No, 337.

LONDON, SATURDAY, FEBRUARY 13. [1829-30.

LECTURES ON SURGERY,

MEDICAL AND OPERATIVE,DELIVERED AT

St. Bartholomew’s Hospital ;BY MR. LAWRENCE.

LECTURE XX.

fTrtdroplaobia continued—Bites of VenomousSerpents-Injuries received in Dissec-tion—Malignant Pustules.

I MENTIONED to you, Gentlemen, in thelast lecture, that hydrophobia can only beproduced by the application of the saliva ofa rabid animal. You may, probably, haveinferred from this statement, although I

did not specifically mention it, that the salivaof a rabid animal, in producing the disease,does not act through any other medium,than that of a recent wound. It may, for

example, be applied with impunity to theentire surface of the skin, the skin coveredwith its cuticle; and that it may also beapplied with impunity to the surface of mu-cous membranes. It does not produce dis-ease by either of these modes of applica-tion.Bites of Venomous Serpents.—A very

active poison, that is, a poison capable ofproducing very serious effects in other ani-mals through the medium of wounds, is pro-duced by certain serpents. In this respectthe serpent tribe consists of two divisions.The one class are quite innocent, those ofthe otber secrete this peculiarly virulentpuson, which, when applied to a recentwound in man or beast, produces effects asfatal as those that take place in hydrophobia.The effect, in fact, in the case of a bite re-ceived from a venomous serpent, is producedmore fjuickty. The same interval of timewhich occurs after the bite of a rabid animal,hs not take place in the instance I am now:: uding to.la the venomous serpents there is a glan-

dular auoaratus in the Beiehbourhood of the

jaw, which secretes the poisonous or acridfluid. The duct of that gland runs throughthe centre of what is called the poisonousfang of the serpent. The poisoned fang ofthe serpent is a very long and sharp-pointedtooth, which is hollow internally ; in fact,the hollow of this tooth is a continuation ofthe excretory duct of the poisoned gland, sothat, when the serpent bites, the poison inthis fang passes through the fang into thewound which is inflicted by it. In this re-

spect, you will find that there is a markeddifference between the teeth of the innocentand venomous serpent. In the engraving Ishall now send round, you will see a repre-sentation of the head of the boa constrictor,a very large kind of the class which is inno-cent. In the lower jaw, you will observethat there are four rows of teeth, two to-wards the palate, and two towards thefront of the jaw. In the upper figure, whichrepresents the head of the poisonous ser-pent, you will find that there are only twoof those parallel rows, namely, the palatineteeth, and that, instead of the others, thereis simply a large fang, projecting towardsthe edge of the mouth, and this is the poi-soned fang. So that, if you could see the

open mouths of serpents, you would imme-diately be able to discover whether theywere innocent or poisonous. This fact,however, so far, is not very material, for onecannot exactly take hold of the head of thesnake, and open its mouth for the purposaof examining its teeth.

There is a large variety of the venomousserpents. The head of the serpent repre-sented in that figure, is that of the rat-tlesnake, a well - known serpent, which

is found extensively on the continent ofNorth America. Its venomous power is

very considerable. In the East Indies thereare several varieties of venomous serpents,but the fatal power varies very considerably.There is one, commonly known by the nameof " cobra di capello." It is called in Eng-lish the spectacled or hooded serpent; forimmediately before it is going to bite, it

corrugates and curls itself up, and there ap-pears to be a swelling just behind its head,very like spectacles ; it is the coluber can-natus of Linnæus. In the West Indies

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there is a serpent which is most generallyobserved to be yellowish or spotted, andwhich is called by the French, " Grandevipere fer-de-lance de la Martinique." Inthis country we have only one serpent pos-sessing a venomous quality, and that is theviper, the " coluber cannatus" of Linnæus.

