crystallization; if the wood be soft and the blood soak deeply into it, one can obtain for the first six or eight days, by maceration, a solution of bloodcolouring stuff which will yield the crystals. After six to eight weeks, especially in soft kinds of wood, the crystal formation no longer is possible, owing probably to the formation of a tannin albuminate, which is insoluble. On iron without rust, dried blood retains its capability of crystallization; it loses it, however, if rust form at the same spot. Blood left on clay or chalk retains also the power of crystallization, unless it is thinly laid on and has been long exposed to the influences of the weather. In instances where linen substances spotted with blood have long macerated in water, so that the blood-colouring stuff is in a great measure extracted, Bryk recommends that the linen be dried and then moistened with acetic acid; on adding further a solution of potassa, a green colour is given to the threads of the fabric.-Vierteljahrsschrift f. d. prakt. Heilk., Jahrgang 1859; Virchow's Archiv, Band xv.; and Wien Wochenschrift, 1858, Nos. 42, 45. The Smethurst Case.-The necessary limitation of space prevents us from noticing in the briefest terms upwards of forty other cases of forensic interest which have appeared since our last report in the British and Foreign Journals. We must, however, for the sake of our Continental readers, say a word respecting the famous Smethurst case, which in this country has for some months been the leading medical topic. This case was one in which poison was suspected; but as there was no evidence of poisoning as the cause of death, save in the imagination of men who have gifts in that direction, we could not logically put the case in our toxicological section. The essence of the case is that a woman, fortythree years of age, and having premonitory indications of abdominal disease, became pregnant. That upon the pregnancy there resulted vomiting, an aggravation of the intestinal disturbance, and dysentery. In great measure from starvation (owing to the inability of the stomach to retain food), to which must be added the exhaustion produced by the dysenteric disease, death was the result. Facilis descensus averni: the medical philosophers who attended the case, not appreciating the meaning of the previous history of the woman, ignoring altogether the fact of pregnancy, and mistaking the symptoms which peculiarly mark starvation, came to the hypothesis that the case was one of slow irritant poisoning. Nevertheless, they took no pains for many days-not indeed until death was at the door-either to remove the poisoner, to look for poison, or to give an antidote. On the contrary, they prescribed for the case as one of ordinary disease almost to the end. When, granting that the case had been a case of poison, it was too late to do anything, the supposed poisoner was arrested, the antidote was supplied, and the poison was searched for. Suffice it to add, that no poison was found in the possession of the prisoner; none satisfactorily in the body of the patient after her death; that the post-mortem appearances were admitted to be dysentery; and that the fact of the existence of pregnancy was revealed by the knife. In spite of all, the vague hypothesis was adhered to. A man was tried for his life, and a jury, overpowered by the dogmatic, and, we may add, stereotyped statement of the scientific witnesses for the prosecution; to wit, that death could only be attributed to irritant poisoning-condemned the prisoner to the scaffold. Since the condemnation the country has risen up against it, and the Secretary of State for the Home Department, than whom a more logical mind is not in this realm, has granted a reprieve from death. The nation is thus happily relieved from a national sin, and English science rescued from indelible disgrace. Another remarkable case of suspected poisoning by arsenic, antimony, or both, has happened in Germany. A woman died, as it was supposed from poison. Portions of her body were examined by two chemists, who found, or thought they found, arsenic, but no autimony. Other portions were examined by two other chemists, who found, or thought they found, antimony, but no arsenic. The whole evidence was then submitted to the distinguished Fresenius, who in an elaborate report, conspicuous for its clearness and science, showed that there was no chemical evidence whatever of death from poison. III. HYGIENE. Building of Hospitals.