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Let us now endeavour to render an account of these pheno’mena; but first of all I should describe the experimentswhich I made in a more exact way with the view of studyingif any electricity were developed by muscular contraction.After preparing a number of frogs in the usual manner ofgalvani, I removed the legs by disarticulating them with theutmost care. I had thus the two thighs of a frog in unionwith a portion of the spinal cord. I cut one of the thighs inhalf, and then prepared in the same manner a certain numberof similar elements, formed of an untouched or unmangledthigh, a portion of spinal cord, and a half-thigh. It is easy tounderstand how with These elements I form a muscular pile,by applying the external surface of the entire thigh uponthe internal surface of the cut thigh of the element nextsucceeding. I afterwards plunge the two extremities ofthe galvanometer (which are so constructed as to pre-vent the necessity of my holding them by the hands tokeep the circuit closed) into the liquid in which thetwo extremities of the pile terminate. I repeated this

experiment a great many times, with piles of twelve, sixteen,or twenty elements. The first, as well as the permanentdeviations, were sometimes more feeble than those whichwere obtained with piles composed of an equal number ofhalf-thighs. This difference must principally be attributedto the greater length and resistance of the circuit. In allthese cases, (after allowing the needle to settle itself at adeviation which, in my different experiments, varied from ten,twelve, or fifteen degrees,) I rapidly touched the lumbar plexusbelonging to the elements of the pile with a sufficiently con-centrated solution of potash, excepting, however, the two last,from the fear that the solution might reach the liquid in whichthe extremities of the galvanometer were plunged. Muscularcontractions immediately followed the application of thealkali, and continued for some seconds, but without beingscarcely ever so violent as to destroy the contact of the ele-ments with each other. During these contractions (if theexperiment be continued without any interruption or changein the circuit) the needle of the galvanometer remains sta-tionary. In some cases, however, I saw the needle descend,and in others rise, two or three degrees; but these variationswere uncertain, and were absent in the greater number ofcases, and were nearly always due to some very powerfulmovements in the elements, which interfered with their per-fect contact.We may conclude, then, that direct experiment negatively

answers the question whether any electricity is developedduring muscular contraction.

It now remains for me to explain the phenomena which arepresented by acting upon the proper current with entire frogs.When the lumbar plexuses of the frogs are touched for thefirst time with potassa, signs of augmentation are nearlyalways obtained; whilst, on the contrary, by treating themwith an acid solution, the needle immediately descends. Ihave repeated and varied for this purpose my former experi-ments ; and observe in what manner these differences maybe explained.Whatever be the form of the muscular elements which are

employed in the construction of the pile,-whether entirefrogs, half thighs, or those which I have just described,-onwetting the surface of these elements with an acid or

alkaline solution, it constantly happens that there are

no contractions, the deviation diminishes, and the needlereturns to 00, where it remains fixed, if the applicationof the alkali be repeated, or if a very concentratedsolution has been used. This effect is analogous to thatalready described, and which those muscular elements pre-sented which had been plunged for some seconds in the acidor alkaline solutions. In the mode of experimenting whichwas adopted, contractions were excited in the muscles ontouching some points with the alkali, which were in a mannerout of the circuit, and which certainly did not constitute partsof the electro-motor element. In the piles formed of entirefrogs, with which we succeeded most frequently in obtainingtransiently signs of augmentation in the current, by touchingonly the lumbar plexuses with the alkali, we touch those trueparts which constitute the electro-motor element, and even inthese cases we never procured signs of the current when wemoistened the muscular surface. I may add, also, that inusing the acid solution, taking care to touch with the forcepsthe lumbar plexuses only, and not the muscles of the thighsor legs, the deviation was not weakened; and notwithstandingthe contractions which were excited, although these were lessstrong than those produced by the alkali, there was no in-crease of the deviation. To see the needle descend it isnecessary to touch the surface of the muscles with an acid or

an alkali; and it will be seen that this agrees with the expe-riments which I related upon the muscular elements whichhad been plunged in acid or alkaline solutions.

It is, then, only with the pile of entire frogs, and by touch-ing only the lumbar plexus with the acid or alkali, that aslight increase of deviation is obtained. On looking back onall the experiments which I have adduced, we must regardthis result as contrary to the negative response which wegave to the question of the development of electricity bymuscular contraction.

If even slight attention be paid to these facts, it is im-possible not to perceive how great is the difficulty which wefind in explaining why, in the particular case of which wehave spoken, the alkali can produce an increase of deviationin the proper current of the pile formed of entire frogs. Iam induced to believe that from the alkali exciting strcugerand more permanent contractions in the muscles than thoseexcited by the acid, it results that in the greater number ofthe cases, these contractions must render the contact betweenthe several elements more perfect, and that, consequently,the interior conductibility of the pile is augmented. In fact,in the pile formed of entire frogs, the contact between theseveral elements are always very imperfect, and some greatdifferences have been remarked in the intensity of thecurrent produced by the same elements, according as theyhave been placed with more or less care.Whatever explanation is given of the slight increase mani.

fested in the intensity of the proper current by touching withthe alkali the lumbar plexus of the frogs, and giving rise to somemuscular contractions, it is certain that this fact alone cannotlead us to affirm that there is a development of electricity inthe muscular current, any more than all those above relatedlead us to conclude that this development does ’not takeplace.

