-and somewhat of an enthusiast, at the same time, which accounts for many of the sentiments of despondency and sanguine expectations blended in his correspondence with Mr. Southey. It has been already mentioned in a former number of this Journal, that the amiable and expectant deceased consulted the Editor, when within a few days of his death, respecting a journey to Nice or Pisa, for the prolongation of his life, if not the restoration of his health!! This shewed the predominancy of the pulmonary over the gastric disease, towards the close of life—a predominancy which fortunately strewed the path to the tomb with flowers, and verified the adage that

"Hope springs eternal in the hectic breast."

XXV.

HYPERTROPHY OF THE MUSCULAR COAT OF THE STOMACH, &C. By M. REY

NAUD.

CASE. A labourer, aged 58 years, of robust constitution, was seized, towards the end of May, 1828, with symptoms of the endemic which then prevailed in Paris. For two or three months this man had complained of loss of appetite, urgent thirst, pains in his limbs and arms, which last had diminished, but never entirely disappeared, and were succeeded by paralysis of the lower extremities. In fact, for three months before his death he was totally incapable of walking. When he came under the reporter's care, the hands and arms were still the seat of darting pains, and they were contracted and distorted. He now also complained of constant pain at the pit of the stomach and under the sternum. His appetite had been quite gone for a month. The epigastrium offered great resistance on pressure-the vomitings were frequent the tongue was moist and natural thirst considerable obstinate constipation-skin dry-pulse slightly accelerated emaciation advanced. This emaciation and these symptoms continued till the 3d of April, when the patient died.

Dissection. Passing over the minute but useless details of dissection respecting the head and thorax, we find that the stomach was more ample than natural, and had contracted some adhesions with the liver. The organ contained some undigested matters, and about two pints of a dark-coloured fluid. The mucous membrane was rather thinner than natural. The pyloric orifice would scarcely admit the point of the little finger. There was a thickened and scirrhous state of the cellular substance interposed between the coats of the stomach around the pylorus for a little way. But the whole parietes of the organ were in a state of great hypertrophy. This hypertrophy was seated in the muscular structure of the stomach, which was as red as the fibres of any of the voluntary muscles.

The lesions which were observed in the cortical substance of the brain, were supposed to account for the loss of sense and motion in the lower extremities; but as they did not appear satisfactory to us, we shall not occupy space with them here. The hypertrophy of the muscular coat of the stomach is curious and interesting. HEBDOM.

XXVI.

ON GLAUCOMA. By WILLIAM MAC-. KENZIE, Lecturer on the Eye in the University of Glasgow, &c.

THIS zealous cultivator of ophthalmology has published a paper on the above subject in the eleventh number of our Glasgow cotemporary, of which we shall offer an analysis to our readers. We shall begin with the pathological anatomy. Very little on this subject is recorded even by the best ophthalmologists. Mr. M. was anxious for an opportunity of dissecting some glaucomatous eyes, and lately was favoured with several in that state. The following are the particulars which he observed.

"1. The choroid coat, and especially the portion of it in contact with the retina, of a light brown colour, without any appearance of pigmentum nigrum.

2. The vitreous humour in a fluid state; perfectly pellucid; colourless, or slightly yellow. No trace of hyaloid membrane.

3. The lens of a yellow or amber colour, especially towards its centre; its consistence firm; and its transparency perfect, or nearly so.

4. In the retina, no trace of limbus luteus, or foramen centrale.

To the first of these changes, namely, the deficiency of pigmentum nigrum, I am inclined to ascribe, in a great measure, the opaque appearance of the deep-seated parts of the eye in glaucoma. This appearance I regard as a reflection merely of the light from the retina, choroid, and sclerotica; it is probably bluish when it first leaves the reflecting surface formed by these membranes, but immediately assumes a greenish hue from passing through the yellowish fluid which occupies the place of the vitreous humour, and through the lens, which is still more decidedly of a yellow, or even amber colour, at that period of life when glaucoma is most apt to attack the eye.

