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ventricle were healthy, but much distended by, large few beats, of increased impulse and power, accompanied coagula. The viscera of the abdomen were healthy; by sufocative or pulmonary oppression, are followed by the brain presented no conditions of disease.
a beat of unsteady force; then the ventricle contracts The first question you will naturally ask after again with spasmodic energy, drives the blood partially witnessing this examination is, what is the pathological forward, partially backward, regurgitatingly, into, even condition that can explain the remarkable suddenness beyond, the auricle, the backward impulse being felt of the death ? Could the defective valvular structures even in the moutbs of the pulmonary veins; so that at be the cause of this instantaneous death? Not of the ventricular diastole, the auricle empty, or nearly so, themselves alone. Could the adhesion of the pericar. the rentricle receives nothing to stimulate its con dium to the heart, with the large amount of lyinph tractile action, and the whole heart fluttering, and deposited at the base of the heart, produce instantaneous | embarrassed, and perturbed by surrounding and external death ? Certainly not; for quite as large an amount bindrances, as well as by this new internal deficiency of of endocardial and exocardial disorganization has been its vital stimulus, and the right side, overloaded by blood recorded in other cases, where the termination of the accumulating there, unable to move forward from the disease has been slow, tedious, lingering,-dropsical obstructed state of the pulmonary circulation, the venaccumulations or pulmonary congestions at length tricle collapses upon a void, the life-current is arrested, putting an end to the patient's sufferings. Could the and the patient instantly expires. Such is the brief endocardial and exocardial conditions conjointly bring category of conditions that are believed immediately about this abrupt decease? I think they could; and to have led to dissolution. the emptiness of the left ventricle conveys a hint how This poor girl's case illustrates most forcibly the this death-stroke may have been produced conjointly irresistible progress of inflammation of the heart, when by these morbid causes. To comprehend the full it has proceeded untreated or unchecked for a cer« force of these conditions, we must not overlook the effect tain time. I believe that had this case come under of pericardial disease* upon the heart's movements, treatment twenty-four or even forty-eight hours after that in pericarditis the heart's action becomes irregular, the first symptoms of acute rheumatism had developed
its impulse increased,-its motions tumultuous; in themselves, in all probability her life might have been fine, that when lymph becomes deposited about the spared. Had she been in the hospital thus early, we heart, its actions become embarrassed, irritable, and should have been on the constant watch for cardiac unsteady. With a heart adhering to the pericardium, mischief, and ready to combat it the moment it declared and surrounded by recently exuded lymph, can we itself in the faintest degree, for it is one of the characa wonder that so sensitive an organ should become teristics and advantages of modern practice, that by irritated and uncertain in its motions. Do not forget the aid of the stethoscope, the earliest possible symptom this consequence of exocardial disease, especially of metastasis to the heart, may, by a watchful ear, be when recent.
detected. In such cases you must not wait for pain in Now, let 118 turn to the internal condition of the the chest, or palpitation, or uneasiness in the præcordia, heart. The disorganization of the mitral valve proved, or other complaint from the patient. In every case of beyond all doubt, that regurgitation to a vast extent acute rheumatism you should never omit to apply the must have taken place during the systole. The dys- stethoscope at every visit to the region of the heart; be poca and burried respiration declare this as well as always on the watch for cardiac mischief, the accuse the pbysical signs. Bear in mind the action of the tomed and educated ear will instantly detect the ventricle and valve in a sound heart. The left faintest rubbing murmur or other indication of metas ventricle contracts on the continued blood which is tatic inflammation, and will be as quickly ready to propelled forward through the aorta, the perfect mitral combat this fearful enemy to the ultimate safety of valve preventing any blood returning backwards into the patient. I have every reason to think that all the the auricle. During the systole the auricle is filling heart-mischief was perpetrated before the patient was with blood, coming from the lungs, and the succeeding admitted. The physical signs underwent no change, diastole of the ventricle receives the blood from the except a partial mitigation, during the time she lived auricle, which is again propelled forward as before. and was under observation. Once or twice