As one of the most striking symptoms of cholera, is the immense quantity of a thin, watery, and almost insipid fluid discharged by vomiting and purging, is it not reasonable to direct our researches in an especial manner to those viscera which furnish this fluid? Now these viscera must be either the pancreas, the liver, or the alimentary canal; and if this last, then it must be that part of the tissue which supplies its peculiar secretions, viz. the small follicles (or glands of Peyer and Brunner) which are situated in the substance of the mucous membrane, and which are found clustered in certain parts of the bowels, known to all anatomists. The quality of the evacuations assures us that it cannot be the liver, and we are therefore led to believe that the offending organ must be either the pancreas or the secretory apparatus of the intestines. I am persuaded that a very attentive inspection of these follicles by the microscope will reveal in their cavity, walls, or surrounding substance, in their developeinent, in the morbid changes of their texture and of their secretions, the seat and perhaps even the nature of cholera. This is not mere conjecture; I have frequently examined the bodies of persons who have died of sporadic cholera, and I have uniformly found the glands of Peyer and Brunner exceedingly enlarged, and yet without any very distinct traces of inflammation. I do not believe that the epidemic differs so materially from the occasional cholera as to be attended with any marked difference in the seat and nature of the dis

ease.

I would say therefore that the cholera has its seat in the alimentary canal in general; and more particularly in the follicles of the stomach and small intestines; that it essentially consists in a "secretory irritation" of these organs; that this gives rise to the dreadful pains of the bowels, and to the profuse watery evacuations; that the symptoms of disturbance in the functions of the brain, spinal marrow, particular nerves and the muscles to which they are distribated; of the heart and lungs, &c. are to be considered only as the sympathetic

effects of the original disease; effects quite analogous to what we witness in malignant dysenteries which are attended with severe pains and excessive purging.

If these ideas be confirmed by dissection, it would follow, that the preventive treatment of cholera should consist, in guarding the surface of the body most strictly from the impression of cold and of moisture, by the use of flannel worn next to the skin; and in avoiding whatever tends to excite, or irritate the stomach and bowels, such as acrid, heating food and drink. The curative measures, when the disease once manifests itself, which are likely to be most useful, are leeches applied to the pained parts of the belly; composing drinks, (such as a decoction of poppy heads sweetened with syrup of gum, and administered frequently,) and the exhibition of plumbi acetas, either in the form of pills, or dissolved in the decoction. I may remark that the preparations of opium are not so efficacious as the decoction of the poppy heads. The former have, in my practice, repeatedly failed, where the latter succeeded to my wish; and the acetate of lead, a sedative "par excellence" in all cases of inflammation attended with copious discharges, has been productive of better effects in sporadic cholera, when exhibited in a state of solution, than formed into pills.

Besides these means the patient ought to be enveloped in warm blankets; frictions most perseveringly employed, and every now and then the steam of water introduced under the bed-clothes, so as to form a hot atmosphere round the body. We must carefully avoid, at least in the commencement, all purgatives, emetics, and irritants, which have been so freely and perniciously ordered by many, for they cannot fail to aggravate the irritation which is the essential character of the malady, and thus to hasten its fatal termination.

P.S. The dose of the acetate of lead may vary from 10 to 25 grains in the course of a day; it will be best given by ordering 3, 4, or 5 grains in a cup of the decoction, every hour or so, until the patient experi

ences some relief of suffering, and the evacuations are diminished. This mode of treatment has succeeded admirably in several cases of most severe sporadic cholera, which have occurred in my practice.

Appended to the preceding letter, are some critical remarks by the Editor of the Revue Medicale. He finds much fault with the Baron for presuming to say that the dissections have not hitherto been conducted with sufficient minuteness and skill, and reminds him of the swarm of young medical men who have left the anatomical schools of France to visit those countries in which the epidemic was raging.

