The

and below, very convex anteriorly, somewhat flattened posteriorly. capsule was semi-adherent, and when removed, the kidney displayed a finely granular (sabulous) surface, pale in color, with a few stellar vessels scattered over it. The interior, on a section being made, displayed the usual fine granular exudation infiltrating the whole structure, fraying out the base of the cones, and contrasting in color with the pale red striated appearance of this pyramidal portion of the organ. The right kidney weighed five ounces and three quarters; the cones were more deeply injected than the other kidney, but in other respects the morbid conditions were similar, the disease not having advanced to the same point, one kidney being usually behind the other in progress.

A careful microscopic examination of these kidneys was made. The white deposit surrounding the cones, and constituting the mass of the disease, was composed of abortive cells, imbedded in what appeared to be a fine granular exudation. This granular matter pervaded the whole organ, and was principally interstitial in regard to its relation to the tubes, as but little tubular structure could be discovered in it. The Malpighian bodies, however, appeared stuffed with this exudation, and the few tubes which were teazed out of the deposit appeared blocked up with it. The epithelial cells along the walls of the tubes, at the base of the cones, appeared undisturbed, but compressed by the contents of the canal. The straight tubes at the apex of the cones were free open canals, the epithelium presenting a natural appearance; but here and there a large straight tube was observed choked with fibrinous coagula, of a brownish-yellow color.

This case illustrates two important facts in the pathology of the kidneys. First, the relation which scarlatinal dropsy bears to acute morbus Brightii; and secondly, the character of the structural changes which at first impede, and ultimately destroy, the function of the kidney.

It was at one time doubted whether the renal disorder after scarlet fever had any thing in common with those forms of disease described by the late lamented Dr. Bright, which the concurrent opinion of European pathologists now designates as morbus Brightii. It scarcely required the genius of a Rokitansky to identify them; yet that great pathologist has not hesitated to recognize in scarlet fever one of the most energetic causes of the acute form of Bright's disease. The symptoms during life are the same, and a microscopic examination of the renal structure establishes the identity of the morbid process beyond all objection. The student in clinical medicine should carefully observe and compare the progress of the symptoms in a case analogous to the present one in its origin, and one which has apparently arisen from exposure to cold and wet, and which is rapidly running an acute course. Frequent examination of the urinary sediment in both cases will exhibit the similarity of the matters thrown off from the renal tubes, and the identity of the changes proceeding in them; and a comparison of the structural changes in the kidney after death will complete the proof. In both, the kidneys will be beyond the natural weight, large, pale, and exsanguinous, with a few scattered, star-like, vascular points. The cones will present a remarkable contrast of color to the surrounding deposit, varying from a

pale pinkish madder to a deeper tone of madder red; they display the linear markings of the straight tubes frayed out at the base, fancifully compared to a sheaf of corn.

Microscopically examined, the whole structure of the organ, tubular as well as interstitial, is seen infiltrated with a product which fills and chokes the tubes, obliterates the Malpighian capillaries, permeates the interstitial plexus of vessels, and eventually offers such an obstacle to the course of the blood and circulation through the kidneys as to bring within limits incompatible with life the excretory power of these organs. The mode of death, in both cases, is clearly traceable to this cause; for, in the great majority, the patients die with symptoms referable to a poisonous agency operating upon the nervous centres, and coma, with or without convulsive movements, is usually the indication of the fatal termination by uræmic poisoning.

As the renal disorder which succeeds to scarlet fever is identical with the acute form of morbus Brightii, it follows that the principles on which these cases should be treated must be the same. They may be summed up in a few words: To lessen the watery or dropsical state of the blood, and to diminish the local blood stasis in the kidneys. The first is obtained by acting briskly on the intestinal track of mucous surface, by which a large amount of fluid is rapidly eliminated from the system. The second object is secured by calling into activity the functions of the skin by diaphoretics, warm clothing, and warm or hot-air baths. The functions of the skin are vicarious of those of the kidney, and whatever augments the first lessens the activity of the latter. The congestion of the kidneys is further alleviated by dry-cupping, and occasionally by abstracting blood by cupping from the loins; but the cases are exceptional which will require the abstraction of blood. If these objects can be successfully attained-indicated by the disappearance of the dropsy and the absence of blood from the urine-no time should be lost in placing the organism in a condition to regain those qualities and powers, the loss of which are most plainly manifested by the impoverished state of the blood. Amongst medicinal remedies, the ferruginous are the most essential; and amongst these, the tincture of the sesquichloride of iron is the most valuable and efficacious. But chalybeates are useless without a wellordered diet. Nutrition must, therefore, be promoted, and it may be aided by a limited allowance of wine. Our best-directed efforts are, however, often frustrated by the intensity of the disease and rapidity of its progress. And this case furnishes an example of the fatality of this disorder, notwithstanding the favorable results which remedies seemed to produce; but it also teaches the value of microscopic examination of the urinary sediment from time to time; and we are taught that by a careful attention to its revelations the insidious progress of the disorder may be demonstrated and recorded even while the progress of the patient, in all other respects, appears to continue satisfactory.-Lancet, March 12, 1859.

