91

at a time when others may be said to be in the full vigour and enjoyment of life.

-7

novelty. This may partly arise from the fact, that here is something they can see, and feel, and smell, as the cause of the peculiar condition induced by the ether; but is it not probable that there may be not a few who manifest their zeal for advancing the new method as a rival to the former method, which they had so vehemently and unreasonably opposed? May there not, moreover, be best mode of hiding their former delinquency and many who, wise in their generation, think the unreasonable dogmatical opposition, is to make a and fumes, attending on this ethereal visitant? Be retreat under the shelter of the noise, and turmoil, the cause what it may, it is of comparative insignificance, so long as suffering humanity profits by the change. to Inge,mabata

they must have felt pain, but, by constraint at the time, had managed to conceal exhibiting any How imperfect is the system of education for physical manifestation of suffering, and, when boys! It is true, in some of the modern grammar aroused, for some sinister purpose, mendaciously schools, a more rational plan is being gradually denied the fact. Nay, there were not wanting even adopted; but look at our public schools-a unimen of high standing in the profession who, in versal law regulates the conduct of hundreds-the their rabid hostility to the new doctrine, went so same system, the exact mode of teaching, and the far as to become the apologists of "cruelty to identical studies are enforced upon all, whether the surgeon's knife acted as a salutary stimulus. animals"; contending that the agony inflicted by capable or incapable of progressing in them; no notice is taken of predilection, peculiar talent, or Had such an absurd and cruel opinion not been ulterior advantage; and then, as to disposition, ment it was uttered, it could hardly have been openly avowed, and put upon record at the mowhat so various? Amongst five hundred boys are We to expect the same predominant inclination? believed possible that any intelligent member of the and yet punishment and reward are apportioned to profession should have promulgated such a revolting all by one uniform rule; the consequence being doctrine a doctrine, too, so much at variance with Having personally tried both methods, and a one experience, as well as opposed to the dictates of there we from a particular, acts one boy receives humanity; for is it not well known to every praq-satisfied myself, of their respective powers for not only to curb but actually to break the spirit of tical surgeon, that the shock sustained by the suspending consciousness, and thus saving patients another of less physical but of more acute mental mortality, subsequent to accidents and surgical operations, I beg leave to offer a few remarks on nervous system is generally the greatest cause of both from the dread and suffering of surgical capability. It is impossible that individual character can be studied in the larger public schools. what appears to me to be their relative merits; for The fault in the education of boys generally is, anguish of body and mental dread of the knife are I presume it will no longer be contended that the subject of inquiry, regulation, or control-the desirable, either as respects the patient or opeheart is neglected, while the mind is tutored-the rator. ཀྱེེ། « moral conduct and the moral sentiment but too

8:1

that the moral emotions and affections form no

operations? IN 2001 20je te transatlantic brethren made known in this country, No sooner, however, was the discovery of our that, by the inhalation of the fumes of ether, consciousnes, could be suspended, and that thus the pain of surgical operations might be mitigated or frequently depend on formal rule, it does not result sorted to by the very individuals who were most entirely prevented, than it was at once eagerly reIki from principle. The mind, in examining cent zealous in their opposition, and most loud in their beauties of creation, and, in examining gene-declarations of scepticism, as to the truth or worth rally the evidences of design, the thoughts should be led to Him who created all things. It would be very desirable that lectures adapted to the capacity of the various auditors should be delivered upon Natural History and Natural Philosophy, these being rendered as interesting as possible by numerous illustrations and practical exemplifications. In training youth there should not be merely a servile subjection, the restraints which are considered necessary being for the benefit of those under 30 instruction, and not for their oppression. The error in most schools is, that there is no confidence between the instructors and their pupils, and this almost invariably arises from the indiscretion or the incapability of the former. There should be neither too much familiarity nor too great a reserve; tc but a mutual regard for each other should be bencouraged.

