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air, equal to the excess of the last above the capacity of the other, will have entered the cells. It may be objected to the present hypothesis, that this portion receives all the carbonic acid, contained in expired air, from the blood,
tact with the blood in the cells, the seat of the function.
to which it is in them exposed, and CASE OF TIC DOULOUREUX, PRODUCED
that all the oxygen lost is there given to that fluid. To this objection, the first experiment is a full answer; and it may be stated, in corroboration, that the same fluid (mucus) is poured into the cells as is found in the passages; therefore the same change takes place in them as in the passages, by the same process, between the same substances.
If the second supposed state of parts exists, namely, if the magnitude of inspiration is equal or inferior to the capacity of the passages, then the same course of procedure will be observed, and the same result follow, as in the former case. This has been traced and pointed out above, except that none of the air will enter the cells or come in contact with the blood, and all the changes effected upon it will be wrought within the passages only.
This account of the result of the process has reference only to the air expelled by expiration; but in this second supposed case, as in the other, there is a portion left behind by each act of expiration, which has been designated alimental, because it maintains the residual, the most important, vitally important, part of the air of respiration, the only part which has influence in the function, none other coming into contact with the blood of the pulmonary artery. Each alimental portion takes the same course, and rises and sinks in the same manner in the passages in this as in the former, and undergoes the same changes; the only difference is, that whereas, in the first, some of the atmospheric air taken in by inspiration goes directly to the cells, and is there exposed to the blood, and is expelled into the atmosphere by the succeeding expiration; in the second, all the air taken in by inspiration is confined to the passages, and all, except the alimental portion, is again expelled by expiration, without coming in con
BY A SCIRRHOUS TUMOUR ON THE
MRS. B. aged 53, the lady of Capt. B. R.N. had been troubled some time with chronic inflammation in both eyes, and though the conjunctiva was considerably suffused with red blood, and lymph thrown out on the cornea, she felt no pain in the eyes. This inflammation reluctantly gave way to the usual remedies. She then complained of pain in the left side of the head, over the temple. This continued (with tempora ry relief from bleeding, blistering, &c.) for a few weeks, when the affection began to put on a more formidable appearance, and was marked with all the characteristic symptoms of that most painful disease "tic douloureux." Paroxysms of severe pain extended over the cheek bone, just below the orbit, the alæ of the nose and the upper lip, which was considerably drawn up, shewing the second branch of the fifth pair of nerves to be affected. The line of demarcation was most clearly drawn, the nerves of that side of the face being implicated only. The pain was not attended with any discoloration of skin, only numbness, and occasionally the cheek and temple were puffed. Pressure neither gave pain nor produced relief: severe fits of pain would sometimes reach the ear, which led me to suppose that the portio dura of the 7th pair of nerves was affected. The digestive organs, in the earlier part of the attack, were not deranged. Thus things went on, with nothing decidedly and unequivocally to lead one to suppose that there was organic disease at the base of the brain; but my suspicions gradually began to strengthen, when no real, or hardly temporary benefit, followed the use of the most approved remedies; such as, externally, counterirritation by blisters, tincture of iodine,
&c.; internally, carbonate of iron in large doses, and for a long continuance. Then followed arsenic, quinine, and, in fact, the whole catalogue of medicines usually recommended; anodyne plasters applied down the face, with fomentations of like matters, together with opiates taken internally, gave the only perceptible relief.
After suffering for about four months in this way, it was perceived that the left eye-ball began, by degrees, to protrude, till it was pushed out to a very considerable extent. Whilst this was going on, the power of vision in the eye became completely lost; then followed, at first in a trifling degree, and then more and more profusely, an acrid discharge from the left nostril, of a very offensive nature. It was now clear that there must be ulceration; and, from the nature and seat of the pain, I concluded that this ulceration was where the nerves supplying the face and head make their exit from the brain. During this time, it was obvious enough that diseased action was extending its ravages; the glands on each side of the neck became much enlarged, and ultimately encroached on the œsophagus so much so, as to render the passing of fluids only allowable.
