hemisphere where it rested on tentorium. On the right hemisphere, and also on the cerebellum, one or two similar dark-colored spots were to be seen. The medullary substance of the brain, the ventricles, thalami, &c. were healthy; vessels not gorged. No other morbid appearances in the head, thorax, or abdomen.

Case 2. A woman aged 25, entered the Hospice Cochin on the 9th of May. For six weeks previously she had laboured under dropsical swellings of the limbs; and latterly there was general anasarca. After shivering, followed by heat, slight delirium, and drowsiness, symptoms of more decided cerebral oppression supervened; the patient would not or was unable to answer questions; she did not appear to suffer from pain; the heat of skin was somewhat in creased, and the pulse was more frequent than in health; tongue natural; abdomen soft and yielding.

Next day the stupor was more complete; but yet she could be roused to open her eyelids and answer questions, though indistinctly; the limbs have lost all spontaneous motion. On the 11th, symptoms worse; dilatation of the pupil; breathing laborious, as if the muscles of respiration had lost their power. The patient died, soon after, coma

tose.

Dissection. The surface of the brain and its investing membranes appeared quite healthy; but, on separating the hemispheres from each other, the corpus callosum was seen to be studded with minute red points; it looked as if any white surface had been sprinkled with red paint. On examining these attentively, it was speedily found that they were not produced by simple rupture and effusion, for pressure on the surrounding substance had no effect in squeezing out any oozing of blood; and there was no vestige of clots; their true nature was an intimate blending of the medullary substance of the corpus callosum with the colouring matter of the blood. From their minuteness, it was not very easy to ascertain whether ramollissement, or any alteration of the cerebral matter, was existent or not. With the exception of a few

scattered red spots on the left thalamus opticus, similar to those just described, no other morbid appearance was detected any where.

Remarks. The attack in both cases has been sudden, and the progress rapidly fatal, unlike the instantaneous shock of apoplexy, arising from simple effusion. The embarrassment of speech, the lethargy and coma, increased from day to day, and death soon following to a state of general exhaustion and insensibility, are peculiar. The pathological appearances are to be considered as a sort of diffused capillary hæmorrhage, or circumscribed effusions of blood, which irritate and disturb the cerebral functions, instead of overpowering and oppressing them, as in ordinary apoplexy. Each of the bloody points described above is to be considered as a miniature of the extravasations which we observe so frequently contained in fissures or irregular cavities of the cerebral substance, after apoplectic and paralytic seizures. It is worthy of remark, that both of the narrated cases occurred in young persons, whose bloodvessels are more resisting than in the latter periods of life. M. Cruveilhier has alluded to this form of disease, in the article "Apoplexia," in the Dict. Pratiq. de Medicine.-Archives Générales.

LII.

CHRONIC HYDROCEPHALUS CURED BY

PUNCTURING.

A CHILD, aged four months, presented a well-marked case of this disease; the largest circumference of the cranium was 18 1-4 inches; the fluctuation was very perceptible at the fontanelles; for when pressure was made upon one, the other was distended and forced out. M. Graefe, compressing the larger fontanelle, plunged a large cataractneedle into the smaller one to the depth of the third of an inch. A little viscid fluid escaped drop by drop; he, therefore, introduced a very fine trocar, and immediately a transparent yellowish-brown liquid flowed

out freely-uniform pressure was made on the head as the water escaped. When an ounce and a half had been evacuated, the infant began to faint and became extremely languid; the canula was, therefore, removed, and a firm bandage put round the head. Stimulants were given, but the child was restless and ill for two days. A similar train of symptoms followed each operation, which was repeated generally at an interval of 12 or 14 days, and sometimes between two and three ounces were discharged at a time; the size of the head sensibly diminished, and the general health improved. The puncturing was repeated eleven times in the year 1829, on the following daysSth, 15th, and 23d of January, 19th of February, 5th and 19th of March, 19th and 27th of April, 5th and 17th of May, 23d of June.

