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we are in a great measure coming back to the long obsolete opinions and practice of last century, it is only wise and right that we should do so when convinced of our errors.

We cannot close these few remarks without recommending to the especial notice of our readers the admirable Treatise on Puerperal Fever by Dr. Ferguson, published two years ago, and of which a copious review was given in our number for April, 1839. One very short extract will enable them to judge of the spirit of its contents.

"The three following propositions embody my views of the source and nature of purperal fever.

1. The phenomena of puerperal fever originate in a vitiation of the fluids.

2. The causes, which are capable of vitiating the fluids, are particularly rife after child-birth.

3. The various forms of puerperal fever depend on this one cause, and may readily be deduced from it."-(Rev.)

CASES OF GLANDERS, WITH REMARKS.

Dr. Delaharpe, physician of the hospital at Lausanne, has published in the Revue Medicale of Paris a memoir on this curious pathological subject. We shall first briefly report two cases which he adduces, and then extract some of his most interesting remarks.

An old pedlar was admitted, on the 17th of August, 1837, in the following state. There was extreme prostration of all the vital powers, and a tendency to delirium, although the patient, when spoken to, answered questions with tolerable accuracy. His face was puffy and of a purplish red colour; the left side of the nose, and the adjoining part of the face, were covered with numerous pustules of different sizes, each one being surrounded with a livid areola, and filled with pus. The largest of these pustules had an indurated base, and resembled a good deal the pustules of variola in suppuration. The left eye was completely closed by the swelling of the eyelids; but, on opening these, the conjunctiva was found to be in state of chemosis. There was a discharge of puriform mucus from the nostrils. On different parts of the surface, but chiefly on the extremities, pustules, similar to those now described, were scattered up and down; and at the side of these pustules were observed patches of a livid hue, and also rounded soft subcutaneous tumors, some of which were of the colour of the surrounding skin, and others were slightly inflamed. The largest of these tumors gave a distinct sense of fluctuation under the finger; several of them looked like large warts, or rather like some of the forms of nævi. On the left buttock was a large gangrenous ulcer, which discharged a fetid ichor; the scrotum was oedematous, of a blueish colour, and exhibited several ulcerated pustules on its surface; its epidermis had become detached in some points, apparently by the friction of the parts.

The breathing was hurried, and incommoded a good deal by the obstructed state of the nostrils; the pulse was rather quick but full; the lips and teeth were covered with a dark coating; the tongue was red at its tip, but furred behind. This patient died on the following day in a comatose state.

*

Dissection. On removing the integuments of the face, a multitude of small abscesses were observed, varying in dimensions from the size of a small nut to

*No satisfactory information could be obtained whether this man had ever anything to do with glandered horses. It was found, however, that he had often been in the habit of sleeping in stables.

that of a millet-seed; all of them contained a yellow thick pus. The left malar bone was denuded at one point, where a pustule was situated. The nasal fossa on this side exhibited large reddish fungosities, which were traced upwards to the ethmoidal cells, and backwards to the pharynx; the nasal passage was completely obstructed, and the natural tissues were with difficulty recognizable amidst the fungous mass. On detaching the tumefied mucous membrane, a multitude of minute pustules were brought into view. The posterior edge of the velum palati, at the junction of the two pillars, was found to contain a small abscess full of matter. In the right nasal fossa, the inferior spongy bone exhibited a fungous patch similar to what, as we have described, was observed in the left one, but only much smaller.

There was considerable subarachnoid effusion on the convex surface of the brain; but the encephalon did not present any other decidedly morbid appearance. The lower half of the trachea was inflamed, swollen, and its mucous membrane a good deal softened. Here and there were observed minute abscesses, similar to those found in the nasal fossæ. The lungs were healthy throughout, with the exception of a minute abscess in the upper part of the right lobe. The heart was normal; so also was the liver; the spleen was friable and softened.

Case 2.-A postillion, 33 years of age, was admitted on the 10th of November, 1835, into the hospital at Lausanne, in consequence of severe pains in the lower limbs, and more especially in the right knee; there were also several painful rounded tumors on different parts of the limbs. One of these, situated beneath the right knee, was of the size of a large egg, and communicated to the finger a distinct sense of fluctuation. A similar tumor, but of smaller dimensions, existed on each arm. There was slight hydarthrosis of the left knee-joint. The patient was put on a nutritious diet, and he was ordered to drink a decoction of mezereum and other woods. One of the tumors on the left leg was punctured with the lancet; but nothing save a little dark blood was discharged from the wound. The other tumors were kept wetted with a decoction of oak-bark, to which some spirit of wine had been added. For three months this patient continued in a weak and ailing state; but, by persevering in the use of tonics, wine, and a generous diet, his health and strength began to be so much improved that he was able to leave the hospital in the following March; he died however during the course of the Summer of marasmus.*

