other chemists, who found, or thought they found, antimony, but no arsenic. The whole evidence was then submitted to the distinguished Fresenius, who in an elaborate report, conspicuous for its clearness and science, showed that there was no chemical evidence whatever of death from poison. III. HYGIENE. Building of Hospitals.-Dr. Mackenna, in a paper on the Hygienic Requirements of Hospitals, gives the following advice to his fellow-colonists: "As it is not likely that we shall in this colony require another large hospital, I shall pass on to enumerate the advantages that smaller ones ought to secure. For a population of eight or even ten thousand, I think one of fifty beds should answer. The site, aspect, and drainage should be the best it is possible to procure; the ventilation should be, as it could easily be, made perfect; the wards should hold six or eight beds; the ceilings should be eighteen or twenty feet in height-as I am convinced that the higher a ward is the better, and that no extension in other directions can compensate for it. The impure air should be drawn gradually off by two or more of Dr. Chowne's syphon tubes of large size, the exterior opening of which should be controlled by a cover and vane to prevent downward drafts in hot winds. The ventilation carried on by the aid of louvres and other permanent openings in the roof is liable to the objection that the hot winds force their way downwards, and instantly expel the cooler air, to the great danger of delicate patients. This can be remedied by changing them to a common tube controlled as above. A cold chamber could, and indeed should, be made in the underground, which by a simple arrangement of evaporating surfaces would procure for one or two, or more chambers above, a supply of air several degrees colder and moister than the outside temperature, by which many an otherwise fatal disease might be effectually checked. No kitchen or other office which could in the slightest degree tend by its ascending odours to taint the air of the wards or passages, should be tolerated, and every care should be taken to keep this story thoroughly ventilated. The passages and wards should be flagged with glazed tiles set in cement, which do not retain the moisture after being washed, nor imbibe impurities, and the walls and ceilings should be coated with a glaze of silicated paint. A permanent verandah should face those aspects much exposed to the sun, and these and the windows should be protected by kuskus tatties. No hospital should have more than a ground and upper story, or be without a pair of wards apart from the house for noisy or unruly patients. Lifts and Arnott stoves (for occasional use in winter) are indispensable in every hospital, and the wards should communicate with each other and with the offices by speaking-tubes. Every mechanical improvement in baths, water-closets, and especially those for the removal of patients before and after operations, accidents, &c. &c., should be provided." Effects of Swill Milk.-A report on milk, by Dr. Percy, read at the Academy of Medicine, New York, introduces us to what is called swill milk, or milk yielded by cows fed on swill, the said cows consuming in the daily swill potations not less than a gallon of vinegar per day. The milk yielded has a strong acid reaction, is deficient in butter and sugar, and, according to the observation of Dr. Percy, is quite insufficient for the purposes of life. It is also said to be wanting in a peculiar phosphoric organic compound which has been found in butter, and is described by Gobley, Treacy, and others. The effect of this milk on children fed with it is thus described: "It is not found that this milk, as given to children, actually in all or many cases sickens them at the time it is given; but the child, though inordinately voracious, is starved and poisoned by slow degrees. The nervous system becomes irritated beyond endurance, the vitality is undermined, and the child dies of marasmus, bowel complaints, cholera morbus, dropsy upon the brain, or kindred diseases." QUARTERLY REPORT ON PATHOLOGY AND MEDICINE. Fellow of the Royal College of Physicians, Physician to, and Lecturer on I. Some Remarks on the Epidemic of Diphtheria (angine couenneuse) of 1857 and 1858. By Dr. BOUILLON-LAGRANGE. (Gazette Hebdomadaire, Nos. 23, 25, 27, 28.) THE author's paper is based upon an observation of 73 cases of diphtheria, 51 of which were cured, 22 having been fatal. His general conclusions are, that we are still far from being acquainted with the real nature of the disease. He entirely differs from the views of Bretonneau, who considers that under all circumstances the diphtheritic germ is sown locally, like