that there is no sufficient apparent difference between | of the first importance. It appears to me that the burns before and burns after death, and thus the ques- coma of jaundice, to a certain extent, proves the tion can only be determined by a dissection of the skin, correctness of my views of the subject. and that the distinction laid down by Christison fails in the case of an ædematous corpse.-(Gazette Médicale de Paris, No. 40. 1846.

OPIUM IN INFLAMMATION.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND
SURGICAL JOURNAL.

SIR,

In conclusion, allow me to say that I feel convinced that Dr. Ranking's misconception of my views was unintentional, and I should not have occupied your pages, only that the importance of the subject itself required it. I am, Sir,

Your obedient servant,

RICHARD CHAMBERS, M.D. Physician to the Essex and Colchester Hospital.

Colchester.

SPONGIO-PILINE.

SURGICAL JOURNAL.

SIR, Having seen Markwick's patent Spongio - Piline advertised, I ordered some of it to be procured, and feel bound in justice to state that, it has proved remarkably beneficial as well as comfortable to a patient of mine who was suffering severely from acute bursal rheumatism, affecting several of the joints. I ordered it to be steeped in a warm spirit-lotion and kept constantly applied, and am so entirely satisfied with the result that I venture to recommend its employment to the readers of your valuable Journal.

Permit me to remove a misconception that occurs in Dr. Ranking's valuable paper on the employment of opium in inflammation. In regard to my views on that subject, he says, "The constipated bowels which Dr. Chambers, in the last number of your TO THE EDITOR OF THE PROVINCIAL MEDICAL AND Journal, seems to regard as indncing the necessity for hesitation in the use of this medicine, I regard as of the least importance in the generality of inflammations." I did not apply that particular remark to its use in inflammation, nor did I for one moment wish to say that such an effect would contraindicate its use in any inflammation, in which it was otherwise indicated. But on the contrary, I look upon constipation as salutary in cases of enteric and peritoneal inflammation, and the purgative treatment of these diseaes to be both vicious in principle and bad in practice. In consequence of observing that the constipation attendant upon enteric inflammation yields pari passu with the removal of the inflammatory symptoms, it was supposed that the relief was owing to the soluble state of the bowels; whereas, I believe we must only regard this state as the consequence of the amendment in the inflammatory symptoms.

My observations on the constipating effects of opium were as follows:-"In reference to the employment of opium generally, I may remark, that the constipation which it causes, renders it obnoxious to some constitutions." There are several diseases not altogether of an inflammatory type in which the influence of opium is urgently required either to relieve pain, or to procure sleep. I would more particularly mention cases of common continued and irritative fevers, and cases of neuralgia. It frequently happens, however, that in consequence of the constipation which opium produces, its employment causes the patient as much discomfort as more than counterpoises whatever relief it may afford. In some cases this effect becomes at once apparent by the furred tongue, dry skin, and headach; in other cases the effects exhibit themselves by a long-continued derangement of the digestive function. If, then, it is possible to prevent all these effects without interfering with the physiological action of opium, is it not desirable to do so?

It would, indeed, be taking a very limited view of the matter to direct our attention merely to the constipation; we must look beyond the effect to the cause itself, which I believe to be an arrest of the biliary secretion; and, when we remember. the influence which an arrest of secretion in so large a depurating organ as the liver must exercise over the quality of the blood, I consider its removal or prevention

I have the honour to be, Sir,
Your obedient Servant,

J. C. BADELEY, M.D.

Chelmsford, Dec. 26, 1846.

INHALATION OF ETHER IN SURGICAL
OPERATIONS.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND
SURGICAL JOURNAL.

SIR,

Having now administered the vapour of ether for the purpose of rendering surgical operations painless in a great number of cases, at our Metropolitan Hospitals and at my own private residence, with perfect success, by means of an apparatus invented by myself and Dr. Boott, and now manufactured by Mr. Hooper, of Pall-Mall, &c., permit me, if not encroaching too much on your valuable columns, briefly to state the appearance of the patient when under the influence of the vapour that indicates the proper time for the operation to commence.

As my own operations on the teeth have now
become numerous and satisfactory to those medical
men who daily witness them, I will not occupy the
time of your readers by entering into details.
I am, Sir,

Your obedient servant,
JAMES ROBINSON.

7, Gower Street, Bedford Square,
January 18, 1847.

"At the commencement of the inhalation always allow the patient to inhale the vapour three or four times without closing the nose; the nose being

closed, observe carefully the appearance of the eye, the pupil of which will be found, in most cases, after about a minute's inhalation, to be considerably dilated; after eight or ten more inhalations the pupil will remain stationary and fixed for a period, varying from two to three seconds; it will then turn towards the upper eye-lid. This motion will be repeated several times. If the vapour be continued the pupil will be observed to turn under the eye-lid and remain fixed; three or four inhalations more and the operator can

commence.

"In operations which are protracted and require any length of time, cut off the vapour by means of the stop-cock attached to the apparatus; permit the patient to breath the atmosphere through the nose five or six times; again let on the vapour, breathing alternately atmospheric air and the vapour of ether, at intervals of half a minute, until within two or three minutes of the completion of the operation, when the pipe, &c., can be removed with perfect safety." J. ROBINSON.

