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from the head through the jugular had assumed this colour,showing that by this time some of the poison had made theround of the circulation. The pupil was widely dilated. The

respirations outlived the circulation. He considered antimonya dangerous medicine.

Dr. AYEES inquired into the condition of the mucus in thealimentary canal The rigid mode of inquiry pursued by Dr.Richardson was the only form of research that could givecorrect information as to the action of medicines.

Dr. E. SMITH, in reference to a remark by Dr. Snow as to the depressing effects resulting from rubbing antimony into the i,skin in cases of phthisis, sxggested that such depression might Iarise from the irritation and pain that was set up, rather than !,from the absorption of the agent.The author having replied, the Society adjourned. i

PATHOLOGICAL SOCIETY OF LONDON.MR. ARNOTT, PRESIDENT, IN THE CHAIR.

Dr. QUAIN exhibited, for Mr. Rae, of Greenwich Hospital,a specimen of

ANEURISM OF THE HEART.

Edward S-, aged seventy-five, seaman, was admitted intothe infirmary on the 1st of August, 1855, for disease of theheart and bronchitis. When first seen, the heart’s action wasfeeble and irregular, with a very loud bruit, obscuring bothsounds, and heard over the whole chest, but loudest at theaortic cartilage and best at the left apex. Whilst under treat-ment he had frequent attacks of dyspnoea; he was never, formany days, free from anasarca of the lower extremities; andat one time the peritoneal cavity was distended with serum.He died during a fit of dyspnoea, on the 14th of February, athalf-past eight P.M. He had long suffered from cough, dyspncea,and palpitation, and had periodic attacks of gout.Autopsy twenty-two hours aftc,2, death.-Body much emaci-

ated. Lungs slightly emphysematous; posterior part of bothmuch congested ; bronchi congested and tumefied ; old pleuriticadhesions on both sides. Liver fatty; its edges rounded.Spleen smaller than usual; greater part of capsule coveredwith a thick layer of hard fibrin. Kidneys granular; corticalatructure of a light grey colour; capsule easily separated.Heart: pericardium contained about three ounces of serum.The organ, which was in a state of fatty degeneration, weighedthirty-one ounces. The aorta was extensively ossified; theaortic valves were incompetent. An aneurismal sac, the sizeof a walnut, was observed between the posterior wall of theleft ventricle and the septum; it extended through the latter,forming a smaller secondary cyst in the wall of the right ven-tricle. From this point it extended downwards towards theapex of the right ventricle, where it seemed to open indirectlyamongst the tubercles.The specimen was chiefly interesting, in a pathological point

of view, as illustrating the formation of cardiac aneurism.Dr. QUAIN, for Dr. BLACK, of Chesterfield, exhibited a por-

tion of bowel, and read the particulars ofA CASE OF ILEUS, PRODUCED BY INVAGINATION OF A PORTION

OF BOWEL, WHICH WAS SUBSEQUENTLY DISCHARGED BYSTOOL.

A young man, aged eighteen, by trade a quarryman, in strongand robust health, was, on the 25th of March, 1855, afterhaving two hours previously partaken of a hearty meal of porkand baked pudding, seized with severe pains in the abdomen,which came on in paroxysms, shortly followed by vomiting.The symptoms continued increasing in severity, and medicaladvice was sought, when remedies were administered with theview of relaxing the bowels, which had not been relieved sincethe first occurrence of pain. For three days, purgative medi-cines by the mouth, with enemata, were administered withouteffect. The symptoms already existing were aggravated, towhich were added those of hot skin, thirst, furred tongue,quick, hard, and wiry pulse, and stercoraceous vomiting. Hewas bled by leeches; fomentations and subsequently blisteringwere had recourse to. On the 29th, Dr. Black saw the patientfor the first time, when he found all the symptoms of generalperitonitis accompanying those of ileus present. The painand tenderness were particularly marked in the neighbourhoodof the ileo-caecal valve. Up to this time, the bowels had notbeen relieved in the natural way. The treatment pursued hadfor its object the arrest of the existing inflammation. Effer-veseent medicines with hydrocyanic acid, and calomel with

opium, were given every two hours, whilst local depletionby leeches, followed by constant anodyne fomentations, andthese ultimately followed by a repetition of blistering, wereapplied externally. During the four following days, themore urgent symptoms gradually subsided. By very carefulmanipulations of the abdomen, between the umbilicus andpubes, a distinct succussion was both felt and heard in thesubjacent viscera in the right inguinal region. In no otherpart of the abdomen could this sensation be produced, norcould any tumour or isolated swelling be discovered. Here,then, was the seat of the obstruction. The symptoms greatlyimproved, the gums were tender, but there was no evacuationfrom the bowels. During the tenth and two following days,warm enemata were had recourse to; and it was not until thetwelfth day that any feculent matter came away. Castor oilwas now administered, vrhen several scanty evacuations wereproduced, which were repeated daily until the nineteenth day,when, at intervals of several hours, the patient had three-evacuations, one of which was seen by Dr. Black, and consistedof blood of a bright colour, from a pint to a pint and a halfin quantity, and mingled with many pieces of what proved,on examination, to be portions of the small bowel, one of thelargest of which was laid before the Society. Dr. Black was in.formed that the two other evacuations were of precisely thesame character. The patient was pale and weak, and com-plained of considerable pain and soreness in the right iliacregion. There being, in addition, a disposition to purge,opiates and astringents were had recourse to. Milk diet, withfarinaceous food, was ordered. The patient was convalescentat the end of the sixth week. Dr. Black observes that thecase is interesting in three particulars :-

