mildest practice in mild cases, as well as of the most active and efficient treatment in severe cases. It is suitable not only to the diseases above-mentioned, but it is also applicable to the exanthemata or eruptive fevers, which require to be treated pretty much on the same principle with common Fever and its modifications: but in the exanthemata. we must be cautious to prevent the disappearance of the eruption before the proper period; and we must be ready to obviate or remedy visceral determinations.

"In the characteristic sketch of common Fever, above drawn, in page 10, it has not been my object to trace its phenomena on regularly to its decline and termination. But I may here add that whatever may be its appearance in the beginning, and by whatsoever title it might be denominated by Nosologists, whether by that of Synocha, Synochus, or Typhus; in its advanced state it becomes occasionally marked by adynamic spasmodic nervous symptoms, with a black or blackish tongue, and a very peculiar alteration of countenance; symptoms which supervened on or take place of the acute sub inflammatory or inflammatory stages. Under these circumstances other indications arise, which call forth the application of the whole medical mind. The Methodus Antiphlogistica, is to be employed not only in a very mitigated manner, but it must be combined with, and often superseded by antispasmodic, antinervous, diffusively stimulating, and tonic remedies, As in the class of tonic medicines, cinchona holds a prominent station, I think it right to observe that this article is scarcely ever useful, and is often injurious in continued Fever during the existence of a hot skin, a quick pulse, and a loaded tongue; cases of gangrene excepted, where indeed the temperature is in general any thing but high, and where cinchona, aided by camphorated mixture, good wine, and a suitable position of the body, is an extremely valuable curative agent. I have already noticed the great efficacy of this bark in Erysipelas, after the previous substraction of some blood from the arm."

"I formerly had an opportunity of witnessing multitudes of Agues of all types in the great hospitals La Salpetriere, and L’Hotel Dieu in Paris. I was a pupil in the lat

ter establishment on the return from Walcheren of the French and some Polish sick soldiers; many of whom were as violently afflicted with the Walcheren intermittents as our troops who succeeded them in that unhealthy island soon afterwards were. The result of my experience is a conviction that Ague is a nervous and spasmodic malady of a very peculiar nature, and that its place in nosological tables belongs to the class of Neuroses and the order of Spasmi. The involuntary, unrestrainable, and extraordinary shaking of the whole frame; the sort of spasmodic closing of each hand, and drawing in and upwards of the arms and lower extremities, and their alternate stretchings; the particular inward sensation in the region of the epigastric ganglions and plexuses during the rigor of the intermittent fit the flushed countenance, the cephaloa, the heaviness, drowsiness, and sometimes stupor and even apoplectic sopor and stertor at the close of the paroxysm; the occasional influence of emotions of the mind in producing or stopping intermittent paroxysms; the periodical visitations of Ague, the general freedom from complaint in the intervals; the liability of the disease to frequent returns after its cure; its long continuance not only for months, but, in some instances, for a great number of years, such as from four to seven, and even so far as twenty-six years, or during life, of which my clinical case books contain detailed histories: These symptoms and circumstances seem to me to denote a very obvious analogy between Ague and other convulsive maladies, especially Epilepsia and Hysteria; an analogy rendered still closer by the notable similarity or sameness of the tonic and antispasmodic remedies prescribed in the first and latter affections. Due attention to this analogy may perhaps, ere long, lead physicians to the discovery of either a per

manent cure, or a meliorated treatment for Epilepsy."

Agues have not been very frequent or troublesome in Dublin. The following quotation contains a rather curious opinion.

Of the reality of febrile contagion our author is firmly convinced.

1

en.

