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provided with the plicæ of the mucous f fcoat extending into its interior. In this I sloligopsis the crop (Fig. 159, e is long, andlongitudinally plicated internally, and thegizzard (Fig. 159, f ; is globular and mus-
cular.The intestine passing from the spiral
stomach of the cephalopods is wide andshort, corresponding with the animal foodupon which those remarkable molluscousanimals subsist. It forms a short singleturn, a little downwards from the thirdstomach, close to the left branchial heart:;it then mounts upwards, passing alongthe fore part of the liver, and terminatesgenerally with a valved orifice, immediate-ly below the commencement of the syphonor funnel of the cephalopods.
In the small sepiola, perhaps the small-est of the naked cephalopods, you observethe œsophagus with scarcely a perceptibleenlargement, passing down behind the bi-lobate liver to the long gizzard, with
strong longitudinal muscular fasciculi, astomach that is here extended longitudi-nally, or from before backwards. This Ivery large and strong gizzard in the se-piola, leads by a wide, short, and free ori-fice into the third stomach, which here is ‘wide and lengthened, and does not per- Iform the quarter of a revolution, and is Imarked by numerous transverse plicas ex-tending inwards, which affect even its out-ward form. In this back view of the se-
piola, you observe the large inferior pairof the salivary glands lying above andbehind the liver. The bile is poured in bytwo long hepatic ducts, uniting into onebefore they enter the third stomach. Theliver here is easily observed, upon re-
moving its peritoneal coat, to consist ofnumerous ramified caeca, which can bedetached and observed, floating loosely inthe water, upon removing the cellular tis-sue and vessels which slightly connectthem together.The magnitude of the liver, the salivary
glands, and the pancreas, here in the
cephalopods, is nothing remarkable, for wefind all these assistant chylopoietic glandsgreater in the molluscous than in the ar-ticulated classes ; in the molluscousclasses we observe a greater number ofspecies to feed upon vegetable substances,or upon animals very low in the scale;whereas the articulated classes we haveseen organized to feed chiefly upon ani-mals, and upon animals even higher inthe scales than themselves.Thus we observe these cephalopods to
possess many parts in common with theclass of birds, the feathered inhabitantsof the air, although they are animals or.
ganized to inhabit the deep recesses o
the ocean, being but imperfectly organize(
for swimming, although admirably pro-vided with prehensile organs, in the formof those long muscular feet, covered withsuckers, and disposed around the headand mouth. As in the birds, we see herethe powerful horny bills ; we see the cropupon the œsophagus, we see the musculargizzard, with its coriaceous lining, of thebirds. Here you will observe there is yetno caecum developed upon the colon; andwe scarcely observe in any of these in-ferior invertebrated animals, a distinctlyclosed or csccal cavity developed in thatregion of the alimentary canal. Indeedyou observe scarcely a distinction yetestablished permanently between the colonitself and the small intestine. The com-
parative shortness of the alimentary canalhere, as in other carnivorous invertebrata,depends 011 two circumstances. The ce-
phalopods feed on animal food, whichmust not be in large quantity, nor lingerlong in the digestive organs to extract itsnourishment, otherwise it would putrefy;its highly compound elements would enterinto new combinations, which would prove
most injurious to life. Another circum-stance is, that those cephalopodous ani-mals are still low in the scale; and weobserve that this internal alimentary canal,for the reception and elaboration of food,. becomes more lengthened and complicated- as we ascend from its first appearance in- the lowest animals, upwards to man, or tothe mammalia, where it is proportionally1 longer, and more divided into distinct partswith distinct functions, than in all the in-3 ferior classes.
