ed. It was necessary to repeat this operation seven times, once with a lancet; on that occasion only was there any subsequent fever or restlessness. Pressure was tried after one of the operations of puncturing; it produced convulsions, and was necessarily abandoned. Gradually the skin became thicker, the quantity of the fluid diminished, it was no longer necessary to repeat the operation, and the child is at present in the satisfactory state described at the commencement of the case. This concludes Mr. Adams' paper. We have condensed it greatly, but we believe that we have presented most of what is important. It is a contribution to our stock of surgical knowledge, and not unworthy of the attention of surgeons. XXXII. SPONTANEOUS CURE OF HYDROCELE. THE following case is related in our valuable contemporary of Dublin. It is extracted from a German Journal. A man, aged 52 years, had been affected with hydrocele for many years. The tumour having been punctured, a quart of serum flowed out, and the testicles were found to be healthy. Nine months afterwards, the tumour had acquired the vo lume of a child's head. Dr. Krimer proposed to cure it radically by incision and extirpation of the tunica vaginalis, to which the patient consented. At the day appointed, Dr. Krimer and his colleagues having gone to the patient, were surprised at not finding the slightest trace of the hydrocele. The man said, that the evening before, having attempted to raise up a weight of 200lbs., he had felt a violent pain and a noise in the region of the inguinal ring. The pain continued most dreadful, as if the belly was being torn open. He then went to bed, passed much urine, and having fallen asleep after the pain, became somewhat easier, the next morning there was no trace of the hydrocele to be found. An ecchymosis existed over the left side of the scrotum. The spermatic cord and epididymis were varicose, the inguinal ring close, and there was not any trace of the liquor. He felt no pain. After a few days the ecchymosis and the varicose state of the cord disappeared under the use of fomentations. There is a slight mistake, and we suppose it is in the translation. Dr. Krimer proposed, we are told, extirpation of the tunica vaginalis. We never heard of such an operation for hydrocele, nor for any thing else, nor is such an operation possible, without extirpation of the testis. It is not a very uncommon thing for a hydrocele to be accidentally ruptured, when the fluid escapes into the cellular membrane. The case before us does not seem to have been of this description ; indeed it is somewhat marvellous, and looks as if it had been loosely observed or narrated. XXXIII. BAD EFFECTS OF SMOKING TOBACCO. SUCH is the title of an article in our contemporary, the London Medical and Surgical. As our readers may like to know what these bad effects are, and as the article devoted to them is brief, though themselves may be long, we will gratify their curiosity by extracting it. "The practice of smoking is now so general, that our atmosphere is strongly poisoned with tobacco-smoke. The air is sufficiently impure in this metropolis, without further contamination. At every corner we see a number of pipes or segars, especially in the mouths of boys or young men. The bad effects of tobacco are first produced on the glands of the mouth, which form the saliva; these are excited and form an increased quantity of this fluid, which, instead of passing into the stomach, to assist in digesting the food, is expelled from the mouth. Great smokers have weakened powers of digestion, and are subject to bilious and nervous complaints, lowness of spirits, and diseases of the lungs and brain. The German medical writers allege, that of twenty deaths of men, be the time at which it was published, the attention of physicians had not been at all directed to the subject of chronic inflammations, especially of those which have their seat in the membranes lining the visceral cavities. Pinel does not even mention them in his Nosographie. In their place we find the unmeaning terms "organic diseases, or defects, and atrophy or decay without any appreciable cause." Corvisart too was ignorant of the true nature of internal morbid changes. If in a case, which was neither consumption, nor disease of the heart, nor any of those inward swellings denominated at that time organic alterations, he observed the progressive decay of a patient affected with a chronic malady, he attributed it to a state of mere feebleness and cachexy(malus habitus ;) expressions vague and utterly unmeaning, or rather we should say extremely mischievous, as leading to erroneous indications of treatment. The History of the Chronic Phlegmasiæ corrected these faults, and shewed that inflammation is the chief agent in the production of those diseased growths and changes which we meet with in the centre of the viscera, and also in the texture of their lining membranes, and that these are the real causes of that incurable exhaustion and decay, which had hitherto been always referred only to debility of the solids, and depravation of the fluids of the body. Moreover it proved that such debility and such depravation are often