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Auscultation and Percussion. By Dr. Joseph SKODA. Translated from
the fourth edition. By W.0. MARKHAM, M. D., Assistant Physician to St. Mary's Hospital.
Skoda has been for many years clinical professor at the General Hospital of Vienna, an institution containing 2,500 beds. Selecting such cases from the entries into the Hospital as he deems most proper for his purpose, Skoda, in the presence of the students, examines them, and gives his diagnosis. The examination, with the diagnosis, is noted down, and a record kept of the future progress of the case. Should it prove fatal, the postmortem examination is made under the direction of Rokitansky, and the appearances noted. These two independent records are then read in the presence of the class, and their agreement or discrepancies commented on; and, under such a system, Skoda has acquired the reputation of one of the most eminent diagnosticians of Europe. Coming from such a source, his work is not to be classed with the numerous manuals upon the same subject which have been issued for the use of students; it is the fruit of careful study, and of long-continued and accurate observation ; while its statements derive weight from the character and experience of its author.
It is well known that, in accounting for many of the phenomena of auscultation, Skoda dissents from the hypotheses proposed by Lænnec, and adopted by the majority of his followers in France and England. Whether the views by which he proposes to replace them are to be fully received or not, we have not space to discuss; but, in the present state of our knowledge, it becomes every one who takes an interest in scientific medicine, to make himself acquainted with them. The gradual manner in which they have forced themselves upon the attention of the English physicians, says much for their general soundness. They have now been a long time before the public. At first wholly ignored or passed over with superficial criticism, they have won their way against neglect and want of appreciation, until they at length command attention; and no one can be deemed to have mastered the subject of auscultation, until he has given the views of Skoda a thorough and attentive examination.
In one respect, the book is particularly valuable to the inexperienced auscultator. Constantly associating the physical signs with the physical conditions on which they depend, rather than with the disease in which they may be most frequently present, he does not lead them to be looked upon as pathognomonic; indeed, he repeatedly directs the attention of the observer to this point, and warns him of the necessity of well weighing every indication of disease.
The translation of Dr. Markham is in good and readable English, free from obscurity or affectation. As a specimen, we give the following extract:
“SOLITARY TUBERCLES. Percussion signs.-Solitary tubercles do not of themselves produce the slightest change in the percussion sound of the lungs, even though they be scattered throughout these organs, and in very considerable quantity. Any change observed in the percussion sound, depends upon some altered condition of the interstitial tissue, occurring in the lung thus affected; the sound is tympanitic when the lung has lost its contractility ; but the infiltration of blood, serum, etc. into the tissue, whereby the air is expelled from the lung, renders the sound dull and empty; so long as the interstitial tissue remains normal, the sound continues normal; but it is less sonorous, if the tissue be more dense and hypertrophied than natural. The statement made by Stokes,
that solitary tubercles, when very abundant, produce a somewhat dull percussion sound,' is incorrect; this may be shown on the dead body.
“ Auscultatory Signs.—The inspiratory murmur may be distinctly and even loudly vesicular, or it may be indistinct, or altogether inaudible, though unaccompanied by râles, or whistling, or sonorous sounds. Råles of every kind, as well as whistling and sonorous, &c. sounds, nonconsonating, may be mixed with the vesicular or indeterminate inspiratory murmur, or râles or whistling sounds may alone be heard. The expiratory murmur may be altogether inaudible, or as loud and strong as that of inspiration, and, like this, be associated with râles, and whistling, and sonorous sounds.
“Swelling of, and secretion from, the bronchial mucous membrane, soon make their appearance, when any considerable deposition of tubercle has taken place in a lung; they may appear in the course of a few days when the tubercles are rapidly developed, but when they are of slower growth, a longer period may elapse before they manifest their presence. In such cases, the inspiratory murmur is either vesicular or indeterminate, and the expiratory almost inaudible; in other words, the respiration may be normal.
