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sented by a similar number; Teratology and Development are illustrated by four, and Therapeutics by three. But following, as is our custom, the order in which the papers are arranged in the volume, we proceed to give a- short analysis of each.
I. An Account of a Case of Arterio-venous Aneurism of the Temporal Vessels, which was treated by Ligature of both the Artery and Vein. By Charles H. Moore, Esq.— The subject of this case was a labourer, sixty years of age, in whom a direct communication had existed for thirty-six years between the temporal artery and vein. The wound was originally made by a surgeon in opening the temporal artery. An abscess ultimately formed in the diseased parts, and the spontaneous bursting of this abscess was followed by such dangerous haemorrhage that active surgical interference became at once necessary. The operation consisted in tying, first, the vein on the cardiac side of its communication with the temporal artery, behind and a little deeper than the ramus of the jaw, a little below the external meatus of the ear; secondly, the temporal artery, displaced by tortuosity, was tied near the posterior edge of the masseter mnscle. The pulsation in the vessels in the temporal region and in the vein previously tied at once ceased. The jugular veins also at once diminished in size, and a pulsation and a thrill previously obvious in them could no longer be detected. With judicious after treatment the case progressed favourably: the discharge from the abscess rapidly diminished, and the ligatures separated on the tenth and thirteenth days; the ulcers assumed a healthy appearance, all oedema of the scalp disappeared; and when the patient left the hospital no pulsation existed in any of the diseased temporal vessels.
II. Case of Communication with the Stomach through the Abdominal Parietes, produced by Ulceration from External Pressure; with Observations on the Cases of CastroCutaneous Fistulai already recorded. By Charles Murchison, M.D.—This is an interesting and valuable paper, written in a clear and pleasant style. Were it nothing more than an account of the vagaries of a hysterical female, it would still be a most important addition to medical literature. We have here a remarkable instance of that morbid mental condition where misdirected volition led the unfortunate sufferer to inflict the most serious and unnatural injuries upon her person. Her purposes of partial self-destruction she patiently accomplished by the most persistent and prolonged methods of injury, designed with peculiar but characteristic cunning, and carried into effect with no less characteristic obstinacy. The case, however, is related and connected with 24 other cases of gastro-cutaneons fistulae in a tabular statement, embracing the following considerations: 1. The causes of such morbid communications; 2. The situation, size, and character of the external opening; 3. How the food swallowed by the mouth escaped through the unnatural aperture; 4. A statement as to the duration of such fistuhe and the possibility of curing them; 5. An account of the general health of those who have suffered from gastro-cutaneous fistulce; and lastly, we have a notice of the contributions to our physiological knowledge regarding the stomach and its functions afforded by experiment and observation upon such cases.
. III. and IV. On the Influence of Liquor Potassa and other Caustic Alkaline Solutions upon the Therapeutic Properties of Henbane, Belladonna, and Stramonium. By Alfred B. Garrod, M.D., F.R.S.—Two important contributions to clinical therapeutics from the same pen are given under this title. No subject can be more important, and no topic shows more clearly how necessary it is that the physician must be a physiologist and a chemist, while the chemist must be at once a physiologist and a physician, in order that the sciences of chemistry and therapeutics shall continue to make mutual progress, and advance the science of medicine hand in hand together. We cannot too highly estimate the value of such clinical inquiries into the actions of drugs as are recorded in these papers; and we hope Dr. Garrod will continue to communicate such statements of accurate facts, which he may determine or collect regarding the action of individual remedies. The refinements of pharmaceutical operations, the less crude, more refined, more elaborate, and more scientific forms in which medicines are prepared for administration, render a study of the incompatible combinations in which drugs may be—nay, often arc—administered, a subject of paramount importance to the physician. But we cannot allow that these observations of Dr. Garrod, however valuable, are perfectly original, for if the reader will turn to page 512 of Dr. Paris's ' Phartnacologia,'* in the middle of a very long tabular synopsis of substances usually considered as incompatible with the different articles of the 'Materia Medica,' he will find the following statements arranged under the following respective headings:
Substances. Incompatible*. ISesulta.
Belladonna . . . Caustic alkaline . . . Decompose atropia
Hyoscyamus? . . . solutions. . . . and render it
Stramonium? . . . ... inert.
