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Dublin Journal of Medical and Chemical

Science. January, 1833.A LARGE portion of the present number

is devoted to a paper on the subject of con-genital strangulated inguinal hernia in in-fants, and congenital hernia of the brain,by Mr. Adams, of the Jervis-street Infirm-ary. We will reduce the article to a size

sufficiently portable for carriage to all quar-ters of the world in our own vehicle for thetransmission of medical facts, and afterwardsconcentrate the chief remaining portion ofthe number, into such a compass as ourusual custom, and fair dealing to our con-

temporary, may warrant.

CONGENITAL INGUINAL HERNIA IN AN IN-

FANT, WITH STRANGULATION OF THE

INTESTINE.

Such a case is distinguished by its rarity.POTT, and the Doctor named Gooes, eachsaw a fatal case in their day, and one oc-curred, years since, in St. Bartholomew’s,which was relieved by operation. The casenow added to the number by Mr. ADAMS,establishes, in his mind, the fact that thereis nothing in the nature of the hernia, norin the age of the patient, which should staythe hand of the operator who has failed inall but the last attempt at relief,-that oi

the knife.The circumstance demands to be noted,

that constipation and vomiting in infants

may only be. symptoms of hernial stran-

gulation which has escaped the vigilanceof the medical attendant. In the followingcase, seen by Mr. ADAMS, the real cause ofthese symptoms had existed unobserved fortwo days. An operation then seemed im-perative, and such it ultimately proved tobe. The child (W. Furlong), aged 18

months, was admitted to the infirmary onthe evening of March 18th. Abundant

diagnosis was made, and treatment adopted,previous to the operation. The cavity beingexposed, the strangulated portion of intes-tine was discovered in immediate contact

with the testis."It was about the size of the largest

cherry, with a polished surface, remarkablytense to the touch, and of a deep maroneshade, a colour which was strikingly con-trasted with the aspect of the epididymisand the brilliant azure hue of the testis.

The stricture was remarkably tight. Guidedby the nail of the index finger of the left-hand, a small blunt-pointed bistoury wasinsinuated, and a slight division of thastricture having been made upwards andinwards, the intestine was returned into thecavity of the abdomen ; and, lastly, the lipsof the wound were united by three stitches.It was deemed imprudent to give any medi.cine by mouth; an anodyne liniment wastherefore applied to the abdomen : the childslept soundly for three hours after the ope-ration, and on awakening, discharged aquantity of flatus and fseces."

Recovery speedily followed, a truss wasdirected to be worn, and a radical cure is

reasonably expected by the surgeon.

CONGENITAL HERNIA OF THE BRAIN.

Describing this species of hernia underthe term " Congenital Encephalocele," Mr.ADAMS says he has, rare as the affection

may be considered, met with five cases ofit within a few late years. Two are yetalive, and of their progress he has notes.The subject induces him to advise greatcaution in the diagnosis of tumours of thecranium, lest surgeons, so hasty or clumsyas hardly in general practice to have anyexistence, should proceed to slice them offwith as little ceremony as they would carveaway a wen. Such things have been in thehospitals of Paris, where candid records aresometimes made, and may have been inthose of London, where candid records arethings unknown. Respecting the symp-toms of the « congenital encephalocele" Alr.ADAMS says --" In all the cases I have seen they have

been well marked, and the diagnosis easy." From whatever part of the contour of

the cranium the tumour which constitutesthe hernia projects, it is of an oval or

spheroidal form, soft and colourless. It isattended with pulsations synchronous withthose of the heart. These pulsations, whenthe patient is at rest, are sometimes indis-tinct, but are rendered very manifest bothto sight and touch on the slightest exercise.The patient, when old enough to be ableto give us an account of himself, says henever feels any pain in the tumour ; if aninfant, he seems to suffer no uneasiness,even when the swelling is subjected to gen-tle pressure. The size of tuis tumour is

momentarily augmented by the efforts of

coughing, sneezing, or even crying ; duringany respiratory effort, a blush or redness isseen rapidly to pass over it, through theskin, which is generally thin, and semi-

