Page images

covered over with dark patches; the kidneys were intensely red ; there was also an aneurism of the arch of the aorta, together with abundant atheromatous deposit. Dr. Clark called attention to the mucous surface of the stomach, of a yellowish cream color, studded over with white, opaque spots, somewhat resembling a granular kidney. Sometimes this white deposit

, in hard drinkers, covers the membrane throughout, the result, probably, of chronic inflammation, induced by frequent and continued stimulation.

Dr. Clark referred to the case of chronic pneumonia presented at the previous meeting. On examination by the microscope, scarcely any aircells were visible ; its substance seemed composed of elastic fibrous tissue. He observed that, in chronic pneumonia, the progress of inflammation was different from that of acute, the fibrinous exudation being extra vesicular, and the contrary in the latter. He did not consider chronic pneumonia as an idiopathic disease, but regarded its existence as a consequence of tubercles.

Dr. Clark then presented the bladder, urethra, and rectum, taken from a man 45 years of age, illustrating the effects of an abscess in the recto-vesical space, extending forward over the pubis,air discharged from the bladder-pus escaping through the catheter afterwards—the urethra pierced by the catheter about an inch and a half from neck of bladder-death from general paralysis--hardening of the brain. The patient, a native of Ireland, 17 years in this country, not married, by occupation a carman, was admitted into Bellevue Hospital, July 19th, '54. He had been for a year and more gradually losing his muscular power. In the spring of '54, he was no longer able to hold the reins to drive his horse, but could walk about, though clumsily. On admission, he could only walk across the room with assistance, dragged the left leg more than the right; his hand hung down almost wholly paralyzed ; yet when lying down he could feed himself

. In August he could no longer walk, but would sit for a few hours in a chair, when lifted out of his bed into it. In September, his strength had so far failed as to oblige him to keep the bed altogether. A month later he could no longer feed himself, or fairly lift his hands singly; by the combined action of the two he could sometimes succeed in placing one hand on his face; nor could he draw


his legs in bed without assistance. For the last two months there has been a marked tendency to flexion of the limbs, not before noticed. He always lay upon his back, his arms pretty sharply flexed on the forearm, and lying on his chest; the wrists also flexed on the forearm. Commonly, the knees were raised, thighs and legs flexed; but this he could not do for himself. It was the most comfortable position for him. About this time (two months before death), he occasionally had retention of the urine, and the use of the catheter was required from time to time. For some two weeks previous to death, he could not speak, or did so with the greatest difficulty; yet from the first his mind has been perfectly sensible, and to the last his intelligence was quick, his sight good, and hearing acute. His bowels were always constipated. He never had a convulsion, nor any sudden change in his symptoms. For a period of eighteen

months, paralysis slowly and steadily crept over him, affecting all parts of the body; but at first the bands more than the legs, and then the left leg more than the right; and finally became nearly equal everywhere, so that he was utterly helpless; yet he could make, to the last, some slight movement in all his limbs. His appetite, which continued good until this time (two weeks before death), now wholly failed. In October it was urgent; yet he emaciated steadily as the paralysis advanced, so that at last, and for two months before death, no consumptive was ever more reduced in flesh. He never complained of any pain in the head or back, never indeed of any pain, except what resulted from a constrained position of his limbs, or some position too long retained. Sensation, though markedly diminished, was never abolished. The power of swallowing diminished as the disease advanced, so that in the last months deglutition was very difficult. Still, he could with effort always swallow fluids. During the last six weeks, on account of paralysis of the bladder, it was often necessary to use the catheter,—sometimes for days together. Two or three weeks before death, as the house physician was performing this duty, he noticed the discharge of a large quantity of air through the catheter. His hand was at the time pressing over the region of the bladder, but he thinks that it was impossible that, by any manipulation of his, the air could have first passed in through the instrument, as sometimes happens in emaciated persons. A few days after, he undertook to demonstrate to Dr. C. this fact, by again passing the catheter. But in this attempt, the point of the instrument was arrested before it reached the bladder, at no great distance from it, and pus immediately began to flow through it. Two or three drachms escaped in this way, and the instrument was withdrawn. No urine nor air appeared. Dr. C. supposed that the point of the catheter had opened an abscess, which had its seat in the tissue between the bladder and rectum; and if this air was really not allowed to pass into the bladder by the catheter, it must have come from the intestines, by a double opening of the abscess. Subsequently, the catheter was not necessary for a few days ; pus was discharged with. the urine, but no air was known to escape afterwards. Nothing new, worthy of note, occurred affecting the bladder or abscess, till death. On postmortem examination, a large abscess was found below the peritoneum, between the rectum and bladder. The catheter had opened it, an inch and a quarter below the neck of the bladder, on the posterior wall of the urethra. A director, or blow pipe, passed forward through this opening was not obstructed till it had entered nearly five inches, and its point had free range both right and left. This abscess reached around, anteriorly, to the bladder, so that pus was found at the symphysis pubis. It appears to come into this point from both sides. The prostate was involved, but probably only secondarily. No communication could be found between it and the bladder, on the one hand, or the rectum on the other. The rectum appeared healthy, with the exception of a nonmalignant stricture, not very firm, about a finger's length above the anus, and of a size freely to admit the finger. It was dilated (after death) without difficulty. There was no ulceration, or even abrasion;

