tical precept that bleeding is always much more useful at the commencement than in the more advanced stage of pneumonia, I should have committed a very grave mistake; for here there was no indication to bleed at any time; the pulse was weak and compressible, and the patient was in such a state that in all probability a loss of blood would have brought on syncope and general prostration, that might have terminated fatally."-Ibid.

ON ANIMALCULE IN THE BLOOD.

The occasional existence of worms in the blood of a living animal is a phenomenon that must excite the curiosity of every one. The allusions to such an occurrence in the writings of the old physicians are so imperfect and confused, that it is difficult to determine what amount of credit we can attach to them. If the observations of Welsch* and Polisiust on worms found within the heart of the human subject are not to be received as authentic, these authors having probably mistaken fibrinous concretions of the blood for actual worms, recent researches however have clearly shewn that such entozoa do really sometimes exist in the hearts of some of the lower animals. M. Barkow‡ found in the right ventricle of a species of heron (Ardea Cinerea) two nematoids which are now preserved in the museum at Greifswald; and M. Baer§ has discovered a peculiar species of the distoma (d. duplicatum) in the hearts of several Molluscous animals.

It is well known that a particular kind of worm (Strongylus armatus minor) is occasionally developed in the fibrinous concretions that form in aneurismatic arteries of Solipedous animals. The veins too of certain animals are not exempt from these entozoa. Treutler found a species of fasciola in the pulmonary veins of a seal and another kind of worm in the vena cava of a deer. Numerous authors have subsequently studied the particular species of Strongyli, that are occasionally met with in the venous sinuses at the base of the cranium and also in the pulmonary veins of the Delphinus Phocæna. Schmitz, while observing the circulation in the mesentery of a frog, happened to observe the appearance of living animalcules existing in the blood. To ascertain if this was of frequent occurrence, he examined the blood of 53 lizards, and of 81 frogs; but without success. At length however, in a frog, he again discovered in the blood animalcules similar to those which he had seen in the first instance. He observed that they made their way through the parietes of the vessels, and then burst and discharged the granular matter which their bodies appeared to contain a phenomenon that has been repeatedly witnessed in certain Polygastric animalcules, &c. It is the opinion of M. Valentin that these blood entozoa, described by Schmitz, most nearly resemble the Polystoma venarum of which Treutler has given so minute an account.

M. Valentin himself has repeatedly found in the blood-vessels of frogs the Anguilula intestinalis. His idea is, that these animalcules are hurried along in the torrent of the circulation, till they, as it were instinctively, stop in some organ that is best suited as a domicile for them; and that they then work their way through the parietes of the vessels. This author also mentions that a Strongylus armatus was recently discovered in the blood from the venæ cavæ of a horse; there was no trace of an opening in the walls of the vessel, or of any communication between it and the intestinal canal.

* Disput. de Verme Cordis. Lips. 1694.

+ Observ. de verm: in corde repert: (Ephem. Nat. Cur.) Observationes de Entozois. 1825.

§ Novæ Obs. de Entozois. 1829.

Observ. Anatomica-Pathol: de Helminthologiâ. 1793.

Dr. Vogt, while examining with a microscope the membrana nictitans of a frog, was surprised to find that the vessels, still filled with blood, contained numerous living animalcules, which moved about with great vivacity: similar animalcules were observed in the blood-vessels of other parts of the body. On inspecting the abdominal cavity of the animal, he observed several browncoloured saccules, similar to those in which M. Valentin has occasionally met with filaria. As he believed that these minute worms are the embryos of entozoa, he examined these saccules with great attention; but they were all quite empty.

In other frogs, however, in which these abdominal saccules existed, he found that many of them contained a filaria-the resemblance between which and the animalcules of the blood is very marked.

Valentin has recently described, in a letter addressed to Müller, some very curious phenomena, which he observed in the blood taken from the abdominal aorta of a trout. On first examining it, he noticed a number of dark-coloured globules mixed with the globules of the blood; they were in rapid movement, without however changing their place. After the lapse of a short time, I was surprised, says he, to perceive first on the side of these globules a sort of transparent appendage or tail; and subsequently that there was evolved an animalcule of an elongated shape, and which was continually in rapid motion round its own axis. This animalcule belongs probably to the old genus Proteus, or what Ehrenberg has called Amaba. Its length did not exceed from a 3 to a 5,000th part of an inch. Sometimes as many as ten and even more could be counted in a single drop of the blood; but in no other part of the body could they be discovered. The only other entozoa that were found were several ascarides in the pyloric appendages.

M. Gluge of Brussels has subsequently communicated to Müller's Archives a description of an animalcule, which seems to be very similar to those mentioned in the preceding notice, and which he accidentally met with in the blood of a frog.

It seems therefore that the existence of entozoa in the blood of certain animals is by no means of very rare occurrence. As yet we know nothing of the manner in which they become developed; but further investigation of the subject may throw light on this very curious subject.—Archives de Medecine Comparée,* No. 1. Oct. 1842.

NOTE ON EMPHYSEMA OF THE LUNGS-CASE OF THE LATE MR. HORNER GREAT SAGACITY OF DR. Baillie.

