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Edward McC———, a baker, aged thirty-six years, was ad- Imitted under the care of Dr. Barlow, Feb. 18th, 1854. This

patient was in this hospital seven months before his presentadmission, suffering from bronchitis, and is described in the

report as a thin, sallow, unhealthy-looking man, with darkhair and eyes. His mother and seven of his brothers andsisters died of phthisis, and his own health has never been verygood. He then remained in the hospital three weeks, andwent out pretty well, but could not return to his business as abaker, as he could not bear the heat, so he did any porteringwork that he could meet with.About three weeks afterwards, he began to feel very un-

well again; had a return of the cough, and went into thecountry for a few weeks. The patient returned to town,feeling quite well. He continued to follow the occupation ofporter, and his health remained tolerably good until six weeksbefore admission, when his cough came on again, and he beganto waste away and lose his strength. He says that he hasbeen living very badly, not being able to procure propernourishment for himself, wife, and child. He only had a smallquantity of meat and potatoes twice a week, and was alsoquite unable to get any beer.A few days before admission the patient got up from his

chair to walk across the room, when he fainted away, and, onrecovery, brought up nearly two gallons (?) of dark-colouredcoagulated blood. He had felt very sick for some time pre-viously.The man continued to cough and vomit up blood during the

remainder of the day and night, and some purple spots madetheir appearance on his arms; he also began to pass blood withhis urine.On the next day, the patient continued to bring up much

blood, and more purple spots came out on the trunk, arms, andlegs. This state of things continued for several days, when heapplied to this hospital.On admission, there were found purple spots and blotches

all over the body, especially the arms and legs; the gumswere spongy and bleeding, and there was effusion of bloodunder the conjunctiva of the left eye.-State when examined :He coughs up a quantity of frothy blood mixed with blackcoagula, and complains of feeling very sick. The urine isloaded with blood, the same fluid is also passed by the bowels;the voice is husky and indistinct; the respiration laborious;skin hot; pulse 112, compressible. The chest is resonant onpercussion, the respiratory murmur being mumed by wheezingand crepitation; heart’s sounds, healthy.

Dr. Barlow ordered low diet, ice, lemonade, and twentyminims of the tincture of the sesquichloride of iron, to betaken in an ounce of lemon-juice every fourth hour.On the next day, it was found that the patient had passed a

very restless night, being much troubled with cough; butthere was less blood in the expectorated matters. Pulse 120;skin hot.

Venesection to three ounces was now ordered, as also twentyminims of dilute sulphuric acid, in infusion of roses, everyfourth hour.On the second day after admission, the poor man continued

to get worse until three o’clock A. when he died, retaininghis consciousness to the last.

Sectio cadave1’is, twelve hours afteq. death. - Body muchemaciated, and well formed, covered all over with spots ofpurpura; effusion of blood under the conjunctiva of the lefteye.-Brain: Dura mater healthy; veins filled with blood;slight sub-arachnoid effusion; the whole substance of the brainperfectly healthy. -Cellular tissue of the trachea and cesophagusfilled with blood.-Lungs: The organs did not collapse onopening the chest; adhesions on the left side; effusion of bloodunder the pleurae generally, and at the root of the lungs severalof the lobules filled with blood; otherwise healthy.-Heart :Flaccid, with points of ecchymosis; pericardium containinghalf an ounce of serum; left ventricle empty; a little athero-matous deposit on the valves.-Abdomen: The mucous mem-brane of the stomach entirely covered with spots of ecchymosis;venous congestion in the small intestines; colon containingmuch green, fluid, fecal matter; extravasated blood under themucous membrane; effusion of blood into the mesentery, andthe glands much injected. Liver, large and pale. Spleen, ofnormal size. Kidneys, large, with effusion of blood under themucous membrane of the pelvis and ureter; structure pale andsmooth, with points of ecchymosis beneath the tunic. Bladder,healthy, except a few small points of ecchymosis.

It will be observed, that although sevei6 brothers and sistersof this patient died of phthisis, (as he states; ) no tubercles werefound in his own lungs.