The disease of glanders is communicable to the human subject by atmospheric infection as well as by the direct inoculation of the diseased matter by a wound. The observations of Dr. Farozzi of Milan in Omodei's journal for August, 1822, prove this. Hufeland seems to have been the first to pronounce that the disease in the horse is communicable to man: in a note to a case of doubtful character reported in his journal for March, 1822, he exclaims, der Rotz der Pferde steckt Menschen an, (the glanders of the horse infects men!) Veterinary surgeons had long known that wounds of the fingers, if infected with the nasal discharge of sickly horses, are apt to assume a most unhealthy character; but they do not

*It is more than doubtful whether we can regard this case as one of glanders in the human subject, or equinia, as it has been denominated by some writers. That there was that peculiar cachectic state of the system, in which there is a tendency to the formation of subcutaneous abscesses, is manifest; but it does not appear that the disease was induced by any infection from the horse. It seems to us to be taking too limited a view of this and similar cases to refer them all to such a morbific cause. There is evidently a striking analogy between cases of this sort and the ecthyma cachecticum described by Willan and Bateman. -Rev.

seem to have been aware that the system under such circumstances is liable to be poisoned by the introduction of a virulent matter into the circulation. This fact, which has been clearly established of late years, cannot now be disputed by any one; although it is probable that some cases, which have been recorded as examples of glanders in the human subject, are of questionable authority. The following one well deserves to be generally known, and we shall therefore give its particulars at some length.

Case 3.-A man, 42 years of age, who had had charge of a glandered horse for a length of time, happened, one day before dressing the animal, to prick his finger; a few days subsequently the puncture became inflamed and painful, and the whole hand was swollen. M. Thierry was consulted; he ordered poultices to the finger and cooling medicines to be taken inwardly. In the course of a week, as a distinct feeling of fluctuation could be perceived in the site of the wound, a deep incision was made there, and gave issue to a quantity of purulent matter mixed with a bloody serosity. This was on the 14th of September; on the 22nd a painful swelling formed on the middle of the fore-arm; this gradually proceeded to suppuration, and, when opened with the lancet, gave vent to a large quantity of unhealthy pus. In the course of another week a second abscess formed nearer the wrist, and was treated in a similar manner. By the use of a generous diet, the patient seemed to be recovering his health and strength; but the amendment was only temporary. In the beginning of November a new abscess made its appearance on the upper part of the same fore-arm, and another about the middle of the arm of the same side; both were exceedingly painful, and the almost constant suffering of the patient brought on a feverish irritation of the whole system.

Fatigued with almost continued suffering for three months, and weakened and emaciated by the profuse suppuration from the abscesses, the patient now applied to M. Amussat, but without explaining to him the probable cause of his cachectic condition. This eminent surgeon suspected a scrofulous taint of the system, and prescribed accordingly. Benefit was derived from the treatment recommended, and by the 20th of December several of the abscesses had cicatrized. On the 4th of January, the two tumors on the arm and fore-arm suddenly vanished, but in the course of the same day a painful swelling made its appearance on the outer part of the right thigh; the system at the same time was effected with feverish chills and heats. This swelling gradually increased in size, and became more prominent and shining on the surface: after the ineffectual use of discutient remedies a blister was applied in the hope of dispersing it, but without any good effects. Although it had now existed for upwards of six weeks, no fluctuation could be detected, nor was this distinct until the first week of April. An incision being made into the most prominent part, a large quantity of thick and dark-coloured blood flowed out, but without the admixture of a single drop of purulent matter. This was a most unpleasant circumstance, and naturally suggested the possibility of the presence of an aneurismal sac; but, as there had not been any pulsation in the tumor, and as the discharge gradually ceased after some time, the fears of the medical attendant subsided.

A probe introduced into the wound could be made to pass for nearly eight inches in a direction right inwards and downwards. M. Breschet was now consulted; after listening to the details of the case, he at once pronounced that it was one of constitutional infection induced by the poisoning of the wound on the finger from the glandered horse. The venous or lymphatic system, participating in the general infection, might probably by the channel of the morbid virus being deposited in different parts, and thus exciting erratic suppurative action. The patient was taken into the Hôtel Dieu on the 4th of May, and there M. Breschet made an incision through the integuments along the entire length

of the swelling, to the extent of nearly eight inches. On separating the edges of the wound, it was now found that the sanguineous collection, that had been discharged five weeks before, was situated in part on the outside and in part beneath the aponeurosis of the thigh. M. Breschet directed that the internal surface of the tumor should be wetted daily with a solution of the ioduret of potassium. A day or two after the patient's admission into the hospital, he experienced a severe pain about the middle of the front of the other thigh, where an inflammatory swelling, similar to the one already described, gradually was developed. It was laid open on the 30th of June; but this was scarcely done, before another painful tumor made its appearance below the knee of the same side, and it was necessary to make an incision into it on the 7th of July. It was gratifying however to observe that the immense sac on the left thigh had been gradually cicatrizing, and every thing on the whole was going on pretty well until the 15th of this month (July), when the left ankle began to be swollen, red, and painful, and the general strength of the system became greatly debilitated. At the same time a cough, night sweats, &c. made their appearance; and diarrhoea soon followed. Towards the end of August, the right eye-lid first, and subsequently the forehead and the entire scalp, became affected with an oedematous swelling, and, a few days afterwards, a dark gangrenous spot was observed about the middle of this puffiness: this spot gradually increased, extending over the whole of the upper part of the face and entirely covering the nose; the epidermis was detached in several places, and a gelatinous bloody fluid exuded from under it. There were also at the same time a copious discharge of viscid fœtid matter from the nostrils; delirium came on during the night; and a number of livid pustules made their appearance upon the surface of the chest and extremities. On the 6th of September the patient died.

