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pected, and who probably never would have had it, had he not gone to such a locality.

10. That consequently, probably many healthy persons who never have had asthma, and never may, would have been asthmatics if their lot had been cast in other localities.

11. That possibly there is no case of asthma that might not be cured if the right air could only be found.

12. That the disposition is not eradicated, but merely suspended, and immediately shows itself on a recurrence to the original injurious air.

13. That change of air, as change, is prejudicial.

14. That, from the caprice of asthma, the constancy of the result in any given case is often deranged.

In reference to the frequency with which London air is beneficial to asthma, the author remarked that he was in the habit of putting to country asthmatics the two questions-" Have you ever been in London? have you ever had asthma there?" and that, if an affirmative answer was given to the first question, a negative one was pretty sure to be given to the second. In his own experience he had found hardly any exception to this rule.

ART. 48.-On Intercostal Neuralgia. By A. W. NICHOLS, M. D.

(Buffalo Medical Journal, July, 1857; and North American Medico-Chirurgical Review, March, 1858.)

Dr. Nichols treats of the causes, symptoms, diagnosis, and treatment of intercostal neuralgia, his remarks being based on an analysis of twenty recorded cases. The results of the analysis go to show that this affection generally occurs after puberty, and under thirty-five years of age. It occurs in persons not enfeebled, but apparently possessing good constitutions. It appears to be developed in those who are engaged in active occupations rather than in those of sedentary habits. All but two of the cases analyzed were observed in the latter part of winter and early part of spring. The left side is more commonly affected than the right. Both sides are rarely affected. It is sometimes observed in the course of pulmonary tuberculosis, and frequently during or after an attack of periodical fever.

As regards the symptomatic phenomena, the histories of these cases confirms the correctness of the descriptions of the affection given by Nichol, in 1818, and, more recently, by Bossereau and Valleix. The most distinctive feature is the existence of pain, and tenderness on pressure, limited to particular points on the thoracic and abdominal parietes. These points are, first, slightly to the outside of the spinous processes of the dorsal vertebræ and almost over the dorsal-intervertebral foramina, just opposite the divisions of the spinal nerves into their anterior and posterior branches; second, about midway between the spinous processes and the margin of the sternum; and, third, near the edge of the sternum, or on the abdomen at the side of the median line. The pain or tenderness may be limited to one or two of these points, and often all three are affected. The tenderness is very circumscribed, extending over a space which may be covered with the ball of the thumb.

The treatment which seemed most efficient consisted of vesication, anodyne, and tonic remedies. The affection was found to persist, in several instances, for some weeks.

ART. 49.-The Chest Goniometer. By Dr. ScorT ALISON, Assistant-Physician to the Brompton Hospital for Consumption.

(Lancet, Nov. 14, 1857.)

This instrument consists of two arms, moving on a centre, to one of which is fixed an arc of a circle, and to the other a hand or index. When the two arms are separated so as to form a straight line, the are and the index are at right angles to them, and the index points to 180°, the half of a circle. The arms are placed upon the part of the chest to be measured, and made to fit it; the angle is then read off. The two sides of the chest are measured and

compared, and the slightest deviation from symmetry is at once detected. The discovery of depression in very early or doubtful phthisis, when the ordinary percussion and auscultatory signs are ill pronounced, readily obtained by this instrument, promises to render it a valuable aid in diagnosis. It will also serve to mark from time to time, with greater precision than by the eye, the progress of disease, whether favorable or unfavorable, as indicated by the form of the chest. The instrument is made of ivory, and is very light and portable. Dr. Alison is collecting observations with it, which he promises shortly to lay before the profession.

ART. 50.-A new Percussion Hammer.

By Dr. VERNON, Physician to the Great Northern Hospital.
(Lancet, Feb. 6, 1858.)

"The hammer of which the above drawing is a representation, is one," says Dr. Vernon, "which suggested itself to my mind several years ago, when attending the clinique of Dr. J. Hughes Bennett, of Edinburgh. Having latterly been more frequently engaged in the diagnosis of thoracic diseases than at any previous time since the idea suggested itself to me, I have had the instrument made by Messrs. Whicker and Blaise, of St. James's Street. The hammer consists of a slender tapering handle of whalebone, eight inches in length, surmounted by a sphere of bell-metal, weighing one ounce. The sphere is grooved deeply in an equatorial direction, and a stout ring of caoutchouc is let into the groove, as a cushion upon which to strike. Such is the instrument simplicity itself.

