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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 In conclusion, allow me to say that I feel conthe case of an edematous corpse.-(Gazette Médicale vinced that Dr. Ranking's misconception of my view's de Paris, No. 40. 1846.

was unintentional, and I should not have occupied your pages, only that the importance of the subject itself

required it. OPIUM IN INFLAMMATION.

I am, Sir,
TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

Your obedient servant,
SURGICAL JOURNAL.

RICHARD CHAMBERS, M.D.
SIR,

Plıysician to the Essex and Colchester Hospital. Permit me to remove a misconception that occurs Colchester. 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

SPONGIO-PILINE. 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

SURGICAL JOURNAL. hesitation in the use of this medicine, I regard as of

Sir, the least importance in the generality of inflammations."

Haring seen Markwick's patent Spongio - Piline I did not apply that particular remark to its use in

advertised, I ordered some of it to be procured, and feel inflammation, nor did I for one moment wish to say

bound in justice to state that, it has proved remarkably that such an effect would contraindicate its use in any

beneficial as well as comfortable to a patient of mine inflammation, in which it was otherwise indicated.

who was suffering severely from acute bursal rheumaBut on the contrary, I look upon constipation as

tism, affecting several of the joinis. I ordered it to be salutary in cases of enteric and peritoneal inflamma

steeped in a warm spirit-lotion and kept constantly tion, and the purgative treatment of these diseaes

applied, and am so entirely satisfied with the result to be both vicious in principle and bad in practice.

that I venture to recommend its employment to the

In consequence of observing that the constipation attend

readers of your valuable Journal. ant upon enteric inflammation yields pari passu with the

I bave the honour to be, Sir, reinoval of the inflammatory symptoms, it was supposed

Your obedient Serrant, that the relief was owing to the soluble state of the

J. C. BADELEY, M.D. bowels ; whereas, I believe we must only regard this

Chelmsford, Dec. 26, 1846. state as the consequence of the amendment in the ! inflammatory symptoms.

INHALATION OF ÆTHER IN SURGICAL My observations on the constipating effects of opium

OPERATIONS. were as follows:-"In reference to the employment of TO THE EDITOR OF THE PROVINCIAL MEDICAL AND opium generally, I may remark, that the constipation

SURGICAL JOURNAL. which it causes, renders it obnoxions to some con

Sir, stitutions." There are several diseases not altogether

Having now administered the vapour of ether for of an inflammatory type in wbich the infuence of

the purpose of rendering surgical operations painless opium is urgently required either to relieve pain, or in a great number of cases, at our Metropolitan to procure sleep. I would more particularly mention

Hospitals and at my own private residence, with cases of common continued and irritative fevers, and

perfect success, by means of an apparatus invented cases of neuralgia. It frequently happens, however,

by myself and Dr. Boott, and now manufactured by that in consequence of the constipation which opium

Mr. Hooper, of Pall-Mall, &c., permit me, if not produces, its employment causes the patient as mucb

encroaching too much on your valuable columns, discomfort as more than counterpoises whatever relief

briefly to state the appearance of the patient when it may afford. In some cases this effect becomes at

| under the influence of the vapour that indicates the once apparent by the furred tongue, dry skin, and proper tine for the operation to commence. headach; in other cases the effects exhibit themselves

As my own operations on the teeth have now by a long-continued derangement of the digestive become numerous and satisfactory to those medical function. If, then, it is possible to prevent all these men who daily witness them, I will not occupy the effects without interfering with the physiological action

time of your readers by entering into details. of opium, is it not desirable to do so ?

I am, Sir, It would, indeed, be taking a very limited view of

Your obedient servant, the matter to direct our attention merely to the consti

JAMES ROBINSON. pation; we must look beyond the effect to the cause 7, Gower Street, Bedford Square, itself, which I believe to be an arrest of the biliary

January 18, 1847. secretion ; and, when we remember the influence which an arrest of secretion in so large a depurating “At the commencement of the inhalation always organ as the liver must exercise over the quality | allow the patient to inhale the vapour three or four of the blood, I consider its removal or prevention times without closing the nose; the nose being

[blocks in formation]

J. ROBINSON

Sir,

closed, observe carefully the appearance of the eye. the popil of which will be found, in most cases, after

Medical Intelligence. about a minate's inhalation, to be considerably dilated; after eight or ten more inhalations the pupil will

OPERATIONS PERFORMED UNDER THE remain stationary and fixed for a period, varying from

