411

THE LANCET.

London, Saturday, December 7, 1839.

DANGER OF EMANATIONS FROM THE DEAD.

A KNOWLEDGE of the changes which the I,

body undergoes after death is of consider-able importance in Medical Jurisprudence ;and the researches of OR FILA on " Juridical

Disinterment" have rendered the history ofdisorganization interesting, although the sub-

ject is in itself repulsive, and has, as that

writer justly observes, obtained less atten-

tion than have the history and laws of orga-nisation. We shall, however, have little

occasion to enter into the details of the

charnel-house in discussing the effects of the

products of putrefaction upon the publichealth; for in this question the volatile ema-nations, which escape alike the knife and

the eye of the anatomist, play the principalpart; and it is to be regretted that the natureof these emanations, like that of specificanimal poisons, has hitherto escaped the

observation of chemists. The phosphorusand sulphur which exist in the tissues ofanimals are believed to have a connection

with the offensive odours of spontaneousdecomposition, and, perhaps, to generate,with hydrogen and carbon the volatile grave-yard poisons. But this is not proved ; andless is known of the mode in which cada.

veric emanations destroy life than of the

modus operundi of the fumes of charcoal.Gases and effluvia are always given off by

the dead body ; but their quantity and

nature vary considerably in different cir-

cumstances. When leaden coffins are used,Mr. WALKER states that the expansive forceof the gases given off causes the coffin to

bulge out, and this compels the workmento "tap" it frequently with a gimlet: a jetof gas escapes which, when ignited, willburn for ten minutes or half an hour. The

men are aware that they here incur consider-able risk, and are extremely careful in theexecution of their task. When the coffin isnot well secured the lead will burst. The

daughter of a clergyman was embalmed,and then put into a shell; the shell was

placed in a leaden coffin with a glass win-dow in the top, that the parent might havethe melancholy satisfaction of seeing the

features of his child. The glass of the

leaden coffin broke on the day after the corpsewas shut up ; "it was replaced by another," which also broke; and then a thick plate-glass was fixed in an iron frame, and sol-" dered to the lead. This lasted, and is now" in the vestry of church:’

It has long been well known that the

emanations from the dead are dangerous, ina concentrated form. Dr. HAGUENOT, ofMontpellier, was led to insist upon this, andupon the evils of interment in churches, byan accident which was very similar to the

late occurrence in Aldgate churchyard.On the 17th of August, 1744, PETER BALSAL-

GETTE, a gravedigger in the church of Notre

Dame, Montpellier, descended into the

grave of W. BOUDOU; he immediateiy felldown senseless; J. SARRAA offered to rescuethe gravedigger, but had scarcely seized hisdress when he became insensible, and wasdrawn up half dead ; he soon recovered his

senses, but had a kind of vertigo and numb-

ness, which were followed by convulsionsand syncope, in the course of a quarter ofan hour; he was for a long time pale and

emaciated, and in the city acquired the soubriquet of " the resuscitated." Three other

persons descended in succession into the

grave ; two of them perished. Dr. H. ex-

amined the nature of the destructive gas, as

well as the imperfect state of chemistrywould permit; a foetid odour was observed,which infected linen with a cadaverous

smell ; lighted paper, chips, &c., when

placed at the opening of the grave, were in-

stantly extinguished ; cats and dogs throwninto it were violently convulsed, and died intwo or three minutes; birds in a few seconds.,Dr. MARET adduced the following facts insupport of the opinion that cadaveric va-pours are noxious. A mild catarrhal fever,he says, prevailed at Saulieu, in Burgundy(1713); the body of a very fat man was.