Hospital Reports.ROYAL FREE HOSPITAL.

Reports of Cases by WEEDEN COOKE, EsQ., Resident Surgeon.

Fever, with Intestinal Hcemorrhage and Delirium Convalescence;subsequently Otitis Interna. Death ; Post-mortem Examination.CASE 1. - Seraphine G-, aged twenty-five, an Italian

image-boy, was admitted Nov. 9th, 1846, under the care ofDr. Peacock. He stated himself to have been ill fourteendays; but from the disturbed state of his mind no correcthistory could be obtained. The pulse was 120; there wassome tenderness of the abdomen; and the tongue was dry,and covered with a cracked, brown fur. Nitric acid and hen-bane every three hours, and ten grains of Dover’s powder atnight.Nov. 10th.-Has passed a pretty good night, but moaned

much during his sleep; the bowels have been twice relieved;the first time he passed a large quantity of dark blood, and ablack sediment fell to the bottom of the vessel; it was veryfcetid, and there was no foecal matter with it; the pulse is104, quiet and weak; the tongue dry and brown; there issome inflation of the abdomen, and tenderness, especially inthe right iliac region; he has made water freely. To continuethe acid mixture, and have one grain and a half of acetate oflead, with half a grain of opium, three times a day.llth.-Pulse 100, quiet, and very compressible; tongue dry

and brown; cheeks much flushed; he was delirious duringthe night, and made attempts to get out of bed; the bowelshave been relieved four or five times since yesterday, and theevacuations consisted almost entirely of fluid blood, of a darkcolour; there is considerable inflation of the abdomen, andsome tenderness, especially in the right iliac region; therespiration is natural; he is much collapsed. To have fourounces of port wine, and a blister to the back of the neck.13th.-Pulse 100, of moderate strength; tongue dry, glazed,

and morbidly red, with the papillae projecting at the tip andedges; face somewhat flushed ; conjunctivse injected, andpupils somewhat contracted; he has a slight cough, and hasbeen delirious during the night; this morning he was soviolent as to require restraint. He now appears more intelli-gent, but has much tremor of the hands and arms; there isless appearance of prostration; the abdomen is less inflated,tense, and tender; the skin is moderately warm; the bowelswere several times acted upon on the Ilth, but only onceon the 12th, and once this morning ; yesterday the stoolscontained no blood, but a considerable quantity passed withthe evacuation to-day, and was mixed with faecal matter;he has taken the wine and some beef-tea each day; he

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slept Yesterday, but last night was restless and deliriousthroughout. To take the acetate of lead and opium pills onlytwice daily; otherwise to proceed as before. ’

14th.-Pulse 116, quiet, and of sufficient volume; skin dry ’,and moderately warm; some abdominal tenderness; tongue .ery red and dry, but not much furred; was extremely rest- i

less and delirious at the early part of last night, but slept alittle this morning; there was much tremor; the bowels havebeen once relieved; the evacuation was solid and very offen-sive in smell; it contained no blood; he has a little cough.To omit the pills, and take the acidulated infusion of roses,-with half-drachm doses of tincture of henbane, every threehours. The head to be shaved, and another blister applied.l6th.-Pulse 108, small, feeble, and quiet; tongue moister

and cleaner; less appearance of prostration ; bowels relievedonce daily; stools fluid, but free from blood; on the nightof the 14th he was restless and delirious, last night he slept;there is to-day no tremor; he has had hardly any wine sincethe 14th, but takes boiled rice and milk; he refuses the beef-tea. To proceed as before.

lth.—He has passed a comfortable night, and was notdelirious; there is no return of the haemorrhage; the bowelshave been once relieved, and the stool looked healthy; thetongue is large and chapped, and somewhat dry; the pulse100, feeble, and very small; the skin moderately warm, butdry; he passed water in bed last night; he has a very slightcough, but no expectoration; he takes his food well, and doesnot complain of thirst ; there is an appearance of weightabout the eyes; he had three ounces of wine yesterday, andwas not flushed after it; there are four or five small, veryslightly acuminated spots, on the lower part of the abdomen,which fade on pressure.18th.-Pulse 116, fuller; he has, however, just taken a

little wine, and his face is flushed; the skin is warmer thanbefore; has passed a good night, and was not delirious; thetongue is large and chapped, red at the sides and tip, brownand dry in the centre; the eruption noticed yesterday hasnot increased, but is, on the contrary, nearly gone; in itsplace there are numerous sudamina at the sides of the abdo-men and chest, and especially on the right side; the skin ofthe abdomen is cool and moist; he had a slight perspiration,but only on the face, this morning. He has taken two ouncesof wine.19th.-Pulse 108, fuller and stronger; tongue much more

moist, and a white fur scaling off; it is still red at the edgesand tip; he slept comfortably last night, and was not delirious,but moans a little; the bowels have been once naturallyrelieved; the spots can still be seen on the abdomen, buthave not become more numerous; the miliary eruption hasextended, more especially on the right side of the trunk, andthe sudamina are much larger; the skin is cool, and notespecially moist; he had, however, a profuse perspirationabout seven o’clock last evening, which lasted nearly half anhour, and was chiefly confined to the face and back; he wasnot more moist than usual in the parts where the sudaminaexist; he makes water freely; the wine flushes him, but hetakes the broth well. To omit the wine entirely.