"The advantage which a percussion hammer has over the fingers is very obvious, especially in cases where much refinement is required. The rudest efforts of an unskilful neophyte will distinguish between the dulness heard in the centre of the hepatic region and the generous resonance of the upper and anterior parts of the thorax. But the greatest utility of percussion is precisely in those cases where we desire to distinguish slight differences, and hence the advantage of a means of defining such distinctions.

"The purpose of a percussion hammer being to produce a clear and definite sound, and not to drive a nail into the body, instead of imitating a carpenter's hammer, as Dr. Winterich has, I have rather taken a hint from the musician, and imitated a drum-stick. The advantages possessed by the hammer in the accompanying figure are

"1. That the stem being round and smooth, it may be lightly and easily

handled.

"2. That the handle being elastic, the hammer-head springs off the pleximeter momentarily, as the hammers of a pianoforte do off the strings of that instrument; the result being a clear tone, the vibrations of which are not checked by the lingering of the hammer on the vibrating body.

"That in whatever direction the hammer falls on the body, if the same spot be struck with the same force, the note produced will be the same; because the handle of the hammer being round, and the head spherical, every axis is equal in length, and the line through which the force acts is equal, in every possible position of the hammer, the operator, or the patient.

"To sum up, the superiority of this instrument over Dr. Winterich's consists in the facts, that it is convenient, elastic, produces the same sound however held, requires no education to use it, and fulfils all its purposes.

"In children and very spare adults I prefer the fingers, because they are generally sufficient, and they recognize the sense of resistance; but in even moderately-developed adults I believe a hammer, and especially the one I have described, will be of great service to those who are not very skilful with the fingers, or have hands too light to elicit the desired sounds."

(c) CONCERNING THE CIRCULATORY SYSTEM.

ART. 51.-A Peculiar Case of Leukhamia. By Dr. N. FRIEDRICH, of Würzburg.

(Virchow's Archiv, Bd. xii. Ht. 1, p. 104; and Med.-Chir. Review, April, 1858.)

This case, in which a peculiar state of the mucous membrane of the digestive organs co-existed with the altered state of the blood, is related at considerable length. The following abstract is by Dr. J. W. Ogle :

CASE. The patient was a woman, æt. 46, who died eventually, having fallen suddenly into a syncopal condition. The outer lymphatic glands were hardly at all enlarged, but the glands about the mesentery and stomach were very much so, showing on section homogeneous soft white masses, very like some portions of the thickened spongy pleura formed from fresh and old pseudomembranous deposits, and found within the thorax. The most interesting observation after death was the unusual state of the mucous membrane of the stomach and intestines.

From the cæcal valve upwards as high as the duodenum, numerous large and small flat and prominent elevations existed, having the closest resemblance to the pulpy typhus infiltration previous to ulceration. These were very plentiful in the lower part of the ileum, where the mesenteric glands were largest, and were obviously occupying the place of Peyer's glands, but were not entirely confined to them. They showed, on section, the same appearances as the mesenteric glands. The large intestine was free from these tumors, excepting the rectum, which contained one or two. In connection with one of these leukhæmic enlargements, in one place a varicose lymphatic vessel of the size of a small quill, and filled with white juice, was seen passing into an enlarged lymphatic gland, but no outgoing vessel from the gland could be distinguished. In the stomach, near the cardiac end, and on the posterior wall, a flat, irregularly bounded elevation, covered by mucous membrane, existed, and several such were seen in the pyloric half of the stomach. These were evidently of the same nature as those in the intestine. The spleen was enlarged, the pulp being very soft, and the Malpighian bodies very large, the trabecular work being very indistinct. The reaction of the spleen, pulp, and of the splenic venous blood was intensely acid. The liver was enlarged, showing in one part a cavernous blood-tumor; and in another part, almost occupying the entire thickness of the viscus, was a soft, roundish tumor of a grayishwhite color and pulpy consistence.