2E2

412 ILL EFFECTS OF ANIMAL EFFLUVIA.

buried in the parish church of St. Saturnin; gle body, 12 years after burial; and that

twenty-three days afterwards a grave was the same corpse occasioned a dangerous dis.

opened by the side of the former to bury a ease in a whole convent.

woman there, who had died of the same Hence it seems to have been well esta.

disease; a very fgtid odour immediately blished, in the last century, that cadavericfilled the church, and affected all those who emanations destroy life instantly, or giveentered. In letting down the body a rope rise to various kinds of diseases; and that

slipped, by which the coffin was shaken-a their effects depend upon the concentrationdischarge of sanies followed, the odour of of the poison, and a variety of accidentalwhich greatly annoyed the assistants; of circumstances. It is to be regretted that170 persons who entered the church, from the subject has not been latterly investi.the opening of the grave until the interment, gated, and that the discoveries and accurate149 were attacked with a malignant putrid methods of chemistry, experimental physi.fever, which somewhat resembled the reign- ology, pathology, and vital statistics, haveing catarrhal fever, but the nature and in- not placed in the clearest light the direct

tensity of the symptoms left no doubt on and indirect effects of the church-yard poi.Dr. MARET’S mind that the malignity was son, in different degrees of concentration.

owing to the infection of the cathedral. The inquiry is too extensive for a privateThis is less circumstantial than it might individual, and well deserves to be under.

have been, but innumerable facts of the taken by the government. Mr. WALKER has,same nature prove that the events were not however, collected several illustrations of

mere coincidences. the effects of animal matter, in what Dr,

The removal of earth from burial places, MACARTNEY calls the two most dangerousor the displacement of coffins, has frequently stages of decomposition-that which takesbeen followed by disastrous results. At place immediately after death, and the extremeRiom, in Auvergne, an epidemic arose im- degree of putrefaction. (Gatherings froramediately after the removal of earth from a Grave-yards, pp. 132-141.) The followingcemetery ; the mortality was most fatal in case appears to have occurred under Mr.

the neighbourhood of the cemetery. A si- WALKER’S own observation :-

milar event had, six years before, caused an " My pupil, Mr. J. H. Sutton, accom.epidemic in Ambert, a small town in the panied by an individual, for many years

same province. Children, who went r occasionally employed in the office of bury.same provmce. Children, who went to be ing the dead, entered the vaults of St. -catechised, were taken ill in the church of church ; a coffin, eruelly bloated,’ as one ofSt. Eustache, in Paris, after certain bodies the gravediggers expressed it, was chosen

for the purpose of obtaining a portion of itshad been displaced; several adults were gaseous contents. The body, placed uponalso affected. Dr. Ferret, Regent of the the top of an immense number of others,

tu 11. r had, by the date of the inscription on theFaculty of Paris, reported that he found plate, been buried upwards of eight years ;respiration of the patients difficult, the ac- the instant the small instrument employedtion of the brain disordered, the heart beat- had entered the coffin, a most horribly offen-

ing irregularly, and, in some, convulsive sive gas issued forth in large quantities. Mr.irregularly, and, in some, convulsive S., vilto unfortunately respired a portion

movements of the arms and legs. A place, of this vapour, would have fallen but for

upon which a convent for the nuns of Saint the support afforded by a pillar in the vault;., ...

he was instantly seized with a suffocatingGéneviève, in Paris, had been situated, was difficulty of breathing (as though he hadcovered with shops. Those who first lived respired an atmosphere impregnated within them exhibited nearly the same symp. sulphur); he had giddiness, extreme tremb-

’ ling, and prostration of strength; in at.toms, which were attributed to the exhala- tempting to leave the vault, he fell from

tions from the dead bodies interred under debility ; upon reaching the external air, he..,,.. ,......, , had nausea, subsequently vomiting, accom.the foundations. Haller states, that a panied with frequent flatulent eructations,church was infected by the effluvia of a sin- highly foetid, and having the same character

413STATE OF THE LONDON CHURCHYARDS.

