609

5th.-That every means of augmenting the circulation with-out simultaneous respiration, augments the formation of thecarbonic acid poison, and consequently tends to destroy life.

6th. - That the modes of inducing artificial respirationhitherto proposed are nugatory and injurious for the followingreasons :-

7th.-1. The posture in which this measure has been at-tempted being the supine, the tongue falls backward, carrieswith it the epiglottis, and closes the glottis against all in-spiration.8th.-2. That fluids accumulated in the fauces, either from

external sources, or by regurgitation from the stomach, operatein the same manner.9th.-3. That the means of artificial respiration hitherto em-

ployed have been either of the nature of the forcing-pump orof the suctiora-pump.

10th. -4. That the former of these, besides having to over-come the impediment already described at the glottis, mustnecessarily be of force great enough to raise the ribs and carry down the diaphragm; and that such a force, as proved byLegallois and Leroy, may injure the delicate tissues of thelungs.

llth.-5. That the other mode of inducing respiration, byapplying and removing pressure, is utterly inefficient, for thereason already mentioned-viz., the obstruction at the glottis.12th.-That there is ONE mode of inducing respiration which

at once obviates all these difficulties, and proves all-efficient.13th.-That this consists : 1. In exchanging the supine for the

PRONE position. 2. In inducing the movements of respirationby alternately allowing the weight of the subject to press onthe thorax and abdomen by laying it on its face, and removingthat pressure by raising it; this last effect being accomplishedby raising the shoulders on the ilia as a centre, or by raisingboth shoulders and hips together by lifting; or, lastly, byturning the subject on the side.14th.-That these measures may be designated prorae-respi-

ration and postural-respiration respectively.15th. -That to these measures may be added gentle pressure

made on the posterior part of the thorax and ribs, and its re-moval alternately.

16th.- That whilst these measures are being adopted, otherssubsidiary, and injurious without them, may be superadded:such are-

17th.-Rubbing the limbs upwards with firm pressure, topromote warmth and the circulation, removing the wet clothesand replacing them with dry ones which the bystanders maysupply, &c., &c.18th.-Before these measures are began, every means of

exciting respiration physiologically-such as irritating the nos-trils and the fauces, dashing cold and hot water alternately onthe face, &c., are to be fairly tried, the patient being Urst placedin the prone position for a moment in order that any fluid presentin the fauces may flow away.19th.-The face and chest may also, when the season is not

inclement, be exposed to the breeze.20th.-But no time must be lost; the patient must be treated

instantly, on the spot; messengers being dispatched for medicalaid, and every means of relief.

21st.-It will be observed, that the measures proposed arelimited to such as may be always available ; other questions,such as those which relate to the use of the warm bath, ofgalvanism, of the inhalation of oxygen, or of pure but diluteammonia (to neutralize the carbonic acid blood-poison), thetransfusion of arterial blood, &c., &c., being left for anotheroccasion.

Dr. Marshall Hall then observed, that it would be obviousthat the RULES for rescuing the patient affected by suspendedrespiration must undergo considerable modification. He added,that the investigation was also in the state of progress ; andthat he had especially to ascertain the precise vulue of each ofour modes of treatment by careful comparative experiment, notagain trusting to mere experience, as it is called, which, as itdoes not consist in comparative experiments, can lead to noaccurate and definite results. For instance, the opinions inregard to the value of the warm bath are not only different,but actually opposite here and in France, judging from expe-rience ; whilst experiment and theory alike prove that it is andmust be injurious, unless it be preceded and attended byrespiration.OPERATION FOR SCROTAL HERNIA FOLLOWED BY SYMPTOMS

.

OF URÆMIA; RECOVERY.