My own experience of hypnotism, or mesmerism, subjects, by proper management, they could be was this, that in many cases of highly susceptible reduced to such condition as would enable the their undergo severe surgical operations without their of inducing a similar immunity from suffering by manifesting the slightest symptoms of consciousserved, that the evidence for the efficacy of the and they would have no recollection of such on the former method. And let it be specially ob- ness or pain during the sleep or nervous coma; former method was precisely of the same character, awaking; that, in other cases, they might maniand equally strong as that which sustains the latter, fest physical indications of suffering pain during namely, the physical condition of the patients the artificially-induced sleep, but have no recollecduring the operations, and their personal testimony tion of it after awaking; and that, in other cases, afterwards, as to their partial or entire freedom there might be consciousness of what was being from pain during such operations. Now, how-done whilst little or no pain was experienced by ever, medical men have become so humble and them. It always appeared to me, however, that a credulous, and, withal, so imbued with Christian great drawback existed to these processes becoming charity, as to believe and admit that, after all, it generally available for such purposes, from the is just possible that patients themselves may be great length of time which was required in many the best judges as to the amount of pain felt by cases to render the patients susceptible of going so them during severe surgical operations and other deep into the sleep as is requisite to secure a comphysical inflictions; and, moreover, that it may be plete immunity from pain, and especially so if they possible for such individuals to speak the truth. went into the sleep with the idea on their minds It is undoubtedly true, that there were not a that the operation was to be performed there and nor an excess of liberty. Young persons require few members of the profession who were begin- then. In most cases it must have been necessary Plenty of free and wholesome exercise, and during ning to have a glimpse of the truth-who were to put the patient repeatedly into the sleep, and to hsuch time they should feel perfectly at ease, and be perceiving that they had been too rash in their conceal from him the particular time when the allowed to amuse themselves as they prefer, pro- the mesmeric phenomena, and their practical im-leading the patient, in fact, to expect it was to be sweeping expressions of scepticism in respect to operation was really intended to be performed,— ovided there is nothing objectionable in such sports; but if improper they should never be permitted, Portance-who were yielding to the pressure from done on some future day. Then, again, a congreat care being taken to check, on its first appear-without, and accumulation of evidence on the siderable number of those who are susceptible of ance, indelicacy or cruelty. Some children are point, as to the power of certain mesmeric or naturally destructive, and are always injuring in- hypnotic processes effecting this happy immunity sects and small animals, and delight in fighting and from suffering during surgical operations. in cruel sports. It is universally admitted that

FACTS AND OBSERVATIONS

As to the relative Value of Mesmeric and Hypnotic Coma, and Ethereal Narcotism, for the Mitigation aior entire Prevention of Pain during Surgical - Operations.»!

By JAMES BRAID, M.R.C.S.E., &c.

Time works wonders: it is the great reformer. 10 Never was this more strikingly displayed than in the revolution which has recently manifested itself in professional faith and practice, as to the possibility and eligibility of suspending consciousness by artificial contrivance during surgical opera-tions. But a very few years ago, those who contended for the possibility of inducing such a condition by mesmeric or hypnotic processes were, by the great majority of the profession, looked upon as credulous fools or arrant impostors. The patients who had been so operated on, and were represented as having been thus saved from physical and mental suffering, were most mercilessly 'assailed as arrant rogues who ought not to be trusted. It was contended, in the face of their most solemn asseverations to the contrary, that

Foreign Review," for October last, the author
avows, as the result of a dispassionate consideration
of the amount of evidence on the subject, together
with the known influence of certain processes on
the nervous system, that the time has arrived when
it is the duty of the medical profession to test the
matter fully and fairly. 11

"

1

Inasmuch as this subject has been fairly tested last September, at Calcutta, before a committee appointed for the purpose, by the Government, I have thought it might be interesting to many of your readers to have the results of the investigation laid before them, so that they may compare the said results with those of the operations performed during the ethereal narcotism, so many interesting examples of which have lately appeared in the Medical Times. The satisfactory results of the latter mode, when properly managed, are now attested by the experience of medical men throughout the length and breadth of Great Britain, as well as America; and it is therefore now established beyond a doubt, to the entire conviction of every unprejudiced and intelligent member of the profession. Indeed there seems at the present time to be a perfect enthusiasm and rivalry amongst medical men of every condition, as to who shall prove the most zealous patrons of this

聊

the influence to an extent sufficient for the cure of

disease would not, even with all the above precautions, be readily reduced into the profound unconscious state requisite to ensure complete immunity from pain during surgical operations.

Such was my personal experience, and for these reasons I considered mesmerism and hypnotism far less available for such purposes with British subjects, than for the relief and cure of various forms of disease. The success of Dr. Esdaile, however, with Hindoos and Mahomedans, seems to have been very great; but still the objection as to the length of time required would be felt to be a serious inconvenience even with such subjects, compared with the rapidity with which the desired ethereal narcotism can be induced. Many individuals, for example, are not possessed of those physical and mental qualities requisite to secure entire success by the hypnotic and mesmeric processes; and comparatively few could be reduced into the state, provided they chose to resist complying with the conditions required. They are much in the position of the person who may have any quantity of wine or spirits set before him without becoming intoxicated, provided he effectually resists drinking them. If they are conveyed into his stomach, however, in sufficient quantity, intoxication is sure to follow, however much he might have attempted to resist their ingestion. Just so is it with the fumes of ether: we have the power of narcotizing patients by this agency, will they or nill they; drunkards, however, seem to be affected with difficulty by the ether. This is the great recom

further adds) whether the writhings and distorted "It, therefore, becomes a question (the report features, in the three cases above described, are to be regarded as proof that the operations occasioned at the time the actual agony of which such sympI have considered it unnecessary to give their toms are the usual evidence, or whether they were mesmerizing processes in detail, but I beg thematic movements) as Dr. Esdaile represents them. mere instinctive movements' (reflex or autoreader's special attention to the following descrip- But our province is only to record facts, and not to tion of the peculiar character of the sleep thus induced, which I shall transcribe verbatim from the physician. enter upon that of the physiologist or the metareport :