470

transparent where it covers the hernia. Oncarefully applying the fingers around thebase of the tumour, theborders of the open-ing in the cranium, through which it has

escaped, are easily felt ; sometimes theseborders are smooth and even ; but I have inone case found them offering rough andelevated edges. The intellectual facultiesin all the cases I have witnessed, at a periodof life when these could be estimated, re-mained entirely unimpaired."But we must not, in all cases, expect to Ifind these characters by any means so

i

clearly developed. IMany judicious observations, derived

from Mr. ADAMS’ experience, follow, re-

lative to situation, contents of tumour, itssimilarity to spina bifida, the dangerousnature of the hernia from over-distentionand ulceration of the hernial sac, its anato-

mical characters, causes, and treatment.On this latter topic, Mr. Adams says,

he has no confidence in the propositions ofthose who have preceded him. Pressure,no matter how modified, he has ever foundinapplicable in any stage. Of the attemptto cure by puncture, he speaks favourablyas a means of preventing worse conse-

quences (deriving his first views of its pro-priety from the occasional success of thatprocess in spina bifida), in spite of the con-demnations it has received on the continent.In his own experience it has been both asafe and successful means of letting- out

fluid contents:’ To a combination of pres-sure with puncture he objects, and on goodground. " In one case," he observes," after the evacuation of the fluid by apuncture of the hernial sac, I tried theeffect of pressure methodically applied bystraps of simple soap plaster and a lightbandage ; but in this case convulsions setin, and the bandage and plaster, as may besupposed, were speedily removed, never tobe renewed."

The author, in a few lines, records onecase of "congenital encephalocele," whichhe witnessed, wherein a small punctureallowed a considerable quantity of limpid

* " I would not wish to be understood to recom-mend the surgeon to have recourse to the operationabove alluded to in every case of congenital ence-phalocele. Occasionally he may meet with cases ofthis complaint where the tumour seems quite in-doleut, and composed of nothing but the brain andits membranes, m a healthy condition, and the m-teguments covering it of the natural colour and con-sistence. Of course, in such cases as this, it mightbe justifiable to make a tair trial of pressuie, butanv more active interference would be uuwar-

rantalile.11

serum to exude, the infant emerging there.upon from a state of stupor; but death en.sued, after a relapse, in nine days. He

closes his paper with a successful. case,which we abridge as follows:-

I will now conclude by giving a de.tailed account of a case, which shall be thesecond on record in which frequently punc.turing the tumour, and evacuating its fluidcontents, has been extended to the conge-nital encephalocele ; and the first, as far asI know, in which this practice has been at-tended with success.

A. B., aged six years, is a healthy-looking little girl, of a muscular frame ; thehead, to the centre of the occipital region,is remarkably well-shaped; but a little be-.low the tuberosity of the occipital bone isI a tumour, about the size of a hen-eg’g,placed transversely; it stands out, but isinclined downwards and backwards towardsthe neck; at first view, it would give theidea that a common wen had originatedhere ; but a closer examination teaches, thatthe tumour has a pulsatory motion in it,synchronous with the beatings of the heart;that it is influenced and increased even insize by coughing and sneezing. It commu-nicates to the hand a soft, woolly feel, andgentle pressure does not give uneasiness.The edges of the opening in the occipitalbone are easily felt through the integuments.The skin enveloping the tumour is thinnerin some parts than in others, and somewhattransparent. The whole surface of thehernia has an uneven aspect, just as if theconvolutions of the brain caused these in-

equalities ; and that the two postarior lobesof the cerebrum form the chief bulk of theprotrusion, seems evident, from the positionof the tumour, and the even, vertical de-

pression, which divides it into two equallateral portions. The head is otherwisecomplete in its form; the fontanelles havebeen lonff since completely closed.At birth the tumour was as large as at

present. The skin, however, was redder,more transparent, and in many points sothin, that it appeared ready to burst andgive exit to a pellucid fluid which it evi-

