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walnut, of a cystic honey-comb structure, of a bony hardness, its cells small, filled with fluid like white of egg and honey; it had nearly corroded the left temple, and extended into the posterior nares; through it passed the third pair of nerves, enlarged and softened; the optic nerve which also passed through its lower part was small; as was the eye-ball, but not evidently diseased. The tu mor adhered by a glutinous substance to the temporal bone and to the eye-ball ; appearing to have corroded all the parts it touched; it extended to the right orbit, the plate of which was partially carious; all the processes of the ethmoid bone and the vomer were carious, or softened, so as to be easily cut out. The brain and cerebellum small, soft, bloody points in it; 1 oz. of serum in the ventricles; a small hydatid in the choroid plexus. The left lung adherent at its anterior part; it did not collapse on the chest being opened; its posterior part vascular; its bronchia loaded with frothy serum; no induration except at one spot of its anterior part, where was some coagulable lymph on its pleura; the mucous membrane of the bronchi not vascular; no blood in the lung; black matter, but no serum in the cellular texture and bronchial glands; the right lung firmly adherent to the chest and pericardium; all its lobes consolidated, like pudding-stone, rather shrunken, not an air-cell or blood-vessel visible; no distinct tubercle. The disease had been allowed to work its disorganising effects without control. No serum in the chest ; some in the pericardium.—The heart pale and flabby.

The serous effusion into the air-cells of the left lung was the immediate cause of death; but simple inflammation will not explain the remarkable induration here seen; hepatisation does not express this condition of the lung; it is truly a scirrhous state, a peculiar phthisical induration.-Ulceration is not an essential component part of the phthisical disorganisation.-The malignant tumor in the head shows that there was a specific cachectic action and disposition in the constitution; a peculiar mode of vascular action, conjoined with a specific state of the blood." 156.

Before we conclude our notice of Dr. Blackmore's cases, it is worth mentioning that they all agree in one particular; a circumstance, too, which no doubt will be very consoling to consumptive patients, and to young medical men, who may be tempted to look into the book for instructions to direct them in practice; we mean their universal fatality. How does this barmonize with the good things promised in the title-“ A practical Treatise on the Forms, Causes, Sanability, and Treatment of Pulmonary Consumption"? The other general remark which we have to make is that, throughout the whole treatise, the name of the stethoscope, the wonder-working safety-tube of the immortal Laennec, is scarcely even mentioned by the Doctor! Attend to the meagre and niggardly notices in the cases which, we suppose, were under the author's care;-" A full inspiration easily made, and respiratory sound heard well by the stethoscope; no pain." "By the stethoscope a strong jarring action of the heart is heard throughout the chest, respiration natural.” Such is the tribute paid to the greatest medical discovery of modern times!!

So great is the want of discrimination displayed in one case that we are tempted to quote it, as a summing up of our censures on the present work, which the Doctor will, no doubt, think much too severe.

"CASE XXXI.-Pearse, m. a. 42, (Feb. 9th, 1831,) a sailor, of intemperate and idle habits, has been ill for six months; at first he had cough and spitting for a month, which subsided without medical aid. On Christmas eve last he spat a cup-full of blood; blood was then abstracted by a Surgeon-Apothecary, who did not see him again. Some medicines were afterwards taken from a Quack;

cough and sputa, not copious, remained. He has now a sallow anxious countenance, with cough, dyspnoea, and occasional hæmoptysis. It was his habit nine months ago to eat only a potatoe and some bread in the day-spirits being his chief aliment. March 21. Hæmorrhoidal tumors painful; much dyspnea, some cough and viscid sputa, some pain at the chest a few days ago; recumbent posture untenable; pulse nearly gone, much anxiety and sleeplessness, costiveness, no dropsy, no fever. At night he eat a beef-steak, and died from suffocation in five hours. The cura to March 23rd, consisted of Miss. sang. 10 oz. empl. canth. duo. emp. picis cum antim. tart. pil. hydrarg. scilla, ipecac. digitalis, colchic. hyosc. ether. nitric. antim. tart. cathart. copaiba ad anum. quinine.