I believe the poison of the animals I havejust now mentioned to you, the rattle-snakeand the cobradi capello, acts most virulently;that is, their poison acts the most rapidlyupon the vital powers. A fowl bitten by aserpent dies in the space of half a minute.The bite of a rattle-snake has proved fatalto a dog in half an hour, but it has requiredthe space of some hours to produce a fataleffect in the human subject; and I fancy itcannot be considered that the bite of theseanimals is invariably fatal in the humansubject, for the quantity of venomous mattercommunicated by them, is various. Thebite of the rattle-snake has a differenteffect, if the animal have not bitten for sometime previously, to what it has under othercircumstances. Supposing the animal hasbeen kept for some time, and has not bittenso as to exhaust any of its venom, it willthen produce a greater effect when it doesbite, than it would produce at other times.In the case of the poison of venomous ser-pents, the same conditions are necessary forits activity, that I,have mentioned to youin instances of hydrophobia,—the poison-ous fluid must be applied to a recent wound.The poison of the viper, or of any other ofthe serpent tribe, may be taken into the sto-mach with impunity. It may be appliedwithout injury to the surface of the body.Thus the bite of a single viper will deprivea pigeon of life very speedily, and a singlebite by no means exhausts the whole of thepoison in the excretory duct of the gland;but you may take the whole of the poisonfrom ten vipers, moisten bread with it, giveit to a pigeon, and it will produce no effect.Thus a student, who was assisting in an in-quiry of this kind, took bread moistenedwith all the venom that could be procuredfrom four large vipers, without its pro-ducing a bad effect. It is necessary, there-fore, that the poison of serpents should beapplied to a recent wound. No other modeof application to the human body, can pro-duce a deleterious effect.

In the experiments, too, that have beenmade on animals, it has been sometimesfound, that dogs wounded with lancets, onwhich the venomous matter has been placed,have suffered no injury ; while, if they werebitten by a serpent possessing the same

species of venom, all the usual effects tookplace.The bite of a poisonous serpent produces

considerable pain in the part that is bitten,and hence the part swells. This swelling

I extends, supposing the bite to have takenplace in an extremity, towards the trunk ofthe body. It not only becomes swelled, butit becomes hard ; and if the patient-if theindividual or the animal survive, the partwill turn livid, vesications will arise on itssurface, mortification will ensue, and, in thefurther progress, the cellular texture of thelimb which has been bitten, will go into astate of inflammation and ulceration ; and,in fact, it will assume nearly the state of alimb in which phlegmonous erysipelas is

produced. At the same time that these lo.cal symptoms take place, very serious effectsare produced on the heart, the circulatingand nervous systems, and the stomach; the

pulse is oppressed, intermittent, and irre.gular; fainting occurs ; the patient is sick;and perhaps the stomach reje’cts every thin,that is taken into it. Paralytic attacks areexperienced; the patient or animal is unableto move the extremities, and becomes ex.tremely feeble. The power of voluntarymotion seems to be lost, vision is impaired,and the most serious effects are produced;under these circumstances, death generallyensues very rapidly. ’

Treatment.-In the treatment of injuriesof this kind, the first object, of course,!’,if the case have been seen at a sufficientlyearly period, to prevent the passage of thepoison from the wounded part towards thecentre of circulation. Hence it is of im-

portance to apply a ligature between thesituation of the wound and the heart; and’if this be done very early, the occurrence ofthe symptoms I have just mentioned, will beprevented. It seldom happens, however,that a case is seen at a sufficiently early pe-riod, to admit of this mode of treatmeut;and, of course, if a ligature be applied, sup-posing the swelling to have already occurredin the limb, it will very likely aggravate thesymptoms rather than relieve them. The

application of a ligature, then, for the pur.pose of preventing the poison passing to thecentre of circulation, and to that of thenervous system, can only be adopted withsuccess at the earliest period after the injuryhas been inflicted. It has been found, byrecent experiments, that if poison have beenapplied to a recent wound, and you apply acupping-glass, so as to produce exhaustionof the air, absorption is prevented; there-fore, if you have the opportunity of doing it,the application of a cupping-glass over theseat of the wound would be advantageous incases of this kind.

Supposing you had not the means of ap-plying either of the remedies I have men-tioned to you, that is, if you do not see (becase sufficiently early, you would have re-course to what I have pointed out to you asnecessary to be done in hydropliobia,namely,careful ablution, to remove the matter from