INFLUENCE OF ÆTHER. two to three seconds; it will then turn towards the The following successful operations, performed under Upper eye-lid. This motion will be repeated several the influence of the inhalation of the vapour of sulphuric times. If the vapour be continued the pupil will be æther, have been reported since our last number :observed to turn under the eye-lid and remain fixed;

| At Guy's Hospital, by Mr. Morgan, lithotomy, on a three or four inhalations more and the operator can country lad; by Mr. Key, on a man aged 26, for strangu. commence.

lated scrotal hernia, with removal of a large mass of "In operations which are protracted and require thickened omenlum. any length of time, cut off the vapour by means of the stop-cock attached to the apparatus; permit the

| At King's College Hospital, by Mr. Fergusson, for patient to breath the atmosphere through the pose

phymosis, on a man aged 43; for abscess and fistula in five or six times; again let on the vapour, breathing

ano, in a delicate female aged 26 ; passing a catheter alternately atmospheric air and the vapour of ether,

through a tight stricture in the bulbous part of the at intervals of half a minute, until within two or three

urethra, in a man aged 32; removal of warts from the minutes of the completion of the operation, when the

glans and prepuce, in a man, aged 21. pipe, &c., can be removed with perfect safety."

At St. Thomas' Hospital. by Mr. Mackmardo, the

removal of a finger, from a child aged 6. 7, Gower Street.

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

the leg. INHALATION OF ÆTEER IN SURGICAL

At Charing Cross Hospital, by Mr. Hancock, removal OPERATIONS.

of the nail from both great toes, in a managed about 34. TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

At the Westminster Hospital, by Mr. Hale Thomson, SURGICAL JOURNAL.

removal of condylomatous growths from the labia, in a

woman of middle age; for phymosis, in a young man. The Lancet of January 9th, page 49, publishes a communication from a physician, reinforced by an At St. Georges's Hospital, by Mr. Johnson, amputation opinion upon a supposed case, given by a Queen's below the knee, in a young man. Counsel, tending to diminish the value of the patent

Atthe Queen's Hospital, Birmingham, by Mr. Knowles, for the Letheon. Will you do me the favour to give

amputation of the leg, in a female. publicity to the following answer to that communi. cation !

At the Lynn Hospital, by Mr. Cotton, removal of I am, Sir,

cataract, in a female, and in an old man; of a cancerous Your obedient servant,

lumour of the lip, in an old man. JAMES A. DORR.

Operations have also been successfully performed by London, 18, Duke Street, St. James's,

Dr. Brett, (extraction of a cataract; ptosis ;) by Mr. January 11, 1847.

Lawrence, (removal of a lumour 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.

J. C. Hall, of East Retford, (removal of a tumour;) by 1st. No counsel can give a client valuable, or even Mr. Rudkin, of Derby, (removal of a sequestrum of safe, advice, as to danger of infringement, who has not diseased bone from the leg ;) &c., &c. read the specification, and does not know the claim of

Mr. R. Lucas, a veterinary surgeon at Liverpool, has the patent. The patept for the Letheon has been also performed an operation on a Newfoundland dog duly sealed, but the specification is not yet made under the infiuence of æther vapour; the animal did not public.

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

JAMES A. DORR. CAUSE OF DEATH IN STILL-BORN INFANTS.' (We question much, notwithstanding Mr. Dorr's Dr. King, of Sackville Street, has just submitted to letter, whether such a patent can be sustained, and

the Medico-Chirurgical Society, an Essay “ On the

cause of Death of Infants Pretermaturally Still-boru," certainly it ought not to be so. Any particular form of

wherein he insists, that death is not from asphyxia, as apparatus may withuat doubt, bo made the property of

| hitherto supposed, but from syncope; and proposes an the inventor; but the attempt to place restrictions on

entirely new practice, by which means the still.born the mode of using a known medical agent by qualified

nfant will be of comparatively rare occurrence. medical practitioners, is as absurd, as its success would be mischievous.-ED.)

· ·

MEDICAL APPOINTMENTS.

METEOROLOGICAL JOURNAL FOR M. Begin has been elected President of the Académie

DECEMBER, 1846. de Médécine, Paris, for the year 1847; M. Bouillaud

Kept at Sidmouth, has been elected Vice-President, and M. Métier,

By W. H. CULLEN, M.D., SURGEON. Secretary.

Mean of External Thermometer at 9 a.m. 36.07 A Medical Lecturer bas been appointed at Gonville .

. . .. .. 9 P.M. 35.75 and Caius College, Cambridge, to direct and superintend

... the Maxima, . . . . . . . 41.61

.... Minima, ....... 30.31 tbe studies of the Medical Students in the College.