Inspection, 12 hours p.m.-The body very warm; no sugillation, but black dissolved blood issued from the incised integuments and muscles. The peritoneum thickened and opake, containing 10 oz. of serum. The left lobe of the liver extended for two inches below the ribs; the whole organ was enlarged and hardish; on a section of the left half a dark nutmeg structure was seen, as if the sanguine-vascular portion was turgid; the back part of the right lobe was more natural. Dark bile in the gall-bladder. The stomach small, its muscular coat enlarged, the veins betwixt its peritoneal and mucous coats as large as a crow-quill; the mucous coat like scarlet cloth, thickened, rugose, granular, containing viscid-yellow-brown acrid mucus. The intestines were very small, their coats thick; the valvulæ conniventes of the mucous coat intensely red, covered with acrid bilious mucus; the peritoneal membrane of a diffuse florid vascularity. The omenta vascular; the mesentery large and vascular. The pancreas large and hardish. The spleen very small, hard and dark. All the digestive organs shewed severe marks of vascular excitement, and constant contraction ;-the sad effects of habitual drunkenness! There was no chyme seen; the last meal must have been digested. In the sacs of the pleuræ little serum; some in the pericardium. The right lung unadherent, turgid with serum, mucus and air, carneous and vascular at the thick part of its upper lobe; the interior of the bronchi vascular. The left lung similar to the right, but not carneous; its air-cells and cellular tissue dropsical. The heart as large as a bullock's; on the under surface of the left ventricle an opake jelly-like spot, as if it had been the seat of inflammation; its muscular substance and cavities vastly enlarged; the right less so. All the cavities and the large vessels, engorged with black grumous blood. -The aorta and pulmonary arteries very large, inelastic like leather-no osseous granules; the valves sound.

The disease in the aorta may have been the primary affection in the chest ; the enlargement of the heart was from idiopathic inflammation, by the constant stimulus of spirits, and also from the difficult transmission of the blood through the aorta and its abdominal branches. The pulse did not indicate the state of the heart.

The morbid condition of the lung was secondary, and the effect of obstructed circulation in the heart.

Alcohol seems to effect a dissolution of the blood; its albumen is coagulated, and the serum extravasated on the circulation being impeded; the glandular or gans become indurated, the hollow muscular system contracted and morbidly vascular.

The dropsy of the lungs, which was the chief morbid appearance in them, was not indicated by external dropsy." 93.

We put two simple queries to the Doctor-1. Is the above a case of consumption at all? 2. Did you even suspect disease of the heart, which, we are told, was found on dissection "as large as a bullock's."?

However Dr. Blackmore may resent the strictures which we have deemed it incumbent on us to make on the publication under review, we are convinced that, ten years hence, he will consider them as salutary, although

very unpalatable. Nothing is so injurious to a young author as undeserved praise-nothing so profitable as censure, if deserved. Dr. B. will say if— and console himself with the reflection that our criticisms are unfair, uncandid, and ill-natured. The public will judge.


MEDICAL REPORTS, SELECTED BY THE MADRAS MEDICAL BOArd, FROM THE RECORDS OF THEIR OFFICE, &c. Madras, 1831. THESE reports are drawn up by Mr. Fleming, the Secretary of the Board, and are necessarily miscellaneous in their nature and unequal in their importance. The first four reports from Messrs. Lister, Thomson, Lawrance, and Scarman, are on epidemic cholera; but unfortunately we have enough of that article now at home, without any necessity for a fresh importation. It is not a little curious, however, to remark that the epidemic cholera which has occurred of late years in India, corresponds much more with that which is ravaging Europe, than that which has been described by the three Boards soon after 1817. This similarity respects the antecedent diarrhoea and the consecutive fever, which now seem to be almost as constant in India as in Europe. This fact alone goes far to shew that epidemic causes are at work on a large scale, and one larger than formerly. The following extract from one of these reports is worthy of record.

"CAUSES. The regiment left Bellary on the 4th October; and, from that day until the 26th, when it crossed the Kistna, the rain was almost incessant, with much thunder. We were detained seven days on the banks of the Hoogery, two at the Toomboodera, and three at the Kistna. The men suffered little sickness during this time; but I imagine the fatigue and exposure they then underwent predisposed them to the disease. Many of them were greatly in want of money, and, I fear, were consequently very badly fed. After crossing the Kistna we had no more rain; the sun was powerful during the day, and the nights were very cold. Many of the patients said they had slept exposed to the open air at night. This is all I observed respecting the cause of this severe attack. There was no cholera in any of the villages we passed. A great many of the followers were attacked, and suffered more severely than the sepoys, not being brought to the hospital till past recovery. 25 cases among the sepoys occurred after our arrival here, and two as late as 13 days afterwards. There was not a case of cholera except in our lines at this station. These facts show the length of time the disposition to the disease may continue in those who have been exposed to its causes. A very remarkable instance of the same kind was mentioned to me by Mr. McCabe, which it may not be improper to insert here. A number of Europeans came from St. Thomas's Mount, where the cholera was raging, to Poonamallee, which was free from the disease. In the course of a few days 22 of them were seized with cholera, whilst not one of the other Europeans at Poonamallee were attacked. These facts seem also to argue strongly that the

disease is not contagious. With respect to sol-lunar influence, these cases favor Mr. Orton's opinion, as 39 of them occurred near the full and change of the moon, and only 14 near the quarters." 16.

