576

dreaded the occurrence of haemorrhage at such times. Didchloroform cause a similar excitement?

Dr. SNOw considered the excitement to arise from the slow-ness with which ether was administered, which might benecessary or not, as the patient could bear it; the chloroform,by its more rapid action, would not cause this so much, butthe return to consciousness, after taking it, presented thesame symptoms as were exhibited after the use of ether. Heconsidered that two practitioners should be present in a caseof labour if inhalation were to be practised, as one person’sattention should be devoted to the inhalation only. Patientswould not die from convulsions while inhaling, but from con-tinuing to inhale after collapse had appeared.

Dr. MURPHY had known ether to cause spasms resemblingthe access of puerperal convulsions.

Dr. COLEY read a paperON DIPHTHERITE.

He was called, on October the 16th, to a child, aged oneyear and ten months, who was breathing with great difficultyfrom an effusion of a foetid false membrane over the fauces;this attack followed a sore throat, subsequent to measles, whichhad suddenly retired. Dr. Coley applied nitric acid to thefalse membrane over the fauces, and shortly afterwards, thebreathing being more difficult, and stertor commencing,tracheotomy was performed with immediate relief; the childwas also ordered a grain of calomel every two hours. On Oct.20th the fauces were found quite free from false membranes,and the breathing continued easy, but was rendered difficultagain by withdrawing the canula the next day and closing thewound by a bandage. The calomel was discontinued thatevening; the child sunk into a state of exhaustion, which in-creased, notwithstanding the administration of ammonia, bark,and wine, and the child expired on the evening of the 22nd.The examination of the body showed an entire absence of in-flammation, but there was effusion into the pleura and peri-cardium. The child took about twenty-four grains of calomelin all. He considered the little patient to have died fromexhaustion. The discussion of the case principally turnedupon the advisability of giving calomel in such large quantitiesto young children; some gentlemen objected strongly to it,while others considered the plan as most useful.Mr. HIRD had found great benefit in cases of low inflamma-

tion from the use of alkalies, as liquor potassaej he approvedof tracheotomy as superior to laryngotomy, and its perform-ance by the knife rather than by a trocar.

Dr. WEBSTER said that at the Congres Sciéntifique in Paris,this summer, M. Bretonneau spoke highly of the use ofhydrochloric acid in this disease, also of alum applied locally.He recommended calomel, in the same way as it was exhi-bited by Dr. Coley.

Dr. COLEY had performed tracheotomy several times inthe country, but, from a prejudice against it, it had been post-poned till a late period. He had found it very unsuccessfulfrom previous extension of the disease to the lungs.

Dr. MuRPHY observed that these cases generally occurredin persons of very reduced constitutions, and asked whattreatment would prevent it. He thought the operationincreased the risk of the child. The case was of an erysipe-latous nature, and he should suppose the treatment oughtto be bark and wine.

Dr. WEBSTER considered that calomel might be given inlarge doses in dry weather, but in warm weather, with a south-west wind, and the barometer low, the child would not bearso much.

Dr. AYRES considered that children bore large single dosesof calomel well, but not repeated doses. Salivation diminishedthe amount of fibrine in the blood; hence, probably, its influ-ence on these diseases.Dr. COLEY said that a second case of diphtherite occurred in

the same family, which was cured by a smaller amount ofcalomel, about fourteen or fifteen grains, he supposed; thiscase was treated early in its course. In answer to a question,he said, that he did not give tartar emetic, as the child was notequal to bear it.Mr. HIRD said, that diphtherite was epidemic at present.

It was a disease allied to erysipelas. He objected to calomel,as not controlling disease of mucous membranes so much asthose of other tissues.

Dr. KING mentioned having given calomel in one-scrupledoses in cases of cholera, at Bilston, in 1832, with great advan-tage. Some patients took two or three ounces, and recovered.A All,,1113ER stated that the same good effect had not followed

_ similar use of calomel during the cholera in Ireland ; on the

contrary, large doses appeared to be injurious.

