because the liquor has no taste, and is as limpid as rock water. At first the patients did not suffer from it, bat after some repetitions of the poison, they gradually lost the appetite, and became subject to gnawing pains in the stomach, followed by debility, disease of the langs, hectic fever, and death.

The use of slow poisons was not, however, confined to the Continent; for a remarkable instance of it happened in this country during the reign of James Ist., in the murder of Sir Thomas Overbury, which was perpetrated in the Tower of London, by the orders of Viscount Rochester, and is mentioned by several of our bistorians. The unfortunate prisoner is said to have taken poison, in very minute quantities, with almost every article of his food. Cantharides and arsenic were mixed with the pepper and the salt; lunar caustic was rubbed over his meat; and when his health failed, poisoned jellies and preserves ministered to his fastidious appetite. His strength was obviously declining, but after this treatment had been continued for six months, Rochester became impatient; and his fears being excited lest Overbury should yet live long enough to divulge some unpleasant secrets of which he was in possession, the prisoner's existence was at length terminated, either by corrosive sublimate, or by suffocation, but by which of these means it is not quite certain.

In the year 1676, the Marquise de Brinvilliers was found guilty of several murders, and was executed at Paris. Having formed a criminal attachment to a man of the name of Sainte-Croix, who was afterwards suffo. cated by the fumes of some deleterious compounds which he was preparing, they resolved to relieve themselves from the power and remonstrances of the Marchioness's relations by poison; and her father was without hesitation sacrificed. The first dose of poison was given to him in soup, and M. d'Aubray suffered so much pain after it, that he sent for a physician, who considered the illness to be an attack of indigestion, and under that impression prescribed for him. M. d'Aubray continued, however, in great pain, and in the space of a few days he expired. Her father being thus disposed of, two brothers and a sister still lived to censure the conduct of Madame de Brinvilliers, and to share the wealth which had been left by their parent. These obstacles could not be endured; and the Marchioness, with "her accomplice, Sainte-Croix, decided that they should be removed." "But this time," says Dumas, "to avoid suspicion, it was necessary to employ a poison less rapid in its action, than that which had killed M. d'Aubray. They recommenced their experiments, not upon animals, lest the difference of organization might defeat their views, but in anima vili. The Marchioness was known as a pious and charitable woman, ever ready to relieve the distressed, and sharing with the Sisters of Mercy the attendance upon the sick, to whom she sent wine and medicine at the hospitals. Thus it caused no surprise to see her at the Hotel Dieu, distributing biscuits and preserved fruits to the convalescent; and her kindness was gratefully acknowledged. One month subsequent to this, she revisited the hospital, to enquire after some

patients, in whose welfare she was much interested, and she was told that they had suffered a relapse, that fresh symptoms had supervened, that a deadly languor overcame them, beneath whose wasting influence they gradually declined. Of its cause she could learn nothing. The physicians told her that the disease was unknown, and defied their utmost skill. She again enquired at the expiration of a fortnight; some of the patients were dead, others still lingered in hopeless agony-animated skeletons, whose only signs of life were the voice, sight, and breath. Within two months all were dead, and medical skill was as completely foiled upon their examination after death, as it had been in their treatment."

Encouraged by this success, Madame de Brinvilliers commenced operations upon her brothers and sister. The sister escaped by leaving Paris, but one of the brothers expired in two months, and the other about five months after they had been subject to the influence of poison; the pain of the stomach, sickness, burning in the chest, anxiety of mind and exhaustion, as well as the disorganization of the stomach, intestines, and liver, observed on examination of the bodies after death, indicating corrosive action of the substances which they had been taking. There can indeed be no doubt respecting the nature of the poisons, for on the death of Sainte-Croix, corrossive sublimate, vitriol, antimony, lunar caustic, and opium, together with an acrid preparation, of which the chemical composition could not be detected, were found in his cabinet; while a paper, writtten by the Marchioness, and detailing many of her crimes was likewise discovered in his house.

