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Experiments on the Contagion of Phthisis. 1 — The remarkable instances now and then seen, in which persons without hereditary tendency to phthisis become phthisical after long-continued attendance on sufferers from the disease, have suggested to many physicians the idea that phthisis is contagious. If there is such a contagion, the mechanism has been supposed to be the inhalation with the breath of fine particles of tuberculous sputa, atomized into the air by the patient's cough. An attempt has been made by Dr. Tappeiner, of Meran, to ascertain whether, by a similar means, animals could be rendered tubercular, and the results of the experiments, which are published in the current number of Virchow's Archiv, are of great interest. The animals experimented on were made to breathe for several hours daily in a chamber, in the air of which fine particles of phthisical sputum were suspended. The sputum having been mixed with water, the mixture was atomized by a steam atomizer. In all cases the sputa were from persons with cavities in their lungs. Dogs alone were employed in the experiments, since they very rarely suffer from spontaneous tuberculosis. The result was that of eleven animals experimented on, with one doubtful exception, after a period varying from twenty-five to forty-five days, all, being killed, presented well-developed miliary tubercles in both lungs, and in most of the cases tubercles were present to a smaller extent in the kidneys, and in some cases, also, in the liver and spleen. Microscopical examination was in accord with the naked-eye appearances.
The quantity of sputum necessary for the effect is certainly a very small one. In three experiments only one gramme of sputum was daily atomized in the air of the chamber, and the quantity of dry sputum must have been exceedingly small. Two ways are conceivable in which the infection is produced. The particles certainly may reach the alveoli, for powdered cinnabar, administered in the same way, was found to have stained the alveoli in twelve hours after an inhalation of only one hour's duration. But some particles may lodge in the mucous membrane of the throat and pharynx, and thence, being absorbed, may affect the lungs as organs specially predisposed. Hence some comparative experiments were made by feeding dogs with the same sputum as that employed in the inhalation experiments. Fifteen grammes were mixed daily with the food of each dog. In two dogs fed at Munich, miliary tubercles were found in the lungs after six weeks' feeding ; in six others fed at Meran, all the organs were normal, - a difference the explana. tion of which is not very clear. In the cases in which the disease was produced by feeding, the intestinal tract was affected, whereas it was free in those cases in which the inhalation was employed. It is remark- . able that, with two exceptions, the animals, up to the time at which they were killed and found diseased, were well and lively, and indicated
i London Lancet, November 23, 1878.
their disease neither by emaciation nor other external symptoms. This suggests that sometimes in man a miliary tuberculosis of the lungs may remain latent, and cause no symptoms until catarrh, with foci of inflammation, sets up phthisis.
A preliminary account of these experiments of Tappeiner led Dr. Max Schottelius to make some similar experiments, not only with the sputum of phthisical individuals, but also with that of persons suffering from simple bronchitis, and with pulverized cheese, brain, and cinnabar. The result was that miliary tubercles were found in the lungs in all cases, and in equal quantity with both phthisical and bronchitic sputum. Cheese produced a smaller quantity; pulverized brain still less; and the cinnabar least effect of all, merely a few whitish tubercles with pigmented centres, with an interstitial deposit of the substance, which had caused no inflammatory reaction. Tappeiner has also experimented with calves' brains in two cases, but with purely negative results. No changes in the lung followed such as resulted from the inhalation of tuberculous sputun.
These experiments are of much interest, but they need repetition on a larger scale, in order that the discrepancies may be removed before much weight can be attached to them as evidences of a specific influence of the phthisical sputum. They unquestionably show, however, that the inhalation of foreign organic matter will cause tubercles in animals naturally indisposed to their development. The appearance of granulations in other organs than the lungs in some of Tappeiner's experiments is a fact of great importance. Whether tuberculous matter produces tubercle when given in this manner more readily than other substances or not, it appears certain that different forms of organic matter produce effects in different degrees. It appears also that the inhalation of these substances is more effective than their administration by the alimentary canal. These are facts of great importance in regard to the question of the contagiousness of phthisis.