On the same page we are also directed to a foot-note, which communicates the fact, that
"Brandes had detected a vegetable alkali in belladonna, which he termed ' atropine.' Succeeding chemists not being able to find this alkali, denied its existence, until Kunge explained their failure by showing that a caustic alkali, which they had employed, even though weak, was capable of decomposing atrophia. By substituting magnesia, he not only obtained it from belladonna, but from hyoscyamus and stramonium; and he has shown that the properties of these three bodies so resemble each other, as to make it highly probable that they contain one common principle of activity."
In justice to the memory of Dr. Paris, we consider it right to draw attention to these statements; seeing that the quotations from the 'Pharmacologia' of Dr. Paris contain the gist of Dr. Garrod's communication.
We concede to the latter physician, however, the merit, first, of bringing a most important subject prominently before the notice of the medical profession; second, of having made and detailed experiments which show the necessary ratio between the alkali and the various preparations of the plants within or beyond the limits of which the active principles of these preparations retain their physiological and therapeutic properties or become inert; thirdly, he has ascertained and directed attention to the time required for the complete decomposition of the active principles. The main fact— namely, the destructive influence of caustic alkalies on the active principle of henbane, hyoscyamus, and stramonium, must have been within the knowledge of the profession during the past fifteen years at least. Some veterans prescribe, and will doubless continue to write prescriptions regardless of the important investigations of chemistry and physiology, which contradict the experience and observation they have been accustomed to regard, and the theories they may have cherished, since their student days. To bring such conflicting classes of prcscribcrs to terms, is the victory we hope to see achieved, and that by such important inquiries as those which Dr. Garrod has proposed for himself at the commencement of these papers. The deductions naturally drawn from Dr. Garrod's investigations are stated as follows in his own words :—
"Neither liquor potassae, nor any caustic fixed alkali, should be prescribed with tincture or extract of henbane, as the virtues of the latter drug are thereby completely neutralized.
"But When it is desirable to administer au alkaline remedy with henbane, either a carbonate or bicarbonate should be selected, which would probably be equally efficacious upon the stomach, if such influence bo required, and certainly as efficient in altering the condition of the urine, and the mucous membrane of the urinary passages. The same precautions should be observed with regard to belladonna and stramonium, if at any time prescribed in conjunction with alkalies."
In his second communication it is shown that the destructive influence of liquor potassae is so great in its action on atropine, that less than twenty minims of the former are required to neutralize one grain of the active principle; while a single grain of pure potash will, even in dilute solutions, destroy an equal quantity of the alkaloid. Dr. Garrod then notices the preservative power of ammonia salts, and gives a statement as
to the time required for complete decomposition of the active principle; concluding his paper with some interesting clinical illustrations of the influence of liquor potassae in rendering henbane and belladonna inert.
V. A Contribution to the Science of Teratology, by Henry K. Silvester, M.D., conveys a minute description of a remarkable instance of congenital malformation of the two upper extremities. The examples of malformations usually preserved in museums convey very imperfect notions of the nature of the various deformities of organized beings. For the most part such museum-preparations represent external form merely. As to the precise nature of the deviation from the normal state we are left altogether in the dark; because, for the most part, no dissection is made of the monstrosity. Descriptive and developmental anatomy, as applied to the science of teratology, is therefore at-the present day very defective. The very careful and minutely-described dissection recorded in this paper is a valuable addition to the science of teratology—valu-. able especially as a case with which similar or analogous cases of deformity may be compared.
The conclusions to which Dr. Silvester arrives regarding the deformity he describes are:
1st. That it appears to have been the result of, first, the original malfoimation of the germ; second, the subsequent deformation of the embryo and foetus by causes operating on its development; and, third, certain compensations and vital accommodations having a conservative tendency.
2nd. That the arrest of development reacts on various parts of the body, and particularly on such parts as have either a casual or a natural connexion with the original malformation.
3rd. That a law of compensation prevails during the growth of the body in monsters. This law is expressed by a certain tendency to render the parts as nearly normal- as possible, and to make up by excessive formation for the defective development of an adjoining part.
4th.*That the inquiry which Dr. Silvester has here instituted, confirms in some measure the opinions held by Vrolik, Mttller, Bischofls, Stannius, and others, that the several parts of the body are formed and developed independently of one another.
5th. That the absence, arrest of development or defective condition of the radius (which appears to be the rule in congenital malformation of the human forearm), is not the normal state in beasts; the ulna being the bone which in them is atrophied.
