the vapour of wine into the abdomen, after the water had been drawn off. The patient was 49 years of age, and had enjoyed good health up to the age of thirtyeight years, at which period he had an attack of hæmatemesis, which lasted four days After this attack, the abdomen began to swell. Various means were employed, without effect, and in six months it was necessary to perform paracentesis. Sixteen pints of clear water were drawn off. In one year more the operation was again necessary; and by the end of 1822, when the patient came under M. L'homme's 1 instance of the freaks of Nature on record, than the following case, which appears to be well authenticated. It is published by Dr. Arnold, in the first Number of the American Journal of the Medical Sciences, for November last. Maria Brenton, aged 27 years, of sound constitution, had enjoyed good health till June 180, when the catamenia became suppressed, and hæmoptysis ensued. For this she was bled profusely, by some irre gular practitioners to whom she applied, till her system was greatly debilitated, care, the paracentesis had been six times and then émetics were administered. performed. The reporter tried various dimetics, but without making any im. Prolapsus uteri now took place, and the unfortunate young woman was rendered pression on the dropsy. At this time he unable to pass her urine without the aid read an account, in Broussais's Journal, of a catheter. In this state she continued of a cure by the introduction of winefor two years. vapour into the peritoneal cavity, after Arnold first saw the patient. No water In September, 1822, Dr. the evacuation of a fluid, and he deter-had been drawn off for 72 hours, and, mined to try this measure. After the operation of paracentesis abdominis, therefore, he contrived, by means of an apparatus w ich cooled the vapour to the animal temperature, to introduce the wine-vapour six times into the peritoneal cavity. The patient experienced no other sensation than that of mere distention, after these operations He was prepared to remove the vapour, if it occasioned much inconvenience; but this was not the case. Only some slight colicky pains ensued, which recurred, from time to time, for two months. The dropsical effu sion never returned; and it is now two years since the operation. M. L'Homme tried the same experiment on another patient, who had been dropsical for more than 20 years; but it failed of success. No had accident, however, resulted from the introduction of the vinous vapour. The operator exhibited to the Academy an apparatus which he had constructed for this operation, and by which the vapour raised from the boiling wine was cooled, in its passage to the peritoneal cavity.Revue Med. 8. PARURIA ERRATICA, OR UROPLANIA. There is probably not a more remarkable strange to say, "the urine found an outlet burst forth, one day, from the naveland this discharge has since continued, with some interruptions. "Nature, wearied in her irregularities, made her last effort, which completed the phenomena of this case, and established a discharge of urine from the nose." Professor Silliman analyzed specimens of all these discharges, and found them to contain urea, alkaline sulphates, muriates, phos. phates, &c. During all this time, urine also came from the bladder, generally of a very high colour when first made, and afterwards turning black. There has been a pretty regular vicarious discharge of blood from the stomach or lungs, ever since the suppression of the catamenia. Dr. Arnold feared that imposture might be suspected, if not practised in this ex• traordinary case, and therefore, to remove every doubt, Dr. Webb and himself kept watch alternately, for 24 hours, on the patient, without, for a moment, losing sight of the parts from which the fluids issued. The quantity and quality of the discharges did not vary from those observed when no watch was kept. It was very curious, (if a fact) that, when the urine was not drawn off from the bladder, for 48 hours or more, the quantity found in it was always less than when drawn off every twenty-four hours. "Sometimes when the urine was not drawn off for seventy-two hours, it would amount to only one or two ounces." In such cases, the vicarious discharges were always increased. Dr. H. allowed the bladder to remain undisturbed for seven days at one period, at the expiration of which, only three ounces were found in that recepta cle. Her general health, mean time, did not suffer. When, on the other hand, the urine was drawn off every two or three hours, the sum total of the other vicarious discharges was greatly diminished. When the account breaks off, "the discharges from the right ear, the right breast and naval continue daily, but they are not so great nor so frequent as they were a year since. From the bladder the quantity is as usual-from the stomach, nose, eye, there has, for some months, been no discharge. A table is appended, occupying ten pages of letter press, exhibiting the quantities of urinous fluid daily discharged, from the various outlets above-mentioned, between the 21st September, 