He tells him that he is mistaken in asserting that profuse evacuations are an essential symptom of the cholera; death may take place, even where there has been trifling vomiting and purging. Again, his opinion as to the identity of the nature and seat of ordinary and of epidemic cholera, cannot be strictly correct, even upon his own premises; for surely the Professor will not deny that the liver, which may be put “hors de question" in the consideration of the latter, is intimately and immediately involved in the former, as is proved by the bilious dejection?

It appears very strange that the Professor has omitted any allusion to the exhalant vessels of the intestines, and directed his suspicions solely to the mucous follicles on their surface. Are not they much more capable of producing the liquid stools than the small glands, which are irregularly scattered, and in some places appear almost altogether deficient.

The circumstance of M. Dupuytren having found the glandulæ Peyeri et Brunneri enlarged in several cases of sporadic cholera, cannot be considered as of much avail; for so common is this morbid appearance, in some continued fevers, that a distinguished physician has proposed to designate these by the name of "dothinenterites," from the Greek words "doliny," furunculus, and " εντερά,” "intestina.

For these reasons, we think that the distinguished author has been led into error, by assuming the effects of the disease for

the causes; as well might we say that the enlargement of the spleen was the cause of intermittent fevers, because such a morbid state is almost invariably found in patients who have died of these.-Revue Médicale.

XVIII.

DISEASE OF PYLORUS, CURED BY
NARCOTICS.

A MAN, ætatis 57, addicted to excesses in wine and women, had been reduced from a state of comfort to much bodily and mental distress. His earliest symptom was the feeling of a dull oppression in the region of the cardia; to this succeeded a pungent pain, always aggravated by wine or other stimulants. Dyspepsia, pyrosis, and increased flow of a sharp acid saliva, which set his teeth on edge, reduced his strength and flesh amazingly, and so imperfect was the digestion of his food, that it was generally passed in part unchanged; the abdomen was swollen, hard, and elastic, and the bowels were obstinately constipated. He had been in this condition for a year and a half, when he consulted M. Virey in March, 1831 :-his appearance then was deplorable-his sufferings, especially at night, very severe, for no sooner did he lie down in bed, than his food was immediately vomited, accompanied with sour belchings, hiccough, and great anxiety; his stomach now could not digest the lightest farinaceous food. Various physicians had been consulted, and various modes of treatment tried, but all to no avail; leeches, blisters, tonics, stomachics, had only aggravated his distress. Every thing indicated the approach, or the actual presence, of organic disease of the pylorus, and the suspicion was strengthened by the lancinating pains felt when the ensiform cartilage was pressed. M. Virey had a most unfavourable opinion of the case.

Treatment. Warm clothing, with an occasional warm bath to soften the skin, which was harsh and dry; his diet to consist of

milk rice with sugar, white, gelatinous meats, and the lightest kinds of fish without any spices. No food to be taken in the evening, in order that the stomach might not be loaded during sleep. By attention to these rules he improved a little; but still, every Dow and then, his sufferings returned in all their intensity, from the slightest mental or physical cause. To lull this excessive susceptibility, resort was had to the syrupus papaveris, in doses at first of 3ij. and gradually increased to 3j. and with much success, for the sickness, belchings, and vomiting ceased, and calm sleep was procured; the medicine, however, lost its efficacy in a few weeks. Opium, in the form of pills, was adininistered, and a Burgundy-pitch plaster, sprinkled with crude opium, applied to the epigastrium. The patient was better for the next two months; a diarrhoea supervened, which, on the whole, appeared to relieve the symptoms, as the digestion was less painful and imperfect during its continuance. By a steady perseverance in the mild and regulated diet, and in the use of the opium, a complete cure was effected in nine months, and he was restored to strength, cheerfulness, and plumpness. It was uniformly observed, that all tonics and stimulants, on the one hand, and, on the other, whatever was enfeebling, invariably aggravated the symptoms and threatened a relapse.-Revue Médicale.

XIX.

TREATMENT OF SCROFULA BY IODINE.

