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pitch. With some, aphonia becomes complete and permanent. The tickling in the larynx grows more continuous and more uncomfortable. With some patients, instead of a sensation of tickling, there is a snorting, a pricking, a painful sense of dryness, a burning, which seems sometimes to descend the entire length of the esophagus, and to reach to the cardia. The patients are seized all at once with fits of cough of extreme violence, resembling the cough of pertussis, accompanied with a sense of anguish and suffocation; their features become livid, their eyes are bloodshot; then the sputa, which I have described, suddenly escape, and are projected to a distance of many yards, as if discharged from a shooting-tube, and the expulsion of which terminates the crisis."

Dr. de Mussy devotes a chapter to the consideration of the lesions and pathological conditions of the parts affected. The lesions are carefully described, but we do not perceive much that is new. The account of the pathological anatomy is given from the observation of the parts taken from only two patients, one of whom died of phthisis. Like Dr. Green, Dr. de Mussy has met with calcareous concretions in the tonsils. These sometimes are found, according to Dr. Cox of New York, sufficiently large to interpose a difficulty in excising the enlarged tonsil. Dr. Robin has proved, by the aid of the microscope, that these concretions originate in small crystals found in the glandules. The uvula, Dr. de Mussy states, is elongated in a great many cases, and he refers this alteration to infiltration of the sub-mucous tissue. He correctly describes the dilated blood vessels, which exhibit their flexuous course upon its anterior aspect. He notices the fact, that the uvula, though double its usual length, may retain its full contractility, though he has generally observed that the muscular power of the part is much reduced. Low inflammatory action, and the presence of cedema, readily account for the loss of power.

The enlargement is not always due to edema, it is referrible in many cases to actual hypertrophy. The author has seen much advantage arise from the amputation of this enlarged part, the proceeding having caused the vomitings and sense of suffocation to cease. There can be no doubt that this operation is calculated to be of great use when the uvula is so long as to lie upon the tongue, or to reach the glottis. We have lately examined the fauces of two patients, both afflicted with phthisis, in whom amputation of the uvula had been performed, and whose fauces had become perfectly healthy. The operation in one case had been performed by Dr. Simpson, of Edinburgh, and the other had been undergone by the advice of Dr. Stokes, of Dublin. The uvula frequently presents two kinds of elevation—one smaller, such as are found upon the vault of the palate; the other larger, the same as are presented by the large glandules in the pharynx. They often present at their summit a yellow colour, which Dr. de Mussy refers for the most part to the presence of pus. We have ourselves found plates of cholesterin and epithelial cells. The pharynx presents large elevations, sometimes the size of a lentil; these, according to Dr. de Mussy, are enlarged glandules. He has seldom seen ulceration of the pharynx, and we believe it is of much rarer occurrence than Dr. Green and others suppose. Neither has he found tubercular deposit in

the pharynx, although, like many other observers, he has seen it in the larynx.

Dr. de Mussy finds the epiglottis frequently the seat of ulceration, the favourite points being its borders. Examined under the microscope, the tubes of the glandules were found larger than natural. The layer of epithelium lining their interior was a little thicker than ordinary. The characteristic of the morbid condition of the glands was one of simple hypertrophy. In some of the larger glandules were found little calculi, chiefly composed of carbonate of lime.

In Chapter X. we are informed that the most frequent complications of glandulous angina are coryza, tracheo-bronchitis, and tuberculous disease. The affection very often extends beyond the larynx, and invades the trachea and bronchi. Dr. de Mussy correctly remarks, that in a large proportion of phthisical patients the pharyngeal glandules are abnormally developed. It has been observed at the Hospital for Consumption and Diseases of the Chest at Brompton, that a large proportion of the patients suffer from aphonia more or less complete, and that the early supervention of this complication argues badly for the result. Of 116 patients, mostly phthisical, whom we examined in one day lately, 10 persons, or 8:6 per cent. had aphonia. The passage of acrid sputa over the surface of the larynx is doubtless a frequent cause of the laryngeal complication; but this is not always the cause, for we find it when there is little or no expectoration. It seems frequently to depend upon the deposition of tubercle in the mucous membrane, or the propagation of irritation along the bronchial tubes. Dr. de Mussy has seldom seen the esophagus implicated, and he contests the view of Dr. Green, that when implicated the disease may become cancerous.

