49

or at least of the relative antecedence and sequence of theevents in the procession of morbid states. Was, e. g., thedisease of the kidney the first diseased element, the retentionof urea, and its conversion into the carbonate of ammonia inthe blood, the second, and the depravation of this fluid by thesalt in question the third, giving rise, as one of the necessarycausative conditions, to the hasmorrhage or purpura? Hewould recall to their minds, that throughout Huxham’s disser-tation, it was taught how markedly just such an effect was in-duced by the use of what the author called " the volatile-alkalisalts." In Dr. Goldie’s essay, some cases of purpura werealluded to, in which there was a deficiency of urea, and anexcess of albumen, in the urine. Then, might not the purpurabe the first, and the diseased kidney, or albuminuria, thefollowing morbid conditions? Dr. G. Johnson had alluded tothe connexion of diseased kidney and albuminous urine withpurpura, and speaks of the latter as a cause of 1"enal disease.Had not the urine been watched, it might have been thought,perhaps, that there was simply baematuria, and hence thealbumen, and no kidney disease. Again, what effect may theturpentine have had in influencing the function of the kidney,and under the effect of which drug, it should be remembered,also, as a point of importance in therapeutics, that purpuraticheamorrhage had come on. The connexion of rheumatism, too,with a state of the blood in which purpura and albuminuriaarose should not be forgotten.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

MR. ARNOTT, PRESIDENT, IN THE CHAIR.

MR. NATHANIEL WARD exhibited a specimen of a ,

SMALL INTESTINE THAT HAD FORMED A HERNIAL PROTRUSION IN THE THIGH.

Strangulation had taken place, and ulceration through all thecoats of the gut at its inner margin, where it had been in

apposition in the Gimbernat’s ligament.-A weaver’s wife, afeeble and thin woman, aged forty-five, was admitted into theLondon Hospital, under Mr. Luke, for a right femoral herniathat had been strangulated for six or seven days. Fceculentmatter escaped after the coverings of the sac had been divided;and on opening the sac, which had given way at its inner part,the fseces were seen to issue from an ulcerated opening in thegut, equal in length to the concave border of Gimbernat’s liga-ment. The patient died five hours after the operation. Onthe post-mortem inspection it was found that about four-fiftlisof the calibre of a piece of the small intestine had formed therupture. In this instance the taxis had never been applied.The case illustrates the fact that the greatest amount of lesionto the bowel in stangulated femoral hernia occurs in that partof it which is in relation with the sharpest and most unyield-ing of the tendinous boundaries of the femoral canal-namely,Gimbernat’s ligament.FATAL INTESTINAL OBSTRUCTION, IN CONSEQUENCE OF A TWIST

IN THE MESENTERY, AND THE FALLING OF SOME FOLDS OFINTESTINE OVER A TRUE DIVERTICULUM.

In December, 1855, a baker boy, of a strong robust constitu-tion, was seized, early in the morning, after taking a hot cupof coffee, with violent pain in the stomach, followed by sick-ness. About nine hours after the attack, he was seen by Mr.Beale and Mr. Williams, of Plaistow, who found that the boy’sbowels had been relieved two days before; that his pulse was120; his tongue slightly furred; countenance anxious; andpain and tenderness on the right side of the abdomen. These

symptoms, together with complete constipation, continued,with some variation in intensity, until the sixth day, whenthose of general peritonitis set in, and carried the patient offon the ninth day from the attack. On an inspection conductedforty-eight hours after death, the peritoneum was found toexhibit the result of inflammation, the intestines being mattedtogether, and connected with the abdominal walls. The duo-denum, jejunum, and ileum were greatly distended, the lower

portion having been highly inflamed, and about two loops of itbeing quite black from congestion. The mesentery in con-nexion with these loops had been twisted on itself, and causedtheir strangulation; and while in this state the folds had fallenover an intestinal diverticulum proceeding from the small gutto the linea alba, about one inch below the umbilicus, and thus

giving rise to an additional amount of mechanical obstruction,which led to a fatal termination. This diverticulum was fiveinches long, and thirty-four inches distant from the caecum.