Mr. URE related the particulars of a case of scrotal herniawhich had recently come under his care. The patient, a short,

thick-set man, in his fiftieth year, had been ruptured for theprevious fifteen or sixteen years, and obliged to wear a trussthe greater part of that time. During eight or ten years hehad been affiicted with asthma. His occupation was that of asawyer. Three days before admittance into St. Mary’s’ Hos-pital, the hernia came down during a violent fit of coughing,.and the patient tried to return it, but without effect. Hetook little heed of the accident till the day of his admission,when the swelling became painful, and he applied to a medicalman, who was unable to reduce it. When brought into thehospital, there was a large tumour distending the left half ofthe scrotum, elastic to the touch, yielding at one point an im-pulse on coughing, and occasioning a dragging pain at the loinswhen the patient attempted to walk. There had been no alvine

discharge for three days. The taxis having been fairly triedwhile the patient was in a hot-bath, and also under the, innn-ence of chloroform, but to no purpose, Mr. Ure proceeded- to-operate. He divided the tissues down to the sac. which.. hecautiously opened, after cutting across a slight stricture at-theexternal ring, and exposed a fold of large intestine. The ad-junct omentum had formed tolerably firm adhesions with thescrotal portion of the hernial sac, preventing reduction. Thesebeing divided with the hernia knife, the bowel was readily re-turned. It had a perfectly healthy appearance. The sac con-tained some serous fluid. The edges of the wound were kepttogether by means of sutures ; a compress of moistened lint.and a bandage completed the dressing. On the following dayhe complained of uneasiness, from flatulence, which was re-lieved by a dose of castor oil with tincture of senna. The nextday he experienced difficulty in emptying his bladder; the -urine trickled away without his knowledge ; it had’ a dark.colour and a strong smell. The catheter was employed accord-ingly. The left side of the scrotum was swollen and oedema’tous. He continued making tolerable progress, his bowelsacting well, his abdomen free from tenderness, until the sixth..day, when symptoms indicative of uraemia showed themselves.He was constantly dozing, muttering in his sleep, rambling in’his talk when roused ; his face had a yellowish tinge ; his fore-head was bathed in a cold clammy sweat ; the surface of thebody generally was below the natural temperature ; the pulsewas 100, weak; he had lost all relish for food; the urine,.which was voided frequently and in small quantity, was of amolive colour, rather low specific gravity (1014), and chazgetl:with albumen. The wound had a healthy appearance. Hewas ordered some white wine, and a draught every fourth hour,..composed of tincture of broom-seed, solution of acetate of arm-monia, spirit of nitric ether, and bicarbonate of potash, in aro-matic water. He took this medicine with advantage for four--days, when tincture of muriate of iron was exhibited instead.After this the urine was passed freely, assumed a natural tint,.-.and contained a mere trace of albumen. Mr. Ure observed,that the patient was in full convalescence, his only annoyancebeing the chronic cough. He deemed the muriated tincture of.iron a valuable remedy, as it not only exerted a diuretic action;but tended also to improve the condition of the blood.

WESTERN MEDICAL AND SURGICAL SOCIETYOF LONDON.

FRIDAY, DECEMBER 7TH, 1855.

MR. MARTYN IN THE CHAIR.

MR. THOMAS C. WHITE read a paper

ON THE PROXIMATE CAUSE OF DENTAL CARIES.

Adverting briefly, at the outset, to the importance of the teeth,.and the necessity of their preservation, to secure health to theindividual, as well as the physical well-being of the humanrace, the author insisted upon the duty that devolved uponmedical men, of investigating their diseases, and exposing thecauses which tended to produce consequences so wide-spread,and as destructive of the beauty of the human face. He statedcaries to be the most frequent of all diseases affecting the teeth,.being eighty-eight per cent. of all others; and should con-sequently occupy the largest share of our attention. He thenproceeded to glance at the structure of a tooth that has been,normally developed, describing, in succession, the enamel, thedentine, the cementum; and the pulp cavity; remarking uponthe minute structures, and their supposed uses, as he passedalong. He next contrasted the appearance and structure of’an imperfectly-developed tooth, the rough and honeycombedenamel, discoloured and deposited in chalky ridges; the dentine