dently contained. In a word, it possessedall the characters of the tumour so oftenseen in the lumbar region, called spina bi-fida. The child was healthy, but the prog-nosis given was unfavourable, as we muchdreaded that the watery fluid the swellingcontained would soon make its exit by anulcerated opening in the integuments. Asthe spontaneous bursting of the distendedsac at the thinnest part of the tumour seemedinevitable, if it were left to nature, it wasagreed that it would be more prudent tomake 11 timely puncture, by means of a

small needle, into that part of the tumouri

471

which was covered by the thickest andsoundest integument, a part of the skin mostlikely to heal.

11 This was accordingly done, and abouthalf an ounce of clear fluid escaped ; the sacnow became flaccid, and a tumour, the sizeof a walnut, evidently formed by the poste-rior lobes of the cerebrum, was found toform the principal part of the protrusion ;the small wound was carefully dressed, andthe child kept perfectly quiet. No un-

pleasant symptom whatever followed thistrivial operation. The next day, however,to our mortification, the tumour was just astense and shining as before, and after a fewdays, the puncture was again repeated, andwith a similar result. In short, this littleoperation was performed on this child seventimes with a fine needle, and once only witha lancet, and on this occasion alone did theoperation itself seem to be followed withany fever or unusual restlessness in the in-fant. Once, however, after the effectualevacuation of the swelling by a simplepuncture, it was deemed prudent to give afair trial to the effects of pressure, whichhad been so much extolled by Salleneuve.On this occasion pressure was effected bymeans of adhesive straps of soap and dia-chylon plaster, and a tight bandage ; butconvulsions came on in the night, and band-ages and pressure were then removed, andwere never afterwards reapplied.

" Under the simple treatment by punc-ture, the limpid fluid was frequently eva-cuated, the skin gradually became thickerand better able to support the distendingforce of the fluid, and as the child grewolder, and the brain became consequentlyfirmer, and its membranes less disposed towatery secretion, the intervals at which itbecame necessary to resort to the operationof puncturing, became longer; finally, thequantity of water was so trifling, that theoperation became no longer necessary. Thebulk of the hernia, however, was not di-minished by the disappearance of the fluid,for the solid part of the tumour was formedof the brain itself, and probably a smallportion of the cerebellum remained behind.

" Mr. Colles and I have examined thischild within these few days ; its bony andmuscular frame are well developed; it is

remarkably intelligent, and all its functionsare performed with regularity."

Mr. KANE thinks that the chemical factswhich occur to analysts are not recordedwith sufficient frequency. Their importance,or application, may not be palpable to theinvestigator at the moment, but in otherhands might prove in a high degree valu-

able. He accordingly here sets the ex-

ample of making public a few notes fromhis memorandum book, as the precursors ofa series. We quote from one of then%.

COMPOSITION OF THE BLOOD IN JAUNDICE.

A specimen taken from a woman yieldedthe following quantitative results :-" Water...................... 762-28Albumen...................... 71’4Fibrine ...................... 2-8

Hematosine .................. 126-7

Phosphuretted Fat.........Oily matter and yellow colouring 2’0

matter ....................Salts, loss, &c................. 3482

1000-00

" This analysis fully confirms the resultof Lecanu as to the existence, in the bloodof jaundiced patients, of the yellow colour.ing matter of the bile, and also as to theabsence of the cholesterine. In conse-

quence of this latter principle being often aconstituent, in minute proportion, of healthyblood, I sought for it carefully, but couldnot detect any trace of it. My results, how-ever, differ in an important relation fromthose of Lecanu; he found that the quan-tity of colouring matter was less than inhealth ; in the foregoing analysis it is verynearly the exact healthy average. I amnot inclined to attribute great importance tothe difference between our results in this

respect. as the quantity of that principlevaries in health between limits extendingbeyond both."

