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Typhoid Fever. Dr. Löschner,* physician to the Children's Hospital at Prague, has written a paper on this subject, the materials for which are drawn from the observation of 104 cases that came under his notice among a total of 6500 children, at a time when fever was not epidemic. He ascertained the ages from 5 to 9 to be those during which the disease is most prevalent, while it attacks boys more frequently than girls. The mortality among the cases that he observed was 8 in 104. He notices a greatly enlarged and highly injected state of the mesenteric glands as having been much more constant than ulceration of Peyer's glands; and on this tendency to affection of the glands, he builds the hypothesis that what is called typhoid fever, is a kind of acute scrofula, though he adduces no other fact in support of this theory.

Measles. An epidemic of this disease that prevailed in the neighbourhood of Glogau, in the spring of 1843, is described by Dr. Posner.† The disease did not cause any remarkable mortality, and presented nothing unusual in its

course.

Dr. Battersby has related some very interesting cases illustrative of the complications and sequelæ of measles, as he observed them during an epidemic in the autumn of 1844. The affection presented much of an asthenic character, and was often associated with diarrhea and dysentery, and with inflammation of the mouth and pharynx. In two or three cases also, where the powers of life were much exhausted, sloughing of the cornea took place. Unlike the affection of the eyes which comes on in phlebitis, it was attended with but very little increase of vascularity; [and it seems questionable whether it was not due rather to the general impairment of nutrition than to any specific influence of the poison of measles.]

Scarlatina. The pamphlet of Mr. J. B. Browns on this subject has been so generally noticed in the various medical journals, as to render any further mention of it in this Report unnecessary.

Dr. Merbach|| has described the dropsy that succeeded to scarlatina, in an epidemic at Dresden, and which sequela appears to have been extremely fatal, causing the death of nearly 1 in every 3 who suffered from it. The treatment adopted, which consisted chiefly in the administration of stimulant diuretics, with the neglect of depletion and of all decided antiphlogistic means, will probably in some measure account for this mortality. Dr. Merbach confirms the statements of previous observers with reference to the characters of the urine, and the fluctuations in the quantity of albumen it contained without any apparent cause. He notices, moreover, that the diminution in the quantity of urea was always in direct proportion to the abundance of the albumen, but that the increase in the quantity of the former always took place more slowly than the diminution of the latter. The work of M. Legendre contains a valuable essay on the anasarca and the œdema of the lung which occasionally succeed to scarlatina. He first notices the frequency with which the eruption of the scarlet fever is overlooked, in consequence of its being but very temporary, and insists on the importance of making very minute inquiries and examining the surface very carefully in all the febrile affections of childhood, in order to ascertain whether the rash is or has been present. He next lays down rules for the hygienic management of children during their convalescence from scarlatina. Lastly, he inquires into the nature and causes of the dropsy, which he regards as the simple result of the action of cold, and not as the consequence of renal disease; the albuminous state of the urine being in his opinion produced by a simple nephritis or even by a congested state of the kidney, and not the token of an incipient stage of Bright's disease. In support of this opinion he appeals to

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Dublin Journal, Sept. 1845.

On Scarlatina and its successful Treatment by the Acidum Aceticum Dilutum of the Pharmacopœia. 8vo, London, 1846. J. f. Kinderkr., May, 1846.

Op. cit., pp. 305-362.

the connexion between the quantity of albumen and that of blood in the urine, and to the simultaneous diminution in the two as the patient approaches towards convalescence. The number of cases on which M. Legendre's remarks are based was only 14; and he does not seem to have had the opportunity of watching any patients who died after the disease had reached a chronic stage, so as to determine whether any tendency to granular degeneration of the kidney is induced by the previous scarlatinal dropsy. [The correctness of his views, however, is borne out by the observations of cases where the dropsy has existed unconnected with albuminous urine, as in the epidemic at Berlin, in the spring of 1840, as well as by the results of recent microscopic_investigations, such as those of Henle, Eichholtz, and Dr. G. Johnson.]

