of his severity; and to the assiduity wherewith he has picked out, for animadversion, whatever weak parts could be detected in the writings of others. The manner also in which his strictures have been made on Hunter, Fox and Duval, is objectionable: in regard to the two former, he should have been pleased to remember, that bare justice at the very least, was due to the illustrious dead; for both of these surgeons were excellent philosophers, and each of them contributed infinitely more to the advancement of dental physiology and pathology, than the small number of their defects will conduce to retard the progress of these intricate branches of knowledge. Mr. Fox, for instance, directs that, "in stopping a tooth, a piece of gold or tin-foil leaf is to be introduced, and carefully and firmly pressed in, so as completely to fill up the cavity;" and, at the end of the section, mentions merely, but does not at all recommend, a fusible metal, pointed out to him by some chemists, as being applicable to the same purpose: it was, therefore, uncharitable to select this as a subject of severe sarcasm, and at the same time pass over in silence the very practice our author himself employs. A comparison, moreover, of M. Duval's doctrines with those of Mr. K. would elicit something by which the latter might be edified. In fine, by condensing his volume into one-third of its present size, and by unveilng his practical rules of all sort of mystery, Mr. K. will transform it into a useful work, and obtain for himself the dignity of an honourable and zealous cultivator of his profession.

We have reason to know that Mr. Koecker is a very excellect practical dentist; and that the zeal and ability with which he manages every operation he undertakes, are truly praise-worthy. These qualifications will, we trust, ensure him patronage and success in this metropolis; but we would have proved ourselves his greatest enemies, if we had failed to point out to him the objectionable parts of his writings.

IX.

Quarterly Periscope

OF

PRACTICAL MEDICINE;

BEING

The Spirit of the Medical Journals,

Foreign and Domestic;

WITH COMMENTARIES.

PART II.

ANALECTA.

"Ore trahit quodcunque potest, atque addit acervo."

1. DISEASE OF THE HEART.

In the last number of the Medico-Chirurgical Review, page 606, allusion was made to the case of Mr. P. (a half-pay quarter-master) residing in King Street, Westminster, as labouring under "organic disease of the heart, with its usual consequences, effusion, &c. &c." as ascertained by auscultation. This patient died suddenly in the night of the 14th October, just two months after the above diagnosis was given, and one month after it was published. We examined the body in the presence of Dr. G. P. Morris, Mr. Ollier, Surgeon of the Western Dispensary, Mr. Lavies, Mr. Clapton, and Mr. Henry Johnson. The following were the appearances :-Edema of the lower extremities-two or three pints of water in the abdomenright cavity of the chest filled with clear serum, the lung of that side being shrivelled to about twice the size of the fist. No marks of inflammation in that side of the thorax. In the left side nothing but an immense pericardium could be seen, on first inspection, the lung being quite concealed. The pericardium was thickened by successive layers of coagulable lymph, and agglutinated to the sternum in front and to the ribs on the side. When opened, a heart of most enormous dimensions presented itself. The apex of the heart was firmly glued to the pericardium by a strong and ancient adhesion, the size of a shilling. The parietes of the left ventricle were one inch and three quarters, in some places, thick-the cavity of the ventricle in proportion. The mitral valve appeared shrivelled and greatly out of proportion to the other parts in the neighbourhood-it could not be made to cover the auriculo-ventricular opening, and was therefore quite imperfect in its function. The auriculo-ventricular opening was of great calibre, so that the two chambers were almost one cavity with an imperfect valve intervening. The left auricle was dilated, proportionally with the ventricle, but its parietes not proportionally hypertrophied. The parietes of the right ventricle were not half an inch in thickness, but the chambers on this side were enlarged greatly. The semilunar valves at the origin both of the aorta and pulmonary artery, were unaltered; but the origin of the aorta itself was rather widened, so that the semilunar valves, at this part,

could not have completely shut the root of the aorta, when the ventricle was in a state of diastole. Scales of bone covered the root of the aorta, which was only enlarged for about the space of two inches from the heart. The vessel, from that point, possessed its natural calibre. The heart was computed to weigh about two and a half, or three pounds.

