348

also pouring out of its numerous follicles an unctuous and oilymaterial, with hydro-sulphuretted gases, to be eliminated fromthe economy. Thus, like the lungs, kidney, and skin, it is a

depurating organ, so that when costiveness exists there is

danger of these excretions being reabsorbed and contaminatingthe blood. He stated that he had within the last twenty

years met with not a few cases of these diseases, some

of which he would class as " acute," others " chronic," inflam-mation of the cæcum-tuphlo-enteritis; they had not appearedto arise from the ordinary causes of inflammation-viz., expo-sure to the vicissitudes of the weather, or alternations of tem-perature, but seemed to be produced by some mechanical, ex-citing, and irritating cause, the lodgment of impacted, hard-ened feaces, undigested food, fruit, skins and stones of fruit,and concretions of varied and different kinds, and often arisewhile the person is in good health. The symptoms may beginmildly, and gradually proceed to greater intensity; or theymay, in excitable subjects, be violent from the onset. Thereis but little febrile disturbance compared with the local painand suffering; less anxiety of countenance than in enteritis;pulse not small, or much quickened at the commencement;there is great tension and tenderness over the cæcum, so thatthe least pressure cannot be borne; there are no rigors; thepain is constant, does not intermit, and its area goes on ex-tending till the whole abdomen is involved; but the right ileo-inguinal region is ever the most tender part. There is obstinatecostiveness; nausea and violent vomiting may set in, especiallywhen drastic purgatives have been persevered in; the positionis characteristic-the patient lies on the right side, body bent,and thigh drawn up; the countenance has not the anxiousaspect of enteritis. If neglected or wrongly treated, the ab-domen becomes tense and tympanitic, and general enteritis orperitonitis may supervene. Should the appendix be inflamedor ulcerated, all the symptoms are more acute, and likely toterminate fatally by peritonitis or fxcal abscess. In the pro-gress of these diseases, adhesions are often formed in its interior,or to other parts; the areolar tissue around may inflame, sup-purate, and give rise to abscess, which may tend upwards anddownwards, and require to be opened; they may either openexternally, or find their way into other parts of the intestinalcanal, the patient recovering, or may die worn out by the dis- charge. Should the ulceration open into the peritonæum, peri- litonitis of a diffused and fatal character will be set up, as in one ’,of the cases related by the author. This termination is fortu-nately most rare, though not uncommon in typhoid and dysen-teric fevers. When resolution takes place it is preceded byaction of the bowels and gradual subsidence of the pain, tender-ness, sickness and fever, about the fourth, sixth, or even theeighth day. This result can only be obtained by most judi-cious treatment; but when mistaken, and treated too activelyby large and repeated bleedings, or violent and continued pur-gatives, there is much danger of a fatal termination, or of longand protracted convalescence. If fæcal abscess forms, the drainon the system is long and exhausting. The author coincides

very much with Dr. Burne, whose papers in the Royal Medico-Chirurgical Society’s "Transactions" he referred to. In theseacute cases, leeching, fomentations, soft poultices, mild effer-vescing aperients, and large bland enemata, will often resolvethe inflammation; if not, calomel and opium or opium aloneshould be given, but violent purgatives are to be avoided. Dr.Rogers places great reliance on bland mucilaginous enemata,passed into the bowels with a long O’Beirne’s tube, with whichhe has often relieved and cured cases of simple obstruction andconstipation that had resisted other treatment ; he thinks theuse of this instrument is much neglected. The author laysgreat stress on cautious dieting, which should be, for a longtime, of the simplest and blandest form - arrowroot, rice,milk, eggs, and subsequently beef-tea and jellies. In thoseforms of acute inflammation that have supervened on some sub-acute chronic form, long perseverance in this cautious regimenis even of more importance. In chronic inflammation, carefulregimen and regulated action of the bowels are essential ; thesymptoms now are all more or less subdued and indistinct:irregular action with colicky pains; diarrhoea alternating withcostiveness and foetid dejections ; hardness and fulness over thecaecum, with tenderness on pressure. The author relies onblisters, iodine, and liniments, mild saline aperients, and strictattention to dietetic rules : from neglect of these he has hadoccasionally to regret the loss of a patient. In simple ohstruc-tion he relies on large enemata, as before stated, and mildsaline aperients, with a sedative, as hyoscyamus, belladonna,&c.; he quoted cases from different authors on the frequency ofthese obstructions and the mistakes often committed by thereckless abuse of violent purgatives, which, even in cases of