610

abounding in irregularities and cells of all kinds, as well asrather extensive canals running throughout the bone. In

proceeding to speak of the causes of dental caries, Mr. Whiteconsidered, with the best authors, that the structural defectsjust alluded to strongly predisposed to caries; although hewas unable to point out the precise mode in which these statesconduced to it, saving that such defects were found to existmore frequently amongst those of scrofulous habits than of otherconstitutions.Such defectively formed teeth then, in which the lime appears

to have been irregularly deposited, leaves its substance morepervious to the fluids of the mouth. Besides which the lime

might be deficient in quantity, and more susceptible of changefrom the action of the saliva, which, under some circumstances,acts as a solvent. Remembering also, that the saliva willsometimes show the presence of both an acid and an alkali ina state of imperfect neutralisation ; that the quantity con-

tained in a tooth is very small, and the length of time overwhich the destructive action spreads; and that the defects andcavities referred to, form so many recesses into which this acidmay penetrate and remain, it was safe to conclude that de-fective formation was one cause of caries. Passing on, theauthor discussed, in succession, the various states of "illhealth" observed in patients suffering with dental caries-in-digestion ; sympathetic ailments, as neuralgia and others; andfortified his opinion, that the teeth were greatly under con-seitutional influence, by reference to experiments and physio-logical observation. The author also expressed his belief inthe hereditary influence, and cited some curious instances.Certain trades again tend to produce caries, of which grocersand lucifer-match makers were examples. Certain localities,especially damp ones, and those where imperfect drainageexisted, appear to be amongst the causes; and, also, mechanicalviolence. Of the teeth most likely to be affected the first molarsappeared to occupy the highest place, and those of the upperjaw usually were the first to decay. The " wisdom teeth" wereoften evolved in an unsound state. The popular idea of thecontagion of caries was met by asserting, that the apparentlysuccessive decay of adjoining teeth was due to the pressure of theteeth against each other, caused by the upward and forwardgrowth of them. For if such teeth were examined at an earlyperiod, long before caries had manifested itself, a round chalkyspot might be noticed, caused by the crumbling of the enamelfibres beneath the firm, but steady, pressure exerted uponthem: this opens the dentine to attacks of acid, and otherirritants, and sphacelus is the result. Having thus discussedmany and various causes of dental caries, and contrasted thefrequency of the disease in civilized society with the immunityenjoyed by man in his savage state, as well as that of the loweranimals, the author was impelled to the conclusion, that" itmay in great measure be attributed to the artificial mode ofliving in a civilized state, which brings on a morbid conditionof the fluids, resulting in impaired nutrition. The treatmentmust, of course, vary with the states and circumstances of thedisease. In an incipient state, from pressure, the removal ofthe affected enamel, and polishing the surface was recom-mended. Where, on the contrary, the disease has proceededso far as to excavate the substance, the sooner it is cleaned outand stopped with gold, or amalgam, the better. When thecaries has progressed to such an extent that the dentine is softand yielding, the slightest pressure causing intense pain,stopping is inapplicable, and recourse must be had to escha-rotics. Of these, perhaps, the most efficient was a combinationof oxide of arsenic with acetate of morphia, mixed into apaste, with creosote. This gives slight pain for about twohours, after which it ceases, and the tooth can then be stoppedand made serviceable for some time. The practice of indis-criminate extraction was declared to be unwarrantable.

EPIDEMIOLOGICAL SOCIETY.

MONDAY DECEMBER 3Rd, 1855.

DR. BABINGTON, PRESIDENT.

