which they were attributed had to do with their origin. The abscess in the young woman forming the subject of Etmüller's case, did not appear until ten years after she had received the blow in the epigastrium from the carriage pole. The other case, quoted from Richerand's 'Physiology,' was evidently that of the celebrated Magdelaine Goré, who was a patient in La Charité at the commencement of the present century. This woman, at the age of twenty, received a blow over the stomach from a fall on a door-step; but the abscess, which ended in fistula, did not make its appearance until eighteen years afterwards. This abscess opened externally on the twenty-first day from its first appearance, and the resulting fistula continued until death, eight and a half years later.* Mr. Poland makes some valuable remarks upon the signs and symptoms which indicate that rupture of some portion of the bowel has taken place, and also upon the best treatment to be adopted in such cases. The prognosis in cases of ruptured bowel must always be very unfavourable; out of sixty-six collected by the author, sixty-four proved fatal; and in the remaining two, it was questionable if any rupture had taken place. The author, however, believes, that some cases do recover, and that many of the cases of injury of the abdomen followed by peritonitis, are really examples of ruptured bowel, of which no evidence could be satisfactorily offered. VIII. Cases of Paraplegia. Second Series. By WILLIAM GULL, M.D.—An analysis of the first series of Dr. Gull's cases of paraplegia will be found in a previous number of this Review" The present essay contains an account of sixteen additional cases, which are illustrated by very beautiful lithographic drawings. Several of the cases are of exceeding interest. Case XVII. goes far to establish an important point, namely, that the spinal centres may be paralysed without anatomical change of their structure. We have ourselves observed one or two cases of complete hemiplegia in which even the microscope failed to reveal any lesion in the suspected locality. It is very desirable that we extend our observations as to other means of investigating the changes which take place in nervous tissue. Case XVIII. presented a not uncommon history of chronic inflammatory degeneration of the columns of the cord almost latent up to a certain point, and then accompanied by a sudden aggravation of the symptoms. Case XIX. was a remarkable instance of limitation of the disease to the posterior columns("chronic inflammatory degeneration.") There was no paralysis, but a want of controlling power; sensation was but slightly affected. The symptoms confirmed Dr. Todd's theory, that the posterior columns of the cord are the channels through which the voluntary movements are co-ordinated. Cases XXII., XXIII., and XXIV., show that the substance of the cord may be damaged by a violent exertion, without any affection of the bones, ligaments, or membranes of the spine. Case XXIX. was remarkable for the obscurity of its clinical history. It was an example of chronic thickening of the spinal membranes implicating and destroying the posterior roots of the nerves of the brachial plexus. The disease was for some time so limited as to produce no other symptom than anesthesia of the left arm. Duchenne's galvanism test proved entirely fallacious. All the conditions which he mentions as characteristic of hysterical paralysis-viz., normal electromuscular contractility, great diminution of electro-sensibility, and no impairment of voluntary motion--were present, and yet the case was one of serious organic lesion. IX. A Case of Pharyngotomy for the Extraction of a Foreign Body; with For the original description of this case, see Journ. de Méd. et Chir. Par Roux et Corvisart, tome iii. p. 407. + Brit, and For. Med.-Chir. Rev., July, 1857. some Remarks. By EDWARD COCK.-The patient was a gentleman, whose age is not stated. The foreign body was a metallic tooth plate, which had been swallowed, and retained at the termination of the pharynx. The operation was performed on January 21st, 1856; the patient made an excellent recovery, and is still alive and well. Mr. Cock has collected the histories of seven other cases in which the gullet had been opened for the extraction of a foreign body. All the cases recovered save two. In one of these death was attributable to pneumonia, which existed at the time of the operation; and in the other, the fatal result was brought about, not by the operation, but by the severe and somewhat extraordinary means which were previously used to dislodge the foreign body. X. Contributions to the Practical Surgery of New Growths or Tumours. Series II. Fibro-plastic Growths. By JOHN BIRKETT.-In this paper, Mr. Birkett records fourteen examples of that class of tumours to which Lebert first applied the appellation "Fibro-plastic." Some of these are remarkable for their returning repeatedly after removal, constituting the "Recurrent Fibrous Tumours” of some writers. Case X., for example, a fibro-plastic growth in the leg, was removed three times, and as often recurred. Ultimately, amputation through the femur was performed; but the growth re-appeared in the stump, and the patient died. The following are some of the conclusions which the author arrives at concerning "Fibro-plastic tumours :" 1. The elementary tissues comprising them differ from those entering into the composition of the tumours called carcinoma. 2. Their progress is slower. 3. They may recur at the primary site of the new growth, or in its immediate neighbourhood. 4. Unlike carcinoma, there does not appear to be a disposition to their production in any of the viscera of the chest or abdomen. (Dr. Wilks in his paper mentions a case of "Recurrent fibroid tumour of the lung.") 5. The lymphatic glands do not become secondarily involved, as in carcinoma. 6. Excision of a primary fibro-plastic growth may be undertaken with a better chance of the eradication of the disease, than in the case of carcinoma; yet amputation of a portion of a limb will not in every case prevent a reproduction of the disease, even although a joint intervene between the seat of the primary disease and the stump. XI. Contributions to Dental Pathology. By S. JAMES A. SALTER, M.B., F.L.S., &c.