After the discharge from the left nostril had continued, and increased in offensiveness, for about three months, bloody matter began to flow from the right nostril also, and the sight of the eye on that side gradually diminished. Thus things went on, from worse to worse-the tumour in the neck increasing. If asked about her head, she would say there was a feeling of torpor and heaviness, not to be described. The discharge of matter was occasionally very copious, and when it did not issue so freely from the nostrils, it passed into the pharynx; and, as swallowing was very difficult, it frequently produced a sense of suffocation; latterly, it seemed insensibly to pass into the stomach and through the bowels. She became extremely emaciated; and, after suffering the most excruciating agony with exemplary patience, and with only short intervals of ease, for upwards of a year, she was seized with a diarrhoea (which
had frequently before threatened), and which now terminated a most deplorable state of existence.
Post-mortem Examination of the Head. On dividing the dura mater, and gradually lifting up the braiu, I discovered a tumour at the base, about the size of a pullet's egg, resting partly upon the left crus cerebri and tuber annulare. On cutting into the tumour, it appeared of a hard, white, cartilaginous consistence; the surface of the tumour, on the fore-part, was ulcerated, as were the parts of the ethmoid and sphenoidal bones adjoining. The great pressure on the left optic nerve accounted for loss of sight; and ulceration had extended along the course of the optic nerve, and matter was seated behind the eyeball: ulceration had extended itself to the right optic nerve and underneath; and this may account for the sight of that eye, in the latter part of the illness, giving way. The scalpel, through the ulcerated parts, passed very readily into the nostril and left eye-ball. A short time before her death, pieces of slough were removed occasionally from the back part of the mouth. There was more water in the ventricles than is usually found. No other deviations from health were observable in the brain.
Two or three conclusions may be drawn from this case:-1st, That it had some connexion with the catamenia, which continued till within two years of her death; and, as Mrs. B. had occasionally complained of a dull pain, and odd sensation above the left eye, probably this tumour might have begun to form some years, as, when well, she frequently expressed a wish to her maid that her head should be opened after her death, feeling convinced that there was something uncommon to be found there, from what she frequently felt; and wherever there seems to be a fixed determination (however slight at first) for diseased action to continue, our prognosis should be doubtful.
MR. RAINEY ON ARSENIC.
To the Editor of the Med.-Chir. Review. 1, Maze Pond, Borough. SIR, AS I believe no process has hitherto been described by which the oxide of arsenic and antimony may be reduced to their metallic state by the agency of galvanism so as to afford an easy and satisfactory test of the presence of those metals in minute quantities, I have been induced to send you the particulars of some experiments which I lately made for the purpose of supplying this deficiency in toxicological chemistry. Should you consider these experiments sufficiently conclusive, and the subject one of interest enough to merit a place in your Journal, you will oblige me by in serting this letter in your next number. If two or three grains of arsenious acid be dissolved in two drachms of strong liquor ammonia and six of water, and a drop of this solution mixed with about half as much liquor ammoniæ be put upon a piece of polished silver, and these brought in contact with a clean piece of zinc, and detained there for a minute or two, decomposition of the arsenious acid takes place; the oxygen appears to be attracted by the zinc, which is discoloured, while the metallic arsenic coats the silver. Nearly all that part of the silver which was covered by the solution, excepting the point of contact of the metals, receives a coating of arsenic: hence in the employment of this test for very minute quantities, the solution should be spread over as small a portion of the silver as possible. The colour of the arsenical coating varies a little according to the quantity of arsenic, but though the quantity may be ever so small, even the 3,000th part of a grain, the metal lic lustre will be distinctly visible. After the reduction has been effected the excess of ammonia must be washed off immediately by immersing the silver in water, otherwise the arsenic will be dissolved. After all the ammonia has been removed the metallic arsenic will be found so firmly adherent to the silver, as to be with difficulty separated. If a drop of pure aqua ammoniæ be put