tions upon the farm; when, without any obvious exciting cause, it began to be painful, and to enlarge. He was attended from time to time by a host of quacks, without getting a whit the better, but gradually losing flesh from the sharp attacks of inflammation in it; disturbed nights from violent" crampy," twitchings. When I saw him the limb presented the following appearances: thigh and leg much wasted; the latter bent nearly at right angles with the former; patella remarkably prominent, and stuck, as it were, in the intercondyloid notch; partial dislocation backwards of the head of the tibia. There were three sinuses apparently communicating with the joint: one between the head of the fibula and the tuberosity of the tibia; the second, above the internal condyle; the third, in the popliteal space: all discharging more or less serous fluid mixed with pus. His general health is good, better than it has been; he has no pain in the joint unless the limb is moved carelessly. Having carefully ascertained that the heart, lungs, and kidneys were healthy, amputation was proposed and readily assented to by the patient and his friends.

entire sarface of both the flaps was covered with |
a layer of thick lymph, which smeared with
healthy-looking pus, here and there separating
the flaps, bore a close resemblance to the pleura
after a sharp attack of pleurisy. The source of
the profuse puriform discharge was an abscess
extending as high up as the trochanter between
the superficial and deep fascia. An in-
cision was next made very carefully down
to the sheath of the femoral vessels, which,
being displayed, were carefully laid open; the vein
was found full of healthy-looking pus, and its
serous lining for two or three inches at its distal
end completely destroyed; beyond this, and ex-
tending nearly as high as the saphenous opening,
the cavity of the vein was filled with coagulated
blood, which at the valves, adhered so closely to the
serous coat as not to be readily removed with the
finger nail. The distal end of the femoral artery
admitted the passage of a probe; when laid
open, a clot of coagulated blood was exposed,
beautifully adapted to its interior, terminating
abruptly at the first branch that was given off;
numerous enlarged lymphatic glands, in the course
of the iliac vein, contained pus, but beyond that
none could be found. Viscera of the chest and

The flap operation was accordingly performed, six arterial branches requiring ligatures. The patient lost but little blood, and bore the opera-abdomen healthy. tion remarkably well; he was removed to bed, and took thirty drops of laudanum in a glass of camphor julep. The knee-joint, examined soon afterwards, presented the following appearances: the patella was fixed by a strong vascular membrane to the articular surface of the femur; the internal condyle had formed for itself a cup-shaped cavity in the head of the tibia, looking like an incomplete ball-and-socket-joint, except in its freedom for motion; the external condyle maintained its natural position; the articular and inter-articular cartilages were entirely destroyed; the cavity in the head of the tibia communicated by a large aper

Remarks. What was the order of the train of symptoms, and the causes of them, which followed the operation? It is pretty evident, from the brief details of the morbid appearances, that nature made an attempt to repair the solution of continuity by throwing out an abundant quantity of coagulating lymph. Was the profuse puriform discharge from the stump, observed on the fourth day, the result of suppurative phlebitis of the femoral vein, or was the redness named an attack of erysipelas? The morbid appearances lead me to form the latter opinion; be that as it may, it is beyond a doubt that either the primary or the secondary suppurative phlebitis of the femoral He went on tolerably well for three or four days, vein, and the subsequent contamination of the pulse ranging from 100 to 120; breathing natural; blood by pus, were the cause of death. The iliac vein, bowels confined, and slightly tympanitic; slight vena cava, heart, and lungs were carefully examined nausea, occasionally vomiting, yet he took some for secondary abscesses, but none were detected; beef-tea, sago, and arrowroot, every four or six the liver, spleen, and kidneys, and with the same ours. But he never slept well after the operation, result: the last-named organs, however, accordthough he took half a grain of morphia at bed-ing to the ingenious theory of Dr. Budd, are not time. so liable to purulent infection as where the portal vein or any of its feeders are attacked with suppurative phlebitis; but this strictly applies to the liver.

ture with the sinus described.

Medical Society.) In several other instances, M. Velpeau had been equally fortunate, and now did not hesitate to say that this discovery was one of the most important facts of the age.

M. Magendie would not join the enthusiasm universally expressed on the subject: the only thing which he very distinctly saw, was that experiments were being daily performed upon the human subject, and that was not a line of conduct which he could applaud. Patients were thrown into a state of intoxication, and in that condition submitted to operation; some were rendered unconscious of pain, but in others the case was different; a patient had been spoken of who, during operation, rose, shook his gory hand, and escaped from the hands of the assistants. M. Magendie knew of a lady, who had been operated on when under the influence of ether, and who died forty-eight hours after. M. Magendie would ask, if it really was an advantage to deprive a patient of all consciousness of suffering during operation? Was it not useful to acquire from the manifestation of pain the knowledge of the neighbourhood, of a nerve for instance-and might not, in a deep wound, a ligature be thrown over a large nervous branch-if the patient did not express any pain whatever?

M. Velpeau and M. Serres answered that, hitherto, the so-called experiments had been made with the greatest reserve; and had not been productive of injury to any one of those who had been the subjects of them.