2Qth.—Pulse 104; tongue dry, brown, and chapped; thesudamina are disappearing; the papular eruption is gone; thepapillae of the skin of the surface generally are elevated andshining ; he perspired freely on the face and head this morn-ing ; the bowels were once relieved yesterday, and the eva-cuation was somewhat solid; he has passed a good night, andtakes his food well; the urine is passed in good quantity, andis clear, though high-coloured. To take a dose of castor oil,and substitute in the mixture the infusion of cascarilla forthe infusion of roses.21st.-Pulse 100, feeble; tongue dry, slightly brown, and

chapped; skin cool and moister; papillae less prominent andrigid; stools natural; urine natural; sleeps comfortably.23rd.-Pulse 120; tongue dry, red, and chapped; skin some-

what drier and warmer; has no cough; the bowels have notbeen relieved since yesterday; he makes water freely; doesnot take his food quite so well as before, but sleeps com-fortably at night. A slight mercurial at night, followed bycastor oil in the morning.

2th.—Pulse 124, quiet; the bowels have been comfortablyrelieved this morning; motion fluid, but healthy; the skincooler and moister; the tongue whitish, dry, and chapped;the face continues flushed; he has a slight cough, and thereis a xood deal of dry mucous rate in the chest. A blisterbetween the shoulders.

25th.—Pulse 112, quiet; skin cool and moist; tongue clean,still red, and chapped; bowels not relieved.

27th—Pulse 112, quiet, feeble; tongue clean, but red, large,

and chapped; bowels twice relieved by castor oil; he takeshis food well.

29th.-Pulse irregular, intermittent, and feeble, from 115to 120; tongue large, chapped, and somewhat dry; skin cooland moist; takes his food well; bowels only relieved when hetakes the medicine. Ordered meat and porter.

Dec. 1st.—Pulse 140; he has just had his porter; tonguestill dry, glazed, and chapped, and a little whitish towardsthe root; skin cool, but dry; great improvement in generalappearance; he takes his food well, but has still some littlecough.3rd.-Pulse 136, small, and feeble; bowels torpid, and only

relieved after medicine. Ordered a vegetable tonic and arhubarb pill each night.8th.-He is up to-day for the first time.15th.-Has continued to improve, but is still weak. Dis-

charged.The weather was extremely cold when he went out, and on

the 18th he was brought back. No history could be obtainedof what he had been doing during the interval. He was,however, when admitted, very much collapsed; scarcelycapable of walking, and nearly insensible, only answering bya monosyllable to any questions put to him, and not reco-gnising those around him. He was directed to have stimu-lants given to him, to have a cold lotion applied to the head,and a blister to the back of the neck. The following nighthe was extremely delirious, shouting almost constantly, andstriking with his hands and feet. He had, at eleven A.M.on the 19th, two grains of opium, and again at five; and afterthese he slept some hours. On the 20th, the collapsehaving increased, and his delirium being rather that ofdelirium tremens than of inflammation, half an ounce ofbrandy was given every two hours, and three grains ofcalomel and one of opium; and the stimulants, with largedoses of tincture of’ opium, were continued. On the 24th, hewas decidedly quieter, and that day a discharge made itsappearance from the ear, which increased to a considerablequantity; under this he became much more intelligent.The opiates and brandy were discontinued for a day ortwo, and he was now directed to have porter and beef-tea.The improvement was, however, only slight, and he graduallysank, becoming weaker and more comatose, till the 3rd ofJanuary, when he died. During the progress of this attack,he had no distinct convulsion or paralytic symptoms. Hewas at first much collapsed; but under the use of stimulants,his face became flushed somewhat; the lips of a naturalcolour; his pupils were at first somewhat large, subsequentlythey became moderately contracted; and the conjunctivae,from being pale and glassy, were a little injected. He wasapparently very deaf during the course of his last illness, andthe hands and feet became extremely livid.