there was But with an imperfect mitral valve, the ventricular con- adecided amelioration of the heart-symptoms; the traction sends some blood forward through the aortic cupping relieved her, and the aggravated action of the canal, but a portion is driven backwards through the heart was for a time brought down; the opium allayed imperfect auriculo-ventricular valve into the auricle; | the constitutional irritability, and assuaged the rheuthe current of blood in the pulinonary veins coming matic fever; but our chief ally was comparatively from the lungs is thus retarded, and this obstruction inoperative. Faint indications of salivation could causes pulmonary congestion, cough, and suffocative with difficulty be obtained, and this, notwithstanding dyspowa. Now, in a heart, the movements of which the large quantity of calomel employed. It is never are embarrassed, as this heart has been shown to bave theless, instructive to remark, how palpably relieved been, by pericardial adhesions and deposits of lymph, all the cardiac symptoms instantly became, so soon as and wbere action was known at times to have been the faintest trace of the constitutional operation of unsteady, tumultuous, and irritable, this faulty con-mercury was developed; but the full effect of this dition of the mitral valve, co-operating with unsteady mineral could not be produced, and the beneficial and irritable action, might, it is conceived, have pro- change could not be sustained. The pathological corduced a fatal condition in the following manner :-A'pition was more powerful than the mercury could
overcome. Such cases will occur to buffle the best- / be evolved from the fibrin," he goes on to say, and he suggested and most active treatment of our art; but is speaking of fibrinous dropsy, "the most different such cases ought not to dishearten us, for they teach forms of tissue, either normal, As cellular tissue, simple us valuable lessons both in pathology and therapeutics; I muscular fibre, cartilage, bone, vessel, nervous fibre; they demonstrate the morbid changes of structure that
or pathological, as pus, granular cells, cancer, tubercle, disease establishes, and they illustrate and develope the principles upon which such cases are to be success
concretiops, &c."* fully treated.
Speaking of the formation of pus, be says, "the The peculiar delicacy and war-like character of the formation of pus is dependent on two very distinct complexion of this poor girl have already been noticed, circumstances. In the first place a fluid must be It may seem a trifing, matter to remark upon, but secreted or separated, to act as as a cyto-blastema; and, her general aspect was so illustrative of the old doctrine secondly, the pus-corpuscles must be formed in and of the temperament, that I cannot forbear alluding from this cyto-blastema, which is always the fibrinous to it. She possessed all the external characteristics fluid, which has already been described in our observaof the so-called sanguine temperament, and to which I tions on fibrinous dropsy, consequently the formation especial susceptibility to acute inflammatory disease
of pas must invariably be preceded by the exudation was attached. Light flowing auburn bair, fair and alabaster-like complexion, florid cheeks, a symmetrical
of a modified blood-plasma." I form, full and early developed, with a mind vivacious
Again, in another place, “The fibrin may coagulate, and intelligent, and her disease the very concentration and thus give rise to false hydatids, apparent serous of inflammatory intensity. Without meaning to revive dropsy, induration of the affected organ, &c. Then or discuss the obsolete question of the temperament, follow the great number of changes which arise from you may, nevertheles, remark, and be prepared to the further development of the fibrin,-suppuration in find, that aniong the youthful who present such the widest sense of the word, with all its modifications characteristics as have been here described, there is a and forms, the forma:ion of granular cells, and ulceraremarkable tendency, and almost special proneness, tion. epigenesis "neubildungen' of the most carving to acute inflammatory disease; and that when such
kind, tumours, hypertrophies, concretions, changes of subjects are attacked by inflammation, it is intense
colour, softening, induration, &c." in its degree, often unmanageable, and speedily tends to a fatal termination.
Dr.J. H. Bennett adopts, if he may not be considered the author of, the views and sentiments expressed by Vogel. “The term exudation," he says, " bas been
introduced into pathology not only to express the act THE LAW OF THE MORPHOLOGY OR META.
of the liquor sanguinis (or lymph) passing through the MORPHOSIS OF THE TEXTURES OF THE
vascular walls, but the fibrinous portion of the liquor HUMAN BODY.
sanguinis itself when it has coagulated." (Fourth Series of Experimental Researches.) “In every case the exudation constitutes a blastema By WILLIAM ADDISON, M.D., F.R.S., Malvern, for the growth of nucleated corpuscles, which differ (Continued from page 315.)