ACADEMY OF MEDICINE. Meetiny of Feb. 2; M. BEGIN in the Chair.

ETHEREAL INHALATIONS.

M. Jobert, after giving an account of several painless operations which he had performed, after the inhalation of ether, stated that three distinct periods might be recognised in the succession of symptoms, produced by ether-1, delirium; 2, unconsciousness; 3, collapse, attended with coldness of the skin: this third period should in no long operation, in which abundant hemorrhage instance be permitted to appear. In any very might be expected, M. Jobert thought it would

be found safest to abstain from the inhalations; but in short operations, such as amputations, the method was perfectly applicable.

Fourth day after the operation, the dressings were removed for the first time, when the margins of the wound were found to be adherent except at its outer angle, through which a great quantity of grumous blood had escaped; the flaps were puffy, a slight erysipelatous blush extended as high up the thigh as the tro- PROGRESS OF MEDICAL SCIENCE. memory of pain was lost when he recovered from

chanter. The stump and the thigh were well fomented, the former immersed in a large breadand-water poultice, to be renewed three times a day. Pulse feeble; nausea combated with effervescing draughts; sago and beef-tea to be continued, and as much brandy and water as he can take without increasing the nausea.

Seventh day.-Discharge from the stump very profuse, still of the same quality, but mixed with flakes of lymph; redness has not increased; was delirious during the night, and partly so to-day; urine passed to-day, sparing in quantity, of high specific gravity, contains abundance of lithates; countenance wears a wild, anxious expression; does not recognise his nearest friends; takes brandy or wine when placed upon the tongue or between the lips.

-

Ninth day. Is comatose since yesterday; urine and fæces escape involuntarily; vomited during the night everything as it was swallowed. Died this evening precisely as if sinking under typhus.

Inspectio Cadaveris.-The stump was first inspected; two ligatures still remain attached to two small branches, all the others separated on the seventh day; there were no signs, during life or afterwards, of the superficial absorbents having been diseased; the flaps were adherent at the margins, but were easily torn asunder; when both flaps were reflected, about one inch of the femur was exposed, wholly divested of its muscular and periosteal coverings; itself healthy; the

France.

ACADEMY OF SCIENCES.

Meeting of Feb. 1; M. BRONGNIART in the Chair.
STRUCTURE OF THE TONGUE AND OF ITS IN-
TEGUMENT, IN MAN AND MAMMIFERE, BY T.
M. BOURGERY, M.D. Dr. Bourgery's memoir
on these points is a correct description of the
anatomy of the organ, but does not contain any
original views.

PAINLESS OPERATIONS.-INHALATION OF

ETHER.

A long debate on this subject occupied the greater part of the meeting, and was chiefly carried on between Professor Velpeau and M. Magendie.

M. Velpeau remarked that, since the last meet ing, he had had several opportunities of applying the new method, and that the results had been exceedingly satisfactory. In one case of fracture of the thigh the patient presented violent convulsive contraction of the muscles, by which a proper adaptation was prevented; inhalation of ether caused them to cease, and permitted the fracture to be reduced with the greatest facility. On the next day, M. Velpeau had removed a tumour from the parotidian region, in a person previously submitted to ethereal influence. (See Medical Times, Feb. 6, Transactions of the Parisian

|

M. Blondin had, in three cases, operated upon persons submitted to the inhalation, and concurred in the opinion expressed by M. Jobert; however, he would say that he fancied the patient suffered during operation, but that the the ethereal ebriety.

Meeting adjourned at five o'clock.

FACULTY OF MEDICINE. LECTURES ON GENERAL PATHOLOGY, BY PRO

FESSOR ANDRAL. MELANOSIS. This is a morbid production, which, regardless of its resemblance with certain natural black colouring matters of the body, we class with heterologous products, chiefly on account of its history, which resembles that of those deposits. During health a black colouring matter is observed on the choroid, on the posterior face of the ciliary process, on the skin, the nipple, and some parts of the brain; in the aged, we also notice the deposition of abundant black colouring matter on the surface of the lung. In disease, we observe a black colour, to be sometimes due to very different causes. It may thus be sometimes referred to a deposit of carbon, either spontaneously formed, or introduced from without; or, in consequence of chemical decomposition, a sulphuret of iron is sometimes thrown off, and deposited on our textures, so as to produce a dark aspect: it can also occasionally be referred to a chemical change of extravasated blood; or, again, to the accidental development of pigmental tissue; this last form constitutes real melanosis. In this accidental tissue the cells of natural pigment exist, but they are not so regular, and contain a nucleus and numerous