curable; it pointed out the signs and epochs of their curability, and also the means for their cure. Henceforth the term "organic disease" had a definite and appreciable meaning: medical men were satisfied in attempting to soothe, and not vainly to eradicate such; and their attention was chiefly directed to prevent its occurrence, or progress, as soon as they dicovered the germ in those obstinate and intractable irritations which equally invade all structures and tissues. The treatment of such cases was no longer empirical, but rational and consistent. The class of fevers was at this period as imperfectly understood, as those of cachexies and of organic diseases. Continued fevers were divided into two sorts; the one attributable to the inflammation of a particu lar organ; the other being viewed as essential, or independent of any local affection: but such a phrase as "essential" means nothing; for we are still puzzled to say, to what cause are we to ascribe an essential fever; in this state of ignorance, the physicians tried to characterise such a case either by the predominating sypmtoms, or by vague and idle conjectures and speculations; if the secretion of the bile was much increased, the fever was termed "bilious;" if that of the mucous surface in any part, a "mucous or pituitous" fever; when the temperature of the body rose high, then it was a "burning" fever; and when it fell much, it was a "cold, or algid" fever; again fevers were called asthenic, putrid, nervous, and ataxic, as they happened to be attended with exhaustion, with putrescency, and with symptoms of disturbance of the nervous and muscular symptoms; there were also hospital, camp, and prison fevers; and fever with petechial, miliary, or other eruptions. In some cases, the character and name were drawn, it would seem, from an idea that a baneful agent was working its effects upon the patient, and defeating the physician's efforts; and hence such fevers were styled "malignant." Does this language convey any knowledge? or does it not rather prove the confusion and chaos in which the subject was involved, and mislead the practitioner not only in his attempts to reason on the nature of the diseases, but also in his efforts to cure them? Hence one set of men was drawing the indications of their treatment from the state of the biliary, or nervous secretions; while another set was talking only of debility, putridity, or malig nancy. Pinel was the first to perceive, and to aim at correcting these errors of the schools. He tried to localise some fevers, as for example the bilious fevers, under the name of meningo-gastric, and the pituitous, or mucous fevers, under that of adeno-meningeal. But he has not told us in his Nosographie, of what nature is the gastric disorder, nor yet of the cause of the increased quantities of mucous, which is characteristic of the second class; moreover he fell into the egregious contradiction of attributing these two sorts of fevers, sometimes to irritation, and sometimes to a primitive change of the biliary and mucous secretions, at the very time that he designated them, essential fevers. Then he vaguely ascribed all his ataxic fevers to a disorder of the nervous system, and most confusedly classed together all fevers in which the vital ener gies are depressed, and termed them adynamic. Not only was there no localisation of the disease, but the indications of treatment in such a system were most injurious: for what is the cause of the loss of power, or debility in fevers, but simply inflammation of some of the viscera? Such was the state of the science, when I published, in 1816, the first edition of my Examination of Medical Doctrines. In it I pointed out the absurdity of expecting to advance the science of medicine, merely by forming groupes of symptoms into particular diseases, which is not less absurd than to say that an assemblage of ten, or twelve symptoms is the virtual cause of those morbid changes which we observe after death. The symptoms in short are nothing but the external and obvious evidences of the malady which is involving the organs in abnormal changes. I proposed to view fevers, as we do inflammations, to localise them in certain parts, or organs, and I attempted to show that the morbid changes of structure which are going on, are the real existing causes of fevers, and not, as had hitherto been supposed, the effects of them. At the same time, I strongly inculcated the propriety of extreme caution in our reasoning on those cases, where the "mobile" of the fever is not apparent. These new doctrines encountered much opposition, but they gradually gained ground, and became more and more adopted, as will be seen by the following events. In 1812, was commenced the large "Dictionnaire des Sciences Medicales," the articles of which were deeply imbued with the doctrines of Pinel, till the year 1817, from which time some sprinkling of the physiological reasonings began to appear. Before the work was completed, the " Dictionnaire Abrégé" was brought out, and in it the physiological medium was preponderant. In the large Dictionary, fevers are enumerated as "essential, or idiopathic;" in the abridg ed one, we read of none but such