inflammation of the hernial sac, having many common features of resemblance, and differing from each other only as they were in different stages of inflammation. In one of them the sac was gangrenous; in the second, fibrin was effused in abundance, but no pus formed; in the third, suppuration took place; and in the fourth, the inflammation was so much reduced that it no doubt terminated by resolution." The whole report merits the attention of the surgeon. Auscultation; its Advocates and Detractors.-We extract-says the editor of the Lancet'-from the last number of the Dublin Journal of Medical Sciences, the following judicious observations by Drs. Stokes and Graves, on the use and abuse of the stethoscope. The chastisement which Dr. Clutterbuck has received from such competent authorities, will, it is to be hoped, prevent him in future from delivering opinions upon subjects with which it is manifest that he is totally unacquainted: In the Medical Gazette, for July 28th, 1838, we have a lecture of Dr. Clutterbuck's on the treatment of periodical asthma, and on blood-letting in the specific inflammations of the chest. In this lecture, the following irritable effusion appears : "I may take this opportunity of adverting to the method of investigating diseases of the thorax by auscultation; that is, by listening attentively to the sounds emitted during respiration; and also by sounding the cavity, by tapping with the ends of the fingers on different parts of the chest. This mode of examination has always been resorted to more or less by physicians; though, from the employment of a load of new terms, invented chiefly by our ingenious neighbours, the French, and introduced by some of our own practitioners who have enjoyed the advantages of the Parisian schools, one would be led to suppose that a new region of science had been discovered, not inferior to mesmerism or homœopathy. As a specimen of the new language introduced on the occasion I may enumerate the following, indicating, it is supposed, as many various conditions of the organs in question. Thus, in the compass of a few pages, you will meet with the following:-' Pectoriloquy, perfect and imperfect-broncophony'-'pneumo-thorax''rhonchus'-'crepitation, fine and coarse'-' vocal resonance'-'tinkling echo''metallic tinkling'-'amphoric, or bottle-like sound'-'clicking'-bubbling' -' gurgling'' snuffling'-' whiffs of a cavernous respiration'-' fistular resonance, like that of a pan-pipe or key'-' pectoriloquy, forming a little island of voice'-cum multis aliis." Dr. Clutterbuck seeks to destroy the fame of Laennec by the worn-out system of denying his originality. Can he point out a single author who used auscultation as Laennec did, from the time of Hippocrates to the discovery of the stethoscope? He cannot. He is strangely ignorant, when, combining the modes of auscultation and percussion, he states that "this mode has always been resorted to by physicians," and his joke about auscultation as equal to mesmerism and homoeopathy, comes with bad grace from one, himself the author of an unphilosophical and exploded theory of fever. But Dr. Clutterbuck is an auscultator. He can tell by "the tone of the when I found an empty sac; I divided the neck of the sac. The patient died in thirty hours. On opening the abdomen, the upper part of the small intestine was found distended, swollen, and inflamed. A segment of a portion of the ileum, which had been down, was deeply discoloured, and retained the impression of the close grip of the neck of the sac. It had been forced back into the body, before the performance of the operation, by the taxis, too much injured for recovery, through the length of the time it had been strangulated. The tumour upon which I operated was the sac, with thickened adipose matter partially surrounding it." Aug. 25, 1838, p. 781. cough whether there is not a great cavity in the lungs, the result of suppuration or ulceration." He can tell with "tolerable precision, whether a quantity of mucus lies loose and floating, as it were, in the air tubes !" He can judge of the state of the larynx by the sound of the voice; and ascertain whether the lungs are pervious to air. His powers of diagnosis are certainly great; his opinion in chest disease must be equally valuable. We suspect Dr. Clutterbuck's sense of hearing must be injured; for to him the ear trumpet" magnifies but distorts the sound, rendering it less distinct than before. He holds that it may be classed with the telescope and the microscope, and includes all three in his anathema! And he adds, that "the information thus acquired, supposing it to be correct, comes too late in general to be of any practical use. It serves to indicate the conse¬ quences of disease, rather than disease itself, and that at a period when they are far beyond the power of art to remedy." It is not true that auscultation only detects fully formed diseases. Its chief value is the facility with which it enables us to recognise the true nature of pleurisy and pneumonia, often a few hours after they have commenced, and consequently at a time when the knowledge, thus obtained leads to the almost instant arrest and cure of the disease. We would ask Dr. Clutterbuck whether it is of no practical use to discover an apyrexial hepatisation, to distinguish between this and a circumscribed pleuritic effusion; to discover whether, in a case of laryngeal disease, the lungs are healthy or diseased? to distinguish between an empyema with or without a pulmonary fistula? to detect a foreign body fixed in the bronchus ? to distinguish, in a case of stridulous breathing, where