AUDIBLE KNOCKINGS OF THE MUSCLES.

AT a recent meeting of the Academie des Sciences, M. Jobert de Lamballe read a paper, the subject of which is highly interesting, not only to the surgeon, but also to the non-professional reader. Not very long ago, this distinguished surgeon was called to visit, in consultation, a young girl about fourteen years of age, who, for more than six years, had suffered from involuntary movements in some of the muscles on the outer side of the leg. These movements were characterized by pulsations or knocks, having almost the regularity of a pulse, each knock being distinctly heard at some distance, as proceeding from behind the external malleolus. A similar affection manifested itself, not long after the first, at a corresponding point in the left leg, though less intense in degree. There was pain, hesitation, and tendency to fall when walking. When the foot was extended, and on applying pressure to certain points along the course of the muscles, the patient could for a time arrest the throbbing; but this invariably produced a good deal of pain and fatigue in the limb. The parents of the girl had become quite settled in the belief that the peculiar sounds or knocks which proceeded from the limb were the result of supernatural agency; and it was not till M. Jobert had made a careful and scientific investigation, and fully explained the matter to them, that their minds were disabused of this idea. He found that these sounds were produced solely by the rising and falling of the tendon of the peroneus brevis muscle, while contracting, or in action, and at the part where the tendon passes along its osseous groove. The involuntary character of these movements he believes to have been owing to some peculiar functional trouble of the muscular fibres or the nerves supplying them.

M. Jobert believes it possible that, by a little practice, these knocks or pulsations, although in the case in question altogether independent of the volition of the individual, could be produced at will, and that it is to the possession of this peculiar power that the entire secret of mediums and the so-called spirit-rappers is due. These peculiar sounds, he stated, could be produced by the muscles and tendons in other parts of the body, and he related the case of a lady who could give rise to them at the hipjoint by assuming a particular position.

M. Velpeau has met with a number of instances of this character, occurring in different localities. The muscles and tendons, both of the shoulder and of the leg, of the upper as well as the lower extremities, were equally capable, in rare instances, of producing these peculiar raps or sounds. Certain conjurors had been known who could even produce a kind of harmony by a succession of knocks, in this way imitating the tune of a dance or a military march.

M. Jobert brought the history of this interesting case to a close, with a few remarks on the surgical treatment which he adopted. The medical attendant upon the girl had failed to do her any good, although he had employed a great variety of remedies, such as leeching and blistering, continued pressure over the part, etc., together with the internal use of