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the wounded part. You may’then cut awaythe surface of the wound ; at all events, youmay scarify and open it, to afford the oppor-tunity for more complete ablution ; or youmay cut it away altogether, so as to removethe immediate seat of the poison. Such,then, are the local means that may be adopt-ed in cases of this kind.Wtth respect to the general measures, the

symptoms that come on are so serious, therapidity of their progress is so great, and80 fatal, that you have very little time for Idelay; you must select remedies, therefore,that you can employ quickly.Now, general experience has shown, that

medicines of a stimulating nature are bestadapted for cases of this kind. Indeed,when you see the depression of the circu-lating system, when you see the powerfullydepressing influence that is exerted over thenervous system, you naturally conclude thatstimulants are the most appropriate. It hasgenerally been found that volatile alkali,exhibited internally, has been followed bythe best effects. Any medicine of thiskind may be given with tolerable freedom.It has been also supposed, that it may beapplied with equal advantage to the wound-ed part, although on this point I think theremay be some doubt. A preparation thatwas called eau de luce, has been consideredto possess a very beneficial effect; it isabout equivalent to a preparation of our own

of the volatile alkali, with some other ingre-dients. In the East Indies, where veno-mous serpents are numerous, and wheretheir bites are very serious, a remedy of thecountry, which has been called the tunjouepile, has been found to exercise a very con-siderable effect ; the chief ingredientin thesepills has been discovered to be arsenic. SomeEnglish practitioners, adopting the hint,have in consequence employed arsenic veryfreely, and in one of the volumes of theTransactions of the Medico-Chirurgical So-ciety, there is a series of cases, related bya surgeon who had an opportunity of ob-serving several of this kind in the WestIndies, where, I suppose, the animal thatinflicted the wounds was the yellow or spot-ted serpent—the 11 grande vipere fer-de-lance de la Martinique." In these cases heexhibited two drachms of Fowler’s solution Iin the effervescing draught, and repeated it ievery two or three hours. He has relateda number of cases in which he adopted thisven’ boid treatment with good effects. Ieail it bold treatment, because two drachms !of the solution of the liquor arsenicalis, orFowler’s solution, contain, I believe, a’]greia of the white arsenic, and I think we i .do not, in general, begin by using the solu- :tion in a larger quantity than about five or aseven drops to a dose.A case of the bite of a rattle-snake occur-

red in this country some years ago. A person, who took care of some animals thawere carried about for exhibition, was bitten in one or two places by a rattle-snakewhich formed part of the exhibition; thi;individual was taken to St. George’s Hospi.tal. His case is related by Sir EverarcHome, in a paper in the PhilosophicalTransactions, I think in about the year 1811,But, according to the result, it would seemthat the bite was not so venomous as wehave been accustomed to suppose it to be for I think the man lived 14 or 16 daysafter he had received the injury, and, in-deed, recovered from its immediate effect,though he died from general inflammation.and sloughing of the cellular membrane ofthe arm, the effect of what might be calledphlegmonous erysipelas of the extremity.Now, in this country, we have not much

opportunity of observing the bites of veno-mous serpents in a dangerous shape, or ofputting into practice any of the remediesthat have been recommended. The onlyvenomous serpent here, as I have alreadymentioned, is the viper, and the venomouspower of that reptile is so feeble as not, ingeneral, to endanger the life of the human

subject. Small animals may be killed by aviper, but its bite does not usually kill adog ; it requires, according to the experi-ments of Foster, three or four viper-bites tokill a dog, yet I must observe. to you, thatthe swelling of the part, and the disturbanceof the nervous, the digestive, and the cir.

cuiating systems, are very serious in thehuman subject after the bite of a viper, and,in many instances, when it has taken placein the young subject. it has nroved fatal.

Wounds received in Dissection.—Underthe division of poisoned wounds, in the syl-labus drawn up for this course of lectures,I have attached a query, a note of interro-gation, to the subject of " injuries receivedin dissection," and I have done so in orderto express the doubt which I feel in myown mind, whether injuries of this kind-whether the effects of such injuries-areowing to the introduction into the humanform of a poison or not. It seems to be verydoubtful in those cases, whether any thing’actually venomous or virulent is introduced,or, whether the results of these injuries mustbe said to arise from such wounds, con-sidered merely as mechanical wounds. Ifthese be poisonous wounds, the poison cer-tainlv follows other laws than those we ob.serve in cases in which we are more inti-

mately acquainted with the poison. If welook at small-pox, cow-pox, scarlet fever, orsyphilis, we see that the application of thepoison produces pretty surely certain effects,and that these will become apparent withina certain time; that they exhibit a certaincharacter, not difficult to be described before-

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hand, and yoti can aseertain, pretty clearly,the symptoms and the course of such inju-lies. But we can give no such descriptionof injuries that arise from wounds receivedin dissection. If they arise from a poison,then it is one of a very uncertain, and, almost you might say, capricious kind.

