199

bten very serious effusion into this cavity, with all the ill effectsof such a complication.W. D- was admitted into University College Hospital

latt on the night of the 21st of July of the present year, statedby the police to have been stabbed with a knife about half anhoui previously. His face was ashy pale and anxious’; pulse112, but regular; respirations about 28, and painful; skinmoderately warm. He complains of tenderness and pain overthe heart, close to the left border of the sternum over the fourthintercostal space, where, on removing some adhesive plaster,there was found to be a deep incised wound, about half an inchlong, with little or no haemorrhage. The sounds of the heartare not unnatural, except that the second sound is rather moremarked or accentuated at the apex than the first sound; apeculiar rumbling noise, perhaps muscular, is heard; the lungof that side appears to be unaffected; respiratory murmur quitenormal over the entire side. After being an hour in hospital,the pulse had come down to 92; the heart’s apex could not befelt distinctly; there is a feeble fremitus to be detected; thesecond sound continues evidently louder than the first. The

patient complains of severe pain when asked to take a deepbreath. The phenomena of the heart’s action are easily exa-mined in the stillness of midnight.

July 22nd.-Remains much the same as last night, but com- plains of a sense of weight over the cardiac region, which stillprevents him drawing his breath to its full extent; tongue isdry and furred; he complains of thirst and anorexia; tendernessabout the wound mu;h increased; there is a tendency to re-duplication of the second sound at the base of the heart; nodistinct friction-sound, though it was thought it could be de-tected in a moderate degree. He was ordered eight leeches tothe region of the heart, also some colocynth and calomel pills.Towards evening the bowels were relieved; the pulse had fallento 80, but was quite incompressible and weak; dulness overpraecordial region very marked; apex of the heart tilted for-ward. He was now ordered a pill every four hours, containinga quarter of a grain of opium and two grains of calomel.23rd.-Complains of a sense of weight over the left side of

the chest; the pain on taking a deep inspiration is relieved;respirations 20, and pulse 80; impulse of the heart not to befelt; still considerable tenderness in the fifth intercostal space;above this the side is quite dull on percussion; the second soundof the heart at the apex is harsh and rough.25th.-Gums sore to-day; pulse low, only 70; pain in the

region of the wound prevents him speaking ; he is afraid tocough because of the pain; the first sound of the heart is return-ing, and the second sound is less accentuated than previously.At the base of the heart we heard, we thought, quite a bruit orfriction sound; the respiration, as is usual in injuries of theribs, is quite abdominal; one side of the thorax expands morethan the other. Five more leeches were ordered, more as amatter of precaution than anything else.26th.-Feels better in every way. The leeches relieved the

pain in the region of the heart; he slept very well after theirapplication; bowels open; tongue moist; no salivation, but thegums are slightly spongy and sore; appetite improved; pulse 76,and compressible. The pills were ordered to be taken at longerintervals, and then discontinued.

27th. -Continues to improve; appetite returned.30th.-Sitting up a little in bed, and more cheerful; cardiac

impulse now extensive.August 14th. -Walking about the yard of the hospital. A

blister, ordered for pain in the cardiac region, had benefitedhim very much. The second sound of the heart has lost all itsabnormal roughness and tendency to reduplication, and he feelsquite restored.

Reviews and Notices of Books.On the Disorders of Infantile Developme2zt and R2clcets, pre-

ceded by Observations on the. Nature, Peculiar Influence, andModifying -Ageiicies of Temperaments. By A. SCHOEPFMEREl, M.D., Lecturer on the Diseases of Children at theChatham-street School of Medicine, Manchester, formerlyChief Physician to the Children’s Hospital of Pesth, &c.pp. 218. London: Churchill. 1855.

To all who have paid particular attention to the progressmade of late years in Infantile Pathology, the name of Dr. S.Merei is well known as that of a close observer and able

practitioner. In consequence of political changes in his native

country, Dr. Merei has for some time been settled in Man-

chester, and has devoted himself to that speciulité in whichhe held so good a reputation on the banks of the Danube. Tohim the city of Pesth was mainly indebted for the possessionof the Children’s Hospital, afterwards taken under the patro-nage of the Archduchess Palatine, Mary Dorothea, and whichat the time of Dr. Merei’s secession, numbered thirty if notmore beds. What may be the condition of the institutionnow we know not, but trust so useful a one has not sunk be-neath the destroying waves of political commotion. In the

present treatise, more than half its pages is taken up withresults of the author’s experience and observation on the die-tetic and other hygenic relations of the various countries inwhich he has, during a varied life, been a resident. Theseare made to bear particularly on a certain theory of tem-

peraments." It appears clearly enough that the varieties of tempera-

ments is a fact of which we understand some principal causeseffects, and requirements, but that on the whole, our know-ledge of them is still far from scientific accomplishment.......A comparative consideration of the national temperamentsof different countries traced as far as possible to the nature ofthe climates, diet, endemic pathology and popular medicine,will probably furnish some additional facts and views on a pro-ject so interesting in its moral as well as physical aspects."- p. 22.