Electro-Puncture in Aneurism of the Aorta.' - Drs. Dujardin-Beaumetz and Proust read a memoir at the recent meeting of the French Society for the Advancement of Science, in which they state that, as the result of the employment of electro-punctures in six cases of aneurism of the aorta, they are enabled to conclude that Ciniselli's procedure, as they have modified it, has become a simple operation unattended with danger, and constitutes an efficacious and rational mode of treatment. In one case, described by Dr. Proust, the patient having died from hæmorrhagic infiltration of the lungs, it became possible to show that a thick layer of fibrinous coagula existed in the portion of the aneurismal sac where the needles had been applied.
This case showed that electro-puncture could be successfully prac1 Gazette hebdomadaire, September 6th. Medical Times and Gazette, September 28, 1878.
ticed in patients whose general condition was a very grave one; that the coagula was deposited at the point of application of the positive pole; and that M. Gaiffe's improved instruments should be employed. M. Teissier observed that several experiments which he had performed corroborated the above conclusions, for he had found sphacelus produced in the arterial wall at the point of application of the negative pole, while several accidents arose during the application. But the application of the positive pole never gave rise to any accident, so that Drs. Dujardin-Baumetz and Proust have good reason for modifying Ciniselli's procedure by employing only the positive pole as the active agent, applying the negative one to a moistened plate with a broad surface placed at a distant part of the body.
The Treatment of Thoracic Aneurism.1 - In an article contributed to a recent number of the Revue mensuelle de Médecine et Chirurgie, Dr. Dreschfeld, of Manchester, deals with the three chief methods of treatment of aortic aneurism, namely, that by the administration of iodide of potassium, that of restricted diet and enforced rest in the horizontal position, and that of galvano-puncture. He prefaces his record of six cases, in which some or all of these agents were employed, by a slight sketch of each method and its rationale. He bears strong testimony to the efficacy of the iodide, first introduced by Bouillaud, and since warmly advocated by Balfour and others, but admits that it is not positively known how it acts. It probably slows and diminishes the action of the heart and the arterial pressure, an effect due rather to the iodine in the salt than to the potassium. Large doses (he advises small doses to commence with, and their increase up to six grammes or more), long continued, often give good results, especially in old subjects, and when the aneurism is of recent formation and small in size. Of the second plan, — best known as Tufnell's treatment, that of absolute recumbency and a restricted, non-liquid diet, Dr. Dreschfeld states that in nearly all the cases in which he has employed it the pulse rate has been much diminished. Galvano-puncture is the most certain in its effects of all the methods, since it promotes coagulation in a threefold manner: chemically, by the electrolytic decomposition of the water and salts of the blood; mechanically, by the inserted needles acting as foreign bodies ; and, thirdly, by acting as an irritant, and exciting inflammation of the wall of the aneurism. The ill results that sometimes, but rarely, happen from its use he believes to be preventable, and he has never seen any embolism occur from detachment of clot formed during the procedure. The currents employed should be of weak intensity, and the time during which they should be allowed to pass ought to be at least thirty minutes. The needles should be of steel, and should be long and fine, well pointed and polished, and coated with insulating material, such as
1 London Lancet, October 12, 1878.
varnish or gum, except at the points. Two or three may be inserted, not too close together, and it is best to connect them with the positive pole, the negative electrode being a moistened sponge applied to the skin in the neighborhood of the tumor. In one case, however, the
, needles were attached to the negative pole, and with good result.