Scarpa has adopted a similar view of the nature of Glaucoma, namely, that it is a reflection; but he assumes, seemingly without proof, that it is from a thickened retina that the reflection takes place. After mentioning that those cases of amaurosis may be regarded as incurable, in which the bottom of the eye presents an unusual paleness, similar to horn, sometimes inclining to green, and reflected from the retina as if from a mirror, he adds, in a note, the following remarks. The retina of a sound eye is transparent; and, therefore, in whatever degree of dilatation the pupil may be, the bottom of the eye is of a deep black. That unusual paleness, then, which accompanies amaurosis, indicates that a remarkable change has happened in the substance of the optic nerve forming the retina, which, according to all appearance, is become thickened, and rendered permanently incapable of transmitting the impressions of light.""

Mr. M. has never detected any other change in the retina than what is abovementioned—namely, a want of the limbus luteus and foramen centrale.

"If the pupil of a glaucomatous eye is small, the appearances are apt to impose on the inexperienced observer for those of cataract. The colour, however, of the glaucomatous eye, is sufficient to prove that the case is at any rate not one of simple lenticular cataract, for opacity of the lens alone is never green. A green cataract is always attended. with glaucoma. On dilating the pupil by belladonna, the green appearance presented in simple glaucoma seems to retire to a greater depth behind the iris, and becomes more circumscribed.

Glaucoma is frequently combined with arthritic inflammation. When this is the case the sclerotica and conjunctiva become loaded with varicose vessels of a livid colour, the pupil dilates irregularly, the lens becomes opaque, and is pushed forward so as almost to touch the cornea; the junction of the sclerotica and cornea becomes of a pearly-white colour; racking pain is complained of in the eye and head, and vision becomes totally extinct. After some time, the inflammatory symptoms subside, and the contents of the eyeball begin to be absorbed, so that it shrinks to less than its natural size, and, instead of the preternatural hardness which it formerly presented, becomes boggy.

The symptoms which we gather from the testimony of the patient, are the following:-vix, sensations of fiery and prismatic spectra, muscæ volitantes, misty and indistinct vision, and pain across the forehead, which is, at first slight, but often becomes severe. Not unfrequently those who become affected with glaucoma have long suffered from those pains in the teeth and head, which are generally accounted rheuma

1

tic. In some instances the glaucomatous eye is still sensible to objects placed to one or other side of the patient, while in every other direction it distinguishes nothing."

Proximate cause. Mr. M. thinks that inflammation may be the cause which leads to the destruction of the hyaloid membrane; and that this, in its turn, may produce a series of other changes. It is also probable, he observes, that the superabundance of the aqueous humour, promotes by pressure, the absorption of pigmentum nigrum, rendering the retina insensible in the end. The destruction of the hyaloid membrane and superabundance of fluid afterwards occupying the place of the vitreous humour, are looked upon by our author as the essential changes which take place in glaucoma.

Exciting and Predisposing Causes. The Germans consider glaucoma as almost always connected with arthritis, or rather as the result of chronic arthritic inflammation. It is much more frequently met with in old than in young subjects rarely occurring before the age of 40-frequently after 60. Mr. M. has been led to suspect that the habitual use of spirits and tobacco operates in the production of this disease.

Prognosis. When glaucoma has commenced in one eye, it generally extends to the other. In its fully formed state, it is absolutely incurable. But it may often be checked in its progress; and, when only one eye is affected, it may sometimes be prevented from extending to the other. We cannot restore the secretion of pigmentum nigrum, but remedies may occasionally arrest the disease, and even improve the impaired vision.

Treatment. This we shall give in the concise language of the talented author. "1. On the presumption that glaucoma originates in an inflammatory affection of the hyaloid membrane, bleeding and purging have been employed in order to arrest its progress; and occasionally this practice has been attended with benefit. Counter-irritation, also, has been found useful, and especially the tartar emetic eruption between the shoulders.

