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themselves to heal, but a great part of the substance it extended from one ear to the other, and from his occipital of the carbuncle fairly exposed, and also under the spine to the third cervical vertebra. He measured it for necessity of healing. But you will observe that the his own amusement, and it was fourteen inches over its surwhole of the space that now remains to heal is a series of face transversely, and nine inches vertically—a carbuncle, openings in the middle of the carbuncle, through which the then, of the largest size, and one, it might have been supsloughs are to be separated, through which, indeed, nearly posed, attended with considerable risk to life. I urged him the whole of the sloughs have already been discharged, and very strongly to take a large quantity of what is called which now merely remain to be healed like the cavities of “support,” for I was at that time under an impression of small abscesses, In that way you narrow greatly the ex- its necessity. He absolutely refused, however, and nothing tent of wounded surface to be healed. Indeed, it by no would induce him to take it. I was therefore content to means always follows that the whole carbuncle, or its whole stand by and study the natural history of disease in this base, sloughs. Carbuncles, if not divided, not unfrequently huge carbuncle; and the natural history of it was a history only suppurate about their centres, and slough only in their that one would have wished to witness in every carbuncle of central parts, and the borders merely clear up by the soften- its size, for no case could pass through its course in a better ing and dispersion of the inflammatory products in them. method. He led his ordinary abstemious life, took moderate Tn every case of that kind you save greatly the amount of quantities of food and of stimulant, lived through a carhealing which has to be gone through. Nay, in some cases buncle of the greatest severity, and finally made a complete 'carbuncles completely abort. One of these cases, of which recovery, and lived for several years after. I have the paper on the table, was that of a woman, aged Another case which impressed me very much was that of sixty-four, who came in with a carbuncle nearly as large as a friend of my own in the profession, who had a carbuncle this, in a condition which, it might be said, required inci- on the back of his neck, of very considerable size. Sir sion at once; but, with the exception of two or three small Benjamin Brodie and Mr. Stanley attended him with me, points, no suppuration or sloughing ensued. That car- and under their advice the carbuncle was cut. I watched buncle dispersed, aborted, cleared away. This case shows its course afterwards, and felt sure that the cutting had the more ordinary course of events—the sloughing of the done neither good nor harm. It went on as carbuncles do central part, the gradual discharge of the sloughs, and the when not cut. But the gentleman was subject to intense comparatively small spaces which are left in the centre of headaches, of which he knew by experience the only possible the carbuncle as the sole space in which the process of remedy was almost entirely to leave off food, and absolutely healing has to be achieved.
and entirely to leave off stimulants. One of these head. On these three points, which are the grounds that have aches occurred during the course of the carbuncle, at a time been assigned as reasons for cutting carbuncles, I have now when we had put him upon very full diet and abundant given you the evidence on which I have ceased from the stimulant. He said then that he must leave off his stimupractice. I fully believe that crucial incisions do not pre- lants and food, and we looked with some aların at what vent extension; that it is only a limited set of cases in which would be the result on the progress of the carbuncle. I the incisions diminish pain; and that with regard to the remember Mr. Stanley saying to him, in his distinct man. time that is occupied in healing with or without incisions, ner, “ My dear fellow, if you don't take food, you will die.” the healing without incisions is very clearly and certainly a Very well,” he said, “ then I will die, but I will not take great deal the quicker.
food and increase my headache.” According to his own The kind of incisions that I have been speaking of is the wish, therefore, we reduced his diet to a very low level. old plan of crucial incisions. Another method which I have the course of the carbuncle was not affected at all, unless 'occasionally tried, but of which I can only state the same it were for good; and after three or four days of this, which general results, is that of subcutaneous incision. This has might be called comparative starvation, he described himbeen supposed to have the same general effect as the other; self in his own emphatic fashion as being as jolly as a and I think that the same general conclusions may be drawn sand-boy.”' respecting it: that it is a measure unnecessary in the treat- Since that time I have watched carefully all cases that I ment of carbuncle, and that it retards rather than hastens have seen, and I am certain that there is no good to be the healing. When I speak thus of the incision of car. obtained by large feeding or abundant stimulants in ordibuncles, however, I do not mean to say that there is no con- nary cases of carbuncle. The whole of these cases that dition of carbuncle in which an incision is not useful. Some have been in the hospital were put on our ordinary meat times a carbuncle sloughs in its central part, with one con- diet, with a pint of porter daily; and I see that two of them tinuous slough of integument holding in a quantity of pus. have had four ounces of wine a day, one of these being a In that case you would cut through the slough, or through person aged sixty-four and the other sixty-three, and both any adjacent part of the carbuncle, to let out the pus, as having carbuncles of considerable size. You will find that you would open an ordinary abscess. But this is not a mea- for patients in private life it will do very well if you sure which is commonly understood by the “incision of a tell them that they may have about two-thirds of their 'carbuncle."