In the abdomen, marks of extensive chronic peritonitis every where existed. The convolutions of the intestines were glued together in many places, and to the reflected peritoneum. The stomach was glued to the liver and to all the contiguous parts. The liver itself was small and condensed, and its peritoneal covering whitened with coagulable lymph. Its structure was granite-looking, and a large white tubercle, an inch and a half in diameter, was cut through, in making an incision into its parenchymatous structure. The gall-bladder was so agglutinated to the neighbouring parts, especially to the colon and stomach, that we had some difficulty in bringing it into view. It contained a number of small angular calculi, as black as jet. They changed colour, however, on being heated, and were evidently the common biliary calculi. The coats of the gallbladder were much thickened; but the state of the ducts could not be properly ascertained amid the mass of adhesive inflammation in which they were entangled. The stomach was very large, and its mucous membrane extensively discoloured, nearly black in many places, and a considerable portion softened and quite abraded. We had not time to examine the mucous membrane of the intestines. There was nothing else remarkable. We think the foregoing case is interesting, as verifying the diagnosis which was given two months previously, by aid of auscultation and percussion, in the presence of several medical gentlemen, especially Dr. Marshall Hall, Dr. Hewett, Dr. Macann, Mr. Lavies, and others. This diagnosis, as respected the organic disease of the heart and the effusion in the chest, the two principal features of the disease, could not have been given, with any thing like confidence, except through the aid of percussion and auscultation. The action of the heart was perfectly regular, and the pulse rather small, to the last; nor did the patient ever complain of much pain or uneasiness in the region of the heart. In fact, his attention was directed to symptoms in almost every part of the body, except the spot where the fatal disease was situated. Mr. Parker had led rather an irregular life, as a soldier, and had been intemperate till lately. He dated the origin of his complaint in November, 1825, when he had been straining rather violently while brewing some ale. He then felt a sudden pain beneath the right scapula, near the shoulder, which continued for several months. Next followed dyspnoea on going up stairs, with sudden feelings of suffocation, causing him to start up in bed. Pains in the epigastrium and region of the liver succeeded, with a sense of beating at the pit of the stomach. After these symptoms had continued for a few months, he got into a state of great irritability and irascibility, complaining of such a host of strange and anomalous feelings in various parts of the body, that he was set down by more than one or two of his medical attendants as completely hypochondriacal. Dropsical effusions, however, in the lower extremities compelled the physicians who took this view of the case, to fear that there was something more than fancy in the business. The biliary secretion was depraved-the appetite irregular the digestion imperfect. Then, of course, the digestive organs were considered in fault, and mercurials and bitters were employed, as well as diuretics; but these produced no permanent benefit, and the poor man was driven almost to insanity by the horrible feelings of mind and body. Still the disease of the heart was not suspected, though the state of the breath, the paucity of urine, and oedema of the

lower extremities, led to the belief that hydrothorax was impending. Such was the state of the case when the writer of this article was consulted, on the 26th of June last, nearly five months before the fatal termination. A single application of the ear detected the organic disease of the heart. The pulsation could be heard even in the right side of the chest; but the most remarkable phenomenon was a whizzing or purring noise in the region of the heart, corresponding exactly with the ventricular contractions, or, in other words, with the pulse. This led, at once, to the conclusion, that there was disease, or at least imperfection, in the valvular apparatus of that side of the heart, while the extent of pulsation left no doubt of the enlargement of the organ. The chest sounded very badly in the region of the heart, and no respiratory murmur could be heard in the lower three-fourths of the right side of the chest. These phenomena were verified by numerous auscultations, and Dr. Marshall Hall confirmed them by two separate examinations, in the month of August following. Neither Dr. Hall nor Dr. Hewett, however, were quite satisfied respecting the nature of the disease of the heart, though convinced that there was hydrothorax of the right side in, particular.