.Mopsy.—The lungs, heart, liver, and kidneys healthy.Spleen large, moderately firm. The stomach and duodenumwere healthy. The lower part of the small intestines weremuch congested externally. Towards the lower part of theileum there existed the remains of ulcers of the glands ofPeyer, nearly level with the rest of the mucous mem-brane, and nearly healed. One only displayed the fibresof the muscular coat at its base; the ulcers were

surrounded by membrane of a black or dark leaden hue.The ulceration in the neighbourhood of the esecum had evi-dently been most extensive. The caecum was healthy, andcontained yellow and moderately solid fasces. The small in-testines were contracted and empty. The minuter glands inthe neighbourhood of the ilium and caecum were moderatelylarge and firm-generally leaden-coloured; one was largerthan usual, and of a rose-colour, but of natural firmness. Thebrain weighed forty-eight ounces and a half, of which thecerebrum was forty-two ounces, the cerebellum five ounces.and a half, and the pons and medulla one ounce. There ex-

isted copious subarachnoid effusion, elevating the membraneabove the level of the convolutions. The ventricles also con-tained a large quantity of clear, limpid serum, and some es-caped from the base. The substance of the brain was firm,sparingly engorged, and in every respect apparently healthy.The sinuses and membranes at the base were free from anyappearance of disease. A considerable quantity of pus welledfrom the ear in performing the dissection; and on laying openthe internal ear the membranes of the tympanum were foundthickened, softened, and broken down. The cavity was filledwith pus, and the same existed also in the canals communi-cating with the tympanum, and in the cells of the bone. Thelining of the cavity was softened and abraded, and readilyseparated from the bone; but the bone itself presented no ap-pearances of disease.

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Abscess of the Cerebellum ; Discharge from the Ear; Death;Post-7r,ffj-tem Examination.

CASE 2.--A delicate female, of small stature, aged twenty-five ; under the care of Mr. Gay; had complained of pain inthe right side of the back part of the head, recurring everyevening for four or five years; it came on about seven P.M.,and increased in violence until midnight, when it subsided;there had never been any symptoms of paralysis, and thecatamenia were regular. These pains became gradually moresevere, until a month before her death, when a discharge ofmatter took place from the right external meatus, with con-siderable relief to her suffering. She continued, however, tohave the nightly attacks, and on the night of the 14th ofSeptember the pain returned, became intensely severe, sud-denly subsided, and she immediately died.

Autopsy.-On removing the brain about half an ounce ofthick, yellow pus, was discovered in that portion of the skullwhich contained the right lobe of the cerebellum, from whichit had obviously escaped, within a short period before death,by a small, round, ulcerated opening at its base. The centreof that lobe was filled with thick pus, without any distinctcyst, the cineritious substance forming its walls being softenedand broken down. The dura mater, arachnoid, and pia mater,just above that part of the petrous portion of the temporalbone which forms the posterior wall of the external auditorycanal, were ulcerated, and this ulceration exactly correspondedwith the point at which the pus escaped from the cerebellum.The bone itself at this point was denuded and soaked withpus, but not broken down. The mucous membrane of the ex-ternal auditory canal was inflamed, and evidently suppliedthe pus which had been discharged. The membrana tympaniwere sound.

____

Chronic Discharge from the Ear; l.feningitis; AbscessofBrain;Death : Post-mortem Examination.

CASE 3.-Jane R-, aged twenty-three. It appears from thestatement of her friends, that her hearing has been defectivesince she had typhus fever when eight years old, and atintervals she has been seized with severe pains in the head,accompanied by a discharge from the ear, for which she hasbeen treated at an ear infirmary. She has now been an out-patient for a fortnight, but no improvement taking place shewas admitted April 1 Oth, under Dr. Peacock. She complainsof severe pain in the head, and in the right ear, from whichthere is a sero-purulent discharge; the right side of the faceis puffy and oedematous, and pressure under the right ear pro-duces much pain; the pulse is 112, large and vibrating; tonguered at the margin and tip, and brownish towards the centre;sleeps very badly. Ordered eight leeches to be applied aroundthe right ear, and a purgative.

April llth.—Pulse 108, tolerably firm; face turgid; pupilsslightly dilated and fixed; eyes dull and heavy; tongue dryand brown, is partially insensible, and moans continually; sherested rather more last night. To have the head shaved;apply the spirit lotion; a blister between the shoulders; anda saline aperient every four hours.12th.-Has passed a very restless night, and has been

slightly delirious; this morning she spoke sensibly, but saidshe could not see; the moaning continues; the tongue is dryand less brown; the mouth is surrounded by an herpetic erup-tion ; she refers her pain to the back of the head; pulse 132,full, but compressible; eyes dull, pupils somewhat dilated,nearly insensible to light; passes her urine incontinently;there is great tenderness over the whole scalp; the ear dis-charges freely a yellowish, bloody pus; there is no loss ofpower or rigidity of the extremities.

13th.-Pulse 128, feeble; pupils less dilated, sensible to light;she is partially intelligent; states that she feels very poorly,but has difficulty in articulating; feebleness, but no decidedloss of power over her limbs; the catheter has been used, butthis morning she passed water, without assistance, into the pot;the stools are passed unconsciously; the ear discharges less;the tongue remains dry; she is deaf, and complains she cannotsee; the moaning continues, and she takes but little food; theabdomen is distended. Ordered ice to the head, a turpentineenema, and the blister to be kept open by savine ointment.

15th.-Slept a little last night; more intelligence to-day;the tongue is moister; moves her right arm invohmtarily ;takes more food; bowels free; passes her urine in bed; pupilsnatural, and sensible to light; pulse 133, sufficiently strong.