as the gas inspired. He reached home with chamber for six weeks. He was himselfdifficulty, and was confined to his bed also affected, notwithstanding that everyduring seven days. The putse, which was ’

scarcely to be recognised at the wrist-al- precaution was taken to avoid the conse-though the heart beat so tumultuously that quences of exposure to putrefying animalits palpitations might be observed beneath matter. The London sextons burn straw inthe covering of the bed-clothes-rangedbetween one hundred and ten and one hun- foul graves, and have various modes ofdred and twenty-five per minute, during the obviating their injurious effects. Thefirst three days; for many days after thisexposure his gait was very vacillating. young and inexperienced gravediggers suf-" The man who accompanied Mr. Sutton fer most, according to Mr. WALKER. He

was affected in a precisely similar way, and adds in a characteristic note, "The oldwas incapacitated from work for some days ;his symptoms were less in degree-prostra-

11 gravedigger, too frequently a reckless,tion of strength, pains in the head, giddiness, « abandoned character, is like an old poacher,and general involuntary action of the mus- .,..,.cles, particularly of the upper limbs, con- " wise in his own conceit, and not easilytinued for several days afterwards ; these " taken ; with him discretion is the bettersymptoms had been experienced, more or « part of valour."’ Mr. WALKER’S notions ofless, by this person, on many previous occa-sions, but never to so great a degree. I your sexton are evidently anything but

have myself suffered from the same cause, exalted; in another note, he calls the oldand been compelled to keep my room up- " fox’s" artifices of self-preservation cc selfwards of a week."

While innumerable facts prove that cada- ishness," and insinuates that the Aldgate

veric emanations are noxious, and some- gravedigger was a martyr of disinterested-

times instantly fatal, daily experience shows ness. His detestation of 11 grave-yards"’

that graves may be opened, in a great num- extends to the gravediggers who have hap-

ber of cases, without any obvious or imme- dened to live longer than they ought, ac-

diate injury to the health. M. PARENT Du cording to the theory.

CHATELET relates the particulars of the Nearly all the London churchyards and

removal of forty-three bodies -victims of churches are filled with dead bodies ; they

the « three days"-in a state of advanced have been travelled over repeatedly by the

putrefaction, from the vaults of the church of sexton’s spade ; the churchyard is generally-St. Enstache. The forty-three bodies were raised considerably above the surroundingremoved in 2i hours, by 23 men and 12 level; 1000 graves are opened every week

carts, without any accident. The task was in the metropolis; the earth is saturated’

superintended by M. LABARRAQUE; every with human putrescence," and permeated-

precaution was taken ; solutions of chlorine by the ascending vapours; and the facts

were used in considerable quantities ; and already adduced show that these vapours

the bodies had, it appears, been originally are mephitic, and instantaneously fatal in-

covered with quick lime. PARENT Du certain circumstances. The mortality of the

CHATELET declared that the success of the metropolis is 45 per cent. higher than the-

measure did LABARRAQUE great honour, and mortalityofthecountrydistricts.and although

that it would be registered, " dalls lesfastes no death or epidemic could be directly

de l’hygiène publique."* ORFILA and DE- traced to the churchyards, there can be little

VERGIE agree that, by taking proper pre- question that a part of the excessive morta-

cautions, bodies may be disinterred for lity is due to their concentrated exhalations;

judical purposes without any imminent but to what extent this cause operates with

risk. DEVERGIE, however, cites a case in the effluvia from sewers, &c., it is impos-which his friend M. PIÉDAGNEL, who had sible to say, without extensive statistical

assisted him in a disinterment, was so seri- and experimental researches. To know that

ously affected as to be obliged to keep his the cause exists, and that the presentsystem of burial is a great social evil, is suf- Annales d’Hygiène, 1830, tome 4, p. 63. ficient to make the members of the medical

414 HINTS ON MEDICAL ETIQUETTE.

profession inquire anxiously how it can be Provincial Etiquette," 41 Keeping sbops,"amended, or how the seeds of sickness and " Connection between Practitioners and

premature death can be extirpated. Chemists," and such like subjects, Con.