Dr. THEOPHILUS THOMPSON exhibitedA PORTION OF LUNG CONTAINING A CONSIDERABLE CAVITT,

’ THE RESULT OF THE BREAKING DOWN OF CEPHALOMATOUS

DEPOSIT,and which had contained six ounces and a half of coagulatedblood, which had escaped from an ulcerated artery. The sur-face of the cavity was irregular, rough, and of a greyish-whitecolour. Material scraped from its surface by Dr. Thompson’sclinical assistants, Messrs. Bond, Vise, and Garrard, and exa-mined in the microscope, was found to contain cells of variousshapes and sizes, flattened, angular, fusiform, or oval, and manyof the larger cells had nucleated nuclei. All the other organsof the body were healthy, and to the unassisted eye there wasno appearance of deposit in either lung, excepting in thecavity; but, with the aid of the microscope, cancer elementswere discovered, lining the air vesicles, filling the bronchialfollicles, intermixed with loose bronchial secretion, and chargingthe minute bloodvessels. The patient, a stout, well-made man,aged thirty-six, had died in the Brompton Hospital, in conse-quence of profuse haemoptysis, from which he had sufferedmore or less for seventeen months. He had no hereditaryliability to malignant disease. The symptoms commenced amonth after a blow. The seat of the disease was the free sur-face of the mucous membrane, and, although appearing to thenaked eye limited to a certain portion of the base of the right.lung, proved to be extensively diffused.

EPIDEMIOLOGICAL SOCIETY.

MONDAY, JULY 7TH, 1856.

DR. RiCHARDSON read a paper0-BT THE PRINCIPLES OF THE INDUCTIVE PHILOSOPHY AS

APPLIED TO THE STUDY OF EPIDEMICS.

Dr. Odling, Dr. Tripe, Mr. W. Rendle, Mr. Hunt, and Dr.Greenhow, took part in the discussion, which was of a livelyand instructive character. Dr. Richardson replied. A voteof thanks was accorded to the author of the paper for his pro-duction.

Dr. BABINGTON read a letter addressed to him, as President,by the Committee of the Epidemiological Society for Supplyingthe Labouring Classes with Nurses in the time of Epidemic andother Sickness, directing attention to the progress made bythe committee in regard to their applications to the Poor-lawBoard. The letter addressed to the Poor-law Inspectors bythe Poor-law Board, calling upon them to aid the committeein their endeavours, was also read by the President.The meeting was well attended by its members, and amongst

the visitors present were several of the newly-created medicalofficers of health.

Dr. Ancell, Dr. Challice, and Mr. H. Northover Pink, wereproposed as members, and Drs. Aldis and Tripe were electedmembers of the Society. Dr. Von Iffland, of Beaufort, NewQuebec, and Mr. W. Isidore Cox, were elected correspondingmembers.

It was announced that at the meeting in August would beread, the report (drawn up by Dr. Babington) " On the Cho-lera which visited Her Majesty’s Black Sea Fleet in the autumnof 1854," compiled from the returns of the medical officers ofthe fleet to queries drawn up by the Cholera Committee of theEpidemiological Society, and sent out by order of the Govern-ment.

Reviews and Notices of Books.On the Defects with reference to the Plan of Construction and

Ventilation of 7nost of OUl’ Hospitals for the Reception ofthe Sick and Wounded. By JOHN POBERTON, L.R.C.S.Reprinted from the "Transactions of the Manchester Sta-tistical Society." " (Read March 20th, 1856.)WE have perused with much pleasure this paper on a subject

now happily engaging the attention of the medical profession.The higher rate of mortality in our larger hospitals, and the

impediments to successful practice therein, occasioned by im-49

50

perfect ventilation, or, rather, by no ventilation at all, are factstoo well known to the experienced hospital surgeon. In the

pamphlet before us, the author endeavours to show, and wethink most satisfactorily, that it is mainly in the defective con-struction of the buildings of most of our English hospitals thatthe evil lies, and recommends to our notice the more efficientplan adopted in certain hospitals on the Continent.

" In constructing hospitals, we have been," he says, "in thehabit of confounding together two things widely different-namely, sick wards and dormitories-wards where the sick andwounded lie continuously throughout the day and night, withdormitories occupied by the healthy for only eight or nine hoursin the twenty-four; of confounding wards where cubic air space,though highly important, is a secondary consideration to thegetting rid of foetid and pestiferous exhalations by a continualrenewal of the atmosphere-with dormitories, in which amplecubic air space is all that is required. It has been owing toignorance or inattention to this essential difference betweenwards for the sick and dormitories for the healthy, that wehave few hospitals in England that are not insalubrious when-ever they chance to be crowded, and which, when crowdedwith such cases as burns, compound fractures, and extensiveulcers, are often the abodes of death, occurring in forms mosthumbling and mortifying to the pride of surgical science, sincethe surgeon, in such circumstances, is aware that the poor suf-ferers have been carried to a public institution to their destruc-tion, and that had they been treated by him in their ownhomes, howsoever humble these might be, the chances of reco-very would have been greater."But there is another point that has been hitherto over-

