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In the wards of the hospital we saw some other patientswho were taking olive oil. They did not object to it: at firstit would produce a little nausea, but the stomach soon gotused to it. Dr. Ramskill told us that he found it gave colouras well as fat, and was useful therefore in anaemia. It shouldnot, he said, ever be given when the temperature of the bodyis at all high and the pulse quick.

HOSPITAL FOR CONSUMPTION, BROMPTON.RAWNESS OF THE TONGUE AND PAINFUL DEGLUTITION

IN ADVANCED PHTHISIS.

Dn. DOUGLAS POWELL gives us a note of the treatmentwhich he employs with success in the above distressing com-plication.The condition of parts found, he says, is briefly as follows :-

The tongue is at first smooth, red, and glistening; if pre-viously furred, the fur clears off in patches, leaving a raw sen-sitive surface. There is a tendency to fissuring and transversecracking of thetongue, and aphthæ sooner or latter appear. Thelips are dry ; the fauces, soft palate, and pharynx are either red and dry like the tongue, or may be pale, but with rami- ’,form injection. Aphonia is very commonly present, havingeither pre-existed for some time or being caused by congestionand dryness of the cords, with aphthæ; or, again-and this is,he thinks, a not uncommon cause,-it may arise from the dry-ness of the larynx, causing the sputa to adhere to the cords,while, from the impaired action of the epiglottis, the cough isineffectual as well as painful. In a very marked case of thislate aphonia, which occurred at Brompton, the ventricles ofthe larynx were found, post mortem, filled with tough mucus,which adhered in streaks to the larynx below. There was noulceration. Diarrhoea is very commonly present. Any hot orpungent fluid gives much pain, and deglutition is very painful:first, from the mere contact of the food with the hypersensi-tive raw surfaces ; secondly, from the compressing action ofthe palate, glossal and pharyngeal muscles pinching up theinelastic and tender surfaces.The combination of remedies most beneficial in these cases,

which must be familiar to all and require no illustration, con-sists of chlorate of potash and glycerine in some syrup contain-ing morphia. The proportions Dr. Powell commonly uses are- chlorate of potash, forty to sixty grains ; glycerine, half anounce ; syrup to four ounces, with morphia, one grain and ahalf to two grains. A teaspoonful swallowed slowly actslocally on the parts affected, relieving at the same time thecough. Of course, in the latest stage of the disease this willbut render the remaining hours of life more comfortable, orprolong life a little ; but there are some cases where the dis-ease of the lungs is considerable, though not incompatible withlife, and the patient having been reduced very low by diar-rhoea, vomiting, &c., this condition of tongue and throat willcome on, and, rendering the taking of nutrients or stimulantsalmost impossible, the patient therefore dies from exhaustion.Indeed, the aphthous condition which follows this is usuallyconsidered a fatal sign in chronic disease , but it is not neces-sarily so. In these cases the above remedy relieves pain, cleansesthe tongue, and enables the patient to take nourishment andremedies which greatly prolong life. The following two casesare examples :-Mary P-, aged thirty-nine, was admitted an out-patient

under Dr. Powell’s care on Feb. 1st, 1868. She had been illthree or four years with cough and partial aphonia. Nowcomplains of cough, expectoration, hoarseness, emaciation, andnight-sweats ; bowels costive, with flatulence ; appetite fair ;pulse quick; great anæmia. Physical signs showed a largechronic cavity at right apex, with consolidation on the leftside.

Feb. 29th.-Night-sweats and dyspeptic symptoms abatedunder influence of alkaline bitter with cinchona; small dosesof iron now given.

April 25th.-Improved. Iron increased and oil given.May 22nd.-An inhalation for hoarseness, which still con-

tinued.July 18th. -Not so well; more dyspnoea, and aphonia com-

plete.On the 25th, rawness of the tongue and painful deglutition

&c. came on. The syrup of morphia &c. given instead of coughlinctus ; other medicines continued. The relief was great; thepain in swallowing and soreness of the tongue disappeared, andthe voice improved. Finding the throat and voice symptoms

always relieved, she has continued to take the syrup as acough linctus up to the present time, also taking quinine andiron and oil. The voice continues husky; but the general healthis considerably improved, and the physical signs have butslightly advanced.