1822, and the 30th July, 1824. This diary was kept by Messrs. Goodwyn, and Joseph Tearing, medical students, assisted by Mr. Greene, another medical student. It would be difficult to produce a case better authenticated than the above-and still more difficult to adduce a train of phenomena so hard to believe. There are one or two phenomena, which we cannot prevail on ourselves to admit, without the aid of deception on the part of the patient One is, the urinous discharge from the ear in a stream, and to the amount of a pint in fifteen minutes. We have seen a man smoking his pipe, and puffing the fumes through his earssometimes through one ear-sometimes through both. Now it is not quite impossible that what was done with an æriform fluid, might be done with a watery one—we mean the forcing it through the eustachian tube, and through an aperture in the membrana tympani. The quantity discharged from the eye was so small, that a strong lachrymation might give it origin. The quantity which issued from the ear was such, that all idea of its secretion there must prove revolting to credibility. The secretion from the glands of the mamma, or even from the extensive membrane of the nose, is not beyond the boundary of belief, knowing, as we do, that Nature performs astonishing freaks sometimes, especially when interrupted in her usual course. Neither do we hold it impossible that a vicarious secretion of a urinous quality, should issue from the stomach, notwithstanding the obloquy which was thrown, a few years ago, on Dr. Yates, in a well-known case in this country. But what shall we say to the urinous eruption from the umbilicus? Upon the whole, we conceive that the respectable Editors of the Journal in question, are bound to investigate the accuracy of the report, and verify or refute the statements which have been made. 9. TYPHUS FEVER.* Dr. Clanny is not unknown to the medi A Lecture upon Typhus Fever, as lately delivered at the Sunderland lufirmary. By WILLIAM REID CLANNY, M D. F.R S. Ed. &c. &c. Quarto, pp. 28. Longman's, Feb. 1828. cal world as a sincere lover of his profession. More than twenty years ago he published a neat analysis of the Butterby Waters, near Durham; subsequently an interesting one of those of Gisland, interspersed with practical observations; recently we had occasion to commend his construction of an instrument, termed the zopuron; and we have now to call attention to his lecture on typhus fever. During a professional career of twenty-four years, he has especially devoted his mind, for the last ten, "to an inquiry into the proximate cause and appropriate method of cure, of typhus," and has contrived, with his usual ingenuity, a well-adapted apparatus for the chemical analysis of the venous blood of typhus patients He has printed several tables of the results of that analysis, which was performed on the sixth, twelfth, and eighteenth days of the fever, and contrasted them with the component parts of the blood in a state of health. For these tables, we must refer to the lecture itself, as well as for remarks elucidatory of them The following extract exhibits a brief summary of the opinions of the lecturer. 75 1000 "In the progress of typhus fever, we observe a direct approximation in the proportionals of the blood to the lymph, which circulates in the lymphatic system, and nothing but a total cessation of sanguification could work this astonishing change in the blood, whilst nature, ever true to herself, causes an increased absorption of lymph by the open mouths of the lymphatics, from all parts of the body, to supply the place of the chyle, which is, as I have demonstrated, no longer taken up from the food in the alimentary canal, as in a state of health. This accounts for typhus blood, in advanced cases, having only of albumen instead of, as in a state of health. The fibrin is also decreased from. All medical history informs us, that the blood of typhus patients decreases in quantity, in a gradual manner, from the commencement of the disease to the turn, in favourable cases, or to a fatal termination in unfavourable cases. From these facts I have come to the conclusion that the proximate cause of typhus fever is a cessation of chylification, and consequently of sanguification, during which time the lymphatics of the whole system act with increased vigour, and in this manner the lymph taken up by them from the system supplies, for the time be. ing, the place of the chyle in the blood, and as long as this continues, the patient labours under an acute disease, heretofore called typhus fever. When the chylopoietic viscera resume their functions, the disease gradually recedes, and health is ultimately restored. From the above facts every symptom and phenomenon of the disease receive a ready explanation." "During the fatal progress of the disease, carbonic acid is not to be found in the blood, and except a turn take place, by which fresh chyle is carried to the thoracic duct, the blood is rendered vapid, and, in some cases, it passes into a putrid state." The author assures us he has "experi mented upon the blood taken