times there were slight pains in different parts of the abdomen, more particularly in the right inguinal region, but these were never severe in their character, and readily gave way to fomentations and leeches, and after extreme emaciation, she died on the 29th of January, 1847.

Post-mortem examination, January 30th, twenty hours after death. The body in the utmost state of emaciation; abdomen hard and much enlarged, measured three feet six inches round over the navel, and one foot nine inches from the os pubis to the ensiform cartilage.

1

The head was not examined. The contents of the thorax were free from disease. The integuments of the abdomen were very much distended. On opening the abdomen, about a gallon of fluid escaped from the cavity of the peritoneum, of a brown colour, and turbid. On examining it, it slightly reddened litmus paper, was 1.020 in specific gravity, and very highly coagulable on boiling. The peritoneum was thicker than normal, and was covered by a thick semi-transparent gelatinous substance, which, on examination

241

under the microscope, exhibited the characters of fibrin, which, most probably, in the process of coagulation, had separated from the fluid. The whole cavity of the abdomen was occupied by the ovaries, which had increased to an immense size; the right one (the one produced,) was rather longer than the left, but not more than half its bulk; it weighed ten pounds, and was composed of cells of different kinds; some were cysts, and contained fluid, (which of course escaped upon being punctured,) others contained a soft substance, having the yellow semi-transparent appearance of colloid matter, whilst other nodules were composed of a hard cartilaginous substance; the two latter, examined under the microscope, exhibited the nucleated cells of malignant disease. There was a small nodule of tubercle, which projected at the posterior part of the neck of the uterus. The liver exhibited nodules of colloid matter, which had the same appearance under the microscope as the portion taken from the ovary. The spleen and pancreas were healthy. The intestines were healthy, but contracted, with the exception of their peritoneal coat, which was rather thickened, and they were covered generally with coagulated fibrin. The kidneys were healthy, but the pelvis and upper portions of the ureters were distended.

ABSTRACT OF THE PROCEEDINGS OF THE ACADEMIE DES SCIENCES, PARIS. February 22, 1817.

ETHER-INHALATION.

M. Flourens read a notice respecting the influence of wether on the medulla oblongata. He remarked that he had previously ascertained that in the spinal marrow sensation was abolished before motion, but that both might be destroyed without destroying the life of the animal. The explanation of this is sought in the following experiment :

A dog being fully brought under the influence of æther, the medulla oblongata and spinalis were laid bare. Pricking the latter in both its anterior and posterior columns gave rise to no movement on the part of the animal. This point being clearly ascertained, the medulla oblongata was irritated, when the animal uttered a loud cry, and the muscles of the neck were seen to contract. The same phenomena were elicited in two similar experiments, from which M. Flourens draws the conclusion that the different portions of the nervous system are successively influenced by the æther, and that the medulla oblongata is the last in the series.

The same physiologist has made trial of other æthers, as the chloric and nitric, the former of which exhibited an action precisely similar to the sulphuric. In three experiments with the latter the animal was destroyed (?) in the space of two minutes.

[The French word succomber is generally employed with the signification of death, but possibly the experimenter here uses it to express insensibility; we do not believe that death would be produced in the short period mentioned, as we have inhaled pure nitric

The inhalation of alcohol did not produce any insensibility, but only intoxication. M. Flourens sums up as follows:-1. The action of the æther upon the nervous centres is successive and progressive. 2. The cerebral lobes are first influenced; next the cerebellum, then the spinal marrow, and last of all, the medulla oblongata.

M. Laugier related several additional operations under æther, and stated that he had particularly remarked, that the colour of the arterial blood was not altered, as has been represented.

M. Gerdy observed that he did not consider it necessary to produce entire insensibility, as he had found patients bear operations without manifestation of pain, in whom the etherization had only produced slight stupefaction.

M. Landouzy related his experiments to determine the combustibility of expired æther, from which it appears that all fear of explosion may be discarded.

M. Ducros suggested that the effects of ather may be immediately dissipated by galvanism.

REAL AND APPARENT DEATH.

Clot

65.46

Before inhaling

Serum

34.54

100.00

3. After inhaling, the serum acquires a slight reddish tinge.

4. The clot appears less consistent before than after inhaling.

5. The globules, fibrin, and the albumen, preserve the same proportions after as before inhalation.

6. The quantity of æther absorbed by the blood is inappreciable in the small quantity of blood submitted to examination. We have, however, endeavoured to ascertain this quantity by studying comparatively under the same thermometric and barometric conditions the tension of the serum before and after inhalation, comparing the result with the tension of a solution of wether of a known strength. By this means we believe that we are authorized in estimating the quantity of æther absorbed, as 0.0008 of the quantity of the venous blood.

INFLUENCE OF ÆTHER ON THE CIRCULATION.

M. Amussat repeated his conviction that the physio

1. A burn of the second degree produces vesication in the living subject.

2. This does not take place in the dead body.

3. The author does not venture to state that vesica

also stated that the blood is rendered more fluid and less coagulable. The latter circumstance he regarded as important in reference to secondary hæmorrhage.

ÆTHER AS A MEANS OF DETECTING FEIGNED
DISEASES.

A novel application of this agent has been suggested

of disease.

M. Serres, in connection with the above communication lamented that there was no certain sign of death, a point of much consequence in many cases, as for instance, where the propriety of the Cæsarean operation becomes a question, and he in consequence proposed a commission to enquire into the merit of the proposed

test.