E. P-, aged thirty-two, a native of India, married, wasadmitted on Sept. 19th, 1868. Has been ill three months ;laid up since July with bad cough, especially at night ; ema-ciation. Appetite bad; thirst; pulse very feeble; tonguefurred ; bowels confined ; general debility very great ; aphonia.Physical examination showed excavation at the right apex.Iodide of potassium in an alkaline bitter given; daily pill withdinner.

Sept. 25th.-Tongue furred and dry, cracked; throat dry;deglutition painful; bowels still costive. Medicine causessickness; discontinued, and syrup of morphia &c. given fourtimes a day; dinner pill continued.

Oct. 3rd.-Tongue still much furred, with dryness. Someblue-pill and rhubarb given.

1Oth.-Patient has improved ; voice still much affected, butno pain ; tongue improved. The alkaline bitter renewed, butdid not agree, and she has continued taking the syrup up tothe present time, and has considerably improved on it alone.She is still, however, very weak, and the case is in other re-spects an unfavourable one.

MedicalSocieties.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, DEC. 8TH, 1868.DR. E. MERYON, VICE-PRESIDENT, IN THE CHAIR.

ON A NEW AND SIMPLE METHOD OF INDUCING ARTIFICIALRESPIRATION IN CASES OF ASPHYXIA FROM DROWNING,STRANGULATION, CHLOROFORM, POISONOUS GASES, ETC.

BY W. P. BAIN, M.D.,S1TRGEON TO THE POPLAR HOSPITAL.

THE author speaks of the necessity of the best and simplestmeans being employed in the above cases immediately and onthe spot, and rapidly runs over the several methods whichhave been adopted up to the present time for restoring ani-mation. He mentions in terms of considerable praise the modeof compression and relaxation of the walls of the chest, espe-cially by simply pressing down the sternum, showing that asmuch as 600 cubic inches of air may be exchanged in the lungsthis way in a minute-a plan of.which it has been the fashionto speak rather disparagingly. He explains Dr. Marshall Hall’smode, which, although a very inconvenient one, is also betterthan it has lately been represented to be.To Dr. Silvester he gives high praise for his discovery of

utilising the muscles used in respiration, by drawing the armsover the head of the patient, thereby expanding the chest, andthus favouring inspiration. He finds fault with it, however,in its being a roundabout mode of accomplishing its purpose,and necessitating three separate movements.The author then introduces a plan hitherto not known in

this country, the invention of the celebrated Pacini, of Florence,which consists in placing the patient on his back on a table orbed, the operator having his abdomen against the head of thepatient, placing his hands in the axillae on the dorsal aspect,and then pulling the shoulders towards him with an upwardmovement at the same time. The shoulders are then relaxed,then the former movement, and so on alternately. In manycases operated on by this method the air makes a loud noisewhen it passes the larynx, as in snoring.

, The author was so impressed with the excellence of this planthat he determined on his return from Italy to make experi-ments on it, as suggested to him by its illustrious inventor.He had not long, however, proceeded with these before he dis-covered two modes considerably superior, and throwing alsosomewhat in the shade the labours of Marshall Hall and Sil-

vester. In experimenting on the dead subject he employed anindia-rubber tube, one end of which was tied in the trachea,and the other communicated -with a small spirometer, upon theprinciple of Hutchinson’s, so that the passage of air to and frothe lungs could be easily observed by means of a scale showingcubic inches. He found that the simple process of raising theupper part of the thorax from the table by taking hold of the