The evacuated fluid was thicker and more coagulable towards the end of the cure. The smaller fontanelle and the sutures in course of time closed; the child became healthy and strong. When 10 months old it began to walk; and on the 26th of November, 1830, the child, aged 24 years, was presented well and active to the Society of Medicine at Berlin.-Graefe and

Walther's Journ. der Chir.

LIII.

THE ADVANTAGES OF REVULSIVE BLEEDING

IN AFFECTIONS OF THE HEAD.

FORMERLY, in the schools of medicine, it was much disputed whether bleeding, local and general, had or had not a revulsive power; that is, of drawing the blood from other parts to that part whence the blood was allowed to flow. This doctrine includes the idea of derivation as well as of revulsion; and when the terms are applied to bloodletting, we mean by the former the abstraction of blood from the diseased part itself, and, by the latter, from a part situated at a distance. M. Chauffard, the author of these observations, states that he has often seen an inflammatory affection of the head aggravated by leeches to the temples or

behind the ears, and relieved at once by drawing blood from the feet or ankles; he mentions several cases of acute ophthalmia, unchecked and uncured by local bleedings from the neighbourhood of the eyes, speedily disappear by the application of leeches to the lower extremities. The good effects are much enhanced by warm hip or foot baths; cold applications at the same time kept constantly applied to the head, and large doses of calomel. The following is an instructive example.

A young child had a very severe ophthalmia, which was treated by leeches to the temples, blisters to the nape of the neck, &c. The symptoms, however, did not abate, and the formation of pus in the chambers of the aqueous humour was the consequence. M. Chauffard ordered leeches to the ankles, followed by hot poultices, fomentations to the abdomen, a general warmbath, while cold was applied to the head, and a dose of 15 grains of calomel twice a week. The pus was gradually absorbed, and vision restored.

As a general rule, our author states that, when a local bleeding near the seat of the disease does not at once relieve the symptoms by the evacuation of blood, and the depression thereby induced, the symptoms are always made worse. Otitis is uniformly most speedily cured by leeches to the anus, vulva, &c. or by opening the saphæna vein; cynanche will yield to one general bleeding, and will frequently resist a dozen applications of leeches to the throat. A hemicrania is often more severe after leeching the temples, and yet vanishes by a hot pediluvium; and every one knows that a neuralgia of the face is generally exasperated by local bleeding, for if the pain does not yield soon after the blood is drawn, the "engorgement fluxionnaire" of the cellular substance which surrounds the nervous twigs is increased, and the pain in consequence is agonizing. The excruciating headaches which succeed to a stoppage of the catamenia, are best relieved by the application of leeches to the vulva; an attack of coup-de-soleil, by opening the saphana vein; the acute hydrocephalus of children by the same means.

case.

A child, a year and a half old, was labour ing under the symptoms of hydrocephalic disease. Pulse small, irregular and threadlike, dilatation of the pupil; occasional flushes of the face; confirmed coma and insensibility to pain, occurring after an attack of hot fever, with severe headach. Three leeches were ordered to each ankle, and the leech-bites to be covered with hot poultices for several hours. The little patient revived somewhat, and on the following day the symptoms were more favourable, and the infant gradually recovered.-Archives Générales.

Remark. We direct our readers' attention to the above remarks, as illustrative of

the good effects of revulsive bleeding in many diseases, but especially in those of the head. We are aware that many may and will object to M. Chauffard's opinion of its superior efficacy, and allege that local bleeding near the affected part would have probably been as successful, in the cases whose eures he ascribes to the revulsion of the blood to a distant part. It is a practice not common in this country, though much followed abroad, and, we are of opinion, with exceeding good effects, especially in those cases of cerebral disease dependant on an obstruction of any accustomed discharge.

LIV.

ACCOUNT OF CHOLERA IN PARIS.

