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Page 1: Reviews and Notices

121

Rapidly fatal Diabetes.M. BECQUEREL exhibited recently before the Society of

Physicians and Surgeons of the Ilospitals of Paris, his instru-ment for determining the amount of albumen in the serum ofthe blood, and of sugar in diabetic urine, by the effects ofpolarized light. At the close of his communication he men-tioned the case of a boy, nine years and a half old, who wascarried off in six days by what he calls acute diabetes—an ex-

pression but very seldom met with. Death took place bycoma, and the urine was very abundant, far greater in amountthan the ingested fluids; clear, staining the linen with pitchyspots, sweet to the taste, frothy, acid, and of a density of 1035.In a thousand parts the solid contents amounted to 94.5 parts,and a quart of urine contained between two ounces and ahalf, and two ounces and three quarters of sugar; the polarizedlight marking between 6°35 to 6°50 on the instrument.

Sterno-sternal Luxations.

A French surgeon writes to L’Union Médicale, in order togive publicity to a case of luxation of the upper piece of thesternum from the middle piece, without fracture. The pa-tient had fallen from a height, upon his feet, in bending fo:-wards. It was M. Maisonneuvo who, in 1842, first set forththat these displacements are not fractures, but dislocations.

Reviews and Notices.

Observations on the Pathology of Group, with Remarks on it,,Treatntent by Topical Remedies. By HORACE GREEV, A.M.,M.D., &c. John Wiley, 161, Bro.’idway, New York; and13, Paternoster-row, London. 1849. 8vo, pp. 115.

IN these days, when the various arts and mechanical inven-tions have done so much for the facile communication of man’sthoughts—when knowledge is so easily diffused through everyramification of society-when hundreds are candidates for thehonours of authorship, where only tens, or perhaps units,would have ventured, an age ago, into the lists for lettereddistinction,-in these days, when printing is so cheap, andbook-making so common, few who earnestly determine uponwriting, ever dream of delivering to the world their " brain’sdeep-thinkings" in a less pretending form than through themedium of a tolerably thick octavo. Before us is a little vo-

lume, propounding new views in the treatment of one of thegravest and deadliest of maladies; and if the author had been soinclined, might have been swelled, by learned comments onthe views of other writers; by telling what is already knownof the affection, in elaborate and diffuse disquisitions, and bythe tedious enumeration of cases, into a portly size. However,considering the importance of the subject, and its practical im-portance, we will bestow on this little book as much attentionas if it were a quarto.Croup is one of those intractable diseases which has hitherto

in a great measure, bid defiance to the most active treatmentof the acutest observers. How painful it often is, to see thelittle sufferer progressively becoming worse, in despite of themost careful watching, and the sedulous employment of means,which the experience and conclusions of the most eminentauthorities have recommended; and when it is recollected thatthe mortality, from large numerical averages, is not less thanone half of the number attacked, the recommendation of anyimprovement of remedies merits a deep and serious attention.One of the most important means whereby the science of me-dicine has latterly made such signal advancement, has beenmainly owing to the greater consideration which is bestowedupon diagnosis; and thus it is that the prognosis of modernphysicians is pronounced with far more certainty; and it is

mainly owing to that, we maintain, (the correct knowledge ofa complaint,) that the curative means are now more certainand successful. The position long ago put forth by Cullen, that )the practice of medicine is founded on conclusions deduced Ifrom reasoning, is undeniable. The more demonstrable and

intelligible the fundamental causes are made, the better ui

f derstood will be the effects. When these cases, whereon tt

i- superstructure of recovering is reared, are laid bare, tt,f fabric is, by being founded on rational principles, more like]

to endure. Without our notions in medicine being reduciblL- to some such principles, its practice becomes a system of mers empir:cis:n. This general desire, which has of late become-

not only in the sclools, but throughout the profession, so alt parent, to aim at more accuracy in deciding upon the radicft- causes of diseases, is evinced by recent writings on the affe(

tions of that locality in the frame, we are about to considerThere are various affections of the throat, and some of thes4

superficially viewed, greatly resemble each other, although itheir essential pathology there is a distinct and importandifference; for instance, between croup and laryngismus, dming the paroxysmal attacks, there are symptoms very mucalike, but which arise from separate pathological condition!

