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decided that the necessity for holding the needle at a distancebeyond that usually required by a person of the p. tient’s age,was not due to mere " presbyopia" or long sight, the kind ofdefective vision incidental to advancing life, but literally to aloss of focal adjustment, a very common accompaniment of"asthenopia." The necessity of a proper discrimination of theaffection must be apparent, and, as a rule, any surgeon who isaware of the nature of its symptoms will readily detect it; butthis is not always the case, and on a future occasion we propose to give a series of cases, with some of the more ordinarycomplications that attend it.We have been induced to select the present example, because

the treatment prescribed was adopted, and was beneficial.The hospital formula for iron, which is merely the sulphate insolution, was prescribed, and the girl’s mother was prevailedon to change her daughter’s description of work to that whichwas less trying to the eyes-namely, the making of coarsegarments of white or light-coloured materials. Besides, sheceased to work by artificial light; exercise was taken daily;the spectacles were discontinued. In six weeks from the com-mencement of this plan, the patient’s whole appearance wasdifferent, and she said that her eyes hardly troubled her. A

systematic temporary rest of the sight was enjoined. It is anessential adjunct in the treatment, and as Mr. Tyrrell intro-duced it, we give him the credit he deserves. In his remarkson the affection which is considered under the head of

"Temporary Congestion of the Choroid," after a system oftreatment in accordance with his idea of the disease, includingbloodletting, irritation, mercury, &c., he writes more

judiciously, -"Supposing a patient could work for an hour, but not

longer, without producing disturbance of vision, he should thenbe directed to work only for half an hour at a time, and toobtain intervals of rest of a quarter of an hour each. He canthus work for two-thirds ot his usual time, while his cureproceeds. The period to be employed at work, and the in-tervals of rest, should be regulated by the character of theaffection: as a principle, it may be stated, that the periodallowed for the employment should be short of that in whichapplication produces the disturbance of vision; and the timedevoted for resting the eyes should never be less than a quarterof an hour."

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, JUNE 24TH, 1856.MR. CÆSAR HAWKINS, PRESIDENT.

TWO CASES OF MALFORMATION OF THE HEART.

BY HANNOTTE VERNON, M.D.

(Communicated by SPENCER SMITH, Hon. Sec.)THE first of these cases was that of a child, which exhibited

hardly any indications of life for several minutes after birth.It ultimately respired freely, but gradually became blue, andabout an hour after birth relapsed into its usual feebleness; thepulse became weaker, slower, and intermittent, and two mur-murs, corresponding with the first and second sounds of theheart, were heard. The child died four hours and a half afterbirth, having been previously convulsed. On examination,the septum of the auricles was found imperforate, there beingonly an oval depression in the site of the foramen ovale. The

tricuspid valve was incompetent, forming only a festooneddiaphragm between the auricle and ventricle. The right ven-tricle gave origin to two vessels-one the pulmonary artery,which had no communication with the aorta; the other theaorta itself, and the septum of the ventricles was deficient atthe base. The pulmonary artery was smaller in calibre thanusual. The left auricle was small, and the lungs very imper-fectly inflated. The author remarked that the peculiarity ofthe circulation before birth in this case was, that in conse-quence of the imperforation of the septum of the auricles, thehead and upper extremities received blood of similar qualityto that transmitted to the trunk and lower extremities. Afterbirth there were-1st, regurgitation from tricuspid incom-petency ; 2ndly, admixture in the aorta of venous and arterialblood, from imperfection of the septum ventriculorum; and3rdly, deficient supply of blood to the lungs, from narrowing

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of the pulmonary artery and propulsion of venous blood intothe aorta.CASE 2.-In this case the child died eight days after birth.

After having presented nothing unusual, it was suddenlyseized with difficulty of breathing, became livid, and diedconvulsed. The septum of the auricles was found to be veryimperfect. The left auricle was very small, received only twopulmonary veins, and had no communication with any othercavity than the right auricle, to which indeed it formed a merediverticulum. The ventricular portion of the heart was single,and did not present any appearance of a septum. It gaveorigin to a single vessel, much larger than the aorta generally,from which two pulmonary branches were first given off. Atthe commencement of the arch a third vessel arose, whichshortly divided into the innominata and left carotid and sub-clavian arteries. The aorta then pursued its usual course.A small vessel arose from the innominate artery, which, afterproceeding some distance towards the heart, became imper-forate. The lungs were very imperfectly expanded. Theauthor remarked that the course of the circulation before andafter birth would appear in this case to have been the same.In consequence of the non-communication of the left auriclewith the ventricular cavity, the right auricle was the recipientof aerated blood, whether from the lungs or placenta. Fromthis cavity the blood passed into the general ventricle, andthence through the general aorta. The pulmonary arterieswere wholly inadequate to transmit a sufficient quantity ofblood to the lungs, and, indeed, after birth a small proportiononly of the blood became aerated. The author remarked onthe rarity of malformations of the kinds of which these casesa.fford examples, and concluded his paper with some observa-tions-lst, on the connexion between malformations of theheart and an atelectasic condition of the lungs; 2ndly, on themode of death in cases of malformation of the heart; and 3rdly,on the relation of cardiac abnormalities and cyanosis.