black particles, which are occasionally found in tute" fungus hematodes." (Mem., this name has
a state of liberty when the cells do not exist. also been applied to a practical form of erectile
Melanosis shows itself in four different forms :- tissues.) Cancer may be developed in all our
1, in a state of infiltration; 2, in the shape of textures, and possesses a remarkable tendency to
tumours; 3, cysts, containing a black fluid; and extend to neighbouring parts, and to be repro-
4, on the free surface of some membranes. The duced after extirpation. This has been explained
two first forms have their distinct periods of hard-by the hypothesis of the passage into the veins
ness and softening; the third is sometimes seen
of the cancerous cells; but the fact is not proved.
in animals, as Henle has shown; and, as to Dupuytren and Breschet vainly sought to pro-
the fourth, it is still a matter of doubt if it should duce cancer in animals by the introduction of
not be referred to the decomposition of altered cancerous matter into their circulation. Hype-
blood. We find melanosis in all our solids, mem- remia may precede cancer, and facilitate its pro-
branes, and parenchymata; alone sometimes, and duction, but it is not so in all cases; it may,
often progressing with other alterations; thus it however, account for the frequent return of malig-
is frequent to see parts affected with chronic in- nant growths in the region from which a cancer
flammation assume a black colour; in old ulcers, in had lately been removed by operation. During
chronic pneumonia, in cancerous tumours, this is the period of hardness the tissues which surround
far from uncommon; in disease a yellow colour the tumour are more or less modified by pressure,
has been noticed; Lobstein has seen it in the they may even be atrophied, and disappear.
pia mater enveloping the spinal chord of newly- When the cancer softens, the vicinous structures
born infants, 1/
are gradually destroyed by ulceration, the veins
open and absorb cancerous matter, or become
obliterated by phlebitis. Hemorrhage during this
period is far from uncommon, whether it origi-
nates from the vessels of the tumour, or from
those of the adjacent parts. Many causes explain
the general modifications observed in the entire
system under the influence of cancer:-1, in the
first place the local disorder; 2, the disturbance
of the function of the diseased part; 3, the pas-
sage into the circulation (by endosmosis or by
absorption) of cancerous matter; 4, phlebitis;
5, hemorrhage; and 6, compression and oblitera-
ion of veins.

Cancer is a morbid production which has an
inevitable tendency to ulcerate and to destroy
whatever tissue it affects, and whatever be its
aspect, form, or symptoms-hence its name;
amongst its characters let us not omit its fatal
disposition to be reproduced. Considering the
subject more scientifically, we must look upon
cancer as constituted by several anatomical ele-
ments; it is the most organized of all heterologous
productions-an assertion which is easily demon-
strated by the microscope, or even by simple in-
spection with the naked eye. The nature and
relative proportions of these several anatomical
elements, observable in cancer, cause it to assume
varied aspects, although its fundamental nature
Iremains unchanged. Thus the microscopic study
of cancer shows it to be formed, in the first place,
of a greyish amorphous substance, common to all
accidental productions, in which are disseminated
granulations more or less numerous; also cells of
la peculiar form, and perfectly distinct by their
size from those of melanosis, pus, or tubercle;
these cells are furnished with nuclei and nucleoli,
the number of the former in one globule varying
from 18 to 30; other cells are found in cancer,
only they seem concentric; or, again, are fur-
nished with one or more fibrous appendages,"
which sometimes give the globule a fusiform as-
pect, which seems to be the first step to the con-
version of the cell into a fibre. True fibres are
also seen, parallel or fasciculated, or forming
even an intricate network. Their numbers may
exceed that of any other element of the cancerous
structure. The differences in the relative pro-
portions of these elements cause four principal
forms of cancer:-1, scirrhus; 2, encephaloid;
53, colloid, or gelatinous cancer; and 4, melanic
s cancer. In scirrhous the fibrous element greatly
predominates; in encephaloid it is the cell; in
colloid cancer the fibres are numerous, but it
is infiltrated with a gelatinous fluid, which is often
contained in special areola; and in melanosis the
only observable difference is the addition of a
black colouring matter. We sometimes find
these four forms of cancer combined in one tu-
icmour-a 'fact which proves the identity of their
intimate nature; it is, however, useful to establish
a separation between them, because their pro-
gress, and the special accidents which each may
occasion, are not precisely the same. Scirrhus is
ea dense, hard, whitish tissue, lobulated and di-
*vided internally by fibrous intersections; it con-
tains the cancerous juice, but in greater quan.
tities, as it is observed, at a later date, and few
23 or no vessels; after a time, scirrhus softens,
and
d occasionally becomes infiltrated with a
gelatinous fluid. Encephaloid cancer, so called
from a certain degree of resemblance with
cerebral substance, is of a dead white co-
colour, hard at first, and differs materially from
scirrhus by its vascularity. When cerebriform
cancer softens, it may remain white, and resemble
more and more closely a foetal brain in a state of
decomposition; it is then called "medullary
fungus"; or it may acquire from internal hemor-
hage a dark, brownish, or red colour, and consti-

parasitic veGETABLE AND ANIMAL PRODUC-
TIONS.

science. This is not all: they have been noticed on the surface of serous membranes, and also on false membranes of the pleura, communicating with air through a fistulous aperture.

