We are sorry that we cannot go along with Dr. Carson in this proposal, nor at all agree with him in the propriety of it. In the first place, we are far from believing that confirmed phthisis consists merely in a common abscess of the lungs. The tubercular state which so long precedes the discharge of purulent matter by expectoration -the repeated inflammatory processes which have occurred-the adhesions and other lesions which take place in the course of the disease, all combine to bring the respiratory organ into a state which could not be bettered, and would almost to a certainty be rendered worse by the operation of admitting air into the thoracic cavity. In the second place, we believe that puncture of the pleura would very seldom lead to collapse of the lung in confirmed or purulent phthisis, on account of the adhesions which are so very generally found in that stage of the disease. In the third place, how could we be certain of the side where the disease is situated, even with the aid of percussion and auscultation? How seldom, indeed, do we find the disease confined to one lung in phthisis. And after all, even if collapse of the lung did take place, would that enable us to heal a scrophulous abscess in the chest, when we find so much difficulty in healing a similar one on any external part, however easy and quiet we keep that part? In fine, we cannot help feeling some degree of surprize that a physician of such talent and sense as Dr. Carson evidently possesses, should broach so wild, not to say dangerous, a procedure in this melancholy disease. 9. Yellow Fever.* A solitary rustic "pent up in UTICA❞—not Cato's UTICA, but a UTICA in the back woods of America, has published a paper in the "Plough Boy," a transatlantic periodical, which is re-published in our respected cotemporary of the north, and contains, in our humble opinion, more rational and just doctrines than some of those propounded by certain self-supposed scavans of Europe. Thirty-five years' observation and reflection induce Mr. Coventry to believe that yellow fever is of local origin" depends on vegetable putrefaction, and in that short stage which generally attends the fever, is not contagious; but if protracted, and assuming a typhoid shape, (as he believes both bilious and inflammatory fevers may and often do,) the patient may generate an atmosphere around him which, without due care, may induce an indisposition in the attendants." But, says this judicious observer, "remove the patient to a healthy and elevated situation-keep him clean, and well aired, and I should expect no more danger from this disease than from a tertian intermittent," Our readers are aware that these are the doctrines long advocated in this Journał. Mr. Coventry.-Ed. Journal, No. 71. 10. Pulmonary Disease. Baglivi's remark on the great difficulty of distinguishing the various diseases of the lungs must have been forced on the mind of every person who goes through even a very moderate share of practice. The following case is one of those that are not a little puzzling. "Agustine Hemon, a female, 36 years of age, of feeble constitution, and very nervous temperament, entered La Charité, first time, in November 1814, with all the appearances of peritonitis, and went out convalescent in the succeeding February. She experienced, however, at her departure shooting pains in the thighs, and dull pains in the abdomen, with bad digestion, and occasionally vomitings. From this time till her re-entry on the 11th July, Hemon experienced sharp and frequent pains in the loins, region of the uterus, and head. She had troublesome cough, and an habitual constipation was changed to a diarrhoea, which had lasted six weeks. There was adema of the ankles-flushings of the face, pain in the nipples, heat in making water, shortness of breath, especially in going up stairs. In the month of April, she had experienced shiverings, succeeded by wellmarked pyrexia and perspiration in the evenings. On entering the hospital on the 11th of April, there was considerable emaciation, with pains in the head, tinnitus aurium, troubled sleep, inability to lie on her back or left side, frequent startings in the night, breathing short, and interrupted by sharp thoracic pains, so as to be threatened sometimes with suffocation. The cough was not very severe, and came on in paroxysms, with scanty and difficult expectoration of mucus, sometimes streaked with black blood. Muscular motion was attended with great anxiety and tendency to syncope. She felt shooting pain in the region of the heart extending to the spine, with sense of great oppression at the pit of the stomach, and tenderness on pressure in both hypochondria. Constipation now had succeeded diarrhoea, with sometimes a discharge of blood from the rectum. Skin was