The number of elements employed should be at first small, and should then be gradually increased at intervals of five minutes ; and he allows three or four weeks to elapse before repeating the operation. Details of six cases are then given. The first, an extensive fusiform aneurism of the ascending aorta in a gardener thirty-eight years of age, was first treated with the iodide, and three weeks later by galvano-puncture, the negative pole being in the sac, and the number of elements (Weiss) increased from five to fifteen. The operation was followed by marked improvement, and was once repeated. The patient lived for nearly four years, pursuing his ordinary avocations, and the sac of the aneurism was found to be largely occupied hy a thick, firm material resembling embryonic fibrous tissue. In the second case, also of the ascending aorta, much relief was produced by the iodide and by rest, but the patient died soon after from an intercurrent attack of pericarditis and pneumonia. In the third case all three methods were had recourse to, and galvanopuncture was thrice performed, the needles being connected with the positive pole. The number of elements ranged from three to twentytwo, and each operation lasted about an hour and a half. The tumor, which was of the size of a small apple, ceased to pulsate and became firm, remaining so six months afterwards, when the patient, a female forty-four years of age, was last seen. The fourth case was.one of a very formidable character, the aneurism almost filling the left half of the thorax, and being on the point of rupture. In spite of iodide of potassium, morphia, and the application of ice, it continued to increase ; and a week after admission galvano-puncture was had recourse to. The needles connected with the positive pole were inserted, five to twentynine elements used, and the operation continued for two hours. It was repeated again a month later, when four needles were used, and the current allowed to pass for three hours; and again about three weeks afterwards, when the operation lasted four hours. A fourth galvanopuncture was made within three weeks from the third, but death occurred ten days later. In the remaining two cases the iodide and Tufnell's treatment were employed, in one with great amelioration. Dr. Dreschfeld thinks the cases show the advisability of combining, as far as possible, all three methods of treatment, employing first the medicinal, dietetic, and postural methods, before having recourse to galvanopuncture, which should, however, in no case be long delayed. He has seen no benefit from the subcutaneous injection of ergotin, and thinks that tying the carotid should be restricted to cases of innominate aneurism.
PROCEEDINGS OF THE BOSTON SOCIETY FOR MEDICAL
A. M. SUMNER, M. D., SECRETARY.
May 20, 1878. The Responsibility of Insane Criminals. — DR. Norton Folsom read a series of twenty-eight cases illustrating the varying degree of responsibility of insane persons in criminal acts. He remarked that attention had lately been directed, in England and elsewhere, to cases in which the patient, though insane, was considered capable of recognizing the moral and legal relations of the act, and was therefore held responsible. If delusions exist, however, the relations between them and the act may be so subtle as to be beyond sane imagination. There is also great difficulty in estimating the strength of a morbid emotion or the degree of clearness of reasoning in a mind even slightly deficient. Massachusetts courts have decided that a knowledge of right and wrong is not the test to be applied; yet it was laid down as such in a capital case in New York a very few years ago. And though the case did not turn upon this point entirely, the fact remains that a man, manifestly insane, as was testified by eminent authorities; whose disease was so evident that one of his victims had decided, on the day of the deed, that his removal to an asylum was necessary ; whose crime was without any sane motive, and was wildly violent and indiscriminating, like many other maniacal homicides; whose delusions and wild conduct before the crime were notorious ; and whose apprehensiveness and hallucinations and inimitably insane demeanor after the crime were such as to convince all experts who saw him and examined his case in person, was hung, in spite of the recommendation of the jury, and on the advice of the superintendent of one of the largest insane asylums in the country, a man of good mind but of inordinate self-conceit, who had declined to examine the criminal, but based his advice on some theory of the compatibility of mental disease with legal responsibility. Though misapplied in this case, the doctrine that responsibility may exist is safe one within certain limits; but doubt should be turned in favor of the criminal. In the case of Jesse Pomeroy, the ground was taken at the hearing before the governor and council that responsibility was modified, not abolished. He appeared to be just so deficient that, while he had it in his power to refrain or not from the crime against the boy, his power of estimating the relations — the moral and general bearing of the act was so lacking as to make it not murder " with deliberate premeditation and malice aforethought,” nor, so far as his mind was concerned,“ murder under circumstances of peculiar atrocity.” It was to him a comparatively trivial act. His offense would then be murder in the second degree, which includes all forms beside those just stated. If the view taken is correct, there was an arrest of development in his brain which impaired but did not destroy his responsibility. It is a popular saying that all men are somewhat or sometimes insane. Nothing could be farther from the truth. Certain irregularities in mental action are compatible with health ; and a given act may be in one person an evidence of insanity, while in another it can be rationally accounted for. A vagary which is under absolute control and is in