In the first place, in the great majority ofinstances of wounds received in dissection,no injurious effect is produced. There arehundreds and hundreds of such wounds

always occurring without any injurious con-sequence. It is really only in a very small- proportion out of the whole number ofwounds that are received, that any prejudi-cial effects are produced in the human frame.We can, perhaps, quite as well explain theoccurrence of these effeets, when they dotake place, by a reference to the particularstate of health of the individual in whomthey occur, as by any particular virulentproperty that might be applied to the wound.Now, it happened to myself, when I wasemployed in dissection, as it has happenedto many gentlemen present, to cut myselfhundreds of times, in dissecting bodies ofall kinds-in dissecting bodies that havedied under every variety of disease, and Inever experienced any ill effect but once,and then I was not in very good health.I had an inflammation of the finger, withswelling up the hand and arm, and, subse;quently, swelling of the glands in the axilla,with suppuration. There are cases, how-ever, in which important local effects are

produced, and in which very serious, andeven dangerous, symptoms occur.

It is then, perhaps, rather a question ofcuriosity than one of direct practical conse-quence, whether these effects arise from a

poisonous matter communicated to the frame,or whether they owe their origin to a par-ticular state of health in the individual atthe time the wound is inflicted. In thefirst place, we cannot point out any particu-lar state of a dead body, or any condition ofprevious disease, that will certainly giverise to any set of symptoms in these cases.Indeed, we shall observe an individual re-ceive a prick or a cut in the dissection of acertain subject, and suffer certain inconve-nience from it ; while others, who have dis-sected the same subject, suffer no injuriousconsequences at all from a similar injury.Then, in the majority of instances, the

effects that are produced seem to be merelysuch as would arise from the infliction of thewounds considered in themselves, withoutany reference to the state of decomposi-tion of the dissected bodies in which theyoccur. Inflammation comes on in the seatof the wound ; suppuration may take place ;the absorbents leading from it become in-flamed ; the absorbent glands to which theylead may become inflamed; the cellular

membrane in which it is seated become!inflamed, and this spreads throughout thewhole limb generally, so that phlegmonouserysipelas is produced. This, in fact, is

capable of itself, without the existence,without any suspicion of the existence, of apoisonous cause for its origin, to give useto very serious local and equally senous ge-neral symptoms. A great majority of thecases ill which those serious local effectsarise, admit of explanation, without anysuspicion of the existence of a poisonousproperty as the immediate cause. The

cause, therefore, arising from the existenceof a poison, must be confined to a few caseswhere some particular local, and some par-ticular general symptoms are produced.With respect to a great number of the ordi.nary cases, I think there can be no hesita-tion whatever in referring the phenomenawhich they exhibit to the effects of thewounds, considered merely as causes ol localinflammation. There was a gentleman, aformer pupil of this hospital, who wounded

his thumb in sewing up a body ; the bodyof a female who had died of some disease ofthe peritoneum. I believe he was hardlyaware of having injured himself, the pnckwas so slight. However, in the course ofthe night after he had received this injury,he felt a very severe pain in the part. He

might but have scarified the part a little,and received some slight wound; however,he felt extremely unwell, and when heawoke in the morning, lie sent for a medicalfriend, who found him in a state of greatexcitement. He was a robust and hearty

person, of a full habit. His friend foundhim with a full, hard, and strong pulse, with

considerable swelling about the part wherethe injury had been received, and that swell-ing extending to the fore-arm and arm. Hewas so extremely restless, and his nervoussystem was so much disturbed, that hecould hardly keep himself quiet. He wasin

’ a state, in fact, which called immediatelvfor pretty active depletion, which was re-sorted to, and he lost about thirty ounces ofblood, I believe, with considerable relief.He was better the next day, but still the

upper extremity generally was swelled ; theabsorbents leading from the thumb along the

fore-arm and the absorbent glands in theaxilla became inflamed ; he had pain in thehead, and the nervous symptoms cont:nufd.Leeches and cold were applied to the head,and purgative medicines were administered.On the following day all the symptoms wereworse ; the limb was more swelled ; the ;n-flammation of the absorbents and of the Db-

sorbent glands more obvious ; -all the symp-toms were more serious, and on this day Isaw him. He fancied, from the swelling ofthe ball of the thumb where the injury hadbeen received, that there must be matitr

