Зображення сторінки
PDF
ePub

ranging it, for such an impression; thus in the case of the eye, or of the ear, the first movements which follow a noise, or strong light are certain automatic and in voluntary actions of the muscles subservient to the organs of vision, or of hearing; the object of which actions is either to mitigate, or to increase and concentrate the external impressions. Now these actions are under the influence solely of the medulla oblongata; but the perception of the impressions belongs to the brain, and to the brain alone; for the brain is the organ of the faculty which wills, and of the faculty which perceives and judges. We are therefore not to regard the medulla oblongata and spinalis as the seat of special and general sensation; they are, so to speak, points of transition, or organs intermediate between the external part on which the impression is made, and the brain which perceives the impression; the function of the medulla being rather to excite a train of movements (those of general locomotion), destined to withdraw the individual organ, or to approximate it to the external agent, or, at other times, to modify and alter the condition of the organ itself; in short, to determine and regulate those special actions which are necessary to the accomplishment of the functions of sense.

MM. Majendie, Dumeril, and Serres, suppose that the trigeminal nerve is fundamentally the real nerve of all the special senses; that it bestows, by a mode of influence which we do not understand, the special sensibility on the optic, olfactory, auditory, and gustatory nerves; and that frequently, especially in the lower animals, it takes the place, and exercises the functions of these nerves. The following are the chief arguments adduced in favour of these opinions. 1. In the mole, there is no optic nerve, but instead of it, there is a twig of the fifth pair; in fishes, there is no auditory nerve; in the cetacea, no olfactory nerve; and yet these animals have in all probability a certain degree of the corresponding sensations. 2. When the

fifth pair is divided, all the special senses are destroyed, or at least enfeebled; when the special nerves alone are divided, the animal still retains in part the capability of perceiving odours, tastes, sounds, and light; but if the fifth pair is divided at the same time, these sensations are utterly and entire y annihilated. 3. Certain of the special sensations may be produced in other ways than the contact or impression of their ordinary stimuli; thus, for example, sound may be heard, although the external ear be plugged up, if a watch be applied to the head, or put between the teeth. 4. The occurrence of amaurosis, anosmia, and agenstia, from neuralgia of the trigeminal nerve. In answer to these arguments, we may state that division of the fifth pair does not immediately and instanter destroy any of the special senses; that a certain interval elapses, and during this interval, certain c! anges have taken place in the texture of the parts on which the nerve was distributed; thus in regard to the eye, the cornea becomes opaque, the conjunctiva inflamed and the humours muddy: the same results follow any injury or disease affecting this nerve; very different, however, is the effect of the division of the optic nerve; the sight is gone instantaneously and for ever. As to hearing the ticking of a watch, when put between the teeth, it is easily explicable on the well-known laws which regulate the transmission of sonorous vibrations; in a similar manner can we understand that those animals which have no external ear, as seals, moles, fishes, &c., may yet have the sense of hearing. And again; can we not hear the noise of our own voices, even when the ears are firmly plugged, and excluded from any atmospheric impulsions on the tympanum? We readily admit, that the 5th pair is intimately connected with the functions of the four special nerves; but this connexion is indirect, and arises from the trigeminal being the nerve of general sensibility, and of common mebility to the hand and face; and when it is destroyed, or disused, certain morbid

[ocr errors]
[blocks in formation]

SCHOOL OF MEDICINE AT ABOUZABEL, IN EGYPT.

At the "séance" of the Academy on the 13th of Nov. M. Clot, the founder and director of the school, accompanied with twelve of his Egyptian “élèves” was present. These twelve foreigners have been sent by the Pacha of Egypt to complete their medical education in France. Among them, some are Ulemas, and others, although born and educated at Mecca have left their homes, wives and families, to be entered as pupils at the School of Abouzabel; an occurrence unexampled in the annals of Islamism. Their names are-Ahemi El-Rachidi Vlema. Mahomet Mansour. Ibrahim En Nabraoni. Hussein El Hibaoni. Issaoni En Nabraoni. Mustapha El Subki. Hussein El-Rachidi Vlema. Mahomet El Chabassi. Mahomet El Succari. Mahom

[blocks in formation]

M. Clot, or rather Clot Bey (for he has been made a Bey by the Pacha,) gave the following interesting details. "After having taken the degree of Doctor, at Montpelier, I went to Marseilles to reside, while there I was invited to go out to Egypt as a physician; I did so, and soon after my arrival in the country strongly recommended to the Pacha, the establishment of a Council of Health, on the model of that at Paris-my advice was followed, both as regarded the councils, and also the organization of hospitals in different parts. To enhance the respect due to professional men, the medical service was put upon the same footing as the military service; and the ranks in the two were assimilated. My next object was to found a School of Medicine; but what