and no pus was found here. The bladder was red, in spots dark, almost black. Its membrane and muscular layer were but slightly thickened. It contained two ounces of pus, of the same appearance as that in the abscess; yet no ulceration of the mucous membrane, no abrasion, no perforations could be found after diligent search. The pus found here must have been produced from the mucous membrane. But the air,-if not introduced by the catheter,-how to explain its presence here? Brain. No lesion could be found in this organ, except hardening of the white matter in the cerebrum and cerebellum, but particularly in the former. This hardening did not seem to be connected with any increased or diminished vascularity. On examining some of this hardened substance by the microscope, it seemed that the change which had ended in this hardening of the white matter, was a change in the nerve fiber itself. There were no “exudation corpuscles," no fat globules as seen in inflammatory softening, no increase in the fibrous element of the part. Nothing, in a word, but a field of mere fibers, furnished with the usual supply of vessels and a few nervous vesicles. Dr. Clark considered that the hardening had resulted from altered nutrition in the nerve fibers, for the following reasons; 1st, The absence of any adventitious matter that could produce it, and the absence of all the usual products of inflammation. 2nd. An unusual toughness in these fibers, as shown in pressing the cover down upon the slice. The fibers broke, so to speak, reluctantly. 3d. The fibers breaking, unsheathed an extraordinary length of axis cylinder, and this seemed firm and hard, and had nothing of the fine, granular appearance natural to it. 4th. The white substance of Schwan did not form in water the swelling, except in a very limited degree and on a few fibers.


Reclamation. Franklin-Street Cholera Hospital versus Mott-Street

Cholera Hospital.
To the Editors of the New York Medical Times.

Gentlemen :— The Editor of the “ American Medical Monthly," in a criticism on Dr. Hutchison's pamphlet on Cholera, appears to doubt the veracity of the statistics of the Franklin-street Hospital, as published by myself, in your journal for March,--preferring rather to depend upon the newspaper reports of the day, than upon a carefully arranged statistical account. To satisfy, however, his skepticism, allow me to offer the following affidavit of Dr. Vandeveer, Superintendent of that Institution. City and County of New York, ss.

Before me came personally Jacob H. Vandeveer, M.D., who_being duly sworn, deposes and says : That he was Superintendent of the Franklin-street Cholera Hospital during the suminer of 1854. That he has read the statistics of said Institution, as published by Dr. Budd in the Medical Times for March, and the same, are to the best of his knowledge and belief, true.

J. H. VANDEVEER. Sworn to before me this 18th day of April, 1855.


Commissioner of Deeds. This I hope will give a quietus to the gentleman's incredulity. Since, however, he has seen fit, by some extraordinary process of mathematical legerdemain, to demonstrate the proposition that 154 deaths in 329 cases is a less percentage than 255 deaths in 606 cases, I will briefly state some of the prominent reasons which might have given the preponderance of deaths to Franklin street, but which dire necessity compels Mott street to assume.

At no one time was the Hospital in Mott street full, while, on the contrary, the wards of the Franklin-street were on several occasions crowded to such an extent, that we were obliged to refuse admittance to applicants, sending them to Mott street for accommodation.