as are symtomatic. In both, the doctrines which I had unfolded in my History of the Phlegmasiæ, were insisted upon, in discoursing upon all the diseases which are included in the catalogue of inflammations. For the last sixteen years, almost all medical researches have taken their rise from, and have been based upon the physiological doctrines. The subject of inflammation is studied, discussed, and specialized, much more than it was formerly; and where inflammation cannot be proved to exist, imitation is supposed to be present, and is now deemed to be the agent in producing a host of organic diseases, which were before merely enumerated in detail. The relations between the changes and vitiations of the fluids, and the different sorts and degrees of inflammatory and irritative actions, are attentively and most zealously examined. In 1821, appeared the second edition of my "Examen des Doctrines" which was published originally in one volume, then in two, and at length in the fourth edition in four volumes. Soon after this period I began my system of "Physiology applied to pathology;" it was brought out in numbers for four successive years. It is devoted to the examination of the etiology of diseases, and to the tracing of those functional aberrations from the healthy to the diseased state, which are caused by the influence of the external agencies continually operating on the living body. This work, as well as the preceding ones, has received the honour of translation into several languages. In addition to these, the "Annales de la Médécine Physiologique" have appeared in monthly numbers for the last eleven years, and my Treaties on Irritation and Madness in 1825, in which last work the cause of the "positive philosophy" was pleaded with a boldness and a freedom, which might have been dangerous to the author. Lastly the cholera morbus, which has so puzzled and bewildered all medical enquiries, must be viewed through the enlightening medium of correct physiology, before we can hope to arrive at a successful therapeutic. We have explained our views upon this subject in an essay which was lately published. According to the physiological school of medicine, no disease is ever primarily and essentially general, that is, affecting equally and at once every part of the system. Disease begins always in one individual organ, even when the disease depends upon a cause which induces an alteration in the humours, or fluids of the body, such as the exciting cause of small pox, typhus, &c. &c. The great aim of the practitioner ought therefore to be, to discover the primitive seat of the disorder, as he may thereby often be enabled to check, and even strangle the nascent evil. By following this mode of examination, French authors have surprisingly reduced the catalogue of malignant fevers, which are now seldom met with, except when medical assistance has been called too late, or has not been accepted. Look at the reports of the different hospitals, and mark how seldom we find the term of general or essential fevers, and how prevailing is the belief that all diseases ought to be regarded primarily as local affections. Even when the physician does not see the case, until the disturbance has been propagated to, and has involved all the functions of the economy, he can do much to relieve his patient by following the physiological method, and directing his attention to those organs which have chiefly suffered. Hence we perceive the absurdity of recommending in fevers only one set of remedies to the exclusion of all others; the remedy must be adapted to the condition and susceptibility of the affected organs. The operation of all agents which influence and modify the state of the system, ought to be our especial study, and the effects of these upon the moving and sentient powers, our only guide in judging of the results. Thus we admit no â priori reasonings and conclusions, into our school; neither any preconceived opinions, nor any implicit following the "verba ullius magistri." Let it not be supposed that our doctrine is that the abnormal changes and modifications, which we have alluded to, are the only immediate cause of all diseases; we know that these causes may exist in the humours, in certain poi sous, in the vicissitudes of heat and cold, in the imponderable agents, and probably also in influences, which cannot be appropriated by our senses, and we are not opposed to any researches calculated to explain or illustrate the action of these causes, and to discover antidotes to them, but we simply maintain that a disease can be recognised only by the aberration from the normal condition of the moving and sentient powers of the body, and that the study of this aberration, sometimes as excessive, at other times as impaired, or irregular action, can alone furnish to the medical man the correct method of ascertaining whether his remedies are beneficial, or injurious. Formerly a patient, who was getting worse, instead of better, while under medical treatment, was often told "Have patience, it is the medicine which is acting upon you;" a gouty man was consoled by hearing that his physician must not relieve him, for his sufferings were in sooth