in form, size, constitution, and power of further
development. The various kinds of development of XIV. INFLAMMATION CONSIDERED MORPHO.
the exudation may be grouped under the following LOGICALLY.
heads"; and here follow sixteen different forms, Before proceeding to substantiate the truth of these
normal and abnormal, amongst which are enumerated conclusions by a microscopical demonstration of the
"pus-cells," “ carcinoma," "muscular tissue" "epivisible changes produced by inflammation, I shall
dermis and epithelium." || remark upon certain questions which are considered
I have carefully perused Dr. Bennett's original doubtful with respect to the process of nutrition.
treatise, and Vogel's Pathological Anatomy; and According to physiologists generally, the lymph, or as
I can find in them no proof whatever that coaguI have lermed it, the protoplasma of blood, is of the
lated fibrin acts as a cyto-blastema,--no demonstranature of a cyto-blastema, exuding through the inter
tion of its evolving muscular fibres, nervous fibres, stices of the walls of the nutrient or capillary vessels,
| granular cells, or pus. Vogel indeed, states that somewhat like water through a sieve, and giving origin to' cells after its exudation; and upon this hypothesis
these things are shewn in numerous parts of his
work, and adrances this as a special reason for they explain the origin of pus-cells.
Vogel even attributes a developmental capacity, i.e., a metamorphic power, not only to coagulable, but •"Pathological Anatomy," p. 55.- Ed. 1847. to coagulated lymph. The fibrinous fluid of a dropsy,
+ Loc. cit, p. 144.
# The italics in tbe above quoted passage are mine, and be says, is capable of organization, and “it is indif
inserted to fix the reader's attention upon the kind of ferent whether the fibrin is in a fuid or coagulated demonstration on wbich the "unlimited" formation of cells
in coagulated fibrin is based. state, as in either case it acts equally well as a cyto-"
Loc, cit.p. 415. blastema, and its capacity is unlimited." "There may ). Monthly Journal of Medical Science, Jap, and Feb., 1847. MORPHOLOGY OF THE TEXTURES.
its being unnecessary to enter upon any refutation of afforded to show that the molecules or granules are the contrary doctrine which I maintain. But I cell-germs. contend that these things are not shown,-that bis! Again, a great deal has been asserted respecting, and book opens with, and is altogether based upon, 'a pany important functions have been attributed to, cerbroad assumption with respect to exudation, and an tain particles seen in the interior of cells, termed nuclei; unlimited cytogenesis in coagulated fibrin, for which but the fact that similar particles may be produced there is no where in it, that I can find, a shadow of by chemical re-agents, and may be seen forming in proof offered.
consequence of their application, by the corrugation Admitting it very possible,-nay, probable, that of the interior contents of the cells has been neglected. portions of the lyinph or protoplasma of blood may Nothing has been more common during my researches, exude through the walls of the capillary vessels, and than for me to see in pus, in mucus, and in lymph, fibrillate, or form, as Dr. Bennett states, “a coating corpuscles, or cells, filled with active molecules, uniof granular malter on their exterior," what proof have formly distributed throughout the cell, and to observe, we that either the granules or the fibres, or any other on the application of a dilute acid or other extraneous element of the exudation, acts in an unlimited mapper matter, the molecular material shrink up into two or as a cyto-blastema for all kinds of cells, muscular three small rounded or oval particles, leaving the space fibre, pus, and epithelium ? None whatever ; nor is | between them and the cell-wall clear and perfectly there any indication of a natural order or law in transparent.* It can scarcely be supposed that such such an interpretation; for coagulated fibrin can be particles or spurious nuclei when set free by the subhypothetically made to produce just what the patho sequent rupture or dissolution of the cell-wall, possess logist may bappen to find by an assumed “unlimited" the property of a cell-genesis, and microscopical cytogenesis, while the fact of an increased amount observers have given no discriminating rule by which of colourless blood-cells becoming stationary upon to distinguish the chemically-formed and inert nuclei the walls of the vessels of irritated textures, is made from those natural ones to which they attribute such to appear anomalous and unnecessary. It is true varied functions. It is upon these grounds I adhere Dr. Bennett states that he has long doubted the truth to the conclusion that the colourless cells of lymph and of the asserted fact of the colourless cells of blood pus are unmetamorphosed blood-cells. Dirested of accumulating in unusual numbers in irritated vessels, its technicalities the inquiry is simply whether the and that he thinks “the observers who have stated colourless cells so abundantly excreted by healing and these circumstances to have occurred, have mistaken ulcerating, or inflamed and suppurating textures, are the nuclei of the epidermic cells in the web of the non-metamorphosing colourless blood-cells, or whether frog's foot for these structures.” The “ Narative of they are the molecules, granules, or nuclei of the Experiments," published at the end of the third series exudation grown into cells. The exudative theory of my Experimental Researches, nay, the short extracts