hot, and fever pretty constant, with morning perspirations. Emaciation now made rapid strides. The dyspnoea and anxiety increased daily. She was bled, but this measure produced no relief; and the same want of success attended the administration of antiphlogistic, antispasmodic, and revulsive remedies. The patient died at the end of three weeks from her entering the hospital. "On dissection, the pleura, heart, pericardium, peritoneum, and all the abdominal viscera were found perfectly healthy. But the lungs were observed to be filled with small vesiculo-cartilaginous bodies, the size of millet seed, which, however, did not prevent the intermediate parenchymatous structure from being perfectly permeable by the air, and crepitous. The mucous membrane at the lower extremity of the oesophagus was red, and covered with albuminous filaments." P. 374. • Dyspnée Nerveuse febrile, et Degeneration Vesiculo-Cartilagineuse du Tissu Pulmonaire. Par. M. Fouquier. Annuaire Med. Chir. Such, says M. Fouquier, was the history of a disease which pre sented, during life, the phenomena of various phlegmasiæ, "but which were merely nervous." Death could not, he thinks, have been caused by the pulmonary degeneration of structure. "Was this painful and promptly fatal dyspnoea to be attributed to asthma ?" We cannot but attribute the functional disorder in the chest and various other parts of the body to the structural change in the lungs, notwithstanding the contrary opinion of M. Fouquier. The respiratory function, and especially sanguification, could not be otherwise than materially molested by such a state of the pulmonary structure; and the influence of such molestation on the various other functions of the system may be readily appreciated. 11. Oil of Croton-Tiglium. This medicine, we have every reason to believe, will prove a valuable addition to our materia medica. Mr. Conwell, lately returned from India, has brought thirty or forty quart bottles of the genuine oil with him, and therefore there will be an ample supply in the market. We believe he means to bring it under a stamp, and then every one may be sure of having the unadulterated substance. We have had some opportunities of administering this remedy, and we have seen many medical men who have used it on a large scale. It certainly does produce nausea in several instances; but we have no doubt that means will be found to correct this quality of the oil. Dr. Nimmo of Glasgow has published some chemical and therapeutical observations, in the April number of the Royal Institution Journal, on the composition and qualities of the seeds of the croton-tiglium, from which we shall extract a few particulars. Having procured a very small quantity of the oil, (12 drops) he poured on it two drachms of alcohol, which produced a partial solution. Pouring this off, two drachms more of alcohol were added, by which an additional portion was dissolved. A third quantity seemed to have no effect. There remained an oily-looking substance, equal to somewhat more than a third of the original oil. The alcohol solution exhibited the characteristic acrimony of the oil-the undissolved portion had none whatever. The solution he considers as preferable to the entire oil, obviating the following objections-namely, the difference of dose in consequence of the inequality in the thickness of the lips of phials-the greater or less degree of viscidity in the oil at different temperatures-and the difficulty of apportioning the dose to difference of age or constitutional susceptibility to the action of the ordinary purgatives. In administering the alcoholic solution in doses relative to the number of drops decomposed, the same effects were produced as have been attributed to the entire oil. → Dr. Nimmo has made a great many analytical experiments on the seeds and kernels of the croton, extracting from the latter an oil equal, if not superior to that prepared in India. But as the original oil is now plentiful in the market, we shall not stop to notice these chemical analyses. Dr. Nimmo recommends the alcoholic solution of the oil to be so prepared, that half a drachm of it may contain a drop. It may then be administered in the following manner :-B. Alcohol. croton. 3 ss. syrupi simplicis, mucilag. accacæ ãā 3ij. aq. distillat. 