Besides those just enumerated, Professor Baldinger, whose authority is quoted by Beckmann, states that sugar of lead was an ingredient in one of the most subtle poisons. "There is no doubt," he says, "that the slow poison of the French and Italians, commonly called succession powder, (poudre de la succession,) owes its origin to sugar of lead. I know a chemist, who superintends the laboratory of a certain prince on the confines of Bohemia, and who, by the orders (perhaps not very laudable,) of his patron, has spent much time and labour in strengthening and moderating poisons. He has often declared, that of sugar of lead, with the addition of some more volatile corrosive, a very slow poison could be prepared, which, if swallowed by a dog or other animal, would insensibly destroy it in the course of some weeks or months," without any violent symptoms.

In relating the foregoing cases, the limits of a lecture would not permit of my entering further into details, than was necessary to show what substances were used as slow poisons, and what symptoms ensued. These are the facts which illustrate the accumulative action of poisons, in contrast to that of medicines; and for fuller information, I beg to refer those who may be curious in such matters, especially to Beckmann's "History of Inventions;" to Mackay, on "Popular Delusions;" and to the "Crimes Célébres," of A. Dumas.

It is much to be feared that the crime of slow poisoning is by no means extinct. In the last century

It was certainly practised; for early in the reign of George the third, Mary Blandy was tried and hanged at Oxford for poisoning her father, by repeated doses of arsenic, and many still more recent instances are reported.

In most of the cases which I have mentioned, death took place in consequence of the destruction of the digestive powers, by the operation of corrosive poisons upon the alimentary canal, the symptoms of which I have several times witnessed, though in a very slight degree, when arsenic and nitrate of silver have been prescribed as medicines; and of the action of narcotics and sedatives upon the nervous system. Farther examples can scarcely be necessary. The formidable influence which medicines exert when administered so as to act accumulatively, ought to make us very seriously consider, not only the primary, but likewise the secondary and subsequent effects of whatever we may be about to prescribe; for although the frequent repetition of a small dose is acknowledged to be in many cases highly beneficial, it is equally true that some medicines may in this manner induce chronic inflami. mation of the nervous membrane of the stomach and intestines; that others may gradually impair the nervous power; and that a third kind may so change the

composition of the animal fluids, as to substitute morbid deposits in the various tissues for those which are naturally formed by the process of healthy nutrition. Thus, while by judicious management, the accumulative action of medicines may be employed as a most efficacious mode of relieving many constitutional disorders, and especially those of a more chronic description, without proper caution we may lay the foundation of diseases, more mortal than those which it was our object to cure.

ON THE PATHOLOGY OF HOOPING-COUGH. By T. OGIER WARD, M.D., Oxon.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SURGICAL JOURNAL.

SIR,

In the number of the Provincial Journal for June 16th, there is a paper by Dr. Fife, of Newcastle, "On the Pathology and Treatment of Pertussis," to which my attention has been more particularly directed, by that disease having been rather prevalent lately in this place, and by my desire to ascertain whether any new light had been thrown upon its nature. In this expectation, I must say, I have been disappointed and it is because I agree with Dr. Fife in the importance of our having settled notions respecting its pathology, that I cannot adopt the view he has taken of its exclusively nervous character, an experience of nearly twenty years having convinced me that such a view is too narrow to be a safeguard for practice. I therefore venture to send you this letter as a kind of commentary and appendix to the theory, to which Dr. Fife has given the sanction of his name.

Dr. Fife sets out by stating his belief, that "the doctrine of the inflammatory nature of hooping-cough is advocated by the majority of the profession." I

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cannot coincide with him in such an opinion, if he means that the disease is considered as inflammatory in all its stages; and I believe that the opinions of the majority of practical men, besides those of a great host of authors, are opposed to its being absolutely of an inflammatory nature, or hyperæmic. Of thirtyeight authors, whose opinions are quoted by Dr. Copland, in his Dictionary, Art. "Hooping-Cough," eighteen considered it as an irritative disease, eight It may be asked why, with such a number of the ideas as purely nervous, and only twelve as inflammatory. of the learned recorded on this subject, I should presume to propound another hypothesis? My reply is, that not one of them, even including that (the best,) of the accomplished lexicographer himself, appears to me as being perfectly satisfactory in embracing and explaining all the phenomena of pertussis ; for although some of them admit its specific nature, they do not trace the influence of the specific element through all the phases of the disease.