__________ sidering the dilemma in which authors andother persons thus find themselves placed

To read some persons writings, it might by the artificial positions of medical men, itbe supposed that 11 medical etiquette" was is hardly to be wondered if equally artifi.a mystery, or perhaps a science which re- cial regulations seem necessary to govern

quired to be regularly learned, like che- our daily intercourse, and that an impres-mistry or botany, before a physician or sion prevails that some code of etiquettesurgeon could conduct himself properly in exists, venerable for its antiquity, and shutthe professional circle. Indeed, it is sur- out from general perusal, by which powder.prising that a chair of Medical Etiquette ed physicians, and practitioners in pumps,was never created at either of our Univer- square their own conduct, and expect igno.sities ; or a course of lectures on it made rant inferiors respectfully to abide, influ." compulsory" at the ColIeges,’;with an ap- enced by that instinct of correct submis.

pointment for Mr. ABERNETHY, or Mr. siveness which naturally belongs to the

GUTHRIE, or Sir A. CARLISLE, or Mr. CÆSAR humble.

HAWKINS, for instance, or some of the well- There can be no doubt that, under a newbehaved Examiners of Apothecaries Hall. medical organisation, there will be settledA few thousand pounds might have been some points of form, courtesy, and supra.made in this way by the Council of the legal observance, under the name, perhaps,College and the Worshipful Company; for of MEDICAL ETIQUETTE. There will then

quite certain it is, that had they chosen to be a lex nonscripta, as well as a lex scripta.ordain attendance on such a course, no stu- For instance, it will not only become mal.dents could have obtained an examination etiquette to create a dispensary for diseasesfor their diploma or license without first of the rectum, or a sanatorium for con.

presenting to them a certificate from the sumption, or to contract for twelve union

"recognised" lecturer on medical etiquette. parishes at sixteen pounds a-piece, but

There is something more in this sugges. to puff in the Court Circular, or writetion than plain people, who are governed newspaper announcements of one’s own

in their professional conduct by the simple attendances in the mansions of the rich, orrules of honesty and common sense, may at compile books simply to advertise the

first imagine. The same powers which author, or give certificates to spectaclecould erect a set of metropolitan chairs of venders and clyster-pump makers. These

ETIQUETTE, have created, fostered, and still proceedings have naught to do with me.

zealously preserve, a formal series of dical science, whose interests are so well" grades" in the medical profession, extend- defined, and afford so safe a rule of con-

ing from the class of perfect Pures, through duct, that, regulated by the plain dictatesthe line of top apothecaries (who, accord- of common sense and honourable feeling,ing to medical etiquette, may be left to die there can be little trouble in arrangingon the way-side by PRESIDENTS Of COLLEGES) the code of etiquette. In the absence

down to the lowest rank of "subordinates," of either of these considerations, or byor counter druggists ; and we find that adopting some rule with which neither

a recent writer, acting in the full spirit of of them has any concern, absurd errors in

obedience to this gradation, occupies his professional life occur. For instance, wetreatise on Medical Etiquette with chap- had last week a remonstrance from one

ters on " Physicians called in at the sugges- accoucheur (Mr. A.) against another (Mr.tion of General Practitioners," 11 Village and B.), because the latter, having been sum-

415THEORY OF MEDICAL ETIQUETTE.

moned unexpectedly to a labour, in the about the outskirts, or in the suburbs, a manabsence from home of the usual medical may

have to attend more cases for others,

than for himself; here also he a(ts the partattendant, and having received a fee for his of assistant to the more established practi-services, (6 has not, up to to this moment, tioner.

handed over the amount" to the absent " Now, to proposed to difficulties, somepersons have proposed to divide the fee;practitioner. What says the last 11 autho- and amongst many this is done by a pre-rity" on this point, ABRAHAM BANKS, Esq., vious understanding to that effect, and if allfees were of much the same magnitude, therean eccentric gentleman who has recently could be no objection urged aguinst this ar-" compiled" an Essay on Medical Etiquette? rangement; but as some practitioners attend

