after periods varying as just stated. 7. In some instances, after the appearance of rigour, fever, nervous and other general symptoms, the axilla becomes painful and swollen. Diffusive inflammation proceeds extensively from this part through the cellular tissue, extending in some cases to both sides, and suppurates or sloughs; inflammation of, and effusion into the pleura, often ultimately supervening. Death generally takes place in these cases with the usual symptoms, and after the indefinite period already mentioned.

finger in the examination of a body, pain is felt lation of the cellular tissue, and often also of in the puncture. It soon increases to the ut- the tendinous structures, takes place; the pain most agony, and is attended by symptoms of in the axilla or shoulder is followed by diffused constitutional irritation, the nervous system and slightly coloured swelling, extending somebeing agitated to a violent degree. No trace times to the integuments of the same side of of inflammation beyond slight redness of the the body. As the disease continues, headache, puncture is observable; and no evidence of in- watchfulness, delirium, irritability of stomach, flammation of the absorbents or veins can be thirst, and singultus vary in severity; and, if detected. In a case recorded by Mr. TRAVERS, no alleviation take place, these symptoms indeath took place forty hours after the puncture crease; the physical and mental exhaustion are was received, with all the symptoms of agoni- extreme; restlessness, followed by insensibilizing excitation of the nervous system, the dis- ty and coma, appears, and death takes place aftemper resembling hydrophobia. 2. In other ter periods varying from four or five to twelve cases, the puncture is also not attended by any or fourteen days. 6. In other cases, a diffusevidence of inflammation, but, in ten or twelve ed swelling, tension, and redness affect the hours afterward, feelings of indisposition are wounded finger, subsequently to the occurrence complained of; violent rigours are soon experi- of severe rigours, prostration of strength, freenced, followed by febrile reaction, nausea, or quency of pulse, and other constitutional sympvomiting, and most rapid pulse. Severe pain toms. The swelling, tension, and redness exis felt about the shoulder, axilla, or pectoral tend to the hand, or up the arm, upon which muscle; but no trace of inflammation can be numerous vesicles form, followed by tumefacdetected between the puncture, generally of a tion, and insulated patches of colour on the finger, and the seat of pain. Anxiety, depres- shoulder, breast, and back, on the same side of sion of spirits, delirium, profuse perspiration, the body. The febrile and the nervous sympsingultus, most rapid and small pulse, insensi- toms continue to increase with the development bility, and death supervene. 3. In some in- of local lesions; and the pulse, strength, and stances, from ten or twelve to twenty-four constitutional powers generally become weakhours after the imbibition of the poison, lan-er, death taking place in the majority of cases guor, depression, shivering, and sickness at stomach are experienced; a vesicle, or pustule resembling that of smallpox, is observed in the punctured or abraded part, and pain is felt in the shoulder or axilla, or both, but without any sign of inflammation of the lymphatics, or of any other tissue of the arm. The pain extends to the breast of the same side, and is attended by nervous excitement, thirst, watchfulness, headache, a hot and dry skin, a frequent and weak pulse, afterward by delirium, irritability of stomach, by swelling or redness about the axilla or pectoral muscle, by sinking of the powers of life, and often by death. 4. In other cases, no vesicle or pustule forms in the seat of puncture, but severe constitutional symptoms are rapidly developed; the pulse in a day or two rises to 120 or 130; delirium soon appears; slight swelling and excruciating pain affect the axilla and breast, attended by diffuse swelling, patches of colour, and severe pain in different and distant parts of the body, by nausea and vomiting, by singultus, and sometimes by yellowness of the conjunctiva and skin; followed by a weak, small, and rapid pulse, exhaustion, laborious breathing, and death. 5. In all the preceding phases of this distressing distemper, the puncture or abrasion by which the poison was imbibed, and the tissues in the vicinity, have presented no alteration, excepting the superficial vesicle or pustule observed in some instances, and no local lesion or disorganization appears until after the constitutional symptoms have been fully developed, and then it takes place near or on the trunk, in the situations already mentioned. But, in another class of cases, the wound or puncture of the finger suppurates, not, however, until after severe constitutional symptoms have appeared, especially rigours, vomitings, pain in the axilla or shoulder, very rapid pulse, physical and mental depression, with white or loaded tongue, dry and hot skin, &c. The puncture or abrasion now begins to suppurate, and swelling extends along the finger and sometimes over the hand. Sphace