-Mr. Salter, in the first place, makes some interesting remarks upon the shedding of the teeth and exfoliation of the alveolar processes consequent upon the eruptive fevers. He shows that such accidents are by no means unfrequent sequelæ of attacks of scarlatina, measles, and small-pox. He endeavours to account for the phenomena by the well-known fact, that in the eruptive fevers the poison of the disease spreads its chief force upon the tegumentary system. The bonenecrosis he looks upon as a secondary consequence of inflammation of the alveolar periosteum excited by the blighted teeth. Some observations follow upon a peculiar affection, which the author describes under the name of "Warty Teeth," and also upon "Polypus of the Tooth-pulp." XII. On the alleged Sugar-forming Function of the Liver. By F. W. PAVY, M.D., Lond. As the author observes, the title of his paper appears somewhat discordant with the opinions expressed in his previous papers in the Guy's Reports. In a former number of this Review* we called attention to Dr. Pavy's experiments, by which he endeavoured to show that the sugar formed in the liver is carried by the hepatic veins to the lungs and there destroyed. He never * April, 1856. doubted at that time the truth of Bernard's doctrine, that sugar was really formed in the liver during life. The object of the present communication is to show, that the sugar which is found in the blood of the right side of a heart of a dead animal has not been generated in the liver, as hitherto supposed, but is nothing more than a post-mortem chemical transformation of a substance which is formed in the liver, and which happens to be with extreme facility, by a process allied to fermentation, convertible into sugar. The author's opinions are founded upon an extensive series of experiments, which have already been communicated to the Royal Society. On upwards of sixty different occasions on which he has examined the blood taken from the right side of the heart of a living animal, sugar has only been detected to the extent of the merest trace. Several other interesting observations corroborative of the author's views are also mentioned, for an account of which we must refer to the original paper. Dr. Pavy's facts will no doubt receive the attention which they deserve, and will call forth the investigations of other competent observers. If the facts are true, the conclusions carry along with them a high degree of probability. XIII. The Influence of Diet on the Liver. By F. W. PAVY, M.D., Lond.— The substance which is generated in the liver, and which, according to the author, exhibits such a remarkable facility for becoming converted into sugar, Dr. Pavy proposes to call hepatine. He describes what he has found to be the most economical and easy method of obtaining this substance from the liver in a tolerable state of purity. The quantity of hepatine which is formed in the liver would seem to vary very greatly with the nature of the diet upon which an animal is fed, being greatest when the diet has been vegetable, least, when the diet has been purely animal, and intermediate, when the diet has been mixed. Thus : The average per-centage of hepatine yielded by the livers of eight dogs Ditto, in three cases after a vegetable diet 6.97 17.23 14.5 The absolute size of the liver in dogs was also found to be materially increased after a vegetable diet. XIV. On Poisoning by Nicotina; with Remarks. By ALFRED S. TAYLOR, M.D., F.R.S.—The case which forms the subject of this communication is the second on record in which nicotina has been employed for the destruction of human life. The first occurred in Belgium in 1851. The Count and Countess Bocarmé were charged with the murder of the Countess's brother, a M. Fougnies, by administering to him nicotina, while dining with them in the Château of Bitremont. The deceased did not survive more than five minutes. The possession of the poison, as well as its detection in the body of the deceased, and the moral evidence, fixed the crime on the count, who was condemned and executed. In Dr. Taylor's case, the poison was taken with suicidal intent, by a gentleman aged thirty-six, well acquainted with chemistry, who had for some months been in a state of great mental depression. Five months before his death, he had casually remarked in conversation that if at any time he took poison, he would select nicotina, because it was certain in its action, and would kill a person quickly. The quantity of the poison which he swallowed it was impossible to determine, and the time during which he survived after taking it was a matter of inference. It was assumed, however, from the circumstances, that he was insensible and powerless within a few seconds, and that he died in from three to five minutes. There were no convulsions. The poison appeared to have acted as a pure narcotic. After death, nicotina was detected in the stomach in considerable quantity. The chemical tests and manipulations employed are carefully detailed. It would appear that nicotina is very rapidly absorbed into the system, and causes a complete stagnation of the altered blood in the over-filled capillaries. The appearance of the various organs, as a result of capillary congestion, was such as Dr. Taylor had never before seen. They appeared as if they had been dyed of a deep purpleblack colour, a condition which must have been the result of the action of the poison during only a few minutes. Dr. Taylor concludes that there is some foundation for the theoretical view of Bernard, that nicotina destroys life by arresting the circulation from the circumference to the centre. The paper terminates with some remarks on the properties of nicotina, and its effects upon the lower animals. PART SECOND. Bibliographical Record. ART. I.-A Dictionary of Practical Medicine, comprising General Pathology, the Nature and Treatment of Diseases, Morbid Structures, and the Disorders especially incidental to Climates, to the Sex, and to the Different Epochs of Life. By JAMES COPLAND, M.D., F.R.S., Fellow of the Royal College of Physicians; Honorary Member of the Royal Academy of Sciences of Sweden; of the American Philoso phical Society; and of the Royal Academy of Medicine of Belgium; lately President of the Royal Medical and Chirurgical Society of London, &c. Parts XIX. and XX.