necessary for the object which nature had in view; and even in many acute diseases, the patient was congratulated on any increase of fever and restlessness, upon the ground that a salutary crisis of his malady was at hand! How often was the raging thirst of fever met with hot drinks, which only add fuel to the distress! We have a memorable instance of this folly in the late treatment of the cholera; but now, thank God, the poor sufferers are permitted to have as much cold water and ice, as they desire. There are indeed cases, in which the patient must submit to the annoying effects of certain medicines; but such cases are infinitely more rare than was formerly believed; but yet we must acknowledge that much injury is often done by their employment; thus, in dyspepsia, how frequently do we see stimulants and tonics ordered, although it is obvious that they must either increase the distress, or only change its character. In short, the art of sparing suffering and pain is not so ancient as many suppose, and has been fostered chiefly under the happy influence of the physiological me thod; for the very essence of this method is to bring relief to suffering organs, and not to regard diseases merely as assemblages of certain symptoms, which must either co-exist, or succeed to each other; by this foolish practice, we neglect the sat, falls blighted. The brilliancy of mirrors is dimmed after reflecting their image, the edge of burnished steel is deadened, as is also the shining beauty of ivory. Hives of living bees are quickly deprived of their busy vitality. Copper and iron become rusted, in consequence of being exposed to the contact of the malignant fluid. Dogs that taste it become mad, and their bite infuses with it an incurable poison. They say, that even that small animal the ant can discover the vicinity of a menstruous woman, and that it throws away the provisions it chanced to be carrying at the moment of making that discovery, not taking to them again. This evil of such a nature and magnitude happens to women every thirty days; but prevails to a greater extent every third month. Some, however, have the menses oftener than monthly, others have them not at all. These latter, however, do not bear children; for this periodical flux is the matter which assists the male in the act of generation.Plin Secund. Natural Histor. tom. ii. lib. 7, cap. 15, art. 13. In the law of Moses, the secretion incident to the function seems to have been considered more in the light of an infirmity of nature and of offensiveness to our senses, than as being possessed of the malignant properties ascribed to it by other ancient writers.-Levitic. xv. 19 —38. Isaiah, xxx. 22. Ezekiel, xviii. 6. In hot climates it is indeed probable that the menstruous secretion is very liable to become acrimonious under certain circumstances of inattention to the duties of cleanliness. Hence, no doubt, the origin of the strict regulations contained in the Mosaic ritual, and imposed upon the females of the Jewish nation during and for some days subsequently to the period of the function. The personal habits of the native women of India are such as lead to the same conclusion. The frequency of their ablutions is such as scarcely to be credited, excepting upon the most veracious testimony." ancient philosophers. It was, indeed, a benefit to the human mind, when Lord Bacon broke the neck of antique sophistry. It is generally believed that the menstruous fluid contains no fibrine. There have not been an adequate number of experiments to determine this satisfactorily. Mr. Brande's analysis appears to deserve most confidence. "Whilst engaged (says he) in observ. ing the colouring matter of the blood, I received from Mr. Wm. Money, House Surgeon to the General Hospital at Northampton, some menstruous discharge collected from a woman with prolapsus uteri, and consequently perfectly free from an admixture with other secretions. It had the property of a very concentrated solution in a diluted serum, and afforded an excellent opportunity of corroborating the facts respecting this principle, which have been detailed in the preceding pages. Although I could detect no traces of iron by the usual mode of analysis, minute portions of that metal may, and probably do, exist in it, as well as in the other animal fluids which I have examined; but the abundance of the colouring matter in the secretion should have afforded a proportionate quantity of iron, if any connexion had existed between them. It has been observed, that the artificial solutions of the colouring matter of the blood invariably exhibit a green tint, when viewed by transmitted light. This peculiarity is remarkably distinct in the menstruous discharge. I could discover no globules in this fluid, and although a very slight degree of putrefaction had commenced in it, yet the globules observed in the blood would not have been destroyed by so trifling a change." M. Desonneaux concludes, that in some women, the menstrual fluid does contain fibrine. Dr. Davis criticises his opinion, and believes that, in a healthy condition Such is the unphilosophical nonsense of of the secretion, fibrine is never present. VOL. XVIII. No. 36. 43 |