The one depends upon an active and morbid change existen- in the throat itself; the other may be, as it often is, a reflec’

tion from the lesion of a distant organ or organs. Theformeis the result of acute inflammatory action; the latter purel:confined to the nervous system. Both are dangerous, but onmuch more so than the other, and each demands a distinctand even opposite mode of cure. Now, such being the casenothing can be of greater consequence to the welfare of thepatient than a correct diagnosis. There is, however, more especially in children of highly excitable and nervous temperament, at times a blending, as it were, of the diseases, and it isin such instances when extreme care is demanded in the em

ployment of remedies. A careful examination of the parts,so far as can be effected, and a right knowledge of themost prominent symptoms, exemplifies, in the progress of bothforms of these maladies, a just estimate of the degree oiinflammation-the amount of spasms-the true tempera-ment-the age—the history, and a consideration of collateralfacts, will only lead to truthful deductions. The paroxysms ofdyspnoea, ever, to a greater or less extent, observed duringthe progress of croup, is more depending upon the irritationproduced in the recurrent laryngeal branches which go tosupply the muscles of the larynx than from the mechanicalobstruction, by effusion of membraneous exudation, given tothe ingress of air; and in the fatal instances of laryngitis, (inthe adult,) such is generally the manner in which death proxi-mately ensues. Ve can now call to mind some cases of

laryngitis that went on to a mortal termination, and proved,on inspection, not to have been fatal entirely from the quan-tity of plastic matter thrown out around the glottis, becausethe fissure was partly patulous, but where it was evident spas-modic contraction must have coexisted. When there is buta moderate quantity of effused matter surrounding the glot-tided chink, it does not require the superaddition of anyconsiderable excess of spasm to destroy life. There is, then,a co-operation, as it were, of morbid actions, and as the actualexcitant (inflammation) to the anormal muscular rigidity iscontinuous, the spasm is thus likely to be so persistent as toproduce death. In respect to what we have said with regardto nervous children, Itayland, who is quoted by our author,thus delivers himself on that point :-

" It (croup) sometimes assumes a spasmodic form, insomuchas the vascular excitement is comparatively trifling, whilstspasm of the glottis and general convulsions occur frequentlyduring the disease, and the remissions are singularly long andcomplete:’-p. 8.

As we have said, it is only recently that pathologists havedefined so definitely these complaints; and we are of opinionthat numbers of cases of so-called croup were considered as andtreated for such, when they were reallv of a non-inflammatorylaryngismal character. It is not to be supposed, that becausea child is taken with a sudden fit of dyspncea, attended withcroupy respiration, and at an age when croup usually prevails,

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together with being under circumstances deemed favourableto its development, that it necessarily follows as being croup;a further state of things should first be determined upon, andthe most decisive of these is, whether any traces of inflamma-tion be visible in the throat. In true exudative croup, suchcan always, to a greater or less extent, be observed. If thereshould be sudden and unpremonitory supervention of the

paroxysm, without any previous sore-throat, or symptoms ofcynanche trachealis before, it is far most probable that theaffection was merely laryngismus, and the patient should bepromptly treated for a spasmodic, not an inflammatory disease.We have asserted that the laryngismal affection is oftencaused by a reflex action in the nervous system, and such we eknow to be the case, both from pathological inspections andexperimental investigations. Disease of the brain itself, assoftening, the effusion of serosity, and tumours, will produceit; enlargement of the thyroid gland, mechanical pressureupon the laryngeals by tumours in the neck, will give rise tospasmodic closure of the glottis. The experiments of the lateDr. John Reid showed, most conclusively, how irritation