"It is well known to all physicians who attentively mark the frequent instances there are of many of the poor becoming sick successively in the same house and in one room. If, out of five or six members of a badlylodged and ill-clad indigent family, necessitated to sleep together, one be seized with Fever, the person who lies closest to him and faces him, will receive and inhale his heated, irritating, and morbific breath, and imbibe his perspirable matter, and will sickThe remainder of the family will in like manner become successively diseased. Should one of these individuals, who may happen to be, unknowingly, in the commencement of Fever, quit the sick-room, visit relatives or friends elsewhere, and sleep with them, his fever will soon develope itself, and be communicated to his new bed-fellows. To this manifest source of contagion may be added the circumstance of the frequent migrations from one wretched lodging to another, of indigent families, who not unfrequently carry sickness in their train, or meet with it in their new places of abode."

XVII.

ROYAL WESTMINSTER OPH

mon.

THALMIC HOSPITAL.

MUSCE VOLITANTES.

Mr. Guthrie said muscæ volitantes were of two kinds; one, unaccompanied by defective vision, the other attended by very impaired sight. The first kind were very comThe patient complains "of a variety of appearances moving before the eye, such as small threads or filaments, assuming the form of worms, zigzags, or spots of greater or less dimensions, but generally small; little globules or webs, or luminous spots sometimes surrounded by a halo, which always move before the eye, and are never fixed.

"These are most readily seen on raising the eye quickly from the ground towards the sky, when they appear to ascend whilst the eye is in motion, and to descend on its

becoming fixed steadily upwards, as if they had been disturbed from, and were returning to their original situation below the axis of vision. Of the different kinds of muscæ volitantes, the filamentous particles, turning and twisting in various directions, are the most common; two or three of which are generally more conspicuous than the rest, although accompanied by an infinity of others less distinguishable, intermingled with small globules, which fall like a fine mist when the eye has been gently raised and fixed on a white wall, or on the sky on a clear day. The filamentous particles, being apparently the lightest, descend the last, assuming the appearance of twisted semi-transparent tubes, or worms, spotted in different places.

"In the evening, or by candle-light, these spots are scarcely to be observed; they are not very perceptible in a room which is rather dark; are but imperfectly seen when looking at the flame of a candle, and but feebly marked when the eyes are raised to the sky, with the lids shut, on a fine clear day. They appear much more brilliant on a clear or bright day, when the lids are half closed; they are also very distinct on a misty day, or when attention is paid to them in light reflected from water or snow. These spots always appear to sink below the axis of vision by their own weight, when the eye is simply turned upwards; and this opinion seems to obtain great support from their falling and collecting, as it were, into a focus in the axis of vision, when this point is made the most dependent by bending the head forward and looking on a white sandy soil. In this way the patient can readily examine them; or by lying down in the head and eyes turned back, they will be open air and looking at the sky, with the found to ascend and lodge themselves in what is the upper, but, in that position, the most dependent part of the eye. The principal diagnostic mark of these appearances is their mobility, which distinguishes them in a very decided manner from the fixed spots often perceived in the eye, and which depend on opacity of the lens, or a defective state of the retina.

that eye. The patient, however, Mr. Guthrie said, had received a more favourable opinion on this point, and if he submitted to an operation, as he was recommended to do, he would not fail to make known the result, in order that a correct opinion might be formed in these cases for the future. The distinction between the two kinds of disease, he considered to be that in the first, the liquor Morgagni was its seat. In the second, the hyaloid membrane lining the septa of the vitreous humour was detatched and floating in it.

Of the second kind Mr. Guthrie said, a well marked case had been related in the March Number of the Medico-Chirurgical Review, as extracted from the Revue Médicale. "The patient complained of defective sight, and on examining the eye a number of small bodies were perceived floating about in the posterior chamber of the eye, glittering with a kind of phosphoric brilliancy.' He had seen two cases of the kind; one of a poor man at the hospital, some years ago, who came but once. The sight was very defective, and on dilating the pupil with the belladonna, a number of shining spots were seen floating about, as the eye moved, evidently deeply seated in the vitreous humour, yet connected with each other. The second case is that of a distinguished General Officer, in whose right eye for three years past, a similar appearance was observable, until the last few months when cataract supervened. He has had very defective sight with that eye for years, so as only to be able to distinguish a person without ascertaining his features at the usual distance at which he distinctly recognized him with the other. On dilating the pupil, a fine membrane or web was seen floating deep in the posterior part of the eye, rising or falling with its motion. The whole of the web could be distinguished, looking like a fine veil, spotted in places with shining spots, and which did not alter their appearance in whatever light they were examined. In describing them to the patient, Mr. Guthrie said he had compared them to the stars in the American flag, when floating in the wind. The supervention of cataract has prevented their being seen, whilst it distinctly marks their situation, and has induced him to form an unfavourable prognosis, indeed to decline recommending an operation on VOL. X. No. 21.

