But it was in the chest that the most remarkable circumstance presented itself. The œsophagus gradually enlarged from the pharynx, which was perhaps rather narrower than usual, to an extraordinary degree of dilatation; the greatest breadth which it attained was situated about four inches above the cardia: the tube then contracted more abruptly, so as to render the termination of the œsophagus, like its commencement, of nearly the usual dimensions. The structure likewise of the cardiac extremity for about an inch, and of the pharyngeal end for about half an inch, was healthy. The intermediate part presented, when inverted, the following curious appearance:—The inner membrane was thickened and opaque, and hadthe appearanceof having partially yielded from dilatation; at the upper part the furrows or thinner parts of the membrane followed in some degree a longitudinal direction; at the lower part the surface was pitted with shallow depressions of various figures. I have represented in the adjoined sketches these appearances, which on the middle of the œsophagus passed from one into the other; at the furrowsor depressions the membrane seemed of the natural thickness and colour; the intermediate raised and thickened part was opaque and whitish. The muscular fibres of the œsophagus were of the natural colour and thickness.
I remain, Mr. Editor,Your obedient servant,Herbert Mayo.
19, George-street, Hanover-square,Dec. 6, 1828.
To the Editor of the London Medical Gazette.
Sir,As the following case may throw some additional light on the pathology of hydrophobia, I have sent it you for publication.
I am, Sir,Your obedient servant,F. Godrich.
Grove House, Little Chelsea,Nov. 29, 1828.
On Thursday morning, the 25th ult. I was called up about seven o'clock to see a man who I understood was exceedingly ill, and waiting in the surgery very impatiently for my arrival. I found my patient (Mr. Barham), a fine looking old man, about 60, labouring at intervals of about five minutes under strong spasmodic paroxysms, affecting the muscles concerned in breathing and deglutition. There was a wildness and an impatience depicted in his countenance, totally different from any thing I had ever observed in other spasmodic affections. His bowels were open, tongue clean, skin moist, pulse full and a little accelerated. I took away twenty ounces of blood, and prescribed a mixture containingʒss.ss.of laudanum for a dose every hour until I should see him again. He walked home half a mile from my house (Gloucester Road, Old Brompton), and left me ruminating on the possible cause of so much mischief occurring suddenly in a fine healthy subject. At ten a message was sent, saying that he was much worse, and requesting me to call as soon as possible. He received me tranquilly, and said he was very glad that I had come to see him, for he was very ill. His symptoms were now more distressing than when I first saw him: he looked wildly and suspiciously at every one entering his apartment, and his breathing was accompanied by a short convulsive sobbing. On looking at his medicine I perceived he had taken none, and expressing my surprise, he assured me it was impossible for him to swallow a single drop, as the attempt had been followed by violent spasms, and produced so much distress, that he had desisted. At this period no one had the slightest idea of the origin of his malady. I poured out some medicine into a tea-cup, the very act of which produced much excitement and alarm. My first impression as to the true nature of his disease arose at this period, from the circumstance of his requiring a tea-spoon, with which he endeavoured to take some of the medicine. The attempt produced much excitement and alarm, and after two or three painful efforts at deglutition, with one desperate effort he swallowed a tea-spoonful, threw away the spoon, and begged, unless I wished to destroy him, that he might have nothing more to swallow. I now left his room, and inquired of a bystander whether any thing particular had occurred to him within the last few weeks. On recollection she said, "About a month since, late at night, a strange dog came into the premises and fought with his own dog; he got out of bed to separate them, and the strange dog bit him in two places, on the left arm and hand; and bit a puppy, which died about a fortnight after in a strangeway, which was thought to be some kind of a fit." To ascertain if this occurrence had produced any effect on his mind, while again bleeding him I said, "You have been in the wars, Sir, and had your hand and arm torn; how did it occur?"—"Oh!" said he, carelessly, "that was done by a dog a long time ago, but it healed." The circumstance was never again mentioned to him, and he died in total ignorance of the cause of his malady. The wounds were perfectly cicatrised, and there was not the least action going on indicative of recent absorption. He bore the bleeding pretty quietly:40℥.40.were removed, which on cooling presented strong marks of inflammation.
Orderedℳiv.iv.Acid. Hydrocyan. omni horâ, in a little water.
Twelve o'clock.—With much difficulty he has taken two doses of the acid; pulse full and hard, 110.30℥.30.more blood were removed.
Three o'clock.—Has taken two more doses; complains of a dreadful sense of suffocation, and implores that nothing more may be given him. Pulse full, and beating at 120 to 130. Continue the acid.
Eight o'clock.—Pulse full and hard. Has taken in all24ℳ.24.of the acid, but so painfully distressing has the deglutition now become, that all attempts at repeating his medicine are discontinued.