applied to the terminal filaments of the recurrents caused thesame phenomena. It has been stated, as a question, however,whether this closure of the orifice be proximately producedby the anormal contraction of all the muscles proper to thelarynx, or from a paralytic condition of the antagonizing setof muscles, whose functions are to keep the glottis open?This question, now incidentally mentioned, is a mere physio-logical doubt, and reducible to no practical bearing. Havingsaid that lesion in the encephalic mass is often followed byspasm of the glottis, it is inferrible that sanguineous conges-tion would, in like manner, as by the exudation of serosity,tumours, &c., cause such pressure and arrestment of its func-tions as might endanger or destroy life. In epilepsy, vascular ’’

obstruction at the base of the brain in this manner producesthe asphyxial symptoms that accompany the epileptic pa-roxysms ; and, indeed, in these fits there is a cycle of pheno-mena operating as cause and effect, by pressure giving rise tospasmodic closure of the glottis, the non-aeration of theblood increasing the vascular obstruction, and still further pro-ducing vascular congestion and mechanical irritation in thegreat nervous centres, which continued, augment in multipleratio a deleterious effect upon the vital functions; and thus itis, in puerperal and other fits of that nature, that the emissionof blood, by relieving the cerebro-spinal organs, is a practiceso rational and beneficial. There is " an hysterical affectionof adult age, described by Dr. Cheyne, which not unfrequentlyassumes the character of croup," (p. 11.) This form of thedisease has of late been particularly pointed out by Dr.Wardell, who, in several controversial and other papers, hasclearly shown that a non-inflammatory, purely spasmodic form,does at times occur in the adult, and assume symptoms similarto those which are more commonly observed in children.Dr. Wardell says—" It is by far most frequently seen in thepersons of hysterically-inclined females, but it may be ob-

served, though rarely, in excitable, nervous young men, oryouths about puberty." - (Ranking’s Retrospect, vol. viii.

p. 38.)"The essential pathological character of croup is inflam-

mation of the lining membrane of the larynx and trachea, at-tended by a concrete albuminous exudation, is unanimouslyadmitted by the best pathologists of the day."-p. 13.

Without the formation of a false membrane no acute affec-tion in the larynx and trachea can be termed croup. The

speedy manner in which the exudative process goes on, is thecause of rendering this fearful disease so mortal. When wetake into consideration the minute anatomical structure of the

lining membrane proper to these organs, the pathologicalchanges are well accounted for. The tonsils are almost whollymade up of follicles, and the lining membrane of the larynxand trachea, though in less degree, are the same. It is around

he tonsils and in the larynx that the greatest quantity of theleposition is observed, and the progress of the disease is fromabove downwards; it never commences in the lower part of,he trachea, or in the bronchial tubes, and ascends upwards, asiome writers have believed. This fact is of practical consider-tion, insomuch as we thus see the reason why topical appli-cations to the throat at the outset of the disease are bene-

icial, most especially powerful canstication. The inflamma-

.ion, of course, spreads by continuity, as it always does withmost rapidity in membraneous tissues, and by at once applyingso effective a remedy as that recommended by our author, itmay readily be imagined that the morbid action would bearrested in its progress, whilst the mere employment of cura-tive means, addressed to the system at large, would be so tardyin the production of their effect as to give time for the exuda-tion to go on, with that celerity so characteristic, as we haveobserved, of the inflammation in these organs. Every prac-tical man is aware that acute diseases in young children

always pass through their stages more quickly than in adults;indeed, this truth is equally the fact with the lower animals.In infancy there is a far higher amount of vital action-thecirculation, secretion, excretion, and powers of assimilationare carried on far more speedily. There must be excess offunctional action in the vital organs, in order that renovationshall exceed decay-which is, in other words, growth. When-ever the functions of a certain organ or organs proceed withconsiderable activity, there disease is liable to occur. It is onthis account that children are more prone to acute pneumonicinflammation than adults. There is, perhaps, another reasonwhy the albuminous deposition is so freely thrown out, andthat is, on account of a greater degree of albuminous mattercontained in the blood of young children, mainly attributableto a greater quantity of carbonaceous matter contained in theingesta. To these two causes, excess of the circulatory func-tions, and a great amount of albumen in the blood, togetherwith the minute anatomical construction of the membrane