THE paper by Mr. KANE contains fiveother articles, one only of which we shallhere have room to notice, that which re-

lates to the late

DISCOVERY OF THE IODIDES OP

PLATINUM, &C.,and in our account of which we shall pro-

bably furnish some particulars to the excel.lent chemist of the Dubliii Journal, froma foreign contemporary, which are as yetnew to the capital of the sister island.Claimants to the discoveries referred to inthis paper, exist in the persons of M. LAS-SAIGNE and Mr. KANE. In the Octobernumber of the Journal de Chimie, M. Las-saigne briefly announced, in an abstract

from a letter sent to the Academy of Sci.ences, his discovery of the iodides of pla-tinum, and the various saline combinationsinto which one of them enters. A per-

472

feet memoir on the subject has, since our’last LANCET went to press, been publishedby M. Lassaigne in the Journal, de ChimieMedicale, for Dec. 1832, or rather Jan.1833 (published in Paris, Dec. 28th last),in which periodical it stands the firstar-,ticle. The essay is one of very great in-terest, and we shall therefore give in this,place a summary of its contents. ;

In this essay on the iodurets of platinumand the double compounds which they arecapable of forming with the basic iodurets,the hydriodic acid, and the hydriodate ofammonia, Lassaigne examines, first, whe-ther iodine is, like chlorine, susceptible ofvarious combinations with platinum, andwhether those combinations correspond with

’ the chlorurets of that metal. The chlorurets

of platinum are two in number: the deuto-chloruret, a compound long familiar to

chemists, and which M. Lassaigne hasfound to possess the property of evolvingchlorine when heated, and thus being con-verted into the proto-chloruret. The deuto-ioduret of platinum, again, is readily pre-pared by adding a solution of the hydriodateof potash to a solution of the bi-chloride ofplatinum, when a dark-brown powder isformed, possessed of many properties analo-gous to those of the bi-chloride of mercury,especially its solubility in alcohol and

ether. To form the proto-ioduret of plati-num was the next problem to be determined.Numerous unsuccessful essays were madeto this effect. In vain was the deuto-ioduret exposed to heat, treated with sul-

phurous acid, and several metallic proto-iodurets. It still remained undecomposed.At length, however, M. Lassaigne’s effortswere effectual. Having prepared, with

great care, a pure proto-chloruret of plati-num, by heating the bi-chloride geutly in aporcelain capsule, by washing the residuumwith alcohol, and, finally, by analysing theproduct thus obtained, M. Lassaigne pour-ed on it a concentrated solution of llydri-odate of potash. No action took place inthe cold ; but by heating the mixture for aquarter of an hour, decomposition graduallytook place, and a black powder was pre-cipitated, which, when analysed, was foundto contain precisely one half the quantityof iodine that exists in the deuto-ioduret of

platinum.The properties of this pToto-ioduret are

striking. Its aspect is that of a very fineblack powder ; free from taste and smelt,insoluble in. water and alcohol, and un-alterable by exposure to the air. When

heated, it is resolved into its elements.

The nitric, sulphuric, and hydrochloricacids, have no action on it at any tempera-ture. Solutions of caustic potash, oi’ soda,decompose it by transforming it into protooxide of platinum. Ammonia converts it

into a greenish substance composed of

protoxide of platinum, ioduret of platinum,and hydriodate of ammonia.

Finally, on ultimate analysis, this proto-ioduret is found to consist of iodine 56.05 ;platinum 43.95. The action of the basiciodurets on the iodurets of platinum, pre-sents several very interesting circumstances.With many of them the bi-ioduret producesa double salt. Thus, when allowed to re-main some time in contact with the solutionsof hydriodate of potash, soda, baryta, zinc,or iron, a part of the ioduret of platinum isdissolved, and a corresponding quantity ofdouble ioduret is formed.