tracheotomy is apparently called for, between tracheal disease and the pressure of an intro-thoracic tumour; to detect the existence of effusion into the pericardium ; or to discover latent disease of the mucous membrane, parenchyma or serous structure in a case of typhus fever. We might add an hundred more of such instances. Let us be clearly understood. We write these remarks for the junior student, who might be deterred from studying an important and now indispensable part of his profession, by the statements above quoted. We seek not controversy with Dr. Clutterbuck, his opinions can only affect the unin formed. In the next number, Dr. Hope, of whom we wish to speak with the respect which his labours have earned for him, has authorised the publication of a series of diagnosis, made by his pupils after a ten minutes' lecture on the most difficult part of medicine, namely, the valvular diseases of the heart. The pupils were inexperienced, and as far as we can learn availed themselves solely of physical diagnosis. Their conclusions, in thirteen cases out of fifteen, were correct," although they had, amongst others, to deal with the rare diseases of the pulmonic orifice. 66 That the pupils, after having been instructed in Dr. Hope's views of the causes and situations of valvular murmurs, should have come to conclusions such as he would have done, is not wonderful; but that these conclusions were correct we have only Dr. Hope's word for. We shall not examine into the evidence of the conclusions, for we know it to be insufficient; but we object to the whole proceeding, as calculated to revive the often repeated and refuted objection to the advocates of auscultation, that they neglect the history of the case and vital phenomena. The following considerations we wish to impress on the pupils of the Meath Hospital. First. That the physical signs of valvular disease are not yet fully established. Second. That taken alone, they are in no case sufficient for diagnosis. Third. That even in organic diseases the nature and situation of murmurs may vary in the course of a few days. Fourth. That all varieties of valvular murmurs may occur without organic disease. Fifthly and lastly. That organic disease of the valves may exist to a very great degree without any murmur whatsoever. Of this assertion we shall hereafter bring abundant proofs. R. J. GRAVES, Repeated application of the same Leeches. By DR. KUNDIG, of Grünengen.' A girl, 20 years of age, and of scrofulous constitution, contracted in June 1836, a painful swelling of the right knee-joint. Two applications of leeches to the joint, together with antiphlogistic and derivative remedies, gave no relief, and Dr. K. resolved to leech the part several days in succession. As the circumstances of the patient made it desirable to avoid expense, the leeches which had once drawn and fallen off were emptied, placed in lukewarm marsh water, and reapplied the next day. This was followed up for fourteen days, and sixteen of twenty-two leeches drew as well on the last day as the first. The inflammation and pain were thus diminished, and the swelling reduced; the leeches therefore were discontinued, and warm fomentations of the decoctions of belladonna and cicuta applied. The disease gradually subsided under this treatment, and the patient resumed her avocations. It would appear from this case, that the desire and power of the leech to reapply itself, are better maintained when the trial is made on successive days, than when the animal is allowed to rest for a longer period. BOOKS RECEIVED.. From the Editor.-Lectures on the Theory and Practice of Physic, delivered in the College of Physicians and Surgeons of the University of the State of New York. By the late David Hosack, M. D., L. L. D., F. R. S., Professor of the Theory and Practice, &c., and of Clinical Medicine in that institution. With an Introductory Letter, by Nathaniel Chapman, M. D., Professor of the Theory and Practice of Medicine in the University of Pennsylvania, &c. Edited by his friend and former pupil, Henry W. Ducachet, D, D., Rector of St. Stephen's Church, Philadelphia. 8vo, pp. 700. Philada., 1838. From the Publisher, Mr. Herman Hooker.-A copy of the same. From the Author.-A Manual of Chemistry: containing a condensed view of the present state of the science, and copious references to more extensive treatises, original papers, &c., intended as a text-book for medical schools, colleges, and academies. By Lewis C. Beck, M. D., Professor of Chemistry and Botany in the University of the City of New York, and in Rutger's College, New Jersey, &c. &c. 3d edit., illustrated with numerous woodcuts. Small 8vo, pp. 482. New York, 1838. From Professor C. Davis, of Georgia.-An Address delivered at the Medical College of Georgia, on opening the course of lectures, 17th Oct., 1837. By Paul F. Eve, M. D., Professor of Surgery, and Dean of the Faculty, Medical College of Georgia. 8vo, pp. 16. Augusta, Ga., 1838. Refutation of charges made by Dr. Caldwell, through the columns of the Louisville Journal, against Professor James C. Cross, of Trannsylvania University. 8vo, pp. 15. Lexington, Ky., 1838. I Casper's Wochenschr. f. d. ges. Heilk., 1838, No. 7. THE AMERICAN MEDICAL INTELLIGENCER. Vol. II. November 15, 1838. No. 16. ART. I.