M. BAUDELOCQUE, physician "de l'Hôpital des Enfans," communicates an interesting memoir on the results of his practice in strumous disease. Sixty-seven girls, from the age of four to fifteen years, were treated by iodine in its different preparations. In all, the disease had existed for a considerable time, varying from nine years to ten months. Fifteen of these children were completely cured; fourteen so much inproved, as to indicate a speedy cure; thirVOL. XVII. No. 33.

teen experienced less benefit than the preceding, but still sufficient to warrant hopes, though distant, of their recovery; five exhibited little, and twenty no amendment at all. All these patients with scarcely an exception, were much worse when they commenced the use of the iodine, than at the period of their admission into the hospital. Far from having derived any advantage from their residence there for several months, or even years, their condition was manifestly less favourable. This remark is well worthy our study, as it disproves the assertion of those medical men, who state that scrofula has a definite duration in the system, and that, after a certain lapse of time, it is easily cured, whatever remedies are employed. M. Baudelocque is satisfied, that the length of time during which the disease has existed in any case, had no influence in assisting or in quickening the cure of the numerous patients under his

care.

Of the 67 cases, 17 had enlargement of the glands of the neck, jaw, and arm-pits; they took iodine inwardly, and employed likewise ioduretted baths, and friction with ointments of the potassa hydriodas, plumbi ioduretum, et hydrargyri proto-ioduretum.

The mode in which the discussion of these enlargements is effected, makes us well acquainted with the nature of their formation; they consist of an aggregation of numerous small tumours, united together by cellular texture, which, in course of time, becomes firm, and increased in extent. In proportion as this cellular substance is dispersed, and returns to its normal state, the small glands, which are less quickly absorbed, become moveable and disjoined, and these, again, are resolved into several still smaller, until they quite disappear. To prevent the deformity of the scars so frequently left after a scrofulous abscess, the loose skin must de destroyed, either by the knife or by caustic, during the cicatrization of the sore, and a new healthy skin will be formed, so as to cause little disfigurement.Revue Médicale,

16

XX.

NATURAL HISTORY OF MAN.

M. GEOFFROY SAINT HILAIRE concludes an interesting memoir by stating that females are generally much shorter than the males, in those races of mankind whose stature is great; the difference being much less among the people of low stature ;-that the races which are most remarkable for tallness, for the most part inhabit the southern hemisphere, while the most diminutive are found in the northern one;-that among the very tall races some live in South America, others in the South Pacific Archipelago, between the 10th and 50th degree of South latitude;-that some very diminutive races live in the southern hemisphere; and that some tall races are found in the northern hemisphere; and if we compare the geographical position of these various divisions of mankind, we arrive at the curious result, that the diminutive races are almost always found near the very tall, and the very tall races near to those of low stature; that the variation in the size of different races may be explained in part by the influence of climate, diet, and mode of life-that it is extremely probable that the stature of the human race has not sensibly diminished, since the earliest age of history, or even from long anterior to that epoch.-Revue Médicale.

XXI.

ABSCESS OF THE HEART.

THE patient, a young soldier, died on the 55th day of confluent small-pox. A month before his death, an unhealthy abscess appeared on his left elbow; the fore-arm and hand of the same side were much swelled, and were cold to the touch; he lay on his right side, almost motionless from extreme weakness, moaning, but he did not complain of any local pain. Dissection shewed a heart somewhat larger than usual; the left side alone was hypertrophied. At the

base of the left ventricle, posterior to the mitral valve, and imbedded in its fleshy substance, was found an abscess of the size of a hazel-nut, containing a white, homogeneous and fluid matter-it did not communicate either outwardly or inwardly, and was completely enclosed in a cyst.-Revue Médicale.

XXII.

MEDICAL JURISPRUDENCE.-ON THE DECOMPOSITION OF THE ANIMAL STRUCTURE.

M. OLIVER and M. Denis were desired to examine the body of a female, who had been interred three months before, as suspicions had been excited that she had been murdered by her husband, and had died from the effects of blows upon her head, and fracture of the skull. The husband alleged that he had obtained the authority for interment from the physician appointed to ascertain the cause of his wife's decease; but it appeared that the physician had never examined the corpse, but had trusted to the husband's declaration that she had died from a rupture of a blood-vessel. The deceased was 55 years of age, and had been affected with hemiplegia for nine years. The body was buried the day after her death, in a dry chalky soil.