ordinary amount of food, and about the same proportion of If you ask why one may not cut a carbuncle though it may their ordinary quantity of stimulants. But indeed there is do no good, I reply that you should never be actively use- scarcely any reason to change in any material degree the less, and that there are some cases in which the cutting ordinary mode of life of a patient with carbuncle. So far does considerable harm. Carbuncles, for the most part, as he can with comfort take that to which he is accustomed, occur in persons broken down in health, exhausted by over- so far he may. If his diet has been habitually low, so it work, or by bad food, or in general deteriorated health-as may remain ; if habitually high, so, within certain limits sometimes in diabetes or albuminuria ; and in all these and somewhat reduced, it may still remain. states it is a good general rule to save the blood they need Now you may ask what I should set down as the things for healing. The loss of blood from the carbuncle itself to be done for à carbuncle. These boards, nearly bare as would not be considerable; the hard substance of the car- they are, may tell you.
In local treatment one of the best buncle, when cut into, does not bleed, or bleeds but little things you can do, if the carbuncle is small, is to cover it But to carry out the incision perfectly, you have to cut into with emplastrum plumbi spread upon leather, with a hole the adjacent healthy texture; and this sometimes bleeds in the middle through which the pus can exude and the very profusely, so as to lead to all the distress and pain of slough can come away. That, occasionally changed, is all plugging the wound with this or that substance to arrest the covering that a small carbuncle will need. It is difficult the blood.
thus to cover the whole surface of a large carbuncle, and to Another measure in the treatment of carbuncles which is keep it clean ; therefore, I think that the best application supposed to be necessary, is very high feeding and large for that is the common resin cerate. This should be quantities of stimulants. I learned the opposite of this in spread large enough to cover the whole carbuncle, and over one of those cases which you will do always well to study, it should be laid a poultice of half linseed-meal and half those, namely, in which the patient refuses to do what you bread. And, if you want to exercise your skill, learn to advise him. It is from such cases that we may often learn make that poultice well, and to put it on well, and to keep what is commonly called the “natural history of disease"- it in its place well. That mode of dressing the carbuncle, its course undisturbed by treatment. A case occurred to me so far as the materials are concerned, will last through its once of an old gentleman, eighty years of age, who had a whole course ; but whilst the carbuncle is making progress carbuncle, as big as it could be, on the back of his neck, for and discharging its slough, you will find plenty of room for the exercise of considerable skill in dressing it, and filling rations of surgery, and less really than that of any disease up the cavities with soft substance spread with this oint- of equal severity that you can name. Of those four deaths, ment. Besides this, the carbuncles are to be carefully one occurred in a patient aged seventy-eight, who died of washed, especially with some deodorising substance, as erysipelas after the carbuncle had nearly healed. Another Condy's fluid, or weak carbolic acid, and the cavities may was a gentleman of about fifty-five years of age, who died be syringed out with it. The importance of cleanliness is of chronic pyæmia. The third was a gentleman aged fifty, very great. You noticed in the man whom I showed you who died with acute pyæmia. And the fourth was a patient just now the spots of acne and boils around the edges of of about fifty years of age, who died rapidly exhausted. The the carbuncle. This points out the necessity of care, first three were from causes which may almost be called which I suppose had not been taken there, to keep the sur. accidental; for so we call them when occurring after an face of the skin adjacent to the carbuncle perfectly dry, and operation, and it would be unreasonable to suppose that free from any contact with the discharge, which seems any other method of treatment would have averted the conreally to have the power of infecting the neighbouring skin, sequences. The other died, possibly, on account of the deand so producing the boils which are apt to arise, sometimes ficient stimulation ; for he was a man who had lived freely, in clusters, around the carbuncle. Of diet I have already and took during treatment less than he had been accusspoken to you. Of medicines I say nothing. Quinine, bark, tomed to have. The main point, however, to which I wish and other medicines of that class, may be given if you to direct your attention, is that the mortality may be as please, or in case of evident need, and so may aperients ; little as two per cent. I cannot doubt that the mortality but there is really no need of them in an ordinary case of was considerably larger when carbuncles were severely carbuncle. But there is one medicine which you may find cut; for the severe cutting meant often severe bleeding, very valuable, and that is opium, especially in all the earlier and was attended with all the consequences of large wounds. painful stages of carbuncle, in which it relieves the suffer- Thus, though I do not know the exact proportion, I believe ing as thoroughly as incisions, or anything I know. After that the general reputation of the danger of carbuncle was the early stages, even that is unnecessary, except for some well founded, and that among the reasons for the diminished patient who may be unable to sleep.