V. S. ad℥xxx.xxx.
During the bleeding he looked wildly at the basin, and begged that no more might be spilt (a drop or two had fallen), repeating frequently, in great agitation, as the blood was running, "Take care! take care!"
Between two and three o'clock next morning my assistant (Mr. Davies) visited him. He found him tolerably passive, but observing every movement with intense anxiety. Pulse full and hard, face flushed, eyes denoting cerebral irritation. He had been at times outrageous. On its being intimated that bleeding was again necessary, a paroxysm came on more intense than any preceding,—and with great effort he submitted. As the blood flowed he became more and more alarmed, till at length he got quite unmanageable; he raged violently at his nephew, who was holding the basin, and ordered it peremptorily to be removed. 30 or40℥.40.were taken away. It was found necessary to put on the straight waistcoat. About four o'clock Mr. Davies wished him to take some more of his medicine. He said, "I can take no more," and on reaching the bottle to put out a few drops, he became violently agitated, threw himself from side to side, and, as well as the incessant spasmodic sobbings would allow, he begged that not one more drop of any thing might be offered him, and that the bottle might be taken from his sight. He did not become tranquillized until its removal. He lingered on till tenA.M.in the same state, a few minutes before which he insisted on getting up, and walked a short way down his garden, returned, laid down on his bed, and died.
Mr. Frederick Salmon, of Old Broad Street, and Mr. Wilson, of Chelsea, were kind enough to assist me in conducting the post mortem examination. On opening the chest, the heart was free from disease, with rather more water in the pericardium than natural; the lungs were completely gorged with grumous blood, and the pleura adherent on the right side. On removing the cranium, which was remarkably thin, and cutting the substance of the brain, numerous red spots presented themselves in the medullary portion; about a table-spoonful of water in each ventricle; the plexus choroides was turgid; the corpora, striata, thalami, and basis of the brain every where preternaturally injected; the cerebellum, crura cerebri, and cerebelli, in a high state of inflammation. On removing the spinous process of the vertebra, the whole cord was considerably inflamed; and opposite the two last cervical and dorsal vertebræ the cellular substance was studded with dark patches of coagulated blood, the theca vertebralis thickened, and the cord in an active state of inflammation. The larynx and pharynx bore not the slightest vestige of disease. The preparation of the cord is deposited in the museum of the London University.
The post mortem examination of this case tends to prove the correctness of Professor Thompson's theory of the proximate cause and seat of this afflicting malady; and the plate accompanying a case recorded by him, in the 13th volume of the Med. Chir. Society, gives a faithful delineation of the state in which the spinal cord was found in this case.
To the Editors of the London Medical Gazette.
Gentlemen,Perhaps the following case may interest some of your readers, and if you think so, its insertion in your Journal will oblige
Your obedient andhumble servant,S. D. Broughton.
12, Great Marlborough Street,Dec. 3, 1828.
On Tuesday, Nov. 25, I was called upon at the St. George's and St. James's Dispensary to advise for an infant at the breast, of five months and fourteen days of age, that had not passed any fæces during six weeks up to the day before I saw it. After its birth it had no passage till the fifth day, and this had apparently been effected by the introduction of a bougie, and which was subsequently continued at intervals for a short time. The infant was otherwise healthy and strong at its birth, and remained so until it had gone about three weeks without any evacuation, when it was observed to be weak in the lower extremities; and at the period of my seeing it the legs were much fallen away in flesh, hanging flaccid and inert. Many aperient enemas and medicines had been given, and, as a last resource, one drop of the croton oil had been prescribed the preceding evening. The infant appeared to suffer from distention, and to be disposed to coma, and the croton oil had distressed it much some hours after it was given. The fæces could be felt blocking up the intestine, but the irritation of the finger produced no attempt at evacuation; very small pieces only having been brought away. Hot baths also had frequently been used some time ago.
Considering the case as one of paralysis in the parts naturally employed to relieve the bowels, I recommended the suspension of all purgative remedies by the mouth, and a table-spoonful of the following injection to be substituted, and to be thrown up with three table-spoonfuls of thin gruel occasionally during the day, by means of a syringe.
℞ Spir. Terebenth. ʒiij.Træ Zinzib. ʒj.Aquæ, ℥iss. M.
Spir. Terebenth.iij.Træ Zinzib.j.Aquæ,iss. M.
The following liniment was also directed to be rubbed in frequently along the course of the spine.
℞ Linimenti Saponis, ℥iss.Liquor. Ammon. Comp. ℥ss. M.
Linimenti Saponis,iss.Liquor. Ammon. Comp.ss. M.