16th.-Since yesterday afternoon she has had several severeconvulsive fits, commencing in the right arm and leg, butsubsequently involving both sides of the body. She is par-tially intelligent; protrudes the tongue, and speaks imper-

fectly ; tongue dry and brown in centre, moist at tip andedges; pulse 140, regular, of good power; pupils dilated andinsensible; stools and urine passed incontinently. The con.vulsions continued at intervals during the next day, and onthe 18th, at six A.M., she died.

Autop,sy, April 19th.- On dividing the right temporalmuscle, a cavity was cut into, containing very foetid pus, andthe bone was found denuded at the upper part of thesquamous portion, over about an inch square; the skull wasof the natural thickness. On dividing the dura mater, a con-siderable quantity of a similar foetid matter escaped from theright side, and from the surface of the -tentorium cerebelli.The superior surface of the hemispheres displayed considerableturgescence of the large venous trunks, and the convolutionson the right side were a little flattened. There was nomaterial subarachnoid effusion; and except on one or twosmall points on the anterior lobe, the arachnoid maintains itsnatural transparency. The Pacchionian bodies were moredistinctly marked than usual. On section, both hemispheresof the brain present their usual firmness, but the quantity ofblood exuding from the small vessels is perhaps increased,There was a small quantity, perhaps two drachms, of a slightlyturbid fluid in the lateral ventricles; and on slicing down to alevel with the corpus callosum, the arachnoid, at the posteriorpart of the longitudinal fissure, was found coated with a softlayer of lymph, and bathed in dark-coloured and very foetidpus, the corresponding portion’of the falx being completelybroken down. On removing the brain, a large cavity, situatedimmediately over the petrous portion of the right temporalbone, of sufficient size to admit the point of the little finger,presented itself; and from this point backwards, the surfaceof the brain is covered by large masses of a soft semi-purulentlymph, and in places is excavated into small superficialcavities. The corresponding portion of the left hemisphere isalso covered with lymph, although to a less extent; as is alsothe tentorium cerebelli and posterior portion of the falx,especially on the right side. The dura mater separateswith perfect ease from the skull, and in the portion corre.sponding to the disease of the temporal bone is coated by amass of soft lymph, probably half a line in thickness. Thelongitudinal sinus, and the left lateral sinus, contain partiallydecolorized but healthy clots; the right lateral sinus is, how-ever, distended with grumous semi-purulent blood, and itslining membrane is of a deep-brown colour, and in someplaces as if ulcerated, in others covered by soft, semi-purulentlymph. The external and internal jugular veins were nearlyobliterated by firm, dark-coloured clots. Some of the smallbranches of the pulmonary veins were obliterated by palelymph, and around them the tissue was broken down, and hada gangrenous odour. There were three or four patches ofgangrene in the lungs, and these organs were generally con-gested. The heart was fatty, and its valves on the left sideslightly opaque from atheroma. The spleen was large andpultaceous; the kidneys slightly granular.

Abscesses of the Brain, producing an Extraordinary Feeble Cu-culation, and terminating in an -apoplectic Seizure; PORI.mortem Examination.CASE 4.-William R-, aged thirty, a sailor, of a sallow

complexion, and much emaciated, was admitted March 30th,1847, under Dr. Beacock. His intellect was very obtuse; hewas loth to answer questions; and would say no more thanthat he had been poorly for three months, and for the lastfew days he had had rigors and a dull pain in his head. Th3

pulse is only 42, and very feeble; the tongue has a white fur;and the bowels are torpid. He was ordered brandy-nd-water and beef-tea, and a dose of colocynth and calomel, to befollowed by a senna draught.March 31st.-He remains in the same listless condition,

making but slight complaint; the pupils answer to light, butrather sluggishly; the pulse has rallied a little, but is still e-,-tremely feeble; the bowels have acted.

April 2nd.-Has passed a’restless night; moaning much;the integuments of the forehead are drawn into a frown, andthe pupils are somewhat contracted, and insensible to theirnatural stimulus; the tongue has a thick white fur at the root;

; and the pulse, 56, is still sluggish and feeble; he is continuallymoaning, and can now with difficulty be aroused; there are no

i paralytic symptoms. Stimulants were now discontinued, andhe was ordered the spirit lotion to the head, a blister to theback of the neck, and to be freely purged with calomel anj

’ colocynth, and the senna mixture. At eight P.M. he vas- seized with strong convulsions, followed JEy coma; the pupi’s- were widely dilated, and insensible to light; he could not 1,,e