2. Calomel, with opium, has been given, on the principle that in almost all cases of deep-seated inflammation of the eye, mercury proves salutary. As is the case in arthritic ophthalmia, with which glaucoma is certainly allied, an alterative course will prove more beneficial than if the mercury were pushed so as severely to affect the mouth. Indeed, it is evident that from the age and constitution of those who are in general the subjects of glaucoma, neither depletion nor mercurialization can, with propriety, be employed, without more than ordinary caution.

3. Rest of the eyes, a mild diet, a healthy state of the skin, and abstinence from alcoholic fluids, and tobacco in every form, must be enjoined.

4. Arthritic inflammation of the eye is often greatly benefited by the use of tonics, as precipitated carbonate of iron, sulphate of quina, and the like. After depletion, such remedies may be also tried in glaucoma.

5. Dilatation of the pupil by belladonna greatly improves the vision of most glaucomatous eyes, and may be employed day after day as a palliative. The most convenient mode of applying the belladonna is in aqueous solution, filtered through paper, and dropped upon the conjunctiva morning and evening.

6. As a superabundance of dissolved vitreous humour appears to form an essential part of the morbid changes which take place in the glaucomatous eye, it is not unreasonable to conclude that occasionally puncturing the sclerotica and choroid might prove serviceable, by relieving the pressure of the accumulated fluid on the retina. The puncture should be made with a broad iris-knife, at the usual place of entering the needle in the operation of couching. The instrument should be pushed towards the centre of the vitreous humour, turned a little on its axis, and held for a minute or two in the same position, so that the fluid may be allowed to escape.

7. The removal of the crystalline lens from a glaucomatous eye not only lessens very much the greenish appearance of the humours, but improves the vision

of the patient. At the same time, although I am persuaded that the absence of the lens might be advantageous even in the early stage of this disease, and prevent, in a considerable measure, its further progress, extraction is an operation, which I would by no means venture to recommend for general adoption in such cases. The patient generally sees too much to warrant our exposing him to the danger of arthritic inflammation coming on after the operation. I have known glaucoma operated on for cataract; that is to say, the amber-coloured lens removed by extraction, the operator apprehending that he was removing an opaque or cataractous lens; and I have seen the incision, after such an operation, heal without inflammation, and the patient receive a considerable accession of vision. But I have also known such violent inflammation follow the removal of the lens from a glaucomatous eye, as entirely destroyed the natural structure of the most important parts of the organ.”

XXVII.

M. CRUVEILHIER ON FUNGOUS TUMORS OF THE MENINGES OF THE BRAIN.*

THE study of cancerous diseases, though repulsive in itself, and not leading directly to the splendid goal of professional ambition, the cure of human nialadies, is productive of many beneficial results. It teaches us that difficult lesson to learn, the when and the where to restrain our hands; it tells us the occasions on which interference would be mischievous, and heroic remedies pernicious; it informs the surgeon, that if there are cases adapted for the knife or the cautery, there are others which to meddle with is murder. We have had but too many opportunities of witnessing the disastrous consequences of operations performed upon malignant tumours, in an improper manner or at an improper time. About two years ago,

Anatomie Pathologique. Huitieme Livraison.

a woman presented herself to a surgeon with a tumour upon the head. It was soft, had an opening in it formed by ulceration, and had existed for a few weeks only. The gentleman, thinking it a common encysted tumour, introduced a lancet and probe, which appeared to pass deeply, and poked about for some time to his own satisfaction, though not to that of the lookers on. A severe and strange set of symptoms followed, and in two or three days the patient was no more. On dissection, the tumour was found to be fungus hæmatodes, and to be in contact with the dura mater, having extended inwards through a large opening in the cranium. A few days ago, we saw a female with ulcerated scirrhus of the breast, who, according to her own account, had undergone a most improper operation in the country. Part of the breast had been removed, a part of the scirrhous tubercle being left behind, to grow and to ulcerate afresh. We might swell relations of this kind to a fearful magnitude, but enough has been said to establish the position with which we set out.