7, Gower Street.

INHALATION OF ETHER IN SURGICAL
OPERATIONS.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND
SURGICAL JOURNAL.

SIR,

The Lancet of January 9th, page 49, publishes a communication from a physician, reinforced by an opinion upon a supposed case, given by a Queen's Counsel, tending to diminish the value of the patent for the Letheon. Will you do me the favour to give publicity to the following answer to that communication?

I am, Sir,

Your obedient servant,
JAMES A. DORR.

London, 18, Duke Street, St. James's,

January 11, 1847.

Medical Entelligence.

OPERATIONS PERFORMED UNDER THE
INFLUENCE OF ETHER.

The following successful operations, performed under the influence of the inhalation of the vapour of sulphuric æther, have been reported since our last number:

At Guy's Hospital, by Mr. Morgan, lithotomy, on a country lad; by Mr. Key, on a man aged 26, for strangulated scrotal hernia, with removal of a large mass of thickened omentum.

At King's College Hospital, by Mr. Fergusson, for phymosis, on a man aged 43; for abscess and fistula in ano, in a delicate female aged 26; passing a catheter through a tight stricture in the bulbous part of the urethra, in a man aged 32; removal of warts from the glans and prepuce, in a man aged 21.

At St. Thomas' Hospital, by Mr. Mackmurdo, the removal of a finger, from a child aged 6.

At the London Hospital, by Mr. Adams, amputation of the leg.

At Charing-Cross Hospital, by Mr. Hancock, removal of the nail from both great toes, in a man aged about 34.

At the Westminster Hospital, by Mr. Hale Thomson, removal of condylomatous growths from the labia, in a woman of middle age; for phymosis, in a young man.

At St. Georges's Hospital, by Mr. Johnson, amputation below the knee, in a young man.

amputation of the leg, in a female.
At the Queen's Hospital, Birmingham, by Mr. Knowles,

At the Lynn Hospital, by Mr. Cotton, removal of cataract, in a female, and in an old man; of a cancerous tumour of the lip, in an old man.

Operations have also been successfully performed by Dr. Brett, (extraction of a cataract; ptosis;) by Mr. Lawrence, (removal of a tumour from the orbit;) by Mr. Partridge, of Birmingham, (strangulated hernia;) Reply to the opinion of Queen's Council, published in by Mr. Parker, of Liverpool, (for strabismus ;) by Dr.

the Lancet, January 9th, page 49.

1st. No counsel can give a client valuable, or even safe, advice, as to danger of infringement, who has not read the specification, and does not know the claim of the patent. The patent for the Letheon has been duly sealed, but the specification is not yet made public.

2nd. So far as the general principles of law enunciated go, they confirm the views of the patentees.

JAMES A. DORR.

[We question much, notwithstanding Mr. Dorr's letter, whether such a patent can be sustained, and certainly it ought not to be so. Any particular form of apparatus may without doubt, be made the property of the inventor; but the attempt to place restrictions on the mode of using a known medical agent by qualified medical practitioners, is as absurd, as its success would be mischievous.-ED.]

J. C. Hall, of East Retford, (removal of a tumour ;) by Mr. Rudkin, of Derby, (removal of a sequestrum of diseased bone from the leg ;) &c., &c.

Mr. R. Lucas, a veterinary surgeon at Liverpool, has also performed an operation on a Newfoundland dog under the infiuence of æther vapour; the animal did not evince the slightest sign of suffering.

CAUSE OF DEATH IN STILL-BORN INFANTS.

Dr. King, of Sackville Street, has just submitted to the Medico-Chirurgical Society, an Essay "On the cause of Death of Infants Pretermaturally Still-born," wherein he insists, that death is not from asphyxia, as hitherto supposed, but from syncope; and proposes an nfant will be of comparatively rare occurrence. entirely new practice, by which means the still-born

PROVINCIAL

MEDICAL & SURGICAL JOURNAL.

By W. R. BASHAM, M.D., Physician to the Westminster troublesome and suffocative cough, with frothy sputa,

stained with blood. He had been ordered opiate draughts every hour, which he had taken up to the hour of the daily visit. A careful examination Case of Drunkard's Delirium, with pneumonia and of the chest quickly decided that a different and very bronchitis: History of the case; character of the energetic plan of treatment was necessary. Auscultadelirium; stethoscopic signs; condition of the sputa; tion:-The left side was duller on percussion than the treatment: death; post-mortem appearances.-Ten- right, and particularly on the mammary and lateral dency of drunkards to collapse; urgency of inflam-region; throughout the right side the resonance was matory symptoms, when supervening in such cases. clearer. On the left side, no respiratory vesicular Physical signs of pneumonia and bronchitis.-Pathomurmur could be detected; bronchial respiration was logical condition of pneumonia; cause of the rust-everywhere, but especially in the mammary region latecoloured sputa; progress of the disease.-Effects of bronchitis, complicated with pneumonia; discretion required in the treatment of such cases.