493. From the above brief account of the several phases of this dreadful distemper, it may be inferred that the local inflammatory action is an unessential and subordinate feature of the disease in its severest forms; that the distemper actually consists of prostration of the nervous influence and vital energy generally, the local irritation arising from the impression or imbibition of the poison occasioning slight change of structure in some instances, and more extensive inflammation and disorganization in others, as already noticed, and as will be more fully described; and that the contamination produced by this poison is characterized by preternatural excitement of the nervous and vascular systems, without power or vital resistance, that soon passes into rapid exhaustion. A circumstance deserving of notice in this distemper is the remoteness of the local inflammation, in the great majority of instances, and in all its above phases, excepting the sixth, from the part at which the poison is imbibed; and the absence of any sign of inflammation of the absorbents or veins in a great proportion of the cases between the seat of injury and that of pain and inflammation. But this phenomenon is also remarked in other maladies produced by a specific animal poison, as syphilis. It would appear that this poison, whether conveyed by the absorbents or by the nerves, especially those supplying the blood-vessels, affects the glands of the axilla, and probably also the axillary plexuses of nerves, in an especial man

ner, and that the surrounding cellular tissue be- | comes asthenically or diffusively inflamed in consequence, and the consecutive lesions are thereby produced.

during the examination of a recently dead subject; the local symptoms in his case having been slight, but the nervous and constitutional disturbance most severe and rapidly fatal.

494. C. Prognosis.-Much depends upon the 496. D. Appearances after Death.-These have severity of the constitutional symptoms at an been but imperfectly described, and comparaearly period of the distemper, and upon the tively few of the fatal cases have been examtreatment then adopted. Those cases in which ined. The lesions observed are, 1st. Those the local affection is the least severe, and the which are found in the external parts of the nervous and febrile symptoms most prominent, body; and, 2d. Those which are detected in are the most dangerous; and, if the disease be the cavities and in the viscera.—(a) In the fornot arrested at an early stage by most decided mer, the changes are in some instances very means, these symptoms, and with them the lo- slight, or hardly appreciable, unless in the vicincal inflammation, rapidly increase and pass be-ity of the axillary glands, in others most extenyond the influence of any remedial means what- sive. These changes may consist of serous inever.-a. The prognosis is generally most un-filtration of the cellular tissue surrounding these favourable when the irritability of the stomach glands, which are generally more or less enextends to the diaphragm and is attended by larged or inflamed, or both, or of a sero-purihiccough; when the tongue becomes brown or form, or puriform infiltration, with or without dry, or both; when the pulse rises above 120 destruction of the cellular tissue itself, as dein a minute, and is weak or small; when anx-scribed in the article on diffusive inflammation iety and mental depression are great, the fea- of the CELLULAR TISSUE (§ 20, et seq.). In some tures sunk, or the extremities cold; when a instances the disorganization proceeds so far lurid, dirty, cachectic, or yellowish hue of the between the pectoral and respiratory muscles countenance and general surface is observed, as to implicate the pleura, the external surface and more especially early in the distemper; of the costal-pleura being also inflamed. The when the individual has been previously out of muscles themselves are sometimes changed, eshealth, is cachectic, or the subject of disease pecially in the vicinity of the sphacelated celluof the heart, or of a varicose state of the veins; lar tissue or of the collections of puriform matand when delirium becomes continued, and is ter; the muscular fibres being of a dirty yellow attended by unconscious evacuations. In these colour, and devoid of cohesion. The veins are circumstances few or no hopes of recovery sometimes implicated, but seldom to a great may be entertained; but, nevertheless, active extent, unless those which pass through the inmeasures, such as I shall recommend, should flamed and disorganized cellular tissue. The not be relinquished. If these symptoms be ac-absorbents between the puncture and the axillacompanied with signs of extensive local disor-ry glands sometimes betray no change, neither ganization, the chances of recovery are diminished, owing to the probable absorption of morbid matter into the circulation. Still, energetic measures should be prescribed; but, unless these measures are of a powerfully restorative kind, they will be productive of no benefit, especially if hiccough be present; and even when most restorative, they may fail, or may not be retained on the stomach, particularly at a far advanced stage of the distemper.

