The experimenter found, in this, and several other cases, that a peculiar effect is produced on the spleen by these operations—namely, that its blood is changed, and capable of producing a disease in other animals, when introduced by a puncture, which affects their spleens and causes death. The same was found to be the case with the spleens of animals living in marshy countries, where intermittents prevail. This is a very curious and interesting fact, which seems to be corroborated by one related by M. Adouard, and which we shall append to this paper.

PEMPHIGOID AFFECTION OF THE SPLEEN, PRODUCING A CONTAGIOUS MATERIAL.

By M. ADOUArd.

The following case was published at the time of its occurrence, in the Annals of the Medical Society of Montpellier. It is here re-published, for the reasons abovementioned.

A French cavalry soldier was affected for some time with ague, in the malarious countries about Lodi. When M. Adouard took charge of the Military Hospital, this man was cured of the ague, but laboured under a considerable enlargement of the spleen. This was much reduced by proper means, and the patient was nearly re-established in general health, when he suddenly expired one morning, without any thing to account for the fatal event.

On dissection, nothing could be discovered, except the enlargement of the spleen, on the surface of which, were several phlyctenæ of different sizes, elevated, nearly colourless, and containing a yellowish fluid, like that of pemphigus. A drop of this fluid came in contact with a chap on one of M. Adouard's fingers, and caused instant stinging pain. was followed, in eight hours, by such

This

constitutional disturbance as to force him

to quit a company in which he was spending the evening, and retire to bed. At midnight, he had a severe rigor of two hours' duration, followed by intense fever, and, ultimately, by perspiration and comparative apyrexia. Next day, there was an ugly looking pustule on the part affect ed, and his whole mental and physical

and inflammation of the hand and arm followed, with fever of a remittent character, but extremely severe. On the 7th day, he was delirious, and a copious perspiration solved the fever. A large suppuration had formed among the mus cles of the fore-arm, which was opened, and then the patient rapidly convalesced. Journal Général.

The above case may be considered, by many, as analogous to those of dissection wounds; but, if M. Dupuy proves that blood, or the contents of phlyctene in the spleens of animals, produce, by inoculation, similar diseased states of spleen in other animals, as he pledges himself to do in a Memoir about to be published, the case will assume an importance beyond that of common dissection wounds. We shall lay before our readers an early account of the promised Memoir.

29. FATAL EXHALATION OF BLOOD INTO THE STOMACH.-(M. ADOUARD.) Pathological Anatomy has clearly proved that great effusions of blood may take place into the substance of the brain and the lungs or into the cavities of the viscera, as well as of the thorax and abdomen, by a kind of exhalation, leaving no trace of ruptured vessel. The following is a remarkable example.

A soldier, of lofty stature, and sangui neous temperament, in the prime of life, became affected with tertian fever at Rome, during the French occupation, and One day, when it was the period for the was in the Military Hospital for cure. réturn of a paroxysm, he was seized with called out for the nurse. a strange sense of general malaise, and In a few minutes he fainted, and, on reviving from this, he threw up some blood from his stomach, and expired.

On dissection, the stomach was found distended by an enormous clot of blood;

but the most careful examination could

not detect the source of the hæmorrhage.

Some of the sudden deaths which we hear of, and which are not investigated by dissection, are caused in this way. Was the above congestion in the vessels of the stomach a fatal substitute for the ague paroxysm that ought to have occurred?

30. CASE OF CATALEPSY. By Mr. NORTH. Hysteria, the mocking-bird of nosology, appears far more frequently in the garb of other diseases than in its own common and unequivocal character. Catalepsy, we consider as one of the Proteian shapes of that multiform disease, in despite of the authority of Cullen, who looked upon it as a species of apoplexy, and, indeed, doubted its existence of Frank, who regarded it in the light of a convulsion, and of SAUVAGES, who refers it to comatose debility. We think Mr. North is right in applying the term hysterical, to the case of catalepsy, which he has lately related in our cotemporary, the Medical and Physical Journal, and which we consider to be a fair specimen of that rare form of disease. The late Dr. Good, with his usual fondness for multiplying distinctions, without difference, places catalepsy in the genus CARUS, making it the second species, the first being ECSTASIA. One of the best authenticated cases, of late years, is that published by Dr. Gooch, in the last volume of the College Transactions, and analyzed in a former number of this Journal. But we shall now notice Mr. North's case.

