125

pitals ; and also to impress the minds of practitioners with the ’fact, that extensive effusion of lymph and the formation ofmatter in the peritoneal cavity might perhaps be preventedby early and vigorous antiphlogistic measures.

Clementine D-, aged twenty-seven years, was admittedJune 19th, 1854, under the care of Dr. Wilson. The patient,who was up to the present attack in perfect health, was seizedabout midnight, four days before admission, with severe painin the abdomen, which began at the lower part, and soon spreadall over the cavity. Towards morning, sickness set in, but thebowels acted freely, probably by means of medicine. Thecatamenia had occurred at the regular time, about a fortnightbefore the attack, and had been quite normal.No direct antiphlogistic treatment seems to have been

employed, and the medical attendant boasted that he had notused the lancet once the last twenty or twenty-five years.

State on admission.-Face very much flushed and hot ; handscold; pulse rapid and oppressed; tongue coated, red at the tipand edges; abdomen very much distended, tender, and tym-panitic; bowels relaxed, constant feeling of sickness, but nowwithout vomiting.The patient was ordered a saline draught, combined with

ehloric ether, also mercury and chalk, with Dover’s powder, tobe taken at night; rhubarb in the morning, and finally fomen-tations to the abdomen.On the third day the abdomen was scarcely so tender, but

more tympanitic; the patient had wandered in the night, andthe stools were thin, ochry, and rather offensive; the face wasnot so much flushed; tongue cleaner and dryer; pulse 130,weak.At night the poor woman was so low that wine was

ordered, which was continued next day, with other stimulants;but she became rapidly worse, the skin cold, and the pulsefluttering, and she died the same evening.Post-mortem exa,millationfow’teen Iaom:s after death.-General

appearance: The body was well formed and in good condition,and the abdomen very tympanitic. —Thorax : No pleuriticadhesions, nor any fluid in either pleural cavity. The lower lobeof the left lung was very cedematous, but the upper lobe healthy.In the same locality, on the right side, a quantity of blood waseffused in the parenchyma, the remaining portion being healthy.The heart was in a normal condition.-Abdomen : On openingthis cavity, which was much distended, the great omentumwas found adherent to the front of the small intestines by recentadhesions; the convolutions were everywhere glued to eachother with lymph, and the spaces left between the adhesionswere filled with pus, forming circumscribed abscesses. Much

purulent fluid was found in the peritoneal cavity of theabdomen and pelvis. The ilium and caecum were healthy; inthe right lobe of the liver, near its under surface, the substancewas congested and infiltrated with pus. All the remainingorgans of the abdomen and pelvis were healthy.

Reviews and Notices of Books.

A Treatise on Hooping-cough: its Complicat:ons, Pathology, ]

and 1erininatioiis. By GEORGE D. GIBB, M.D. Fcp. 8vo,pp. 395. London: Renshaw.

IN his preface to this work, the author makes a kind ofapology for presenting it to the profession. This, we believe,was scarcely necessary, for it possesses a quality which, at thepresent time above all others, should ensure it a welcome. Itis thoroughly a practical work. We are not aware, however,that the original parts of the volume occupy any very considerablespace; on the contrary, they seem to be contained in a fewpages; but the work, as one of reference, is of value, and givesa complete history of hooping-cough in all its bearings. The

original portions appear to be the author’s views of the natureand seat of the disease, and its treatment by a new remedy.The first he thus sums up :

’’ 1. Toxication of the blood, produced by some unknownspecific influence, peculiar in its nature, not unlike that ofmeasles and scarlet fever, in the circumstance of its affectingpersons once during their lives, generally children under fiveyears of age.

" 2, Irritation of the terminal loops of the nerves supplyingrhe mucous membrane of the bronchial tubes, producing vas-

cularity and consequent secretion of a greater or lesser quantityof mucus.

’’ 3. Reflex action of the pneumogastric and respiratorynerves, followed by congestion of the vessels of the medullaoblongata and pia mater surrounding it, and also at the originsof its nerves.

" 4. Spasmodic contraction of the circular and longitudinalmuscular fibres of the bronchi, consequent upon the foregoing,manifesting itself in the series of sudden expiratory efforts, andthe well-known sonorous back-draught or hoop.

" 5. The immediate result of which is frequent and rapidrespiration to compensate for its temporary absence, producinga highly oxygenated or super-oxidized state of the blood, witha tendency to the formation of fibrinous concretions in theheart during the spasms.

’’ 6. As a secondary result of the spasmodic muscular con-traction of the bronchi, we have a temporary hypertrophy ofthe muscular fibres thus acted upon, which disappears againafter the cure is established.

" 7. The disease is at first irritative and catarrhal, andafterwards nervous and spasmodic, both due to the unknownpeculiar exciting cause present in the blood.

" 8. It manifests the peculiarity of running a special coursethrough its different stages, three in number, but which maybe cut short, or greatly diminished by medicinal treatment."- pp. 211, 212.