The gist of Dr. Fife's argument is to show that pertussis is distinct from bronchitis, and the major portion of his paper is occupied by the proofs; but while he shows pretty clearly what it is not, he does not define as evidently what it is, inasmuch as its pathology, as far at least as I can ascertain, is comprised by him in the following propositions :

1st. The larynx is mainly implicated in the produc◄ tion of the paroxysm of cough, the chest being comparatively passive, and the violence and convulsive nature of the cough resembling that which arises from the pressure of foreign bodies in the larynx.

2nd. The hoop or whoop is physiologically requisite to compensate for the interruption which respiration sustains during a paroxysm.

3rd. The vomiting which terminates the cough, in all probability, has its origin in the participation of the stomach in the morbid condition of the larynx.

4th. Hence the actual seat and nature of pertussis are essentially referrible to some morbid condition of the pneumogastric nerve, which influences the secretion of the mucus so frequently discharged from the stomach.

Now, admitting the truth of the first proposition, the second is by no means a corollary to it; for, although a deep inspiration always follows the expulsive efforts of a cough, yet it is by no means "physiologically requisite" that this inspiration should be attended by a whoop; pathologically, however, it is requisite that the whoop should occur, as this is the characteristic of the disease. Again, as Dr. Fife has omitted to state in what consists the morbid state of the larynx, we are not much enlightened by the third proposition,that the stomach participates in this condition, whatever it may be; nor is the conclusion respecting the pneumogastric nerve at all borne out by the premises that the stomach and larynx are equally affected. It may be so, but there is no proof given, physiological or pathological, that it is so. Even if we take it for granted that the pneumogastric nerve is the point de depart of the symptoms, Dr. Fife ought to have informed us how this morbid condition of the nerve has been produced.

But with the intention of contrasting pertussis with bronchitis, Dr. Fife has laid down six other propositions bearing on the pathology of the complaint, to which,

as they are still insufficient to complete its illustration, I have ventured to append seriatim an explanatory

comment.

1st. "Pertussis is essentially a disease peculiar to infancy and childhood."-Hooping-cough being one of the zymotic diseases, can only attack, as a general rule, the same individual once in the course of his life; and as it is readily "caught" and few persons enjoy an immunity from it, the younger members of the family are most liable to it, simply because the elder have already passed the ordeal; still there are many instances of persons advanced in life, suffering from the disease for the first time. Another proof that it is not essentially peculiar to infancy may be taken from the cases, by no means unusual, where, in large families affected with pertussis, the mother or nurse has been seized with a cough closely resembling that of the children.

2nd. "The cough is convulsive, always occurs in paroxysms, and very often assumes a periodic type; and it commonly terminates in vomiting."-This proposition admits of no dispute, because until the disease has assumed these characteristics together with the whoop, we cannot say whether it be pertussis or mere bronchitis.

3rd. "The patient is comparatively well during the intervals.”—If, by "comparatively well," Dr. Fife means comparatively with patients suffering from mild bronchitis or simple catarrh, the expression may be correct in a degree, otherwise, it cannot be admitted that the majority of patients affected with pertussis, except in a slight degree, can be deemed well at all; for their almost constant leuco-phlegmatic appearance after the disease has existed for some time, clearly indicates that there is some great obstacle to the due oxygenization of the blood. Indeed the emphysematous state of the lungs in most fatal cases, whatever may have been the complications, militates strongly against such a favourable view of the condition of the patients during the intervals of the cough.

accidental cold. I am, not, however, disposed to deny that a violent attack of bronchitis or pneumonia may cause a cessation of the whoop, which I should explain thus,-either that the new and violent action set up by the inflammation of the bronchi supersedes the specific disease; or that the mechanical irritation of the bronchi by the more acrid mucus, (the product of pure inflammation,) excites a slight and frequent cough, sufficient to expel the offending matter before it accumulates to so great an amount as to require for its removal a series of convulsive actions, such as are exhibited during a paroxysm of hooping-cough.