Referring to the notification of these dis.coveries made by M. Lassaigne in the Oc.tober number of the French Journal, Mr.Kane points attention, in the January num-ber of the Dublin Journal, to a paper pub-lished by him (Mr. K.) in the July numberof that work, on the iodide of platinum, andits saline combinations, , in which," to

quote his own words on the present occa-sion, " he described that substance at length,developed the history of the compounds itforms with the iodides of the basic metals,and enumerated all the important facts inits history." After noticing a slight differ-ence which exists between himself and theFrench chemist, as to the composition ofthe per-iodide of platinum, and congratulat-ing himself that " so eminent a chemist asLassaigne has fully established the accuracyof his (Mr. K.’s) investigations, " Mr. Kaneadds, that his paper was read to the IrishAcademy in June 1832, and published inJuly, while that of M. Lassaigne was pub-licly read only on the 17th of Septemberfollowing, and ‘° that it is thus evident thatLassaigne has been anticipated in these re-searches," though without, evidently, beingaware of the fact.We have not room in our present number

either to pursue the subject farther, or to

473

give an analysis of the remaining articlesin our contemporary. For the following’important fact, however, relative to the che-mical action fif the magneto-electric current,we must at once find space. Mr. Kane an-

nounces, at page 397, that he has, after

many unsuccessful trials, succeeded in ef-

fecting the decomposition of water, by meansof the current of electricity induced in aconductor by the action of a magnet. Theform of apparatus used for generating thecurrent, was the disk revolving rapidly be-tween the poles of a magnet.

THE LANCET.

London, Saturday, January 5, 1833.

REPORT ON THE CHOLERA IN QUEBEC.

THE permanent Committee of the Facultyof Medicine in Quebec has published a re-’port of the results of its inquiry into the’measures pursued by the Board of Healthin that city. From the information fur-

nished to the committee by the medical prac-titioners, it would seem to be the unani-

mous opinion of the profession in Quebec,that the pestilence which has desolated thatprovince is identical with the terrible ma-

lady which has prevailed so destructively inseveral parts of Europe.

Although, as the report affirms, it has

been impossible to obtain an accurate ac-count of the number of deaths, yet the com-mittee have felt no hesitation in assertingthat upwards of three thousand have fallenvictims to the pestilence.

Defective as were the arrangements of

the majority of the Boards of Health in thiscountry, it would appear that they werespecimens, indeed, of correct contrivancewhen contrasted with the measures adoptedby the Board of Health in Quebec. If com-

plaints have been urged by the professionof this country against parochial officers andother officious personages thrusting them-selves into committees whose duties in-

volved the preservation of the public health,still they have not had to incur threats of

prosecution and loss of practice consequenton what may be termed a venial non-oom-

pliance with the provisions of the law. Butprosecutions have not been threatened onlyin Quebec, having been actually institutedagainst some most respectable practitionersfor not conforming to orders, in cases whereconformity was next to impossible.The committee justly complain, that while

the members of the profession generallywere employing the most unremitting exer-tions to protect the public from the ravagesof the pestilence, the Board of Health didnot employ any means for purifying, cleans-ing, or fumigating those houses in whichcholera was reported to have existed pre-viously to the 20th of August. In one in-

stance, however, a medical practitioner ofexperience observes, that he did " once

meet a health-warden going through his pro.cess of disinfection-the preventive adoptedby the Board-that of sprinkling the floorsof the house with a solution of chloride of

lime ;"-and in another instance, greateractivity was observed: " The Board causedthe tenants of an infected house to be turned

out of doors on a rainy morning about 9 a.m.- the floors to be scraped and rubbed,and the walls whitewashed. They werethen allowed, at five p. m., to resume pos-session of their wet apartments,—theirpersons and eifecta having undergone re-

peated ablutions from the rain during the

day." The Report adds, that, " subse-

quently, sickfiess and death occurred in boththese houses."-On reading this account,we are almost forced to believe, that the

splendid band of wiseacres headed by thelearned and astute Sir HENRY HAI.FORD,had been practising its peculiar fooleriesand vagaries in the Province of Quebec.The principle upon which the quarantine

law was framed, and on which the Board

professed to act, was, that Cholera is a con.tagious disease. But, inquires the per.manent Committee of the Faculty of llIedi-

cine, " Did the Board of Health, oi its