mortality of carbuncles may be set down as chief, the more But there is one measure in the treatment of carbuncle frequent avoidance of the custom of cutting them. which is seldom employed, and yet is of great importance, Speaking of the mortality of carbuncle, however, I must and that is letting the patient have very free air. The remind you that I am not speaking of a disease which somegeneral idea that carbuncles are very dangerous diseases times passes under the name of carbuncle—the carbuncular has commonly led to the patients being entirely confined inflammation of the lip which sometimes occurs in young to bed and kept shut up in their rooms. There is in that persons: a disease which you may not have seen, and may an unnecessary care; and this, too, I learned from a patient pass many years without seeing. It was described by a who refused to comply with injunctions-a gentleman with former house-surgeon of this hospital, Mr. Harvey Ludlow, a large carbuncle on the back of his head, who would as malignant pustule of the lip. Dr. Budd, of Bristol, has not keep his bedroom. He had been accustomed to an also so described it. Commencing at one spot, inflammation active life, and after seventy or eighty years of that cus of the whole lip follows and spreads to the face, and then tom he was quite indisposed to remain in his room. So disease of the lymphatics ensues, with pyæmia as its conwith that carbuncle he daily came down stairs, changing sequence. It is a disease so unlike carbuncle that it ought his room and moving about the house as well as the pain not to be known under the same name. It seems to me not and weakness would allow him. No carbuncle could go on like the accounts given of the malignant pustule abroad, better; all the stages were passed through without any and I have seen no other disease like it in England. It risk or trouble, and it healed with unusual speed. After attacks especially young persons from fifteen to twenty-one; that I had a yet more striking case. A lady came to Lon- and of fifteen cases that I have seen, only one recovered. don “for the season," as she called it; and she had not That disease is not carbuncle, nor is the mortality of that been here more than a week or ten days before a carbuncle disease to be counted in estimating the mortality from carcame out on the back of her head, just under her hair. It buncle. Ordinary carbuncle on the lip and face has none was a great vexation to her that she had to give up all her of those special characters, and is not more fatal in those amusements; and so, as she did not mind the pain, she situations than in any other. would go out. And it was then that, for the first time and the last, I saw any value in a “chignon.” She dressed her carbuncle under the chignon, and she went to the park, to the theatre, and to dances unharmed, and with her carbuncle quite unseen, and no trouble whatever followed. It healed up after the ordinary fashion in about the ordinary time. But, indeed, you may see cases of this description on a much larger scale if you watch the carbuncles that USE OF BRUCINE IN STOMACHAE come to us in the out-patients' room. There we often see them of considerable size, and they do as well among the
EPILEPSY. out-patients as among the in-patients; and yet these outpatients are freely in the air all day, and many of them By J. SPENCE RAMSKILL, M.D. LOND., continue at their work. So you may set it down as one point to be attended to in the management of carbuncles
TO, AND LECTURER ON MEDICINE AT, THE LONDON HOSPITAL, that patients should not be confined to their room. They should at least have change of air in their own house; and, unless they are too low, they should not avoid exposure to the fresh open air.