249

got to protrude his tongue; and breathed stertorously; the Iright arm and both legs were extremely rigid; and the leftarm in a state of resolution. A dozen leeches, were appliedto the head. He died at half-past twelve the same night.A r;7 4.—The right hemisphere of the brain was

extremely flattened, and the cineritious substance of a palesalmon hue; the convolutions of the left side were flattened,but to a less degree than those on the right. On slicing theright hemisphere, a large quantity of a greenish-coloured pusescaped from the anterior lobe, and a large cavity was hereexposed, situated externally to the corpus striatum; the shapeof it was irregular, and it was surrounded by numerous smallexudations of blood, (capillary apoplexy,) which also werescattered over its bounding cyst; the size of the cavity wassufficient to have lodged a small hen’s egg. Beneath thisthere existed another cavity, which extended into the base ofthe anterior lobe, where it was bounded only by a thin layerof cerebral substance, chiefly the grey matter; this, externally,was of a peculiar leaden hue; the brain here adhered withsufficient firmness to require to be detached by the finger.Besides the large cavity now dissected, there existed a third,on the outer side of the upper surface of the same hemisphere;this would have accommodated a cob-nut; contained a similargreenish-coloured pus; and was bounded by an indurated cyst,which resisted the knife in the section of the hemisphere.The lateral ventricles contained pus, mixed with clear serum;the membranes at the base were opaque and adherent; andthe two hemispheres were firmly united along the longitudinalfissure. The heart weighed nine ounces, it was extremelyflaccid; the coats of the aorta were greatly diseased andthickened; and the rest of the organs, with the exception ofthe spleen, which was large, were natural.

Scrow3 Cyst occupying the Right Lobe of Cerebellum ; Serous Effu- ’

sion M Ventricles; Sudden Death; Post-mortem Examina-tion.CASE 5.-James B-, aged twenty-five, a healthy-looking,

stout man, was early in life trained to boxing, and about fouryears ago had his last encounter, which was a very severeone. Immediately afterwards he was attacked with vertigoand intense pain in the head; he was bled, and underwentother treatment, from which he derived benefit. Theseattacks of vertigo, however, frequently recurred, and as fre-quently he was either cupped, bled, or blistered. He was inthe habit of falling when attacked, but was never known tobe convulsed or paralyzed. He was admitted May 26th,under the care of Mr. Gay. He complains of acute pain inthe back of the head; there are some slight feverish symp-toms, a little heat of skin, and acceleration of the pulse; thepupils are active, and appetite good. To be cupped on theback of the neck to six ounces, and have a calomel purge.May 27th.-No relief from pain in the head, otherwise as

before. Ordered a saline purgative, the head to be shaved,and the whole scalp blistered.28th.-Head somewhat relieved.29th.-He is this morning vomiting, and complains severely

of his head; the bowels are free; pulse 65, slow. Ordered aneffervescing mixture with ammonia, and five grains of calomel.30th.-Has passed a better night, but at ten A.m. apparently

fell asleep, and so died, there having been neither convulsion,alteration of the pupil, nor paralysis, during the time he was inthe hospital.

A1äopsy, June 2nd.-Membranes of the brain normal; theveins on the exterior were extremely turgid, whilst thepuncta vasculosa in the substance were very few, there beingapparently a diminished supply of blood to the interior of thebrain. The ventricles were much distended with clear limpidserum. The foramen of Monro was much dilated and dis-tended by the effused fluid; there was also fluid at the base.The pineal gland was enlarged. The right lobe of the cere-bellum contained an exceedingly thin delicate cyst, distendedwith serum, adherent to ti-ie surrounding tissue, so large thatbut a very thin softened layer of cineritious matter remainedto invest the cyst; and in this remnant of the cerebellum wasdiscovered a small hardened cyst, apparently the remains oian apoplectic clot. The pons Varolii and left lobe of thecerebellum were healthy.

.E<sMa)-.&mdash;The study of cerebral diseases is one pregnant withthe best results: A careful record of the progress of fatal casesand the post-mortem examinations, will help, ten times morfthan the citation of successful cases, to improve our diagnosisand, as a consequence, our treatment of these comparativel3obscure diseases. In scrofulous habits these affections of th(

brain are known to be very rife. How many children areannually destroyed by hydrocephalus; and why ?-because thefirst symptoms are overlooked; the mind is not sufficientlyconsidered as an indicator of the state of the brain. It hasbeen too much the fashion to attribute dulness of intellectand laziness of body to moral causes: they are undoubtedly, inmany instances, but the symptoms of cerebral disease, andshould be taken as warnings of the approaching danger: ithas likewise been too much the custom to attribute headachto some remote cause with which the brain "sympathizers," infact, the brain being locked up from our view, we are naturallyloth to suppose disease which we cannot sensibly perceive;hence it is that numbers of even young persons, in whomtreatment, it may safely be presumed, would have the besteffect, are allowed to die, because the symptoms of earlyremediable cerebral disease are so indistinctly marked, andhave been so little observed. Of the insidious nature of headaffections, connected with discharges from the ear, the casescited are good examples, and much may be gained from themfor future guidance. One of the most important considera-tions for the practical surgeon is, the propriety of promotingor of repressing aural discharges, especially those which theexanthemata so frequently leave in children, and which, inthe commencement, undoubtedly take place from the mucousmembrane of the external ear. In the case of a littleboy in the hospital a twelvemonth ago, under Mr. Gay,the notes of which have been lost, there was, at first, a puru-lent discharge from the ear, which succeeded an attack ofscarlatina. It was unheeded: after a time the child began tocomplain of pains in the head; strabismus of the left eye fol-lowed, then convulsive fits; an abscess formed behind the ear,the portio dura became paralyzed, a large portion of the tem-poral bone, consisting of parts of the pars petrosa and themastoid process, as well as a piece of the frontal, exfoliated,and eventually he died from exhaustion, and during a fit;although, as far as the skull was concerned, perfect mem-branous reparation had taken place. This is the type of aclass of cases by no means uncommon in scrofulous children.We have the discharge from the ear, and headach, occurringat short intervals; subsequently convulsions; perhaps comaand paralysis, and ultimately exfoliation of bone, and death.In such cases, early local treatment has been almost entirelyconfined to soothing applications: such cannot be good prac-tice. The discharge comes primarily from the membrane ofthe external ear; it is the result of diminislied not of increasedaction, and, consequently, gentle local stimulation, combinedwith invigorating general treatment, will be best calculatedto stop a process of suppuration, which, if allowed to continue,will assuredly extend itself to the bony structure of the ear, andeventually to the brain itself. This requires to be insistedupon, because it is so commonly received an opinion, that dis-charges from the ear should not be interfered with; thus mostinconsistently acting in direct opposition to the acknowledgedpractice in chronic suppurative discharges from the urethra /and bronchi. In Dr. Peacock’s case of fever, with subsequentinflammation and suppuration of the internal ear, the deliriumprevented his complaining of earach, which is to be regretted,since an early and free puncture of the tympanum mighthave given so much relief to the vessels of the brain as to haveput a stop to the arachnitis; it was perhaps a hopeless case,but the experiment would have been perfectly justifiable.

