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120 P. M—, aged thirty-seven, a stable-helper, was admitted into the accident ward on the 15th of October, 1864, having been some few minutes previously knocked down by a cab, and kicked Gn the head by the horse. On examination, there was found to be a severe lacerated wound of the scalp over the upper part of the occiput ; and at this site a circular fracture of the skull was discovered considerably de- pressed. His symptoms were purely those of concussion of the brain. He was perfectly unconscious and insensible ; the surface of the body was pale and cold ; the pulse very small and weak; breathing slow, but regular ; the pupils were con- tracted. There was no stertor, nor any sign indicating pres- sure on the brain. The symptoms just mentioned slowly but surely improved ; and at the end of eight hours he was again quite sensible, slept quietly and soundly during the night, awaking the next morning perfectly sensible. He complained of but little pain, and that chiefly was referred to the scalp wound. The pupils were still contracted somewhat, and but little amenable to light; the tongue was clean. These symp- toms continuing, though certainly not increasing, for a few days, he was given some small doses of calomel, and a blister put on the nape of the neck. He now daily improved, had no headache, slept well, and the’ appetite was good ; the pupils acted more normally, though still somewhat contracted. The wound of the scalp was discharging healthy pus, and was gradually granulating up. He became so much better that, contrary to orders, he moved a little about the ward. On the morning of Nov. 2nd (seventeen days after the acci- dent) he complained of being very drowsy and of feeling a little confused ; the face was rather flushed; tongue clean ; bowels regular ; pulse 60, rather small; pupils natural. Nov. 3rd.—Much the same as on previous day. Cold ap- I plied to the head, and an enema given. I 4th.-Head symptoms increased in severity; pulse 80; the left pupil contracted, the right dilated. Though apparently comatose, he understands when spoken to in a loud tone. 5th.-Insensible, and cannot be roused ; tongue getting loaded; pulse still 80, rather small and soft; there is slight stertor; his bowels are confined, and he passes his urine in- voluntarily. An enema was given, and another blister applied high up in the neck. 6th.-He still continues insensible; the pulse has risen since yesterday to 120, very small; face much more flushed; breath- ing more decidedly stertorous. Bowels were moved after the enema. He rapidly became worse during the day, without much appreciable change in the symptoms, and died, seemingly exhausted, in the afternoon. ’ On making a post-mortem examination, the wound was found dry and glazed, the scalp around it being easily separable from the skull, which was dry and white. On opening the head, the membranes were seen to be slightly abnormally injected, particularly over the site of the injury; over this part too, but entirely confined to it, was a very thin layer of greenish creamy pus. The brain-structure seemed perfectly healthy. On exa- mining the skull-cap, a circular piece of bone, the size of a halfpenny, was found, as if cut out with a punch, depressed to the extent of at least two lines; the inner table did not appear to have been at all splintered, but cleanly broken. The site of the fracture was in the occipital bone at the angle formed by the junction of the longitudinal and lateral sinuses. Medical Societies. ROYAL MEDICAL AND CHIRURGICAL SOCIETY. TUESDAY, JAN. 24TH, 1865. DR. BASHAM, V.P., IN THE CHAIR. CONTRIBUTION TO THE NATURAL HISTORY OF "WINTER COUGH." BY HORACE DOBELL, M.D., M.R.C.P., PHYSICIAN TO THE ROYAL INFIRMARY FOR DISEASES OF THE CHEST. Tuis paper was an analysis of fifty-eight cases of " winter cough," the details of which were given in an appendix. The cases were arranged in four groups, according to the physical signs :- 1. Cases in which there were physical signs both of bron- chitis and of emphysema. 2. Cases in which there were physical signs of bronchitis, but not of emphysema. 3. Cases in which there were physical signs of emphysema, but not of bronchitis, and in which there was no history of previous bronchitis. 4. Cases in which there were physical signs of emphysema and not of bronchitis, but in which there Was a history of pre- vious bronchitis. Each case was reported in the form of answers to a set of forty-one questions relating to the short breath, the cough, the taking of colds, the past illnesses, the occupation, the dwelling, the food, the habits, and the family history of the patient, in addition to a concise statement of the personal con- dition at the time of examination. The number of facts thus collected was too numerous to admit of their being discussed within the limits of a paper ; the author therefore restricted himself to an analysis of the cases under the several groups, and a comparison of some of the principal facts in a series of twenty tables, thus putting the materials into a convenient form for future use. Dr. SALTER questioned the appropriateness of the words ’’ natural history" in the title of the paper. He thought nothing was gained by removing the ordinarily received landmarks of a vocabulary by taking up a word and transplanting it into a position not its own, and that nothing tended so much to weaken and impoverish the resources of a language as attempt- ing to expand the use of words too far. By " natural history’’ was generally understood the history of organized beings, animal and vegetable. No doubt the study of disease was the study of a department of nature ; but if the use of the expres- sion " natural history" was defended on this ground, it would be as appropriate to speak of the natural history of astronomi- cal or any other natural phenomena. The point on which the paper seemed to promise to throw some light was the causa- tion of emphysema ; but in this it had disappointed him. The only case that really bore on the subject was the single case in which emphysema was said to have existed without bronchitis; but he could not conceive that bronchitis really was absent in this case. Emphysema with cough and without bronchitis he could understand ; but emphysema with 10inter cough and without bronchitis he could not understand : the bronchitis might be very feebly pronounced, but he did not believe in any non-bronchitic winter cough. While containing much that was interesting, and suggestive of many hints for future useful work, he thought the paper suffered a great disadvan- tage from being so entirely a paper of figures. And he thought, too, that it very well illustrated what had been often said of figures-that they could be made to prove anything. Take, for example, the fact stated by the author-that patients with emphysema had bad spirits, while those with bronchitis had, good; and his explanation-that this difference depended on- the presence of expectoration in the one case and its absence in the other. He (Dr. Salter) thought that this statistical evidence of the exhilarating tendency of expectoration was a strong proof of the omnipotence of figures. He differed from the author in the little importance he assigned to occupation in the causation of winter cough ; he (Dr. Salter) found it the most potent of all circumstances in the production of the affection. By far the larger proportion of sufferers from it who came under his observation were those whose occupation exposed them to all weathers, and at the same time prevented their lying by-such as vendors of things in the streets, cab- men, porters in Covent-garden Market, &c. Indeed, the fact that the disease was due to climatic influences was itself a proof that those whose occupations the most exposed them to those influences must be the greatest sufferers. He quite agreed with the author as to the undefined use of the word " asthma"; that a great many cases of so-called asthma were simply chronic bronchitis ; and that any chronic difficult breathing is commonly called asthma. At the same time, he thought that a carefully directed inquiry would generally de- tect whether such cases were truly asthmatic or not. Dr. DoBELL said he begged to thank the Society for listening so patiently to his very dry paper. He had hesitated to bring it before them because of the number of tables and calculations which it contained. He was much obliged to Dr. Salter for his suggestions about the term " natural history" used in the title; but he entirely disagreed with him. When treating of animals or plants, the term " natural history" was used to comprise a description of the " conditions of their existence;" the circum- stances influencing their development, maintenance, growth, and reproduction ; their habitats, habits, and the like. It was precisely this kind of information which he had collected with regard to "winter cough ;" and he must, therefore, maintain