A LARGE proportion of the cases of epilepsy have, as an Treating your cases of carbuncle upon this plan, I believe aura, or warning of the coming fit, some disturbance reyou will find that the great majority will pass through their ferred to the stomach-such as nausea, attacks of flatucourse well. I cannot tell you what the ordinary proportion lence, undefinable sensations, represented as rising upwards, of deaths from carbuncle is; but I know that carbuncles and consciousness ceasing when the sensation reaches the are commonly looked upon in the profession as dangerous head; and these are the cases, also, in which vomiting folthings, and a large carbuncle on the back of the head is considered to be fraught with risk to the patient's life. But lows the fit. The vomited matters always contain food, and that is very far from being the case in my experience. Re- sometimes in an undigested condition, although some hours membering, as far as I can, or rather guessing
at the number may have elapsed since the last meal. There may be no of carbuncles I have had to treat, I should say that there is proper symptoms of dyspepsia in the intervals between the no other disease of the same extent and general severity fits beyond a constant disposition to the generation of flatus, which is attended with so little risk to life. During twenty indicating permanent disorder of the ganglionic nerves. years of hospital and private practice, I cannot have treated less than 200 carbuncles; and of these 200, four have died, The functions of the pneumogastric, moreover, become pergiving a mortality, at a fair guess, of only two per cent.-a verted; and the cause of this may be at the root of the mortality which is less than that of most of the minor ope- nerve, or at its periphery. Supposing disorder of the centre
Abstract of a Lecture
PHYSICIAN TO THE HOSPITAL FOR PARALYSIS AND EPILEPSY; PHYSICIAN AND
ASSISTANT-SURGEONS IN H.M. INDLAX AXD BRITISH SERVICES.
to be the starting-point, then perversion of the normal cumulative action, or suddenly poisonous effect, from the function of the nerve at its periphery in the stomach (and administration of either alkaloid. You will find great satisalso sometimes elsewhere) is its natural expression. But faction in giving bromide in large doses at bedtime, at the supposing the nervous centres to be only in the usual con
same time ordering brucine twice daily; thereby you en
sure the sedative action of the bromide, and the tonic effect dition belonging to epileptics---not healthy, but in a mor- of brucine on the whole nervous system. bidly irritable state,—then a temporary disorder, produced by undigested or indigestible food, in its peripheral branches, will increase centric disturbance, cause reflex contraction of
SCIENTIFIC INVESTIGATION INTO THE cerebral bloodvessels governed by vaso-motor nerves, and an
CAUSES OF CHOLERA. explosion in the shape of a fit. The same argument applies to disorder of the small in
(Concluded from p. 41.) testines, the splanchnic nerves furnishing the medium of III. REPORT OF INTERVIEWS WITH PROFESSOR communication between the mucous membrane and the reflex
ERNST HALLIER, AT JENA, Oct. 1868. centres. The fit in that case is usually followed by diarrhea, and not by vomiting. Such cases as these are not best treated by bromide of potassium alone. One of the bad DR. D. DOUGLAS CUNNINGHAM effects of this drug, perhaps the only one caused by the bromide even in moderate doses, is what we call the bromide
DR. TIMOTHY LEWIS, dyspepsia. The objective symptoms are foul breath, a white tongue, involving the edges as well as the dorsum, and not necessarily furred, with great languor and sleepiness. Anorexia must be added to the list. It will be found that when
PROFESSOR HALLIER received us with the greatest kindsuch a condition exists there will be an accession of fits, al- ness, and endeavoured to show us his preparations and to though up to the time of the stomachal disorder the attacks explain his views as completely as possible; but he considered may have completely ceased.