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there, and he very strongly urged the neces-sity of opening it to let out the matter. Al-

though no matter was felt, a pretty deep in-cision was made into it, and a small drop ofmatter did actually flow out. A poultice wasapplied to the part, and he was greatly re-lieved. The puncture was made very deep,and when the limb was enveloped in thepoultice, he lost about thirty or forty ouncesof blood without being aware of it. Thereseemed to be a considerable artery cut, andhe was the better for it. However, the

swelling of the fore-arm and arm went on,and in the course of the day on. which theincision was made, and between that andthe following day, in consequence of theurgency of the symptoms, he lost blood fromthe arm twice, and had an enormous quan-tity of leeches applied to the head, the armand fore-arm. Indeed the only relief he ex.perienced was from the application of theleeches, and these he applied without count-ing them, merely taking a handful and lay-ing them on, and after their removal layingon another handful, so that, in the space ofabout four-and-twenty hours, there wereabout a couple of hundred leeches applied tothe upper extremity. By these means theinflammatory action was pretty considerablyreduced, and after the lapse of about threeor’four days, he found himself exceedinglyaltered. At that time, and while lie had agentleman attending him almost constantly,(Dr. Gordon,of Finsbury Square), a particularchange took place. The limb became feebleand cold, and, under these symptoms, Dr.Gordon gave him a large quantity of opium,which relieved him; he continued exhibit-

ing opium until the symptoms were removed,and, in this way, under the employment ofopium, he gradually recovered. Now, I canhere see nothing more than the effect oflocal irritation, the production of very highinflammatory action in the. constitution of anindividual whose habit disposed him to it,while the effect of depletion, in controllingthat disturbance, is made very apparent; sothat in a case of this kind, I couceive therecan beno reason for calling in the aid ofapoi-’son to account for the effects I have detailed.We do not require the action of poison atall to explain the symptoms in this case.There are some other cases in which the

local and general symptoms have been ra-ther different; and it is in those particu-larly, that the agency of poison has beenregarded as the true cause. There was aphysician who lived in the neighbourhood ofLondon, who examined a lady that had diedof puerperal peritonitis at eight o’clock inthe morning of the 28th of December. Heassisted in sowing up the body, and was notaware that he had injured himself; he didnot know that he had pricked himself. At

eight in the evening of the same day, I

being then dining out in company with afriend, he felt some heat and uneasinessin the end of one of his fingers, and he

then thought he must have injured himself.On looking at the finger, a slight blushwas observed upon it, and when the partwas more particularly examined, a minuteopening in the centre of that blush was ob-served, so that the inference was, that hehad pinched that partin sewing up the body.He had it touched with the nitrate of silver,and also with a small quantity of the nitricacid, those applications being at hand. Now,these remedies were unattended with pain.He went home, and finding the finger still

uneasy, as the former applications hadgiven him no pain, he again applied thenitrate of silver, continuing the applicationtill he felt it sensibly, and then the painthus produced increased to a degree ofagony. Shiverings came on, and he passeda terribly restless night. When he was seenearly in the morning, red lines were ob-served extending along the back of the hand.At eight in the morning of the 29th, theeschar was observed to be about the size ofa split pea, which of course was supposed toarise from the application of the nitrate ofsilver. Leeches were directed to be applied,and fomentations, poultices, and aperientmedicines ordered. About one o’clock onthe same day, that is, on the day after thaton which he had opened the body, the fingerappeared swollen, and put on a livid appear-ance, the pain being very considerable. Themedical friend who saw him, made an inci-sion through the integument down to thebone, and by so doing, found that the twolast joints of the finger had mortified. Noblood flowed, nor was pain experienced.The last phalanx and the middle phalanx ofthe finger were already in a state of gan-grene ; red lines were observed extendingalong the fore-arm up to the ulna, and un-easiness was felt in the axilla. At this timehe experienced a complete prostration of

strength, and felt himself as weak as a child.There was an irregularity in the breathing,considerable torpor, and the pulse from 90 to100, and soft. During the rest of the day,he had much of a heavy kind of sleep, withintervals of severe pain. The hand and arm.swelled now very considerably ; the ab-sorbents inflamed along the arm, and theaxillary glands also became affected. A

greater degree of torpor and depression su-pervened, with difficulty of breathing, ac-

companied by an erysipelatous blush iu theaxilla, and about the side of the chest. Am

opening was made in those situations with.out giving vent to any matter, and the gen-tleman died at six o’clock of the morning ofthe ist of January, the fourth day after sew-ing up the body. Now, in this case there;certainly was a remarkable effect produced