difficulties to conquer!! On the one hand how to convey to foreigners the language of a science, so full of technical terms; and, on the other hand how to commence the teaching of anatomy in a country, where the act of merely touching a dead body is deemed the most profane sacrilege. I explained my wishes to Osman Bey, who promised to communicate them to the Vice Roy; but he, although favourable to the plan, was unwilling to interfere with the religious prejudices of his people. I therefore boldly resolved to address myself at once to the Ulemas, or priests; they objected, and gave as their reason, that to cut a corpse was to inflict pain upon it; to this I answered, that if dead bodies really do feel pain, it must be much more severe to be gnawed away by worms than to be dissected by the scalpel. I also pointed out to them how necessary a knowledge of anatomy was to the right understanding and treatment of diseases, and urged the importance and dignity of a profession, at once most useful and honourable, and which would tend so much to augment the credit and influence of the priesthood. They at length consented, and forthwith I began to accustom my pupils to seeing and handling the dead body. All Cairo soon knew that dissection was practised at Abouzabel, and although the feeling against it was strong at first, reason soon overcame prejudice. At the end of the first six months, we had a public examination; and during that time were translated into Arabic, a Treatise on Anatomy, Majendie's Physiology, Begin's Surgical Pathology, the Internal Pathology by MM. Sanson and Roche, and works on Military and Naval Medicine by Percy and Kerandren, and also Orfila's book on the Recovery of Persons who have Drowned and asphyxiated. We were obliged to coin many new Arabic words to convey the meaning of the originals; and so diligent has been the Academy of translation, that now we have a vocabulary of upwards of 6,000 words, whose meaning is perfectly understood. Attached to the school, is a class of Pharmacy and of Veterinary Medicine; and we propose to add immediately

one for Midwifery, to be attended by Negro and Abyssinian women. The affairs of the school are conducted on the plan of a college, where the pupils are lodged, boarded, clothed, taught, and rewarded, at the expence of the Viceroy. Some of the pupils are Christians; and they are treated quite as well as any of the others. At the time of the glorious expedition into Syria, 250 surgeons were sent from the school to join the and during the disastrous invasion army; of the cholera, the zeal, skill, and kindness of these pupils were most nobly and praiseworthily displayed. In Cairo alone 60,000 were cut off in 29 days; most of the European residents, and among these the medical men, with the exception of two or three, fled from the place. Of the 150 pupils who gave their professional assistance, 30 died. In the village of Abouzabel 900, out of a population of 1,800 inhabitants, perished. The particulars will appear in a Memoir, which will be speedily printed at Marseilles.

The object of our present visit to France, is to complete the education of these twelve Egyptians in all the branches of medical science, and to improve their knowledge of the French language, in order to enable them to fulfil the duties of Professors upon their return home. The School of Abouzabel musters already more than 400 scholars; and out of these I selected 16 who appeared to be the most industrious and clever; four of them I left in Egypt to superintend the education of the others during our absence; and twelve have accompanied me to France. The Academy will much oblige me by examining and questioning them, that a correct idea may be formed of the progress which they have hitherto made."

Great applause followed this speech. M. Pariset explained the reason of M. ClotBey appearing in the Oriental costume :"the Viceroy of Egypt (said he) has formed very exalted ideas on all matters of religion; and, in testimony of respect for M. Clot's great services, he has honoured him with the dignity of Bey, and requested him, upon leaving Egypt, to bear the garb and insignia

[merged small][ocr errors][merged small][merged small][merged small]

Dr. Marie presented an interesting specimen of a carbonate of lime calculus, which had been expectorated by a young phthisical patient.

1833-SE'ANCE OF 8TH JANUARY. M. Bally resumed the reading of his memoir on cholera. An instructive discussion followed, whether there be such a species of disease as dry cholera, or cholera unattended by any intestinal discharges.

M. Gerardin mentioned two fatal cases, in which no evacuations from the bowels had taken place; but all the other symptoms. of the concentrated disease were present. In the first, no post-mortem examination was made; and, in the second, the intestines were found distended with the rice gruel fluid; and, on tracing the rectum, it was ascertained that for the extent of three or four inches, the gut was so much contracted,

that a goose-quill could not be passed through. Now we cannot properly admit that these were cases of dry cholera; as the characteristic secretions had actually taken place into the bowels, and were prevented from being discharged by stool, only in consequence of the spasmodic drawing-together of the rectum. Almost all the members of the Academy agreed in this view, and to none had occurred any case of the disease, in which the bowels were found quite empty after death.

LXXXI.

CALCULUS IN A CHILD EXTRACTED BY WEISS'S FORCEPS-EXTRAVASATION OF URINE-CURE.*

W. A. æt. 7, admitted Oct. 17, 1831. He had had constant pain and difficulty in making water for more than six months. For two days there had been complete retention. A sound in the urethra detected a calculus one-fourth of an inch within the posterior boundary of the scrotum, where a small circumscribed painful swelling was felt externally. Several attempts had been made to hook it hence with a probe, and to favour its escape by dilating the anterior part of the canal with bougies, &c. The bladder was now much distended, the urine had been retained for forty-eight hours, there was much constitutional excitement, and the portion of the canal where the calculus lay was inflamed, tumid, and painful. Dr. M. had seen a similar case which nearly proved fatal, and Sir A. Cooper had seen two fatal cases of the same description.

