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of the heart and emptiness of its cavities are negative characters which may depend upon various causes. Fatty degeneration of the organ can at the utmost be regarded as predisposing to syncope. Admitting death by idiopathic asphyxia, or some affection related to syncope, that this may be expected not frequently to occur in the puerperal state may be deduced from a consideration of the various anatomical and physiological modifications determined by that condition.
We pass over much of the author's paper, and confine ourselves to reproducing his general conclusions :
“1. When a woman dies suddenly during the puerperal state, it is highly probable that her death should be referred to that state, whether there did or did not exist an organic affection of a nature to give rise to sudden death. Such affection would then be mischievously influenced, and its termination may have been precipitated. 2. When a woman dies soddenly, a latent organic affection may have existed prior to pregnancy or have become developed under its influence. In these rather numerous cases an autopsy can alone reveal the true cause of death. 3. The introduction of air into the uterine veins is possible soon after delivery, before contraction has taken place; and this is a material cause of sudden death that may easily be overlooked. The spontaneous development of gas in the blood may be of easier occurrence in the puerperal state; but facts are not yet sufficiently assured to maintain its reality. 4. There is reason to believe that the puerperal state predisposes to the formation of sanguineous concretions in the heart and large vessels. This is a material cause of sudden death which may often be misunderstood. 5. The chloro-anæmic state, frequently met with in pregnant women, seems to predispose them to sudden death. At all events it is a debilitating cause, diminishing vital resistance. 6. All debilitating causes would seem to predispose to the occurrence. It seems to me that this is why sudden death occurs oftener among multiparæ than primiparæ, and in persons of a lymphatic and nervous constitution than in those who are more robust. 7. All sudden puerperal deaths, inexplicable by an anatomical lesion, seem to be the result of a nervous affection, the point of departure of which may be located in the cerebro-spinal or in the ganglionary system. 8. The pernicious effects upon the pregnant woman of pain, of vivid moral emotions, errors of regimen, &c., are incontestible. Under all these circumstances the nervous element is powerfully affected ; and it is highly probable that we should not seek elsewhere for the cause of inexplicable sudden deaths, which take place in the puerperal state, beyond all prevision, and without any organic lesion.” (tome xxii. p. 332.)
VI. On the Yellow Fever. By M. DUTROULAU.—In this memoir M Dutroulau, a medical officer in the French navy, describes two epidemics which he witnessed at Martinique in 1851, and at Guadaloupe in 1853–6. We confine ourselves to his observations on the treatment of the disease. In his view, the disease consists in a peculiar alteration of the blood, determined by a specific miasm, and passing through two phases entirely opposed to each other; one of these is inflammatory, giving rise to the early series of symptoms of irritation and vascular congestion; and the other is the stage of decomposition or dyscrasis, indicated by ataxo-adynamic phenomena. In the first period bleeding was resorted to; one or two venesections, together with numerous leeches, were employed during the first twenty-four hours, warm and aromatized drinks and mustard poultices or foot-baths being used at the same time. Ample evacuations were also induced by purgatives given by the mouth or in clysters. Whenever the yellow fever had been preceded by one or more intermittent paroxysms, or whenever abundant and deceptive sweating masked the true characters of the affection, quinine was exhibited, but it never exerted any effect on the course or ultimate gravity of the disease. Although this antiphlogistic treatment is the rational one to employ in the early stage of the disease, it often failed in its effect or the cases were unsuitable for its application. The author was therefore glad to try the effect of various empirical remedies, which were said to have been of use in former epidemics. From these, however, little or no benefit accrued; and he found the best plan was to modify the antiphlogistic treatment, so as to bring it in harmony with the powers of the patient. When the second stage had set in, the individual symptoms-such as vomiting, hæmorrhage, cerebral complications—were met as they arose. Whatever these predominant symptoms might be, the ataxo-adynamic state which accompanied them was usefully combated with quinine, employed in frictions and lavements. Stimulating drinks were also found useful—such as Madeira diluted with Seltzer water; but musk, camphor, or ammonia, given on account of the typhoid complications, seemed but of slight utility.