British and American Medical Journals.SINGULAR MALFORMATION OF THE UTERUS; SPONTANEOUS RUPTURE

IN THE EARLY MONTHS OF PREGNANCY.

The following is an outline of the facts of this singular case,466pied by a cotemporary from the Buffalo Medical Journal : -

" A girl, seventeen years of age, was seized with colic-likepains, and died soon after. She had previously enjoyed goodhealth, and had menstruated regularly until three monthsbefore the attack."On post-mortem examination the following appearances

were observed:-The cavity of the abdomen was filled withcoagulated blood, surrounding a fostus of the third or fourthmonth. The uterus was ruptured along its right side, fromthe fundus to near the neck. The left ovary and Fallopiantube were entirely wanting. The right ovary and Fallopiantube were present, but the latter entered the uterus near theneck, and the ovary was correspondingly lower than natural."The uterus appeared to be developed to the size of the

third or fourth month of gestation. The placenta was attachednear the fundus upon the left side. On the side of the uteruswhere the rupture occurred, the walls of the organ were ex-tremely thin. At the seat of the rupture there seemed to benothing but the peritonaeum; and in the immediate neigh-bourhood the friability was such that it was readily torn bythe fingers with slight force. On the left side, the walls wereof the usual thickness, but did not present the common fibrousappearance. 0;! exmnÙzat1"on of the neck, no apedure could befound, nor was there any trace of an os tizzcce. The neck re-sembled a tendon in appearance, but was of less deusity. ’1’7I(’1’ewas no commum’cation between the cavity of the uterus and the1’agina."

ON IRRITABLE ULCER OF THE RECTUM, AND ITS TREATMENT.

Mr. B. COOPER, in a lecture in the }’Iedical Gazette, describesvery clearly this painful form of disease-painful to the

patient, and sometimes not less so by its obstinacy to thepractitioner. Speaking of irritable ulcer, he says,-

" Such a condition of ulcer not unfrequently attacks therectum, under the form of a narrow elongated fissure runningalong one of the folds of the mucous membrane, near to theorifice of the anus. The edges of the fissure are free fromany callosity, and it bears a strong resemblance to the crackswhich frequently affect the lips."The most usual situation for the ulcer, as far as my expe-

rience goes, is at the posterior aspect of the rectum in themesial line, although 1 have sometimes found it on the sideof the bowel. The ulcer may involve merely the edge of theverge of the anus, or extend a considerable way up the intes-tine, but may always be detected by passing the finger intothe rectum, when the nature of the sore is readily appreciatedby the extreme pain which the patient experiences directlythe finger comes in contact with the fissure." The symptoms of the disease are highly characteristic: a

burning pain is experienced during the act of defalcation,which continues for a considerable time after each evacua-tion. During the intervals the patient enjoys comparativeease, but still occasionally suffers from heat and lancinatingpain about the anus, but nothing to be compared to the agonyproduced by the passage of the faeces over the ulcerated Sur-face and through the sphincter, and which is commonly moreor less in a state of spasmodic contraction." The bowels are in these cases generally constipated; now

this symptom involves the question as to whether this consti-pation is not produced rather by the unwillingness of thepatient to evacuate his bowels than from any derangement offunction ? The best, and, indeed, the only positive, evidenceof this disease, is the introduction of the finger into therectum, which, on being withdrawo, will be marked with astreak of blood, and lead to the discovery of the size and posi-tion of the ulcer.

" If the disease be allowed to remain for any considerabletime, the patient’s health becomes seriously affected by theconstant suffering, and from the countenaice one might sup-pose that the disease was of a malignant character. The

digestive functions become deranged; the appetite fails; theslightest exertion, such as the act of coughing or blowing thenose, is sufficient to excite the pain; and any excess of diet is

sure to aggravate all the symptoms.