"Before attempting to grasp the stone with Weiss's catheter forceps, or to push it back behind the edge of the scrotum, and cut down upon it, I passed a steel sound along the urethra, to ascertain its exact situation. I then found that it was dislodged from its former position, and had passed back as far as the bulb,—probably by the pressure of the boy's finger during the painful attempts at micturition. From the

* Macfarlane's Reports.

dilated state of the canal posteriorly, the sound was easily introduced into the bladder, pushing the stone before it. Although the urethra was now freed of its irritating cause, and there no longer existed an impediment to the discharge of the urine, yet I regretted that the stone was again lodged in the bladder, in as much as the operation of lithotomy, which might be required for its removal, was a more serious procedure than cutting down upon it in the urethra. It appeared, however, that the parts were in a favourable state for attempting to seize the stone, which was evidently of small size, and to extract it through the urethra. I therefore passed, with ease, into the bladder, a pair of catheter forceps intended for an adult; and on opening their blades, gave exit to a stream of urine, which from the small size of the catheter portion of the instrument, continued to flow for a considerable time before the distended bladder was perceptibly reduced. After moving about the expanded instrument in the bladder, I could not ascertain whether the stone was laid hold of or not, until I had partially withdrawn it. It passed freely out as far as the posterior edge of the scrotum, when its progress was arrested. I then discovered, by external examination, that the

calculus was between the blades of the forceps, which were separated nearly onefourth of an inch. As the narrowest part of the canal was still to be passed, I considered that the removal of the stone by an incision in the perinæum would be the safest prac tice. I found, however, on again attempt. ing to withdraw the instrument, that the resistance was comparatively trifling; and as the calculus, so far as could be ascertained by external examination, was fairly embraced, and even covered by the blades of the forceps, I determined to continue slowly and cautiously to extract it. There was some difficulty experienced about the centre of the scrotum, and at the orifice of the urethra ; but this was gradually overcome without force, and a stone, broken into fragments, was extracted. The patient complained but little of pain, and not more than three or four drops of blood were lost."

Dr. M. ordered an elastic catheter to be introduced as soon as the patient was placed in bed. In this the house-surgeon failed, and at 12, p. m. Dr. M. found that only a small quantity of urine had been passed by the penis, and that there was swelling of the scrotum, which had commenced three or four hours previously. There was evidently urinary extravasation. Large-sized catheter passed, and to be retained-scarifications-fomentations. On the 18th the swelling and dusky redness had increased, and extended over the pubes. More scarifications. On the 20th the inflammation had extended over the pubes as far as the anterior spines of the ossa ilii. On the 21st the catheter was found obstructed, and the urine passed by its side. On the 23d he had an attack of convulsions, which did not recur, and next day a small stream of urine issued from an ulcerated opening on the dorsum penis, close to the pubes. On Nov. 12th he was dismissed cured.

"When the calculus is small, whether the disease occurs in a child or an adult, I would prefer attempting its extraction by the urethra to the painful and hazardous operation of lithotomy. When it is too large to pass along the whole canal, it may be brought into the perinæum, cut down upon and extracted. For this purpose that ingenious instrument, the catheter forceps, invented by Mr. Brodie, and recommended in his valuable Lectures on Calculous Disorders,' as published in the Medical Gazette, is preferable to the one employed by Sir A. Cooper. It is, however, liable to several objections; the most important of

Last year we saw a man with calculus in his urethra behind the glans. It could be pushed backwards and again brought forwards to its former situation, but it could not be impelled by any pressure from behind through the glans. We made various attempts with probes, directors, &c. accompanied with pressure from behind to hook it out. The attempts were unsuccessful. At length we crushed it by means of a very fine pair of dressing forceps. Some swelling of the extremity of the penis and of the anterior part of the urethra succeeded. The urethra inflammation passed away speedily, but the prepuce continued much infiltrated, and after a week or so the corpora cavernosa behind the glans felt hardened. In some days more it was evident that there was a collection of matter. This was discharged by a puncture, and the opening was soon healed. The cavity of the abscess never communicated with the urethra, but whether it actually extended into corpora cavernosa, or was merely in the external cellular texture, we cannot pretend to determine.

Dr. Macfarlane relates a case of calculus in the bladder of a female child, three years and four months old. Weiss's dilator was introduced and retained for ten minutes, and subsequently the calculus, as large as a pigeon's egg, extracted with forceps. The child has recovered without inconvenience.

LXXXII.

ACCIDENTS.

THE following remarks on this subject are taken from the third edition, just published, of Mr. Mayo's Outlines of Physiology.

which are the small size of the catheter part Loss OF MEMORY FROM OLD AGE, OR of the instrument, and the impossibility of ascertaining when the stone has been laid hold of Mr. Brodie, in the only case in which he employed this instrument, states, that when the bladder was empty he endeavoured to close the forceps, but found that he could not do it, the stone being seized. I have only to add, that in the instrument belonging to this Infirmary, which was made by Weiss, it is impossible, when it is in the bladder, to ascertain whether a calculus is between its blades or not."

"It has been remarked, that of the powers of the mind, the memory is the first to decay. Old age, which impairs the mind, makes its first inroad on the memory. Wine, while it raises the animal spirits and stimulates the fancy, at the same time disturbs the memory. After injuries of the head, that have eventually been followed by idiotcy, the failure

« НазадПродовжити »