The great mortality from yellow fever, whatever mode of treatment may be employed, has led to great attention being paid to the subject of prophylaxis, and in the author's opinion experience has now sufficiently shown, at least the means of arresting an epidemic. The disease never spreads beyond a short distance, either in extent or height, from the shore of an infected spot. It is true that the rigorous determination of such distance has not yet been made; and it is probable that it may vary in different localities. Nevertheless, the magnificent establishment at "Camp Jacob," at Guadaloupe, placed at five and a half kilometres only from the coast, and at an elevation of 550 metres above the surface of the sea, has in no wise disappointed the hopes entertained concerning it during the six years of its existence, and may be regarded as the type of preventive localities in the French Antilles. As soon as an epidemic breaks out, the portion of the garrison and of the European civil population not acclimatized, should be evacuated on such spots, all communication being cut off with the infected locality. Vessels at anchor, too, should, when invaded by the disease, evacuate their
upon the heights; or, better still, if they can put to sea prior to any accident appearing. To retain a garrison at the seaside, or to set sail for more favourable latitudes, baving the disease already on board, will almost certainly expose to irreparable misfortune. Vessels already infected, or coming from infected places, should be sequestrated in healthy spots at a distance from European populations, or the preservative means already indicated should be applied to them.
VII. On the Origin and Development of the Fungus of Muguet (Oidium Albicans). By Dr. GUBLER.—The following are the conclusions with which M. Gubler terminates his memoir:
“1. The concretions of a pultaceous appearance known by the name of muguet are formed by the fungus oidium albicans. 2. Without having recourse to the hypothesis of spontaneous generation, we may admit that the oidium is the product of spores disseminated in the atmosphere, some of which become attached to the entrance of the digestive tube, and there undergo development. 3. As the muguet originates in spores transported through the atmosphere, such spores must be necessarily more abundant where the disease prevails; and the invasion by the cryptogam is more imminent for those inhabiting such localities. 4. Another mode of propagation has been confounded with contagion properly so called. This bas been demonstrated by successful experiments, in which the byssoid filaments taken from the mouth of one child, and applied to the healthy mouth of another, have given rise to muguet in the latter. 5. But the spores held in suspension in the atmosphere, or the filaments applied to the mouth, do not necessarily induce muguet, the development of this microscopic fungus requiring conditions which are only found in certain morbid states. The diseases in which muguet has oftenest been met with are derangements of the digestive organs in young infants ; and in the adult, the latter stage of phthisis, typhoid fever, and angina. In all these affections there is one common character-viz., a morbid state of the alimentary canal, with a changed condition of the buecal fluids, which from being alkaline have become acids. 6. All leads to the opinion that it is upon this acid reaction that the development of the oidiuin depends. On the one hand, it is constantly present as long as the cryptogamic vegetation is progressive, or at least stationary; and, on the other, acidity of liquids holding organic matters in solution remarkably favours the production of mould. Finally, clinical practice teaches us that, with the exception of mechanical or caustic agents of destruction, there is no better means of ensuring its radical dispersion than the employment of alkalies. 7. The spores of oidium, then, meeting with an acid medium, germinate rapidly in a soil congenial to them. Their filaments become developed, either among the masses of epithelial cells in a state of desquamation, mingled with concretions of altered mucus or parcels of food, or in the intervals left between the raised epithelium and the mucous dermis, or, again, in the glandular cavities. The fungus lives exclusively at the expense of this humus, and does not penetrate into the interstices of the tissues, nor abstract anything from the circulatory juices. It is then a false parasite. 8. The production of muguet is, then, a simple accident, an epiphenomenon observed in the course of affections varying both as to their nature and their gravity. 10. It may, however, constitute a complication, inasmuch as by obstructing the glandular ducts, by lining the mucous surfaces with a thick and continuous layer capable of impeding sucking and deglutition, by keeping up the acid fermentation of the products of secretion, and by irritating the surfaces to which it has become attached, it may for a period prevent a return to the normal condition. 11. From these propositions we may deduce some therapeutical consequences. In the first place, we must remove healthy children from the vicinity of, and especially from contact with, the subjects of muguet. When it has become develop :d, it must be mechanically removed from the parts to which it has become attached, the parts being well washed with strong alkaline lotion. Where there is no contra-indication, Vichy water may also be given internally.” (tome xxii., pp. 460–2.)