MEDICAL SOCIETY OF LONDON.

SATURDAY, MAY 24TH, 1856.DR. CHOWNE, PRESIDENT, IN THE CHAIR.

Dr. WINN exhibited a specimen of’ ABSCESS OF THE BRAIN,which he had removed from the body of a lady who had beenattacked with puerperal convulsions and coma about a fort-night before death. For the early history of the case he wasindebted to Mr. Halford, with whom he saw the patient.From this gentleman he learned that the patient, a lady thirty-eight years of age, was seized in the first instance with con-vulsions, about six weeks before her confinement. The secondand fatal seizure occurred two days before labour. The con-vulsions were of an epileptiform character, and followed byprofound coma. The labour was unusually rapid, the childhaving been suddenly expelled by the unaided efforts of the! uterus, while the mother was perfectly unconscious. She hadnever suffered from convulsions prior to this last and secondlabour. Dr. Winn saw her for the first time ten days beforedeath. She was then lying in a state of stupor similar to thatarising from concussion of the brain. When roused, she wouldstare wildly, put out her tongue when asked to do so, andthen relapse into a state of unconsciousness. The urine waspassed involuntarily, her milk was scanty, and the lochia veryoffensive. She had lost three sisters, one from phthisis, andher brother was supposed to be insane. A great point ofinterest in the case was the fact that the first seizure super-vened on a moral shock of a peculiar kind. She received theintelligence, at one and the same time, of the death of herchild and of a rich legacy that had been bequeathed to herhusband. As she had been suffering from pecuniary difficultiesfor a long period, and had never been a person of strongintellect, it may naturally be inferred that the conflictingemotions attendant on the receipt of such a singular com-bination of good and bad news, must have acted most in-juriously on a weakly-organized brain. It was worthy ofremark, that, a short time before death, the muscles of thejaw were fixed by a sort of tonic tetanic spasm, and it becameimpossible to feed her. This event probably hastened herdeath. The brain was carefully examined by Mr. Halfordand Dr. Winn about thirty hours after death. The skull was

remarkably thick, and all the bones of the body were largelydeveloped. The membranes of the brain were healthy; and

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no disease could be detected in the right hemisphere of thebrain. In the middle lobe of the left hemisphere extensivedisease was discovered. Nearly the whole of the upper portionof the medullary substance was in a softened state, the con-sistence of cream. At the base of the same lobe was found amass of coagulated lymph, containing an abscess the size of abean. It was worthy of notice that the convulsive movementswhich preceded death were chiefly confined to the right sideof the body.Mr. PULVERMACHER exhibited his chain battery.Mr. MILTON exhibited an armed bougie.

,

Dr. RICHARDSON admitted Dr. Brinton’s claim to priority inhis discovery that antimony injected into the tissues of theskin may be immediately found in matters ejected from thestomach.

Mr. H. SMITH exhibited the bones in a case of resection ofthe hip-joint by Mr. Jones, of Jersey; and also in another caseat an earlier period.

Dr. HYDE SALTER read a paperON THE PATHOLOGY OF HOOPING-COUGH.

After enumerating some of the many discrepant and imagina-tive theories of the nature of hooping-cough that writers onthe subject had indulged in, the author stated, in answer tothe question-To what category of derangements do the most’constant and characteristic features of the disease the mostintimately unite it ?-that, in his opinion, it was to the conta-gious fevers-to those diseases which consist of the assumptioninto the body of some specific 1nataies 1n01’bi introduced fromwithout, and undergoing a certain process of self-multiplicationwithin the system-to the zymotic diseases ; in fact, in favour,of this view, he said, there was this threefold evidence :-

lst.-That hooping-cough was contagious.2nd.-That it runs a definite course, having certain premo-

nitory signs: certain phenomena when the disease has attainedits height, and certain sequelx.

3rd.-That it is self-prophylatic ; a person having had itonce, dces not have it again.Now the three circumstances-contagion, definite course,

,and self-prophylaxis, are, he maintained, par excellence, thethree characteristic circumstances of the contagious fevers, andthe possession by any disease of’these three features wouldalways be, to him, a aumoient warrant for its admission intothat family of disorders. The author then thus stated, inmore exact terms, his views :-That the catching of hooping-cough depends upon the inoculation of the system with aspecific poison; that this poison chooses for itself a certaineliminatory surface as its emunctory ; that the surface that itso chooses is the respiratory tract of the mucous membrane,from the conjunctiva to the ultimate bronchial tubes, although- the whole of the tract need not be involved in every case ; thatits material presence gives rise to an exalted sensibility andinflammation of the part; and that the exalted sensibility andinflammation constitute the proximate cause of the specificsymptoms. The author’s conviction of the correctness of theabove theory was based on the following considerations :—

a. The premonitory symptoms of catarrh, injection of theeyes, coryza, &c.

b. The symptoms of vascular disturbance of the trachea,bronchial tubes, large and small, down even, in many cases, tothe ultimate lung structure, that generally accompany or followthe cough.

c. The intermediate position in regard to time, of the laryn-geal, between the nasal and the bronchial symptoms, implyinga creeping down of the condition of the mucous membrane, ina regular course.

d. The power which one child will have, who does not hoop,of communicating the disease to another who will; showingthat the spasmodic part of the affection is non-essential.

e. The eliminatory power of the surface, which is consistentwith the supposed final cause of its being affected.

f. The support derived from the whole weight of the argu-ment of analogy.