answers the latter alternative of the question in the quoted by Dr. Bennettt himself, prove conclusively affirmative, and assumes a cito-genesis in lymph and that the mistake he supposes did not occur either to coagulated fibrin. Dr. Williams or myself. The question Dr. Bennett | The advocates for this theory concede that coagulated here raises is simply one of fact, and as such I leave fibrin, to be the subject of a cell-multiplication or it to be determined by future obserrers, making, suppuration, so as to discharge or excrete an abundance howerer, this remark, that Dr. Williams mentions of pus cells, must become vascular-be permeated Mr. Toynbee as having drawn his attention to the by currents of blood. Now, as blood contains phenomenon.
abundantly colourless cells, which may be seen with But, to return, the metamorphosis of lymph may drawn from the red circulating current, and become be watched in progress in the lymph of newly drawn stationary in the protoplasma space, so the weight of. blood, and fibres are seen forming in it so abundantly evidence is therefore, I conceive, in favour of my as to render the materials coherent and solid, but conclusion. there are no appearances indicating a cell-genesis ; Finally, it appears to me from my investigations, and it is contrary to all analogy to assume that that the law or order of Nature is, universally in all the same fluid matter can form indifferently either living structures, that incoherent cells precede the cells or fibres. In the lymph of newly-drawn blood, coherent, cellular, and fibrous textures. Therefore and in recent healthy pus, we see with the microscope for fibres, fibrous textures, fibrin in solution, or fibria multitudes of well-formed cells, and free molecules coagulated, to act as a cyto-blastema and be metaand granules, similar to those seen within the cells, but morphosed backward into cells, would be an anomaly we do not see a corresponding number of transitional or exception to be adopted only upon proof. forms or young cells, aor has any evidence been The fibrinous and all the other constituents of the
interior matter of blood-cells contribute to the elabo- ' perspiration profuse; limbs rigid ; pulse 98. He was rating function of the cell, and to the sum of the ordered forty drops of laudanum. At six, p.m., be was product which the cell may ultimately deliver up,
still easier; the perspiration and countenance natural; whether new cells, a fibrillating matter, or a fluid
bowels open; motions dark, and offensive. Fifty drops secretion; but that coagulated fibrine, or any of the
of laudanum were directed. molecules, particles, or nuclei, inclosed among the
Friday 23rd, 11 o'clock, a.m., (the first time I saw
him.) Complains of having had a very bad night; fibres, are capable of again becoming elaborating cells,
severe trismus ; difficulty of swallowing ; violent spasmas. multiplying cellular forms, and giving rise to suppu
of the muscles of the neck, chest, abdomen, and limbs, ration " in the widest sense of the word,” is a question
with constipation and profuse perspirations; head much much too important to be concluded by inferences drawn back; great toes strongly drawn towards the opposed to general laws. To be adopted it ought to be soles of the feet; body very rigid, and spasms occurring proved demonstratively. But, let it be granted, or let about every half minute; pulse 105. He states that us assume, that cells of sundry kinds, muscular fibres, about six weeks since, as nearly as he can recolleet, ia and epithelium, do spring from “ an uplimited cyto-raising some bars of iron, he injured the last phalanx genesis” in coagulable or coagulated fibrin or lymph,
of the middle finger of the right hand. The wound is
now all but healed. Nail loose, so that in handling it and the application of the law and doctrines of mor
it came away in my hand. phology to the phenomena of inflammation and scrofu
R. Calomel., Pil. Opii, utrq., gr. j. Fiat pilula omni lous diseases is not thereby affected; for, if, as occurs
hora sumenda. in inflammation, the normal elements of an osseous,
. 3, p.m. Expresses himself as easier; has had some cartilaginous, or fibrous texture, be permeated by an
sleep. We administered the sulphuric æther for three or increased number of blood-currents, and fettered or
four minutes at a time, repeating it at short intervals. hindered in their function by an unwonted accumula- Under its influence the patient became quiet and antion of abnormal cells and protoplasma, the metamor- quil; breathing natural, with diminution both in frephosis is irregular; and if, in the manner granted, quency and strength of spasms, and with a disposition these textures become transformed, as they do in to sleep. Continue the pills. scrofulous diseases, into red and vascular textures, 6, p.m. Has slept ever since, and the spasms nearly copiously excreting the cellular forms, denominated as frequent, still they do not entirely rouse him. pus, the metamorphosis is retrograde.