3ss. m. ft. haustus. "After swallowing a little milk, take the draught very quickly, and wash it down with repeated quantities of the same diluent." He has administered this remedy in more than one hundred instances, and to some patients many times. In not more than three or four cases was vomiting produced-and that not in a violent degree—in not many was nausea felt-in all cases purging was induced in a space of time between half an hour and three hours after taking the medicine the purgative effects were generally moderate, and rarely accompanied by griping. He attributes these steady and quiet effects to "the instantaneous and equable diffusion of the active principle of the croton over the inner coat of the stomach and abdominal viscera, when the above formula was employed." Whereas, he observes, it must unavoidably happen that the oil, taken merely mixed with any fluid; made up into pills with any substance; or diffused with sugar or starch, may, at times, be applied in a concentrated form to a particular part of the stomach or intestines, and excite nausea and vomiting in the one case, and spasmodic action, with pain and hypercatharsus, in the other. Among the cases which Dr. N. had occasion to treat, was a lady, who, for the cure of abdominal dropsy, had undergone a course of mercury, and used diuretic medicines of the most powerful kind, without effect. She was rapidly sinking under an accumulation of the dropsical fluid, with a total loss of appetite and strength. The alcoholic solution of the croton was administered, at first cautiously, and afterwards in augmented doses, so as to cause three or four evacuations daily from the bowels, with the most beneficial consequences. By augmenting the appetite and strength, and by the discharge of watery stools, the size of the abdomen was soon reduced. After two weeks' use the stomach became irritable, and the croton was suspended. The complaint shewed strong symptoms of returning diuretics again failed; and again recourse was had to the croton combined with opiates and aromatics. By this the cure was effected. Our author found the croton a powerful auxiliary to opium in the cure of delirium tremens. "In all cases in which there is a superfluity of the secretion of bile regurgitating into the stomach, it is of service, unless the medicine itself be rejected by vomiting." In the removal of jaundice from obstruction or spasms in the bowels, it proved most beneficial. "In a case of excessive corpulence, with the most alarming symptoms of determination to the head, amounting at times almost to apoplexy, a few doses of the solution produced the most signal benefit; and, without having had occasion to let blood, every symptom was removed which could have been expected from venesection." We hope the attention of the faculty will be directed more strongly than ever to this powerful medicine. We think it will prove a valuable adjunct to other purgative substances, when their operation is wished to be quickened. We have advantageously combined it, of late, with aloes, quicksilver pill and squill, in two cases of dropsy; and in three or four other cases we have observed its power of increasing the action of the kidneys. 12. Bath Waters. An anonymous writer in the Journal of Science deplores, in very feeling terms, the neglect into which the once celebrated waters of Bath have now fallen. He attributes the public depreciation of these waters, in a great measure, to the writings and opinions of the late Dr. Parry. This anonymous writer makes Dr. Parry to state that all diseases, without exception, consist “either in absolute or relative excess of momentum, impetus, or determination of blood in some portion of the arterial system." Now our readers have only to turn to page 36 of this volume to be convinced that this anonymous critic (like many critics of the present day) never read the work he censures. True it is, that Dr. Parry, (as well as every other observant physician) traces the majority-the great majority of diseases to partial or general increase of circulation; but he does not make this a universal law in pathology. We have noticed in our review of his work several of those diseases which that eminent and enlightened pathologist attributed to a state the reverse of what is quoted above. Mr. Abernethy is next assailed, and the "deranged digestive organs" ridiculed, like the vascular doctrines of Dr. Parry. The anonymous writer is somewhat more happy in his hits at a celebrated medical surgeon in Bath, whose practice forms a kind of antithesis to the old Bath-water courses. Instead of pouring down fluids by the mouth, this gentleman exhibits solids a tergo-that is by the tail-a fundamental kind of practice which the writer ap Mr. Brande's Journal, No. XXV. The Abernethian School might quote very ancient medical autho`rity for the gastric doctrine of their master. Among others, Serenus Samonicus, who, in his medical precepts, has the following remarkable passage, which might serve as a very excellent motto for the school in question. "Qui stomachum regem totius corporis esse "Contendunt, vera niti ratione videntur. Hujus enim validus firmat tenor omnia membra :- De Med. Precept. Can this piece of antient pathology be questioned or excelled in the present day?-Ed. |