France, Austria, Northern Germany, Italy, Turkey, Hunga.ry,Great Britain, &c., are all placed under contribution to the endabove pointed out. In the treatment of the subject, there is acertain rambling discursiveness or prolixity, an absence of scien-tific precision and arrangement, which detract somewhat fromits character. Nevertheless there will be found very much in-

teresting matter, pleasant to read and easy to follow. Insome points, Dr. Merei’s work recalls to our mind the lateDr. James Johnson’s hygienic writings, though in others thereis a great difference. We miss the sparkling humour, for

instance, although Dr. Merei is not entirely without vivacity,as the following extract will show, speaking of England, Dr.Merei observes,

" In this country there is but little in the meteorologicalagencies to excite the circulation or the nervous system, littleto gladden the eye or elevate the mind. The atmosphere isgenerally sunless, heavy and dulL This is not only seen butfelt. An anecdote is recorded of a lady of high rank, havingsaid to an Eastern ambassador,-‘ Is it true your excellencythat in your country there are worshippers of the sun ?’ Yes,my lady,’ replied the ambassador, ’it is perfectly true, anddoubtless you would be one also if you ever saw him.’"’- p. 26.

If instead of sun we have beautiful green turf we yet have asad want of musical voices, and this owing, it would appear,to the dampness of the atmosphere.

" A fact merely referable, I believe, to the nature of theEnglish climate, and by the universality of which I have beenstruck, is the character of the voice of the natives. The dif-ference between its tone and that of the Italians, nay, even ofGermans or French, is remarkable. In the great majority, thevoice of the English female sex, even though not unpleasantin tone; or when it sounds as is said ’ sweet’ in singing-=isweak, frequently less than weak. Nor is the male voice sosonorous as on the continent, and when strong, then generallyit is less melodious or even harsh. Fine and full melodiousvoices are decidedly much rarer here in both sexes than on thecontinent.

" To what quality of the atmosphere is this owing ? To therelaxing influence of moisture upon the fibres of the larynxand bronchi ? Most propably so; though perhaps the jointthermo-electric condition may also contribute to that effect.p. 27.We have not space to touch upon the other division of Dr.

Merei’s treatise, but can recommend its perusal as bearing outour good opinion of the author as a close observer of thediseases of children.

200

Observations on Diseases of the Rectum. By T. B. CuFr,mc,F. R. S., &c. Second Edition. London : John Churchill.pp. 129.THIS work, of which the first edition must be pretty

well known to our readers, affords a short, but, at the same

time, concise account of the subject of which it treats. And,we think, it may thus be found useful to students, as well asto practitioners, who do not possess the leisure to bestow onlarger works or more voluminous writers. Unlike some

productions of the prolific press of our day, it is one which

would greatly suffer by condensation or abridgment; while, onthe other hand, we are not sure that its value would not beenhanced had greater labour and the results of more extendedresearch been expended on its construction. With a highopinion of its author’s literary and practical abilites, we wereled to expect considerable additions with this reprint, andhave been somewhat disappointed. But we shall still hope inthe future successes of this monograph to learn more of theresults of Mr. Curling’s increasing experience in relation tothe management of that class of diseases to which he has paida considerable degree of attention; and we trust that he willfind time and opportunity to communicate them to his brethrenat no very distant period.

Foreign Department.SOME EXPERIMENTS ON THE SMOKE OF TOBACCO.

IN Froriep’s Joztrnal, of a recent date, an interesting articlehas been published on the habit of tobacco smoking, and onpoisoning by nicotine. Amongst the facts there mentioned, arethe. experiments instituted by M. Malapert, a pharmacien ofPoitiers. His intention was to ascertain the exact quantity ofnicotine absorbed by smokers, in proportion to the weight oftobacco consumed.The apparatus used consisted of a stone jar, in which the

tobacco was made to burn, connected with a series of bottles. communicating by tubes. The bottles were either empty, orcontained some water mixed or not with a little sulphuric acid.From a few experiments, it was found that, in the smoke oftobacco extracted by inspiration, there is ten per cent. ofnicotine. Thus a man who smokes a cigar of the weight of iiseventy grains, receives in his mouth seven grains of nicotine i

mixed with a little watery vapour, tar, empyreumatic oil, &c.