The dissection was performed with the greatest care in in the presence of MM. Breschet, Amussat, and many other medical men.

Without mentioning the phenomena observed in the various external abscesses, which are very minutely reported by the narrator, we proceed at once to describe the state of the nasal passages. The whole of their mucous surface was coated with a gelatiniform sanies; when this was removed, the surface appeared irregularly furrowed by ecchymoses which occupied more than half its extent, and in which could be observed several minute pustules, analogous, except in size, with those on the surface of the body with the aid of the microscope it was found that some of them exhibited small circular points of ulceration.

The lungs exhibited numerous circumscribed points of lobular inflammation; the state of the heart is not mentioned.

It deserves to be mentioned that the horse, from which the patient, it is believed, caught the complaint, was examined by a distinguished veterinary surgeon, M. Bouley, and pronounced by him to be affected with "morve chronique dite tuberculeuse."

Remarks. The most remarkable phenomenon in the preceding case was certainly the successive transference of the matter which engendered the disease upon a point sometimes remote from, and at other times more near to, the place where it had at first fixed its seat: this sort of metastasis occurred no fewer than ten times in the course of one year. There appeared a swelling, which was painful for the first few days, but without exhibiting a decided inflammatory aspect; its progress was slow; and, when it was opened with the knife a quantity of matter, sometimes of a healthy character and sometimes more or less blended with blood, was discharged, and this discharge continued for some time. Then all on a sudden it ceased entirely, and almost invariably a new swelling made its appearance in some other part.

Another peculiarity of this case is that there were none of the symptoms of acute glanders until near its close; then the eruption of pustules on the body,

the discharge of fætid mucus from the nostrils, and the development of acute irritative fever, were not to be mistaken. But it is to be remembered that the disease is not unfrequently observed to follow nearly a similar course in the horse; the health of the animal may be for a long time but little, if at all, affected; and, were it not for the oozing of the viscid mucus from the nostrils, it might be pronounced to be perfectly sound. Suddenly, however, after this local complaint has continued for some time, the symptoms of the acute form of the disease make their appearance and the animal is quickly carried off.—Revue Medicale.

MOST OBSTINATE HICCUP CURED WITH QUININE.

A countryman was seized, while recovering from an attack of ague, with a convulsive hiccup which recurred every few moments. A variety of antispasmodic remedies, such as ether, valerian, musk, assafoetida, opium, &c. were tried, but without relieving the troublesome symptom: blisters, also, as well as other cutaneous irritants, were applied with equal unsuccess. For nine days the hiccup continued with but little intermission, and this was only at irregular intervals for about a quarter of an hour at most.

Suspecting that, although all the other symptoms of the ague had ceased for some time, this convulsive affection of the stomach might somehow be connected with it, the medical attendant administered a large dose of quinine in an enema. A few hours after it was given, the hiccup ceased almost entirely; but it again returned, as violent as before, next day. The quinine was again ordered, and with equally happy effects; and by persevering in its use for a few days, the symptoms did not return.-Journal des Connois. Med. Chir.

WALNUT-LEAF TEA, A GOOD REMEDY IN SCROFULOUS COMPLAINTS.

Professor Negrier of Angers, a respectable authority, has for some years past been trying the effects of an infusion of the leaves of the walnut-tree in a variety of scrofulous maladies, and the results of his experience have led him to form a most favourable opinion of it as an antiscrofulous remedy.

He reports a great number of cases of disease of the lymphatics, with or without ulceration of the integuments, of scrofulous ophthalmia, of affections of the bones and periosteum, &c. in which decided and very marked benefit was obtained from a course of this simply prepared tea. A handful of the fresh or slightly dried leaves may be added to a pint of boiling water, and of this infusion a small cupfull may be taken twice a day. An extract may also be prepared by evaporation, and this Dr. Negrier recommends to be given at the same time, either in the form of pills or of a thick syrup. A strong decoction of the leaves he has used with excellent effects as an application to scrofulous ulcers.—Archives Generales.

Remark. We know nothing practically of this remedy, but somehow or other we feel inclined to predict that it is one deserving notice, and that it will be found useful in some cases of lymphatic and cutaneous disease. Whenever we pass a walnut-tree, and smell the peculiar odour which it gives out, the idea always occurs to us that it is not destitute of tolerably active medicinal properties. Moreover, as a general remark, scrofulous diseases are, on the whole, much more benefitted by vegetable remedies than by those of a metalic nature, except, perhaps, steel; and this we know is more kin, so to speak, to the body than any other of its class.-(Rev.)

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