The concluding part of his essay gives an account of that cedema of the lung which comes on as a sequela of scarlatina, for the most part in cases where general anasarca is present or has previously existed. He describes the sudden manner in which its symptoms often appear, while though the dyspnoea that attends it is extremely urgent, there are no auscultatory signs of the affection of the lungs. The chief point in the paper. however, is the anatomical description of this condition, which is an oedema of the interlobular celluar tissue, compressing the air-cells in greater or less degree, and thus differing from the oedema of Laennec, in which the fluid is supposed by that author to be contained within the pulmonary vesicles.

Variola. An elaborate paper on the anatomy of the smallpox pustule has been written by Dr. Simon,† of which only brief mention can be made here. He states that the pustule does not always owe its central depression to the presence of a hair-follicle pinning down the epidermis, but that in parts where no hair-follicle exists, the appearance is probably owing to the rapid desiccation of the exudation first poured out, while fresh matter is afterwards effused around it. The white membraniform layer immediately below the surface of the pustule is not in reality a false membrane, but is chiefly made up of the lower desintegrated stratum of epidermis, and the cellular structure of the pustule is produced by this stratum remaining in connexion with the cutis at some points, while at others it is detached from it.

The utility of the application of mercurial ointment or plaster, as a means of producing the abortion of the smallpox pustule, and thus preventing pitting, and diminishing the danger of the disease, is confirmed by the experience of MM. Goblin, Charcellay, and Briquet, and M. Thielmann and Dr. Panck§ state that they have obtained equally favorable results from the frequent use of a solution of the corrosive sublimate. M. Thielmann employed it of the strength of gr.j to 3ij. Dr. Panck used it of about half that strength.

M. Tardieu has related a case of the simultaneous existence of variola and vaccinia in a man aged 18, who was vaccinated on the day on which the eruption of smallpox had made its appearance. The variola ran its course with its characters modified, and after the desquamation of its pustules an irregular eruption of cowpox appeared. From this case he concludes that we may vaccinate with the hope of doing good, not merely during the preliminary fever of variola, but even after the outbreak of the eruption.

The work of M. Steinbrenner, who, with M. Bousquet and M. Fiard, has shared the prize of the French Academy for the best essay on vaccination and its influence on smallpox, will be found to contain a great amount of information on the subject, collected with the most laborious industry. In reply to the five questions proposed by the Institute, M. Steinbrenner decides

+ Müller's Archiv, 1846, ii.

Described by Dr. Philip, in Casper's Wochenschr., Aug. 29, 1840. Revue Méd., and Oesterr. Med. Wochenschr., September 20, 1845; Bull. de l'Acad. Roy. de Méd., April 15, 1846; Gazette des Hôpitaux, September 19, 1846.

§ Gazette des Hôpitaux, April 16, 1846; Oesterr. Med. Wochenschr., September 20, 1845. Gaz. Med., November, 1845. Traité sur la Vaccine. 8vo, Paris, 1846.

1st. That the preservative power of vaccination is almost always permanent, and that when it is not so the period of immunity varies greatly according to individual peculiarities. 2d. That the vaccine virus does undergo a positive deterioration by transmission through successive individuals. 3d. It is therefore desirable to obtain fresh lymph frequently, which might be done by taking it annually from the cow, by which we should be much more sure of succeeding than by retrovaccination or any similar means. 4th. There is no necessary connexion between the intensity of the local phenomena of vaccination and its preservative power, but there is such a relation between the preservative power and the amount of constitutional disturbance. 5th. Revaccination is desirable not because it is always necessary, but because we have no means of distinguishing the cases where it is needed from those in which it is superfluous.

A very elaborate collection of statistics, intended to illustrate the same questions as are treated of by Dr. Steinbrenner, has been made by Dr. Lane, but is not of a kind to admit of abstract.

In an account of an epidemic of smallpox at Heidelberg, and of revaccinations which he practised there, Dr. Hoeflet makes an assertion which is opposed to general experience. He asserts that he found the pustules of revaccination bear to those of primary vaccination just the same relation as those of a second attack of variola bear to those of a first attack. He states, moreover, that he observed this modification, although he never employed revaccine lymph, and though he always vaccinated directly from arm to arm. M. Legendret has related the particulars of some chronic affections of the shin which were cured by the appearance of the eruption of smallpox. The cases which underwent improvement were either papular, vesicular, or pustular, while an eruption of porrigo favosa of the scalp was not in the least benefited by a copious eruption of smallpox.

DYSCRASIE, ETC.