The parasitic animal productions differ from each other far more than the vegetable; some belong to the class infusoria, and are developed only when signs of putrefaction are present: of this class is the "trichomonas," lately described by Dr. Donné as characteristic of syphilitic pus. The animal parasites either belong to the surface of the body, as the various acari-pediculi, &c.; in which case they bear the name of epizoa, or they occupy the internal parts of the system, and are called entozoa, The division at present adopted for the latter is that proposed by Rudolphi, who classes them under four heads-1, hematodes; 2, crématodes; 3, cestoids; and 4, cystids.

1. Hematodes are so called from their resemblance to a thread; several varieties present considerable interest:-A. Filaria medinensis occupies the cellular tissue of the limbs, and sometimes of the body or scrotum. The animality of this worm has long been a subject of doubt, but cannot any longer form a question. This singular parasite is observed only in the tropical climates of the old world, or on persons lately returned from those countries; the body resembles a long thread, six or seven inches in length, and is terminated by a distinct head and suckers; hitherto, none but females have been met with, and inside their body numerous young filaria are found to exista circumstance which explains the numerous and ingenious precautions taken by the natives to avoid breaking the worm during its extraction. Abscesses and We now come to the history of other accidental ulcers are the result of its presence under the productions, which enjoy an independent life from skin. Very lately, small filaria have been found that of the organ in which they arise. The ques- in the crystalline lens, in a case of cataract (in tion of their origin involves the important pro-man). It is said they have also been met with in blem of spontaneous generation, and has not disordered bronchial glands an assertion which hitherto received a satisfactory solution. Amongst cannot be received without much reserve.quB. these independent organisms thus produced by The trichina spiralis is a very small hematode disease, some belong to the vegetable, others to which occupies the muscular texture, and prothe animal, kingdom. The former are all micro- duces little white stains. C. The trichocephalus scopic fungi, and placed on the exterior surfaces is a small worm, visible, however, to the unarmed of the body: hence their name, " epiphytes." eyes; its anterior part, very thin, is convoluted; it occupies the cæcum and commencement of colon. D. The ascarides lumbricoides (usually occupies the small intestine, but may pass into the colon, whence it is speedily expelled or as. cend into the stomach, and be rejected from the mouth it has been seen to pass into the larynx, and we have ourselves noticed two instances of sudden death in children produced by this cause. M. Guersant has recorded a case in which these parasites had penetrated into the biliary ducts. Their sexes are distinct, and their organization very perfect. E. The ascarides vermicularis is much smaller than the former, and occupies exclusively the rectum. F. Another hematode presents some interest from the fact of its residing in a cyst; it is the strongylus gigas of the kidneymuch more common in the dog than in man.

2. Crematodes owe their name to the numerous

The causes which facilitate their production cannot be thrown into play without the interference of air, and seem to be somewhat akin to fermentation or decomposition. One chemical circumstance singularly assists their development: it is the conversion of a naturally alkaline fluid, such as serum, into a slightly acid compound; cells are formed in the fluid, which soon assume a tubular shape, and form the vegetable substance. (Dutrochet, Andral, Gavarret.) The experiment can be repeated easily by adding to serum a few drops of sulphuric acid; it is important not to precipitate the albumen, and, consequently, nitric acid should not be employed. The same occurrence will, therefore, be noticed whenever a naturally alkaline fluid will, during the accomplishment of any of our functions, come into contact with an acid, a circumstance not unfrequently observed on the skin in the galactophorous ducts of the mamma, &c. Of late years this question has been the object of much curious research, and vegetable productions have been observed in many fluids, and on the surface of several solids of the body; they have been met with in the urine in cases of diabetes mellitus, and of granular kidney; in milk, in the contents of the intestine, and in vomited substances; on the 4. Cestids are so called from their analogy to skin they have been observed in tinea capitis, in common cysts. The cysticercus polycephalus is mentagra, and within the capillary follicles in a cystid furnished with several small appendages plica polonica, and also on the surfaces of old called heads, and which are susceptible of being blisters, or of chronic ulcerations. These vege. protruded from, or drawn into, the cyst; this paratable products have once been observed in the site has been found in muscular substances, in meatus auditorius externus, in mucous exuda- the heart, in cellular tissue, in the cerebral memtions, in a state of incipient decomposition, in the branes, and in the brain itself. That form of mouths of children affected with thrush. They cystid which consists merely of a bladder, Laennec are asserted to have existed in the intestinal ul- called acephalo cyst, and it has received also the cerations of a case of typhoid fever, and lining name of hydatid. Laennec's description was as the excavations of the lung in a case of consump-complete as it could be at a time when microtion; once even in expectorated matter but for scopic studies were not cultivated; he showed this we cannot vouch, we only record the state of how the young hydatid was formed on the internal

pores of their surface, as they do not belong to the human species; one genus is very common in sheep-it is the hepatic distoma which has been said to exist in man and in shepherds; but this, of course, we merely mention, without answering for the truth of the fact.