-London, 1858. OUR readers, in fact the whole medical world, will, we are assured, with us congratulate Dr. Copland upon the completion of his great work, to which we are brought by the publication of the nineteenth and twentieth numbers. Whether we look to the magnitude of the undertaking, the profound research which it displays, or the vigour and breadth with which all the subjects are handled, it equally claims from us the homage due to the most admirable qualities that can adorn the scientific physician. It would be difficult indeed exactly to determine the influence which this vast work, long before its completion, has exercised upon the medical mind of this country. Doubtless much of what is now the common property of all educated practitioners might be traced to this fountain, and if Dr. Copland from time to time sees seed that he has sown, bringing fruit in various ways, it will be to him a gratifying proof of the hold which his labours have acquired over the medical public. It is our duty to thank him for having persevered to the end, and it is equally a duty and a pleasure to offer him the cordial good wishes that he may long be able to wear the laurels due to the citizen who has achieved what will assuredly be are perennius. Of the two numbers which bring the 'Dictionary of Practical Medicine' to a close, we can now only say that they prove the careful attention which the author continues to pay to the medical literature of the day; it may suffice to point to the complete manner in which he discusses the subjects of syphilisation, the most recent views regarding the parasites infesting the human body, and the researches into the histology and pathology of the supra-renal capsules. A very complete Index is appended, which materially facilitates reference, and which the more deserves acknowledgment, because, from the contents of the work being alphabetically arranged, some authors might have thought themselves at liberty to save themselves the tedious labour of compiling an index as well as a "Classified Contents." The latter not only affords a very useful summary of the subjects elaborated in the body of the work, but serves also as a guide to the author's views on the classification of disease. Indeed, he has been true to himself, and we have little doubt that his cotemporaries and posterity will concede that his "attempt" "to arrest the attention, to engage it with an unflagging interest, to infix what is important or undisputed on the memory, and to carry on the mind, by an enlightened induction to a due recognition of pathological principles, and of therapeutical intentions and precepts," has been fully realised. Thirty years of his life have been devoted to the work by the author, and he has, we are told, laboured on it alone and unassisted. To him alone, therefore, belongs that full meed of praise which such devotion, such labour, such energy deserve. ART. II.-On Amputation by a Long and Short Rectangular Flap. By THOMAS F. TEALE, F.L.S., F.R.C.S., Surgeon to the Leeds General Infirmary.-London, 1858. pp. 72. FROM tables published at length by Mr. Teale, compiled from the reports for the last few years in the Medical Times' and 'Gazette,' it appears that out of 640 amputations of the thigh and leg for accident and disease, nearly one in every three proved fatal. In cases of amputation of the leg for accident, as nearly as possible one-half died. When we add to this statement the fact, that however much a compiler may be distinguished for carefulness and honesty of purpose, yet that the favourable cases find their way into his lists more readily than others, it must be allowed that a safer mode of performing amputations is a great desideratum. In the corresponding tables, published by Mr. Teale, where the amputations were performed according to his new method, the numbers are not sufficient to admit of comparison upon all points, but as far as they go they must arrest and command attention. "The amputations of the thigh for disease present 3 deaths in 17 cases, or nearly in the proportion of 1 to 6. In the London hospitals the ordinary amputations of the thigh for disease show a mortality of 1 in 44. In the Provincial hospitals the mortality is 1 in 4. "The amputations of the leg for disease (by Mr. Teale's method) show a mortality of 1 in 27, which contrast most favourably with the ordinary modes of amputating. In the London hospitals these amputations are attended with a mortality of 1 in 3, and in the Provincial hospitals of 1 in 4." (p. 21.) The risk of a fatal termination is, however, by no means the only evil to which a patient who is unfortunate enough to lose a limb is subjected. It appears from the statements of those who have had most experience in the adaptation of artificial limbs, that the cicatrix has, as a rule, been adherent to the extremity of the bone, and that it has continued for years in an irritable condition. Thus, after amputation of the leg and thigh, the best mechanicians have been unwilling to allow any of the weight of the body to rest upon the extremity of the stump. Moreover, in cases where no weight has been allowed to rest upon the extremity of the divided bone, but has been distributed by means of a bucket over the surrounding parts, yet has there been "tenderness and pain occasioned in almost every instance where the integuments pertaining to the stump are forcibly drawn upward." The end of the stump is easily inflamed and abraded by friction." (p. 68.) In order to remedy these evils, Mr. Teale proposes his new plan of operating "The chief advantages of this mode of operating are: "1st. The avoidance of tension. '2ndly. The formation of a soft covering for the end of the bone, consisting of parts free from large nerves. '3rdly. The non-disturbance of the plastic process, and consequent placing of the large veins of the limb, as well as the smaller veins of the bone, in a condition the least likely to take up purulent matter, and putrid blood or serosity. '4thly. The favourable position of the incisions for allowing a free outlet for purulent and other discharges." (p. 10.) |