On the treatment of the disease, Dr. de Mussy is very expansive. When on the subject of hygienic rules, he enforces the importance of pure air and reparative regimen, and freedom as far as possible from moral emotions. The patient, he says, equally dreads a cold, humid atmosphere, and one that is very dry. Currents of air are to be shunned, and he should avoid walking contrary to the direction of the wind. The food and drink should not be exciting. The voice is not to be much exercised. These rules will meet with the approbation of the profession, but Dr. de Mussy has omitted all mention of clothing. Clothing sufficient to guard against external cold, or the undue lowering of the temperature of the body, is of the utmost importance, and it is essential to attend to this point by night as well as by day. We have known examples of disease of the larynx to depend upon the accidental sleeping without the usual night-cap, aye, even upon such a trifling reduction in clothing as is involved by replacing a larger shirtcollar by a smaller one.

While upon the subject of hygienic rules, we would suggest that the practice of having ventilators in our rooms and public conveyances, placed on a level with our ears and throats, is very favourable to the invasion of this and other allied diseases.

True to the doctrine that glandulous angina depends upon the herpetic diathesis, Dr. de Mussy, in treating the disease, relies chiefly

upon the exhibition of sulphur; and here he closely follows his teacher, M. Chomel. The natural waters are the form most depended upon, and those of Eaux Bonnes, in the Pyrenees, are greatly preferred. He says :

“For a long time sulphurous waters have been employed in this disease, confounded under the name of bronchitis or laryngitis, in the class of those numerous catarrhal affections in which the sulphurous water-treatment is applied with so much success. For my own part (he says), I have often proved its efficacy. It appears to me to answer the various indications of the disease under discussion.” (p. 129.)

The immediate results of the treatment are these : “It appears that the nervous action becomes more powerful, nutrition and assimilation are more active; all the functions are performed with more energy and harmony; the patient gives expression to these combined results by saying he has more life.”

His appetite increases, his muscles acquire more vigour, he experiences a general excitement which is reflected upon the intellectual faculties. The functions of the skin are stimulated, in general the respiration is more easy and abundant. The Eaux Bonnes are administered internally, and applied externally in the form of baths. The duration of the treatment is divided into seasons of between twenty and thirty days. One season will frequently suffice, but in old standing cases two seasons are often necessary.

It has been long acknowledged by sagacious observers, that not a little of the benefit which the sick derive from a residence at wateringplaces is due to the change given to the mind, and to the operation of a pure atmosphere. The atmosphere and climate enjoyed by the frequenters of the Eaux Bonnes are of the most salubrious character. Dr. de Mussy says:

“ An incontestible fact in favour of Eaux Bonnes is the excellence of the atmospheric conditions. The air has that purity which we seek in the mountains, without being exposed to the violent agitations which are elsewhere experienced. At Eaux Bonnes the atmosphere is habitually calm, the girdle of mountains which surrounds this valley, and the slope on all sides, oppose an almost insurmountable barrier to the winds, or do not permit their arrival until they have lost all their impetuosity.” (p. 142.)

The author has a few words, and only a few, to say on the use of other internal remedies. He has very little faith in mercurial preparations, and finds in Dr. Green a faithfulness to “the traditions of Anglo-Saxon medicines,” because that physician combines the use of mercurial preparations with topical medication. He has had little experience in the use of the preparations of iodine. For our own part we have seldom seen iodine of much use in such diseases : applied locally it has produced great irritation; and even internally administered, as we before stated, it has caused irritative action in the neighbouring parts, such as the nose and the conjunctivæ. Some physicians have reported advantage from inhalation of iodine in pulmonary affections, associated with disease of the larynx. The consideration of internal remedies concludes with a few words on the employment of

balsams and narcotics. The former are recommended after the more acute symptoms are appeased, and the latter, held to be necessary in the acute forms of the malady, are very unfit auxiliaries in the chronic state when the patient is of an irritable constitution. Of the latter class of remedies, the most important are opium, hyoscyamus, lactucarium, cherry laurel water. Belladonna is contra-indicated.

Dr. de Mussy believes that the sulphurous treatment alone will in many cases succeed in the cure of the disease ; but he acknowledges that examples of glandulous angina do occur which resist this treatment. He has then recourse to topical medication, which he holds to be very valuable.