Although a large proportion of this nicotine is rejected, bothby the smoke puffed from the mouth, and by the saliva, a

portion of it is nevertheless taken up by the vessels of thebuccal and laryngeal mucous membrane, circulated with theblood, and acts upon the brain. With those unaccustomed tothe use of tobacco, the nicotine, when in contact with thelatter organ, produces vertigo, nausea, headache, and somno-lence ; whilst habitual smokers are merely thrown into a stateof excitement, similar to that produced by moderate quantitiesof wine or tea.From further investigations it is found that the drier the

tobacco the less nicotine reaches the mouth. A very drycigar, whilst burning, yields a very small amount of wateryvapour; the smoke cools rapidly, and allows the condensationof the nicotine before it reaches the mouth. Hence it comesthat the first half of a cigar smokes more mildly than thesecond, in which a certain amount of condensed watery vapourAnd nicotine, freed by the first half, are deposited. The sameremark applies to smoking tobacco in pipes, and if smokerswere prudent, they would never consume but half a cigar orpipe and throw away the other. Smoking through water, orwith long tubes and small bowls, is also a precaution whichshould not be neglected.

ON THE INFLUENCE OF HYGIENE AND EDUCATION UPON

GESTATION AND PARTURITION.

M. MATTEI, Professor of Midwifery, at Bastia (Corsica), hassent to the Revue Thérapeutique du Midi, an extract from awork he is about to publish, which extract treats of ar. importantand novel subject, and is full worthy of attention. The authorthinks that the state of frame existing before gestation, andwhich has considerable influence on parturition, differs much

according to the social condition of women. This state shoud,therefore, be studied first among the working classes, and tlenamong the middle and higher.The education of girls belonging to the middle and uvper

classes is faulty, inasmuch as it always opposes the normaldevelopment of the body. Whether at school or at home, thechild is shut up in rooms, mostly shut out from sufficient airand light. Constantly sitting, either with books or theneedle, the poor girl strains her mental powers to learn herlessons, and strives to keep up with her little companions.The only actual physical exercise consists of a little pianoplaying, a few steps of dancing, and a little walking; thesebeing quite inadequate to favour the development of the body.*Hardly is she allowed to go and play in some court-yardssurrounded with gigantic walls, and her chest is, above allthis, compressed by stays which act as injuriously on theorgans of the thorax as on those of the abdomen.

This total want of exercise, especially when afterwards con-nected with the reading of novels, and attendance at balls andtheatres, tends to over-excite the nervous system, and to

generate a chloro-anæmic state. Uterine life seems, at thesame time, to assume the more activity as the general strengthfails. This early puberty, combined with systemic debility,a puny osseous system, a narrow chest, and an incompletelydeveloped pelvis, produce such a state of things, that, whensuch girls marry, they remain childless, or abort on theslightest excitement. When they go their full time, :theyseldom have a natural or physiological labour, and are seldomable to suckle their children. One confinement produces moreshock upon these weakly organisms, than five among womenliving in the country, with whom parturition is generallynatural.

It is a lucky circumstance for the women residing in cities,that they are not long before losing the faculty of conception;for fecundity is in an inverse ratio with the progress of ourcivilization. But this unfavourable state of health is not con-fined to parturition, for the efforts made by the patient, andthe uterus itself, are generally followed by acute or chronicaffections of the womb, and leave the nervous system in astate of irritability, which will produce the strongest symptomson the application of the slightest cause.The best means of avoiding all these evils, is to favour the

development of the muscular and vascular systems, which, intruth, act as a counterpoise to the nervous system; the moreso, as by the vigour of the former, the full development of theskeleton, so indispensable for proper parturition, is consi-derably favoured. To attain this object, we must pay littleless attention to the physical than to the intellectual educa-tion, and allow young girls to leap and play as their natureimpels them; and we should let them take, at night, as muchrest as they feel inclined, for it is during sleep that the work ofrepair and growth is actually going on. We should be in nohaste to cramp the mind, and its attention should only befixed in an agreeable and attractive manner.

I Much improvement is needed in our systems of teaching:and it is not improbable that by well adopted modes oftuition, more might be taught in one year to girls of eight orten, who can understand what they are told, than in two

years by the ordinary method with younger children. Exer-cise is of great importance to the young girl, so that the chestand pelvis may attain their full development; the proper ex-pansion of the chest is indispensable to her health, (as is alsothe case in the other sex,) and such expansion should certainlynot be opposed by the use of stays.

Let, therefore, stays be used by ill-made or fat women, forgracefulness of the waist does not depend on slimness, but on adue proportion with the rest of the body. We should notsacrifice physical education to intellectual culture; both may,in the training of young ladies, be carried on together, if theproper means be used, and if any sacrifice is to be made, let itfall on the cultivation of the intellect. No doubt cleverwomen have much influence on the refinement of society, butit must be remembered that a woman, possessed of very littleknowledge, has nevertheless an exquisite delicacy of feeling,and a natural gracefulness in the expression of her sentiments.And even supposing her qualities were confined to those of agood wife and mother, she would still fully deserve all theesteem and attachment of which man is capable.Many of the disadvantages just pointed out as weighing upon

young ladies, whose parents are well off, fall very heavily ongirls belonging to the working classes residing in towns.

* We have reason to know ttat in some girl-schools in this countrygymnastic exercises, walking, and running about in the open air, are properlyattended to.