The new remedy is thus treated of:-" It would be presumption in me to say that this substance

has been discovered, but in its effects upon the disease, nitricacid, in whatever manner administered, not only arrests theparoxysms and removes the hoop, but shortens the diseasealmost as effectually as quinine does intermittent fever.

" It not only produces a powerful antispasmodic effect, butan equally tonic influence, and supplies to the blood an element- nitro!ren-which removes or neutralizes the excess of fibrinexisting in that fluid-one of the dangerous elements of thedisease-and so destroys the poisonous principle combined withit, which is the primary cause of the affection.

" If this remedy cures pertussis, it differs from the greatmajority of others in the fact that its action in the economycan be explained upon rational grounds.

" Nitric acid possesses- antiseptic properties in a high degree,and probably the influence of these assist materially in thecure by acting directly on the blood, as well as supplying itsnitrogen, and prevents the two rapid generation of the fibrinfrom the albumen."The nitrogen acts also as a sedative, in diminishing the

stimulating effect of the oxygen so rapidly absorbed, and as anantispasmodic in allaying irritation, and therefore lesseningthe severity of the paroxysms. If hydrocyanic acid is usefulin many cases, it is as much owing to its nitrogen as thesedative and antispasmodic properties which it possesses."The presence of the excess of fibrin has been elsewhere

explained to depend upon the frequent respirations, imme-diately after the paroxysms have ceased; it may also beinfluenced by the peculiar poison itself which has contaminatedthe blood. Whatever remedy will check this tendency mate-rially assists in the cure; it is in this manner that ether andchloroform act by arresting the process of sanguineous super-oxidation, and, with the other properties possessed by thoseagents, equally assist in the cure.

" As a general tonic, nitric acid possesses the advantages inpertussis of rapidly allaying the dyspepsia, which is sometimesaccompanied with sickness and irritability of the stomach; itrestores the healthy state of the mucous membrane of thebronchi, it arrests the spasm, diminishes the cough, and finallydispels the hoop altogether.

" Dr. Arnoldi and myself have never met with any ill effectsfrom its use, and all the cases treated by it were carried to asuccessful issue, the cure in all being very speedy, with fewexceptions, and the disease being at the same time abridged inthe length of its ordinary duration. So far as experience hasshown, relapses after cure are very rare indeed.

’’ Should inflammation of the lungs or abdominal organshave set in previous to its employment, it must be avoided,and the treatment must be adopted as recommended for thosecomplications in the next chapter."But if we have reason to fear congestion of the brain or

convulsions, the acid may still be safely given, and with goodresults, for the purpose of lessening the paroxysms. It willalso prove useful in the remittent fever, combined with othersubstances, if there be no existing irritation.

The details of a few cases only will now be given to illus-

126

trate the successful effects of this remedy, as all possess a

similarity in their general features." My friend Dr. Arnoldi has treated upwards of one hundred

cases of pertussis with nitric acid, with the most satisfactoryresults; and since I commenced its use, sixty-seven cases werecnred at intervals varying from two to fifteen days, butaveraging between six and seven days.

" It may be as well to mention here that the object enter-tained by Dr. Arnoldi, in using this acid as a remedy inpertussis, was to introduce the elements of the atmosphereinto the blood by the process of gastric digestion, so as toenable the lungs to out stand the stage of temporary asphyxia,which always is induced during a, severe paroxysm. Whetherthe theory be correct or not, the result, he says, of his practicehas been almost universally successful.

"I think it not improbable that the greater portion of theoxygen is chemically appropriated before the blood becomessensibly relieved by the nitrogen; because, if it were not so,a still greater amount of fibrin would be formed, and a ten-dency to aggravation, by inflammatory complication would bethe result."-pp. 334-338.The evidence brought forward in favour of nitric acid is

certainly very great, and fully warrants its employment inthe often intractable disease, hooping-cough. The chapter onthe mortality from liooi)i-,ig-co,,igh is deserving of consideration.Dr. Gibb’s work is a valuable addition to medical literature.

Lectm’esoll Educatio-a, delivered at the Royal Institution of GreatBritain.On the Importance of the Study of Physiology as a B2-aizc7t

of E’laccatiorz,fbr all Classes. By JAS. PAGET, F.R.S.0. the Importance of the Study of Economic Science as a

prartclt cf’L’cttccatior2 for all Classes. By W. B. HODG-sox, LL.D. London: Parker and Son.

WE have already had occasion to notice the earlier lecturesof the course recently delivered at the Royal Institution, andhaving now before us the concluding ones, can only reiterateour good wishes for the success of the lecturers in a path soworthy of scientific and benevolent men as in the encourage-ment of the masses to strive at the attainment of the advan-

tages of the learned; the invitation, in fact, to become partakersof the mental feast which the lecturers one and all have helpedto spread. Both the subjects now before us need but littleargument, in order to show their importance more or less toevery one, and especially with regard to physiology is there adeplorable degree of ignorance amongst the multitude. Mr.