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; very rapidly; a chain of serious effects on; the animal economy, by which, in the space! of four days, death was produced in an in-’ dividual previously healthy. A gentleman,

who was a few years ago a dresser at thishospital, an individual not very exemplaryin his mode of living, being apt to indulgein the pleasures of the table, and not quite apattern of regularity, opened a body, in thecourse of which he slightly pricked himselfin one of his fingers. It happened, that onthe day on which this occurrpd, he had a ilarge party of friends at his house, and thathe drank very freely. In the course of the

night he was awoke with excessive pain inthe finger, and before the middle of the fol-lowing day, the last phalanx of his fingerhad mortified. Swelling of toe finger, ofpart of the hand, and of the limb generally,inflammation of the absorbents, and of theabsorbent glands, took place, and thus con-siderable fever, combined with phlegmonousinflammation of the hand, fore-arm, andarm, occurred, and the patient was in a stateof the greatest danger. However, by makinglarge incisions through the skin and cellularmembrane, he recovered.Now, it is to be observed in the first of f

the cases I have mentioned, that of the phy-sician who examined the body of the lady,and who died in four days afterwards, andas in many other of the most serious cases

that are recorded, the injury had been re-ceived in the examination of patients who

had died of inflammation of the peritoneum,and more particularly of puerperal perito-nitis ; so that if there be any poisonous in-fluence capable of being communicated tothe body, it would seem to be more espe-cially from the bodies of individuals whohave died of this kind of disease. In thecases of these two individuals, however, wehave instances in which on the one handmortification took place at a very early pe-riod, and was soon followed by death., and,on the other, of mortification followed by re-covery.Now, so far as the mere occurrence of

mortification, consequent on an injury, goes,1 do not deem it to be a sufficient proof of :the operation of any poison. I remember every well a butcher’s boy being broughtinto this hospital and placed under my care, 1

whose hand had been pierced by a look, :which had torn away a large triangular flap iin the palm of the hand. It had not merely !torn the skin, but both the skin and cellularmembrane, making a flap which one wouldhave united very well to the subcutaneous t

parts; yet, in that case, the flap mortified, c

though the wound was produced merely by ia hook, so that the mere mortification does r

not prove that any poisonous influence has tbeen excited, nor does it appear to me that c

the general symptoms of these cases are 9

such as to induce a belief to the eontrarg,We merely observe in them such sympa-thetic influence upon the circulating andnervous systems as may be produced byserious local injury, without the presence ofany poison whatever, but which, occurringunder particular states of health, is such,that in one case it terminates in recovery,and in another is fatal. I am still in doubt,therefore, whether there is any poison com.municated in cases of injuries received indissection.

Malignant Pustules.-I am aware thatanimal substances, in certain states of de.composition, are capable of producing a

directly deleterious effect upon the humanframe. I have already had occasion to men-tion to you, in speaking of mortificationfrom local injuries, of the influence of whatis called malignant pustule, where mortifi.cation takes place. This is not very com.mon in this country ; but, in others, wherebutchers flay certain kinds of animals, andchance to cut themselves, attacks of this dis.ease are experienced, and a particuiar eflectis produced, which takes a certain course.Professor Delpech recognises this disease inhis treatise. There is a iegularity in its

proceeding, which indicates the existence ofa certain specific or peculiar cause..we donot see anything like this to account for theserious consequences that are observable incases of this kind, of which we ourselves aresometimes in possession.

Treatment.—Now, with respect to thetreatment of injuries that are received in

dissection, some persons adopt the plan oftouching the wound with the nitrate of sil.ver, and I should suppose that that is a safeand a good mode of proceeding. There canbe no doubt that if you expose the wound,thoroughly wash it, and touch it with thenitrate of silver, you would be likely to pre-vent any ill consequence likely to arisefrom it. Some have recommended that itshould be washed with the oil of turpentine,which would have nearly the same result.These are means of a preventive kind.Now, if any inflammation should come on,

I conceive it would be necessary to keep thepart in which the wound has been receired,at perfect rest ; to foment or to poultice it,to apply soothing’ applications. If there weresymptoms of decided inflammation proceed.ing, then it would be necessary totake bloodfrom the part by leeches; to take medicinesfor the purpose of evacuating the aliment-ary canal; and to adopt such measures ofthis kind as might be necessary until tbs

danger is past. If still more considerableinflammation should have come on, and, ifmatter should have formed, then I sbouldthink it advisable to open the part free!). Incases in which inflammation, swelling, andany thing like the formation of matter, occurs