In accordance with, and supplemental to, the foregoing incidental remarks, I would describe pertussis as a zymotic disease, affecting primarily the mucous membrane of the air-tubes and the blood, and secondarily the medulla oblongata and respiratory nerves, producing a violent and convulsive cough, attended with a peculiar sound characteristic of the disease. I purposely omit from this definition the state of the stomach, as the complaint may exist in its perfect form without any affection of that organ; and I propose to devote the remainder of this paper, except a few words upon the treatment, to the completion of the arguments already adduced in support of this definition of hooping-cough.

If the essential character of zymotic diseases is that they are transmissible by contagion, which, exciting a peculiar ferment in the blood, renders it ever after incapable of receiving the same impression, and thus secures to the patient an immunity from future attacks, we have greater reason to claim the admission of pertussis among them. than that of any now grouped together in this class of complaints; for a second seizure by hooping-cough is far more rare than of small-pox, measles, or scarlatina. In each of these diseases we observe a local affection, attended with a constitutional disturbance of a febrile kind. In smallpox it is the dermis and deep seated portion of the mucous membrane of the tongue, fauces, larynx, and conjunctiva; in scarlatina it is the papillæ of the skin and tongue, and the mucous membrane of the nares and throat, with the tonsils; in measles it is the capillaries of the skin, and of the mucous membrane of the eyes, naies, and respiratory passages, that consti

5th. "It is not attended with fever, or, when this occurs, it does not bear any proportion to the frequency or violence of the paroxysms.—That pure pertussis is unattended by fever will scarcely be admitted as a general rule by those who know how difficult it is to distinguish it from bronchitis during the early part of its course. That the fever does not bear any proportion to the violence or frequency of the paroxysms is true, because these depend upon a cause that is not fully brought into play until the inflammatory stage is

over.

6th. "The whoop is lost as soon as inflammation of the bronchi begins."-From what has just been stated, I conceive this proposition is true only as far as it relates to intercurrent bronchitis, and not by any means constantly so even in this case; for we often observe the force and frequency of the cough aggravated by an

pertussis affects the respiratory mucous membrane, and some pathologists would also include the gastric under its influence; and in like manner, its first invasion exhibits more or less of a febrile character, the symptoms of the early stage of hooping-cough being purely catarrhal. As in other zymotics there is always a state of indisposition that precedes the appearance of the characteristic eruption, so I conceive the dubious primary catarrh of pertussis serves as a forerunner to the outbreak of the perfect form of the disease, distinguished by the whoop and by a profuse secretion of mucus.

But the very term zymotic necessarily implies a diseased condition of the blood, the source of life and of all secretions; and although we shall probably never be able to ascertain what changes are produced in that fluid by the poison it has imbibed, nor where. fore each poison selects a peculiar locality for the display of its effects, still we cannot doubt that the blood, directly, by its properties or products, or

independently of the horizontal posture, which also augments it, and hence the cough is troublesome at night. It may be objected that similar causes will provoke an access of cough in other catarrhal affections, and especially in asthma; but, admitting this to be the case, I contend that the cough is not so easily excited, nor is it so violent in ordinary catarrhs as in pertussis, and the exception of asthma favours rather than opposes this view, as there is always a greater or less amount of cerebral congestion in the nervous form of that disease..

The prolongation of the paroxysms of coughing after the first series of expulsive efforts, and the consequent whoop have terminated, is to be explained by the persistence of some irritation, either of mucus in the bronchi, or of food in the stomach, for when these have been emptied of their contents, the paroxysm terminates. The consideration of this symptom of vomiting has hitherto been omitted, because it is neither peculiar to hooping-cough, nor invariably present, and because it is more or less an attendant upon all severe fits of coughing, from whatever cause, in many persons. Indeed, when we reflect upon the numerous sympathies of the stomach, besides its own affections, that may induce vomiting, it is almost impossible to fix upon any one sole cause of the symptom in hooping-cough; for instance, the vomiting may be the effect of the mechanical compression of the parietes of the stomach by the efforts of coughing, which also overcome the resistance of the other sphincters; or it may arise from the irritation of the Jarynx and bronchi, by the mucus being transmitted to the stomach, as occurs when the fauces and larynx are tickled by a feather; or from a similar transmission of the specific irritation by means of the par vagum, to the stomach; or it may be the result of congestion of the brain by the cough, either simple or specific, producing its usual effect of vertigo and sickness. On these grounds the solution of this question may be fairly left for future discoveries. At present our view of the pathology of the cough is not rendered clearer, whichever we may adopt as being the cause of the vomiting that occasionally attends it.