that of syphilis, forgetting, as the author justly observes, that wherever the virus may be deposited, at least with very rare exceptions, the throat, the tonsils, or the nasal fosse are the parts in which the diphtheria is first manifested. Dr. BouillonLagrange admits the possibility of contagion, but denies the necessity of this element in the propagation of the disease. He holds that we are nearer the truth in regarding the disease as one primarily constitutional, manifesting itself on the mucous membrane, in the same way as the eruptive fevers are characterized by a rash. This view, he adds, may be less attractive than the one accounting for the propagation by local contact, because it deprives us of the excuse for employing heroic remedies. Pathological anatomy, chemistry, the microscope, have not, according to our author, thrown much light upon the study of diphtheria; the first has only confirmed what clinical observation had previously taught regarding the state of internal organs; it has also demonstrated the liquid state of the blood and the internal congestions which result from this condition, and the asphyxia produced mechanically by the false membranes in the air passages. Dr. Bouillon-Lagrange urges the propriety of paying more attention to the lymphatic system, which he believes to play an important part in the disease. He concludes by calling upon chemists and microscopists to study the state of the blood at different stages of diphtheria, which "may be the sole means of obtaining a knowledge of the morbid state which certainly precedes the primary modification of this fluid, before the profound alteration unavoidably entailed by the enormous deposition of fibrine upon the mucous membranes." II. Diphtheritis: the Epidemic Malignant Sore-throat prevailing in Albany, New York. (American Medical Monthly, December, 1858.) It appears that our American confrères are also surprised by the appearance of diphtherite, an epidemic of which prevailed in Albany, a town about one hundred and fifty miles north of New York, during the end of last year. We gather from the brief summary of a meeting of practitioners in that town, that a large number of the inhabitants were attacked. One physician had had forty cases, of which four were fatal, "the larynx, trachea, and bronchia were found lined with a diphtheritic exudation, readily separated from the mucous membrane, which was found entire, except upon the tonsils, which were excavated, enlarged, and much congested. The secretions were copious, offensive, and very acrid. In one fatal case gangrene of the uvula had taken place." During the valence of diphtheria, scarlet fever occurred very rarely. Gargles containing chlorates of potash and soda or vinegar, the mineral acids, and tonics internally, constituted the prevailing treatment. At the time of the meeting, in November, 1858, the disease appeared to be on the decline. pre III. 1. On the Presence of Strongylus Gigas in the Urinary Organs of Man. By Dr. J. LEHOCQ. (Archives Générales, June, 1859.) 2. On the Development of the Larca of the Lucilia Homini-voraz in the Pharynx. By Dr. COQUEREL. (Ibid.) The first of these papers gives an interesting account of a very clever fraud perpetrated for a series of years by a young woman upon a large number of medical men, who believed that she was in the habit of passing strongyli from her urethra Suspicion, however, was aroused, and at last Dr. Lehocq, by the aid of M. Robin, succeeded in determining that all her symptoms were the result of her own manipulation, and that on the last occasion at least, when she was supposed to have passed a strongylus, the parasite proved to be portions of a pigeon's intestine. The case deserves a place in the memorabilia of medical experience. The second paper gives another instance of the development of a peculiar parasite in the human body, which Dr. Coquerel brought under the notice of the profession some time ago. It occurs in Cayenne, and results from the deposition within certain cavities of the human body of the eggs of an insect hitherto unknown, a species of diptera, called by Dr. Coquerel, Lucilia hominivorax. In the cases formerly detailed, the frontal sinuses and the nasal fossæ were the parts affected. In the present instance, gangrene of the pharynx and of the nasal fossæ, and death, resulted from the development of the larvæ of the lucilia in these parts. By keeping the larvæ and watching their transformations, the additional proof has been obtained of the correctness of the opinion adopted concerning them. IV. Exophthalmia as a Symptom of Disease. By C. E. FLEMING, M.D. (Charleston Medical Journal, January, 1859.) Numerous observers