THE disease in Paris, as in all other places, has committed far greater proportional ravages among the poor and ill-fed, than among those in more comfortable circumstances. Males have suffered much more from this scourge than females, and the aged and intemperate than the active and abEtemious. Most of the victims have passed 30 years; still, however, many children and young pregnant women have fallen sacrifices. It has been remarked that in most, but certainly not in all, there were the

irregularity of the bowels, before the violence of the choleric attack. The seizure, in almost every case, occurred between midnight and four or five o'clock in the morning. The usual course of the symptoms has been as follows:-Borborygmi, uneasiness and pain in the bowels, followed by watery or whey-like stools, ejected by frequent squirts, without any effort, colic, or tenesmus; then succeed the watery vomitings and cramps; but these last have by no means been constantly present. Most patients have complained of a distressing pain at the epigastrium, increased by pressure, and frequently extending over all the belly; urine very scanty; restlessness; extraordinary prostration, almost to the annihilation of

vitality, even although the evacuations were

cold of the whole surface and of the tongue; not very profuse; feebleness of the voice; pulse feebly or not at all perceptible; face shrivelled and blue. Most of the patients having been 10 or 12 hours ill, were cold, who were brought to the hospitals, after pulseless, and cadaverised. An instance has scarcely been known of a recovery, after the pulse had ceased at the wrist.

been, generally, great internal congestion

The pathognomonic phenomena have

the stomach and intestines have been uniformly found abnormal in some respects, exhibiting either numerous red injected patches, or large ecchymoses; the secretory follicles were always enlarged. No feculent matter was ever found in the intestines; but, in its stead, the rice or barley-waterlike liquid, which was sometimes tinged of a brown or reddish colour in those cases in which the intestines were ecchymosed. The blood had probably exuded and mingled itself with the watery secretion. In one or two, not the slightest trace of disease could be found on dissection. The urinary bladder was always contracted. No lesion has hitherto been remarked of the nervous plexuses and ganglia in the abdomen.

Treatment. The employment of stimulants has generally been followed in the stage of prostration and cold, but not with

much success. M. Recamier and some other physicians have used the cold affusion as a stimulant; and it is reported that this method has had better effects in restoring warmth and circulation, than frictions and external heat. The above short sketch is taken from the Archives Générales de Medecine for March; and we shall now lay before our readers a more particular and circumstantial report of the disease, as it has been observed in the different leading hospitals of the French metropolis; and first we select one or two cases from the Clinique of M. Broussais.

Case 1. F. Belleval, a soldier, was brought to the Hôpital du Val de Grace at 9 P.M. on the 31st March. Extremities cold and livid, &c.; pulse thread-like; tongue red; intense thirst. He had been seized five hours before with cold shiverings; severe pains in the head, borborygmi, cramps, vomiting, but no purging-there was great prostration and stupor; but intellect unclouded. Treatment-dry frictions; 20 leeches to the mastoid processes, and 40 to the epigastrium; iced water to drink. The patient expressed himself relieved in proportion as the leeches fastened. On the following day all the dangerous symptoms had vanished, and he gradually recovered.

Remarks. Though the above case may not be deemed one of concentrated cholera, it is worthy of being studied in connexion with the treatment pursued. If not the disease itself, it is only one degree of kinship

removed from it.

Case 2 of cholera, or choleroid disease occurring at the same hospital, a month before it invaded Paris as an epidemic.

A man, aged 29 years, presented most of the symptoms of cholera: his extremities cold; his aspect cadaverous; racking and unintermitting pains of the bowels; borborygmi, profuse diarrhoea, and severe vomiting of a yellowish green matter-great tenderness of the epigastrium much increased by pressure-pulse small, frequent and intermitting: skin cold; great thirst;

OBSERVATIONS AND EXPERIMENTS ON RESPIRATION.