He has a chapter on "One Practitioner for almost as few shillings as others do for’ guineas, it seems unfair that he who may

being accidentally sent for to the patient have paid two or three guineas should in" of another," and a chapter on °‘ One Prac his turn only receive a crown, or less, for

,....,., ’ conferring a similar kindness. The incon-"titioner attending a case of midwifery, or venience also of having anxedremunera-11 an accident, for another." Independently tion must be clear to every one, as in manyof some common-place remarks about sup- cases a practitioner might have to pay more

than he receives.planting brother practitioners, the former" To remove all these difficulties, wechapter does not contain a shadow of a rule would therefore propose that, whenever oneto gnide Mr. A. in his opinion of Mr. B., practitioner is accidentally called in to at-

guide his opinion Mr. tend labour foranother-exceptingamongstthe conduct of Mr. B. in retaining the fee. intimate friends, who of course will COQsultMr. BANKS occupies the chapter with an their feelings much better by allowing a

,

. , larger latitude of generosity, if we may useexpansion of the profound axiom that it is that word-he shall receive half the fee, re-disbotiourable to act dishonourably. But, cognising no fee below one guinea, or above

in the last quoted chapter, we have the fol- two, and that this shall in future be consi-in the last quoted chapter, dered perfectly compatible with the highestlowing disquisition :- notions of honour and professional etiquette,« WHEN ONE PRACTITIONER ATTENDS A CASE as it would appear to be consistent with

OF AIIDWIFERY, OR AN ACCIDENT, FOR equity and common sense. The same rule,ANOTHER

, with some slight modification, might apply

"There seems to be no general under- to accidents, especially those of a serious

standing in the profession, as to what is to character."be done in respect to the fee ; some will take Here, however, no case in point is stated.it, and keep it, and occasionally the patient Previous agreement to attend for anotheralso if they can; others compromise thematter, and retain a portion; whilst others, was not made in the case of our correspon.again, persist in refusing any consideration dent, and, in default of that, beyond allwhatever. It is, perhaps, more congenial ,. , , ,

with the highest notions of honour, and more doubt the guinea belonged to him who hadconsistent with true dignity, to adopt this earned it, not to him who was earning anotherlast practice, but many inconveniences ne- guinea somewhere else. The mal-etiquettecessarily arise from it; for instance, unlessit be universally followed, it leads to a great would be, by offering the guinea to the absentdeal of unfairness. A very sensitive prac- practitioner, to suppose him mean enough totitioner may always persist in refusing any tafCP it. c - * would stareremuneration, whilst he, under similar cir- take zt. Sir ASTLEY COOPER would stare

cumstances, shall have every fee wrested at a guinea from Mr. LISTON, received infrom him: this is most unjust, and places Burlington-street, at 11 o’clock, because Siran honourable man in a very disadvanta-geous position. To give another illustra- AsTLEY was not in Conduit-street when thetion of its injustice-there may be two men patient called at 10. Why should surgeonsin a neighbourhood, the one having a very - in general practice as their etiquette,large, and the other a small practice ; the in general practice adopt, as their etiquette,chances in this case will be, that the man of a rule that would be grotesque in

" pure"small practice will do ten or more times as surgery.much for the other practitioner as that other

21 ’

,

does for him, so that he becomes in a mea- We break ground on this subject, first ofsure his assistant, without the fair compen- all, because it needs discussion, and, in thesation. Again, in London, from the incon- next place, to caution our medical brethreaf

next place, to caution our medical brethrenvenient practice of employing medical men * ’

at such great distances, it often happens that against expecting to find, in the work of

416 GASTRITIS FROM ARSENIC.

Mr. BANKS, either laws or opinions that cansupply any deficiency in their libraries. It

may afford texts for criticism, but is, withsome exceptions, a childish production.