VIII. Observations on the Toxicological Search for Arsenic. By M. BlondLOT.The author is of opinion that by the process employed by most toxicologists for the destruction of organic matters by sulphuric acid, a more or less considerable portion of the arsenic is lost, to the risk when the tissues only contain traces of the poison, of missing it altogether. His attention was drawn to the subject by observing, during post-mortem examinations after poisoning by arsenic, portions of this substance in the stomach converted into a beautiful yellow colour by the sulphuretted hydrogen engendered by putrefaction ; and he came to the conclusion that arsenious acid dissolved and disseminated in the parenchymata may, under the influence of putrefaction, be converted into an insoluble sulphuret, which MM. Danger and Flandin's method is powerless to detect, inasmuch as in the process of carbonisation by sulphuric acid the sulphuret undergoes no change, and remains as insoluble as before. Moreover, carbonisation by sulphuric acid also gives rise to the formation of a certain amount of insoluble salpburet. Thus he has found that one-balf of the arsenic sought may be lost. To avoid this source of error, after repeated washings with boiling distilled water to remove all the soluble arsenious acid from the carbon, a second washing should be performed with ammoniacal water in order to remove the sulphuret. After careful evaporation to dryness, the residue may be treated by concentrated boiling nitric acid, added several times in small quantities, and the excess of acid having been expelled, a second solution of arsenic may be obtained, which, added to the first, constitutes the suspected liquid to be submitted to Marsh's apparatus.
IX. A Case of Cæsarean Operation performed with success. By M. BORIE.- This was performed at the Maternité, at Tulle, on the person of a ricketty but hardy primipara, aged twenty-nine, in whom the space between the sacro-vertebral angle and the triangular ligament of the symphysis pubis measured but from five to six centimetres at the utmost. A living child was delivered, and the woman recovered rapidly. Chloroforin was employed, and a longer incision than usual was practised in opening the cavity of the abdomen.
X. On the Amount of Utility of Permanent Exutories in the Treatment of Chronic Diseases. By M. ZURKOWSKI.—This testimony in proof of the utility of exutories is not derived from original observations made by the author, but from the collection and comparison of cases which have been already recorded. These cases are arranged under three categories.
1. Permanent Exutories in Chronic Phlegmasia.—Lesions which result from chronic inflammation, when exempt from all diathesic influence, are generally, even after a very long period, susceptible of resolution. Such fortunate terminations have frequently been due to the employment of exutories. It is especially in disease of the articulations that the greatest number of successful cases have been observed. Of 58 of the cases of Pott's disease and white swellinys, the exutories were the sole means employed in 22; they were used in conjunction with other means in 12, and in 24 they were resorted to after other measures had failed. A no less positive amount of success has attended their use in chronic myelitis and the consequent paralysis -44 instances of recovery from such paralysis, with or without vertebral disease, being on record. Of 20 cases of amaurosis, 7 were treated exclusively by exutories
, and 13 after the failure of all other means; permanent success resulting in the whole. So with 30 cases of various descriptions of ophthalmia, the great bulk of which had previously been treated without success. Besides these, may be mentioned old cases of pleuritic and peritoneal effusion.
2. Exutories in Tuberculisation.—The author reports 10 instances of palmonary consumption treated with success by exutories. These individuals were all the issue of healthy parents, with no antecedent phthisis in their families. There were no concomitant or anterior abdominal affections, signs of scrofula, or disease of the bones or joints. But all the patients had cavities at the upper part of the lung, accompanied by the usual cortege of symptoms.
3. Exutories in Neuroses.-Their ben cial effect has been observed in the various forms of these, whether relating to modifications of sensibility, motility, or impressionability, or to aberrations of the perceptions, of the intellectual powers, or of the inoral and affective faculties.
Seeing, then, how useful this means may often prove, how comes it that it has fallen into discredit? By reason of the abuse which arose from its indiscriminate employment, whether suitable indications were present or not. Among the conditions which should oppose
the use of permanent exutories as a means of treating chronic disease, are the following:
1. Deep-seated Alterations of Structure.-For example, the atrophy or melting down of an organ, wbich bas already given rise to symptoms of resorption or colliquation. In subjects placed even in the most favourable conditions, if the organs have undergone deep-seated alterations, if the general reaction is continuous, giving rise to disturbance of some important function, and especially if nutrition be already deeply impaired, not only have exutories no longer any chance of success, but they may even hasten the fatal termination.
2. Degenerations.-Without speaking here of primary heteromorphies, for which no one would think of employing exutories, we allude to those insidious transformations of simply indurated or hypertrophied tissues, which are brought about either by the sole effect of chronicity, or under the influence of some diathesic or hereditary condition.
3. Tuberculisation. Although exutories may exert a beneficial action in cases of isolated tubercles, limited to a circumscribed portion of an organ, they offer no chance of success in general tuberculisation—that is, when the diseased process has been set up in several organs at once, or even in several parts of the same organ. It is from their having been too frequently employed in cases of this nature, that their credit has become compromised to the extent of causing their utility to be doubted in cases in which they are really indicated.