Absolute Mean . ......... 36.25 Mr. Paget, Mr. McWhinnie, and Mr. W. Pennington,

..... of eight preceding years. 40.56 are candidates for the appointment of Assistant Surgeon

Extreme bighest on the 20th ..... 50.50 to St. Bartholomew's Hospital, vacant in consequence

.. lowest .. 14th ..... 22. of the resignation of the office of Surgeon, by Mr.

.. range .. ....... 28.50 Vincent.

Mean daily range . ........ 11.15 Dr. Robert Lee has resigned the appointment of

.. Dewpoint at 9 A.M. ..... 31.71 Pbysician Accoucheur to the Brownlow Street Lying-in.

.. ..... 9 P.m. ..... 30.61 Hospital; and Mr. South that of Professor of Surgery Mean of Barometer at 9 A.M. ..... 30.045 to the Royal College of Sargeons.

. . . . .. . 9 P.M...

30.061 Extreme highest on the 30th .... 30.701

... lowest on the 23rd .... 28.850 ROYAL COLLEGE OF SURGEONS

. . . range . . . . . . . . . .

1.851 Gentlemen admitted Members on Friday, January Number of days fine ........ 22nd, 1847 :-S. M. C. A. A. Smith; G. Goodlad ; J.

... dull ... ... .. 3. L. Johnston; E. D. Allinson; T. Bridgwater; A. G. .. · · · snowy .. ... .. 2. Willington ; H. G. Grayling; G. R. Skinner ; C. H. ..... on which any rain fell 8. Dunhill : J. Hyslop : W. E. Hughes ; J. Beecroft: c. | Quantity of rain in inches . . . . . . 1.404 W. Wray: W.A. Salmon; W. Weston ; W.F. Tomkins;

PREVAILING WINDS. T. H. Tanner.

N. | N.E. | E. | S.E. | S. | S.W. 1 W. | N.W

20 1 1 1 0 1 1 0 1 1 2 1 6 ROYAL SOCIETY.

BOOKS RECEIVED. AWARD OF THE ROYAL MEDAL IN PHYSIOLOGY, POR 1845.

The Retrospect of Medicine, &c. Edited by W. The following important requisition for a Special

| Braithwaite, Lecturer on Obstetric Medicine at the General Meeting has been presented by Mr. Wharton

Leeds School of Medicine, &c. Vol. XIV. JulyJones :

December. 1846. London : Simpkin, Marsball, and Co. We the undersigned, Fellows of the Royal Society of 18

of 1847. pp. 455. London for improving natural knowledge, do hereby, in the Microscopic Anatomy of the Human Body, in conformity with the Statute, chap. xii., § 2, require a | Heahh and Disease. By Arthur Hill Hassall. F.L.S., Special General Meeting of the Society to be convened,

of the society to be conveneu, | &c. Part VI. London: Highley. 1847. 8vo. for the purpose of considering and determining on the

A System of Surgery, by J. M. Chelius, &c. Translegality of the circumstances under which the award of

lated from the German, and accompanied with additional the Royal Medal in Physiology for 1845 was first Notes and Observations. By John F. South, Professor of recommended by the Physiological Committee, and under Surgery to the Royal College of Surgeons, and Surgeon which it was actualiy made by the President and Council. To se Thomas's Hospital. Part XV. London: Renshaw. T. WHARTON Jones. W. F. CHAMBERS.

1846. 8vo.
JAMES Copland. John WEBSTER.

Ninth Annual Report of the Suffolk Lunatic Asylum.
ROBERT LEE
JAMES CLARK.

December. 1816. Woodbridge: 1847. 8vo., pp. 29.
RICHARD Bright. MARSHALL HALL.

A Manual on the Principles and Practice of OphJames R. MARTIN. ROBERT E. GRANT,

thalmic Medicine and Surgery. By T. Wharton Jones, GEORJE GULLIVER.

F.R.S., Lecturer on Anatomy, Physiology, and Pathology, January 7th, 1847.

at the Charing Cross Hospital, &c., &c. London:

Churchill. 1847. Fcp. 8vo., pp. 570.
OBITUARY.
Died, January 4th, at Andover, aged 82, Philip

TO CORRESPONDENTS.
Hedry Poore, M.D.

Communications heve been received from Dr. Cullen ;

Dr. Hastings; Dr. J. Black; Dr. Barclay ; Mr. C. Jaguary 5th, at Edinburgh, J. Henry Davidson, M.D.,

L. Prince ; Dr. Addison ; Mr. R. Reedall; Liverpool ; one of the Physicians in Ordinary to the Queen in

Dr. A. W. Davis ; Dr. Seddome; Dr. Wake ; Dr. Scotland.