Malignant tumours on the head are not uncommon. In the paper by Sir Astley Cooper on exostoses, published in his and Mr. Travers' surgical essays, one or two cases of fungus hæmatodes are detailed. We have ourselves seen several, and M. Cruveilhier, in the 8th livraison of his Plates of Morbid Anatomy, before us, delineates some well-marked specimens of the disease. We believe that the origin of some of these tumours is incorrectly described by some au thors. M. Louis, the celebrated secretary of the still more celebrated French Academy, conceived that these malignant tumours proceeded from the dura mater, and described them under the title of fungus of that membrane. Siébold attempted to overthrow the opinions of M. Louis, and, relying on a case or two, maintained that the fungus originated in the diploë of the cranial bones. From that time to this there have been many and hot controversies on the subject; but, like the men with the cameleon, all are right and all are wrong. It will be our object to prove that, oc

casionally, the malignant growth takes its rise from the dura mater, and occasionally also from the diploë. If we ventured to place reliance on our own observations, we should say that the latter description of cases was more frequent than the former: but we speak on this point with diffidence. The history of this controversy, is the type and the emblem of almost every dispute in physic. One man saw a case in which the fungus originated in the dura mater: another found an instance of its birth in the diploë. Each maintained that his was the real Simon Pure, each concluded that his adversary was mistaken. Like the knights in the fable, they lustily fought on their own sides of the shield, but, unlike those knights, they had not the good hap to be thrown to the opposite, and discover their respective mistakes. So it is with physic and physicians. A man has a case which bears on a mooted point:-through the medium of excusable delusion, and the glass of personal feeling, this solitary fact is erected into a principleand for that principle he fights with as much pertinacity as if he were contending for the empire of the world. Poor worm! The observer of to-morrow disbelieves his fact and upsets his reasonings, to substitute a tissue as ephemeral in their stead.

M. Cruveilhier takes a sensible and extensive view of these cancerous tumours. He shews that they sometimes arise in the dura mater, sometimes in the diploë. Of the former there are two classes: the one take their growth from the external layer of the membrane, and protrude through the cranial bones; the second proceed from its internal surface, and press inwards on the brain. Other tumours, again, are formed in the cellular texture beneath the arachnoid, and, amalgamating that membrane to themselves, it becomes difficult to determine that they have or have not been produced from the internal surface of the dura mater. Lastly, it is not uncommon for tumours of the cranial bones to exist along with tumours springing from the interior of the dura mater. In the present article, M. Cruyeilhier confines himself to the

consideration of productions of the latter class.

We have already stated, that cancerous tumours attached to the interior of the dura mater are more frequent than those external to it. We meet them on the surface of the brain, at the basis, attached to the falx and the tentorium. When situated on the petrous portion of the temporal bone, they may rather be regarded as belonging to it than to the dura mater; when in the sella turcica, they have erroneously been considered as a disease of the pituitary gland or infundibulum.

These tumours frequently appear to follow a blow, a fall, or a concussion; the symptoms attending them are mostly equivocal; indeed in the earlier stages there are usually none at all. But, sooner or later, the pressure, gradually augmented on the brain, becomes a source of irritation to itself or its mem

branes, and a train of symptoms, sometimes sudden, sometimes slow, are the necessary consequence. Frequently hemiplegia suddenly comes on; we have seen a complete and rapidly fatal apoplexy. A man, says our author, sixty years of age, was returning on foot to his native place, when suddenly he lost. his senses, and recovered with hemiplegia of the right side. Nearly four months afterwards he died in the Ste. Antoine Hospital; and, on dissection, a cancerous tumour, as large as the fist, was found at the side of the falx cerebri, beneath the cerebral arachnoid, and lodged in a deep excavation of the middle lobe of the brain. In the case of sudden apoplexy to which we have alluded, the patient, a middle-aged woman, had been subject, for some time, to obscure cerebral symptoms, prior to invasion of the fatal attack. On dissection, a tumour of fungus hæmatodes was found in the substance of the right hemisphere of the brain.

Most commonly, and especially when the tumour occupies some portion of the basis, the symptoms of compression are established more gradually; sensation and motion are first diminished and then destroyed in the parts of the body in connexion with the affected side of the brain: the intellectual faculties are en