4. Hereditary Influence. This exerts great pathogenic influence in chronic disease. Next to tubercular affections, it is in the neuroses especially that it plays so immense a part. In the examples of epilepsy and insanity, in which exutories have proved useful, the patients have been exempt from this fatal influence. Unfortunately these are the rarest cases; the immense majority are subjected to hereditary influence, and exutories will fail to exert any salutary effect upon them.
Besides the Memoirs we have noticed, there are in these volumes éloges on Roux and Magendie; Reports on the Mineral Waters of France in 1854 and 1855; and Reports upon the Epidemic Visitations in 1855 and 1856. In this last, from the pen of M. Trousseau, there is some account of the epidemic of diphtheritis which prevailed at Boulogne in 1856. We have also passed over a paper by M. Poterin du Motel on Melancholia; another by M. Reynal, on Herpes Tonsurans as observed in the horse and ox; and one by M. Michel, on the Applications of the Microscope to the Diagnosis and Treatment of Disease. This last is an able resumé of what is known upon the subject, but defies analysis.
On Wounds and Injuries of the Eye. By WILLIAM WHITE COOPER, F.R.C.S.,
Ophthalmic Surgeon to St. Mary's Hospital, Senior Surgeon to the North London Eye Infirmary, &c. Three coloured Lithograpbic Plates, containing seventeen
figures, and Forty-one Woodcuts. London, 1859. 8vo, pp. 330. In his preface Mr. Cooper states, that although his subject forms part of systematic treatises on the eye, he is not aware of any English work specially devoted to injuries of this organ; and that when in charge of difficult and anxious cases, he has often felt the want of such a book of reference as that which he now endeavours to supply. Those who shall peruse Mr. Cooper's work will readily agree with the author, that to render it interesting and useful no pains bave been spared. Believing that cases tend to impress facts upon the memory more strongly than precepts, Mr. Cooper has introduced them freely, although generally in a condensed form, and confining them as much as possible to the illustration of leading points of practice.
The order in which Mr. Cooper takes up the several divisions of his subject is as follows -1. Foreign Bodies behind the Eyelids. 2. Foreign Bodies in the Eyeball. 3. Gunshot wounds. 4. Incised and Punctured Wounds. 5. Contusions. 6. Rupture of the Eye-ball. 7. Intra-ocular Hæmorrhage. 8. Burns and Chemical Injuries. 9. Sympathetic Inflammation.
In his first chapter, among other causes of irritation, Mr. Cooper notices the exposure of the eyes to the dust and emanations arising from the preparation of drugs of various sorts.
Euphorbium (he tells us) is the plant most dreaded by drug-grinders. It causes so great irritation that it is necessary to protect the face and eyes with a mask, having glasses to see through. Not only does the dust cause violent ophthalınia, but, if inhaled, may produce insanity. Cantharides is very injurious to the eyes of workmen, and even the vapoor of cantharidin produces powerful effects. The preparing of oil of 'mustard, infusion of black mustard, powder of hellebore, gamboge, squills, and veratria, is also injurious. of iodine, bromine, and chlorine, are very irritating; as are the fuines of ammonia and strong acetic acid. (pp. 5–6.)
Mr. Cooper considers minutely the effects of foreign bodies within the conjunctival sinuses, or fixed in the epithelium of the cornea. One of the consequences of such, injuries we think he has omitted, and that is, the occasional formation of pterygium from foreign particles remaining fixed for a considerable length of time near the margin of the cornea.
Under the head of Foreign Bodies in the Eyeball, Mr. Cooper mentions a number of interesting cases of wounds of the crystalline, either occurring in his own practice, or recorded by others. One of these is a case in which a scale of metal struck the
eye of a man, who ten days afterwards applied to Dr. Von Gräfe. Close examination discovered a small cicatrice of the cornea, a wound near the centre of the anterior capsule, and, finally, the foreign body in the posterior cortical substance of the lens. Dr. Von Gräfe passed a cataract-needle in the track of the foreign body, and enlarged the opening in the capsule, hoping that with the increase of imbibition the fragment might descend towards the aperture, and so become more accessible. After fifteen days it had moved to the middle of the crystalline, and eight days later into the anterior chamber, enveloped in cortical substance. A puncture was made, and as the knife was withdrawn, the foreign body escaped. Recovery followed, with as good vision as the loss of the crystalline would allow. (pp. 29–30.)
The following case, quoted from M. Desmarres, while it shows the utility of the ophthalmoscope in the examination of cases of minute deep-seated injuries of the eye, excites suspicion as to its alleged ultimate result-namely, the preservation of good sight with a wounded lens.