25

XVIII.

ST. GEORGE'S HOSPITAL.

I. CASES IN WHICH THE BLOOD WAS FOUND AFTER DEATH PRETERNATURALLY FLUID.

The life or death, the innocence or guilt of a fellow creature, having recently been made, we might almost say, to hinge on the fluid condition of the blood after death in the body of Mr. Neale, we gladly seize on the opportunity offered us, of showing how fallacious a criterion of violence inflicted this particular condition of the blood must be, by the mention of cases that occurred at St. George's Hospital, in which it was present in a more or less marked degree. This fluid state of the blood is really far from unfrequent in postmortem examinations, and doubtless were it oftener looked for, it would oftener be found than even at present it is. There are certain diseases, in which on the whole, it is noticed with more regularity and constancy than in others, and of these we think that phlebitis may be ranked as the head and front We know that many cases of fatal inflammation of the veins are on record where no such condition of the blood is alluded to, and consequently where in all probability it did not exist.These, however, are the exceptions rather than the rule, and we must confess that, in the cases we ourselves have been fortunate or unfortunate enough to witness, the phenomenon in question was almost invariably present. The following, which

occurred upwards of a year ago, was a ve. ry well marked instance of the fact.

CASE 1. Inflammation of the Cutaneous Veins af the Leg and Thigh-DeathNon-coagulation of the blood.

A butler, 56 years of age, was admitted into Hospital October 23d, 1827, under the care of Mr. Brodie, with varices of of the veins of the right leg and foot, and a small varicose ulcer above the internal malleolus Under the use of poultice and soap-strappings, &c. he went on tolerably well, till the morning of the 15th of November, when he had a sharp rigor, followed during the day by general malaise, and pain in the course of the veins during the night. On the 16th the thigh was found to be swollen, and the veins evidently inflamed. The swelling of the limb, and inflammation of the vein increased, delirium and rapid prostration succeeded, mortification, or rather gangrene, was established in the limb, and at, 2 p. m. of the 17th, the patient died.

On dissection, the coats of the inflamed vein were a good deal thickened, its cavity filled with loose, broken down coagulum, and its inner membrane of a dark red colour. This staining of the internal coat was traced along the great venous trunks to the heart, which was soft and flabby in its texture, and distended with dark fluid blood, having only one or two very trifling portions of coagulum mixed with it. The aorta, and indeed the arterial system generally, was highly coloured, not in patches, but one uniform and vivid red, not extending, however, beyond the inner coat. The blood throughout the body was uncoagulated, and the veins up on the surface could be traced by their purple colour, almost as distinctly as if they had been injected. The staining of the inner coat of the aorta was so marked, that the vessel was removed from the body on that account, and is or was in Mr. Brodie's Museum at the School of Great Windmill Street.

Traumatic gangrene, and likewise, we suppose, the other varieties of gangrene not traumatic, frequently present this appearance of the circulating fluid.

James Scarlett, ætatis 57, was admitted December 1st, under the care of Mr. Brodie, in consequence of a compound fracture of both bones of the right leg about three inches above the malleolus, received by falling from a scaffold, 20 feet high, in the works going on at Apsley House.He went on tolerably well till the evening of the next day, when he became anxious and low, and during that night was delirious. On the 3d, complete sloughing of the subcutaneous cellular membrane, with commencing death of the integuments had taken place from the instep to the knee. The system, as might be expected under such circumstances, was extremely depressed, and seeing that if nothing were done the man must inevitably die. Mr. Brodie removed the limb, some three or four inches above the knee. slept for an hour after the operation, and appeared somewhat better in the evening, but the calm was delusive-be became affected with delirium and vomiting in the night-the symptoms of sinking soon bebecame established-and after lingering till the 6th, he died on that day at 2 p. m.