Prefutory Terrzarks.-Clinical observa-tions are, for the most part, made on patientsin public hospitals, but as the diseases of
the poor are usually far advanced beforethey are admitted into our charitable medi-
cal institutions, students seldom have op-portunities at an hospital of becoming ac-quainted with diseases in their early stages,and are excluded from seeing diseases,which, in consequence of their mild cha-; racter, are not usually considered fit ob-jects for admission.. There are some diseases which are
f met with only in particular classes of1 people, the poor being affiicted with ail-
ments which are seldom or never ob-served amongst individuals in other ranks Iof life; while, on the other hand, affluentpersons are subject to diseases which do !not afflict the indigent portion of thecommunity. There are also many dis- Ieases which, though they are common to ,all, assume considerable variety of cha- Iracter according to the different classes ofpeople affected by them,-the habits ofthe body, as well as the avocations of the Imind, having each much influence on thehuman frame, and greatly modifying thecourse of disease. The clinics of hospi-tals, therefore, are to such extent im- Iperfect as a means of instruction to thosewho are educated for the medical profes-sion ; and not only in these respects, butin another, inasmuch as the nature of
hospital practice limits our acquaintancewith the effects which particular modesof treatment produce at distant periods;whereas in the classes of society whosediseases are treated in private, the historyand treatment of affections can generallybe traced to their termination, and theultimate results distinctly ascertained.Moreover, in hospital practice it is toocommon to conceal the result of caseswhich are unsuccessfully treated, from thepublic eye, and especially reprehensible,though but too frequent, is it, to recom-mend in clinical reports certain systemsof treating diseases, which time subse-
quently proves to be unworthy of con-fidence, the true character of those sys-tems, however, not being afterwards laidbefore the public, all further experience ojthe remedies or modes being thus con-
, cealed, as far as their propagators are
concerned.It has long appeared to me that an-
other great fault in the records of hos-pital cases is, that of giving undue import-ance to examples of diseases which areremarkable only for their rarity or theirformidable characters. The same unduevalue seems often to be placed on what isseldom to be seen in disease, as is award-ed to objects for gratifying the senses ;whereas the student would derive essen-tial advantages from being made familiarwith the symptoms, and expert in the ma-nagement of diseases, which, though notendangering life, yet materially affect thecomfort of those who are afflicted by them.Besides, it ought to he remembered thatthose diseases which are usually consi-dered to be of minor importance, exhibitphenomena equally interesting to the
pathologist, with those of a more seriouscharacter, while the former, from their
greater frequency, afford a far more ex-tended field for observation.
These considerations have led me to
think that clinical observations not con-
fined to the diseases of any one class ofthe community, but including those of the! middle and upper ranks as well as the
indigent, are still wanting in our annals,and that their communication would
greatly contribute to the advancement
of medical science. The collection ofmaterials in sufficient quantity to form a
distinct volume of such clinical remarkswould, without douht, advantageously oc-cupy much time and thought, but to ren-der such a work complete, the co-opera-tive efforts of many individuals would be
necessary. My present purpose, there-’ fore, is merely, as often as circumstances. permit me, to bring together some casesto illustrate a particular practical or pa-thological point, being guided in the se-lection by those accidental circumstances3! which may, at the time of recording them,; more particularly engage my attention. In) narrating cases I shall endeavour to avoid unnecessary details, and simply recordsuch parts of their history as appear ne-cessary to illustrate the particular pointfor which thev are adduced.
I may here observe that many of the
cases to which I shall refer, and many ofthe observations which will accompanythem, were collected and formed at anearly period of my practice. Thus I shallhave the advantage and satisfaction ofknowing that time has enabled me to con-firm their accuracy by subsequent experi-ence on repeated occasions, and I shalloffer them to the public with the greater
confidence. I cannot here avoid observing. that the habit of noting down cases and; recording observations in early life is amost valuable custom. It not only facili-
. tates composition, but leads both to accu-. racy of thinking, and a correct mode ofobserving the multiplied phenomena ofdisease. Moreover, the impressions whichare made on the mental faculties whenyoung are far stronger than those whichoccur to us in advanced years, and habits
- of industry acquired when the surround-ing objects of life are new to the mind, lay- the foundation for future excellence in anyr avocations that we may be pursuing, and- in none so firmly and usefully as those oft the medical art. Youth, too, affords un-e paralleled advantages for gathering infor-[. mation worthy of being recorded relativet to the practical rules and opinions of emi-
- nent men in various branches of science,a with whom we then have opportunities,e I as students, of coming in contact. Hows much useful knowledge daily goes into ther grave with those who possess it, which- ’ might have been saved to the professionand the world, had it been recorded byindustrious pupils and anxious observers
amongst those whose duty it is in earlylife to profit by the orally-communicatedexperience of others !
CASES OF K-’EVUS SUCCESSFULLY TREATED
BY ARTIFICIAL ULCERATION.