The topical medication is discussed under three heads: dry insufflations, liquid applications, and gaseous inhalations. The dry powders which have been employed in France are sugar, sub-nitrate of bismuth, acetate of lead, alum, sulphates of zinc and copper, nitrate of silver, and calomel. Dr. de Mussy makes use of dry powders less frequently than of liquid applications. Of the latter agents, nitrate of silver is, as in this country, the most esteemed, and in applying it the common laryngeal probang is employed. This he claims as the invention of M. Trousseau. The author communicates little that is novel on this point, or on the use of moist inhalations. M. Trousseau has recommended the employment of cigars made of paper, saturated with a solution of arsenic. Dr. de Mussy is of opinion that the laryngeal probang very seldom penetrates the larynx, and shares the scepticism of some surgeons in this country. We would simply remark here that we have made the experiment upon the dead body, and after having, as we believed, easily introduced an instrument into the larynx, have cut down upon it, and found it there. Dr. de Mussy is not aware that the topical use of oils, glycerin, tannin, and other agents, has been proposed and adopted in this country. We happen to know that glycerin is employed with the most soothing, if not absolutely curative, results in some affections of the glottis and larynx. It is applied to the glottis by means of a large camel-hair pencil, or introduced into the larynx with the probang. The former method is easily accomplished, and scarcely ever fails to remove the sense of tickling and dryness, and to improve the voice from the moment it is practised. Though the author does not refer to the subject, we would mention that the glottis may be very advantageously brought into view with the aid of Avery's glottis speculum.

A few words on the use of vesicatories and croton-oil frictions, and recommendatory of the amputation of the uvula when elongated, close the treatment of the disease.

In conclusion, we would here express our conviction that the present work reflects credit on the author. The descriptions of the diseases and of the morbid appearances are excellent and truthful; the arrangement of the work is exact, and the language is ever remarkable for its elegance. The subject has been discussed in all its relations. The morbid appearances are well and faithfully depicted. The microscopical anatomy, as far as we know, is to be relied upon; it corre

sponds with our own observations; but we regret that the author's opportunities for research have been so limited. The connexion between glandulous angina and the herpetic diathesis we believe to be over-stated; and we know that the sulphurous treatment, at least in this country, is less essential than the author believes. There are grave omissions in the work—the necessity for regulating the liver and bowels is scarcely glanced at; the employment of quinine and the mineral acids is passed over in silence; and though the administration of alkalines, combined with vegetable tonics or the decoction of ulmus fulva, is so beneficial in some forms of skin disease he would designate herpetic, and in the lithic-acid diathesis, these important agents are only once referred to, and that incidentally in a note; cod-liver oil, dry cupping, and leeches, have not one word in their favour.

Dr. de Mussy is doubtless an accomplished gentleman and a painstaking physician, and we think he will yet improve his work. Let him add a little more pathological anatomy and microscopical observation, and withdraw some of the many not very interesting cases which so unnecessarily enlarge the volume. When he has made a further acquaintance with the statistics of the disease, he will find, or we are much mistaken, that it is less frequently associated with herpetism, less rarely a primary local disease, and more dependent upon tuberculosis or a scrofulous diathesis than his work would lead his readers to believe.

REVIEW XII. 1. Chimie appliquée à la Physiologie et à la Thérapeutique. Par M. le

Docteur MIALHE, Pharmacien de l'Empereur.-Paris, 1856. 8vo,

pp. 703 Chemistry applied to Physiology and Therapeutics. By Dr. MIALIE. 2. A Treatise on Therapeutics and Pharmacology, or Materia Medica.

By GEORGE B. WOOD, M.D., President of the College of Phy

sicians of Philadelphia, &c. &c. 2 vols. 8vo, pp. 1741. THE work of M. Mialhe, although under the new title of Chimie appliquée à la Physiologie à la Thérapeutique,' is in reality the second edition of a treatise published by the same author in 1845, and named, • Traité de l'Art de Formuler, ou Notions de Pharmacologie appliquée à la Médecine. The present volume, however, is very considerably enlarged, the additions being made chiefly to that part which pertains to physiological chemistry. We shall endeavour to present to our readers a short account of the contents of the work, and dwell a little upon the points we deem either useful or possessed of such novelty or interest as to call for particular comment.

About fifteen pages are first devoted to general considerations, more especially as to the influence of the vital force upon those chemical laws to which inorganic bodies are subject. “ Organized bodies,” says our author, “either animal or vegetable, present, in the same way as inorganic substances, the physical phenomena of electricity, heat, light,

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