|

A prominent feature of interest in this case was the complication of acute pneumonia, with a condition which, if not strictly delirium tremens, was closely allied to it, being a state of great physical and constitutional disturbance brought on by the inordinate use of intoxicating liquors. The effect of alcoholic stimuli in excess, is at first to produce great cerebral excite

and was neither so full nor so hard as previously; the prognosis of the case, notwithstanding, still continued most unfavourable. At the afternoon visit the state of the chest was similar to that of yesterday; and owing to the blistered surface of the left side, could not be minutely examined. Bronchial respiration, with moist crepitations, were heard posteriorly on the left side; on the right side, mucous rhonchi were heard in eachment, with exaltation of the circulating powers; to this region. The sputa were copious, frothy, and of a more dusky dirty hue than yesterday; the tenacity was not very great, and they did not partake so much of the characteristics of pneumonia as of bronchitis. The pulse was 140, small and compressible; countenance anxious; eyes glazed; pupils contracted to a point; tongue moist; odour from the body offensive and cadaveric. The symptoms continued thus till the evening, when he changed, became comatose suddenly, the vital powers quickly failed, and he died at seven p.m.

invariably succeeds a state of great prostration, and extending in some cases to collapse,—in fact, a failure of the powers and functions that have been thus unnaturally excited, is the usual characteristic of the drunkard's excess. Now, in the case under consideration, superadded to this dangerous tendency to prostration and collapse, were unequivocal symptoms of intense pulmonary inflammation, requiring the most energetic measures, and the unhesitating use of agents, which, without this pulmonary complication, the preexisting state of the patient would most emphatically forbid. The prospect of a favourable issue was from the first extremely limited, for the pneumonia of drunkards is specially a fatal disease; they are proportionably more prone to the disease, and in them its progress is unusually rapid and uncontrollably fatal.

On approaching the bed-side of this patient on the morning after his admission, you witnessed his hurried and alarmed looks,-his restless, yet vacant gaze on those around his bed,-a certain amount of incoherence in his words, yet sufficiently conscious to protrude the tongue when asked; this organ quivering, furred, white and moist; the pupils contracted; and the hands, when released from the strait waistcoat which his violence rendered necessary, agitated and tremulous. He coughed frequently and had no sleep. You could not fail to recognize these as the expressive symptoms of the drunkard's disease; and inquiring no farther, you might have imagined that opium and ammoniacal stimuli were all that this case would require. But in the investigation of a case you must carry your inquiries beyond those limits which the eye merely

Sectio cadaveris eighteen hours after death., Body well formed; limbs muscular, and rounded by subcutaneous fat. On opening the cavity of the chest the Jungs did not collapse, but were adherent to the pleura costalis by firm attachments of fibrinous tissue; no evidence of the formation of recent plastic exudation: the right lung was dense and gorged, but crepitated throughout on pressure, and floated in water; no trace of fibrinous exudation could be detected in any part of this lung; when squeezed a white frothy fluid oozed out from innumerable openings of the more minute bronchi: the left lung crepitated only at its apex and the inferior margins; the central parts felt dense and earnified; its condition was such that it easily tore or broke down into a granular mass, and it did not float in water; this portion of the middle lobe was of a darkbrown, red, dirty colour, it constituted an example of lobular pneumonia in the second stage; the central portion of the hepatized mass was softer than the circumference, and appeared to be passing into the stage of purulent softening. Submitted to examination under the microscope granular corpuscles and blood-reaches, the senses of hearing and of touch must lend discs were alone observed; in some few of the former acetic acid developed central nuclei. The mucous membrane of the trachea exhibited a fine bright-red capillary injection; passing into the right bronchus the colour became more of a madder hue; and in the smaller ramifications of the tubes in this lung of a still more dusky appearance. The left bronchus exhibited much the same condition as the right; but the mucous membrane of the subdivisions had here become of a purple tinge, which colour was maintained even into the hepatized mass. The liver was much enlarged; its inferior margin extended to within a quarter of an inch of the umbilicus; a section exhibited a bright, sienna-orange colour; it had also a granular appearance; no evidence of portal congestion; under the microscope it presented innumerable fat vesicles; its weight was ninety-two ounces. The kidneys were healthy, presenting evidence of venous hyperæmia; right kidney weighed five ounces and a half; left kidney six ounces and a half. The brain presented no aspect of disease; its weight was forty-six ounces.

their aid, and by them you must satisfy yourselves that no complication exists,-no lurking mischief in deepseated organs, working insidiously to a fatal termination, while you have been busy only with those symptoms that lay on the surface, and are most easily and obviously detected. Here the respiratory movements of the chest were so much accelerated, that even without the stethoscope, pulmonary disease was to be suspected.

On carefully examining the chest, first by percussion, the left side was duller than the right, and this dulness was specially in the mammary and lateral region; on the application of the stethoscope over this spot, bronchial respiration, with a dry crepitating murmur was heard. The presence of bronchophony, and the total absence of any vesicular murmur, convinced me that the central portion and probably the root of the left lung was the seat of the inflammation. Superiorly and in the axilla of the left side, mucous rhonchi of small bubbles veiled all other respiratory sounds. The resonance of the right side was not much affected, but the mucous gurgling was heard in every region. This