DR. MURPHY read the following paper, onPUERPERAL FEVER,

in which he dwelt at some length on the importance of definingmore accurately the true character of this disease. He objectedto the terms "puerperal peritonitis," "uterine phlebitis,""arthritis," &c.,as correct expressions of what he would

prefer to call a puerperal plague. The name puerperal feveis the most commonly used, and therefore the best understoodHe denied that it was puerperal peritonitis, because it did noagree with that inflammation, either in the mode of the attackin the symptoms, in its morbid appearances, or in the influenciof remedial agents. He pointed out the sudden manner of th(attack without any obvious cause, the cases where the symptomsof puerperal peritonitis were absent, and yet the patient diecof this disease, and presented all the usual morbid appearance:in the peritoneum. He compared the morbid changes observeoin peritonitis from ruptured uterus with those described irpuerperal fever, and pointed out the difference ; and, lastly,directed attention to the great difference in the effect of thetreatment most commonly pursued for peritonitis, stating thatdepletion has been used successfully in cases of puerperal feveIto such an extent as fifty ounces of blood, in cases the parallelof which in peritonitis will not bear bleeding at all. Mercuryhas failed utterly in arresting this disease, and opium iaequally useless, unless in combination with the most powerfulstimulants. He therefore thought it quite incorrect to callpuerperal fever "puerperal peritonitis." It seemed to himequally an error to name the disease "acute uterine phlebitis,"admitting the greater difficulty of distinguishing each becauseboth were blood diseases. He thought true uterine phlebitisa rare disease; that the most eminent pathologists have agreedthat the lining membrane of the veins is scarcely susceptibleof inflammation; that the uterine veins consist only of a liningmembrane, and do not inflame; if they did so easily, uterinephlebitis would be the result of every severe labour, especiallywith putrid children. He quoted some cases of true uterinephlebitis and puerperal fever with the veins chiefly engaged,in order to point out the difference. He considered the depo-sitions of pus so frequently found as the evidence of depravedor poisoned blood, and quoted a case of Mr. M’Whinnie’s, fromthe " Transactions" of the Royal Medical and Chirurgical So-ciety, as an illustration of his argument. Assuming puerperalfever to be the result of a poison, he stated that we did not as yetknow what that poison was, but the nearest approach we couldmake to it was its close resemblance to the poison of putridanimal matter. In illustration he mentioned the effect of theeffluvia, from Mont Fanen on the Maternite at Paris. Hereferred to a case of severe labour, in which, having to removea putrid placenta, his arm afterwards exhibited a malignantpustule, which was very like the pustules sometimes foundamongst the meat-slaughterers in the south of France fromputrid meat. He mentioned a case of putrid uterus, whichproduced all the symptoms of so-called puerperal peritonitis,although in the Dublin Lying-in Hospital, where the patientwas, there had not been a single case of this fever for a yearbefore or for a year and a-half afterwards. He referred to Mr.Henry Lee’s researches, and to Weal, in support of his opinion,that the uterine veins do not easily inflame, and concluded bymaking a marked distinction between pus and putrid matter.He denied that healthy pus was a poison; its properties wereto preserve the circulation from contamination; decomposedanimal matter had the contrary effect, because it destroyedthose healthy properties of the blood; it had less power ofcoagulation, was easily dissolved into pus, and in such casespus, or what is called pus, is found everywhere, infiltrating theuterus, in the liver, spleen, lungs, and even the heart, and allthis without inflammation. He therefore objected to the term"uterine phlebitis," as used to express that form of puerperalfever, but did not wish to be understood to assert that a specificinflammation could not form a part of this epidemic, but itappeared to him that we might as well adopt Broussais’ doctrine,and call typhus fever "gastro-enteritis," as name puerperalfever by these local inflammations. On a future occasion hewould conclude this subject.

EDINBURGH UNIVERSITY.-The various classes havenow settled down to the customary routine of the wintersession. Professor Goodsir has offered several prizes for com-petition by the students of his Anatomy Class, and Dr. Gregoryhas announced the same intention with regard to his. These

prizes, it must be remembered, are at the private expense ofeach professor; for, with the exception of a few bursaries andscholarships to the students in the Faculty of Arts, there arescarcely any of consideration at this University. The HopePrize, instituted by the late Dr. Hope for the chemicalstudents, although a large one, has had no candidatesfor it during the last few years; however, it is to be hoped,with the additional incentives given to students this session,that so valuable a prize will not be wanting in competitors.