*" As the deposit of the tubercular matter increases, and in many cases even at its first deposition, swelling of the bronchial mucous membrane, accompanied or not by secretion, takes place; and then the same auscultatory signs appear, as those described under the head of catarrh. The slow development of tubercles almost invariably takes place in the upper part of the lungs, and hence, in such cases, we very frequently find the auscultatory signs of catarrh permanent there, the respiratory murmur being elsewhere healthy. Rapidly developed tubercles, however, do not manifest themselves in the first instance at the apices of the lungs, but are frequently scattered equally throughout the whole of a lung, or of one lobe. I may here remark, that there are no distinct signs by which we can with certainty diagnose the existence of acute miliary tubercles; we can only surmise their presence with a greater or less degree of probability. Of this fact, Lænnec was well aware. Dr. Stokes offers the following remarks upon the diagnosis of acute miliary tubercles: "If in a case which exhibits the signs and symptoms of severe bronchitis, or in which we observe a crepitating râle, continuing without intermission, we find incomplete dullness over a considerable extent of the surface of the thorax, unaccompanied by bronchial respiration; and if the stethoscope shows that the lung is almost everywhere permeable to air, and obstructed only at certain places, or, if the crepitation be too feeble to account for the dull percussion sound, we may diagnose the acute inflammatory development of tubercle.
“ According to my experience, most cases of acute tuberculosis are unaccompanied by any of these signs, and every one of them may be present, without the disease being tubercular.” pp. 232–4. McC.
Manual of Human Microscopical Anatomy. By A. KÖLLIKER, Professor
of Anatomy and Physiology in Würzburg. Translated by GEORGE Busk, F. Ř. S., and Thomas Huxley, F. R. S. Edited, with notes and additions, by J. Da Costa, M. D. Illustrated by three hundred and thirteen engravings on wood. Philadelphia: Lippincott, Grambo, and Co. 1854. pp. 802.
The connection between microscopical anatomy and practical medicine is every day becoming more and more recognized, and the importance of cultivating it, proportionally felt; proof of which is furnished by the many and valuable works which the press is constantly affording. In the one before us, we have a systematic treatise by an author whose name, as stated by its American editor, is a sufficient guarantee of its excellence. It was published in the latter part of 1852, and designed by its author as a text-book for students and practitioners of medicine; and if any indorsement of its character is needed, it is furnished by the reputation of its translators, and the fact of its adoption for publication by the Sydenham Society. The work presents, as the author says, a combined view of the relations of the elementary parts of the body and of the more intricate structure of the organs, and gives the results of labors recorded more at length in other works. The translators have added many original observations of their own, in the shape of notes, and appendix, and also some extracts from Professor Kölliker's larger work on microscopical anatomy. The American editor, Dr. Da Costa, has also incorporated in it, the more recent contributions to histology, besides making further extracts from Dr. K.'s former works. It may, therefore, now be regarded, as he says, as a fair exponent of the actual state of the science. He has also supplied an index, which was wanting in both the German and English editions, and been able to correct many errors with regard to the measurements. The wood-cuts are the same which were used in the original German edition, and are very distinct; and the whole mechanical execution of the work is highly creditable to its enterprising publishers.
Memoirs of the Imperial Academy of Medicine. Paris, 1854. J. B.
BAILLIERE. pp. 783.
The Imperial Academy of Medicine was specially instituted by royal decree of 20th December, 1820, to advise the government on all matters relating to public health; and, especially upon epidemic or epizootic diseases, and questions of medical jurisprudence; also for the examination of new remedial agents, or secret remedies, mineral waters; and for the encouragement of vaccination. In continuation of the memoirs of the National Medical Society, and of the Academy of Surgery, both now extinct, it publishes, annually, a quarto volume of its memoirs, and every fortnight, a bulletin of its proceedings, containing an exact transcript of the minutes. The volume for 1854, contains 783 pages, quarto, of which 184 pages are devoted to the historical portion, comprising the Eulogy upon Orfila, by Dubois d'Amiens, perpetual secretary, 32 pages; Report upon the Prizes for 1851, 52 and 53, by M. Gibert, annual secretary, 21 pages; “Les Savants Oubliés,” by M. Cap, 11 pages; and the Report upon the Epidemics of France in 1852, by Gaultier de Claubry, 120 pages. The Memoirs, properly so called, occupy the remainder of the work, 580 pages, and consist 1, of an article “ On the Etiology of Epilepsy and the indications which the study of the causes furnishes for its treatment," by M. Moreau, (de Tours). 2.“ On the use of Ergot, Secale Cornutum, in its relations to physiology, obstetrics, and public hygiene," by Aug. Millet. 3. “Report on the Medical Service at the Thermal Watering Places, for 1851–2," by M. Patissier. 4. “ A case of Black Discoloration of the Face in a young female,” (a unique case), by M. Boisquet, d'Herault, and, 5, “ On the Treatment and Education of Idiots in general, and particularly those in the Bicètre,” by M. Collineare.