The patient, as usual, was a young female, who arrived in London, much fatigued by her journey, and in a state of great mental anxiety, resulting from a love-affair. First, she had pain and swelling in one of her feet-then intense pain in her head, with slight hysterical paroxysms, &c.—in short, each day presented a new form of disease, which at last so puzzled her medical attendant, (not Mr. North) that he thought the devil must be in the girl! A physician was consulted, and pronounced the complaint hysteria. When Mr. North was called, the young woman was supposed to be dying. She was apparently in a profound sleep, into which she had fallen after a violent attack of hysteria. No motion could be perceived in any part of the body-no pulse in any artery-scarcely any action of the heart-no respiration pupils contracted-temperature of the body below par. She drew in a gentle but deep inspiration about every ten miA stimulating enema, and four drops of oil of croton on the tongue. She continued in this state for twelve hours, VOL. VIII. No. 15.

nutes.

when a slight hysterical paroxysm dissolved the spell. The next shape in which Proteus appeared, after an interval of a few days, was a violent trembling of the whole body, succeeded by a short sleep, and then ar attack of hysteria. In a day or two afterwards, the real cataleptic phenomena were developed. "She resembled a figure of wax which might be moulded to any form. In whatever position she was put, she remained as immovable as a statue, however awkward and fatiguing it might be. She was, for instance, placed in a sitting position, with her arms in a boxing attitude, and thus she remained till the caprice of the by-standers put her into some other form. One eye was opened to its full extent, the other at the same moment closed. It remained fixed, and the pupil as perfectly contracted and immoveable as before. The globe of the eye appeared quite insensible to the touch, as did the other parts of the body." On two or three occasions, she was placed in a standing position, with her limbs in various attitudes, which would, with difficulty, have been assumed, even for a moment, by a person in health, and which could not have been so long supported by voluntary efforts. When the nervous influence was pended, the muscles suddenly relaxed, and, if standing, she would fall as if struck by a cannon ball. She continued in this cataleptic state, with intervals of various duration, for a fortnight, and then the malady assumed the form of chorea. After this, her breasts swelled, and became very painful. She was sent to St. George's Hospital, where the same curious alternation of symptoms occurred. She is now in the country, and still suffers from violent attacks of hysteria.

ex

Mr. North makes many judicious observations on those diseases which partake of the hysterical character, and which mislead young practitioners so much, especially by inducing them to make use of depletive measures, which generally aggravate the hysterical disposition, and multiply the puzzling forms of disease. In most forms of hysteria, however, the secretions are depraved, and the bowels torpid or irregular. This was the case in Mr. North's patient, and authorised purgation. But, even this measure may be carried too far 29

delirium, indicating the extent of irritation. If relief be not obtained, the swelling extends along the limb, the skin becomes of a darker colour, the erysipe

MONODES.

The late debates in the Medico-Chirurgical Society, (continued for three nights in succession) on Mr. Lawrence's paper on Erysipelas, have excited considerable sensation; but we shall defer all remarks upon the subject till the paper is published in the forthcoming volume of the Society's Transactions, when we shall dedicate a long article to erysipelas. In the mean-time, in order that every man may have his due in the merit of introducing an important remedy (incisions) into practice, we shall lay before our readers the following extract and case, which latter occurred at the Westminster Hospital more than four years ago, and in which the practice of Mr. Hutchinson was successfully employed by Mr. Guthrie, long before it was introduced by Mr. Lawrence at Bartholomew's. The case will, also, tend to show Mr. Guthrie's views as to the cause of the bad symptoms in erysipelas phlegmonodes, and the reason why relief is so suddenly obtained by one or two long incisions carried through the skin and cellular membrane, but not through the fascia.

"This species of inflammation is usually the consequence of injuries; the skin assumes the erysipelatous tint, although it is in general something of a brighter colour. The part swells more rapidly, does not admit of the impression of the finger being made with the same facility as in either common erysipelas, or in the oedematous inflammation, and does not retain the mark in the same manner. There is clearly a thickening of the parts beneath the skin, which is also evidently on the stretch, is very tense, and therefore glistening. The pain is considerable; it is not, however, either, or the whole of these symptoms which attract particular attention, it is the rapid depression and derangement of the nervous system. The altered and subdued appearance of the patient from the previous day, his hurried manner, the quickness and irritable state of the pulse, the foulness of the tongue, heat of skin, and