upon the arsenical coating, it will gradually dissolve the arsenic, and this solution placed upon a piece of glass may be made to exhibit the presence of this metal when tested by the nitrate of silver or sulphate of copper. It will also exhale the alliaceous odour if collected in a sufficient quantity and ignited with charcoal. A very weak solution of tartrate of antimony may be tested in the same manner. The metallic coating which this salt imparts to the silver may be easily distinguished from arsenic both by its colour, and more satisfactorily by the easy solubility of the latter in liquor ammoniæ, which does not affect the former. The decomposition of the sulphate of iron and copper, the muriate of cobalt, nitrate of bismuth, the nitro-muriate of platinum, and pro-bably several other metallic oxides, can be effected by means of a similar employment of galvanism; but these which have been named differ from antimony and arsenic in not requiring the aid of ammonia to decompose them. The manner in which ammonia contributes to assist the decomposition is probably by yielding hydrogen to the oxygen of the arsenic, and perhaps too by acting slightly upon the zinc, it increases the galvanic action of the metals. Minute bubbles of gas are apparent about the point of contact of the zinc and silver, which from their remaining involved by the solution may be presumed to be nitrogen. To ensure the efficacy of this test, the silver, and more especially the zinc, must be kept perfectly clean and bright, otherwise the latter covered with a small portion of arsenic from a former experiment, when brought in contact with the silver might give it a coating of metallic arsenic, and lead to mistake or uncertainty. If the arsenic acid has been previously mixed with tea, broth, or porter, it still suffers decomposition on the application of the foregoing test, though in a slightly diminished degree, unless the quantity of arsenic be greater than that already named. G. RAINEY.
May 23, 1832.
P.S. The arsenical coating may very conveniently be tested by the addition
of a small quantity of slightly diluted nitric acid to it, and afterwards dissipating the moisture by the heat of a spirit lamp. The acid, when first applied, detaches the arsenic, which soon becomes oxydized and combining with the silver, coats it with a greenish-yellow crust. As a piece of coin was employed in this experiment, the green colour may be attributed to the copper which had been mixed with the silver.
DRS. VIVENOT, SEN. AND JUN. ON THE
CHOLERA OF VIENNA.
In our last number we published the letter of Dr. Yates (see page 607), accompanying the translation of a paper by the above-mentioned eminent physicians of the Austrian capital-a paper that was first solicited by the Board of Health here, and afterwards refused insertion in the Cholera Gazette, because the writers were non-contagionists! We regret that the press of matter, and the lapse of time prevents us from giving more than a short extract from this interesting document, to shew that the physiciaus of Paris were not the only people who denied contagion in cholera on the Continent.
"The observations which chiefly lead us to the conclusion that the disease is not contagious, are as follow:
1. Without having recourse to any kind of preservative, having left the house fasting, we exposed ourselves freely and unreservedly to the influence of the disease at a time when it was at its highest; and, during the first days of the most violent raging of the disease, we came in the most perfect and nearest possible contact with the patients, and even had our faces and clothes soiled by the rejected contents of their stomachs; and then we would often remain fatigued, exhausted, and deprived of sleep for days together, but still in the enjoyment of the best of health up to the present hour.
2. By reason of our very numerous avocations, and the hurry and pressure of business, we were prevented either
cleaning our clothes, washing with vi negar; or having recourse to any other similar precaution, after having visited the sick on any one occasion; and yet we do not know of a single instance in which the disease had been carried from the Cholera Hospital (No. 2 in the town, the care of which was intrusted to my father, Dr. Vivenot) into private practice, either by himself or me, who inhabited the same house, and had, moreover, the charge of a district of the town, containing a population of 14,000 persons. We seldom found that nurses (and especially those whose duty led them to attend on cholera patients) were attacked by the disease; and when it did so happen, it could generally be traced to other causes, to wit, improper diet, previous indisposition, timidity, anxiety, or other contending emotions, which predispose to, and are themselves exciting causes of, the disease.