Dr. Salter finished his paper by refuting, in succession, cer-tain objections to his theory, which he could conceive others tomake, but which, from our limited space, we are unable toenumerate.

Dr. 1-tICHARDSON believed that hooping-cough belonged tothe zymotic class of diseases. He advised that Dr. Saltershould ascertain if the mucus is inoculable, and suggestedthe pig as a fit animal. He had seen pigs with croup, small-pox, measles, and plague. Inoculation acts well in modifyingdisease, by introducing but a very small dose at once, and forthe same purpose, it is advantageous to inoculate from matter

obtained from animals which had been the subjects of thedisease.

Dr. EDWARD SMITH had proved, in a paper published in the"Transactions" of the Royal Medical and Chirurgical Society,that the deaths from hooping-cough were mainly due to

bronchitis; but he believed that inflammation was only anaccident, and not an essence of the disease. He had doubtsas to its being a blood disease, in the sense of being introducedinto the system in the form of an organic poison; but, at allevents, he considered that the spasm is all that distinguishesit necessarily from a common cough. The secretion is in greatpart due to the violent spasmodic cough ; and the plan oftreatment, which in a large experience he had found suitable,was to arrest the spasm, and thereby both the cough and thesecretion; so that, in a very short time, the attack is reducedto the condition of a common. cough. Since the disease maythus be cut short in probably all uncomplicated cases, and yetnot be more liable to return than when allowed to run itscourse, he could not support the author’s theory of eliminationof the poison in the secretion of the mucous membrane of thelarynx and bronchi. It is, however, just possible that thesupposition of the gradual destruction in the system of thepoison might account for the non-recurrence of the diseasewhen thus cut short; but that would be an assumption, and,if true, would render the theory of elimination of no value inpractice. He strongly commended the employment of smalland increasing doses of morphia, on the plan laid down byhim in a paper published in the Edinburgh -41"edical Journalfor Mav.

Dr. W-1-NN believed that the disease does not run through aregular course. He admitted that it is a contagious disease,but its evidences are mainly nervous.

Dr. WEBSTER remarked upon the difference of opinion exist-ing as to the pathology of the disease. He did not consider ita contagious disease in the sense that measles is contagious,and he did not think it run through a definite course. It mayalso recur. It is more common in the winter, and withnortherly winds and frosty weather. Change of wind and airare often beneficial. Treatment will often cut short the attack.He believed the disease chiefly affected the head. It is morefatal amongst female young children.

Dr. CAMPS thought that the author’s cases must have beencomplicated with some inflammatory condition. Mild tem-

perature is beneficial. It does not run a definite course, andtreatment may cut it short.

Dr. RADCLIFFE did not believe in the necessary connexionbetween hooping-cough and true inflammation, and when thatcomplication exists, the hoop is suspended. The disease iscapable of being arrested, and hence does not run through adefinite course.

Dr. HEADLAND did not agree with the peripheral theory,and thought that the centric theory accounted for the produc-tion of the paroxysm. Many poisons do not act upon elimi-nating parts of the system. He did not approve the experi-mentum crucis.The author replied.

NORTH LONDON MEDICAL SOCIETY.

WEDNESDAY, MAY 28TH, 1856.MR. PARK IN THE CHAIR.

DR. RussELL REYNOLDS brought forwardCASES ILLUSTRATING THE RATIONAL TREATMENT OF EPILEPSY.

Rational treatment is distinguished from two other kinds-viz., the empirical, or non-rational, and the à priME, or falselyrational. It consists of the application deductively to parti-cular cases, of inductively acquired knowledge of the diseasein general, and of remedies in general. The measure of successattending treatment is. in the long run, the measure of its ra-tionality ; for such application to particular cases is the experi-ment by which we may test the correctness or incorrectness ofour interpretation of phenomena, both of disedse and medica-tion. This is, however, true only when we have attained toan accurate measure of success. The so-called accidental curesare not accidental, but are dependent upon undiscovered laws;neither are they exceptional, for there are no exceptions tonatural laws; but there are few laws so accurately compre-hended in the sciences of pathology and therapeutics, that wecan announce them without the aid of per centages, averages,and means. The latter are, then, numerical expressions, notof the whole truth, but of such fractions of the truth as we are

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