Gangrene. Dr. Battersby§ describes a case of gangrene of the skin in a female child, aged 10 months. The disease began with the appearance on the limbs of several vesicles, a good deal like those of varicella, but larger, the cutis beneath some of them being black and gangrenous. The child lived for a fortnight, during which time no attempt took place at separation of the dead parts, and the gangrene extended from the thigh to the vulva, and partly up the abdomen. Dr. Battersby mentions a similar case recorded by Dr. Hutton in Dublin Journal,' xvii. p. 485. [A case is mentioned by Řilliet and Barthez, Maladies des Enfans,' ii p. 195; references to others are given by Richter, Ueber den Brand der Kinder,' pp. 9-12; and one instance of it came under the notice of the writer of this Report, in which the skin of the face was affected.]

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Scrofula. Mr. Phillips's Treatise on Scrofula || contains a very large amount of valuable statistical information. The grand objects of the work, however, is to prove the non-identity of phthisis and scrofula. He confesses the apparent identity of the deposit, however tested; but in scrofula inflammatory change in the gland precedes the deposit; while the lung is unaltered around a simple deposit of tubercle. Further, the two diseases are not prevalent in the same districts, nor in the same sex, nor at the same age, and 18 out of 20 phthisical patients show no sign of scrofula; from all which facts taken together Mr. Phillips draws the conclusion that though allied they are not identical diseases.

• American Journal of Med. Sci., July, 1846. Op. cit., p. 439-449.

+ Gaz. Méd., April 25, 1846.

§ Dublin Hospital Gazette, March 15, 1846. Scrofula,-its Nature, its Causes, its Prevalence, and the Principles of Treatment. 8vo, London, 1846.

309

ON A NEW MEANS OF RENDERING SURGICAL OPERATIONS PAINLESS.

JUST as our last proof was passing through our hands, we received from our medical friends in Boston the account of a matter so interesting to surgeons, and indeed to every one, that we take the opportunity of introducing it here. We know nothing more of this new method of eschewing pain than what is contained in the following extracts from two private letters, kindly written to us by our excellent friends, Dr. Ware and Dr. Warren, of Boston-both men of the highest eminence in their profession in America-and, we may truly say, in Europe also. It is impossible however, not to regard the discovery as one of the very highest importance, not in the practice of operative surgery only, but also, as Dr. Ware suggests, in practical medicine also. We trust our friends will forgive us for putting into print their private communications. The importance of the subject and the necessity of authenticating the statements, are our excuses. The authors of the discovery are Dr. C. T. Jackson and Dr. Morton.

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"Boston, November 29, 1846. “ I found, on my arrival here, a new thing in the medical world, or rather the new application of an old thing, of which I think you will like to hear. It is a mode of rendering patients insensible to the pain of surgical operations, by the inhalation of the vapour of the strongest sulphuric ether. They are thrown into a state nearly resembling that of complete intoxication from ardent spirits or of narcotism from opium. This state continues but a few minutes-five to tenbut, during it, the patient is insensible to pain. A thigh has been amputated, a breast extirpated, teeth drawn, without the slightest suffering. The number of operations of various kinds, especially those in dentistry, has been very considerable, and I believe but few persons resist the influence of the agent.

،، The effect is not exactly the same on all. In some, the insensibility is entire, and the patient is aware of nothing which is going on; in others, a certain degree of the power of perception remains, the patient knows what the operator is doing, perceives him for example, take hold of a tooth and draw it out, feels the grating of the instrument, but still has no pain.

"There are no subsequent ill effects to detract from the value of this practice, none even so great as those which follow a common dose of opium. One person told me she had some unpleasant sensations in the head for a short time, and was weak, languid, and faintish through the day, but not more so than she ordinarily was from having a tooth drawn. Another told me that he experienced something of the same kind and in addition that his breath smelt very strongly of ether for forty-eight hours, and was indeed so strongly impregnated with it as to affect the air of the room in which he sat, so as to be disagreeable to others.

"One of our best operative surgeons informs me that he regards it as chiefly applicable to cases of the large and painful operations which are performed rapidly, and do not require any very nice dissection, but that for the more delicate operations, which require some time, he would prefer to have the patient in his usual state. But it is impossible at present to judge what will be the limits to the application of such an agent. Objections may arise of which we do not dream, and evils may be found to follow, which we do not now perceive. Still it certainly promises much in surgery, and perhaps may be capable of application for other purposes beside the alleviation of pain. Would it not be worthy of trial in tetanus, in asthma, and in various cases of violent internal pain, especially from supposed spasms?