Perspirations still profuse; æther repeated with the The following case will, I think, put the matter in a same effect. Continue the pills. clear and intelligible point of view, and furnish rational
9, p.m. The same. We repeated the æther with the
effect of reducing the tension of the muscles generally, grouods of distinction between inflammation and
those of the chest and abdomen especially. Marked scrofulous disease.
diminution of strength and frequency of spasms ; (To be continued.)
perspiration not so profuse; pulse 104, reduced by the æther to 98, this was probably owing altngether to the relief from the spasms; bowels constipated.
R. Ol. Ricini, et Ol. Terebenth, utrq., oz. j., in forma · CASE OF TRAUMATIC TETANUS: INHALA.
enematis. Pills every second hour. TION OF ÆTHER.
* 24th, 9 a.m. A tolerable night; spasms still frequent By David CHALMERS, Esq., Surgeon to the North but not severe; muscles of chest less affected than Dispensary, Liverpool.
those of the abdomen or limbs. Repeat the æther. On Friday, the 23rd of April, I met Mr. Owen in Bowels not moved. consultation on a case of tetanus. The patient was a R. O1. Ricini, oz. j.; 01. Tiglii, gtt. j. M. Sumat strong, muscular, young man, named Nolan, statim. aged 20, a brickmaker.
12.m. Repeated the æther. Mr. Owen first saw the case on Saturday, the 17th, 3 p.m. Æther repeated, bowels still constipated. and found the patient then complaining of stiffness of R. Extr. Colocynth, Co., gr. iv.; 01. Tiglii, gtt. j. M. in neck and difficulty of swallowing. A few ounces of forma pilulæ ; sumat j. quaque secunda hora. . blood were taken from bis arm at his mother's urgent 9 p.m. Bowels freely opened after taking three request, and five grains of calomel, to be followed by pills; has had during the day much greater hardness a black draught in the inorning, prescribed.
and spasm of the abdomen, but is now altogether On Monday, the 191h, he was reported by his mother much relieved. Repeated the æther, and ordered cocoa as nearly well; but on Wednesday, the 21st, Mr. Owen and milk; hot gin and water freely. Continue the pills was again sent for at 11 o'clock at night, and found every second bour. him labouriong under all the well-marked symptoms 25th, 9 a... Spasms in abdomen and lower limbs of tetanus. Pulse 110;' abdomen very hard. Sixty very severe, forcing flatulence from the bowels with drops of laudanum were prescribed, and fifty drops great noise ; upper half of the body as before. Has more to be given during the night. * On Thursday, eaten a bit of mutton chop. Repeated the æther. 8, a.m., Mr. Ower found him better, he had slept well 9 p.m. Spasm has been more severe to-day in the during the night; the spasms were not so severe; abdomen, but not so frequent. Repeated the æther.
NON-MALIGNANT TUMOUR OF THE UTERUS.
26th. Going on favourably, and from this date till!
THREE CASES OF the 4th of May, had the æther three times daily, and once daily till the 17th. Pills given every fourth hour,
NON-MALIGNANT TUMOUR OF THE UTERUS, Un the 26th æther discontinued. On the 8th of May
ACCOMPANIED BY THE USUAL SYMPTOMS began to walk, and on the 9th got down stairs. He is | OF CANCER OF THE UTERUS. now able for work.