the superficial nor the deep-seated. In some instances, these vessels appear thickened or enlarged, and are, in various places, surrounded by sero-puriform, or puriform collections, in small quantities, in the cellular tissue. The arteries of the limb are rarely altered, excepting the smaller branches, which either supply the disorganized cellular tissue, or which traverse it. The state of the nerves has not been accurately observed, or has been reported as not materially changed; but in one or two instances the nerves of the arm, especially the internal cutaneous nerve, have been found inflamed. The aponeuroses, the fascia, the theca, and the tendons have sometimes been found inflamed, or surrounded by, or covering, or containing puriform matter or pure pus. Lesions of one or more of these structures are chiefly seen in those cases which are noticed as constituting the fourth, fifth, sixth, and seventh phases of the distemper (§ 492); in many of those cases, which are ranked under the first, second, and

495. b. A more favourable result may be anticipated if the pain is less violent, if the pulse becomes less frequent, and the delirium is only present at night. If sleep be obtained, if the tongue continue moist, if singultus be not present, and if medicines be retained on the stomach, more sanguine hopes of recovery may be entertained. As respects the local affection, much will depend upon the rapidity and extent of its progress under the integuments and muscles of the affected side; and the amount of ease obtained from incisions, and the discharge of purulent matter. If the discharge be follow-third phases, these lesions, excepting those of ed by a limitation of mischief or disorganization, and if the inflammation of the deep-seated cellular tissue has not implicated the pleura, it may be hoped that such measures as assist vital resistance may still prove successful, not only by arresting, but also by remedying the already existing disorganization. Of eight cases which I have seen of this distemper, seven recovered; but all these came under my care at an early period. The fatal case occurred in a gentleman who was the subject of varicose veins, and was otherwise cachectic. I saw him shortly before his death, which took place after a short period from the imbibition of the poison

the cellular tissue and axillary glands, are either wanting, or so slight as not to be remarked. The lesions of these several tissues are generally most remarkable when the limb and external parts in the vicinity of the axilla present the more evident signs of disease or disorganization; and the symptoms during life vary with the texture more especially implicated, as shown in the articles upon the diseases of these textures. In the majority of cases, and more especially when the poison has been imbibed from a very recent or warm subject, no alteration can be traced after death in the arm, or any connexion between the abrasion or punc

ture of the finger and the changes existing in the vicinity of the axilla and pectoral muscles, more than could be observed during life.