from persons labouring under acute diseases, and could, in no instance, find those changes which invariably present themselves in typhus." His treatment consists of occasional venesection; leeches, cupping, and blisters, for local pain, or determinations of blood to particular organs; carbonic acid water, or effervescing draughts, with enemata of carbonic acid in an unmixed state, and in cases of extreme exhaustion, ablutions of tepid sherry wine, Aperient medicines should be given ac cording to circumstances, and not in a general way, and uniform attention to moral causes, ventilation, and cleanliness is indispensible. Not having seen the apparatus of Dr, Clanny, not having scrutinized into the accuracy of his analysis, nor having subjected either his opinions or mode of cure to the test of experience, we can only recommend them to the candid consider ation of our readers, as emanating from an ingenious and experienced physician, who laudably occupies his time, directs his talents, and spends his money, for the relief of suffering humanity, and the ad vancement of his profession. 10. LARYNGOTOMY. Dr. Smith, the editor of the Philadelphia Monthly Journal, has published a melancholy case of a girl, ten years of age, who was attacked with severe cough and difficulty of breathing soon after an attempt to swallow a triangular piece of dried gourdshell. The symptoms had continued five weeks, when Drs. Smith and M'Clelland saw the patient. The cough now came on in convulsive paroxysms, which produced the appearance of a sudden emphy 1 sema in the throat during each attack. Respiration was very difficult and striduJous, and the poor girl could not lie down in bed at all Deglutition was also very difficult. There was some fever. Dr. M'Clelland conceiving that a foreign body was lodged within the larynx or trachea, determined on an operation. "An incision was commenced at the lower edge of the thyroid cartilage by a bold plunge with a sharp-pointed scalpel, and carried downwards into the cavity of the trachea, below the cricoid cartilage. An aperture was then made about an inch in length, through which the air instantaneously rushed There was very little hæmorrhage. The symptoms were not relieved, and therefore a long and slender pair of forceps was carried down to the bifurcation of the trachea-but no foreign body could be found. The case was necessarily left to the efforts of Nature. After the operation, à more copious expectoration came on, and the cough was much relieved. The emphysematous appearance of the neck also subsided. The febrile symptoms continued, and the little patient died in eight days after the operation. On dissection, the piece of gourd-shell was found impacted in the left bronchus, about half an inch from the bifurcation, and surrounded by tough coagulated lymph. It was swollen very much from the moisture and heat of the parts, so that it completely obstructed the bronchus in which it lay. There was complete pericarditis, with several adhesions of pericardium to the heart. The left lung, as might be expected, was congested, and, in a great measure, hepatized, from pulmonic inflammation. as more Dr Smith considers the mode of ope rating adopted by Dr. M'Clelland a great improvement in tracheotomy. "Nothing," says he 66 can look ridiculous than to see a surgeon making a long and tedious dissection, for the purpose of getting into so superficial a cavity as the trachea. A bold plunge of the scalpel accomplishes the thing at Once " Dr. S. avers that there can be no danger of hæmorrhage. In this we cannot quite agree with him. We have seen great hæmorrhage, from a slight wound of the thyroid gland, which pours out blood like a large vessel. Now, by repeated cuts, we do not divide many vessels at one time, and we can tie as we go on, if necessary; but the "bold plunge" may throw more work on our hands, in this operation, than may prove quite conve nient. High up in the throat, near the thyroid and, cricoid cartilages, we may wound the gland, which is sometimes irregular in its size and situation. Low down in the neck, the trachea recedes considerably from the surface, and a plunge into the trachea there might be more bold than prudent. TRANSACTIONS OF SOCIETIES. 1. HEMATEMESIS-MELENA. In a late sitting of the Westminster Medical Society, Mr. North furnished some cases of the above disease, as a subject for discussion. The first case was that of a young woman, who had been in apparent good health, up to the occurrence of the accident, with the exception of a suppression of the menstrual discharge, of a few months' duration. As the vomiting of blood was considered to be vicarious of this suppression; as each discharge seemed to relieve the symptoms of oppression about the præcordia; and, as the patient appeared to bear up well, both mentally and corporeally, against the attack, no apprehensions were enter The tained by the medical attendants, and a favourable prognosis was given. patient, however, died suddenly, a few hours after this judginent was delivered. Some dark grumous blood, or secretion of a melænic character, had