From what has been stated, we may briefly recapitulate the series of events that constitute the pathology of pertussis in the following order of sequence :Specific toxication of the blood, inducing irritation of the bronchi and increased secretion of mucus, and consequent congestion of the lungs; toxication, and congestion of the brain and medulla oblongata by the blood, now rendered still more vitiated by the pulmonary congestion, which, producing specific irritation of the respiratory nerves, renders them more easily affected by slight stimuli, and causes irregular contractions of the muscles under their influence, so as to produce a spasmodic cough of a peculiar kind.

By this view of the pathology of pertussis, its complications are easily explained. The head symptoms are the effects of the congestion of the brain, from the violence of the cough opposing the return of the blood to the chest. The abdominal complications also are mostly referrible to the same cause. Of the chest affections, some arise from the mechanical effects of the blood and air expelled from, and compressed with violence within, their vessels, by the efforts of coughing; others from simple congestion of the blood; while a

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third order arise from organic changes induced in the congested blood by the influence of accidental circumstances or hereditary predisposition. Hence it follows, that the morbid appearances in fatal cases of pertussis may be very various, though in my own experience congestion of the brain and lungs, with emphysema of the latter organs, have been most usually met with. I have never met with pure crepitation in pertussis, though mucous rattles, with bronchial respiration, are very common physical signs, and for these reasons, and that alleged by Dr. Fife, that the fever bears no proportion to the violence of the symptoms, I do not believe that hooping-cough must be attended, though it is preceded, by bronchitis; and therefore, when there is no fever present, I can only attribute the mucous rattle, to increased secretion from congestion of the lungs.

In order to complete our account of the pathology, it remains for us to shew by what means pertussis wears itself out during its third period, or that of decline. As it differs from the other infectious diseases În not being attended with any visible local manifestation of its action, we cannot state with certainty, how the blood casts off the zymotic element; but reasoning from the analogy of the rest, in which the breath, almost all the secretions, and more particularly the specific products of the malady, are contagious, we may infer that the emunctories of the body are the outlets by which the morbid products make their escape. Still there is no such speedy convalescence as we frequently see in the others; the cough may become rapidly less frequent and violent, but it does not cease suddenly, and leave the patient with nothing but debility to contend against. This slow convalescence, however, is quite consistent with the view that has been taken of the nervous nature of the cough, and it is well known how difficult it is for the system to shake off any habit of a convulsive kind,—as hysteria, chorea, and epilepsy; and the facility with which the disease returns under the influence of a common cold, or other irritation, even months after it is supposed to be cured, is a strong support to the idea of its essentially nervous character in the latter stages. I conceive, then, that the system relieves itself of the dregs of hoopingcough (to use a zymotic metaphor,) by the secretions; but the disease not having, like the other zymotics, any special organ except the bronchial membrane on which to exert its force, the purification of the blood, and hence the convalescence, is more protracted than in them.

With regard to the treatment of pertussis, in mild cases I have found that recommended by Dr. Fife, viz., emetics and sedatives, with an occasional mild :nercurial to correct any disordered secretions, quite sufficient to carry the patient through the disease with comfort and safety. But when the cough is violent, the features puffy, the eyes bloodshot, and there is general oppression, with mucous rattles in the lungs, I cannot agree with Dr. Fife in his objection to depletion by leeches, (I have never used general bleeding,) as I find them to have frequently a most remarkable effect in relieving the congestion and mitigating the paroxysms when applied to the head and chest. Of the two modes, however, when both organs are affected, I have found most benefit from their application to the head. It is chiefly in consequence of its leading to this