have drawn attention to the fact that in anæmic individuals a peculiar prominence of the eyeball takes place, unaccompanied by any palpable disorganization of the structures in or about the globe. It has been attributed to a deposition of fat, or to varicose veins behind the eyeball, to atony of the recti muscles, to enlargement of the globe from diminished tension of the sclerotic. Dr. Fleming has investigated six cases that have fallen under his notice, which presented the following symptoms: anæmia was first established to a greater or less degree; functional derangement of the heart ensued, entailing organic change, especially dilatation. The thyroid gland next enlarged; and, lastly, the eyes began to protrude, and well marked exophthalmia, or pro-ptosis, as it is also termed, was ultimately established. In all his cases the patient had previously suffered from rheumatism, upon which the author lays great stress, inasmuch as he regards the rheumatism as the real origin of the whole chain of phenomena. Dr. Fleming holds that the protrusion of the eve is due to the loss of tonicity in the muscles; they become weak and unable to perform their functions properly, one of which he maintains is, that when they contract together, they draw the globe back upon the cushion of fat in the posterior part of the orbit, so as to diminish the antero-posterior diameter. Dr. Fleming quotes two cases of strabismus in support of his view. In one the internal rectus was divided; the eye then turned outwards by the action of the external rectus and was protruded quite perceptibly; in the other the internal rectus was first divided, which caused slight protrusion, and when, in order to rectify the outward squint that followed, the external rectus was also divided, a very considerable protrusion of the eye occurred. In order still further to illustrate the subject, Dr. Fleming made some experiments upon dogs. On See British and Foreign Medico-Chirurgical Review, Oct. 1858, p. 531. dividing the internal and external recti alone, he found that the eye respectively turned inwards or outwards with scarcely any perceptible prominence, but that when all the muscles of the eyeball except the external rectus were divided, the eye almost immediately shot forwards, being also rolled outwards by the undivided muscle. The author considers that in these operations and experiments an analogy exists with the state of exophthalmia of anæmia, but we are disposed to think that the free movement and parallelism of the eyes which exist in the morbid condition under consideration contradict such an assumption, and that Dr. Fleming's explanation is therefore incomplete.* The author advocates the usual medicinal and hygienic treatment adapted for anæmia as suitable to anæmic exophthalmia, but he does not state that he has actually succeeded in restoring the eye to the normal condition and appearance by such means. V. Practical Communications. By Dr. FRANZ INNHAUSER. (Zeitschr. der k. k. Gesellsch. der Aerzte, No. 51.) From these communications we extract the following case of variola occurring three times in the same individual:-In 1857, a maidservant, aged fortyfive, who was attending a patient of Dr. Innhauser's labouring under genuine variola, had been repeatedly vaccinated in childhood without any result. When twelve years old she was infected by genuine variola, leaving large, deep, confluent cicatrices. In 1855 she was again attacked with variola, in consequence of nursing a man labouring under true variola. It was severe, and the cicatrices were readily distinguishable from the marks left by the first seizure. Three weeks after the recovery of her mistress in 1857, she was attacked a third time with variola, numerous pustules formed, but no cicatrices. VI. On a Musical Bruit, not yet described, heard at the Middle and Lower Part of the Sternum in a Man affected with Cirrhosis of the Liver. By L. LEMAIRE. (L'Union Médicale, Jan., 1859.) The following case occurred in the clinical wards of M. Bouillaud: Joseph Venn, aged forty-three, admitted into the Charité, Sept. 6th, 1858, had always enjoyed good health, with the exception of slight bronchitis seven years ago; until two months before admission, his abdomen was seen to enlarge; loss of appetite and diarrhoea followed, with thirst and loss of strength. On admission the abdomen was swollen, tympanitic above, fluctuating at the inferior part; the dulness of the liver was slightly increased, that of the spleen considerably. The tongue moist; the pulse eighty, regular; the heat of the skin normal. The heart occupied its normal limits; the valvular sounds entirely normal (by an evident misprint they are stated to have