UNIVERSITY COLLEGE HOSPITAL.RETENTION OF URINE; DEATH FROM CHLOROFORM.

(Under the care of Mr. ERICHSEN.)DEATHS from chloroform are now becoming a kind of unfor-

tunate casualty which, like shipwrecks and railway accidents,may from to time be expected. It is satisfactory, under suchpainful circumstances, to know that in all cases every precau-tion is taken, before the inhalation, to prevent unfavourableresults, and the most strenuous efforts used, when life isthreatened, to save the patient from his fate. The case which

lately occurred in this hospital fully exemplifies this, for theanaesthetic agent was administered by a gentleman appointedfor the purpose, and the means of revival were most promptlyand vigorously employed. We give a few particulars of thecase, as noted down by Mr. Howitt, the dresser of the patient.George S-, aged 29 years, was admitted October lltb,

1854, suffering from retention of urine. The patient is a fine,well-made man, who says that he experiences great pain; the in-tellect is quite clear, but there is slight incoherence.He states that, three months before admission, he had a

first attack of retention of urine, from which he was relievedby Mr. Sv indle, of Finchley, who drew off the water severaltimes. He remained quite well for two months, up to four daysbefore admission, when, after a short journey, he had slightpain, and had his water drawn off for two consecutive days.As the urine, however, came away very imperfectly afterwards,several attempts were made to pass instruments without effect,and he lost a considerable amount of blood. The patient wasthen sent up to Mr. Erichsen, who saw him on the day of ad-mis&ion, at a quarter to four, and found the bladder distendedto the umbilicus, and the man complaining of severe pain.

No. 4 catheter was now tried, when Mr. Erichsen felt severalfalse passages in the anterior portion of the urethra, and astricture near the bladder. No. 1 was then tried, but as, with.the most careful management, no instrument could be passed,Mr. Erichsen determined to puncture the bladder through therectum.

Accordingly, at four o’clock, Mr. Cardell, the house-surgeon,made the patient inhale chloroform, commencing with forty-drops, poured on lint. In a few minutes forty more were added,when the man became violent, talking loudly and struggling-forty drops more were given in about two minutes, (whilst Mr.Erichsen was endeavouring to pass a catheter,) when the pulse-suddenly stopped, (having up to that moment been regular at76,) the breathing became stertorous, and the face flushed.Cold water was immediately dashed into the face, and the

lungs inflated by Mr. Erichsen, using the mouth-to-mouth.insufflation. As respiration was beginning to fail it was keptup artificially, and the galvanic battery sent for. This arrived.in less than two minutes from the stoppage of the pulse, andwas set to work directly. At this time the man rallied, andMr. Erichsen thought that he would come round, but he againdeclined and breathed irregularly for a few minutes more.

Artificial respiration and stimulant frictions to the limbs werethen kept up till five o’clock when the body was quitecold.Post.mortem e.xani.tatior2, seventy hours uften deatia.-Ex-

ternal appearances : A strong muscular man, with incipientsigns of putrefaction about the abdomen, neck, and chest.Lividity about the ears and the posterior and lateral parts ofthe neck. The face does not present the usual pallid aspect ofdeath, but has a somewhat reddish hue. Rigor mortis present,but not to any great extent. Thoracic and abdominal muscleshealthy in appearance. The veins of the upper part of thethorax, accidentally wounded in opening that cavity, pouredout a quantity of dark venous blood.

It is rather strange, considering that the deaths from inhala-tions of chloroform have now, in this metropolis alone, beenrather numerous, to find a case of this kind inserted in theBulletin de l1hérapeutique of Paris, on the 15th of April,1854, mentioned as the firt which had occurred in the Frenchcapital. It is true that two or three cases had been recorde(Ibefore the above-mentioned date, but our French brethrenascribe them to the severity of the operations, and to thenervous shock experienced by the patients. However thismay be, we are desirous to allude to tlais first case, as it bear"analogy, in one res]!ect, .with J’>1r. Erichsen’s case.The patient in Paris, a woman forty years of age, was to be

operated upon for a polypus uteri; and as she had had severalfits of haemorrhage, the surgeon, M. Richard, proposed to

operate without chloroform, as he the vital energysomewhat lessened by the loss of blood; but the patient re-

quested the use of the anaesthetic agent. It should be noticedthat the period of excitement was well marked, a circumstance