3. Cestoids or flat worms: two varieties tænia solium and T. lata.

髻

face of the pant cyst, and became, after a time,
free within itscavity; how the progress of time
caused the gerrating cyst to burst, and how the
parasitic growt thus became multiplied under the
influence of it own organic laws. Microscopic
research has sown that this fluid contained in
hydatids is repte with animalcule, to which the
name of "echinococcus" has been given;
hydatids have only been observed in parenchy-
mata-viz., theliver, spleen, kidney, lung, and
brain.
We here clos the first part of these lectures,
treating of the aerations of the physical condition
of our organs: ve now turn to the consideration
of those changes which disease induces in their
dynamic state.

PART II.

Alterations of the acts of the living organism Bare what we understand by the alterations of the dynamic state. Life is a power-a force comparable to that which governs the world. Life directs and regultes the phenomena presented by organized bodies some of which are, it is true, kanalogous to thoe which take place in inorganic substances, although modified by the intervention of life; whilst obers are proper and special to life, being intimatly connected with the arrange. ment of organic mtter: thus all living bodies are endowed with irritability, sensibility, contractility, and plasticity. Anther special property of living abodies is that of peserving their temperature of these properties of life, some, like sensibility and -contractility, can only become developed when Sa peculiar arrangement of organic matter is presents others, like irritability and plasticity, resquire simply the existence of life for their production. The regular play of these properties constitutes health; disease is the result of their disturbances Let us establish, as a principle, that any derangement of these properties necessarily implies an alteration of organized matter. The salteration may escape detection, but doubtless it -is présent, and we must not wait until we have reeorganized it, to study the functional change.s

which led into the corresponding sterno-clavicular articulation, but, as it had existed for some time, and had merely a covering of lint dressing, he took no notice of it.

surfaces, and to these we must add the organs of
special sensation; from these parts the excitement
is propagated to the entire system by two channels,
the blood, and the nerves; a singular phenomenon,
called sympathy, also serves to convey the ex-
Mr. Tufuell made the dissection, expecting to
citement from one part to another; and, lastly, find effusion into one or both cavities of the brain,
it may be transmitted by the narrower medium after delirium of so many hours' standing, and
of continuity of tissue. These various agents do conceiving that the cerebral disease was attributable
not always produce the same degree of excite- probably to metastatic action, consequent on the
ment. This difference of action may depend suppressed bronchial secretion. But the ventricles
npon the nature of the stimulant, upon the in-contained nothing more than their usual exhala-
tensity of the action, its duration, its continuity, tion; the cerebral substance generally, however, was
or intermittence, and the peculiar aptitude of the congested, together with considerable vascularity of
affected tissues to receive it. Let us remark that the arachnoid. The left lung was studded with
this aptitude is, in many cases, subservient to
tubercles in the first stage; the right contained a
habit. Thus, in a person accustomed to the use
few. The heart was healthy, as also the abdominal
of fermented liquids, a peculiar susceptibility is viscera, excepting slight congestion of the liver and
created, which, if illness occur, may be betrayed some thickening of the gall-bladder, which contained
by the nervous system, and by the symptoms of between its serous and mucous laminæ some
delirium tremens. Thus, when the use of certain
stimulants has degenerated into a habit, their
sudden removal is not unfrequently the cause of
disturbance. On the other hand, by the total
withdrawal of an habitual stimulant, a morbid
susceptibility is generated, which may prevent
the system from ever again returning to the
use of that stimulant without inconvenience.
Thus, after prolonged darkness, the eyes accus-
tomed to obscurity become inflamed when they
receive the impression of light; thus again, when
abstinence has been injudiciously prolonged,
during convalescence, it often is extremely difficult

to make the stomach bear food without due ex-
citement.

External stimulants may act upon the irritability diffused through the entire system, but the irregularity of repartition of the excitement between the various organs, the localization of excitement in any particular part, gives rise (as Broussais very clearly observed) to irritation. External stimulants may exercise their action upon particular organs, as may vomica on the spinal chord, cantharides on the genital and urinary apparatus, or tartar emetic upon the act of vomiting, which that medicine produces even when it has been introduced into the body without being placed in contact with the mucous membrane of the stomach.

D. M'CARTHY, D.M.P.

The most general properties of living bodies is irritability. It is by hypothesis we admit of its existence, but it is a supposition indispensable to the explanation of a certain number of facts; and we must admit it on the same grounds that in -natural philosophy we allow the existence of the Dr. Gober gives the following as the microselectric fluid. We must, however, recollect that scopic constituents of fæces:-1, vegetable celsome phenomena, which we now account for by, lular tissue; 2, vegetable hairs; 3, vegetable the theory of irritability, may at a future days spiral vessels; 4, elongated quadrilateral plates, perhaps, receive another explanation. Thus it id of a light yellow colour, in great abundance, but by increased irritability that we have endeavoureal of uncertain nature-not affected by acetic acid, to account for certain varieties of physiologicbcular fibre, displaying transverse striæ by action of insoluble in cold ether-perhaps portions of muscongestion, such as that observable in the wome, iodine; 5, crystals of during gestation. Within a certain limit of tim -the now flourishing doctrine of irritability will probably prove insufficient, but in the present

state of science we ought not, we cannot reject it. Let us, therefore, examine, the deviations of irritability.