On microscopical examination, the author concluded that the intestinal tumors had the same histological elements as the enlarged glands; namely, large and oval nuclei, as also round cells, chiefly with single nuclei. The tumors appeared to have no original relationship to the pre-existing follicles of the mucous membrane, but to be developed in the mucous and submucous tissues. On examining parts of the deepest portions of the tumors, where connected with the deep layer of the submucous tissue, the numerous and enlarged areolar tissue-cells were seen to contain two and more endogenous nuclei and cells undergoing fatty degeneration; and every transitional form up to large and oval spaces filled with various endogenous formations, presented themselves. The follicles of the mucous membrane were seen to be atrophied and filled with fatty detritus.

The author traces the origin of the colorless elements to the areolar tissue corpuscles of the intestinal mucous membrane, and in the same way he traces the growth before spoken of on the pleura, and which consisted of numerous colorless elements, partly nuclei and partly cells, to the pre-existing areolar tissue corpuscles of the pleura. He declares that in the most beautiful manner it can be seen how by endogenous formation within them, at first two or three, and later on more, nuclei arise, which grow to such an extent that the special areolar tissue of the pleura can hardly be seen. This endogenous cell-growth appears to occur without any special preceding afflux of blood. The spleen showed white follicles, consisting of small, colorless cells, containing fat-drops, as also many free nuclei, some fine fatty detritus, and remains of cells. Here

and there large cells, with many endogenous nuclei, were seen. The pulp contained numbers of spindle-shaped spleen corpuscles, and many large and small colorless cells, some being in a state of fatty degeneration, others containing many nuclei, also a great number of large blood-corpuscle-holding cells. The hepatic cells were double or three times their natural size, and most of them were very irregular in size, containing two or three large, sharply-contoured, round and oval nuclei. The liver substance, like the spleen, gave an acid reaction. The grayish-white tumor within this viscus consisted of small, round, nucleated cells, and also free nucleus-like bodies in a soft connective tissue stroma, containing spindle-shaped cells. The author supposes the colorless elements to have arisen from the areolar tissue cells of the hepatic stroma when undergoing contemporary growth. He also found in the middle of the tumor a circular space, in which large, clearly contoured cells filled with many endogenous glittering nuclei existed. This is supposed by the author to be analogous to the newly formed follicle found by Virchow (see his "Gesammelte Abhandlungen," s. 207) in the liver of a leukhæmic patient, and considered by him as a degenerated areolar tissue corpuscle, enlarged by endogenous growth. The blood was also generally very acid, especially in the splenic vein blood, where were found the largest number of white corpuscles. The above case tends to confirm the observations of Virchow upon the existence of leukhæmic tumors of the liver and kidneys, and upon the supposed part which connective tissue corpuscles play in the production of colorless forms in leukhamia; and also those of Schreiber ("Dissert. Inauguralis") as to the changes in the intestinal membrane. The author also quotes a case of leukhæmia related by Robin and Isambart ("Gaz. Medic." 1856, p. 682), in which Peyer's patches were pale and enlarged; and alludes to the observations of Virchow and Leydig, who suppose a most intimate connection to exist between connected tissue corpuscles and the commencement of lymphatic vessels. He concludes by drawing an analogy between leukhæmia and abdominal typhus, both in respect of certain anatomical characters, increase of colorless corpuscles, &c., as also in the tendency to hemorrhage, the formation of ulcers of the mouth and skin, the diarrhoea, &c. He mentions the interesting fact that the pulpy tumor mass, on exposure to the air, assumed a reddish color, as did the leukhamic pleural patch, and this accords with the observations of Virchow, Valentin, Gubles, and Quevenne, as to the spontaneous change of color which lymph corpuscles undergo under the action of the air.

ART. 52.-Remarks on 70 cases of Hypertrophy of the Heart.
By Dr. VAN DER BYL.

(Medical Times and Gazette, May 1, 1858.)

These remarks were made at a meeting of the Pathological Society after the exhibition of certain specimens of the disease in question: "Hypertrophy of the heart occurred in 70 cases out of 380 post-mortem examinations; that is, in 18.4 per cent. of patients dying from various diseases. In all the cases the heart weighed upwards of 14 oz. in the adult male, and upwards of 12 oz. in the females. Of these 70 cases, 46 were males and 24 females. The average age of the males was 43.3 years; the average weight of their hearts was 19.3 oz. The average age of the females was 41.6 years; the average weight of their hearts 15.6 oz. Some of the principal morbid appearances associated with hypertrophy of the heart in these 70 cases were: Disease of the aortic valves in 36, of the mitral in 32; in 22 of these, aortic and mitral disease coexisted; vegetations on the aortic valves in 9, on mitral in 5; adherent pericardium in 9; atheroma of aorta in 13, of pulmonary artery in 1; cerebral hemorrhage in 4; bronchitis in 10; phthisis in 7; granular disease of kidneys in 46; cirrhosis of liver in 21, &c. The eight volumes of the Transactions of the Pathological Society' contain accounts of 40 cases of hypertrophy of the heart, in which the weights are given. Of these 34 were males, and only 6 females. The average age of 31 of the males was 44 years; the average weight of the heart of the 34 males was 22.1 oz., the heaviest weighed 40 oz. The average age of the females was 37.5 years; the average