While in Franklin street, the hospital building being small and incommodious, the dying, the critical, and the convalescent cases were necessarily put together in the same apartment; in Mott street, on the contrary, the building being large, airy, and well ventilated, a distinct ward was appropriated for convalescent patients—an advantage which needs no comment.

This statement of facts has been drawn from me-not with a desire to enter into any discussion relative to the comparative merits of the statistics of the two institutions, but solely for the purpose of self-vindication in relation to the editorial criticism in the “ American Medical Monthly."

Respectfully, your obedient servant,


Letter from Paris.—Memoir of George Louis DUVERNOY. It has pleased God, who wills that his laws should be known and practiced, to remove from earth a chosen expounder and exemplar of their harmonies. The friends of science and religion mourn the loss of him who is the subject of this notice, deceased March 1st, 1855.

George Louis Duvernoy was born August 6th, 1777, at Montbelliard, Department of Doubs. His father, a Protestant minister of the confession of Augsburg, a man of profound piety, directed his early studies, which were continued at Stutgard, in Germany. In 1799, he published his first memoir on organized bodies, containing ideas new at that epoch. In 1800, his critical analysis of the work of Bichat, entitled “Researches upon Life and Death,” attracted the attention of many savans, particularly of George Cuvier, who immediately called to his aid this young man of only 23 years, already distinguished for his extensive acquirements, great exactitude of observation, and ability for generalization. At first he was occupied in preparing many articles on the natural history of Molluscæ, in the first five volumes of the first edition of the “Dictionary

of Natural Sciences." He commenced at the same time some articles on comparative anatomy, describing organs not only in their anatomical relations, but in their functional harmonies ; one of which, rich in details, was read before the Society of the Faculty of Medicine, Paris, 1804.

The year 1805 is marked by the appearance of one of the works which especially hallow among the learned the name of Duvernoy. In 1803, George Cuvier, with Constant Duméril, published the first two volumes of their immortal “Lectures on Comparative Anatomy.” M. Cuvier, anxious to undertake other works, and particularly his researches upon fossil bones, and fatigued by the numerous dissections which these first volumes demanded, proposed to his young compatriot to complete, by the aid of researches made upon the specimens in his rich collection, the plan which he had conceived for the last three volumes. These volumes included all the organs of nutrition and reproduction. Cuvier had divided the subject, and determined the number of lectures. Duvernoy, observing nature and making his descriptions from the specimens, preparations, and numerous animals, put at his disposal, completed, in September, 1805, the last three volumes; of which the anatomical facts and the manner of exposing them belong to Duvernoy, while the general plan belong to Cuvier. The great anatomist was pleased, in numerous parts of his works, to render homage to his colaborer, and to reserve ex. pressly for him the honor of the descriptions and discoveries. Certain articles, only, were from M. Cuvier, as also were the generalizations. Duvernoy was modestly devoted to the glory of his illustrious master; but it is due that, by the side of this great genius, should be made an honorable mention of the author of researches so complete for that epoch, upon the organs of alimentation (except the teeth, described by Cuvier), upon the organs of circulation, and generation, in the vertebrata. These parts of this celebrated work figure by the side of the brilliant chapters of generalizations; and their scientific value is so confounded with the work of the master, that the name of collaborator has disappeared from the eyes of the greater number. It pertains to the impartiality of the scientific world to render to their true author these pages, which Cuvier had never neglected an occasion to declare to be the work of Duvernoy. In studying these works under this point of view, there is recognized a distinct character. The organic comparison is most assiduously made; we there see the most marked sentiment of the “Unity of Organic Composition,” which Cuvier seems to have feared to adopt, as a cause of illusions and errors, but which he admitted when evidence demonstrated it. These works completed, M. Duvernoy was suffering from his close application, and returned to his native village for the practice of his profession, in 1812.

In 1809, Cuvier, about departing on his scientific explorations, obtained for Duvernoy the title of Associate Professor of Zoology of the Faculty of Sciences of Paris, and yielded to him the direction of all his scientific affairs during his absence. Called to teach the science to which he had devoted such arduous labors, invested with all the confidence of the great naturalist, his future success seemed assured. In con

« PreviousContinue »