there was no time to do full justice to his plan of investiUnder such circumstances your best proceeding will be to gation or to the proofs of his opinions. It would require, use any ordinary alterative aperient with• effervescing salines, and when the colour of the tongue has returned he thought, at least two months' work for this. and by that time the other symptoms I have mentioned will I. Apparatus which Professor Hallier employs. — These are have disappeared also—then to recommence the bromide generally rather complex, as Professor Hallier's method of treatment in conjunction with lactate of soda, in a dose of observation depends for the value of its results on the supfrom five to fifteen grains, in some bitter infusion, the best position that isolation is as perfectly secured as possible. of which is the infusion of chiretta. I prefer chiretta be- 1. The large apparatus, as described in his " Gährungscause it acts as a cholagogue, and the only objection is that Erscheinungen," p. 14: It consists of a glass flask, fitted it occasionally produces diarrhoea. You may give the bro- with two tubes, one of which is connected with the isolating mide for a long period in this combination without having media, whilst the other enters the receiver of a small airto suspend it on account of the "bromide dyspepsia.” pump, by means of which any amount of air can be drawn
Now a suspension of epileptic attacks is, for many reasons, through the whole apparatus. He thinks that, if it were always desirable. Yet suspension is not cure; and, for the possible (i. e., if a sufficient number were at hand), only this most part, when you cease to give bromide of potassium, kind should be used. He considers its great advantages to the attacks return. Can we prevent these? I think we can lie: 1st. In its being as perfect an isolator as is possible often do so by building up the patient, by using means to be obtained without resorting to great expense. 2nd. In to improve the nutrition of the tissues, of the nervous its affording means for the supply of as much air as may be masses, and of the ganglionic nerves especially; for I hold thought necessary. 3rd. In enabling the material culti. that a convulsion is an impossibility in a perfectly healthy | vated to be used in considerable amount, which he considers brain and nervous system; and I think these views should almost essential for good results. Of course it has the disform the basis of all treatment. Is there any tonic remedy advantage of not providing any means for the continuous of value for this purpose? I think so; and I have found observation of progressive development, as the results of the best in brucine,- beyond many of recognised value. the cultivation in it can only be examined on breaking open Mr. Tyrrell (of Malvern) has published some cases treated the flask. successfully by strychnine. I have used this drug exten- 2. The small apparatus : This consists of a small bellsively, and when the patient can remain under close obser- glass, communicating with the air by a bent tube, and vation, or if he be attended by intelligent friends, I should standing in a basin of permanganate of potash. In this, as not hesitate in proper cases to recommend its use. But described in the “Gährungs-Erscheinungen,” the substance there are cases of idiosyncrasy, and small doses will some- to be cultivated is made to rest on a small glass or earthentimes evoke disagreeable toxic symptoms. I have not ware dish, so as to keep it out of the permanganate solubeen annoyed in this respect with brucine, perhaps be- tion. (See Fig. 2, a.) cause it is a weaker alkaloid, and the patient gets more easily II. The substrata which Professor Hallier employs. accustomed to its use. Its physiological effects, however, so 1. The freshly exposed pulp of a lemon, "which, as freshly closely resemble those of strychnia, that it may be taken for exposed, may be presumed to be free from spores or fungal granted their therapeutical virtues are the same. I usually elements.” order it in a solution made of the same strength as the 2. Thick starch paste, containing some salt of ammonia. liquor strychniæ of the Pharmacopoeia, and commence with 3. Solution of grape sugar. a dose of ten minims, to be taken twice daily; every third 4. Cork which has been previously soaked in alcohol. day an addition should be made of five minims to the dose, This is carefully dried, and “when employed as a subuntil from a third to half a grain is reached. If any stiff- stratum is kept so, but surrounded by moist air." ness of jaws or other toxic symptom appear, the dose is to 5. Fresh potato. be diminished by five minims, and continued until any In making a series of observations on development, he new objectionable symptom is manifest; then it is employs the large apparatus for getting fully developed again lessened. You will not find any benefit from results, and several of the small ones for results which may either brucine or strychnine till a full dose is reached; be frequently examined, and so show the steps of developoften the reverse effect. As a rule, patients will take ment. twice as much brucine as strychnine, without any neces- In making any series of observations, two pieces of sity for diminishing the dose. After the continuous lemon, cork, &c., should be employed, on one of which administration of brucine for a month, I think it well to spores are sown, and on the other they are not, so as to be suspend its use for some days, and then again resume it. I able to compare the one piece with the other. may remind you that Dr. Marshall Hall used strychnine in III. A summary of Professor Hallier's views as gathered epilepsy, but he gave it in very small doses, and without from explanatory statements made whilst demonstrating his pre
Given in large doses, and with the precautions parations of cholera stools, fc.-Professor Hallier stated that already mentioned, I have not met with any case suggesting the fundamental idea of the whole theory is that "moulds are mere unripe forms of ustilagines." This is a view of schizosporangium or the cholera cyst; but they may prohis own, and is not generally recognised. He believes that bably on investigation be found to occur on the rice plant any fungus of this series may appear under various forms; in India. The schizosporangia of the cholera series are in these forms depending on the nature of the substratum, this climate peculiar to the disease only. They can only be and on the degree to which ripening goes on. If the spores of developed on a nitrogenous basis, and under a high teman ustilago be cultivated, two forms always appear-viz., the perature. Cholera originates under the same conditions in schizosporangic and the cladosporic forins; if the soil on which true cysts can be produced. This may possibly cause which any of these forms appear alters or ferments, the the difference between Asiatic and European cholera—the forms produced are different. He states that each species first being due to the micrococci of the schizosporangia ; and of ustilago has three ripe forms of fructification, and that the second to the micrococci of their unripe representatives, each of these has a corresponding unripe representative, mucor sporangia, as well as to the indigenous ripe form, the use of the unripe form being probably, according to tilletia spores. Professor Hallier, to prepare a more nitrogenised soil on Professor Hallier does not state positively that cholera is which the higher forms may be developed. “If tilletia due to the fungus, and he does not believe that any infeccaries be cultivated on weak, poor soil, we get only unripe tious disease can be caused by spores per se. It is only forms-i.e., moulds make their appearance.'