hernia, have been given till death removed the sufferer fromhis tortures. In the more obstinate cases, electricity, dashingcold water, tobacco fomentations over the abdomen, and infla-tion with bellows, have each been successful. We quote entirethe last sentence : " Should all means fail-and fail, unfortu-nately, they do-we may yet retard the approach of Death,and throw our ægis over our patient. ’ Operative surgery’hasdone much for suffering humanity, and here it comes to our aid- heaven-born, twin-born with Medicine, one and indivisible.Of old, statues and temples were raised ; now they are wor-shipped in living shrines,-grateful hearts, blessed by them."

Dr. STOCKER thought that in all cæcal affections the patientshad been previously ailing, perhaps for years, with some dis-orders of the bowels. He believed when perforation took placeit was not followed by acute pain.

Mr. LEE said that the author had not drawn sufficient dis-tinction between these diseases and those of the vermiformappendix.

Dr. HARE lucidly recapitulated the distinctive characters ofcascal disease as given by the author. He briefly referred toanother affection of the cæcum, which he would designate per-tuphlitis. He agreed with the author as to treatment.

Mr. ADAMS said that the diseases of the appendix were moreacute and fatal, and he referred to the fatal character of ob-structed rectum in children.

Mr. HOGG cited a case in his own family of obstruction inthe appendix; fæcal abscess set in, which was most judiciouslyopened by Mr. Hancock. The patient recovered.The PRESIDENT laid great stress on the use of opium in these

diseases, arresting inflammation and relaxing spasm, &c.Dr. ROGERS had seen inflammation of the caecum set in sud-

denly in children who never had any previous disorder of thebowels. If perforation took place into the peritoneum, thepain was most acute, and required large doses of opium to sub-due it. He was happy to find the opinions of the MedicalSociety opposed to the use of violent purgatives in cæcal dis-eases.

PATHOLOGICAL SOCIETY OF LONDON.DR. WATSON IN THE CHAIR

Dr. PEACOCK related a case of

TYPHOID FEVER, FATAL FROM RELAPSE, AND SHEWINGFRESH DISEASE OF THE INTESTINES.

A female, aged nineteen, a servant, residing in Camden Town,was admitted into St. Thomas’s Hospital on the 30th of Nov.,1857. She then stated that she had been ill three weeks. Shewas taken with cough, and pains in the limbs, and generalfebrile symptoms; but she was too weak, and her intelligencetoo much impaired, for this report to be depended upon. Atthe time of admission she presented characteristic symptoms oftyphoid fever. There was much torpor of mind, delirium,and tremor of the extremities; the tongue was dry and brown;there were sordes on the teeth, a quick pulse, diarrhoea,, andan eruption of rose-coloured spots, fading on pressure, on theabdomeu and back. On the 9th of December, the bowels be-came much relaxed, and there was blood in the stools; andthis continued for three days. On the 12th she began to im-prove ; and on the sixteenth or on the seventeenth day fromadmission, and the thirtieth from reported seizure, she wasconvalescent. The pulse had fallen to 92; the bowels wereregular; she took her food well; was quite intelligent; andhad gained strength. She continued to improve till the 23rd,and then was taken worse without any assignable cause, thetongue again became dry and brown, the teeth were coveredwith sordes, and the pulse quick (119) and weak. There wasa return of torpor of mind, tremor and delirium, with vomitingand diarrhoea. On the 29th she had again rallied consider-ably ; but during the evening she passed a large quantity ofblood from the bowels, and became collapsed, and died thefollowing morning. There was no fresh eruption on the skinduring the relapse.On examining the body, the organs were found generally

healthy, except the spleen, which was large; the mesentericglands, which were large and soft; and the mucous membraneof the large and small intestines, which displayed evidence ofold and recent typhoid disease. In the lower part of the ilium,cseoum, and colon more especially, there were numerous ulcers,some healing or nearly healed, with depressed edges and shallowcavities, or only marked by very slight remains of abrasionand puckering of the abjacent mucous membrane, while others