medicines. M. Jobert treated the case as follows: he cut across and completely divided the body of the peronæus brevis of both legs, by means of a subcutaneous section; then, by means of a suitable splint or apparatus, put up the limbs so as to secure their perfect immobility. When reunion had taken place, the girl recovered the complete use of both members, and no trace of the affection has since appeared. The cure was complete and permanent. M. Jobert continued his remarks, and observed that a German physiologist, M. Schiff, whose attention had been given largely to this subject, made the discovery, some three or four years ago, as to the seat and origin of these peculiar sounds which have been so commonly attributed to supernatural agency. Observing that the sounds proceeded invariably from the foot of the bed of the individual who pretended to be influenced by spirits, M. Schiff began to question, and to have serious doubts of their supernatural origin, and was not long in concluding that they were the result of natural causes, to be accounted for and located in the body itself. From his knowledge of anatomy, he was led to think that the seat of these sounds might be the peroneal region, where there exists a bony canal or groove, along which pass the tendons of the peronei muscles. After a little practice, he was enabled, in whatever position he placed himself, to imitate all the tricks and prodigies of spirit-rappers, and he clearly established the fact that these peculiar sounds originate in the tendon of the long peroneus muscle; and moreover, that they are dependent on a diminution in thickness of the sheath, or in the total absence of the sheath of this muscle. While agreeing with M. Schiff as to the seat of these sounds, M. Jobert differs with him, as we have already seen, as regards the particular muscle producing them. The one believes that it is the peroneus brevis; the other is of an opinion that it is the peroneus longus which is mainly concerned in their production. They differ again on another point, viz. the sounds or knocks observed by Schiff were purely physiological, altogether voluntary, dependent upon the will; in the case of M. Jobert's patient, the movements were of an involuntary nature, painful, consequently morbid. The subject is really one of much interest, and well meriting a further investigation on the part of anatomists and physiologists. When once the purely physical character of these sounds is demonstrated, much may be accomplished in the way of dispelling the absurd superstition connected with spirit-rappings.-Correspondence of Boston Medical and Surgical Journal.

NOVEL THERAPEUTIC USES OF RAW MEAT.

Raw Meat in Diarrhea.-Our readers have, doubtless, not forgotten the interesting history of the two little twin daughters of a wealthy Mulhouse merchant, who had been reduced by unconquerable diarrhoea to the last gasp of life, and who, fed with the pulp of raw meat, returned, in a few months, to a state of perfect and robust health. Many facts

have, since then, confirmed our confidence in the value of this Russian mode of treatment. M. Trousseau never allows an opportunity to escape of recommending it, and of pointing out the best manner of rendering it both useful and acceptable.

The meat best adapted to the purpose is the fillet of beef; some patients, however, prefer the centre part of mutton chops. It should be cut fine, pounded in a mortar, and strained through a sieve or cullender. The pulp, thus separated from the cellular texture of the muscular substance, is then gathered with a knife, and rolled in salt or powdered sugar, or mixed with currant-jam.

One of M. Trousseau's grandchildren would take it only when mixed with racahout, a farinaceous compound of cocoa, ground rice, and potatoflour, sweetened, and flavored with vanilla. M. Trousseau causes it sometimes to be rolled into small salted balls, of the size of a hazel-nut, or in little oblong gobbets, which may be administered in soup, to the number of thirty or forty, equivalent to four or five ounces of meat pulp. In grown persons, and particularly with ladies, the physician will probably meet with a repugnance, which he must overcome by concealing the repugnant character of the medication. For this purpose, some appearance of cooking may be imparted to the food, by exposing a thick slice of the meat, for twenty minutes, to the action of a brisk fire; its surface is thus roasted, the interior parts remaining raw, and being then treated as we have said. M. Trousseau has thus caused to be prepared by M. Mialhe (one of the principal apothecaries of Paris) meat-pulp combined with confection of roses, destined for delicate stomachs, which is taken without disgust, and even with pleasure, under the agreeable denomination of Damascene Preserve.

In children, the dose of raw meat, the first day, should not exceed 21⁄2 dr. in four meals. It may be doubled on the second day, and on the third attain eight drachms; and so on, without any other additional food than albuminous water. It is easy to measure with precision the quantity administered daily, by means of a small balance and the current coins, the weight of which is well known-the franc being equivalent to one drachm, and the five-franc piece to six drachms. The dose may be carried as far as ten or twelve ounces, and the children gradually recover their good looks, their plumpness, and spirits. At the end of a month or six weeks, when diarrhoea has entirely ceased, the quantity of raw meat can be gradually decreased, and broth or underdone eggs can be substituted so as to reduce the dose of meat to three or four ounces daily.

It is necessary to be aware that, at first, when already the nature and abundance of the diarrhoea has undergone a favorable change, the motions are red and fetid. In one of the little Mulhouse patients we above referred to, this animal diet appeared to have occasioned the development of tape-worm, a parasite commonly met with in Abyssinia, where the natives feed on raw meat; but this kind of nutriment not being so long persevered in, generally, as was the case in the instance of the little girl alluded to, this circumstance must be considered exceptional, and cannot counterbalance the decided benefits yielded by the Russian method of treatment, in cases of chronic disturbance of the bowels, and especially in