0. "As the transient forms of the human fcetus are for the most part comparable to the persistent forms of the lower animals, the malformations occasioned by impeded development often acquire a brutelike appearance." (Vrolik.)
We here learn how the study of a careful and minute dissection of malformed parts tends to show, that a full-grown monster is no lusus naturae; but, that its form is the result of certain definite laws, the tendency of which is to compel the tissues to rectify as far as possible the original defect in the germ, by means of a principle of vital accommodation and compensation.
VI. On some Points in the Pathology and Morbid Anatomy of Glaucoma. By J. W. Hulee, Esq.—In this disease, when all sight is lost, and when a hard and painful condition of the globe of one eye places the other in danger, it has lately become the practice with some ophthalmologists to excise the eyeball, a practice instituted for the first time in the Royal London Ophthalmic Hospital in the winter of 1854-55. Such an operation has afforded frequent opportunities for examining and dissecting eyes affected with glaucoma, directly after extirpation, and while the parts were still fresh. The results of such dissections are given by Mr. Hulke in this valuable communication, which also embraces a short record of the symptoms of the disease (but we regret to say, not in connexion with the dissections he records) of the ophthalmoscopic phenomena witnessed during life within the eye, and of the structural changes observed in the tissues immediately after removal from the orbit of the living patient.
The new observations recorded by Mr. Hulke in this communication, may be stated to consist in the detection, by the ophthalmoscope, of small hemorrhagic spots upon the retina, with turgidity of the retinal veins, whilst the transparent media of the eye were still clear. The microscope afterwards detected these spots to consist of capillary haemorrhagies, and proceeding from the capillary vessels in the inner layers of the retina, when the effused blood either spreads laterally among the elementary structures of the retina, or bursts through the hyaloid membrane into the vitreous humour. The retinal capillaries were irregularly dilated, aDd studded with small fusiform and globnlar enlargements—miniature aneurismal pouches.
Mr. Hulke has now and then also seen such pouches on small blood-vessels one remove from the size of capillaries, but never on the larger vessels or great trunks. These pouches, and the vessels communicating with them, are usually crammed full of blood-corpuscles; and in the haemorrhagic spots the tissues are infiltrated with blood discs and stained with blood pigment. Otherwise, the retinal capillaries are healthy. We are not sure if we are warranted m concluding that Mr. Hulke considers such changes in the retinal vessels to be the earliest lesions in glaucoma, followed by those he describes in the vitreous humour; while the changes fn the colour of the lens again follow the changes in the vitreous humour and retina. We suppose he believes such to be the order of events, because he writes :—" It is probable that they (the vitreous humour and the lens) derive their colour from the same source, namely, the h&'matine of the blood." It', therefore, the colour of the lens acknowledges such an origin, the haematine which colours it can only be derived from the ruptured capillaries of the retina discharging their contents of blood discs, which become entangled among the vitreous humour in a delicate web of coagulated fibrine. Withered blood discs he has also observed in all stages. Moreover, Mr. Hulke has also seen "small filmy blood clots imbedded in the vitreous humour, and tied by a slender point to the retina at the spot where the ruptured niembrana limitans has allowed the blood to pass from the retina into the corpus vitreum." Now, if the yellowish colour of the vitreous humour is thus derived from the colouring matter of the blood so effused, soaking through it and staining its substance, it is extremely probable that the lens is secondarily affected from the same source or cause, just as we see the nucleus of a microscopic cell coloured in a high degree, by all colouring matters which pass through the fluid contents of the cell to its interior. Indeed the crystalline Ions, like the nucleus of the microscopic cell, seems to have a special power of attracting colouring matter when so circumstanced; and thus it is often found deeply coloured when little or no colour can be perceived by the naked eye to pervade the vitreous humour itself. Now, if the crystalline lens may be regarded in the relation of a nucleus imbedded in the hyaloid fossa of the vitreous humour, these observations Mr. Hulke has made afford to our mind a very satisfactory explanation of the cause of alteration in the colour of the lens, and of the period of time at which the change of colour most probably is established; the innermost portion of the lens and the lamellae immediately.posterior to it being sometimes so deeply coloured as to impair its transparency. Mr. Hulke, however, does not state these conclusions; and we also think his observations are consistent with the fact that the amaurotic element is not unfrequently the earliest indication of approaching glaucoma.