355

rarely observed with women; and whilst the operator wasintroducing the ligature which was to encircle the base of thetumour, the pulse suddenly stopped, and no effort could excitethe action of the heart.Now Mr. Erichsen’s patient had lost a good deal of blood

by catheterism before he entered the hospital, and was muchexhausted by pain. Perhaps it will be worth while for sur-geons to carry these circumstances in their memory, the moreso as it stands to reason that paralysis of the heart is notunlikely to take place where the vital fluid is deficient inquantity. Indeed, ansemia is perhaps as important a counter-indication to the inhalations of chloroform as fatty heart; forin the former case, it seems that the blood is, at a certainmoment, not sufficiently stimulating to the central organ ofcirculation; whilst the heart is, in the latter case, unable, at acertain period of the anfesthesia, to go on contracting, for wantof healthy muscular substance.Nor should we omit to allude to the insniSation into the

lungs, to which Mr. Erichsen had rapidly recourse in the hopeof saving the man’s life. It is well known that M. Ricordsucceeded, in a case of the same nature, in exciting respirationand the action of the heart. Mouth-to-mouth insufflationrequires on the part of the surgeon a certain amount of

generous resolution, which the desperate circumstances inwhich it has been used are well calculated to inspire.

Medical Societies.

MEDICAL SOCIETY OF LONDON.MR. HEADLAND, PRESIDENT.

SATURDAY, OCTOBER 21ST, 1854.

INJECTION OF THE CELLULAR TISSUE IN CHOLERA.

DR. RICHARDSON referred to a paper by Dr. Buchanan, inwhich it was stated that he had injected the cellular tissue withwater in cases of cholera. His (Dr. Richardson’s) suggestionwas made quite independent of these experiments. Dr. Bu-chanan’s treatment had proved unsatisfactory, it not beingpossible to inject sufficient fluid to be of service into thecellular tissue; the proceeding producing considerable pain,and the fluid not having been absorbed. It would be difficult,if not impossible, to throw sufficient fluid into the cellulartissue to effect a cure: but this was not the case when theperitonaeum was injected. During a debate in the Society lastsession, Dr. Richardson had predicted that, if a case wereever met with in which a dropsical patient should becomeaffected with cholera, the dropsical symptoms would be relievedby the new disease on the one hand, and the patient would besaved from the fatality of the choleraic attack on the other.He referred to a case of cholera, complicated with cardiac dis-ease and dropsy, both which diseases disappeared under treat-ment.

Mr. HENRY SMITH presented to the Society the parts removedafter

EXCISION OF THE KNEE-JOINT,which operation he had performed four days previously, upona little boy who had been under his treatment for nearly ayear with disease in the joint. Mr. Smith, in showing theparts, stated that some of the violent opposers of this operationhad at first grounded their opposition upon the fact that, in theearlier cases, death had taken place; but now that the operationhad been performed by various surgeons, with a success

equal, if not greater than that attending amputation throughthe thigh, the objection thrown out was, that the cases inwhich the operation had been performed were not sufficientlyserious to warrant any such measures, and would have recoveredby themselves. He was anxious to show the Fellows of the ISociety that no such objection held in the present case, for, in-dependent of there being a large amount of disease within thejoint itself, which would have precluded recovery, there wasan abscess of considerable size in the head of the tibia, which had obliged him to remove more of that bone than he had Ifintended. He had tried to save the patella, but the articulating ’Isurface of this bone was so much diseased that he took it away. ’The patient was at that time doing admirably, and he should Iinform the Society faithfully as to the future result of the case. ii

CHOLERA BLOOD.