-Dr. Mackenna, in a paper on the Hygienic Requirements of Hospitals, gives the following advice to his fellow-colonists: "As it is not likely that we shall in this colony require another large hospital, I shall pass on to enumerate the advantages that smaller ones ought to secure. For a population of eight or even ten thousand, I think one of fifty beds should answer. The site, aspect, and drainage should be the best it is possible to procure; the ventilation should be, as it could easily be, made perfect; the wards should hold six or eight beds; the ceilings should be eighteen or twenty feet in height-as I am convinced that the higher a ward is the better, and that no extension in other directions can compensate for it. The impure air should be drawn gradually off by two or more of Dr. Chowne's syphon tubes of large size, the exterior opening of which should be controlled by a cover and vane to prevent downward drafts in hot winds. The ventilation carried on by the aid of louvres and other permanent openings in the roof is liable to the objection that the hot winds force their way downwards, and instantly expel the cooler air, to the great danger of delicate patients. This can be remedied by changing them to a common tube controlled as above. A cold chamber could, and indeed should, be made in the underground, which by a simple arrangement of evaporating surfaces would procure for one or two, or more chambers above, a supply of air several degrees colder and moister than the outside temperature, by which many an otherwise fatal disease might be effectually checked. No kitchen or other office which could in the slightest degree tend by its ascending odours to taint the air of the wards or passages, should be tolerated, and every care should be taken to keep this story thoroughly ventilated. The passages and wards should be flagged with glazed tiles set in cement, which do not retain the moisture after being washed, nor imbibe impurities, and the walls and ceilings should be coated with a glaze of silicated paint. A permanent verandah should face those aspects much exposed to the sun, and these and the windows should be protected by kuskus tatties. No hospital should have more than a ground and upper story, or be without a pair of wards apart from the house for noisy or unruly patients. Lifts and Arnott stoves (for occasional use in winter) are indispensable in every hospital, and the wards should communicate with each other and with the offices by speaking-tubes. Every mechanical improvement in baths, water-closets, and especially those for the removal of patients before and after operations, accidents, &c. &c., should be provided." Effects of Swill Milk.-A report on milk, by Dr. Percy, read at the Academy of Medicine, New York, introduces us to what is called swill milk, or milk yielded by cows fed on swill, the said cows consuming in the daily swill potations not less than a gallon of vinegar per day. The milk yielded has a strong acid reaction, is deficient in butter and sugar, and, according to the observation of Dr. Percy, is quite insufficient for the purposes of life. It is also said to be wanting in a peculiar phosphoric organic compound which has been found in butter, and is described by Gobley, Treacy, and others. The effect of this milk on children fed with it is thus described: "It is not found that this milk, as given to children, actually in all or many cases sickens them at the time it is given; but the child, though inordinately voracious, is starved and poisoned by slow degrees. The nervous system becomes irritated beyond endurance, the vitality is undermined, and the child dies of marasmus, bowel complaints, cholera morbus, dropsy upon the brain, or kindred diseases." QUARTERLY REPORT ON PATHOLOGY AND MEDICINE. By EDWARD H. SIEVEKING, M.D. Fellow of the Royal College of Physicians, Physician to, and Lecturer on I. Some Remarks on the Epidemic of Diphtheria (angine couenneuse) of 1857 and 1858. By Dr. BOUILLON-LAGRANGE. (Gazette Hebdomadaire, Nos. 23, 25, 27, 28.) THE author's paper is based upon an observation of 73 cases of diphtheria, 51 of which were cured, 22 having been fatal. His general conclusions are, that we are still far from being acquainted with the real nature of the disease. He entirely differs from the views of Bretonneau, who considers that under all circumstances the diphtheritic germ is sown locally, like that of syphilis, forgetting, as the author justly observes, that wherever the virus may be deposited, at least with very rare exceptions, the throat, the tonsils, or the nasal fossæ are the parts in which the diphtheria is first manifested. Dr. BouillonLagrange admits the possibility of contagion, but denies the necessity of this element in the propagation of the disease. He holds that we are nearer the truth in regarding the disease as one primarily constitutional, manifesting itself on the mucous membrane, in the same way as the eruptive fevers are characterized by a rash. This view, he adds, may be less attractive than the one accounting for the propagation by local contact, because it deprives us of the excuse for employing heroic remedies. Pathological anatomy, chemistry, the