IN consequence of some communications

which we have lately received on the sub-

ject of Cancrum 0;’M, we are glad to havean opportunity of inserting the cases, whichwill be found at page 404 of this week’s

LANCET, and which have been observed andpresented to us by Dr. P. H. GREEN. Wehave some other cases, similar to those Iwhich we now insert, to pliblish ; and, pro.bably, it will become an interesting subjectof inquiry, whether mercury be one of thecauses of this most fatal disease.

ROYAL MEDICAL AND CHIRUR-GICAL SOCIETY.

Tuesday, November 26, 1839.

Sir B. C. BRODIE, President.Three cases of Acute Inflammation of theStomach; one produced by Ai-senious Acidtaken medicinally, two Idopathic. ByJoHN BURNE, M.D., Physician to theWestminster Hospital.In consequence of suggestions for em-

ploying the arsenious acid in substance, inthe form of pill, rather than the arsenicalsolution, in menorrhagia and other uterinedisorders, contained in a paper read in 1838,before the Medical and Chirurgical Society,Dr. Burne administered it in pills, contain-ing each the 20th part of a gr&in, to a younglady labouring under menorrhagia, withoutthe production of any unpleasant effects.

In a second case, however, a young woman who had suffered from amenorrhœafor nine months previously, took a similarand equal dose on Thursday, two on Friday,and one on Saturday. On the evening ofSaturday, symptoms of inflammation in thestomach came on, and which after subsi-ding to some degree, recurred twice. Onone occasion being attended with delirium,palsied shaking of the head, swimming oftheeyes, and such debility and exhaustion, asto place life in imminent danger, "A re-sult so disastrous and unexpected," saysDr. Burne, " that I thought the detailsmight be useful as a caution to others whomay be disposed to administer arseniousacid in substance. For myself, I shall here-

after abstain from prescribing it in thisform."The next case was one of spontaneous

and idiopathic muco-gastritis, which provedfatal in fourteen days. The inflammationin this case was probably preceded bychronic disease of the muciparous glandsof the stomach, of which a considerableportion exhibited them of unusual size andappearance.The last case, also spontaneous and idio.

pathic, was one in which Dr. Burne con.

siders the symptoms to have shown that theinflammation was seated in the sub-mucous,muscular, and sub-serous tissues of thestomach, and which he compares and con.trasts with the symptoms of the case icjme.diately preceeding.

Dr. ADbISON inquired upon whatevidenceDr. Burne founded his diagnosis that thecases adduced were those of muco-gastritis,rather than of gastritis, properly speaking.There might be a difference, but he, Dr.A., could not see upon what evidence thatdifference had been founded.Dr. BURNE had no other evidence to offer

than the pathological condition of the caseshe had adduced, so far as the acute form ofthe disease went. But comparing these ap.pearances with those observed in sub-acuteor chronic cases of gastritis, he thought itquite made out that such differences as

those he had pointed out in his paper didoccur.

Dr. ADDISON thought that we shouldprofit little by comparing the appearancesobserved in acute cases, with those signswhich were present when the stomach wasaffected with chronic disease. Every kindof appearance might be found in the stomachafter death, in cases in which there hadbeen no peculiar symptoms to indicatedisease previous to dissolution. The sto.mach would be found affected in various

ways from a variety of diseases, of whichthere had been no symptom before deathto account for them. Acute gastritis wasa very rare disease. Dr. Burne had alludedto a case of "acute gastritis" which he, Dr.Addison, had treated some years since in

Guy’s Hospital. Now, he had no recollec.tion of that case himself, and certain it was,that he had never treated a single case inthe hospital in question as acute gastritis.It was true he had often been requested tosee cases of "acute gastritis," but he hadfound the symptoms present to be dependentupon other diseases, as stone in the kidney,hydrocephalus, calculus in the gall-duct,&c. ; and, in one case, the complaint turnedout to be acute peritonitis. The latter case,indeed, might have passed as gastritis, hadnot the patient died, and the real nature ofthe disease been revealed. With referenceto Dr. Burne’s first case, he might mentionthat such instances were not uncommon.

The inflammation referred to occurred not