He

Dissection. Passing over some particulars foreign to our present purpose, we may observe that on cutting down to the femoral vessels in the groin, and following them on from that to the face of the stump they presented no unusual appearance from without. On being removed from the limb and laid open, both artery and vein were found to be more or less filled with dark and semi-fluid blood, and both presented on their internal coats, a deep and nearly a blood-red dye. This was very far from the injected appearance caused by inflammation, but evidently a staining merely of the coats in contact with the semi-fluid blood. The lining membrane of the heart, especially the right chambers, of the venæ cavæ, and even of the aorta, was more or less tinged by the blood, which in all was fluid, or nearly so. We could give some further instances

of this unnaturally fluid condition of the blood in phlebitis, gangrene, and some of those cases of purulent depôts, so often met with in hospital practice. However, it would be tedious to ourselves and to our readers to multiply examples of the fact; suffice it to say that such it is. The case we are next to describe was of a different character from any of the preceding, and has already been noticed, with another view, in our pages.

CASE 3. Removal of part of a thickened Prepuce Insidious and fatal PneumoniaFluid State of the Blood.

A young man, of four or five and twenty years of age, was admitted under the care of Mr. Keate, on the 18th of February last, with the prepuce much thickened after paraphymosis. The thickened part was removed by Mr. K. on the 20th, and on the 22d the patient was observed to be nervous and irritable to an extraordinary degree. On the 23d, he was in a state of great depression, with hurried breathing, but no cough, and perfect power of taking a full inspiration. At twelve o'clock next day he died.

Dissection. On raising the sternum, the veins passing to the right side of the heart were gorged with black and fluid blood. The right chambers of the heart were also gorged with fluid blood, and the left were much more filled with the same than they usually are; so much indeed was this the case, that it became a matter of remark and dispute on its cause in the dead-house. On removing the calvarium, the veins of the dura and pia mater were turgid, and filled with more or less fluid blood, whilst the section of the brain displayed numerous and large black points, evidently the dark venous blood contained in its vessels. The lungs we may mention were violently inflamed, the pleuræ too inflamed, but in a less degree.

On the 2d or 3d of the present April, a female patient of Dr. Seymour's who had laboured for some years under Winter cough, and died, we believe, with some symptoms of thoracic inflammation, was examined in the hospital dead-house, and found to present the fluidity of the blood to a very great degree. The gentleman, Mr.

We think that the cases here brought forward would suffice of themselves to shake the faith of any unprejudiced man, in the value of the fluidity of the blood as a test of this or that state of system prior to the fatal event, and especially as a medico-legal test of violence inflicted. It may, and no doubt it very commonly is, a concomitant or consequence of sudden death, but it certainly is also found when the death is slow and produced by ordinary causes, in the ordinary way. The why and the wherefore we do not understand, most probably we never shall; but the fact is as certain as that two and two make four, and sorry we should be to fling it in the balance against a prisoner, when Justice is weighing his guilt or innocence.

There is an appearance presented by the arachnoid membrane, which is not unfrequent met with in post mortem investigation, which looks very like the effects of disease, and is often, no doubt, considered as such, but which, we are strongly inclined to suspect, is not of the nature it would seem to be. The first case in which we particularly observed it, was that of the young man who died of peripneumony after the removal of part of his prepuce, already more than once referred to. The patient in question had, by all accounts, been healthy, had never presented any "head symptoms," as far as we know or could learn, and died of inflammation in a distant organ-the tissue of the lungs. The second case that fell under our notice, was that of a diabetic, under the care of Dr. Hewett, who died, we