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at a distance from the seat of injury, that isfor example, in cases of wounds in the

fingers or hand, when redness and uneasi-ness occnr about the axilla or chest, if an)thing like the formation of matter should beobserved there, I think the best course oi

proceeding would be freely to open the part,The danger in this case is of inflammation

arising and proceeding in the cellular mem-brane of such parts; and, when it does sc

proceed, we know very well that there is awant of disposition in the parts to limit theinf,ammation ; that such inflammatiou is aptto creep on and involve them to a consider-able extent ; that the matter does not tendto approach the surface, and, therefore, thata free incision into the part is according toexperience a most advantageous mode oftreatment.As to the constitutional disturbances that

may ensue in conjunction with these localsymptoms, generally speaking, they are al-together of an inflammatory kind, and bytreating the case by the antiphlogistic meansaccording to the extent of disturbance, youwill succeed best. I confess I do not regardthose cases with any thing like feelings ofalarm; because, in the great majority ofinstances, if proper attention be paid to them,

, they terminate favourably. I do not con-ceive, therefore, that, generally speaking,they should create alarm or be viewed withapprehension. I acknowledge that I amratlierinclined to discourage the idea thatthese wounds are of a poisonous nature, be-cause I conceive its prevalence likely to

give rise to much unnecessary alarm. I donot, however, argue against the supposi.tion merely on this ground, but I give youmv real and serious opinion upon the sub-ject, free from any notion of that kind ; I amglad to be able conscientiously to arrive atthe conclusion I have come to, that youranatomical studies might not be prosecutedwtthdreitd.

Although the venereal disease is capableo being communicated during life, we donot know of its having the power of beingcommunicated from the dead subject to theiinttg. Neither in cancer, fungus hæma-todes, nor in any similar case, have we anyinstance of disease of the same kind beingcommunicated to the human body throughrL° medium of a wound inflicted in dissect-ing the parts after death.I have mentioned to you, that I have only

once suffered inconventence from a woundinflicted while dissecting, and that was inopening a person who had died of cancer intLe stomach. In that case it happened, as does in many others, that the body (Vas

opened very recently after death ; it was

scarcely cold. The man died of the most for-midable affection of the stomach, and I wound- my fore -fin-ey, 0 from which very consi-

derable swelling of the glands of the axilla,with induration and suppuration, came on.One of my medical friends who was kindenough to visit me, made, 1 observed, avery long face when he saw the case, andhe conceived, as I afterwards found, that theglands in the axilla had taken on a scirrhouscharacter, which partook of the same affec-tion as existed in the stomach of the body Ihad examined. He mentioned this to ano-

ther gentleman who was visiting me, withstrict injunctions not to let me know of it,for fear of its alarming me; however, thoseinjunctions were not attended to, and wehad a good laugh over it, because I was notin the slightest degree alarmed. Now, cer-tainly, in examining cases of this sort, casesof cancer, syphilis, fungus haematodes, andso forth, I do not know of any particularpoison being communicated to wounds re-ceived on such occasions. There may be

exceptions to this general rule : there are, Ibelieve, some instances recorded, of indivi-duals who have received wounds, either inthe examination of animals dyingunder par-ticular states of disease, or in administeringsomething during life to those animals ; forinstance, there are instances in which indi-viduals have received an injury to the handwhile administering medicines to a glan-dered horse, and particular symptoms haveoccurred ; , abscesses, for instance, haveformed in parts of the body. Now it has beenfound, that the matter of such abscesses is

capable of communicating the glanders tohorses or asses ; so that there may be in-stances of particular poisonous wounds com-municating peculiar poisonous effects to thehuman frame.

EDINBURGH UNIVERSITY.

LCLINICAL LECTURES IN MEDICINEBY

DRS. ALISON and GRAHAM.

[January 14th and 18th.]

SEVERE CASE OF TYPHUS GRAVIOR.

[Concluded from p. 629.]AT the conclusion of the lecture on the

18th inst., L.. Alison finished his observa-tions on this case (BV. Meikison’s):—

Although the termination of his diseasewas accompanied by remarkable stupor, yetno morbid effusion of serum was found inthe brain. Such effusion is usua’1y metwith in some degree in similar cases to thepresent, but geiieraUy bears no proportionto the stupor ; the inference therefore is