proper to the parts in question, is to be referred the quickformation of that deposition which constitutes a false mem-brane. The conditions which increase the danger in croupare, the amount of morbid excess, in which the circula-tion is carried on, the presence of a great proportion of albu-men in the blood, the length of time which has elapsed sincethe disease set in, (if long, of course a greater density of theplastic matter,) and the degree of cohesion by which it ad-heres to the surface of the mucous membrane. Some morbidanatomists have been of opinion that the submucous cellulartissue, being as it is generally distended with serous fluid, isan important change, entering into the causation of the fatalresults. Such, however, is a position, untenable becausethere have been observed many instances of inspection inwhich the submucous filamentous tissue was but very slightlysurcharged with serum, whilst at the same time co-existedconsiderable firmly adherent exudative deposition, readilyaccounting, by mechanical and physical obstruction, for thecause of death. Our author has noticed this fact, and cites inconfirmation the authority of Rokitansky. If we remember

right, both Andral and Cruveilhier make mention of thesame.

Of the treatment: " In preparing the solution," says ourauthor, " the pure crystals of nitrate of silver should be em-ployed, and not the fused or solid nitrate, as the latter is muchmore likely than are the crystals, to contain the nitrate ofpotash or copper, or lead in combination. A solution of thecrystals, of the strength of from two to four scruples of thesalt to an ounce of distilled water, when applied freely to themucous membrane, does not act, as has been supposed, byburning, or by a destruction of the textural matter. It formsimmediately co-union with the albumen and other secretionsof the mucous lining, whilst it operates at the same time toproduce a most favourable change in the vital action of theparts:’-p. 29.

In a notice that we made, some months ago, on an excellent

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work by Mr. Wade, on Strictures of the Urethra, as treatedby potassa fusa, that gentleman mentioned objections, like ourauthor, to the common nitrate of silver, and when he did em-ploy that caustic, preferred the crystals, as more pure andmore effective. Our own experience has convinced us thatthere is more danger in the employment of weak than strongsolutions of the caustic preparations of silver; that inflam-matioti of the subjacent and surrounding parts is more prone

-

to supervene when a diluted solution is used, than when thesubstance itself is applied. When diluted, it stimulates and

-

produces inflammatory action; when used in the crystal orstick, the parts subjected to its action are completely altered,

- and the anormal process arrested. We have known the com-mon lunar caustic applied very freely in numerous instancesto the uterus, and remember no instance of untoward results;but we recollect a case recently treated by a solution, whenalarming symptoms supervened in that organ and its appen-dages. This was by the use of the uterine syringe, and theinjection of a solution of caustic into its cavity. Dr. Edwards,in a series of essays on uterine diseases, published in ourColumns a few months ago, (April 17th, 1849,) has directedthe reader’s attention to what we have insisted relative to the

application of caustic to mucous membranes. That writer

asserts, that the local application of nitrate of silver to themucous membrane of the womb is decidedly the safest andthe best. "The solid nitrate of silver," says Dr. Edwards,a will not produce (generally speaking) one half the painfuland uncertain effects as a solution of a few grains to theounce: ’

"The instrument which I have ordinarily employed formaking direct medicinal applications to the fauces and intothe cavity of the larynx in the topical treatment of croup, isone composed of whalebone, about ten inches in length, slightlyeurved at one end, to which curved extremity is securelyattached a small round piece of fine sponge."-p. 83.

Dr. Hancock Douglas, of New York, (who is a near rela-tive of Dr. Green,) called upon us two or three months ago,And showed to us the instrument above described, and of whichthere is a correct representation in the drawing contained inthe work before us. Dr. Douglas assured us he had seen themost marvellous results from the new and fearless method of

practice, which it is the object of this little work to recom-mend. We asked him several questions connected with thesubject, and to each the most satisfactory answers weregiven. Dr. Douglas assured us there was no danger whateverin dipping down the extremity of the instrument to thebifurcation of the bronchial tubes, and that the operation wasat all times easily performed. This gentleman had also inhis case a tongue-spatula, without the aid of which it would bedifficult to freely expose the glottis to the view. On placingthe spatula on the tongue, that organ is readily brought for-ward, and the fissure can at once be seen, and the instrumentreadily introduced. We introduced Dr. Douglas to Mr. Weiss,at whose establishment can now be obtained the instrumentrecommended by our author.In conclusion, we must assure our readers that the little

