Parisian Dissecting-Rooms versus the English.-True it is that subjects for dissection are far more numerous than those in England. In this point there is certainly a superiority. When, however, the accommodations that are provided in the Parisian dissecting-rooms are taken into consideration, the preference will be given to those of our own country. Let the student who has been accustomed to the dissecting-rooms in England enter those in Paris: the stench which first assails his nasal organs is almost insupportable, from the system of smoking which is carried on within them. Again, there is nothing like decency or order kept up; portions of viscera, detached limbs, pieces of dissected muscle, fat, and cellular membrane, are seen to cover the floor. It is necessary to be careful how we tread, lest we should stumble against some limb lying in our way, or slip up, from stepping on some viscid substance that may be strewed upon the ground. There are two great dissecting schools in Paris. One is close to the Ecole de Médecine, and adjoins Dupuytren's Museum of Morbid Anatomy; the other is situated near the hospital of La Pitié, and is called Clamart. This is one of a more modern date than the former, to which it is thought preferable. It is certainly situated in a more airy neighbourhood, and its accommodations are somewhat of a better order. It is necessary for all those who intend to dissect, to become pupils of the Internes, who have the choice of all subjects brought for dissection. Each interne has four pupils, who are attached to one subject, that is usually changed every ten days or a fortnight. The sum for the season, which lasts about five months, is about one hundred and fifty francs, or six pounds. To those who would be free from the inconveniences of the common dissecting rooms, a means is offered of dissecting in private, by becoming the pupils of the overseer of the school, who has private rooms set apart for this purpose. He of course demands a sum of money in proportion to the convenience offered, and this more especially of the English, who are always supposed to have a superabundance of money, wherewith they can afford to pay handsomely. Case of Secretion of Air from the Human Skin3 By Sir Francis Smith.-(The Dublin Journal of Medical Science, January, 1841.)—An hypochondriac gentleman, thirty-five years of age, informed Sir F. Smith that he was liable to immense disengagements of gas from the stomach; that he also occasionally discharged air from the urinary bladder; and had observed an escape of air from the surface of his body when under water in the bath. Little attention was paid to the last of these statements till the 15th of May, 1840, when Sir F. Smith was hastily summoned to the bath to see the phenomenon of the disengagement of air from the skin of his patient. He was found in a bath at 79°, and his chest, abdomen, shoulders, and hands, were literally covered with small air bubbles. When he removed his hands from the bath, the bubbles disappeared; but when he replaced them below the water, the air bubbles were observed to make their reappearance, at first very minute, but gradually increased in size till the palms of his hands became again coated with them. He frequently wiped away the bubbles from his hands and chest, but in every case they were soon replaced by others. The bubbles of air ran together, when pushed with the finger, like globules of mercury, without quitting the skin, or becoming loose in the water. This circumstance was observed for twenty minutes by Sir F. Smith; and towards the end of that time, the margins of the upper end of the bath, opposite where the shoulders had been, were coated all round, for the depth of about two inches, with minute bubbles of air. 1 Edinburgh Medical and Surgical Journal, July, 1841, p. 289. On the non-occurrence of Albuminous Urine during the Dropsy which follows Scarlatina.' By Dr. Philipp, of Berlin.-(Casper's Wochenschrift fur die Gesammte Heilkunde, Nov. 1840.)-The results of Dr. Philipp regarding the occurrence of albuminous urine during the dropsical symptoms which follow scarlatina, are at variance with what have been observed in this country. In an epidemic scarlatina which raged at Berlin, he ascertained in sixty cases that the urine was not albuminous, though the dropsical symptoms were fully developed, and could only be traced to this complaint. The dropsical symptoms appeared at shorter or longer intervals; often four or five weeks after desquamation. The urine was tested both by means of heat and of nitric acid, but by neither of these was the slightest trace of albumen discovered. He is inclined to attribute this to the rarity of disease of the kidney at Berlin, seeing that for the last two years only two cases of Bright's disease of the kidney have been noticed. The scarlet fever, too, appears to vary somewhat in its type from that which occurs in this country, as he mentions that the deaths from this affection generally result from its complication with croup, as he calls it, or cerebral disorder. Dr. Philipp mentions that the dropsical symptoms are so mild and unattended with danger, that, though they occur in most cases, he has not met with one which proved fatal. On the prevention of Pitting in Small-pox by means of Sulphate Ointment. By Dr. V. Midaveine.-(Annales de la Societé de Medecine de Gand, December, 1840.)