"It was brought into use by a dentist, and is now chiefly employed by that class of practitioners. He has taken out a patent for the discovery, and has despatched persons to Europe to secure one there also; so you will soon hear of it, and probably have an opportunity of witnessing its effects." Faithfully yours, JOHN WARE." "Boston, November 24th, 1846. "You may have heard of the respiration of ether to prevent pain in surgical operations. In six cases I have had it applied with satisfactory success and no unpleasant sequel. "I remain, &c., JOHN C. WARREN."

XLV.-XXIII.

21

Since the above was in type we have seen a more extended communication on the same subject, published by Dr. Bigelow in the 'Boston Medical and Surgical Journal.' The more material parts of this we hasten to extract :

“It remains briefly to describe the process of inhalation by the new method, and to state some of its effects. A small two-necked glass globe contains the prepared vapour, with sponges to enlarge the evaporating surface. One aperture admits the air to the interior of the globe, whence, charged with vapour, it is drawn through the second into the lungs. The inspired air thus passes through the bottle, but the expiration is diverted by a valve in the mouthpiece, and escaping into the apartment, is thus prevented from vitiating the medicated vapour.

"A boy of 16, of medium stature and strength, was seated in the chair. The first few inhalations occasioned a quick cough, which afterwards subsided; at the end of eight minutes the head fell back, and the arms dropped, but owing to some resistance in opening the mouth, the tooth could not be reached before he awoke. He again inhaled for two minutes, and slept three minutes, during which time the tooth, an inferior molar, was extracted. At the moment of extraction the features assumed an expression of pain, and the hand was raised. Upon coming to himself he said he had had a 'first-rate dream-very quiet,and had dreamed of Napoleon-had not the slightest consciousness of painthe time had seemed long; and he left the chair feeling no uneasiness of any kind, and evidently in a high state of admiration. The pupils were dilated during the state of unconsciousness, and the pulse rose from 130 to 142.

"A girl of 16 immediately occupied the chair. After coughing a little, she inhaled during three minutes, and fell asleep, when a molar tooth was extracted, after which she continued to slumber tranquilly during three minutes more. At the moment when force was applied she flinched and frowned, raising her hand to her mouth, but she said she had been dreaming a pleasant dream, and knew nothing of the operation.

"A stout boy of 12 at the first inspiration coughed considerably, and required a good deal of encouragement to induce him to go on. At the end of three minutes from the first fair inhalation, the muscles were relaxed and the pupil dilated. During the attempt to force open the mouth he recovered his consciousness, and again inhaled during two minutes, and in the ensuing one minute two teeth were extracted, the patient seeming somewhat conscious, but upon actually awaking, he declared it was the best fun he ever saw,' avowed his intention to come there again, and insisted upon having another tooth extracted upon the spot. A splinter which had been left afforded an opportunity of complying with his wish, but the pain proved to be considerable. Pulse at first 110, during sleep 96, afterward 144, pupils dilated.

"These cases, which occurred successively in about an hour, at the room of Dr. Morton, are fair examples of the average results produced by the inhalation of the vapour, and will convey an idea of the feelings and expressions of many of the patients subjected to the process.

"The inhalation, after the first irritation has subsided, is easy, and produces a complete unconsciousness at the expiration of a period varying from two to five or six, sometimes eight minutes; its duration varying from two to five minutes, during which the patient is completely insensible to the ordinary tests of pain. The pupils, in the cases I have observed, have been generally dilated; but with allowance for excitement and other disturbing influences, the pulse is not affected, at least in frequency. The patient remains in a calm and tranquil slumber, and wakes with a pleasurable feeling.

"It is natural to inquire whether no accidents have attended the employment of a method so wide in its application, and so striking in its results. I have been unable to learn that any serious consequences have ensued. One or two robust patients have failed to be affected. I may mention, as an early and unsuccessful case, its administration in an operation performed by Dr. Hayward, where an elderly woman was mdae to inhale the vapour for at least half an hour without

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