It would be interesting to trace the origins of the various organic changes which this unfortunate officer presented on dissection, but no regular or minute history of the symptoms could be obtained, in consequence of the afflicted patient's running from one medical man to another in the vain hope of cure. The reporter, however, saw him every day, for nearly five months, and never had reason for altering the opinion formed during the first interview. There can be little doubt, that the enlargement of the heart was the primary disease. The adhesions and thickening of the pericardium bore all the marks of long standing inflammation; and the band which united the apex of the heart with the internal surface of the pericardium, was as white, dense, and strong as ligament. We conceive, then, that the enlargement of the heart had been going on for years; and that all the other changes were of a far posterior date. The peritoneal inflammation agglutinating the abdominal viscera, though not recent, was, in all probability, much more so than that in the chest. The effusion of water into the right side of the thorax was, unquestionably of recent formation, and had gradually increased during the attendance of the reporter. We all know how soon a lung will be diminished to a very small compass, when encroached upon by water in the chest. One morbid structure, however, which dissection disclosed in this case, may perhaps claim seniority over the enlargement of the heart. That was, the granulated texture and diminution of bulk in the liver. We think there can be little doubt that this morbid change was produced by the early and long continued habits of irregularity, not to say intemperance, of a soldier's life. It is such a change as we not unfrequently see resulting from similar habits. But the question is, had this change of structure in the liver any thing to do with the organic disease of the heart? We think it is not at all improbable that the liver disease, attended, as it must have been, with disordered function in the digestive organs generally, contributed originally to disturb the function of the heart, and ultimately its structure. But this was anterior to the illness which caused the patient's death, and had nothing to do with that event. Neither could any human sagacity have detected organic change in the liver during life. Its function was deranged, it is true, but so it often is, without any change of structure. The organic disease of the heart, in fine, produced the dropsical effusion in the chest-and this was the immediate cause of death. The adhesive inflanımation in the abdomen was an accidental occurrence, and although its sequelæ occasioned much distress, they did not affect life.

2. CAN THE BLOOD BE THE SEAT OF DISEASES ?*

That the fluids, as well as the solids, do occasionally undergo alterations in a state of disease, is pretty generally admitted; but the question is, can the blood be the primary seat of diseases-or can a change in the condition of this fluid be entitled to the denomination of diseases? and can disordered function in various organs be the consequences of this change in the fluids? M. Segalas thinks that an answer in the affirmative may be safely given. Numerous experiments have now been made on animals, with the view of ascertaining this point, by different physiologists. The following suite of trials were confined to the effects of alcohol and nux vomica on dogs.

1. If a certain quantity of alcohol be thrown into the jugular vein of a dog-half an ounce, for example-the animal is instantly killed, and the blood is found very much changed, being grumous, and, in colour, resembling milk that is turned. The lungs are reddened, and firmer than natural.

2. If the alcohol be diluted by four or five parts of water, the animal soon falls down, in a state of complete intoxication, being motionless, insensible, and only exhibiting signs of life by slow breathing carried on by the abdominal muscles, and by a scarcely perceptible pulse.

3. When the quantity of alcohol is small, as for example a drachm, the animal only staggers about for a few minutes, and soon after appears as if nothing had happened. This return to health takes place in proportion to the elimination of the alcohol, as is evident from its odour on the pulmonary exhalation.

4. The above experiment was several times repeated, and always with the same result. If the animal be watched, and the experiment repeated as soon as the pulmonary vapour ceases to exhale the odour of the alcohol, an ounce of this spirit may thus be passed through the veins of a dog, of 30 pounds weight, in the course of an hour.

5. The same quantity thrown at once into the veins, quickly suppresses the respiration, and the heart ceases to pulsate in the course of two or three minutes.

On examination of the body, no alteration can be perceived in the solids, with the exception of some increase of density in the lungs. But the blood was always found to be materially altered. It was not grumous, as after the injection of the pure alcohol; but it had a creamy appearance, and was more uniformly thickened.

Exp. 6. If the alcoholic injection be made into the bronchia, the inebriation takes place equally soon when introduced into the veins, and the appearance of the blood is the same in both cases, but, in the former, a larger quantity of alcohol is necessary to induce these changes in the blood, and a longer time for its operation, than in the latter mode of experimenting. 7. Whether we divide the eighth pair of nerves, or leave them intact, injection of alcohol into the bronchia produces the symptoms of intoxication in the same time, and to the same degree.

8. Intoxication through the medium of the stomach requires more al cohol, and much longer time for its operation, than when the fluid is thrown into the venous or respiratory vessels. The intoxication is also much more slow in being dissipated.

9. The blood appears thickened after this kind of inebriation, even when the animal is killed by asphyxia.

* Experiences relatives à cette question, "La sang peut-il être siège de Maladies? Memoire lu à l'Académie des Sciences, 21 Feb. 1826. Par Segalas D'Echapare. Archives, Septembre, 1826.