March 8th.

M. Flourens read a second memoir upon the physiological action of ether, in which he exhibited its close affinity to asphyxia.

M. Roux related a case of tetanus, in which he considered that the fatal event was decidedly hastened by the inhalation of æther.

ANALYSIS OF THE BLOOD AFTER INHALATION
OF ETHER.

M. Lassaigne communicated the results of an exami. nation of the venous blood of an animal before and after inhalation. The following is a summary of his observations:

1. The blood taken before and after inhalation did not differ sensibly in colour, nor as to coagulation; that taken after inhaling exhaled a strong odour of æther.

subversive of the credibility of this test, having succeeded in raising a perfect vesication in four corpses. [The reader may recollect some experiments on the same subject by M. Champoniflon, (Prov. Journal, Jan. 27, 1847.,) which are strictly in accordance with those related by M. Bouchut.]

ABSTRACT OF THE PROCEEDINGS OF THE
ACADEMIE DE MEDECINE.
February 23, 1847.

The claims of Mr. Wells to priority in the application of æther-inhalation having been discussed, the meeting proceeded to the consideration of the employ. ment of the extract of nux vomica in chorea, which formed the subject of a memoir, by M. Trousseau, and was reported upon by M. Gaultier de Claubry.

ETHER-INHALATION IN OBSTETRICAL PRACTICE.

M. Dubois observed, that although what he had to bring before the meeting was to a certain extent connected with the subject of previous discussions, he yet considered that he should adduce much that was new and important. M. Velpeau and M. Bouvier bad been the first to express the surmise that the stupefying effects of æther might be made available, in removing the pains attendant upon parturition, but the speaker was the first [in France. Transl.,] to put the practice to the test. His objects in his experimenta tions were to assure himself in the first place, that the æther was inoffensive to the mother and child, and also to learn the action would not extend itself to the muscles of the uterus, and so destroy its contractility. In illustration of his investigations, he narrated the following cases :—

A female, aged 18, primiparous, exhibited no sen. sation of pain while the forceps was applied. In a second and similar case, the same insensibility was observed.

In reply to the question whether æther has the power of abolishing the contractility of the uterus, and the abdominal muscles, he related the subjoined cases :A female who had been in labour with her first child for two hours, was the subject of regular and severe pains. Inhalation produced certain unpleasant phenomena, such as determination to the head, injection of the eyes, stertorous breathing, &c., but, nevertheless, the contractions of the womb were not affected, and took place without the slightest consciousness on the part of the patient. During the insensibility, the pulsations of the fœtal heart were distinctly perceptible, but appeared to diminish in frequency as the insensibility of the mother became more profound.

In another female, who cried out loudly under the severity of her pains, æther produced complete insensibility in three minutes; during this period the uterine contractions continued with their usual vigour, but gave rise to no expression of pain on the part of the patient. In this state the child was expelled, and on recovering her senses, the patient declared that she had been perfectly unconscious of suffering.

243

the natural pains of labour in a most marked manner; but, on the other hand, that it does not suspend either the contractions of the womb, or of the abdominal muscles. In answer to the question put by some of the members, M. Dubois further stated that he had not observed that any ill effect was produced upon the child by the inhalation.

March 2nd.

ON CATHETERISM IN STRICTURES OF THE @SOPHAGUS.

This was the title of a memoir by M. Trousseau, having for its object the recommendation of graduated probangs in the treatment of constriction of the esophagus. In the discussion which ensued, M. Gerdy remarked that there was nothing novel in the treatment, and related a case in which he had succeeded in restoring the calibre of the passage, after it had been so far reduced as to admit an urethral sound with

difficulty. M. Cloquet observed that great discrimination was necessary as to the nature of the obstruction, in cases in which this mode of treatment was proposed. It was spoken of by Velpeau as of great value in spasmodic and simple inflammatory strictures.

March 9th.

ETHER-INHALATION DUring Labour.

M. Bouvier related the following case:-A female, aged 26, entered the Hospital Beaujon, having been in labour for five or six hours. The uterine contractions were rapid; the os uteri dilated to three centimeters; the membranes projecting; and the cervix obliterated, firm, and resisting. The pains being extremely violent, the patient inhaled æther. At the expiration of eight minutes she became insensible, and from that moment the uterine contractions ceased, but recommenced on her recovery. As M. Bouvier observed, this case is directly opposed in its result to those of Dubois and Simpson, both of whom mention that the uterine pains are not influenced by the agent.

In remarking on this case, M. Roux enquired whether the intermission of the pains was not accidental, and unconnected with the inhalation, and alluded to the naturally intermittent character of the uterine contractions.

March 16th.

After the reading of a commission of inquiry on several different methods of embalming, M. Dubois presented a specimen of

SPONTANEOUS AMPUTATION IN THE FETUS

The infant had been born two days. The middle and ring finger of the left hand had lost the upper phalanx, as had also two toes on each foot. The extremity both of the fingers and toes exhibited a sort of wound still bloody, thus attesting the recent removal of the parts. In addition to these accidents, the left leg presented a deep circular depression similar to that produced by a ligature. The same appearance in a greater degree existed also in the right leg. At the time of birth the amputated parts did not shew any traces of irritation, but have since become inflamed. The umbilical cord was not more than half its usual length, but the placenta was normal. M. Dubois proposed to make some observations on this case at a