Durrant; A Sexagenarian ; The Birmingham PathoJanuary 6th, at Studham, Herts, Thomas Sweeny,

logical Society; Mr. J. M. Bryan ; Mr. Cotton. Esq., surgeon.

Inquirer must attach his name before his communication January 10th, aged 35, J. E. Jones, Esq., surgeon, can be published. "The subject of it is very important Gravesend, Kent.

and requires a full investigation.

PROVINCIAL MEDICAL & SURGICAL JOURNAL.

A COURSE OF LECTURES ON OLINICAL so much so, as to render necessary confinement by . MEDICINE.

the strait waistcoat. Suffers from an exceedingly

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

stained with blood. He had been ordered opiate Hospital,

draughts every hour, which he had taken up to LECTURE VI.

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.- Patho murmur 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

rally ; respiratory murmur was also detected here, bronchitis, complicated with pneumonia ; discretion

accompanied by some moist mucous gurgling. On the required in the treatment of such cases.

right side, the vesicular murmur was veiled by the preGentlemen,-You have been present this day at the sence of bronchial respiration and mucous rhonchi, in post-mortem examination of two cases of acute disease the large as well as the small tubes. The pulse was 120, of the pulmonary organs, which, tbough they do not full and elastic, round and compressible; the tongue exbibit any uncommon features, are nevertheless of moist, but furred; the respiration 48; frequent urgent interest to those who are engaged in pathological cough; pupils contracted to a point; ibanner very stadies; for every opportunity of making post-mortem restless, and much incoherence. With these physical examinations, affords us the valuable means of either signs there could be no doubt that acute inflammation confirming or disproving the diagnosis made during life ; of the bronchial mucous membrane existed, combined and what is still more important, we are presented with with pneumonia of the left side, probably at the root a view of the organic processes which constitute the of the lung. disease, and learn the direction in which those organic Here was a fearful combination of evils to contend changes proceed. The probable fatal or favourable against,-a drunkard, intoxicated for more than three issue of parallel cases is thus more easily determined, days, continuously an habitual drinker, suffering from and the nature and direction of our therapeutical acute pulmonary infiavimation. Such individuals will efforts more clearly defined.

scarcely, under any circumstances, bear depletory R. H., aged 29, a green-grocer, had been drinking measures; nevertheless, in such a case as this, they for the last tbree days, and during tbat time, in a are imperatively required, and you must be prepared to continuous state of intoxication, was brought to the treat them with the cupping scarificator, and antimony, hospital, on the night of January 5th, at half-past calomel, and opiuin, in one hand, and with ammonia twelve o'clock, by a neighbour. On admission into and other stimuli, if necessary, in the other. AccordBurdett ward, he is reported to have presented all ingly this patient was cupped to twelve ounces between the symptoms of a case of delirium tremens. His the shoulders, a large blister covered the left side of manner was much excited; his answers to questions the tborax, and Hydrarg. Chloridi, gr. j.; Opii, gr. j.; were hurried and indistinct; there was great trembling Antim. Pot. Tart., gr. 4, given every four hours. The of the limbs, particularly of the hands; the tongue pulse was directed to be watched ; and if, after the was tremulous, was quickly protruded, and as suddenly cupping, it continued full and hard, a fartber amount withdrawn; the mind rambling incoherently on a of blood was to be abstracted. variety of subjects; the pupils were contracted, and On the visit the next day, it was reported that the the skin bedewed with a clammy moisture. He was cupping had relieved the breathing and frequency of ordered a dose of opium. In the morning, the report the cough, that the respiration bud fallen from 48 to book states that he had been very restless all night; 40, and that the sputa were still frothy and sanguinolent. do sleep; much excitement and violence of manner; 1 The pulse had improved in character after the cupping,

No. 3, February 10, 1847.