| tent compared with the extent of the swelling, and is seen for a very short time, perhaps for a few hours only, never longer than a few days, 497. (b) If the external alterations have been on the same spot, and next is observed in some but superficially observed, the visceral changes distant part, possibly even on the opposite limb. consequent upon this poison have been still Besides, this peculiar redness, vanishing quickmore imperfectly described, if, indeed, descri- ly from a part, does not leave any vesication or bed at all. The most prominent lesions have desquamation after it, as is seen in cases of been observed in the pleura, particularly in that erysipelas. When the swollen parts are incisof the affected side, when the diffuse inflamma-ed they yield only a small quantity of blood, or tion of the cellular tissue and its consequences serum and blood, unless the incisions are dehave extended to the pleura. In these cases layed until the effused fluid assumes a puriform the pleura is inflamed, generally throughout character. On this topic Dr. COLLES remarks, that side of the thorax, and the cavity contains that this peculiar disease, the effect of slight a turbid serum, or a large quantity of bloody se- wounds received in dissection, presents much rum, with flakes of lymph floating in it. The less of inflammation of the wound or its vicininflammation extends from the costal to the ity than occurs in the various diseases to which diaphragmatic and the mediastinal pleura, and slight injuries more frequently give rise. Here even to the pericardium, the pulmonary pleura the injury seems to produce mischief by excibeing also inflamed. The lungs are rarely af- ting a fever, which in its turn induces a swelling fected, but they have been found more or less and redness of very peculiar character, although congested. The heart has been seen somewhat at length (if the patient chance to survive) it flabby, and its right side and vena cava have pre- will end in inflammation and suppuration of sented inflammatory appearances. The stom- the wounded limb. (Dub. Hosp. Rep., vol. iv., ach, intestines, liver, &c., are generally repre- p. 247.) sented as natural, and the brain, spinal cord, and their membranes either have not been examined, or they are said to have been unaltered. 498. E. Causes predisposing to Infection by this Poison.-There are manifestly circumstances which predispose to the infection of this poison, and increase the virulence of the distemper produced by it. Attention to these causes may aid in preventing, or even in coun-examination of recent subjects, irrespective of teracting its effects. The operation of this, as well as of all animal poisons, is favoured by whatever lowers the powers of life or weakens the vital resistance to injurious agents; by the depressing emotions, by fear especially, by disordered states of the digestive organs, or by accumulations of secretions and fæcal matters in the digestive canal; by a languid, impoverished, or an impure state of the circulating fluids; by general cachexia or anæmia; by fatigue, want of sleep, or exhaustion of nervous energy; by excesses of all kinds; and by an irritable and susceptible state of the nervous system. Probably also idiosyncrasy, the nervous and irritable temperaments, a debilitated state of the frame, or natural delicacy of constitution or conformation, favour the morbid impression of this poison, and impart a greater intensity to its effects. My experience has shown that these circumstances are influential in the way now stated; while their opposites are equally influential in resisting the operation of the poison, or in rendering the effects less dangerous.

500. Having seen the inoculation of this poison so frequently during examinations of puerperal subjects, and of persons who had died of erysipelas, the question suggested itself: Can the distemper which results be merely a form of erysipelas produced by inoculation? But this idea was met by the fact that it has been caused by wounds or abrasions received in the

the disease which produced death, although my experience has shown that these maladies, and inflammations of serous membranes attended by fluid effusion, have most frequently occasioned it. There still remains much to be ascertained respecting it, before accurate views as to its nature can be entertained; for the changes produced in the nervous systems and centres, the appearances of the blood, both during life and after death, and the possibility of propagating a similar distemper by the serous fluids of the body of one who has died of it, or by the secretions during life, have not been investigated. Strongly impressed with the imper fect state of our knowledge of the pathology of this distemper, owing chiefly to the very superficial examinations of the bodies of those who have died of it, and to the general adoption of a very injurious practice in the treatment of it -a practice which has proved unsuccessful in the great majority of cases for which it has been prescribed, and which is yet persisted in with little variation, I would, nevertheless, suggest the following views as to its nature, espe cially as they have been the basis on which I laid my indications of cure in the cases which were treated successfully.

499. F. Nature of the Distemper.-The constitutional symptoms are generally the same in all cases of this terrible malady, and differ merely in severity and the rapidity of their course. They always precede the more prom- 501. a. The poison communicated by, or iminent local alterations, but become more severe bibed from, a recently dead human body is of a with the progress of these. In addition to sev-specific nature, and produces a specific malady; eral other phenomena characteristic of this distemper, it is generally observed, in the more prolonged cases, that, previously to a termination in death or recovery, swelling and inflammation affect a portion of the limb interposed between the original wound and the first seat of pain. The swollen parts present a redness very unlike that of erysipelas; for the tint is that of peach-blossom, and is very small in ex

specific, more especially, as respects the constitutional symptoms, and peculiar, as just shown, as regards the consecutive pain and inflammation in the axilla, arm, and side.