When exhumed, it did not present the appearance of much decay; the external surface, and the pectoral and abdominal viscera were little altered; but on examining the head, the right hemisphere was found softer and more decomposed than the left one, the anterior lobe was converted into a fatty matter, semi-consistent, and quite similar to what covered all the surface of the brain and spinal marrow, in the place of the pia mater, which had altogether disappeared. A similar greasy substance was discovered in both pleuræ, posterior to the lungs, which were quite shrivelled and dry. M. M. Oliver and Denis were led to the conclusion, that adipocire was formed at those parts where blood, or a bloody fluid

had been deposited, and that, therefore, this female had died of a cerebral hemorrhage. Such was their opinion, founded partly on the greater softness of the right hemisphere, and partly on the fatty degeneration of the anterior lobe, which indicated that it had been the seat of the hemorrhage; else how was the fatty deposit not found in other portions of the cerebral substance? The occurrence of a similar matter in the two pleura is easily accounted for on the same view of the subject; for we know that in rapidly fatal apoplexies, there is generally an excessive congestion of blood in one or in both lungs; and it is but probable to suppose that after death there may be a gradual sudation of the same into the cavities of the pleuræ.

The husband was acquitted on the strength of the medical evidence.-Revue Médicale.

XXIII.

LETTER ON CHOLERA, BY DR. OCHEL, OF

PETERSBURG.

By far the greater number of medical men in St. Petersburg are of opinion that this epidemic is not contagious, but that it is propagated by aerial miasmata and exhalations from the earth. The sudden appearance of the pestilence, and the rapidity with which it diffuses itself whenever it appears, strongly corroborate this idea. Moreover, many who escape the disease in its violent and concentrated form, suffer from choleric or choleroid attack, which are to be viewed only as diminutives of the great original; thereby distinctly proving that its severity and fatality are in proportion as the patients are predisposed to be affected by the influence of the atmosphere.

Dr. Ochel contends that the proximate cause of the disease is a paralysis of the organ of circulation. His remarks apply chiefly to the third stage, or what has been called the "stadium reactionis," which varies exceedingly in its character in different individuals. In many it commenced

with delirium, which was speedily followed by coma, and numerous patients died in this state; in others there were neither delirium, nor coma, but inflammatory attacks of different viscera, sometimes of the liver, and not unfrequently of the parotid gland; in a third class he observed, fevers of various types, gastric, bilious, inflammatory, typhoid, or even intermittent. The treatment which he found by far the most effectual, consisted in giving repeated doses of common sea-salt in tepid water, till it produced bilious vomitings and stools. Out of a great number of cases, he selected 15 of the most aggravated; in each of these he gave the solution of salt, and in every case bile was copiously evacuated in less than an hour: 13 were saved and two died. When the bile passed downwards, either at the time, or on the morrow, he observed that the patients were generally cured in three or four days; when it did not, they were subject to relapse of particular symptoms, as watery vomitings, cold extremities, &c. &c.; but these threatenings vanished as soon as the bile was evacuated by a few spoonsful of tincture of rhubarb. Some of the medical men tried emetic doses of ipecacuan and tartrate of antimony, and found that nearly the same success was obtained, provided a sufficient quantity of bile was evacuated. Even the lower orders in Russia, who refused to apply for medical assistance, resorted to large quantities of oil and tepid milk to excite vomiting, and frequently with good effects.

From these facts, Dr. Ochel infers that the correct mode of treating cholera is to evacuate the bile as quickly as possible; and that whatever tends to check the vomiting and purging, before this effect is produced, is decidedly pernicious; for though death may be thus prevented at the onset of the disease, the foundation is almost always laid for the secondary disease, or "stadium reactionis," which never takes place when the bile has been freely discharged in the first stage. Dissection of rapidly fatal cases adds confirmation to this view of the subject; the gall-bladder is found distended with bile, and the ducts closely contracted. Wẹ