looked as to our English hospitals, and, mainly, from inatten-tion to the essential difference, above-mentioned, between sickwards and dormitories: I refer to arrangements calculated toprevent the creation of what may be denominated an hospitalatmosphere, which arises from the wards communicating withone another by passages and stairs. It is owing to this kindof intercommunication that, if a foul state of the air happen inonly a single ward, such foul air spreads, and speedily pollutesthe entire building. In a few of our hospitals, the plan of con-struction is good; in the majority, bad; but in not one of themthat I have seen is the plan such as to render impossible theformation of an hospital atmosphere. Yet this all-important Iobject has been attained on the Continent in several instances, ’,where we have a plan of construction at once ingenious andperfectly successful-a plan that, when first seen and under-stood, never fails to excite feelings of pleasure and admiration. iI now allude more particularly to the Bordeaux Hospital, the ’Imost attractive altogether that I have examined; although itmust be admitted that the St. John’s Hospital, Brussels, thenew Lariboissaire and the Beaujon Hospitals, Paris, are builtafter the same plan, and are, perhaps, not very much inferior.’, i

iThe peculiarities of these buildings, the points wherein they Idiffer from our British Hospitals, Mr. Roberton endeavours to

Imake plain, by means of a lithographed sketch of the groundplan of the beautiful Bordeaux Hospital, which accompanyingthe pamphlet, adds much to its value, besides explaining theviews enunciated therein.

Remarking on the ventilation of a ward, and the means bywhich this may be effectually accomplished, he writes,-"By the ventilation of award it will have been observed

that I mean the admission into, and circulation through it, ofthe external atmosphere; not, necessarily, at all times by openwindows, but, when circumstances require, through perforatedplates of zinc, having the apertures so small as to rob the air-currents of what in them is disagreeable or hurtful to the sick.I have little faith in scientific ventilation, so called, whetherthe downward mode, the upward mode, or the circuitous mode.I should almost as soon think of looking for my daily supply ofwater for purposes of ablution from the scientific formation of itout of its aeriform elements by galvanic agency, as of depending -,

upon such refined expedients for the purity of a sick ward. Ifa ward is to be kept perfectly sweet, the air 2nustgow throughit in correspondence with the natural movements of the atmo-.sphf’.I’e without. Let the windows of the opposite side walls-tall windows, they ought to be tall, reaching near to thecieling-be thrown open, and, instantly, the air enters at oneside, and escapes at the other, the side of admission being de-termined by the direction of the wind at the time. Sometimesthe air is entering by the windows on a particular side-thewind shifts, and now it enters on the other side, and escapes by

50

this. There is an unceasing flow of the atmosphere, mostlyparallel to the surface of the earth, which purifies everyobject it is permitted to embrace. A perfectly stagnantcondition of the external atmosphere-if it ever exist-is ex.tremely rare. I therefore repeat, that curious and refinedmodes of ventilation, which may answer for entertaining-rooms,public offices, and other kinds of apartments occupied by personsin a state of health, fail when applied to an hospital, whereefiluvia from the bodies of the sick, animal matter from theirbreath, and the foetor from ulcers, wounds, &c., combine topollute the atmosphere, so as no ventilation can dissipate,other than Nature’s,-I mean the ceaseless, it may be imper-ceptible, flow of the external air through the wards. This mode,and no other, is worthy the name of hospital ventilation."

Various other points tending to promote the salubrity of anhospital are touched upon; as, for instance, that there be adischarging shaft in the wall, shut by a sliding cover, by whichsoiled clothes, &c., are at once passed to the wash-cellar; thatthe cielings and walls be painted and highly varnished to pre.vent the imbibition by the plaster of eflluvia; that there be aneating-room for convalescents; that the atmosphere surroundingthe sick should not be unnaturally dry or hot, as is too oftencaused by artificial modes of heating; all of which, beyondopen fire-places or open stoves, are condemned; that with re-spect to the choice of a site, it ought, if possible, to be on anelevation, to the windward of the city, having a soil naturallydry, or admitting of easy drainage, and that the plot of groundought to be large enough to include gardens, not merely toplease the eye of the sick, but to provide, as well, the means ofrecreation and exercise for convalescents. For these, and othermatters not mentioned, we must refer our readers to the

pamphlet itself, which, containing much practical informationand many valuable suggestions, we trust will not be confined,as to its circulation, merely to the locality of Manchester; for itought to be in the hands of the governors of all our public hos-pitals, and of every respectable architect and civil engineer inthe kingdom.

A T,.eatise on the Diseases of the Breast and lammary Region.By A. VELPEAU. Translated by MITCHELL HENRY,F. R. C. S., &c. (Printed for the Sydenham Society.) 1856.