Dr. CRISP said that a few weeks since, when examining drycholera blood under the microscope, (with a one-eighth inch

glass,) about a. week after it was taken, he saw a small insect,about the sixth part the size of the human blood-globule,(nhu- of an inch.) It moved with great rapidity upon theglass, with a swimming-like movement, using the posteriorlegs chiefly as a means of progression. Its movements were sorapid, that it was difficult to take an accurate sketch of it;but it resembled in form, and in its mode of progression, theDytiscidce. The insect was watched for nearly half-an-hour byDr. Crisp and his friend, Mr. R. Corner, and an endeavour wasmade to detach it from the glass by means of turpentine, butthe attempt was unsuccessful. The same glass had been usedpreviously for other objects, but the insect was seen soon afterthe examination of the cholera blood. Dry blood from variousanimals had been repeatedly examined before, but nothing ofthis kind had been observed. The sketch of the insect hadbeen shown to Professor Quekett, who said that it was new tohim. Dr. Crisp remarked that he should not have mentionedthe subject at the Society had he not received that morningthe Gazette Alidicale de -31ontpellie2- for October 15th, 1854, inwhich there was an article on cholera, headed, "]’üiraculous

Discovery: the Cause of Cholera an Insect, and that Insect aScorpion; the remedy an emeto-cathartic of tartarized anti-mony and sulphate of soda pvery quarter of an hour." Dr.

Crisp said he attached but little importance to the communi-cation he had made; but he was anxious to know if the insecthe had alluded to had been seen by others, and in a diseaseabout which so little was known he thought that some specula.tion was allowable. The

DISCUSSION OX CHOLERA

was resumed byDr. LANKESTER, who opened the debate by making someremarks on the very unsatisfactory results of inquiries withregard to the origin and nature of cholera. With regard to itsorigin, we could only reason from analogy. Certain diseases,which were ordinarily sporadic or endemic, became contagious.Instances of this were given in the case of erysipelas, gangrene,and dysentery. Gangrenous matter sometimes produced thehighly-contagious puerperal fever. Phlegmonous erysipelashad been rendered communicable, and followed by epidemicparotitis. In this way cholera may have been started intoexistence, as, probably, syphilis, and other contagious diseases,had been before it; and evils yet unknown might occur fromthis process of transformation in morbid conditions of thesystem. Whether this process occurred as the result of achanged condition of the cells, or a chemical change of matterproduced in the cells, could not yet be determined. It badbeen a question whether the cholera poison was propagated inthe body, or out of it. Facts seemed to indicate that mattersnot connected with the living body could retain for months, oreven years, the poison; and probably, under some circum-stances, it might be reproduced even out of the body. Dr.Snow believed it to be reproduced in the mucous membrane ofthe body, and diffused by the agency of drinking water. Theextensive co-existence of the disease with water suspected ofcontamination did not confirm this theory, and facts occurredinconsistent with it. Thus, in the case of the Broad-streetpump, which Dr. Snow had accused of spreading the cholerain that district, he knew that in one family where cholera hadbeen fatal, that although they had drank water from theBroad-street pump, they had, for above a week before theattack occurred, taken it boiled. The sewer near the wellalluded to by’Dr. Snow was a new sewer, and not in a con-dition to allow of a free passage of its contents into the sus-

pected well. He believed that impure water was a predis-posing cause; and in the case of the Broad-street pump, hecould say, from having examined it, that, like most of thesurface well-water of London, it gave indications of the presenceof a considerable quantity of organic impurities. The most

important element in the cholera problem seemed to be thepredisposition to the disease. In what the condition of thesystem consisted that invited cholera, we were ignorant; butthe proximate causes of that condition we knew somethingabout. The exhalations from decomposing animal andvegetable matter was one. In six houses in Marshall- street,in which the sewers were trapped, no cholera occurred; whilstin nearly every other house the inhabitants suffered. Whereone house or gully was trapped, and another was not, the un-trapped spot exhaled a larger quantity of the gaseous andinjurious matters. Putrid food was bad. He had seen casesoceiirrino, immediately after the ingestion of decomposing or" high" food. In Dr. Guy’s tables, published after theepidemic of 1849, those trades appeared to suffer most whomight be supposed to be exposed to the ingestion of, or theexhalations from, decomposing food, as fishmongers; polilterers,