been tout à fait anormaux), without any murmur. Over the middle and inferior part of the sternum, over the right cavities of the heart, a musical sound was heard, which so closely resembled a sibilant râle as at once to suggest the presence of bronchitis, but on examining carefully the different parts of the thorax, the * Mr. Dixon (On Diseases of the Eye, second edition, p. 313) observes in reference to this question, that atony of the recti muscles might produce a certain amount of prominence, but is hardly compatible with such free motion as usually exists; and a shortening of the levatores palpebrarum, such as would account for much of the seeming prominence, would hardly allow of complete and easy closure of the eyelids. An interesting historical and critical article on the subject of exophthalmia, may be found in the Gazette Hebdomadaire de Médecine,' April 8th, 1859, in which we find the proposal of Dr. Hirsch supported that the affection should be called the malady of Basedow, who was the first to write on the subject. 48-XXIV. •17 vesicular murmur throughout was found soft, and unaccompanied by any kind of râle. The bruit was continuous, and not isochronous with the beats of the heart. It was increased at each inspiration, and it increased in intensity as respiration became accelerated. The bruit continued when respiration was arrested. A strong continuous blowing murmur was heard in the vessels in the neck. The bruit continued on the 8th, on the 9th it changed to genuine bruit de rouet, which was heard in the præcordia, and which increased in intensity the nearer one approached to the xiphoid process; it varied in character, but was persistent, even when respiration was arrested. The bruit became feebler as death approached, which occurred on the 24th. Bouillaud declined offering an opinion as to the cause of the sound. The post-mortem threw but little light on the subject; the heart and chief arteries were perfectly healthy, nor was there any marked abnormity in the lungs. The liver was in a state of advanced cirrhosis, but the fossa of the vena cava was almost obliterated, and the vein seemed to have been compressed between the edge of the liver and the spine. It is possible, according to the author's opinion, that this compression was the cause of the abnormal sound; but it was by no means proved that this compression really existed. VII. On the Foramen Orale of the Adult. By Dr. H. WALLMANN. (Vierteljahrsschrift für die Practische Heilkunde, xvi. Jahrgang, 1859.) After a short inquiry into the illustrations afforded by comparative anatomy regarding the forainen ovales, the author states that he has examined the permeability of the fossa ovalis in 300 autopsies of persons of all ages, and that in 130 of these he found it open. Dr. Klob, who recently read a paper on the same subject at Bonn, found the foramen ovale patulous in 224 out of 500 subjects, a proportion that corresponds closely to that of Dr. Wallmann. These numbers, it is to be observed, give a higher ratio than Bizot's,* who found the foramen ovale open in 44 out of 155 cases not affected with cyanosis, or about 28 per cent. Of the 130 cases of Dr. Wallmann, 9 were under twenty years of age, all the rest were adults ranging up to ninety-three years, the majority (or 95), however, being under forty; 105 were men, 25 females. The patients died of the most various diseases-we merely note the relative frequency and nature of the cardiac complaints-hypertrophy of the left side of the heart, 14 times; dilatation of the right side, 9 times; insufficiency of the aortic valves, 4 times; insufficiency of the mitral valves, once; vegetations on the mitral valves, twice; pericarditis, 4 times; pericardial adhesions, 5 times; atheroma, 15 times. The only point suggested by the author in reference to cyanosis that we need advert to, is that the cyanosis occasionally occurring shortly before death, may be favoured by the presence of a patulous foramen ovale. VIII. New Researches into the Nature of Hysterical Convulsions. By Dr. BRIQUET, Physician to the Charité, &c. (Archives Générales, June, 1859.) The author's object in the present paper is to prove-1. That hysteria consists of a series of allied acts, and that the various phenomena associated with it, however contradictory and incongruous they may appear, depend upon certain simple pathological laws. 2. That in the great majority of instances one is able to distinguish clearly between such attacks and those of epilepsy and eclampsia. 3. That we possess means sufficiently powerful to arrest them when we choose. Dr. Briquet analyses 254 cases, in which he was able to Jones and Sieveking's Pathological Anatomy, p. 336. |