502. b. This poison is connected with the secreted and exhaled fluids before they have undergone any change or decomposition, and before any of the properties imparted to them during life, or during the departing vitality of

the frame, has escaped from them; the loss during decomposition of properties derived from, or depending upon the state of vitality, rendering them inert. In these respects, as regards the source of morbid properties, and the loss of those properties, the fluids producing this peculiar malady in every respect resemble the fluids infecting small-pox, measles, scarlet fever, &c.; are identical with the infection of the exanthemata; decomposition or putrefaction destroying, while recent production increases, the poisonous properties.

and, as these nerves are intimately associated with the vessels and absorbents of the limb, on the one hand, and with the ganglial system on the other, the morbid impression or irritation produced by the poison is followed by a general disturbance or tumult of all the functions actuated by the ganglial or the organic nervous system; by excessive vascular action, without nervous energy or vital resistance, these states passing into exhaustion, with sinking of vital power, and contamination of the circulating fluids.

506. f. The primary impression of this poison is not only irritating, and productive of exquisite pain, in many instances, and of inordinate excitement in most, but it is also of a depressing nature, inasmuch as it often is followed by a numbness in the vicinity of the puncture, or by aching, or feebleness of the limb; the local change thus primarily produced being probably a chief cause of the consecutive chan

503. c. There is every reason to infer, from facts already before the profession, that this poison exists, probably in various and varying grades of activity, in the serous and exhaled fluids of all human bodies recently dead, whether from accident or disease, and irrespective of the nature of the disease; but that certain maladies, especially those in which the serous membranes and the circulating fluids are most liable to be especially affected, as puerperal dis-ges which take place, especially after the frame eases, erysipelas, peritonitis, &c., appear, in the present state of our knowledge, to cause this distemper the most frequently.

504. d. We do not possess evidence of this infection being communicated by a person labouring under the effects of poison-by a living person; and this may arise from the circumstance of the fluids which are more especially or specifically infectious or poisonous being those which exist in shut or serous cavities or in viscera, and which cannot hence be imbibed during life; although other fluids, exhalations or secretions, which are probably less poisonous or infectious, may communicate a modified or less virulent malady, as, indeed, seems to have been the case on some occasions, as noticed below.

is infected, in the glands and other structures in the axilla and its vicinity of the inoculated side.

507. g. The constitutional commotion, generally developed from ten to twenty hours after the imbibition of the poison, is displayed by all the organs actuated by the ganglial system, and by the brain; both the organic and the cerebrospinal nervous systems evince much disorder, and this disorder is characterized by altered or excited sensibility, and by deficient energy; the functions of vital organs being co-ordinately affected, vascular action remarkably excited, and the blood, and all the secretions from it, ultimately more or less altered, as in malignant distempers.

508. h. The nature of the constitutional commotion, of the vascular excitement in this malady, has been misunderstood by most practitioners and writers, and the character of the

505. e. The morbid impression made by the poisonous fluid imbibed from a recent subject, seems primarily to affect the nerves of sensa-pulse misinterpreted; and, because there have tion in connexion with those of organic life;

* Dr. NELSON states, in his account of the illness of Mr. NEWBY, who died from the effects of this poison, that Mr. N.'s assistant had an erysipelatous inflammation of the fauces, and the pupil an attack of low fever, during the latter part of Mr. NEWBY's illness; that the housemaid was severely affected with cynanche tonsillaris; that the nurse had a slight attack of pyrexia, with pain and stiffness at the back of the neck, followed by erysipelas, which proved fatal; and that another who assisted just af ter Mr. N.'s death had also erysipelas, but recovered. Dr. NELSON adds, "Was the disease which destroyed Mr. N. erysipelas produced by inoculation and affecting the cellular substance of the breast and parts adjoining? Did the five cases which occurred during his disease and after his death arise from erysipelatous contagion ?" (Medical and Phys. Journ., Aug., 1823.)