1st. The nature and seat of the obstruction.2nd. The mode in which the obstruction was produced.3rd. The effect of the treatment adopted.Having dwelt on each of these particulars, Dr. Black next

observes : " For the occurrence of invagination in a bowel likethe ileum, it seems to be requisite that there shall be paralysisof one portion of it, with at least normal peristaltic action ofthat portion immediately above the paralysed part." Paralysis,then, being one essential condition of such iliac invagination,how is it produced? Dr. Black says, in one of the followingways, viz. :-

1st. By a simple loss of innervation in some portion of thetube.

2nd. By a matting together of its muscular fibres, from in-flammatory exudation, and by the consequent abolition of theircontractile power.

3rd. By mechanical distention from within, owing to thepresence of alvine concretions, &c.; or by such an amount ofpressure externally to the gut, that the peristaltic action of thelatter remains more or less abolished even after the removal ofthe exciting cause.

r In support of the foregoing propositions, a very elaboratepaper was read.

Reviews and Notices of Books.Physical Exploration and Diagnosis of Disease affecting the

Respi2-ato)-y 02,gct?is. By AusTmr FLINT, Professor of the-Theory and Practice of Medicine in the University of Louis-ville, &c. pp. 636. Philadelphia, 1856.WE are informed by Dr. Flint in his preface that the number

of American practitioners who give much attention to the

principles and practice of physical exploration is very small,the advantages of the latter being practically rejected by alarge proportion of the medical profession. We are afraid Wemust cast the same judgment upon our brethren in GreatBritain. Some will exclaim against this we doubt not; butsuch reclaimers must bear in mind these terms of the proposi-tion-viz., much attention by a very small number. Take the

number of practitioners from Caithness to Cornwall, and askhow many are in the daily habit of practising auscultation?We cannot join our author, however, in assigning the samecause for our own deficiencies as he brings forward for theshortcomings of the American profession. He thinks the lattermay be in a measure due to the paucity of works treating onthe subject specially, and with a degree of fullness comm -surate with its importance. Whatever may be the case in

547

America, such does certainly not hold good here, and the rowof books now before us on our shelves, and the remembrance ofthe clusters of stethoscopes which have this very day fed oureyes, would exclaim against our assigning any such wants forthe neglect of physical exploration at the present day. What

then is the cause of it? Simply this: physical exploration, toba worth the time and trouble it comparatively causes bothpatient and practitioner, must be M)’e. Few students passinto practice with more than a vague and uncertain knowledgeof its principles, and this knowledge more one of words than of8eW. Left to themselves, on their first recourse to it, they getbewildered or uncertain as to the nature and signification of itssigns, and as practice increases, time becomes more precious, andthey are the less inclined to search for a jewol, the value of whichthey are in doubt of when they succeed in discovering it. And

to our mind it appears this must continue to hold good untilvery great changes take place in medical education. Let anyone acquainted with the general principles of auscultationreflect that three winter and two summer sessions constitutethe time in which the English student is initiated into the Ipure and collateral medical sciences from clinical medicine and Ifsurgery to botany and the "decompositions"!! That during ’,this period he is often an assistant to another when he isunable to assist himself, and that the utmost ingenuity is oftenexerted to talk over or "petition," as it is called, the Collegeor the Hall to " let him up" before the time ! ! ’,Such an one can then judge with how much knowledge of

auscultation the student is launched into practice, and how farworth the latter’s while it is to go on like Messrs. Feeble and ’,Potter, of high-art notoriety, in spending much time upon thatwhich turns out to be of no use to him after all. Auscultation, ’,to be a staff worth leaning on, must be trustworthy and sure,and it is a staff like that of the .e-ctyef—one requires to ilearn how to use it.Dr. Flint has sought to supply, by the volume before us, the

want he conceives to exist in the literature of auscultation. Hehas given us between 600 and 700 pages, devoted to the respira- ’

tory organs, and certainly no one can now complain that Americais deficient in a full and systematic treatise upon this importantbranch of diagnosis. But with all respect to Dr. Flint’s abilityand intention, we are at a loss to conceive in what way thepresent treatise can displace so complete a work as that ofour countryman Dr. Walshe. Neither are books which arefit to be initiatory works for the student; there are othersmore applicable to this purpose, and we have not been able toperceive the advantages the American treatise possesses overthe English one, for the advanced student or somewhat per-fected practitioner. It is only infinitely more difflise, and cer-tainly less original in its form and matter, and we do not:find, after its perusal, sufficient warranty for the very extendedmanner in which Dr. Flint has drawn out his subject. Hadthe author attempted a work about one-half the size of the