By E. J. SHEARMAN, M.D., Rotherbam, Member of Owing to carelessness on the part of the patient's
the Royal College of Physicians. friends, he did not get so many pills as ordered ; he had, however, about thirty, and his teetha were not (Read before the Sheffield Medical Society, March 4, 1847.) affected.
In the Dublin Medical Journal for 1842, Dr. The foregoing case differs from all other cases that
Montgomery says, " the disease of cancer uteri is too I have met with, in having so many days threatened before it made its real attack The sererity of the
universally recognized as one of the most frightful spasms, by being less marked on the chest than on the scourges of humanity, to render it necessary for me to other parts of the body, afforded a better opportunity attempt any description of its horrors, or to impress for the administration of the æther, at the same time on even the most junior of my hearers the importance that the great congestion of the lungs and head conse- of closely studying the phenomena of an affection, quent on violent spasms of the chest was in great hitherto found so utterly intractable by every known measure prevented. The marked influence of the means; and which, when once fully established, entails -æther on the spasms in their worst state, and the stiil
upon the unbappy sufferer, one unbroken train of more marked influence on the great rigidity of the
miseries, from which it has been truly said, 'temporary muscles in the chronic state, prore it to be an agent
relief can be found only in opium, and permanent rest of great power in spasmodic action of the muscles. Even three weeks after the invasion of the disease,
only in the grave.' But I am perfectly convinced, the legs and thighs were so rigid as to require the
from many years' observation, that something may be
done, to stem, at its source, the torrent of agonies exertion of all my power, added to the patient's own exertion, to flex them on the abdomen, but after
that will otherwise overwhelm the patient; nay, I having had the æther be flexed and extended them firmly believe it may, in many instances, be altogether bimself with facility.
turned aside, and the victim be rescued from the sad In using the æther at first I was careful not to give fate impending over her."
. it bim in its strongest state, owing to its great effect Agreeing perfectly in this opinion, and baving on the already excited muscles of the throat, but
| during the last twenty years of my practice met with afterwards he had it as strong as we could give it
many anomalous cases simulating cancer uteri, whicb, him, using hot water to increase the evaporation, and
(until the late improvements in the diagnosis of such exhausting from one and a half to two ounces of the
| cases,) were allowed to run their uninterrupted course, strongest æther at each administration. The spasms were always allayed by it, increasing during the interval,
I am induced to lay before the members of this Society making him long for our re visiting him; his oply the following cases, which have occurred in the last cry was that we did not give him enough of it.
two years, and which I hope are not altogether This case, and one reported formerly from the uninteresting, as they have long been submitted to North Dispensary, seem to me to be as convincing the tests of sight, touch, and manual manipulation, proofs of the efficacy of æther as any that have appeared. methods, which until very lately, have not been fully The case I allude to was the reduction of a disloca.
made use of by medical practitioners for ascertaining tion of the femur into the ischiatic notch, of fire
such diseases. weeks' duration, less two days, and the patient, a powerful navigator, forty years of age. Two sets of
Case I. pullies were applied to him with different fastenings A single lady, aged 48, consulted me in June, 1845, to the thigh; the strain was kept up by one set, but in order to obtain relief from the pains produced by the other set was also kept up so nearly to tlie same what her medical attendant called “cancer of the strain, that on the slightest slip of the principal pullies, womb." She gave me the following history of her
the second set took their place. The strain was kept disease :--Two years ago she was, and bad been all her · for one hour and a half, and during the whole of the life, perfectly regular; she was menstruating at the time
time he was under the influence of the æther. It she received a very sudden and heart-rending shock by was about six weeks afterwards before he could walk the sudden death of a valued friend; the catamenial freely.
discharge suddenly stopped, and never re-appeared in a June 10, Everton, Liverpooi.
healthy form. From that time to the present she has suffered from occasional sharp pains in the back and loins, traversing along the crest of the ilia and groins, often shooting dowa the front of the thighs; and this pain was attended with frequent discharges of sanious Auid, mixed with clotted blood, in various quantities. Latterly these pains bare taken on a periodical type and increased in riolence, commencing about seven