3. Locking up and seclusion did not prevent the spreading of the disease. On the contrary, those persons who did so, and imagined themselves safest, frequently fell a sacrifice within the very walls of their supposed asylum, in consequence of an anxious separation from their friends and relatives; and were so much the more certain of the epidemic, as they were the victims of their fears.
4. The falling sick of cholera of seve ral individuals of a family, or of various persons in one and the same house, depends upon, and is to be attributed to, sorrow, anxiety, or fright, which all excite the disease; a circumstance which by no means speaks for the contagious nature of the epidemic."
A perusal of the paper from the pens of the Doctors Vivenot has impressed us with a high opinion of their talents and judgment, as physicians and phi lanthropists.
BROUSSAIS' LECTURES ON CHOLERA. It was to be expected that the numerous disciples of Broussais would press their master for some declaration of opinion and practice, on such a destruc
tive epidemic as that which has lately scourged the French capital. Accordingly the professor of the Val de Grace has delivered two lectures on cholera, that have attracted considerable attention on the Continent, and even here, where we had the advantage of priority in observation. We can only abbreviate the professor's chief ideas.
1. M. Broussa's believes that the disease has reigned in Europe at former periods (à d'autres époques), and that it is the same epidemic which, in the fifteenth century, was called the "black plague." The professor seems puzzled how it should have travelled from India by way of Russia, instead of coming by a much quicker journey with the English ships and commerce! In Paris, there was an avant-courier of cholera, namely, a morbid sensibility (" une grande susceptibilité intestinale") of the alimentary canal.
II. "How has this scourge been generated, or how has it got amongst us? Its invasion has been too sudden to account for it by the introduction of a germ, a veritable contagion, passing from the infected to the healthy. Nevertheless, as there is generally more than one person affected in each house -as several people usually take the disease in succession-as the epidemy spreads, as it were, by chance or caprice, through towns and villages, under conditions the most opposite, and under circumstances the most dissimilar—sparing some and scourging others, we are compelled to confess that there is something mysterious and unknown in the mode of its propagation."
III. The predisposing causes were numerous. Among the chief were derangements of the digestive organs preceding diarrhoea and other affections of the intestinal canal-fear, of whose influence M. Broussais cites some curious illustrations. The Neapolitan Ambassador had studied the charts day and night, watching the course and predicting the irruptions of cholera. Among other predictions was one, that he himself would fall an early victim to the contagion of cholera! It may be fairly presumed that in this, as in many other instances, the prophecy fulfilled itself!
All excesses, moral as well as physical, predisposed to the epidemic.
M. Broussais considers the disease as varying in its phenomena, according to three different portions of the alimentary canal on which it happens to make its first impression. The first portion extends from the mouth to the termination of the duodenum-the second consists of the small-and the third of the great intestine. The last is most frequently the seat of cholera the first is least frequently attacked
and still more rarely are all three invaded at the same time. When the colon is affected, there are slight colics and abundant evacuations, by each of which the patient feels relieved; but, after a time, the evacuations change their appearance, becoming white, very thin, flocculent and characteristic of cholera. There is no bile. When the small intestines are first affected, there are borborygmi, distention of the abdomen, and ultimately diarrhoea. When the stomach and duodenum are primarily affected, there is constipation instead of diarrhoea, nausea, vomiting, at first without pain, but afterwards with progressive suffering, cramps in the lower extremities, and a kind of trismus of the lower jaw.
In some cases the disease first attacks the nervous system, and the patient faints, or becomes prostrated in an instant, with vertigo, but with no pain, no gastric or intestinal distur bance. Vomiting or diarrhoea, however, do not fail to succeed sooner or later.
The lining membrane of the alimentary canal has been found more inflamed and disorganized, according to M. Broussais, than we have found it here. The consequence has been, that the celebrated professor of the Val de Grace has pronounced the disease to be highly inflammatory action of the whole alimentary canal-and that it is extremely rapid in its course. If we do not always find the mucous membrane red and injected, he thinks it is owing to the quantity of watery fluid thrown out, by which the membrane becomes blanched.
The treatment pursued by M. Brous