micrococci that are efficient agents in producing disease. These ripe and unripe forms may be thus tabulated, This may account for the fact that tilletia spores can be and taking as an example the fungus associated with cholera :- constantly are swallowed in large quantities without proUnripe.
ducing any bad effects. They are not retained long enough 1. Macroconidia.
in the intestinal canal to produce micrococcus, and therefore
1. Tilletia caries. 2. Penicillium crustaceum.
pass through quite passively.
2. Cladosporium. 3. Mucor racemosus.
The question of “micrococcus ” being thus introduced, 3. Schizosporangium Professor Hallier stated his views on the subject. He (cholera cyst).
defines micrococcus as “particles of plasma without any The ripe forms are distinguished from the unripe ones by cell-wall.” When these particles acquire such a wall they having a cuticula developed, which makes them much more become either“cryptococcus” or “arthrococcus,” according resistant.
to the nature of the medium in which they are contained. “Macroconidia” is the term which Professor Hallier Micrococcus, on being introduced into a fluid capable of alapplies to dilatations such as occur in mucor racemosus. coholic fermentation, becomes cryptococcus, corresponding He believes that they are unripe forms of fructification, and with the bodies which are generally included under the are capable by a ripening process of becoming tilletia caries vague term “yeast cells.” If, on the other hand, microspores; but in place of ripening they may, unlike the ripe coccus be introduced into a fluid capable of sour fermentaspores, germinate at once. If the soil on which this germi- tion, they become arthrococcus—i.e., they assume an elonnation takes place be sour and poor in nitrogen, penicillous gated form, and become one form of what are commonly forms result-i.e., the unripe representative of the clado- termed bacteria. The term " bacteria," as usually applied, sporium. If, on the other hand, the soil be rich in nitro- includes both arthrococcus and micrococcus, but no idea of gen, mucor forms appear-i.e., the unripe representative of their nature and relations had been attained until Professor the schizosporangium. A schizosporangium is precisely the Hallier discovered that they were merely the ultimate elesame as a mucor sporangium, save that it has a cuticula ments of fungi. developed on its exterior, and that the contained spores are Micrococcus and arthrococcus are multiplied by fission; each provided with a sheath.
cryptococcus cannot be so multiplied, “from the strength The mode of germination in the two forms is quite dis- of its walls and hollowness of its centre,” and it is theretinct. Each spore on a schizosporangium on germinating fore multiplied by gemmation. Micrococcus may be degives origin to a filament, which pierces both the sheath veloped into higher forms in two ways: peculiar to the spore and the wall of the containing capsule, 1. It may acquire a cell-wall, and pass on through the without rupture having taken place. In the mucor sporan- arthrococcal or cryptococcal stage to the formation of a gium, on the contrary, rupture or disappearance of the cap- fully-developed fungus. sule always takes place before germination, as it, being desti- 2. It may under favourable conditions germinate at once, tute of a cuticula, is not strong enough to resist the pressure and give rise to mycelium. of the swelling spores. (See Fig., and compare with Fig. 4 In these views, as well as in those referred to above, in the Halle report.) In Fig. 11, however, the schizosporan- Professor Hallier stands quite alone. gium had ruptured (a). The only form of the series asso. IV. Preparations.