In the ninth volume of the Ti-an8actionsof the Medical and Clzirzeryical Society(1818), I endeavoured to point out theanatomical characters of nævus, and thevarious modes of treating this disease.Besides the different operations of extir-
pation, the ligature, the seton, and tyingthe vascular trunks supplying such tu-mours, all which modes of treatment werein use, I then proposed another modewhich I had at that time adopted only innsevi of a small size. I can now with con-fidence venture to recommend this modeof treating not only small nsevi, but as asafe and very easy mode of removing næviof the largest size. I have employed itwith complete success, where none of theother modes of operating were even prac-ticable, in consequence of the great extentand the dangerous position of the tumourThe mode to which I allude is, that of
destroying them by ulceration, a practicewhich I was first led to employ, from hav-ing noticed the effect of a strong solutionof corrosive sublimate, when applied toa subcutaneous nsevus, situated on theback of a child. By means of this appli-cation the skin ulcerated, and the ulcerspread rapidly, destroying not only theinteguments, but the substance of the tu- mour; after which the ulcerative processwent no further, and the surface cica-trized. I had also observed that nature
occasionally employed the same processfor effecting a spontaneous cure of nævi,an ulceration commencing on a thin por-tion of skin covering the tumour, andthen extending into the tumour itself,whifh it ultimately destroys
The most effectual and easily manage-able mode of producing an artificial ulce-ration for the destruction of nsevi, whichI have been able to contrive, is by theapplication of kali purum, the action cfwhich is so powerful as to destroy the
vitality of the soft parts on the slightestapplication. The dead portion is after-wards separated from the living by a pro-cess of ulceration, and after the sloughthus formed has come away, an ulceratedsurface remains, the ulcer spreading overthe whole extent of the diseased mass.No bleeding takes place during this pro- Icess, as nature employs the same meanshere to prevent hemorrhage as when apart of the body mortifies, the extremitiesof the vessels being gradually filled up bycoagulated blood, in proportion as the
ulceration advances in the mass, and thecells of the parenchyma are filled with
coagulated blood, the circulation throughthese having been arrested.
It is sufficient to apply the kali only toa small point of the tumour, for whichpurpose a piece of adhesive plaster, witha hole cut in its centre of sufficient sizefor the application of the caustic, shouldbe placed on the tumour, which serves tolimit the action of the kali to the desiredextent. This done, the kali is to be rubbedon the skin, until a sufficient action is dis-tinctly produced, which is indicated bythe discoloration of the skin. If, in twoor three days, it is found that the actionof the kali has not been sufficient, it mayithen be reapplied and rubbed on a greaterextent of surface, or with greater force,thus securing the formation of a larger9. and deeper slough. In this manner may _
i it be used any number of times, and it ist surprising, hfter a complete slough has
thus been formed, how rapidly the subja-cent tumour melts away. It is not requi-site that the dead portion should separate,and leave the ulcerated surface exposed. Onthe contrary, the slough should be left un-molested, as it forms the best dressing, andthe ulcerative process will be found to goon imperceptibly, as it were, underneath-it, its progress being indicated only by the-collapse of the tumour._,..__.,..,_.._..._ ___.. __-__......_.
The excellent effects of the kali purum,and the mode of using it, are illustratedin the following cases:-
Case 1.—An infant, two months old, wasbrought to me with the largest subcuta-neous naevus I recollect ever to have seen.It was situated on the left side of the
chest, its base covered the greater portionof the pectoral muscle, and it was of suchbulk as to prevent the arm from restingon the side. It had all the usual charac-ters of this species of tumour, and the childappeared, in other respects, to be in per-fect health. The removal of so formidablea mass with the knife was quite imprac-ticable, and to attempt to include it in aligature would have been equally hazard-ous. I was therefore led to attempt itscure by ulceration, and the result was-most satisfactory. I proceeded with greatcaution, applying the kali only on a sur-face not exceeding the size of a sixpenceat the edge of the tumour. The kali was
applied in like manner every second day-for one month to an adjacent portion of-the tumour, and every third or fourth dayfor the succeeding month, the ulcerativeprocess being not only established, but ac-celerated, by this mode of treatment, theresult of which was, that the whole of the
mass ulcerated and sloughed away; andwhen 1 saw this child several years after,
I had the gratification to find that no ves- tige of the tumour remained, nothing, infact, to denote that it had ever existed, butan extensive cicatrix.