microscope, have not, according to our author, thrown much light upon the study of diphtheria; the first has only confirmed what clinical observation had previously taught regarding the state of internal organs; it has also demonstrated the liquid state of the blood and the internal congestions which result from this condition, and the asphyxia produced mechanically by the false membranes in the air passages. Dr. Bouillon-Lagrange urges the propriety of paying more attention to the lymphatic system, which he believes to play an important part in the disease. He concludes by calling upon chemists and microscopists to study the state of the blood at different stages of diphtheria, which "may be the sole means of obtaining a knowledge of the morbid state which certainly precedes the primary modification of this fluid, before the profound alteration unavoidably entailed by the enormous deposition of fibrine upon the mucous membranes." II. Diphtheritis: the Epidemic Malignant Sore-throat prevailing in Albany, New York. (American Medical Monthly, December, 1858.) It appears that our American confrères are also surprised by the appearance of diphtherite, an epidemic of which prevailed in Albany, a town about one hundred and fifty miles north of New York, during the end of last year. We gather from the brief summary of a meeting of practitioners in that town, that a large number of the inhabitants were attacked. One physician had had forty cases, of which four were fatal, "the larynx, trachea, and bronchia were found lined with a diphtheritic exudation, readily separated from the mucous membrane, which was found entire, except upon the tonsils, which were excavated, enlarged, and much congested. The secretions were copious, offensive, and very acrid. In one fatal case gangrene of the uvula had taken place." During the prevalence of diphtheria, scarlet fever occurred very rarely. Gargles containing chlorates of potash and soda or vinegar, the mineral acids, and tonics internally, constituted the prevailing treatment. At the time of the meeting, in November, 1858, the disease appeared to be on the decline. III. 1. On the Presence of Strongylus Gigas in the Urinary Organs of Man. By Dr. J. LEHOCQ. (Archives Générales, June, 1859.) 2. On the Development of the Larvae of the Lucilia Homini-vorax in the Pharynx. By Dr. COQUEREL. (Ibid.) The first of these papers gives an interesting account of a very clever fraud perpetrated for a series of years by a young woman upon a large number of medical men, who believed that she was in the habit of passing strongyli from her urethra. Suspicion, however, was aroused, and at last Dr. Lehocq, by the aid of M. Robin, succeeded in determining that all her symptoms were the result of her own manipulation, and that on the last occasion at least, when she was supposed to have passed a strongylus, the parasite proved to be portions of a pigeon's intestine. The case deserves a place in the memorabilia of medical experience. The second paper gives another instance of the development of a peculiar parasite in the human body, which Dr. Coquerel brought under the notice of the profession some time ago.* It occurs in Cayenne, and results from the deposition within certain cavities of the human body of the eggs of an insect hitherto unknown, a species of diptera, called by Dr. Coquerel, Lucilia homini vorax. In the cases formerly detailed, the frontal sinuses and the nasal fossæ were the parts affected. In the present instance, gangrene of the pharynx and of the nasal fossæ, and death, resulted from the development of the larvae of the lucilia in these parts. By keeping the larvæ and watching their trans formations, the additional proof has been obtained of the correctness of the opinion adopted concerning them. IV. Exophthalmia as a Symptom of Disease. By C. E. FLEMING, M.D. (Charleston Medical Journal, January, 1859.) Numerous observers have drawn attention to the fact that in anæmic individuals a peculiar prominence of the eyeball takes place, unaccompanied by any palpable disorganization of the structures in or about the globe. It has been attributed to a deposition of fat, or to varicose veins behind the eyeball, to atony of the recti muscles, to enlargement of the globe from diminished tension of the sclerotic. Dr. Fleming has investigated six cases that have fallen under his notice, which presented the following symptoms: anæmia was first established to a greater or less degree; functional derangement of the heart ensued, entailing organic change, especially dilatation. The thyroid gland next enlarged; and, lastly, the eyes began to protrude, and well marked exophthalmia, or pro-ptosis, as it is also termed, was ultimately established. In all his cases the patient had previously suffered from rheumatism, upon which the author lays great