weight of their hearts was 17.5 oz.

Disease of the aortic valves occurred in 28, of the mitral in 17; in 14 cases aortic and mitral disease coexisted. From this analysis of Dr. Van der Byl's observations, and of the cases recorded in the Transactions,' it appears: 1. That hypertrophy of the heart occurs in nearly 18 per cent. of patients dying from various diseases. 2. That it is about twice as frequent in males as in females; or, exactly as 8 to 3. 3. That the average age of males and females is nearly the same; that of the males being 43 years, and of the females 39. 4. That in hypertrophy of the heart, disease of the aortic valves is more frequent than disease of the mitral; as 8 to 6. 5. That in hypertrophy vegetations are more frequently situated on the aortic than on the mitral valves. 6. That adherent pericardium exists in about one-eighth of the cases. 7. That granular disease of the kidneys occurs in about two-thirds of the cases."

ART. 53.-A Remedy for Palpitation. By. Dr. KOLLIKER.
(Verhandl. der Phys. Med. Gesellsch.; and Edinb. Med. Journal, May, 1858.)

In a case of severe palpitation, Dr. Kölliker has found that deep inspiration and subsequent holding of the breath sufficed, after a few times, to cut short this most unpleasant symptom.

ART. 54.-A case of Sudden Death from the impaction of a detached clot in a contracted mitral orifice. By. Dr. VAN DER BYL.

(Lancet, Jan. 30, 1857.)

At a recent meeting of the Pathological Society of London, Dr. Van der Byl exhibited a fibrinous congulum or globular vegetation, which had been found in the left auricle of a woman, æt. 25, who had died suddenly in the Middlesex Hospital. For three weeks before her death she had suffered from oedema of the legs, ascites, orthopnoea, and frequent cough. The heart's action was rather forcible with mitral regurgitant bruit; and that she never had rheumatism. The urine was very albuminous, but contained no casts of tubuli. On the 4th of November, after breakfast, she suddenly fainted; she was seen almost immediately by the house-surgeon, Mr. Tatum, and then appeared insensible; the pulse was scarcely perceptible; the heart's beat was strong and quick; respiration gasping. The heart's action ceased in about a minute; she then gasped four or five times and died.

Post-mortem examination.-The heart was found enlarged, weighing fourteen ounces and a half. On opening the left auricle, an irregular, shaggy looking mass was seen sticking in the mitral orifice. When it was washed out and floated in water, it assumed a sac-like appearance, and was about the size of a pigeon's egg. The portion required to complete the sac or capsule was found adherent to the inner surface of the auricular appendix by means of fibrinous bands and processes, which were entwined in the musculi pectinati. Three or four smaller globular bodies, about the size of peas, were found in the left auricular appendix, similarly fixed. On squeezing one of these, it burst, and yielded a thick, grayish, purulent-looking matter, which seemed to form the contents of a capsule, similar to, but smaller than the one found detached in the auricle. There can be no doubt but that the larger capsule was of exactly the same nature as the smaller ones, and that they all are fibrinous coagula, in which the central portions have softened or broken up. There was no actual organic union between any of these coagula and the walls of the auricle. The mitral orifice was much contracted, and measured only four-tenths of an inch in diameter. The chordæ tendineæ of both flaps of the mitral nerve much thickened and shortened; the apices of both papillae to which the chorda were attached presented a white fibroid appearance; some small warty vegetations projected from the free margins of the contracted mitral orifice. The aortic valves were perforated by several small openings, on the posterior wall of the left ventricle, half an inch below the aortic valves, the endocardium presented a thick, rough patch, resembling a cicatrix, about the size of a shilling. The brain was healthy, and there was no obstruction in any of the ves

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