precursor of the inflammation of the subcutaneous tissue; the distinction between them is well marked, and cannot be mistaken. The firmness of the part first affected, has by this time yielded in some degree; its resistance, or elastic feel, is less evident, and it has obtained a springy fluctuating feel to the touch, which is peculiar, and which it has acquired before any matter has formed. On making an incision into the part at this period, the cellular tissue will be found to have changed its characteristic for a gelatinous appearance of a light leaden colour, which it obtains from the deposition of fluid into its cells, nearly in the act of being converted into pus. The septa composing the cells have not at this period lost their life, and the fluid does not at first exude, as it will be found to do a few hours later, when the matter deposited has become purulent. When this change has taken place, the patient is obviously in the greatest danger, and if the cause of irritation be not removed or alleviated, he will in many instances die under the most marked symptoms of irritative fever of a typhoid type. When the powers of the constitution are equal to sustain and resist this state of disease, relief is obtained by the sloughing of the skin, and the discharge of the matter beneath. The skin is, however, exceedingly tough, and before it yields and dies, the fascia beneath the cellular membrane is often destroyed, and the muscles are implicated and exposed. Mr. C. Hutchinson thinks 'pus is seldom formed in the substance of the adipose part of the tela cellulosa exterior to the aponeurotic expansion, that is, between this membrane and the skin; its most common position is beneath these parts, and in immediate contact with the muscles.' This opinion does not accord, however, with my observation; the sloughing of the fascia, and the formation of matter beneath being most frequently caused by the continuance of the disease, and rarely occurring when the proper method of treatment has been adopted. Mr. Hutchinson recommends several small incisions to be

made, about an inch and a half in length, and from two to four inches apart, varied in number from four to eighteen, according to the extent of surface the disease is found to occupy. I have found one or more longer incisions answer equally well, and they appear in many instances to be preferable, giving more decided relief, as one incision can sometimes be made so as to be very little remarkable, whilst several smaller ones occasion more deformity. On making an incision at an early period, the leaden-coloured and slightly gelatinous appearance of the cellular membrane will be readily perceived, and the state of tension of the skin will be immediately estimated by the retraction of the edges of the wound, one of four inches in length separating two in width. Sometimes a considerable quantity of blood will flow from the divided surface, but this will in general be greater if the incision be carried through the fascia, which is seldom necessary at an early period of the disease. If the operation has been delayed until the springy fluctuating feel, communicated by this gelatinous state of the cellular membrane, be changed into the more marked feeling which is communicated to the foot when stepping on a bog or quagmire, the cellular membrane will have been destroyed, the skin will have been undermined, a part of it must be lost, in spite of the operation, which will only be in time to allay the constitutional symptoms, and thereby perhaps save the patient. I attribute these violent constitutional symptoms, not to the formation of matter, or the sloughing of the cellular membrane, but to the stretching and over-excitement of the skin when in a state of inflammation, caused by the swelling of the parts beneath; whence the relief obtained from the incisions. This opinion seems to be confirmed by the fact, that the constitutional symptoms subside, and the patient is placed in safty, although the incisions should not have been made until after the whole of the cellular membrane had passed into a sloughing state, and which process must be afterwards completed, and the parts separated, before the cure can be accomplished. The following case is so striking an instance of the efficacy of long incisions, and of their capability to remove the greatest constitutional irrita

tion, that I do not consider it necessary to adduce more.

"Thomas Key, aged 40, a hard drinker, admitted into the Westminster Hospital, as an accident, on October 21, 1823, at night, and under my care, in consequence of falling and striking his left arm against a stool four days previously, which had given rise to erysipelatous inflammation. He was smartly purged with calomel and jalap, on his admission, which was followed up the next day by small doses of the antimonium tartarizatum and sulphate of magnesia, so as to cause both vomiting and purging. In the evening he lost twenty-five ounces of blood from the temporal artery. The arm was very much swelled, the skin of an erysipelatous redness, very tense, elastic, springy, and yielding a sensation of fluctuation, the inflammation being evidently deep-seated; pulse one hundred and twenty, strong, tongue dry and furred, great thirst, skin hot, is very restless, unruly, and wandering. After the bleeding he became quiet, a profuse perspiration broke out over the whole body; he appeared relieved and comparatively tranquil. Fomentation, and poultices were applied every three hours to the arm.

"On the 30th, his state not being improved, a consultation was held to determine on the propriety of making incisions into the inflamed part; but this was considered improper by the parties consulted, and saline medicines with small doses of tinct. opii were substituted.