In another and more difficult class of cases, where long-con-tinued headach precedes a purulent discharge from the ear,where the pain becomes at length severe and paroxysmal,and has been relieved by the occurrence of the discharge, wehave much reason to suspect an abscess in some part of thebrain, which, according to the general law which appears todetermine these formations, is making its way through the .

membranes and the bone to the external ear; the severer andparoxysmal pains indicating the implication of the mem-branous envelop of the brain, especially the dura mater. Thedischarge of pus from the ear, in these cases, appears to besymptomatic of an ulcerative process, by which Nature wouldrelieve the abscess contained within the cranium, and hassuggested to Mr. Gay the propriety, in such cases, of a careful

. examination of the bony walls of the ear, for the purpose ofascertaining how far they may be involved in the disease; and

, should they be found, as in many instances recorded by Aber-crombie, Brodie, and others, to be softened and carious, he

i thinks it might be feasible to attempt, by a small, strong,, curved trocar, to make a passage towards the suspected cere-J bral abscess, sufficiently large to evacuate its entire contents,, and thus allow of its closure. Considering the importance ofr the neighbouring structures, the two petrosal and lateral} sinuses, the portio dura and Gasserian ganglion, it would bA .

250

undoubtedly a formidable proceeding, but an examination ofthese parts will show it is quite possible to avoid them; andsince the certainty of a fatal result is acknowledged, if therebe no surgical interference of this kind, we should be neglect-ing our duty if we allowed difficulties to thwart us. It mightbe readily noticed in the dead subject, that from the densityand thickness of the portion of the pars petrosa, to whichallusion has been made, its perforation would be, in itshealthy condition, impracticable, and it is only in those cases

I.where caries or softening has taken place, that the means ofrelief here suggested could at all be available.

Original Papers.ON THE

SOURCE OF H&AElig;MORRHAGE IN PARTIAL SEPA-RATION OF THE PLACENTA.

BY W. D. CHOWNE, M.D.,PHYSICIAN TO CHAKING-CROSS HOSPITAL.

(Read before the Royal Medical and Chirurgical Society, June 29th, 1847.)(Concluded from p. 29.)

VENOUS BLOOD RECEDING.

Many have considered that the blood cannot escape fromthe uterine veins into the uterus,-that such escape would beincompatible with the anatomical arrangement of the veins ofthe uterus,-that it would be a backward course, and there-fore does not occur.Every individual vessel of the venous plexus of the uterus

giving lateral support to the fluid passing through it, we knowthat wherever a breach of continuity takes place, or, in otherwords, an opening is made, the support at that point beinglost, the blood escapes.A vein divided by a scalpel, whether on the external or the

internal surface of the uterus, bleeds, and the open and ex-posed orifices of distended veins, on the inner surface of theuterus, would be in no essential point different from woundedveins, and would, so long as they remained distended, bleedalso. Neither is there any impediment to the blood flowingfrom any collateral branches of the venous plexus in any direc-tion, seeing that " the veins of the uterus form a plexus of thelargest and most frequent communications we know of amongthe vessels of the human body;" that these veins are withoutvalves, and, moreover, that however much any particulararrangement in the course and position and distribution of theveins in the substance of the uterus, and the valve-like struc-ture at their orifices, may be relied upon as giving securityagainst escape of blood, such reliance is unfounded, and thearrangement insufficient, and manifestly insecure; and finally,that haemorrhage as certainly takes place from the said veinsas it does from varicose veins, in whatever part of the bodythey may be, even from those of the inferior extremity, not-withstanding the obvious valvular structure by which theyalso are provided with seeming security: instead, therefore, ofquestioning the efficacy of the uterine arrangement, howeversimilar or equivalent it might seem to a valvular arrangement,we are obliged to admit the fact, that it does not answer thepurpose of valves, and that it does allow free, and even fatal,haemorrhage to take place.