We regret that our space does not permit us to analyze the contents. of this most interesting volume. The last paper would more particularly deserve notice at this time, when, in our own State, the legislature has made most liberal appropriation for the improved moral and physical treatment of this most unfortunate class of our fellow beings. We add one of the conclusions of the paper, viz., " that the results already attained prove the efficacious method adopted at Bicètre, and that it is most desirable that particular establishments for the education of young idiots be formed, entirely separate from those destined for the insane." The Memoirs are sent to all scientific associations in correspondence with the Academy, our own Academy having recently been added to the
“ Observations on some of the Remedial Properties of Simaba Cedron,
and its employment in Intermittent Fevers. By S. S. Purple, M. D. Editor of the New York Journal of Medicine, pp. 16.
Dr. Purple has rendered an important service to the profession in calling their attention to this plant as a substitute for quinine. It is to be regretted, however, that at present, its high price, which will, no doubt, be diminished as the supply increases, prevents its coming into general use. It is procured from Central America, where it has long had a reputation for the cure of wounds by poison snakes. Dr. Purple recommends its use in intermittent fever, and cites five cases as cured by it in his own practice. It has also been used with advantage in chronic dysentery, diarrhea, and dyspepsia.
Arsenic Eaters, by Dr. J. J. TSCHUDI, (Journ. de Chimie Medicale).
Translated for the Medical Times, by Benjamin Canavan.
In the report of a remarkable trial of one Anne Alexander, for poisoning, which took place before a jury at Cilli, it was stated, that three of the witnesses were interrogated as to whether the deceased, Lieut. M. Wurzel, was a “poison eater” or not. The affirmative was not proven, and the only testimony (of little weight) which could have rendered the supposition probable, was that of First Lieut. M. J., who declared that in 1828, he found in the drawer of Wurzel, a small box containing little substances of the size of a grain of maize, which could not have been aught but white arsenic. The testimony of the other witnesses was based merely on hearsay.
Poison eating, being for the medical public a phenomenon more or less unknown, I have thought of publishing some facts and observations on this matter. In some countries of Lower Austria and Styria, particularly in the mountains which separate it from Hungary, there is met with amongst the peasants the remarkable habit of “ arsenic-eating." They purchase it under the name of hedri (hedrich, huttegruuch), from herb peddlers, &c., and they in their turn, obtain it from the workers in Hungarian glass, veterinarians, quacks, &c.
The arsenic-eaters have a double object; firstly, to give themselves a fresh and healthy air, and also a certain degree of plumpness. They are consequently(!) very frequently young peasants who have recourse to this expedient through coquetry and a desire to please ; and it is really surprising with what success they attain their wish ; for the young poison-eaters are eminently distinguished by their freshness of color, and an appearance of buxom health. I will cite only a single case among many within my knowledge. A milk-maid, good-looking, but thin and pale, living on a farm in the village of H- , having a lover whom she wished to attract more strongly by her charms, had recourse to the afore-mentioned means, and took arsenic many times a week. The desired result was not slow to appear, and after a few months she became plump, buxom, blythe, a belle of the first water. In consequence of augmenting imprudently the dose of arsenic, she fell a victim to her coquetry. She died poisoned, and her end was deplorable. The number of deaths by the abuse of arsenic is not insignificant, particularly amongst the young. Every ecclesiastic in those countries can enumerate many victims, and the results of my inquiries amongst pastors are very curious. Through fear of the law, which renders illegal the possession of arsenic, or that the small, still voice” reproaches them for their crime, the poison-eaters conceal as much as possible the use of this dangerous remedy. Usually, it is only a death-bed confession which raises the veil of secrecy. The second advantage which poison-eaters have in view is, to become