-CASE OF DEATH FROM SWALLOWING A CENT. BY ORLANDO FAIRFAX, M. D., OF ALEXANDRIA, D. C. Professor Dunglison. Alexandria, D. C., Oct., 1838, Dear Sir,-If you deem the following case of sufficient interest for insertion in your valuable periodical, it is much at your service. With great respect, very truly yours, O. FAIRFAX. On the 19th of Oct., 1838, I was called to see Mary, a negro girl, aged 12 years. I found, on my arrival at the house, that she had just expired. I was told by her friends that they had not been (aware of her being in ill health until the previous evening, when she suddenly discharged from the mouth about a wineglassful of blood; that after this discharge she was cheerful and apparently well for about twenty hours, when the hemorrhage was renewed, and she expired in a few minutes. I saw about ten ounces of florid but not frothy blood, which was what she had discharged on the second occasion. Upon further enquiry into the history of the patient, I ascertained that she had swallowed a copper coin (a cent) about two years since, and that ever since she had complained of pain about the upper part of the sternum, with occasional difficulty of swallowing; but that she had not been the subject of diarrhoea, and that she had never complained of pain in the abdomen.. Necroscopy, twenty hours after death.-Exterior: moderately plump; abdomen rather full; some blood flowing from the mouth and nostrils. Thorax. Heart, lungs, and pleura perfectly natural. On slitting open the œsophagus the coin is discovered, situate with its planes parallel to the axis of the tube and presenting forward and backward, and having two opposite parts of its circumference resting in deep longitudinal sulci, produced in the coats of the oesophagus by ulceration. One of the ulcers, having perforated the coats of the oesophagus, has formed an opening about two thirds of a line in diameter into the aorta, at a point five lines below the origin of the left subclavian. The calibre of the aorta at this point is not enlarged. In the cellular membrane, in the fork formed by the bifurcation of the trachea, is a globular cyst, of the size of a walnut, and containing a fluid strikingly resembling white of egg. Abdomen.-No morbid adhesions between the different portions of the peritoneum. The peritoneal coat of the intestines is of a remarkable bluish green, which colour has been imparted to that portion of the surface of the liver which rests on the colon. The stomach is distended with dark, coagulated blood, and the mucous membrane is of a brownish-red colour. The mucous membrane of the small and large intestines is of a somewhat lighter colour than that of the stomach, and throughout is thickly studded with na VOL. II.-16 infinite number of enlarged muciparous glands, of the size of millet seed. The small intestine contains little else than greenish mucus. The colon is remarkably large, and contains a great quantity of a substance, black and pasty, having an unusual odour, and adhering with great tenacity to the mucous membrane. The coin, on being compared with a new one of the same denomination, is found to be twenty-six grains lighter. O. FAIRFAX. ART. II.-RESEARCHES ON CEREBRAL OTORRHEA. BY PROFESSOR ALBERT, OF BONN. CASE 6.-A man a little more than 40 years of age, lean, has suffered for two years from violent cephalalgia, especially on the right side. He relates that at its commencement there was profuse otorrhoea of the same side, which had lately occurred on the opposite side, but in a less degree, followed by complete deafness. The pains increasing, Professor Hendrin, of Groningen, was consulted, who trepaned the patient above the right ear, at the place where the pains had commenced. At the termination of a few days, the otorrhoea had entirely ceased, and the patient thought he could hear a loud noise; but in proportion as the suppurating wound approached a cure, the otorrhoea returned to the same extent, and was accompanied with cephalalgia and difficulty of deglutition. The patient died suddenly a few days after. Autopsy. Almost entire destruction of the petrous bone, with caries of the mastoid process; effusion of pus into the base of the cranium, compressing the medulla, which explains the difficulty of deglutition and sudden death. Nothing extraordinary in the part trepaned.1 CASE 7.—Guillen Basé, ætat. 22; attacked with fever and delirium after having had an aching tooth drawn, on the 28th of September; four days after, purulent discharge took place from the auditory meatus. Died on the 4th of November. Autopsy-Dura mater strongly adherent to the arachnoid, and dotted with small points, particularly towards the longitudinal sinus; convex surface of the brain studded with a large quantity of tubercles, filled with a purulent mass. The cerebral substance, when cut in slices, presented striæ of the same matter. The choroid plexus filled with vesicles containing pus. Cerebellum covered with same mass. The nerves of the seventh and eighth pairs almost destroyed by the pus found in the internal meatus. The superior and horizontal semicircular canal and the inferior portion were filled with pus; the foramen ovale destroyed, and the membrane of the tympanum perforated.2 Regarding the short duration of the disease, it is difficult to indicate with certainty the point of departure of the affection; considering, however, the rapid progress and the great disorganisation of the brain, it is fair to presume that it commenced in the latter organ. CASE S.-C., ætat. 18, affected for many years with otorrhoea and deafness, had, in 1810, an abscess behind the ear through which a probe might be introduced into the mastoid process, and which subsequently closed. Afterwards the patient was seized with cephalalgia, which in 1813 became very violent. On the 14th of May, he had pungent pains in the head, with anxiety, fre Willemier, Dis. de Otorr., &c., p. 27. 2 Willemier, 1. c., p. 89.' |