It is known, moreover, that fluid passes even freely from thevena cava to the cavity of the uterus, where delivery has beenrecent. I lately passed a tube into the vena cava of a womanwho died on the fourth day after her delivery, and injectedplain water by means of an ordinary injecting syringe. Theonly incisions made were such as enabled me to proceed withthe experiment. The uterus was contracted to about the sizeof the human heart; the fluid passed freely, and escaped by Ithe vagina. A ligature was then put round the vagina, and

I

tied; the injection was repeated, and the uterus became dis-tended with water; the uterus was then laid open, and the

injection again proceeded with; the water flowed freely bothom the venous orifices in the wound of the uterus, and fromthose opening in the place where the placenta had been in-serted.

VENOUS HEMORRHAGE GREAT DURING LANGUID CIRCULATION.

The extent to which, in uterine haemorrhage, the vascularsystem is sometimes exhausted in a very short time, is lessreconcilable with the doctrine of haemorrhage from thearteries of the uterus than from its veins.There are, between the arterial and the venous systems,

differences worthy of notice,-in what might be called the faci-

flities of large haemorrhage in a brief space of time, duringIdiminished force of the heart’s action.In the arterial trunk at any given point,-as, for example,where the spermatic arteries are given off,-the blood at that, point is subdivided, a small portion passing into thesebranches, the larger portion proceeding to other parts; andthere is no reason to believe that arterial blood retrogrades,! strictly speaking, so that any part of the larger portion shouldbe liable to find its way into any branch beyond which it hadonce been propelled, without first returning to the heart, and

again circulating through it.In the venous system, at the corresponding point, the blood

is, on the contrary, accumulated, and comprises, not only theproduce of the spermatic veins, but also the whole quantitybrought back by all the other veins more distant from theheart; the whole of this is liable to retrograde, and to find itsway readily into branches (which it has passed in its progresstowards the heart) without again returning to that organ.

Thus, in the arterial system, the quantity of blood capableof passing into the branch from the trunk is that contained inthe trunk at the point of distribution, minus all that is dis-tributed to branches more distant from the heart.In the venous system, on the contrary, the quantity of blood

capable of passing into the branch from the trunk, is that re-turned by the branch plus all that is accumulated in thetrunk from branches more distant from the heart.

In the arterial system, the vis a tergo being reduced in acertain degree, liability to hsemorrhage from an open artery isdiminished in proportion.In the venous system, on the contrary, the vis a tergo being

reduced in a similar degree, liability to hsemorrhage from anopen vein (partly owing to the tendency of fluids, in accord-ance with the laws of gravitation, to seek the readiest pointof exit) is not diminished in like proportion.

In accordance with these facts, and this greater facility ofvenous haemorrhage, we perceive that the blood in uterinefloodings is essentially venous; that the flooding, even whenthe heart’s action is reduced to almost nothing, is copious ina degree out of all proportion to the quantity that a circulationso languid could transmit through the minute spiral arteries,communicating with such cotyledons of the placenta as remainattached; and, also, that haemorrhage continues, after all con-nexion with the placenta, arterial or otherwise, has ceased.

ABSENCE OF PLACENTA.

We have the additional evidence, that profuse haemorrhagesoccur in cases of abortion so early in the period of utero-gesta-tion that no placenta is yet formed; and still further, thatcopious hasmorrhages, even dangerously copious, occur in theunimpregnated uterus.

POST-PARTUM HaeMORRHAGE.

With regard to the occurrence of post-partum heemorrhage,I cannot deem it necessary to add arguments, or authorities,or examples, to prove the existence of a fact which suggested toDr. Blundell the performance of transfusion; and to accou-cheurs of experience and practical skill, in various countries,almost every diversity of means, therapeutical, physiological,and mechanical, which ingenuity and science could devise.

UTERINE HYDATIDS, (so CALLED.)Whether uterine hydatids (the ordinary clustered cysts)

are the result of impregnation, or the contrary, is not a ques-tion of importance to the present subject, otherwise than thatthe minute investigations and acute discussions which havetaken place in relation to their origin, leave no doubt of thefrequent existence of hydatids in the womb, in the total ab-sence of anything resembling placenta in structure; yetformidable haemorrhage accompanies their expulsion, a well-known fact, suitably expressed in. the remark of Sir C. M.Clarke, " That this hsemorrhage is more frightful than thatwhich follows the removal of the placenta from an uncon-tracted uterus."-Observations on Diseases of Females, part ii.p. 116.

’ A French lady whom I saw several times while she wassuffering from finally uncontrollable haemorrhage, consequentupon the discharge of hydatids, died of exhaustion. Whathad passed during life was always carefully examined: it con-sisted of blood and hydatids, and their pedicles only. I exa-mined the body after death; the womb contained only a littlefluid blood.Passing from deductions founded upon occurrences within

the uterus, and concealed from view, to facts which comeunder observation of the eye, we find those deductions amplysupported.