work before us is one promising the greatest practical interest,and reflects very great credit on Dr. Green for having intro-duced a practice which he unequivocally proves is more suc-cessful than any other remedial measures brought to bear onthat appalling disease. When we call to mind the fearful

mortality of croup, that not a less proportion than two thirdsof the little patients labouring under the disease die-nay,that even, in true membraneous cramp, it is said the mortalityis far higher still; any discovery that can decrease the fatality-should be carefully considered. -NVe can only say we heartilyrecommend to our readers, and the profession generally, thisclever and valuable monograph, and we trust that in thiscountry, as well as in America, it may have an extensive cir-culation.

i On the Nature and Treatment of Diseases of the Kidney, con-r- nected with Albuminous Urine. By G. OWEN REES, ILD.,

F.R.S. London: Longman. Svo, PP. 134.DR. OwEx REEs has been long known to the profession as

an able and indefatigable labourer in the field of animal

, chemistrv. This little work will add justly to his reputation.. It is altogether practical, and may be said fairly to embrace,. in a moderate compass, all that is at present known on the. subject of which it treats.

Further Observations on Chloroform in the Practice of Mid-wifery. By W. J. MURPHY, A.M., M.D. Taylor &. Walton.Pamphlet.THE advocates of the use of chloroform in the practice of

midwifery may claim Dr. Murphy as one of their staunchestchampions. We have regarded the discussion of this im-

portant subject, as having been carried oii in the Societies, andin pamphlets generally, as being more for "victory than fortruth." While chloroform, on the one hand, has been ex-tolled beyond its just merits, on the other hand, it has beenabused and condemned to an unwarrantable extent. The ab-surd system of giving an undue degree of merit to a medicineis not less injurious to its reputation than to unjustly decry it.Let the history of many vaunted remedies attest the fact. Thetar-water of Berkeley died from the excess of praise withwhich it was ushered into the world, and was only generallyrevived, in the form of creasote, after the lapse of a century.A more just appreciation of its merits would have been a5-tended with a different result, and this valuable medicinewould not have been almost lost to practitioners for so long aperiod. We make these observations on the subject generally,and not in reference to the able pamphlet before ns. Wearebound to say, that if all the advocates of the use of chloroformwere as temperate and as just as Dr. Murphy, the questionwould have received a much better chance of being satisfac-torily settled. At the same time, the -experiments of Mr. T.H. Wakley, and the experience of others on the dangerouseffects of chloroform, under some circumstances, should neverbe lost sight of in the inquiry.

Essay on Intestinal Auscultatioix. By CHARLES HOOKER, M.D.Boston: David Clapp. Pamphlet.

THE facts advanced in this pamphlet are curious; if theviews arrived at by Dr. Hooker will bear the test of furtherexperience, lie will have rendered a service to his profession.

The London and Provincial llleclical Directory for 1850.London: Churchill. Small 8vo, pp. 580.

THE fifth volume of this work evinces a great degree of carein its preparation, a commendation which could scarcely beawarded to its predecessors. It is altogether very much im-proved under the management of the publisher. If any mis-takes or omissions are observable, we believe that the blamewill justly fall on those members of the profession who failedto respond to the inquiries made of them. We would suggest,however, that in future numbers of this work the fellows andmembers of the difR’rent medical societies should have the dis-tinctive titles affixed to their names. It would be simply agraceful acknowledgment of an honour, which, small as it maybe in some cases, is regarded by many as of importance. Asthis broad mirror of the lineaments of all the known membersof the profession is probably in the hands of most of them, weneed not extend our notice, beyond a recommendation thatthose who have it not should at once procure it.

THE MIDDLESEX HOSPITAL.—Mr. Waterhouse, of the BritishMuseum, has been appointed to deliver the lectures on com-parative anatomy in this school. The course will consist ofabout twenty-five lectures, and we understand that the osteo-logy of the vertebrated animals will be the subject of the firstseries.