349

were evidently of quite recent formation, having tumid andabrupt edges, and the usual yellow eschars, either still at-tached, or only imperfectly separated.

Dr. HARLEY showed

TWO DISEASED SUPRA-RENAL CAPSULES.

which were removed from a patient of Dr. Mackenzie’s. Bothglands were much enlarged, especially the left, and on sectionwere seen to have entirely lost their normal appearance. Onmicroscopic examination, the medullary as well as the corticalnormal structure was found to have become entirely replacedby tubercular deposit. The patient was a married woman,aged thirty-three, and of a strumous constitution. She hadbeen treated at various times during the last eight years byDr. Mackenzie on account of general ill-health, uterine derange-ment, and enlarged liver. She had a peculiar, sallow com-plexion, which up till within a short time of her death wasimputed to the hepatic derangement. Latterly, however, Dr.Mackenzie attributed it to diseased supra-renal capsules. Un-

fortunately, the skin was not examined with the microscope,so that it impossible now to say to which category of cases thepresent belongs; both the liver and the capsules having beenfound by Dr. Sanderson, who made the post-mortem examina-tion, to be diseased.

Dr. HARLEY next exhibited a diseased supra-renal capsulewhich he had removed by operation from a rat. The case isone of peculiar interest on account of the diseased organ havingbeen removed from an apparently healthy animal. The animal,in fact, was selected from amongst a number of others onaccount of its being the largest and strongest-looking, and yeton examination the capsnle was found at least three times itsnormal size, and the seat of extensive tubercular deposit.Contrary to the usual course, the animal died six days afterthe operation. The left capsule was found apparently healthy.The rat was shown to the Society. There appeared to besome disease in the neighbourhood of the solar plexus, whichDr. Harley did not remark upon as he had not had time toexamine the animal carefully before bringing it to the meeting.

EPIDEMIOLOGICAL SOCIETY.

MONDAY, MARCH 1ST, 1858.DR. HEADLAM GREENHOW IN THE CHAIR.

DR. RICHARDSON read a paper on

THE INVESTIGATION OF EPIDEMICS BY EXPERIMENT.

He commenced by pointing out the weakness of the presentsystem of epidemiological study, which sought after results by ’,

trying to descend from the general to the particular. Thismethod lets pass simple laws, which lie at the root of all

inquiries. It is painful to say, as a fact, yet a fact proper tobe said, that the researches at present so laboriously conducteddo not tend to such proofs of unanimity, or to such positivenessof science, as might, on a priori reasoning, be expected fromthem. The present modes of research may bring out negatives- they may bring out partially-accepted positives, and a suffi-cient amount of positive evidence to satisfy a section of men; ;but as yet they have failed to educe such demonstrations thatthose who are educated to the same mark can read off the samephenomena by the same process of thought and inductivelearning. The author next proceeded to point out carefullysuch experiments as might be reasonably instituted for the

purpose of investigating particular epidemic disorders, especiallysmall-pox, scarlet fever, and typhus, commenting also on thecare which should be taken in the selection of the animal sub-jected to experiment, and shewing that in inquiries relating tothe three special diseases named above the pig is the properanimal to be selected, as one more susceptible of these diseasesthan other members of the inferior animal kingdom. Thence,leaving propositions for the history of experiment itself, as ameans of investigation, the author explained what had beendone in recent times towards the production of some diseasesartificially, and the information derivable from this form ofinvestigation. He followed up this argument with a minutely-revealed account of some experiments performed by himself, inwhich all the characteristics of typhus, symptomatological andpathological, were produced by the introduction of alkaliesinto the system. He showed further that the typhous condi-tion, which could be induced by the injection of animal putridmatter, was coincident with, and dependant on, the develop-ment of a superalkaline condition of the blood; and he con-