-The danger of applying mercurial preparations to the whole surface of the body, induced Dr. Midaveine to seek some other means which would be more generally applicable, and yet possess an equally modifying power over the variolous pustule. From the success he obtained in sixteen cases of small-pox, he thinks he has found in sulphur ointment a remedy equally efficacious in preventing the maturation of the pustule, and the subsequent pitting, as the mercurial preparations, whilst its application is not attended with the same danger to the patient. He employed it of the strength of one and a half to two drams of flowers of sulphur to each ounce of lard, the smaller proportion being used for the varioloid affection, the larger for the confluent small-pox. The whole body is rubbed with this three times daily; and the sooner the application is made after the appearance of the eruption, the greater is the chance of its speedily arresting its development. The pustules shrivel and dry up under this treatment, the appetite speedily returns, and convalescence is soon established. Facts relative to the Statistics of Menstruation. By Dr. Adelmann, of Fulda.-(Neue Zeitschrift fur Geburtskunde, August, 1840.)—During the years 1834, 35, and 36, Dr. Adelmann ascertained the period at which menstruation had commenced in five hundred and seven individuals. From this it appeared that in girls with black hair, the average age at which menstruation commenced was 16; in girls with brown hair, the average age was 17; and in girls with fair hair, between 16 and 17. The average duration of each menstrual period, four to five days for the black-haired girls, and three to four days for the brown and fair-haired. Only one in one hundred and two cases was met with who menstruated regularly at the interval of three weeks; all the rest did so at regular periods of four weeks. 'Edinburgh Medical and Surgical Journal, July, 1841, 2 Ibid, p. 292. 3 Ibid, p. 298. p. 290. ART. L-NOTES ON THE TREATMENT OF CHRONIC PLEURISY, WITH EFFUSION.' BY THE LATE JAMES HOPE, M. d. The following paper must possess a high interest for our readers, when we inform them that it was commenced by Dr. Hope during his last illness, and concluded on his death bed. Unable to complete it as he could have wished, he was compelled to dictate it in the shape of notes, which he finished only four days before his decease. To those who knew Dr. Hope well, this zeal for science and his fellow-creatures will occasion no surprise. It was consistent with the character of the man, who died as he had lived, an accomplished physician and a good man. It has The symptoms of chronic pleurisy, with effusion more or less filling one side of the chest, are perfectly well described by systematic authors, as Dr. Law, (Cyclop. Pract. Med. p. 395 a.) yet there is no class of affections more habitually overlooked by the bulk of the profession than this-certainly one of the most destructive to life if neglected beyond a certain period. I am glad to notice that Dr. Stokes makes a similar remark. Some fault attaches indeed to the systematic writers alluded to, for their mistaking the state of anæmia, with its quick pulse, for irritative fever, by which they not only mislead themselves, but also their readers, as to the nature of the patient's condition, and, consequently, as to the appropriate means of cure. resulted from this, that a far too unfavourable impression of the curability of chronic pleurisy with effusion, or empyæma, as it is called after a certain time, has become prevalent. Dr. Law thinks more favourably of the possibility of cure. He with justice, however, excepts tubercular cases, and those in which the patient is not assisted; yet I think that he is mistaken in supposing that a copious evacuation from some other organ may not occasionally prove critical, and empty a chest. A case occurred to me in which absorption did not commence so soon as I expected; namely, within a week, when the patient was attacked with hypercatharsis to the amount of sixty watery evacuations in two days. The chest, meanwhile, which was dull within two inches of the left clavicle, and had the heart protruded to the right side of the sternum, had completely emptied itself, and the patient recovered. Broussais met with only one favourable case out of eighteen. Laennec's view was equally gloomy, and Dr. Townsend's is no less so; Dr. Thomas 1 Medico-Chirurgical Review, July, 1841, p. 295. Davies feels the same so strongly, that he hurries on the operation of paracentesis at a very early period of the disease-a circumstance which is the main cause of the unusual success of the operation in his hands. From this aggregate of unfavourable opinions it results that, at the present time, there is a prevalent doubt whether the fluid of empyæma is ever absorbed. This fluid, it may be remarked in passing, may be either sero-fibrinous and albuminous, or contain pus in any degree up to its pure condition. This seems to be now a settled question, and I think it ought to be so, as the fluid, in healthy subjects, kills not by its quality, but by suffocating. I cannot feel surprised at this want of success in the cure of empyæma, when I notice the unsettled, vacillating, inadequate treatment recommended even by those writers who think most favourably of the possibility of a cure. Dr. Law's treatment comes nearest to that which I have found effectual, but he is too timid in continuing the gentle use of mercury, from fear of its inducing irritative fever and hectic. This supposed irritative fever, however, is, in most cases, nothing more than excitement of anæmia, (a fact of which he does not seem to be at all aware, as even in the convalescent period he does not even name iron as a remedy,) and the hectic is a necessary consequence when the fluid is pus, and this is diffused through the whole circulation by the process of absorption. I have steadily continued the gentle external use of mercury through the most violent hectic, coming on twice a day in tremendous paroxysms; while I have counteracted this by the free use of mineral acids; and by a diet, not only of strong broth at luncheon, but of animal food at dinner-the patient's tongue being clean, and his appetite and digestion always