A few pages back we have given a brief account of a discussion at the French Royal Academy of Medicine on the subject of Pulmonary Emphysema. Since writing that article, we have been reading the recently published memoirs of that distinguished statesman and most amiable man, the late Francis Horner, M.P.; and his case seems to us to be altogether so very interesting in a medical point of view, and so well calculated to throw some light-as far as a single example can do-on the history of the disease in question, that we do not hesitate to give the details at some length, as recorded in the work alluded to. Our readers will observe that, in many respects, it bears out the opinions expressed by M. Louis

(This is the first number of a new Journal recently started in Paris under the immediate management of M. Rayer. It promises to be of great interest; the study of comparative pathology has hitherto been far too much neglected.—

and M. Bouillaud, &c. on the frequent co-existence of Cardiac affection with Emphysema of the lungs.

Mr. Horner seems never to have been a very robust man; his constitution or temperament was of the bilious-phlegmatic kind; and for many years he had been subject to stomach complaints. In 1816, the year preceding his death, he began to exhibit symptoms of pulmonary disease, the nature of which could not be very easily made out. In the Summer of that year we find him writing thus to his father: "I am still a little plagued with a cough, in which there is nothing at all material, except the circumstance of its continuing so long, which I think is owing to the cold weather. To be sure of this, I have seen Dr. Warren, who thinks there is nothing in it; but considers the stomach, as of old, chiefly in fault, and has given me some directions to observe on that head." We gather from a subsequent letter that, along with cough, difficulty of breathing, amounting often to breathlessness, and palpitations of the heart, there was extreme muscular debility; for we find him at one time alluding to a "feeling of mental lassitude that seemed to wither me within," which he had experienced at Edinburgh in the course of the Autumn.

The opinion of his physicians both in that city and also in London was, that his complaint was some affection of the lungs, neither phthisical, nor yet dropsical; but they felt considerable embarrassment in determining its real nature. The advice of all was, that the Winter should be passed in a warm climate, and that all active exercise, including much talking, should be avoided: No vociferation Sir, even if you are paid for it," was the injunction of Dr. Gregory. He went to Pisa; but the change does not seem to have produced any very decided benefit, for we find a friend writing to him in the first week of January thus: "As your breathlessness seemed not to be at all relieved either by the change of climate, or by the treatment recommended to you by Baillie and Warren, I made out a statement of your case at present, as well as I could collect the particulars from your own letters and your brother's, and sent copies of it yesterday to both these physicians, with a request that they would take it into their consideration, and give me their opinion...... Baillie thinks it (your illness) may proceed from a consolidation of part of the substance of the lungs, in consequence of which there is less space for air, or it may arise from a change of structure in the aircells, by which they are become larger, and in the same proportion afford a smaller surface for the oxygenation of the blood. In either of the last suppositions there is no danger from the complaint, though there may be much inconvenience. They recommend to you to resume the use of the mercurial pill, and to try the effect of the supercarbonate of potash."

While at Pisa, Mr. Horner put himself under the care of Dr. Vacca Berlinghieri, who seems also to have been much puzzled about the case. Opium, in doses of a grain at bed time, (and this was occasionally repeated in the morning), was found to procure great relief to the dyspnoea : "The relief," he writes himself, "seems to me quite marvellous, and I could fall down and worship my pill like a Turk; what is very new to me indeed, I have got through the labours of my toilet, not only without pain and palpitations, but with scarcely any feeling of exertion; and I am altogether a stronger and a better man than I have been a great while." From the very decided relief which the use of the opium seems to have invariably given, Dr. Vacca thought it reasonable to believe that the chest symptoms were, in part at least, owing to an affection of the nerves of the lungs.

As usual with most patients labouring under thoracic complaints, Mr. Horner appears never to have entertained any apprehension himself about the result of his malady: there is usually an innate hopefulness not only in phthisis but in most pulmonary complaints that is truly surprising. The fatal change at last seems to have been very sudden and unexpected; the dyspnoea and cough became worse, and there were strong palpitations of the heart, with a low, irregular, and

intermittent pulse, and general prostration. His brother had left him for a few minutes, and on returning to his bed-side found his face deadly pale, his eyes fixed, and his hands cold: it was thought at first that he had merely fainted; but it was soon found that life was extinct.

The following report of the appearances found on dissection was drawn up by Dr. Vacca.

Sectio Cadaveris.-The body was not much emaciated, All the abdominal viscera were perfectly sound; only the venous system was unusually gorged with blood. On opening the thorax the lungs were observed to be singularly shrunk, especially the right one. Their colour was livid, and their surface was very un even this unevenness was produced by a great number of transparent vesicles, varying in size from that of a pea to that of an almond. By far the greater number of these vesicles were on the anterior face of the lungs; few on the posterior. On compressing them they disappeared, and the air, with which they were filled, passed into the bronchi: they re-appeared on blowing air into the trachea. These vesicles did not communicate with the cellular tissue, which unites the air-cells together, so that the case must be regarded not as one of Emphysema, but of an abnormal dilatation of the air-cells. A great portion of the substance of the lungs, especially at their posterior part, was condensed, indurated, and in many places completely hepatised. The different lobes did not adhere together; neither was there any adhesion between the pulmonic and the costal pleuræ. The lymphatic glands of the bronchi were larger than usual; and the membrane of the air tubes was slightly engorged.