stress, inasmuch as he regards the rheumatism as the real origin of the whole chain of phenomena. Dr. Fleming holds that the protrusion of the eye is due to the loss of tonicity in the muscles; they become weak and unable to perform their functions properly, one of which he maintains is, that when they contract together, they draw the globe back upon the cushion of fat in the posterior part of the orbit, so as to diminish the antero-posterior_diameter. Dr. Fleming quotes two cases of strabismus in support of his view. In one the internal rectus was divided; the eye then turned outwards by the action of the external rectus and was protruded quite perceptibly; in the other the internal rectus was first divided, which caused slight protrusion, and when, in order to rectify the outward squint that followed, the external rectus was also divided, a very considerable protrusion of the eye occurred. In order still further to illustrate the subject, Dr. Fleming made some experiments upon dogs. On * See British and Foreign Medico-Chirurgical Review, Oct. 1858, p. 581. dividing the internal and external recti alone, he found that the eye respectively turned inwards or outwards with scarcely any perceptible prominence, but that when all the muscles of the eyeball except the external rectus were divided, the eye almost immediately shot forwards, being also rolled outwards by the undivided muscle. The author considers that in these operations and experiments an analogy exists with the state of exophthalmia of anæmia, but we are disposed to think that the free movement and parallelism of the eyes which exist in the morbid condition under consideration contradict such an assumption, and that Dr. Fleming's explanation is therefore incomplete.* The author advocates the usual medicinal and hygienic treatment adapted for anæmia as suitable to anæmic exophthalmia, but he does not state that he has actually succeeded in restoring the eye to the normal condition and appearance by such means. V. Practical Communications. By Dr. FRANZ INNHAUSER. (Zeitschr. der k. k. Gesellsch. der Aerzte, No. 51.) From these communications we extract the following case of variola occurring three times in the same individual:-In 1857, a maidservant, aged fortyfive, who was attending a patient of Dr. Innhauser's labouring under genuine variola, had been repeatedly vaccinated in childhood without any result. When twelve years old she was infected by genuine variola, leaving large, deep, confluent cicatrices. In 1855 she was again attacked with variola, in conse quence of nursing a man labouring under true variola. It was severe, and the cicatrices were readily distinguishable from the marks left by the first seizure. Three weeks after the recovery of her mistress in 1857, she was attacked a third time with variola, numerous pustules formed, but no cicatrices. VI. On a Musical Bruit, not yet described, heard at the Middle and Lower Part of the Sternum in a Man affected with Cirrhosis of the Liver. By L. LEMAIRE. (L'Union Médicale, Jan., 1859.) The following case occurred in the clinical wards of M. Bouillaud: Joseph Venn, aged forty-three, admitted into the Charité, Sept. 6th, 1858, had always enjoyed good health, with the exception of slight bronchitis seven years ago; until two months before admission, his abdomen was seen to enlarge; loss of appetite and diarrhoea followed, with thirst and loss of strength. On admission the abdomen was swollen, tympanitic above, fluctuating at the inferior part; the dulness of the liver was slightly increased, that of the spleen considerably. The tongue moist; the pulse eighty, regular; the heat of the skin normal. The heart occupied its normal limits; the valvular sounds entirely normal (by an evident misprint they are stated to have been tout à fait anormaux), without any murmur. Over the middle and inferior part of the sternum, over the right cavities of the heart, a musical sound was heard, which so closely resembled a sibilant râle as at once to suggest the presence of bronchitis, but on examining carefully the different parts of the thorax, the * Mr. Dixon (On Diseases of the Eye, second edition, p. 313) observes in reference to this question, that atony of the recti muscles might produce a certain amount of prominence, but is hardly compatible with such free motion as usually exists; and a shortening of the levatores palpebrarum, such as would account for much of the seeming prominence, would hardly allow of complete and easy closure of the eyelids. An interesting historical and critical article on the subject of exophthalmia, may be found in the Gazette Hebdomadaire de Médecine,' April 8th, 1859, in which we find the proposal of Dr. Hirsch supported that the affection should be called the malady of Basedow, who was the first to write on the subject. 48-XXIV. •17 |