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arms caused a considerable influx of air, varying with the anglethat the arms made with the body. For instance, if the bodywere raised by the arms at an angle of 450 (towards the face)the inspiration would amount to, say, 20 cubic inches. If the

body were lifted by the arms in a vertical direction, the amountwould be 15 cubic inches, and if pulled up by the arms at anangle of 45° (towards the feet), the amount would be about 10cubic inches. But by the first of these modes a quantity ofair considerably greater than by Hall’s or Silvester’s plan wasgenerally obtained.The best and most simple method, however, which the

author has discovered is founded upon those of Silvester andPacini. He simply places his fingers in the axillæ in theirfront aspect, with his thumbs over the outer ends of theclavicles, and draws, with a certain amount of power, theshoulders towards him. On relaxing his hold, the shouldersand chest return to their former position, and so on with alter-nate motion. In this case, therefore, there is only one move-ment to be effected instead of three, and he avoids the fatigueof having to bear the weight of the patient’s arms as well, asis required by Dr. Silvester’s method. It has the advantagealso of being accomplished in a more rapid manner than anyother plan. As far as the author’s experiments have gone, thequantity of air inspired at each movement by this plan is about30 to Dr. Silvester’s 20, and as the operation can be conductedwith much greater rapidity, the author considers that at leasttwice the quantity of air can be inspired by this mode than byany other yet known ; and he expresses a wish that a subjectwhich is of such practical importance should be further inves-tigated.The paper was illustrated by lithographed tables, setting forth

results of successive experiments with the various methods; andDr. Bain explained that in the first experiment, the method ofSilvester was first used, then that of Marshall Hall, then thatof Pacini, then his own four methods in succession ; and thatthe series was then re-commenced with Silvester’s method again.Mr. BOWLES said that the description of the Marshall Hall

method, as given by the author of the paper, was incomplete,and that, if practised as described, the method had not beenfairly tried. Pressure on the spine when the patient wasrolled into the prone position was an important element, andthis had not been mentioned. In cases of drowning, the firstthing to be done was to get rid of the water from the lungs, ithaving been proved by the experiments instituted by the Com-mittee of the Society, that this water was the chief source ofdanger to life. The presence of water in the lungs of drownedpersons had also been shown by Professor Casper. In thecase of a patient brought to St. George’s Hospital, and whodied there shortly after arrival, water was found in the lungschurned into foam by the air introduced by the diligent prac-tice of Silvester’s method. In a case managed by Mr. Trol-lope, of St. Leonard’s, the method of Silvester was first tried,and as the patient seemed to be losing ground, the MarshallHall method was substituted for it. Water then flowed outof the mouth, and the patient ultimately did well. We donot usually find water in the mouth, because it escapes easily,even from the larger bronchi, during the transport of the

patient ; but it does not escape easily from the smaller tubes,and in them it may soon be churned into froth. There is nodifficulty in the introduction of air into the chest, but the in-troduction of air is useless while the patient is in the supineposition, and while water is retained. A person with sus-

pended animation requires but little air, and any method willintroduce enough. The important question is, By what methodcan the water best be got rid of ? In conclusion, the necessityof perseverance, even in cases of apparent death, was dweltupon by the speaker, and instances of recovery after prolongedimmersion were related.

Dr. SILVESTER remarked upon the possible injury to theparts entering into and surrounding the shoulder-joints, as anobjection to Dr. Bain’s method. He thought it similar in

principle to his own, but that it was safer to act upon thechest through the arms. He objected to frequency of artifi-cial movement ; and maintained that, if the movements weretoo frequent, air would not pass below the bronchi, as mightbe determined by the use of the stethoscope. Dr. Bain hadexplained in what order his experiments were to be read; and,so reading them, they seemed to show that the power of intro-ducing air into the chest increased in proportion as the effortsof the operator were continued. Dr. Bain had been less suc-cessful with his (Dr. Silvester’s) method than the Committeeof the Society; and he would himself undertake to introduceinto the chest by means of it, not thirty or forty, but sixty,cubic inches of air. He was himself desirous to get rid of

water when it was present, but did not believe that it usuallyentered the lungs. He had failed to introduce it even by in-jection ; and, if it did enter, it could not be got out againeither by the Marshall Hall method, or by position. TheMarshall Hall method was not new, but had been used and

reported upon by the Royal Humane Society a century ago.It was open to grave objections, and often seriously injuredthe patient.