$

nected the pathology of putrid fever, so called, with the con-ditions analogous to those which had thus been artificiallyproduced. In a connected, simple mode of argument, whichpeculiarly arrested the attention of the audience, the questionwas next put, whether, when the virus of a disease is intro-duced into a healthy animal so as to reproduce that disease,the symptoms and the pathological changes are due to anabsolute reproduction of the virus itself, and to the actualpresence of such virus, or whether the virus acted by settingup such new changes in the body that a product, generatedsecondarily and differing in character from the original poison,was the cause of the symptoms ? He (Dr. Richaidson) wasinclined to the latter view, and gave some clear experimentalevidence in support of his position. He admitted at the sametime that further experiment was required, and argued thatuntil this point was defined no sound progress could be madein the study of epidemics.

It is impossible, in an abstract, to give more than the briefestoutline of a communication written in so condensed a style,and opening up for consideration so many subjects, each differ-ing in detail, yet having but one object; but the final proposi-tions laid before the Society were as follows :-

1. That by experiment it might be ascertained in what ex-creta the poisons of certain of the epidemic diseases are located.

2. By what surfaces of the body such poisons may be ab-sorbed so as to produce their specific effects.

3. Whether the virus of a disease in reproducing its diseasein a healthy body, acts in the development of the phenomenaby which the disease is typified primarily or secondarily-i. e.,by its own reproduction and presence, or by the evolution ofanother principle or product. ,

4. Whether climate, season, or other external influences,modify the course of epidemics, by producing modifications ofthe epidemic poisons, or modifications in the system of personsexposed to the poisons.A discussion followed, in which Dr. Greenhow, Dr. Camps,

Mr. Hunt, Dr. Delimee, Dr. J. Bird, and Dr. M’William tookpart.

Dr. RICHARDSON having replied, the meeting then adjourned.

Correspondence.

ADMINISTRATION OF MERCURY INSYPHILIS.

[NOTE FROM PROFESSOR MILLER.]

’’ Audi alteram partexn."

To the Editor of THE LANCET.

SIR,-I have observed that in your journal of March 20th,p. 303, my name is introduced into what is called "the In-flammation and Bloodletting Controversy." In a letter fromDr. Markham the following occurs : " Dr. Sanderson wrote in

your journal of Feb. 27th, ’Mr. Syme uses mercury, and di-rects us how to use it in his book. The Professor of Surgeryteaches us that for syphilis

" there is no remedy equal to mer-cury."’ It is only now that I gather, from Dr. Sanderson’sletter in THE LANCET of last week, that Mr. Syme and theProfessor of Surgery are not the same person. It is not, there-fore, Mr. Syme, but Mr. Miller, who makes the assertion aboutthe excellence of mercury. "

Now, let me put this matter right, so far as I am concerned.At p. 483 of my " Practice of Surgery

" I use the words, " Forsuch affections of the system, there is no remedy equal to mer-cury," &c. But, by " such affections," I mean-and show thatI mean-exclusively the secondary constitutional symptoms

. following the true Hunterian or indurated chancre.As regards the treatment of syphilis i-rt general, I am neither

. a mercurialist nor an anti-mercurialist, in the sense of a parti--

zan, but have always occupied a place somewhere between the- two, though nearer to the latter than the former.L Had I been alluded to by name only, I should probably notL have troubled you with this brief reclamation; but as I am

specially designated "the Professor of Surgery, ’ it seems pro-- per that what I

" teach " should, if possible, not be misunder-L stood, or at least should not be misrepresented.

If my real sentiments regarding the use of mercury in syphi-- lis be thought of any value, favour me further by inserting the