The result justified my expectations; for, during the night after this prescription, two injections having been given, some large and hard ash-coloured lumps came away, and these were shortly followed by a forcible spouting out of a continued stream of feculent dark liquid; a brisk diarrhœa having been kept up till the Saturday following. The infant's appetite is become voracious, its appearance lively and healthy, and its legs as firm and strong as is usual at such an age. Cold water is recommended to be dashed upon the loins, the liniment to be continued occasionally, moderate doses of magnesia and rhubarb to be given when required, and the turpentine injection to be used if any return of the complaint should be threatened.
To the Editor of the London Medical Gazette.
Sir,Having seen a case of dislocation of the patella, reported by Mr. Mayo, in your Journal a few weeks since, in which there was experienced some difficulty in the reduction of the bone, I beg leave to send you the following, in case you may think it worth insertion.
On Saturday last, I was called to a young woman who had dislocated the patella of the left knee joint outwards; the inner edge rested upon the outer surface of the external condyle, and was immoveably fixed, and caused great pain when touched. She says it was occasioned by her foot slipping backwards from one stair to another, and she immediately fell down.
I commenced the reduction, as stated by Mr. Mayo, but I could only produce semiflexion, and that gave her great pain; insomuch that I was obliged to desist, and the patella remained instatu quo. But when the knee was thus semiflexed, I desired my assistant to extend the leg suddenly; and having my fingers on the patella at the time, and pressingit inwards, it immediately returned to its natural position.
I must confess, sir, that I should have been afraid to have continued the flexion as described in Mr. Mayo's case, "by bending the knee to the utmost," fearing that the remedy might be worse than the disease, and the result proved that in this case it was not necessary.
I remain, Sir,Your obedient servant,P. M. Hoskings.
168, Fleet-Street,Dec. 3d, 1828.
To the Editor of the London Medical Gazette.
Sir,The mistake of the printer in substituting the word "every" for "even," in the paper on Vaccination (p. 40), so materially affects the sense of the passage, that I must request the favour of the following insertion:—
"3d. That while the vaccine cicatrix retains even one distinct fovea or depression, the individual continues unsusceptible both of small pox and of re-vaccination; but that," &c.
I am, Sir,Your obedient servant,Thos. H. Burder.
2, Brunswick Square, Dec. 15, 1828.
To the Editor of the London Medical Gazette.
Sir,The valuable papercommunicated to your Journal, by Mr. Stanley, last week, has brought to my recollection a singular appearance of the parts in front of the shoulder-joint which I dissected about two years ago. It is a fact worth recording; and perhaps you will be kind enough to insert it in your next number.
The circumstance was this—that in the right arm, instead of there being a biceps muscle having two origins, the one the shorter from the corocoid process, the other the longer from the upper part of the glenoid cavity of the scapula, there was simply a one-headed muscle arising from the corocoid process. I could find no tendon passing through the joint answering to the long head of the biceps, neither was there any appearance of a biceptical groove; the capsular ligament was, perhaps, thicker than it is found in ordinary cases.
I knew nothing of this man during life, and am therefore unable to give any account of the use which he made of this arm.
I am, your obedient servant,C. M. Burnett.
House Surgeon's Apartments,St. Bartholomew's Hospital, Dec. 8th.
To the Editors of the London Medical Gazette.
Gentlemen,As you did me the honour, on a former occasion, to publish some remarks in defence ofauscultation, against its enemies and detractors, I trust you will permit me to say a few words in reference to a communication in a late number, from a gentleman who appears to be a friend of that method of diagnosis, but whose ignorance of the subject is likely to be more injurious to the cause than either open enmity or secret detraction. The case in question (page 780, vol. ii.) appears, from the dissection, to have been clearlyemphysema of the lungs, as there stated; but I appeal to every one practically acquainted with the physical signs of diseases of the lungs, whether the results of the exploration with the stethoscope, as narrated in the case, were those pathognomonic of that disease? I say they were not only not pathognomonic of this affection, but they were actually incompatible with its existence. The same ignorance of the subject is shewn in relation to the disease of the heart, which, I boldly maintain, no one was justified in pronouncing to behypertrophy of the left ventriclefrom the stethoscopic indications stated in the case.
It is just possible that the writer of the case may have made further explorations on which his diagnosis was founded; but if he had such in his case-book, it is equally unfortunate for the credit of the stethoscope and his own, that he suppressed them in his printed case.
I have the honour to be,Gentlemen,Your obedient servant,A Stethoscoper.
Nov. 25, 1828.
To the Editor of the London Medical Gazette.
Glasgow University, Nov. 26, 1828.