A remarkable instance of the effects of locality is mentioned by Mr. Lister of the 46th Regiment. In the month of August, 1826, a detachment, arrived from Bellary on the right bank of the Kistna. The river had overflowed its banks, and the men were delayed for want of boats on the oozy soil for a day or two. The cholera immediately broke out; and continued till they crossed the river and got to some distance on the other side, when it disappeared. Two officers who were very much afraid of the disease caught it, and one of them died. Many other instances are related by the different reporters of the injurious influence of rivers and malarious localities, as also of the strong predisposition caused by fear. We could add many similar instances in this metropolis, both of the tenacity with which the disease clings to the banks of Rivers, and the sedative effects of terror as predisposing to the choleric orgasm. As to the remedies employed by the Madras Reporters, we need not enumerate them here. Few of them were useful— none specific.

II. Dysentery. Dr. Mortimer, in a report, draws the attention of the profession to the employment of ipecacuan in dysentery, given in nauseating doses immediately after bleeding, either general or topical, followed by a dose of castor oil. This remedy was exhibited to the extent of five grains (mixed with some powdered gum arabic) every hour or second hour, as the patient's stomach would bear it without actual vomiting. During the taking of this medicine, no fluids were permitted to be swallowed. The nausea is rather distressing, and vomiting is often induced though not desired. Sweat is generally excited. The improvement of the biliary secretion under the administration of ipecacuan was manifest. Where the bile was vitiated or redundant calomel, in considerable doses, was employed. This Report is drawn out to an unreasonable length by the unnecessary multiplication of cases, and the tediously minute detail of all the symptoms and remedies. Still the Report contains valuable materials for the Indian practitioner's guidance at the bed side.


III. On the Use of Sulphate of Quinine. By Surgeon W. GEDdies and others. Our author, who has used the quinine very extensively in India, affirms that, next to opium, it is the most valuable medicine we possess. efficacy in checking the tendency to paroxymal exacerbations of disease, so general in tropical climates, renders it an invaluable remedy there as well as elsewhere.

"The types of constitutional affection, attendant on dysentery, irritation, debility, and the like, all appear, at times, to put on this paroxysmal form; and, as tending much to aggravate the original disorder, it is evidently an important point, in the treatment of them, to check the febrile exacerbations at as early a period as possible. Wherever, therefore, in any disease, an evident increase of the frequency of pulse, and heat of skin, has been observed to occur, at any particular period of the day, for two or more times, I have at once, without reference to the presence of any other symptoms, had recourse to the quinine, in combination with other remedies for the relief of whatever other disorder may attend the febrile exacerbations. I have thus used the quinine, not only in intermittent

fever, or, its more violent form, the remittent type, but I have extended its use to check the exacerbations of the febrile affection attending, and so greatly aggravating, acute dysenteric affections. I have also applied it to prevent the quotidian exacerbations, occasionally occurring in convalescence from tedious, or severe, disorders, such as hepatitis, chronic degrees of dysentery or diarrhoea, bad health with ulcers, and the like. I have used it likewise for the relief of some other disorders of an intermittent nature, and for rheumatism; and its tonic powers have been applied for various states of the constitution requiring such remedies." 202.

Mr. Geddes proceeds to the particulars of his treatment; but they need not detain us here, as the principle is easily understood, and the application is now in common use among the best informed practitioners.

This report is followed by one from assistant Surgeon Malcolmson, on the same subject, and proving the great value of the quinine, in tropical fevers of intermittent type. Mr. Cruikshank succeeds Mr. Malcolmson, and these two are followed by several other reporters, all bearing the same testimony.

IV. Cases of Phlebitis. By SURGEON BOND. Several cases of this dangerous affection are related, one or two of which are fatal-the rest successful, apparently from an operation which Mr. Bond got into the habit of performing in such cases. The operation is thus concisely described by one of the members of the Madras Medical Board, who was superintendent surgeon of the station, where Mr. Bond practised, and witnessed the cases.

"The operation was performed as follows. An incision was made with a scalpel through the integuments, and the median basilic vein exposed, a director was then introduced through the puncture, and, with a probe pointed bistoury, the opening was extended above and below as far as there was any appearance of pus, which was carefully extracted by pressure, and the wound closed in the usual manner." 271.

V. Syphilis treated without Mercury. A long train of reports are here presented on a subject that excited considerable interest a few years ago. We believe that few practical surgeons, now-a-days, trust to the non-mer. curial treatment of syphilis, where the disease is unequivocal. Nevertheless, the experiments and investigations on this subject, have greatly checked the abuse of mercury in syphilitic complaints, though they have not shaken the faith of surgeons in a well regulated administration of this powerful medicine.

The volume concludes with some additional reports on the use of quinine, and a short paper by Mr. Lane, on purulent and gonorrhoeal ophthalmia. We beg to return our best thanks to the Madras Medical Board for the volume which we have thus hastily noticed.

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