been very acute pain, and remarkable frequency of pulse, often with delirium, many have most unwarrantably inferred the existence of sthenic or true inflammatory action, instead of its opposite, and had recourse to large vascular depletions, which have aggravated the pain, increased the frequency and weakness of the pulse, and induced or rendered more severe and continued the delirium. Oh! that ignorance would be less presuming, and not actually inflict the death it is blindly attempting to pre

vent.

509. i. The state of predisposition of the poisoned person, depending upon temperament, Mr. DELPH, surgeon, imbibed this poison from a woman constitution, and the existing health, is most who had died a few hours previously of visceral inflamma- probably influential in developing the primary tion, the body being still warm when it was examined. The woman who nursed this person and washed the linen impression and the consecutive effects, or in was seized with fever. Mr. SMART, who assisted Mr. aggravating their severity. This has been provDELPH in this examination, was also attacked with symp-ed by cases which have come under my own toms of low fever on the second day afterward, and with observation, where surgeons, who have aided numbness and inability to move the right arm. The side became tender and swollen; the fever typhoid, and the me in the inspection of very recent bodies, have, sensorium much affected. During the early part of Mr. without any wound or abrasion of the cuticle, SMART's illness he was taken care of by a servant who happened to wound the index finger of the right hand. The or after such injury, complained only of comwound became inflamed, swollen, and livid; and although paratively slight constitutional symptoins, which early opened, much pus was discharged, and the extonsor yielded to treatment, without the local symptoms having appeared.

tendon had suffered. A tumour soon afterward formed in the axilla, which was also opened. This man was removed to his father's house, and was nursed by his mother, who had an attack soon afterward of inflammation of the hand, with

much fever. In none of the above cases were the absorb ents of the arm inflamed, showing the red line which usually marks the track of the mischief from the punctured part into the system." (TRAVERS, Op. cit., p. 327.)

510. k. In most cases no morbid connexion can be traced between the puncture, or the point of inoculation, and the subsequent alterations which take place in the axilla and vicinity: no change is observed in any of the tissues

pulse was rapid, and the febrile symptoms and delirium excessive: reasons more correctly indicating the propriety of adopting very different measures. Dr. COLLES, knowing that this treatment was most frequently followed by an aggravation of the malady, simply advises calomel in doses of three grains every three or

between this situation and the puncture or | ed, if, indeed, any definite or rational plan had scratch in the finger or hand; unless the change ever been prescribed. The means which had exist in some of the nervous fibriles, and be of usually been employed consisted of blood-letsuch a nature as not to admit of recognition by ting, general and local, opiates, fomentations, the unaided senses. The constitutional com- purgatives, &c.: the blood-letting having been motion is generally ushered in by altered sensi-prescribed for the insufficient reasons that the bility of the poisoned part and of the arm, but is unattended by any visible change, although in some cases the absorbents, either superficial or deep-seated, appear to be affected, and is characterized by its early appearance, and by remarkable physical and moral depression and anxiety, followed by rigours, which are succeeded by reaction and excessive nervous and vas-four hours, with the intention of quickly excicular excitement, devoid of energy or vital power. The alterations which occur in the axilla and vicinity never commence until the constitutional disturbance is produced, generally after the rigours and consequent reaction, and are preceded by exquisite pain, often extending to the shoulder and arm.

ting ptyalism. But, despite of the magic number three, he might consider himself most fortunate if he succeed at all in this intention, and "fortunate beyond compare" if he succeed either quickly or with a perfectly favorable issue.