present, we think he might have produced a useful manual forthe American student; but his ambition has led him towardsanother project, in our opinion already sufficiently well at-tained for the present, and the result is such as we havestated. The work is writtep, too, in a manner which, beyondany work we have read for some time past, leaves the leastpermanent impression. Except as regards chronic pleu1’isy- ,

a subject Dr. Flint is master of-we can call up no vivid pic-ture, of sign, symptom, or disease, before our eyes. We arebound to say, however, the author proves himself quite up tothe advancements of the day, and is well acquainted with theliterature of auscultation and of diseases of the chest. Of the

special features of Dr. Flint’s labours, the following extracts5i11 sufficiently inform our readers. The author has j

"striven to make the work as practical as possible, andtherefore the various topics are considered with almost exclu-sive deference to their direct clinical bearings. Very littleattention is devoted to theoretical questions. To the mecha-nism of physical phenomena relatively small space is accorded,

recognising, as the only safe basis of our knowledge of theirsignificance and pathological relations, clinical facts taken inconnexion with morbid anatomy, and believing that à IJ1’iorideductions from the laws of physics, or analogical inferencesfrom experiments made out of the body, and even with thedead subject, are to be received with great circumspection.......With respect to certain signs, the views which I have been ledto form from personal observation are original. I may parti-cularise here the characters of pitch, distinguishing the respira-tory sound commonly called rude, or t’OMA, and which give toa prolonged expiration its significance as a sign of increaseddensity of lung, from tuberculous or other solid deposit; alsothe relative pitch of the inspiratory and expiratory sounds in,the cavernous, as contrasted with the bronchial, respiration,Other points, not dwelt upon by writers on this subject, whichI may mention in this place, are the importance of determin,ing the line of the interlobar fissure as a means of distinguish-ing between the percussion dulness of lobar pneumonitis andliquid effusion, and the clinical value of the souffle, or bellowssound, accompanying the act of whispering, as a sign of solidi-fication. "-pp. vi. vii.With reference to the views of Skoda, Dr. Flint remarks,

that

" The theory of consonance, by which this author attemptsto explain some of the most important of the physical signs,and upon which he bases certain practical conclusions, appearsto me very far from being satisfactorily established. In hisclassification and designation of physical signs, I am unable toperceive that aught is gained in clearness or simplicity. Someof his assertions pertaining to matters of simple observation.involve a denial of the positive results of the experience, not ofone, but of nearly all, observers. For example, that thecrepitant rhle, as described by Laennec, is rarely heard inpneumonitis; and that the percussion resonance is not affectedby the presence of isolated tubercles in any very considerablequantity, unless accompanied by an altered condition of theinterstitial tissue. "-p. viii.

’’ The only innovations I have ventured to propose are, thesubstitution of a new name for rude or roug7t respiration-viz.,broncho-vesicular, and the use of the terms vesaculo-tynapanitieresonance, applied to a percussion-sound combining thetympanitic and vesicular qualities, and 5<’OMC/M-c<M’/K?Mrespiration, denoting a mixture of the cavernous and bronchialmodifications of the respiratory sound."-p. ix.The substitution of pncum01’rhagia for pulmonary apoplexy,

of pneumonitis for pneumonia, of plcuralgia for pleurodynia,we have also noticed; as also the excellent index possessed byDr. Flint’s work.

___

CHEMISTS’ WEIGHTS.7’0 the Editor of THE LANCET.

SiR,-The Annoyance Jury for the city and liberty of West-minster, having recently brought before the Burgess Court thecircumstance of several of the chemists in their district whowere retailing drugs, &c.., by weights which had not beenstamped with the Westminster stamp, and that the jury inconsequence had inflicted fines upon the parties, the subjecthas been considered by a full Court, and the following decisioncome to-viz., believing that it was not the intention of solarge a body of respectable tradesmen as the chemists anddruggists of Westminster to commit a wilful evasion of thelaw :-Ist.-The Court remit the whole of the fines levied by the

jury.2nd.-That in future all weights in use by chemists, &c.,

living and trading within the city and liberty of Westminster,must be marked with the Westminster stamp, from one grainupwards; but weights below one grain need not be marked.

3rd. -To avoid any chemist, &c., being taken by surprise,three months’ time will be allowed for the purpose of havingtheir weights stamped; after which time, all fines levied bythe jury will be confirmed by the Court, and the fines en-forced.

Thinking the above information might be useful to a verylarge number of your subscribers, as well as to the chemists ofWestminster in general, I have much pleasure in sending thisto you for insertion in your next number, should you thinkproper to do so.

I am, Sir, your obedient servant,I am, Sir, your obedient servant,WILLIAM CRIBB,

One of the Burgesses of Westminster.