Case 2.-For the following account of avery large naevus on the face, treated by iulceration at the Hospital of Surgery, Iam indebted to Dr. REID, under whoseimmediate care the treatment was con- ducted :—
July 1, 1829. A boy, eight months old, ’jhad a tumour of about the size and form iof half a small orange, occupying the cen- tre of the right cheek, and flattened at thetop, where there was no open sore, butwhere the surface was of a speckled whiteand red colour, and concave. The edgesof this indentation were of a dark red,and much thickened. It could be handledfreely without causing the child to cry.It was increasing rapidly in size, and the Itemperature of the part was always higherthan that of the other cheek. Several,eminent surgeons saw this case, and gavean unfavourable opinion as to its termina-tion, in consequence of its great size andsituation. One gentleman thought thatexcision offered the only probable chanceof cure, but was afraid that the diseasehad spread too deep to allow even of thatoperation. On the 7th of July, a space ofabout the size of a sixpence, in the centre’of the tumour, was rubbed freely with thekali purum, a piece of plaster with a holein it of the requisite size having previouslybeen applied. Two days afterwards itwas again rubbed, only a very smalleschar having formed. On the 19th of
August, up to which time the kali hadbeen applied every other day during thefirst fornight, and every third day afterthat time, the whole apex was covered byan eschar, half of which had come away,leaving a cavity in the tumour. On the25th of August the tumour was much re-duced in size; the eschar then occupieda space of about the size of a crown piece,and the cavity was filling up with granu-lations. The kali was now again appliedround the edges. The application of thecaustic was continued on different parts ofthe tumour about twice a week, untilwithin a few days of the 14th of Septem- Iber, on which day the eschar was entirelythrown off, and the sore had healed. Inanother week a fresh eschar, of about thesize of a shilling, was formed, as therestill remained an elevation above thecheek. One or two sloughs were againthrown off, and the tumour was broughtto a level with the cheek, and by the be-ginning of November nothing was observ-able but the scar occasioned by the caus-tic, and a certain induration of the integu-ments.
There has never been the slightest in-crease in size of the cheek since that pe-riod, and as the boy has grown up, the! scar has become even less observable than’ before, the parts being much softer to thetouch than formerlv.i Remarks.—These cases are sufficient to’ point out the mode by which nævi, of
! whatever size, and in whatever situation,! may be cured by ulceration; and I mayremark, that I have never yet met withany case in which such treatment was not! applicable. In my opinion, indeed, thisplan renders the more severe operationsof extirpation, and, more particularly, oftying large arterial trunks, such as thecarotid artery (which dangerous modes oftreatment I had recourse to myself in three’ instances, before I was aware of the plannow detailed), quite unnecessary, and, infact, I would say, inadmissible. As such
, serious operations are still resorted to bysome eminent surgeons, I am the moreanxious to make public the present safeand efficient mode of curing nasvi.A considerable number of cases were
treated on the principle of ulceration inthe Hospital of Su)-ye;-,q, in Panton Square,! and I have adopted it in a great number
’! of instances in private practice. Manycases have since been successfully treatedwith the kali purum by other surgeons.
DESCRIPTION OF A PECULIAR
DENTAL APPARATUS ATTACHEDTO THE VERTEBRAL COLUMN.
Described by M. JOURDAN to the Academyof Sciences, Paris.
M. JOURDAN has discovered in thecoluber scaber of Linnæus, in the upperpart of the alimentary canal, a kind ofdental apparatus composed of thirty osse-ous processes covered with enamel, someof which were formed like incisor teeth,and projected two lines into the cavity.These processes belong to the thirty ver-tebras which succeed the axis, and withregard to their form may be distinguishedinto two series. The first comprises twenty-two teeth; they are elongated from be-fore backward, and flat transversely ; theirprojection in the body of the vertebra isbarely more than a half line, and thecrown of the little tooth is sharper as it isnearer the head of the animal. They havenot all the same direction ; the anteriorare directed downward and backward;the middle, directly down; the posterior,downward and forward. In the subjects