This property has been considered of such vast oimportance that it has been the foundation of a theory which for many years governed medical "science, and was proposed by Brown, who considered all diseases as the result of increased or

diminished irritability. When this property is brought into play, excitement is produced; but -were it not for certain agents called stimulants, which throw irritability into action, excitement would remain in a latent state. Stimulating * powers are of two orders--they may emanate from e external agents, or arise within the organism itself. The former are very numerous caloric, light, - electricity, and air, for instance; air stimulates by mits contact, its currents, its vibrations, by its com. -ponent principles, and, also, by the elements which loit amay accidentally contain; and is not only a Satimulant but as chemical agent, by which special modifications of the system are occasioned food, esdrinks, medicines, are also stimulants, and at the same time act chemically upon the body. Three b surfaces receive the impression of external stimuLalants; viz., the cutaneous, respiratory, and digestive

ammoniaco magnesian phosphates, in considerable numbers; 6, fat gloand mucous granules; 9, brown colouring matter bules; 7, granules, abundant; 8, epithelium cells of bile.

SURGICAL SOCIETY.

J. W. CUSACK, Esq., in the Chair.

Mr. Tufnell related the case of a soldier, who, nine weeks before, was seized with violent hæmo

ptysis after using some exertion in loading a luggage

day, and on the third, a second profuse discharge
took place. On the fifth day the symptoms were
as follows:-violent ague, short cough, dulness
under the left clavicle, and night sweats.

cart. Three pints of blood were discharged the first

expectoration for many hours, and the man com-
A few days ago there was a total cessation of
plained of uneasiness in his chest,there being also con
siderable dyspnoea. He took an emetic in the even-
ing, which had the twofold effect of evacuating his
stomach, and getting rid of the accumulated mucus.
After this he slept for three or four hours, but
awoke at twelve o'clock that night with slight de
lirium, which, by five o'clock, became violent, and
at nine o'clock in the morning he fell back and
died suddenly. Mr. Tufnell had previously ob-
served a fistulous opening beneath the right clavicle,

serous fluid.

Here was an entire absence of disease in any of the cavities sufficient to account for the sudden death, and serving to strengthen Mr. Tufnell in a conjecture as to its probable cause, which had its

origin in the following accidental circumstance.

During the post-mortem examination he passed a Probe along the track of the fistulous opening before mentioned, and found that it entered the jugular vein. It was possible then, he thought, that the disease of the sterno-clavicular articulation may have extended to the neighbouring jugular vein, and that the latter gave way in a violent inspiratory effect during one of the paroxysms of delirium. It became a difficult question to decide, however, whether the vein was thus diseased, and had given way, or whether the opening might not have been made by the probe, and so lost its value as a means of accounting for death.

Dr. Benson asked whether deliriam of this wild character has been observed by Mr. Tufnell or others to be of frequent occurrence in cases of phthisis? He had rarely experienced it himself, but an instance of it had lately occurred in a female at Baggot-street Hospital, in the advanced stage of phthisis. She laboured under extreme debility and dyspnoea, there being cavities in both lungs, copious purulent expectoration, and profuse sweating; yet, when the delirium set in, she acquired considerable strength; the sweats, expectoration, and dyspnoea ceased; the disease then assumed the character of mania, which has continued for several weeks unaltered.

·

Dr. Hargrave inquired whether at any time Mr.o Tufnell had any reason to suppose air passed int or out of the sinus alluded to, or if he had eve observed any puffiness above the clavicle?

Mr. Tuffnell; None whatever. !

LARGE FIBRINOUS DEPOSIT IN THE RIGHT SIDE
OF THE HEART. BY DR. BELLINGHAM.
A soldier, aged about 20, just returned from
India, where he had had fever, was seized with acute
for several days, and then came to St. Vincent's
bronchitis, for which he underwent no treatment

Hospital. He now laboured under extreme dys-
pnoea; the extremities were cold and livid, face
congested, action of the heart and pulse very
feeble. The only physical signs present was a
sibilant râle over both sides of the chest, but no
mucous rale. Notwithstanding the free use of
stimulants, the man sunk and died within twenty-
four hours after admission.

Autopsy. The bronchial lining membrane, as far as it could be traced, of an intensely red colour, the

membrane itself being thickened from tuberculous deposition; no mucus in the air-tubes; lungs considerably congested.

The heart was of the natural appearance and size; its right ventricle more than half filled by a firm semi-transparent mass of fibrine adhering to the carneæ columnæ and chorde tendineæ, and partially obstructing the auriculo-ventricular orifice. The remainder of the cavity of the right ventricle and the left side of the heart were filled with ordinary post-mortem coagula,

Dr. Bellingham attributes the immediate cause of death to the fibrinous deposit in the right ventricle, which obviously had taken place before death. The majority of deaths in bronchitis are, he observed, from asphixya, owing to the patient's