good. Dr. Townsend seems principally to follow Broussais (phlegmasie chronique) and Laennec, neither of whom make use of mercury, and the former would only venture on a blister as an experiment! He likewise falls into their great error of mistaking anæmia for fever, and therefore starves the patient at a moment when there is a great demand for animal nutriment in any way in which it can be borne. The treatment of Dr. Thomas Davies is that of calomel and opium, and counter-irritants in the first stage, but he thinks these inefficient in the stage of chronic effusion. He therefore, as already stated, burries on the operation of empуæma. The writer on pleurisy in the Library of Practical Medicine (Vol. III. p. 124) seems to have but an indifferent opinion of the curability of chronic pleurisy with effusion. After the third week or so, he thinks mercury of little benefit, and that it is even injurious when the hectic stage comes on; but approves of counterirritants, and follows Dr. Stokes in his approbation of the use of the hydriodate of potass, to act both as an alterative and a diuretic; also of the iodide of iron. Dr. Stokes, whose writings on pleurisy I had not the pleasure of seeing till long after I commenced my own observations, I find to be far the most successful in his treatment of chronic pleurisy and empyæma. In an excellent chapter, containing a considerable portion of original matter-some, perhaps, a little fanciful-he mentions that he cured twenty cases running by the use of a pint daily of cold solution of Lugol's iodine, and from a quarter to half an ounce of the ointment rubbed into the side. He is likewise very favourable to the use of blisters. I have myself been instrumental in curing five and thirty cases consecutively, during the space of four years, but principally two years and a half, while I was assistant-physician to St. George's Hospital, no cases having been withdrawn, or added from an anterior date, except three; the 1st was Mr. Garnett, whom I saw about 1833, who had also fatal ulceration of the bowels; the 2d, the Rev. Mr. — whom I saw about 1833; the 3d an outpatient of St. George's, whom I found to have tubercular disorganisation of the lungs, and whom I, therefore, transferred to Dr. M'Leod, as an in-patient of St. George's. Paracentesis was practised; the tubercles were found; and he died from inexpansion of the lung, which was bound down to the spine. The remainder of the cases all dated within three months, as well as I could make out by most carefully catechising the patient respecting the first feeling of pleuritic pain, or ailment of any kind. The pain was frequently forgotten, until the patient was perhaps asked whether he had not had a little lumbago, pain in the back, &c. Nor is this surprising; for copious effusion very soon relieves pleuritic pain. A very great proportion dated within two months, and from that time down to three weeks or a month. I seldom saw them earlier than a month, as they were either neglected and misunderstood cases amongst the out-patients of St. George's, or private patients whom I was called to see in consultation at a late period of the disease; the complaint of the latter having, with few exceptions, been also overlooked. The following is a list of the previous duration of the disease in all my private cases, amounting to seventeen; but I lament to say that I cannot at present give the dates of those, eighteen in number, who were out-patients of St. George's, and the notes of whose cases I drafted out of 15,000 notes of cases, which I saw at St. George's (for I took notes of almost all). The notes of these eighteen cases having been separated from the others, I have unfortunately mislaid them. Unless, therefore, I recover them, I must trust to the confidence of the public for the accuracy of the facts. They were all demonstrated, as they occurred, to the students of St. George's. Coachman of Sir Clifford Constable's, ill a fortnight, but previous bronchitis. Miss Caldow, ill from two to three weeks. Robert Watts, ill eighteen days. Mr. Tapson, ill a month, Patrick Millerick, ill a month. Aldersgate street student, under Mr. posed lumbago nine weeks before. for supposed phthisis-had sup Miss Miller, disease of ten weeks' standing for two months. The Rev. Mr. Barter, two months and a half, but previous pneumonia. Mr. Hamilton, ill three months. Eliza Gray, ill three months. Mr. Morgan, stitch in back three months before. I ever since. The Rev. Mr. -?ill upwards of three months. As I have not leisure to continue this paper at present, I subjoin the following memoranda of how I shall proceed, if time permit.' The private cases being in great detail, and in general features greatly resembling each other, it would be useless to give the whole in full. Therefore pick out a few which give at length, as general types-for instance, Miss Miller, Mr. Morgan, and Sir Clifford Constable's coachmanthe remainder, insert in an abbreviated form, together with such of the outpatients of St. George's as I can recall to memory, though I have lost the notes of their cases.-Show that I used mercury in all degrees of intensity, so as to ascertain what quantity was the most effectual, but, at the same time, least injurious.-Show that I always used opium, in full proportion, with the mercury, and that I used the milder and the external forms when the others could not be borne-thus taking especial care to protect the mucous membranes. Add that I found prompt and free salivation by calomel and opium, and the use of one or two drams of ointment on each groin and axilla night and morning for forty-eight hours, (in conjunction with the other remedies presently to be specified,) produce the most rapid and satis 1 It will be observed that, from this point, the form of private notes is adopted. |