Sir,Having lately perused, in the 35th Number of the Medical Gazette, some observations "on the mechanism of the act of vomiting," by Dr. Marshall Hall, in which, after controverting the different opinions which have been entertained by physiologists on this question, he endeavours to prove that vomiting is an effort, not ofinspiration, but ofexpiration, and advances this opinion as having originated in himself, I beg, through the medium of your Journal, to refer that gentleman to Richerand's Physiology, where, on the subject of vomiting, page 70, he says, "Sometimes the action of the muscular fibres of the stomach is quite inverted; they contract from the pylorus towards the cardia; and this antiperistaltic motion, in which the contractions act with more force and rapidity, and in a manner decidedly convulsive, produces vomiting. The action of the abdominal muscles then connects itself with that of the stomach; the viscera are propelled upwards and backwards, by the contraction of the large muscles of the abdomen;the diaphragm ascends towards the chest; if it descended, in contracting, the œsophagus that passes between its two crura would be compressed, and the expulsion of food through the cardia could not be effected. It is also observed,that during expiration only, any thing can pass from the stomach into the œsophagus." Again, on respiration, page 147—"In every effort of expiration, as coughing andvomiting," &c. Here, then, we see that Dr. Hall's views, as far as regards vomiting being an effort of expiration, have long since been advanced by Richerand.
The profession are certainly much indebted to Dr. Hall for his corroboration of these views; at the same time he should not have taken to himself the merit of having first suggested them.
Sir,Your most obedient servant,A Subscriber.
To the Editor of the London Medical Gazette.
Dec. 19, 1828.
Sir,
The events disclosed during the late trial in the Court of King's Bench, must fill every well-disposed mind with astonishment and horror. The moral aspect of the case is marked by every feature capable of exciting a sense of shame for our profession, and of sorrow for our kind. Can it be that a publication conducted in the spirit of the extracts produced at the late trial of Cooper against Wakley should be fostered and encouraged by a large proportion of the medical public? Is it indeed true that no feeling of loathing and disgust should have induced the purchasers of the Lancet to protest against its glaring injustice, its undisguised ferocity and malignity?
I am not a reader of that work myself, and but for the disclosures recently made in our courts of justice, together with what I have learned from your own pages, I should know little about it. Some of its early numbers convinced me that it was a production not deserving of support, whatever ability there might be connected with it; subsequent events have amply justified this decision, and I now address these few hasty lines to you, to express my humble hope that all the respectable medical men throughout the kingdom will arise, and with one voice oppose this moral pestilence, which at once corrupts and degrades their profession.
Theodium medicum, bitter and vindictive as it unfortunately has been, never, I believe, appeared in a form so repulsive. Are we living in the nineteenth century? Have arts and sciences, which are asserted of old to soften the manners and temper the violence of our nature, produced no such fruits amongst us? Is serious, and perhaps irremediable injury, to be inflicted on reputation; and is the sufferer thereafter to be dared to mortal combat, and this too by the wrong-doer? Is it thus that professional justice is to be awarded? Is it thus that knowledge is to be advanced, the dignity of our profession to be maintained, its benefits enlarged, and its usefulness transmitted? Is it thus that the young men are to be taught how to acquire an unworthy and discreditable notoriety; to disregard allthe decencies, charities, and higher virtues of life; and to bring into the exercise of our art the insidious cunning of the knave, the vulgar dishonesty of the pilferer, and the audacious bearing of the bravo?
I know not how others may feel on the present occasion: I am entirely unacquainted with the parties who have been at issue in the late suit—I have no bias of any kind, but what must arise in the mind of every man who has any regard for the profession to which he belongs, or who loves truth and fair dealing—I am sure that it is not less for the interests of society at large than for the advancement of medical science, that just principles should regulate all our dealings, both with the public and with each other. It is manifest that of late we have signally and woefully departed from them; and it is most distressing to know that this departure has been sanctioned by so many members of the profession. I now entertain a confident hope that all who reflect on the character of the late libel will feel that their owncharacteris at stake if they do not mark their disapprobation of it in every possible way. Sure I am that, if the principles which guide the Lancet become generally acceptable, it will mark an æra of moral degradation which no surgical dexterity, no medical acquirements, however eminent, could possibly redeem.
Veritas.
Cases of longevity are not only much more common, but also more extraordinary in respect to a greater duration, in Russia than in any other part of Europe; thus, from the report of the holy synod, published in 1827, it appears that there were living in 1825, among those who professed the Greco-Russian religion throughout the empire, not fewer than 848 males who were 100 and more years old; among whom, 32 had passed the age of 120, 4 were between 125 and 130, and 4 others between 130 and 135 years of age. Out of 606,881 males who died in 1826, 2785 had passed the age of 90 years; 1432 that of 95; and 818 that of 100. Among the latter, 38 were more than 115 years of age; 24 more than 120; 7 more than 125; and one was 160 years old at his death.