been disOn dissection, the charged by stool. mucous membrane of the stomach and of the upper intestines, was found in a sof tened state, so that it could be easily scraped off by the scalpel Beneath, there were numerous points of redness, or of ecchymosis, both in the stomach and bow. els. No disease could be recognized in any of the collatitious viscera In another case, the symptoms were so nearly similar, that Mr. North did not detail them. Two physicians pronounced the disease devoid of danger-but Mr. North, remembering the foregoing case, gave a doubtful prognosis, notwithstand ing that a fellow of the college was against him. The patient died almost immediately after the doctors had decided that she was not to die-at that time! The third case was that of an old woman, and consequently the gastrorhagia was not vicarious. No dissection was permitted. Mr. North remarked that, in his researches among authors on the subject of hæmatemesis, they appeared to him to consider a discharge of blood from the stomach, when vicarious, and when it was not accompanied by severe or threatening symptoms, as always devoid of dan ger. It was upon this principle that the confident and favorable prognosis was given in the first two cases by the physicians. It was argued, however, by Dr. Johnson, Dr. Barry, and Dr. Copland, that the disease should not be held so cheap-for, in the first place, it might not always be safe to pronounce a vomiting of blood vicarious, because a suppres⚫ sion of the menstrual or hæmorrhoidal flux had preceded the accident-and, in the second place, the hæmatemesis is so very frequently the effect of disease in some of the collatitious viscera, as the liver, spleen, &c. that it may be, and too often is, attended with considerable danger. Dr. Johnson, in particular, contended that the disease could not be pronounced devoid of danger, unless it was periodical, and unequivocally vicarious of some other discharge. When it happened, for the first time, no man could tell what might be the event. He observed that a simple and accidental vomiting of blood, unattended with any melænic discharge from the bowels, was infinitely less dangerous than when a black secretion, like tar, constituting melæna, issued per anum. This last affection is always a dangerous disease. Dr. Barry did not agree with Mr. North, as to the general opinion of writers on this subject. Chomel, who had great experience, and who had written, ex professo, on the subject, pronounced hæmatemesis "une maladie grave." In the first case related by Mr. North, he considered the mucous membrane of the stomach and bowels in a state bearing strong analogy to that which sometimes obtains in purpura hæmorrhagica. It was agreed, on all hands, (with one exception,) that the blood issued from the VOL. VIII. No. 16. one capillary vessels, by a sort of exhalation, and that they were in a kind of atonic condition at the time. The exception to this opinion was enunciated by Dr. Ayre, who believed that the blood, in all these cases, came from the liver, and not from the vessels of the stomach or bowels. This pathology, however, wanted material point of support-anatomical evidence. Dr. Ayre had not traced the sanguineous or melænic fluid into the ducts of the liver; but he had observed that the premonitory symptoms of hæmatemesis were the same as those which preceded and accompanied other and unequivocal affections of the liver-while the remedy which he had always found effectual in removing the complaint was calomel, the medicine which was also most efficacious in hepatic disorders generally. The worthy Doctor having somewhat inadvertently contemned the pathology of Hippocrates and the ancients, on account of their ignorance of anatomy, and want of opportunities for post-mortem researches, was taken to task by Dr. Barry, who maintained that Dr. Ayre's pathology was founded on precisely the same principles as those of Hippocratesthe symptoms and the effects of remedies. Dr. Ayre had observed a blanched state of the liver and spleen, in some cases where the intestinal hemorrhage had proved fatal. This, however, was evidently the consequence of the hæmorrhage itself, and would have been the same whether the blood came from the liver or from any other part of the system. But, whatever might be thought of Dr. Ayre's pathology, (which certainly appeared to us to be much too limited,) the practice which he had found to be so uniformly successful-namely, repeated small doses of calomel, till bile appeared in the motions, and till the melanic discharges ceased, should not be despised. Dr. Copland related some cases which had been treated by the oil of turpentine, both by the mouth and by enema, with complete success. In these cases, there was discharge of half-digested blood from the bowels-but not the melænic stools. Dr. Johnson had seen three cases of idiopathic hæmatemesis, where no melænic discharges were present, and where there was no evidence of organic disease, in which half-drachm doses of sulphate of zinc suddenly arrested the hæmorrhage from the stomach, as soon as vomiting 66 |