THERE is a condition of the parts composing the organ of respiration, a knowledge of the influence of which on the function, must very materially modify the prevailing theory concerning it. This condition is the permanent patency of the air passages and cells. It pervades every portion of the passages. The mouth, nose, and larynx having bony walls it cannot be denied to them; the trachea and main trunks of the bronchi being occupied by cartilaginous rings, must also have it awarded to them; but as the cartilaginous rings occur less and less frequently, the farther the tubes dip into the lungs, and, as at their terminations, none are to be found, so that the extremities of all the tubes are entirely membranous, their claim may be doubted. Yet it must be borne in mind that these tubes are strictly attached to the air-cells, and therefore must remain open as long as the cells continue so. It is well known that the cells are open after death; for they are found to contain a large quantity of air, at that period when the lungs are under the greatest degree of compression of which they are susceptible, whilst the thorax is entire and atmospheric pressure is excluded. They must be more expanded during life, to which state attention is at present solicited. In further proof of this point, it may be observed that, after death, when the utmost degree of compression which the ribs can permit exists, the tubes are not closed; for if the thorax be opened, the lungs shrink considerably, and air is expelled from the cells through the tubes, which it is clear could not be effected, were they closed.

This fact (namely, the ever-pervious state of the air-passages) established, the influence it holds on the function is next to be traced. It is identical with that of the tubes of an hydraulic engine, the common lifting pump for instance; in that, the tubes are ever full of water, and the water thrown up by the action of the piston, comes not immediately from the well, but was previously resident in the tube. In like manner, in the action of the organ before us, the air expelled by expiration comes not immediately from the cells, but is the contents of the passages. And, in inspiration, the atmospheric air drawn in descends not to the cells, but the air previously contained in the passages enters the cells, and the supply from the atmosphere takes its place in the passages. It is evident that all the air of an inspiration does not reach the cells, the seat of the function, and that if the capacity of the passages be equal to the bulk of an inspiration, none does. It is a question, then, whether any, and if any, how much, is employed in the function?

To answer this question with full satisfaction, it is necessary to be in possession of the exact measure of the capacity of the passages, and of the bulk of an inspiration. Who shall presume to determine the amount of an inspiration, when men of so great physiological knowledge are so discordant in their statements as they have been? In this dilemma, there is no alternative left,

bat to take the highest estimate which any of them has given, and that is 56 cubic inches. It must then be enquired whether the capacity of the passages be equal to that?

The state of the lungs is ever varying; the tubes are always contracting and expanding; the time when the measurement is to be taken, is when an inspiration has just been completed, before expiration begins. Then the diaphragm is contracted, and the abdominal viscera pushed downwards; the ribs raised; and the thorax enlarged, the cartilaginous bronchi, incapable of diametral enlargement, are stretched longitudinally; the cartilaginous rings re

ceding from each other, the membranous portions are both distended laterally, and drawn out lengthwise. The cavity of the thorax, thus expanded, is filled by the lungs, and throughout their substance the tubes ramify, from their root, at the termination of the trachea, to countless points on their whole circumference touching the boundary of the cavity. Their size, too, is not inconsiderable; dissection shews them several lines in diameter; and it must be admitted that, before they can be examined in this way, they have much contracted, and lost, at least, one fourth of their bulk. It will be seen to be impossible, contemplating the figure of the lungs so out of all order, and the distribution of the tubes so perplexed, to come at a precise valuation of their capacity. A probable one is the utmost to be obtained. If it be granted that the bronchi, cartilaginous, are capable of containing 40 cubic inches (it is contended that this is a low computation) then the second position, viz. that none of the air of inspiration reaches the cells, is established; for no person will refuse 12 cubic inches of contents to the mouth and nose; and four to the larynx and trachea; making together 56, equivalent to the bulk of an inspiration, none of which, therefore, can pass beyond their limits.

Taking it for granted, because physiologists agree on this point, more than on any inspiration and expiration are equal in bulk other in connexion with the subject, that

-that atmospheric air is an agent in the function-and, seeing that, in the functional process, some of the air taken in must necessarily be dissipated, an anomaly seems At present, another difficulty claims attento present itself. It will be solved hereafter. tion, which is raised by the presence of carbonic acid gas, in mixture with the expired air, which it is said to receive from the blood; but whence it cannot receive it, if it enters not the cells. The following experiment will remove the difficulty.

Two long narrow glass jars, each containing 120 cubic inches, were procured; a hole was drilled in the centre of the bottom