out fre

and was neither so full nor so hard as previously; the A prominent feature of interest in this case was the prognosis of the case, notwithstanding, still continued complication of acute pneumonia, with a condition most unfavourable. At the afternoon visit the state of which, if not strictly delirium tremens, was closely the chest was similar to that of yesterday; and owing allied to it, being a state of great physical and constituto the blistered surface of the left side, could not be tional disturbance brought on by the inordinate use miputely examined. Bronchial respiration, with moist of intoxicating liquors. The effect of alcoholic stimuli crepitations, were heard posteriorly on the left side ; in excess, is at first to produce great cerebral exciteon the right side, mucous rhonchi were beard in each ment, with exaltation of the circulating powers; to this region. The sputa were copious, frothy, and of a invariably succeeds a state of great prostration, and more dusky dirty hue than yesterday; the tenacity extending in some cases to collapse,-in fact, a failure was not very great, and they did not partake so much of of the powers and functions that have been thus the characteristics of pneumonia as of bronchitis. unnaturally excited, is the usual characteristic of the The pulse was 140, small and compressible; counte. drunkard's excess. Now, in the case under considerDance anxious; eyes glazed ; pupils contracted to a ation, superadded to this dangerous tendency to prospoint; tongue moist; odour from the body offensive tration and collapse, were unequivocal symptoms of and cadaveric. The symptoms continued thus till intense pulmonary inflammation, requiring the most the evening, when he changed, became comatose sud energetic measures, and the unhesitating use of agents, denly, the vital powers quickly failed, and he died at which, without this pulmonary complication, the preseven p.m.

existing state of the patient would most emphatically Sectio cadaveris eighteen hours after death. Body forbid. The prospect of a favourable issue was from well formed; limbs muscular, and rounded by subcu- the first extremely limited, for the pneumonia of taneous fat. On opening the cavity of the chest the drunkards is specially a fatal disease; they are proJungs did not collapse, but were adherent to the pleura portionably more prone to the disease, and in them its costalis by firm attachments of fibrinous tissue; no progress is unusually rapid and uncontrollably fatal. evidence of the formation of recent plastic exudation: On approaching the bed-side of this patient on the the right lung was dense and gorged, but crepitated morning after his admission, yon witnessed bis hurried throughout on pressure, and floated in water; no trace and alarmed looks,-his restless, yet vacant gaze on of fibrinous exudation could be detected in any part of those around his bed,-a certain amount of incohethis lung; when squeezed a white frothy fluid oozed | rence in his words, yet sufficiently conscious to protrude

om innumerable openings of the more minute the tongue when asked; this organ quivering, furred, bronchi: the left lung crepitated only at its apex and white and moist; the pupils contracted; and the hands, the inferior margins; the central parts felt dense and wlien released from the strait waistcoat which bis carnified; its condition was such that it easily tore or violence rendered necessary, agitated and tremulous. broke down into a granular mass, and it did not float He coughed frequently and had no sleep. You could in water; this portion of the middle lobe was of a dark- not fail to recognize these as the expressive symptoms brown, red, dirty colour, it constituted an example of of the drunkard's disease; and inquiring no farther, lobular pneumonia in the second stage ; the central you might have imagined that opium and ammoniacal portion of the hepatized mass was softer than the cir- stimuli were all that this case would require. But in cumference, and appeared to be passing into the stage the investigation of a case you must carry your of purulent softening. Submitted to exainination inquiries beyond those limits which the eye merely 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 their aid, and by them you must satisfy yourselves that acetic acid developed central nuclei. The mucous no complication exists,-no lurking mischief in deepmembrane of the trachea exhibited a fine bright-red seated organs, working insidiously to a fatal termination, capillary injection; passing into the right bronchus the while you have been busy only with those symptoms colour became inore of a madder hue; and in the that lay on the surface, and are most easily and obvismaller ramifications of the tubes in this lung of a still ously detected. Here the respiratory movements of the more dusky appearance. The left bronchus exbibited chest were so much accelerated, that even without the much the same condition as the right; but the mucous stethoscope, pulmonary disease was to be suspected. membrane of the subdivisions had here become of a ! On carefully examining the chest, first by percussion, purple tinge, which colour was maintained even into the left side was duller than the right, and this dulness the hepatized mass. The liver was much enlarged ; its was specially in the mammary and lateral region; on inferior margin extended to within a quarter of an the application of the stethoscope over this spot, inch of the umbilicus; a section exhibited a bright, bronchial respiration, with a dry crepitating murmur sienna-orange colour; it had also a granular appear- was heard. The presence of bronchophony, and the ance; no evidence of portal congestion ; under the total absence of any vesicular murmur, convinced me microscope it presented innumerable fat vesicles; its that the central portion and probably the root of the weight was ninety-two ounces. The kidneys were left lung was the seat of the inflammation. Superiorly healthy, presenting evidence of venous hyperænia; and in the axilla of the left side, mucous rhonchi of right kidney weighed five ounces and a half; left small bubbles veiled all other respiratory sounds. The kidney six ounces and a half. The brain presented no resonance of the right side was not much affected, but aspect of disease; its weight was forty-six ounces. the mucous gurgling was beard in every region. This

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