VII. On the Analysis and Immediate Principles of Human Excrements in the Diseased State. By W. Marcet, M.D., F.B.S.—It is proposed in this communication to show first, that there is an easy and very practical method of analysis applicable to faeces in the diseased condition, capable of affording assistance in the diagnosis of disorders of the digestive system. Secondly some practical and clinical illustrations are given of the results so obtained. Dr. Marcet founds his method of analysis upon the adoption of a process by which the taecal evacuations are mechanically divided into their immediate principles, instead of being chemically decomposed. Proceeding in this way, Dr. Marcet "offers to the medical profession a method for the analysis of excrements in a state of disease calculated to yield results at least'as important as those we have already derived from the analysis of urine."
Wc recommend our readers to study for themselves the processes and results as detailed in this important paper.
VIII. On the Membrana Decidua which surrounds the Ovum in Cases of Tubal Gestation. By Robert Lee, M.D., F.R.S.— The main object of this paper is to bring together the evidence which demonstrates the existence of a membrana decidua surrounding the ovum in cases of tubal gestation; a fact previously demonstrated by M. Chaussier in 1814, by Professor Schroeder Van der Kolk in 1857, visible in preparation No. 14, series xxxiii., in St. Bartholomew's Hospital Museum.
IX. On the Action of Galvanism upon the Contractile Structure of the Gravid Uterus, and its Remedial Powers in Obstetric Practice. By F. W. Maceenzie, M.D. —The results of some investigations undertaken for the purpose of determining the exact influence of galvanism upon the contractile structure of the gravid uterus are here recorded; the best method of applying it is also demonstrated; and the results are related which have followed its employment in certain cases attended with difficulty and danger. Hitherto investigators on this subject have not observed a proper distinction between the specific action of galvanism upon the uterus, and the action of other agencies collaterally in operation; so that in deducing their ultimate conclusions, they have undoubtedly in some instances mistaken the post hoc for the propter hoc.
In illustration of the first of the inquiries instituted by Dr. Mackenzie, he relates experiments performed on the gravid uterus of a pregnant bitch. In that animal he exposed the organ, so as to ascertain by visual, and tractile examination the effects of galvanism upon it. He thus found that the structure of the gravid uterus undoubtedly responded to the stimulus of galvanism in a peculiar and remarkable manner; that the action thus excited is a slow and vermicular-like contraction of the organ limited to the portion included in the current when the galvanism is applied locally, and affecting it more generally and more powerfully when it is applied through the medium of the spinal portion of the nervous system. The contraction of the uterus under the stimulus of galvanism is shown to differ most widely from that of the voluntary and other involuntary muscles when acted upon by the same agent; inasmuch as it is more slow in its development, more sustained in its duration, and more gradual in its subsidence, approximating, by these conditions, to the contraction of the uterus during labour.
Dr. Mackenzie shows that the most effectual mode of employing galvanism so as to direct its influence upon the gravid uterus in the human female is to direct the current in a longitudinal direction through the organ from the upper portion of the spinal chord; that is to say, by applying the positive pole of the machine to the upper part of the spine, at the nape of the neok, and the negative pole to the cervix uteri, by means of a vaginal conductor. It is necessary that the current be sustained continuously until the desired result is obtained; individual galvanic shocks exercise little or no specific influence in exciting uterine contraction. It is further stated, that in proportion as the constitutional powers fail, so is the influence of galvanism less powerfully exercised upon the uterus, until at length, with increasing exhaustion, it ceases to exert any influence whatever.
Some interesting clinical evidence is adduced, demonstrating the usefulness of galvanism in obstetric practice, while the author cautiously and prudently states that galvanism must always be regarded as an agent to be used in exceptional cases, and only when the better recognised and more established rules of practice either fail altogether, or offer little prospect of doing good. Still, there are many cases in which it may be usefully resorted to, and some in which it seems to afford the best security to life. Of such cases are especially to be noticed the following: (1.) Cases of placental presentation, in which profuse haemorrhage continues to recur, notwithstanding the employment, of the plug and other means, before the os uteri is sufficiently dilated to admit of manual assistance. (2.) Cases of haemorrhage in the early months of pregnancy, which resist the usual means employed for their suppression, and which, from the contracted state of the os and cervix uteri, do not admit either of mechanical or manual interference. The cases detailed appear to show that in galvanism we have a powerful and reliable means of moderating and controlling active haemorrhage, and of simultaneously accelerating the dilatation of the os uteri and the general progress of the labour. It appears also that such a sustained current of electricity may also be continued for a