I " Although this distressing affection will not yield to theremedies recommended in irritable ulcers in other parts ofthe body, its treatment is fortunately very simple. It con-

577sists in passing the forefinger of the left hand up to the ulcer,and directing along it a straight probe-pointed bistoury beyondthe very extremity of the fissure; then, turning the cuttingedge towards the sore, you divide the ulcerated surface, aswell as the fibres of the sphincter muscle, which are connectedto its submucous aspects."This procedure is usually sufficient; but if there be any

reason to believe that suppuration has taken place in the cel-lular membrane beneath, the incision should be continued soas to divide the verge of the anus, and thus insure a free exitfor the matter."In the after-treatment, I strongly recommend (when the

patient has recovered the effects of the operation) that he bedirected to acquire the habit of evacuating the bowels at bed-time, instead of in the morning, so as to secure the six oreight hours’ subsequent recumbent posture, and the certainreceding of the rectum into the pelvis, which does not occurin a diseased state of this bowel if the patient follows hisdaily avocations immediately after the act of defalcation.This disease I have certainly found more frequent in femalesthan in males, and to prevail rather in the higher than in thehumbler classes of life.

" It is to Mr. Copeland that I am indebted for a knowledgeof this disease, as well as for the operation, which I believe Imay describe as almost infallible as a means of cure :’

The last number of the Edinburg7b.Afont7ilyTournal containsa communication of some interest ’

ON THE MORBID ANATOMY OF TYPHUS FEVER,made to the Medico-Chirurgical Society of that city, by Dr.HuGHES BENNETT. The following is an abstract of the prin-cipal facts referred to by the author :-" Until the commencement of the present session, cases of

intestinal lesion in typhus fever have been exceedingly rare.For the three years previous to the present session, the authoracted as pathologist to the Royal Infirmary, during whichperiod he examined upwards of 500 individuals who had diedof this disease, and had only met with ulceration three times :but since November, it had become more frequent."The cases of fever admitted into the Royal Infirmary from

the 1st of November, 1846, to the 30th of June, 1847, amountedto 2071. Of these, 278 died, and sixty-three had been in-spected after death. It was upon these data that the follow-ing statements were founded."The organ most frequently affected was the spleen. In

the majority of cases it was more or less enlarged andsoftened, presenting a mahogany-brown colour and creamyconsistence. In ten cases, the spleen contained one or moreinfiltrated masses of typhous deposit, of a yellowish or

brownish-yellow colour. In two cases, the deposit hadsoftened and burst into the peritonarum, causing fatal peri-tonitis."The organs affected next in frequency, after the spleen,

were the lungs. The most common lesion was bronchitis, thebronchial lining membrane being of a deep mahogany orpurple colour, more or less infiltrated with serum or exuda-tion. The fine bronchial tubes were frequently filled with amuco-purulent matter, more or less fluid, and in a few caseschoked up with a reddish-brown creamy substance, probablya modified form of the exudation (typhous deposit) describedby Remak. The apices of the lungs were very commonlyosdematous, yielding on section a copious greyish, frothy fluid.In fifteen cases, the lungs were more or less consolidated byexudation, which seldom presented the characters of normalhepatization. It was sometimes of a dirty-yellow tint, atothers of a brownish-chocolate colour, existing in masses ofirregular outline and of variable size, resembling the typhousdeposit previously spoken of, occasionally found in the spleen.In three cases there was pulmonary apoplexy."The intestines presented, in nineteen cases, the lesion

described by Bretonneau, Louis, Cruveilhier, and others,(dothincnteritis, typhoid ulcer.) The elevated patches hadbeen observed occasionally to extend as high as the duo-denum, and as low as the rectum. In one case, numerousdothinenteritic elevations, about the size and shape of a splitpea, extended all over the ascending and transverse colon. Ina few cases, the isolated follicles in the large intestines wereobserved swollen and empty, presenting in their centre a dark-blue or black spot. In others, the round and oval patches ofthe small intestine were hypertrophied, elevated above themucous membrane, and of a greyish or slate colour. Perfora-tion of the intestine, causing fatal peritonitis, had occurred inthree cases. Dysentery, with flakes of lymph attached to themucous membrane Qve’r the ascending and transverse colon

was associated with intense dothinenteritis in one case. Ovaland round cicatrices, exhibiting different stages of the healingprocess of the intestinal typhous ulcer, were observed in twocases.