Paget claims regard for this branch, more especially as a meansof mental cultivation, in contradistinction to the more exactsciences, on the ground that it trains the mind to the contem-plation of its own imperfections, by revealing the extent of thefield for enterprising investigation and curious research, andby its very uncertainty counteracting the dangerous tendencyto that fatal vice or folly, intellectual arrogance. Dr. Hodgsonably defends economic science from the attacks made so

wantonly upon it by those who lay at its door the imperfec-tions of its professors, in the same way as religion has beencharged with the crimes of those bigots and zealots who havepersecuted in its misused name.

It is gratifying to be able to say that the promise afforded bythe commencement of this course has not been injured by itsclose ; and important and wide as have been the subjectstreated of, they have been touched in an earnest and unpe-dantic spirit, worthy of admiration and imitation.

Contemporary Medical Litreature.

AMPUTATION IN COMPOUND FRACTURE WITH GANGRENE.

ONE of the greatest questions in practical surgery is theperiod at which amputation should be performed in compoundfracture when gangrene supervenes. For a long time therehave existed two parties in the profession which entertainexactly opposite views upon this point. One contends that

you should not operate until the gangrene has ceased to spread,

and that the line of demarcation has been fairly established.This party is headed by the celebrated Pott, and we findamongst its ranks, besides many eminent surgeons, the lateMr. Colles, than whom there was no higher authority on apoint of practice. The other party maintains that the operationmay be performed while the gangrene is spreading. It isheaded by the distinguished Larrey, and we find Guthrie andmany other surgeons of repute following on the same side.....If within a certain period no disposition to an arrest of thegangrene appears, we ought to operate while the patient isstrong enough to bear it. Should, however, the gangrenespread quickly, accompanied by great prostration of strength,delirium, and rapid pulse, the operation is inadmissible.-Dr.WILMOT in Dublin Hospital Gazette.

TUBERCLE AND INFLAMMATION.

The opposing theories of the innammatory or non-inflam-matory origin of tubercle have their supporters. There is no

good reason for adhering exclusively to either theorv. Thattubercle may arise as a mere lesion of secretion may be admit-ted, while it it not inconsistent with such admission to advancethat it is often the effect of low inflammatory action longcontinued, and therefore amenable to treatment, and in thisform demonstrating to us the great practical importance of sub-duing such treacherous forms of inflammation, whether pul-monary, cerebral, or abdominal, that left unchecked wouldultimately end in its formation.-Dr. LAW, op. cit.

PERIOD AT WHICH A DROWNED BODY WILL FLOAT.

A man, named Shoemaker, was alleged to have been drownedon the 4th of September; the body was found floating on the7th of September, three days afterwards; if it were universallytrue that bodies do not float until decomposition takes place, (inthe waters of the Hudson under from six to ten days,) then this’could not be the body of Shoemaker. Amongst the conflicting’evidence given on the trial was the following-Dr. Benj. Budd,.assistant-coroner in New York, had had occasion to see manydrowned bodies, say 150. Never knew a body to rise in lessthan six days, unless some mechanical means were used to raiseit. Should judge the body found to have been in the waterfrom ten to twenty days. Has never known a body to be inthe water less than seven days that was mutilated by fishes.Bodies that have been hooked up in three, four, or five dayshave not that. peculiar bleached appearance as those present.that come up in from seven to ten days. On the other hand,Henry C. van Wie, four years coroner of the county of Albany,had held a good many inquests on drowned bodies. Has knowntwo or three instances where the bodies have risen in three orfour days. They will bleach out directly in warm weather.They will be mutilated by fishes directly after decompositiontakes place. Remembers an instance of holding an inquest ona body that drifted ashore, and had been drowned four, five,or six days. Had held in one season inquests on fifteen infantsunder three months old, found floating in cigar-boxes, near thecity of Albany; cases doubtless of infanticide.&mdash;.P/t:7ct<MAtO!Medical and SU1’gical Journal.

HOW LONG CAN A PERSON REMAIN UNDER WATER AND

RECOVER?

A youth, named Ritter, recently fell into Elk river, in NewEngland, and remained in deep water fifteen or twenty minutes.before he was brought up, when he recovered as from a regularepileptic fit. He was crossing on a log, when he was seized bya paroxysm of this disease&mdash;epilepsy&mdash;to which he was subject.- Op. cit.

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VENESECTION.

It may be very well to refrain from bloodletting in the treat-ment of feeble or unsound patients in large citaesp but whatwill our provincial friends say to the wholesale interdiction ofthe lancet? That we do not now bleed as we formerly did, is.obvious enough; but do we err in the opposite extreme ? Wehave ourselves "a theory" that it might be better at once todiminish the quantity of the circulating fluid than to render itunfit to support life, or repair injury by slops and physic.By the way, if it is so bad a practice to bleed, how does ithappen that we have so much leeching and cupping, especiallyin private practice? These questions are worthy of consideration,both in a pathological andmedico-ethical point of view.&mdash;.DnHtMed. Press.

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