Dr. HEADLAM GREENHO v observed that Dr. Bain’s methodwas certainly the best, if excellence could be tested by thequantity of air that was introduced. He believed that waterwas distinctly inhaled into the lungs in drowning, when peoplefell into the water in a state of consciousness, and made effortsto breathe. Water was not found in the lungs at post-mortemexaminations unless they were made soon after death. It be-came absorbed, or in some way disappeared. The period ofimmersion after which recovery would be possible would varyvery much in different cases, and would be longest where therehad been no efforts to breathe (as when people were stunnedwhen they fell into the water), by which water could be forcedinto the lungs.

Dr. PEACOCK suggested that the question of the comparativemerits of Dr. Bain’s and of other methods should be referredto a committee for investigation.The PRESIDENT inquired whether it was the pleasure of the

Society that the debate should be prolonged beyond ten o’clock;and it having been decided in the affirmative,

Mr. CLOVER referred to the great importance of being ac-quainted with the best means of maintaining respiration incases of suspended animation from anaesthetics; and expresseda belief that more of such cases than usual might possiblyoccur in consequence of the free use now being made of nitrousoxide. He thought, in chloroform cases, that the first thingto do was to expel the chloroform-laden air from the chest,and then to maintain artificial respiration. He found that

respiration always stopped before the action of the heart ; andbe had himself used Silvester’s method with great advantage.He had seen resuscitation after forty seconds of suspendedbreathing. He recalled to the Society Dr. Marcet’s apparatusfor supplying air to the lungs.Mr. CARTER confirmed Dr. Silvester’s statement about the

antiquity of the Marshall Hall method, which had been usedby midwives in Dr. Marshall Hall’s native county from timeimmemorial as a means of recovering new-born infants appa-rently dead. Dr. Marshall Hall stood in the same sort of relationto the method that Jenner did to vaccination. He expressedsurprise that the best means of maintaining artificial respira-tion had not been adverted to by any speaker. This was the

application of a Faradaic current to the phrenic nerves, wherethey pass over the scaleni muscles, according to the methoddescribed by Professor Ziemssen. By this means patients ap-parently dead from chloroform, and from the inhalation ofcarbonic acid and of coal gas, had been restored to life ; andrecently Pernice had applied the same means successfully tonew-born children, who could not be made to breathe in theordinary way. One of the convenient galvanic batteries nowmade by Stohrer and others should always be at hand whenchloroform was being administered, or at places where deathsby drowning were liable to occur.

Dr. BARNES confirmed the remarks of previous speakerswith regard to the inconvenience or danger of the MarshallHall method as applied to infants, who were very liable to beinjured by it. He described a case of recovery after submer-sion for a period of at least five minutes.A Fellow suggested that Dr. Bain’s plan might be used in

the prone position, which would facilitate the escape of water.Mr. JONES said that several years’ experience as house-sur-

geon at St. George’s Hospital led him to prefer the method ofartificial respiration by intermittent pressure upon the parietesof the chest and abdomen. The difficulties of the MarshallHall method were very great, especially with heavy or bulkypatients. He related the case of a new-born child apparentlydead, and tied up in a parcel with a ligature round its neck,but that eventually recovered, to illustrate the importance ofperseverance in efforts to restore suspended animation.

Dr. BAIN thanked the Fellows for the attention with whichthey had listened to his paper, and for the observations that ithad called forth. His only object had been to find the simplestand easiest method of introducing air into the lungs. Hecould not explain the better results obtained by his method,unless-and the idea had only occurred to him during the de-bate-they might be due to the circumstance that the thoraxwas elevated directly, through the clavicles and sternum, in-stead of indirectly through the latissimi muscles.