"In all the cases where the intestinal ulcerations wererecent, the mesenteric glands were enlarged, soft, and friable,and of a greyish or reddish-purple colour. Some of theseglands reached the size of a hen’s egg. On section, they pre-sented a finely granular surface, of a dirty yellow-greyish ordark fawn colour, produced by infiltration of the typhousdeposit, which was generally soft and friable, but sometimesin one or more parts of the swollen gland, broken down witha fluid of creamy consistence.

" In two cases, there were glossitis and laryngitis, with ton-sillitis ; in one case, abscess in the kidney; and in one, anabscess in the posterior mediastinum."The brain did not appear to participate much in the dis-

ease. It presented only occasional congestion, with slighteffusion into the sub-arachnoid cavity, or into the lateral ven-tricles.

" The blood, in the great majority of cases, was fluid, and ofa dirty-brownish colour. In those instances, however, wherethe disease had been protracted, and especially in such aspresented well-marked typhous deposit, firm coagula werefound in the heart and large vessels.

" In seven cases, no lesion whatever could be discovered." The typhous deposit consists of a yellowish or flesh-

coloured exudation, sometimes passing into a brownish colour,from the admixture of more or less blood. When first formedit is of tolerably firm consistence, as in the spleen and glandsof the mesentery and intestines, but rapidly undergoes theprocess of softening. In parenchymatous organs, it may beslowly absorbed or resolved, as in the lungs, spleen, andmesenteric glands; or it may produce ulceration or gangrene.In either case, should the individual recover, cicatrices, with.puckerings in the tissue are produced, the parenchymaaround the deposit having contracted and become indurated.On mucous membranes, the deposit is thrown off in the formof slough, and discharged by the excretory passages, leaving a-characteristic round or oval-shaped ulcer. This process maybe followed by cicatrization or perforation of the gut byulceration. In the former case, it leaves a round or oval-shaped depression in the mucous membrane, often of a bluecolour, which subsequently becomes covered with epithelium:in the latter case, it produces death by peritonitis."The minute structure of the typhous deposit varies in

different situations. In the lungs, spleen, and intestinal canal,it contains, at an early stage, a number of roundish or irre-gularly shaped corpuscles. They are about the two of a milli.-metre in diameter, contain several granules, with a nucleusabout the 5)Q of a millimetre in diameter Acetic acid rendersthem more transparent. They are conjoined with numerousgranules and molecules, which become more abundant as theprocess of softening advances. In the mesenteric glands, ahigher degree of cell formation takes place. Cells are formed,about the i!û of a millimetre in diameter, containing from twoto six, and sometimes even more, nuclei, which become verydistinct, with thick edges, on the addition of acetic acid, whilstthe cell wall is partially dissolved. The same cells may occa--sionally be seen in the elevated typhous deposits of theintestinal glands. Sometimes, the only appearance observablein the deposit is that of numerous molecules and granules;mixed with blood corpuscles.

" Dr. Bennett considered that the pathology of this affectionconsisted in a primary alteration of the blood produced by the-peculiar miasm or poison causing typhus fever; that under-

such circumstances, local inflammations were set up in par--ticular organs; and that the exudation attending it, instead ofpresenting the usual appearances, and undergoing the usualtransformations, became modified so as to constitute thetyphous deposits."These observations are accurate and very useful, as tending

to elucidate the obscure pathology of typhus. There is no

evidence, however, yet to show that the deposit takes placeas the result of local inflammation. Morbid matter, beyondquestion, exists in the blood; this, by its presence, may exciteinflammation, and be deposited where this condition exists;or it may be, and is, deposited quite independently of any suchcondition, as we find tubercle, cancer, and similar matters.The deposition seems to be an effort of the system to get ridof the noxious matter. But why this accumulation is foundin one case and not in another, remains, with other questions1

a subject for further investigation.