WE are glad to see Velpeau’s great work on the Diseases ofthe Breast in English costume. Mr. Mitchell Henry’s transla-tion is a very creditable performance. The volume reads morelike an original English treatise than a translation, and this weconsider one of its great merits.The author says, "In executing the task which, as editor,

the Council of the Sydenham Society has been pleased to con-fide to me, I have endeavoured to the best of my ability, topreserve the peculiarities in the style of the original, withoutwholly sacrificing the comfort of the English reader. If heshould be inclined to find fault with the construction of sen-tences that too unmistakably bear upon them the marks oftheir foreign origin, I would beg him to remember, that what-ever ideal standard of perfection he may propose for a transla-tion, in practice the limit is almost necessarily confined to afaithful rendering of the original, and leaves but little scope forthe graces of style."The reader will perceive that the author, upon many points

of importance, considers it his duty to express dissent fromclaims of priority, and the like, which, if allowed, would plucka leaf from the chaplet that adorns the illustrious dead, for thepurpose of adding to the reputation, already great, of Velpeau

himself. He refers especially to the chapters on Cysts and onAdenoid Tumours. He thinks the deliberate judgment of anyimpartial person must be, that Sir A. Cooper is not open to thecriticisms advanced against him by Velpeau, but that he isfairly entitled to the honours that have usually been accordedto him, and by no one more unreservedly than by Velpeau’sfriend and former pupil, M. Lebert.

" If," says the translator, " what M. Velpeau states as to theviews entertained respecting cancer and adenoid tumour, &c.,be correct, the general condition of pathological knowledge onthese subjects in France must be vastly below what it is

51

throughout England and America. A similar remark appliesto many of his observations on the diagnosis of cancerous dis-eases ; but as I have added wherever it seemed called for, a shortnote to these statements, it is needless to repeat them here."

It is with much satisfaction that we bring this able translationof one of the Continental surgical classical works under thenotice of our readers. The book should find its way into the

library of every British surgeon.

A Short Sketch of some of the F01.ms of Tetanus, as they appeal’in India. By JOHN JACKSON, M.D. Pamphlet. London:John Churchill.

IT was sought to be proved, in the defence of Palmer, thatCook died of tetanus. One of the witnesses subpoenaed by theCrown to show that the symptoms of this disease differed inmany essential particulars from those under which Cooklaboured was Dr. Jackson, late Presidency surgeon at Calcutta—a gentleman who had been engaged twenty-five years in ex-tensive public and private practice in that capital. Thoughtetanus may be more frequent in India, and arise in manycases from causes which would not produce the disease in thisclimate, the symptoms presented by the affection seem to beidentical in every respect with those observed in this country.The pamphlet before us has been published by the author,

we presume, in consequence of his having been examined as awitness in the memorable trial alluded to. An abstract offifteen cases is given, which occurred during the year 1852 atthe Native Hospital at Calcutta. For a history of the cases,which consist of eleven of traumatic and four of idiopathictetanus, we must refer to the pamphlet itself. The followingremarks, which are thoroughly practical and instructive, wetransfer to our pages:-

" With the exception of hydrophobia, to which tetanusbears a stronger resemblance than to any other disease, bothin the local symptoms and the general paroxysms, there is nodisease more agonizing to the patient, appalling to the beholder,or less amenable to general means of treatment, than tetanus,both in its traumatic and idiopathic form.

" Like hydrophobia, it is found both in the East and WestIndies, and is much more common within the tropics than inmore northern latitudes. In the plains of Bengal it occursmore frequently during the long rainy season, and in the coldweather, than at other times of the year. The slightest injurymay bring on an attack, which, after some hours of premonitorysymptoms, ends in a series of paroxysms, and destroys life.Sometimes it will arise from cold, in the natives of India; whilstin the European habitual drunkard it will succeed exposure tothe burning heat of the sun. It will take place sometimes onthe decline of small-pox, or arise a few days after childbirth,or miscarriage. I have seen a healthy European young woman,living in a healthy locality, who has gone favourably throughthe stage of labour, attacked with tetanus on the third day,and after intense suffering, destroyed by it on the fifth. Thenatural functions went on unimpaired. The discharge con-tinued, and the pulse was unaffected until within a few hoursof her death. The mental faculties, as is the case always,remained undisturbed until the last.