The pericardium was sound; it contained a small quantity of serosity. The heart was extremely soft and flaccid, so that it was readily torn with the fingers. Its right auricle was much dilated, and filled with blood. The walls of the corresponding ventricle were much attenuated; it was in them that the flaccidity of the muscular substance was most conspicuous. Within its cavity was a firm, fibrous, and whitish-coloured coagulum, which adhered very strongly to the columnæ carneæ. This coagulum had been most probably formed during the last moments of life. The right cavities of the heart did not exhibit anything unusual.

Baillie, in his Morbid Anatomy, and Lieutaud, in his Historia AnatomicoMedica, have related several cases of morbid change which have some resemblance with the present one; but I do not observe that either of these authors had ever found shrinking of the substance of the lungs, dilatation of part of the air-cells, hepatisation of a large portion of the pulmonic parenchyma, and an affection of the heart, in the same individual.

Pisa 12th Fevrier, 1817.

DOCTEUR VACCA BERLINGHIERI.

The following note from the late Dr. Warren (for many years one of the leading physicians in this Metropolis), in reference to the preceding report, will be also

read with interest.

"I have shewn Vacca's account to Dr. Baillie, who considers the case as exhibiting a very unusual form of disease, and one which is evidently out of the reach of medicine. The state of the heart presented no unusual appearances; the flaccidity and tender structure of its fibres being met with very frequently in individuals whose constitutional powers have failed by slow decay: the appearance within the right ventricle was a coagulum of blood not uncommonly found in that situation after death. The condensation of the lungs is also not unfrequently met with, and justifies the opinion which Dr. Baillie held to you of such an alteration of structure being the probable cause of Mr. Horner's difficulty of breathing—which was never attributed to water in the chest, but to an obstruction in the circulation of the blood through the lungs, arising from some cause not easily distinguishable. The enlargement of the air-cells to the extent mentioned by Dr. Vacca is a disorder so rare, that there are only three instances to

be found in the anatomical collections with which Dr. Baillie is acquainted. The immediate cause of death appears to have been owing to the increase of the obstruction of the lungs to such an extent, as to have prevented the free passage of the blood through the branches of the pulmonary artery, by which the right side of the heart become gradually gorged with blood, and its action was slowly suspended.

PELHAM WARREN."

Remarks. This case is altogether an exceedingly interesting one, and forms a good theme for a little practical discussion. What was the primary complaint,-the fons et origo,' of the long-continued suffering, and finally of death? It was said at the time, and this too by men of the highest professional authority, that it was Emphysema or morbid dilatation of the air-cells with partial solidification of the substance of the lungs, and it was regarded, as we have seen from the preceding report, as an instance of an extremely rare form of disease. But it may be very fairly asked, was the pulmonary complaint the primary, or was it not rather the secondary, affection? Was it not the result of the dilated atonic condition of the heart? We think it was; and that the case of Mr. Horner was in fact one rather of cardiac, than of pulmonic, disease. From the want of energy in the ventricles, more especially in the right one, they were unable to propel with ease the stream of blood that was continually pouring in. The necessary consequence of this was, that the circulation through the lungs was more and more embarrassed, until a complete congestion took place in certain parts, and the pulmonary parenchyma thus became impervious to the air. The remaining portion of the lungs had to compensate for the deficiency, and had therefore extra duty to perform: hence the dilatation of the air-cells, and hence the dyspnoa and also the distress in the action of the heart. The history of the case seems to confirm this view of its pathology: the symptoms were always much aggravated by bodily exertion, and they were remarkably relieved by the use of opium-which no doubt tranquillised the movements of the heart for a time, and thus enabled it to discharge its contents more completely and more regularly.

Does change of climate hold out any prospect of benefit in such cases ?-we think not. Rest and quietude in a pure atmosphere, passive exercise in a carriage when the weather is fine, great attention to the stomach and bowels, the use of mild tonics and antispasmodics, perhaps smoking, and certainly cheerful occupation of the mind-these are our chief remedies in such a case. To these we might be inclined to add, in most instances, a seton over the region of the heart. The grand thing is to form a correct diagnosis; the proper treatment follows almost as a matter of course.-Rev.

MISCELLANEOUS NOTICES.

1. Acupuncture in Neuralgia.

M. Lallemand of Montpellier has for many years been in the habit of using acupuncture in cases of genuine neuralgia with very decided benefit: against rheumatic pains, he says, it is quite inefficacious. We must therefore be careful to discriminate the cases for its employment; otherwise we shall certainly be disappointed. If the pain be limited to the trajet of the nerves, we may with tolerable confidence promise relief, if not a complete cure, of the suffering. M. Lallemand relates many cases: one we shall briefly notice. A man had for six months been afflicted with most severe pain along the whole course of the sciatic nerve; five needles were inserted along its tract, and left in for three hours. The application was repeated, at intervals of one or two days, four successive times; and the man was then completely cured.