"October 31. Pulse one hundred and thirty, he is weaker and more irritable, was delirious all night, and in a state of great restlessness, countenance sunk, skin dry and hot, tongue furred, and altogether in a state of extreme danger. The arm greatly swelled, of a darker colour, and giving to the touch a strong fluctuating boggy feel, I made two incisions forthwith into the fore-arm; one on the back part eight inches in length, the other five inches long on the under edge in the line of the ulna down to the fascia, which was in part divided, and one vessel bled freely. There was not any matter beneath it, but a considerable quantity of serum and matter of a gelatinous appearance was discharged, mixed with venous blood, but no pus. The incisions did not give much pain.

"November 1. Pulse ninely and steady; tongue furred, but rather moist; heat of skin moderate; slept occasionally during the night, and was much quieter; says himself he had a good night. The arm is less swelled; the cellular membrane is evidently sloughing, and this state extends beyond the extremities of the incision on the back of the arm, which was therefore augmented to the extent of eleven inches. Ordered to continue the saline mixture, four grains of calomel, and four of the extract of colocynth, and the infus. of senna and salts to be given afterwards, and repeated until a due effect is produced.

"From this time he gradually recovered the incisions were made, however, too late to prevent the loss of a considerable quantity of cellular membrane and

skin.

"When a deep-seated erysipelatous inflammation takes place below the fascia of a limb, the whole extremity swells, it becomes firm, heavy, of a dull whitish colour; and is scarcely affected by the erysipelatous blush; is painful, and rapidly destroys the powers of life; the patient sinks unconscious of his danger, when he fancies himself relieved. The appearance of the part on dissection very much resembles that noticed page 97. It is a fatal termination by no means uncommon in persons of a bad habit, afflicted with erysipelatous and gangrenous inflammation or sloughing abscess in the neighbourhood of the rectum."--On Gunshot Wounds, 2d Ed. p. 105-11.

Messrs. Moulin and Guibert have lately published a paper and some cases illustrative of the nature and treatment of this dangerous species of erysipelas, in which they condemn the practice of incisions, as unnecessary and cruel, and rely on great numbers of leeches to the limb or part, with the various other items of the antiphlogistic plan. This was the treatment recommended by Messrs. Brodie, Travers, and several eminent surgeons, in opposition to Hutchison, Guthrie, Lawrence, and some others. It appears, however, by a case related in the paper, that the celebrated Boyer is inclined to the practice of incisions. Of this case we shall give a few particulars.

Case. Mr. R. aged 52 years, of strong constitution, was bled in the arm on the

6th May, 1824, quickly after which, the limb swelled and became very painful. Cold applications were employed, but the inflammation advanced, and great fever came on. Emollient poultices were applied for two days, during which the tumefaction and other symptoms increased. On the fourth day, the inflammatory tension had arrived at the greatest degree the pain was intolerable-the fever ardent-the prostration extreme, although the pulse was full and hard. The wretched patient had never slept a moment for three nights, At this time, Baron Boyer was called in, viz. on the 10th May, and recommended incisions, "not only to take off the inflammatory tension, but, also, to give vent to the purulent matter which had probably formed." The friends of the patient, however, would not admit of the operation, and all the symptoms became exasperated, with the addition of delirium. On the 11th, another consultation was held, at which Baron Boyer, M. Fouquier, and M. Guibert, assisted. It was now determined, as incisions would not be submitted to, that a number of leeches should be applied to the inflamed and swelled member. But it was too late

the patient expired at eight o'clock the same evening!-Bibliotheque Med. Sep. 1827.

Several other cases are related-some

to show the fatal effects of the bark and wine system, formerly too generally employed-and some to illustrate the good effects of the antiphlogistic regimen, with repeated relays of leeches to the part. But, as we shall soon return to this subject, we shall say no more on the present occasion.

32. NEW REMEDY FOR ASTHMA.

Whoever is conversant with this distressing complaint, knows with what eagerness the afflicted patients fly to the window for fresh air, when attacked with a paroxysm of asthma. They experience relief from this procedure, or they would not have recourse to it. Indeed, it appears that, in pure spasmodic or periodical asthma, there is a peculiar constriction of the air-cells and finer bronchial tubes, which prevents the ingress of the atmosphere, and threatens suffocation. Impressed with this idea, which is cer