1. Micrococcus. Professor Hallier exhibited numerous FIG. 11.
preparations, some of which he considered proved the development of micrococcus, and others its direct germination. In those showing development the field presented bodies like yeast cells mingled with granular matter; but of
course no preparations could show that they were mere 7 modifications of one another. In those showing germina
tion there were also granules present, but in this case mingled with fine filaments; but one could not see definitely that these were organically connected. And, as generally, fully-developed fungi existed in the same preparations, but one could not feel certain that the filaments were not mere detached portions of these, associated by mere juxtaposition with the granular matter.
Professor Hallier instituted a culture of scarlatina blood in our presence, in order, if possible, to demonstrate this development and germination of micrococcus. The small apparatus already described was used for the purpose. A drop of the blood being placed on a glass slide (the blood having been preserved for about three weeks in a closed test-tube), a little grape-sugar solution was added as a substratum, and a covering glass placed over it, the latter
being separated from the slide by a perforated piece of thin X 250 cardboard, which had been soaked in alcohol. This pre
paration exhibited under the microscope numerous more or
less disintegrated blood-corpuscles, associated with granular a. Schizosporangium. bb. Macroconidia.
matter and numerous minute circular bodies, which Dr. From Dr. Hallier's Preparations of Cholera Stools.) in process of developing into tilletia spores." (Hallier.) Hallier described as being various stages of micrococcus.
(See Fig. 12, c.) However, owing to the short period of our ciated with cholera which is peculiar to the disease is the stay with him, no result whatever was attained.
BRIEF REMARKS ON
a, Small cultivating apparatus.
coccus, and arthrococcus. 2. Illustrative of the relation of moulds and ustilagines. Professor Hallier showed some preparations which, he con- bodies, apparently an aggregation of spores, as figured in sidered, demonstrated the tendency on the part of mucor dilatations (i. e., macroconidia) to ripen into tilletia spores. Hallier speaks
his work termed “ Phytopathology.” In this work Dr. These macroconidia (see Fig. 11) presented a double contour,
the relation existing between these bodies which he ascribed to a tendency to the formation of a cuti and urocystis, judging from their form and method of cula. This condition was quite indistinguishable from the germination. He seems now, however, to have abandoned same appearance produced by the mere shrinking of the this view of the relation of these bodies to urocystis ; neverprotoplasm, as noted at Halle. (See Fig. 5 in that Report.) theless he maintains that they are analogous to cysts found In several of these preparations some tilletia spores un
in cholera evacuations. doubtedly existed, but they were always merely lying among the other materials of the preparations, and their existence in such preparation might have been due to mere accidental entrance into the cultivation. The preparations SOME OF THE FORMS OF DISEASE OBwere chiefly derived from cultivations in the large apparatus; therefore, of course, the separate steps in the deve
SERVED DURING AND SINCE THE LAST lopment were not seen to take place.
UNUSUALLY FINE SUMMER. 3. Preparations illustrative of the tendency of penicillium to form dilatations resembling macroconidia. A great num
BY THOMAS B. PEACOCK, M.D., F.R.C.P., ber of these preparations were exhibited, as, in Professor
PHYSICIAN TO ST. THOMAS'S HOSPITAL, ETC. Hallier's opinion, they prove the identity of mucor and penicillium. (See Figs. 13 & 14.)
The summer which has just passed has been very reFig. 13.
markable for its extreme warmth and dryness, and it might naturally be expected that so unusual a season should exercise an obvious influence on the forms of disease prevalent during its continuance, and since it has been succeeded by cold and wet weather. In this paper I propose to offer brief notes of some of the affections which have fallen under my own observation, prefacing them by some account of the weather, and of the amount and causes of mortality, derived from the Registrar-General's weekly and quarterly returns.
Mr. Glaisher's reports very decidedly show the exceptional character of the season. He states that the first
eleven days of the year were cold, but after that the temX250
perature rose above the average, and continued so through
out the winter, spring, and summer. In the quarter ter4. Rice-plant cultivations. Professor Hallier also showed minating March 31st the exceptions to the excess of heat bis preparations illustrative of the conditio of the rice were few in number and small in amount. Altogether the