" One mild case, with recovery three weeks after childbirth,occurred in the Native Hospital, and is noted amongst thepresent cases. At another time I have known a young healthynative woman, after miscarriage, seized with tetanus. Aftersome premonitory symptoms, severe spasms came on, and shedied after thirty-six hours."The natives of India seem more disposed to attacks of this

disease than the Indo-Britons, although, from the peculiartemperament of the latter, thought the more likely subjects.The surprise of people, and the apparent ignorance of thisdisease, amongst the natives, is very remarkable. I haveknown a poor little lad brought by his parents, who had beensubjecting him to a beating for obstinacy in not opening hismouth to answer them or take food, who was labouring underlock-jaw, the effects of a burn, and who died within twenty-four hours after I first saw him.

" Tetanus follows not unfrequently an incision made by aclean-cutting instrument. I have known it occur after theoperation for hernia; whilst the cicatrix was forming, thepatient died. I have seen it take place after amputation of alimb. A case of such nature is recorded in the present list, in

a woman whose leg was amputated. After eight days, tetanusset in, from which she recovered. I have seen it arise from theirritation of dentition, when trismus, with opisthotonos, com-menced twenty-four hours after the patient was first seen. Thedisease came on after convulsions with insensibility, with thereturn of consciousness, and continued until the hour of death,the tetanic symptoms being a much more alarming conditionthan the previous insensibility.

" In infants, from the third to the fifth day, the occurrenceof tetanus must have been seen by every medical officer inIndia much engaged in professional duties, both amongst thenatives and Europeans. But in these cases there is alwayslock-jaw, and recovery is most rare.

" One singular character of the disease, which has beennoticed by all, is, that the slightest scratch will produce adisease as fatal as the most severe laceration. I have severaltimes found it arise from a slight wound on the ball of thegreat toe, caused by a man striking his foot against a rattanmat. And it is not the least improbable that some cases whichhave been noted as idiopathic may have arisen in this way, thepatient forgetting the occurrence of the injury, and havimglittle or no trace of a wound to remind him. I have knownthe same occur when the specific poison of hydrophobia hadtaken place, the patient remarking that he might have beenbitten three weeks before, when he was engaged with somefighting dogs, though the wound was so slight he had for-gotten it.

" In some of the cases of injury the disease showed itself-after nine days. After burns the seizure is generally earlier.I have never seen less than six hours of local and premonitorysymptoms before the general spasms supervened.

" Of the various plans of treatment which I have adopted, Imay mention that I have tried all that have had any degree ofrecommendation, but with so little success that I had, up to alate period, looked upon every case as well-nigh hopeless.From seeing the benefit of venesection, with a dose of laudanum.and aloes, in a horse suffering from tetanus, keeping the animalin a dark room, I have adopted the same plan, but without suc-cess. I have divided the posterior tibial nerve in two cases wherethe injury was in the foot, but the patients both died. Treat-ment with tobacco I have tried with some degree of relief tothe spasms, but I found it caused extreme exhaustion, and thepatients died. Ice to the spine, opium, camphor, I have tried,but I have no faith in them. I have found hemp and aloesmuch more beneficial, and from the use of chloroform I haveseen patients derive great relief; but it was not until I hadused this in combination with hemp and aloes, supporting thepatient with good diet, quinine, and wine, and keeping him in aastateof perfectrest, that I have met with anything like success."

ROYAL MEDICAL BENEVOLENT COLLEGE.To the Editor of THE LANCET.

SIR,-I am perfectly confident that the Council of this most.excellent institution is anxious to carry out the objects atprofesses strictly in conformity to the benevolent intention ofits esteemed projector, and that the most worthy, and at thesame time charitable, objects should be selected for its benefit;and I trust a few words in reference to the qualifications of-candidates for the Foundation Scholarships will not be deemedirrelevant or impertinent.

According to the present mode of voting, the wealthy friendsof a candidate, by employing agents to look up proxies andsecure votes, give him a decided and unfair advantage overanother whose friends are differently circumstanced, and whois consequently, e<e<e?-M paribus, the more deserving object ofthe two.Taking a cursory view of the balloting paper, our best sym-

pathies would be enlisted in favour of the widow with ten ortwelve children, in opposition to her with one or two only;but let the cases be fully scrutinised, and we find the smallernumber penniless, and an adequate provision for the larger.

I would therefore respectfully suggest that, previous to theCouncil admitting the eligibility of a candidate to go to thepoll, they should require a full and explanatory statement ofhis friends’ present and his own future pecuniary resources.

In asking you to insert this suggestion, I am aware it is notthe most effectual manner of impressing its necessity on theCouncil; but not having a voice in that body, and having theinterest of the institution at heart, I trust it may draw theattention of some of the worthy men comprising it to there-sent inefficient system.-I have the honour, &c.,

July, 1856. A II1R GOVERNOR.51