513. The virulent poison imbibed from a recently dead body invades the healthy frame with a rapidity and intensity proportionate to the deficiency of vital power opposing the invasion; and whatever means are administered to the person infected by this poison, calculated to

511. . The inflammatory changes in the axilla and vicinity do not take place in some of the most violent and dangerous cases; the poison, apparently, not being intercepted by the glands, and affecting chiefly the nerves and ex-lower vital power and resistance, will only agerting its noxious influence upon the nervous gravate the effects by accelerating the absorpsystems and constitution generally. These tion, and facilitating the operation of it upon changes are merely contingent upon the major- the frame. All animal poisons exert more or ity of cases, and do not constitute the disease; less of an asthenic influence upon the healthy the constitutional affection not only preceding body-an influence which is not only morbid, them, but being also over-proportioned to them. not merely an alteration from the healthy conThey are, moreover, in some instances, entire-dition, but also one of depression, a condition ly absent, as in the first phases above specified characterized by an imperfect as well as alter(492). I therefore agree with Mr. TRAVERS ed manifestation of the functions of life, and in stating "that the local inflammatory action tending to the extinction of those functions. is an unessential and subordinate feature of the But when this primary effect is not so intense, malady in its severest form; the disease itself relatively to the powers of life, as to overwhelm consisting in a direct prostration of the vital for- these powers altogether, they react against it, ces, marked by preternatural excitement and oppose it, resist its extension, and often comrapid exhaustion." pletely overcome it. In many instances the 512. G. Treatment.-It has been justly re-impression made by the poison on the nervous marked by Dr. COLLES that, "whatever difference of opinion may be entertained as to the nature of this affection, it will be allowed that, although some few have escaped, yet the plans of treatment hitherto pursued have all proved quite unequal to contend with so formidable a disease." But the plan which he proceeds to advise has nothing to recommend it in preference to those which have been previously adopt-poison in question, this is what actually occurs

system, and the contamination induced in the circulating fluids, lead to a violent struggle between these changes and the powers which resist them; the struggle ultimately terminating either in the removal of these changes or in the annihilation of the powers which have opposed them. Now, if I have observed and interpreted aright the phenomena produced by the

after the imbibition of it by the healthy frame : first, asthenic and morbid action; secondly, vascular excitement, the morbid influence on the nervous and vital powers still continuing; and,

The following case illustrates this rapid and violent form of the malady: Mr. E., medical student, punctured his finger in opening a body recently dead. This occurred at noon (of Monday), and in the evening of the same day he found the wound painful. During the night the pain in-thirdly, disorganization and death, which are

creased, and symptoms of high constitutional irritation were rapid in proportion to the invasion of the cause, present on Tuesday morning. No trace of inflammation, and the failure of the vital powers of resistance. however, was apparent beyond a slight redness of the spot If it were asked, What are the measures which at which the wound was inflicted, which was a mere puncture. In the evening he was visited by several physicians, are most likely to increase not only the first and but no local change could be discovered. The nervous sys-third of these effects, but also the second? I tem was agitated in a most violent and alarming degree, the symptoms nearly resembling the universal excitation of hydrophobia; and in this state he expired at three o'clock on Wednesday morning, forty hours from the injury, (TRAVERS on Const. Irritation, p. 262.) This case, and other instances of a less violent character, seem conclusive of one of two things, namely, either that the poison acts upon and affects the constitution through the medium of the organic nervous system, or that it is absorbed into the circulation in some cases without inflaming the absorbents or glands, or veins, occasioning the most severe effects upon the nervous system and vital energy, although inflammation of these structures, more especially of the glands and the surrounding cellular tissue, is often produced in consequence of the affection of the nervous system, or of the absorption,

or of both.

could not hesitate to answer, those very measures which have been hitherto too generally adopted to remove them. It may, however, be contended that the reaction which supervenes requires to be moderated by blood-letting in order to prevent its exhaustion; but I have shown that the reaction is most morbid--is a tumultuous excitement, deficient of power or constitutional resistance; that the pulse is that of irritation-of what JOHN HUNTER Would call constitutional alarm; that the blood is not inflammatory, and the coagulum is not firm; and,