M. RACIBORSKI ON PURULENT INFECTION.

"M. Bonnet, chief surgeon of the Hôtel Dieu at Lyons, has recently directed the attention of the profession to the good effects of cauterising either with the actual or the potential cautery-ulcers and suppurating wounds, with the view of preventing or even of curing that very formidable affection which has been called purulent Phlebitis and purulent Infection. It appears to me that a temperate discussion of this question is calculated to throw some light on several topics in Pathology, that are a good deal canvassed in the present day.

"In my thesis, published in 1840, I examined with much care the various theories (of metastasis, absorption, aspiration, phlebitis, &c.) which have been proposed by different writers, to account for the formation of those internal abscesses or purulent deposits, and the occurrence of the other morbid affections, which not unfrequently accompany open wounds in a state of suppuration, and it then, as I stated at the time, seemed to me that none of them was satisfactory in an ætiological point of view. We can at present allude to the last only of these theories, and shall now very briefly state our reasons for refusing our assent to it.

"The doctrine of phlebitis reposes on the assumption that there is a passage of the pus-secreted by the inner surface of the veins in a state of inflammation, after operations, injuries, accouchement, &c.-into the current of the circulation. But it is very far from being proved that such a passage or transmission ever takes place. On the contrary, it would seem, from the researches of most pathologists in the present day, that the first phenomenon in actual phlebitis is the formation of a coagulum that plugs up the inflamed vessel, and which thus detaches the diseased from the healthy portion of the tube. In such a state of things, it is obvious that any purulent matter, which may be secreted in the former part, cannot become mixed with the general mass of the blood. M. Dance himself had felt the force of this objection so much, that, in order that he might be able to give some degree of consistency to his ingenious romance, (to use the expression of M. Tessier, to whom unquestionably belongs the merit of having first clearly established the importance of this point,) he was obliged to suppose that the secretion of pus takes place before the formation of the coagulum -a position at utter discordance with the observations of all the best pathologists. But, by a curious contradiction, when he was describing the symptoms of phlebitis, he enumerated in the last stage those which he considered to be owing to the passage of purulent matter into the blood. If space permitted, we might adduce other arguments that are unquestionably opposed to the doctrine that the symptoms, of what has of late years been called Purulent Infection of the system, are attributable to a suppurative inflammation of the veins."

"M. Bonnet seems to be one of those surgeons who attribute the constitutional disorders, which occasionally attend suppurating wounds, in part to an inflamed state of the veins, and in part, also, to the direct absorption of purulent matter into the system. But neither of these doctrines can well serve his purpose, when he attempts to give a reason for the successful results of cauterising the wounds themselves, or the adjacent veins, as a means of counteracting these disagreeable consequences.

May not the following theory-derived from the study of Liebig's beautiful researches-furnish a better explanation of the subject in question?

"It is well known to the chemist, that, if a small portion of yeast be placed in contact with a solution of sugar, the latter substance begins immediately to undergo certain changes, the result of which is the formation of alcohol and carbonic acid-and yet the yeast itself has lost nothing of its weight. May not something akin to this take place, when a portion of purulent matter, in a state

of decomposition is brought into mere contact with the blood? and may not the entire mass of the circulating fluids in this manner undergo a certain change, as we daily see take place in the fermentation of large quantities of vegetable juices, when the minutest quantity of leaven is added to them?

"If we examine attentively the cases, in which the symptoms of purulent infec◄ tion, or purulent diathesis appear, we shall find that these symptoms have almost always occurred under circumstances that are favourable to the decomposition of the secreted pus: indeed, the physical characters, as well as the chemical properties, of the purulent fluid abundantly prove the truth of this observation.

"The pus, having become vitiated-whether this has been from neglect of cleanliness in dressing the wound, or from the mere influence of an unwholesome atmosphere that may, perhaps, be charged with molecules in a state of putrefaction, or from the mere influence of an elevated temperature-communicates the movement of its decomposition to the coagulum which stops up the extremity, and thence to all the mass of the blood."

*

"It has usually been too much the case with pathologists to ascribe the alterations, which are met with in the veins of those who have died from suppurating wounds, to an inflammation of the parietes of those vessels. But I am persuaded that, in very many cases of this sort, the pus, that is found in the interior of the affected veins, is no more the direct consequence or result of a phlebitis, than is the deep red colour of their lining membrane, so frequently seen in fatal cases of typhus fever.

"In support of this opinion, I might allude to the accidents which are apt to follow dissection-wounds. In these cases all the phenomena, from the earliest local symptoms observed during life, to the most serious anatomical lesions discoverable after death, might seem to justify the appellation of Phlebitis,—which has been usually applied to this state;-and yet what is more manifest than that there is a primary alteration of the blood, under the influence of a fluid in the state of decomposition? Does not the success, which generally attends the im mediate cauterisation of the wound in such cases, abundantly prove that it is to the destruction of the poisonous matter by the caustic employed, and not to the action of this on the parietes of the veins, that the curative effects are really attributable?

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"It is in this manner that we should explain, I think, the cures obtained by M. Bonnet from cauterising wounds in a state of suppuration; and I am, at the same time, led to believe that, if we were to combine this practice with irrigations of cold water-so as to establish, as it were, a continual current of water around the solution of continuity-we might obtain most salutary results, and prevent many of those distressing and fatal accidents which too frequently supervene after severe accidents and operations.”—Archives de Medécine.

MISCELLANEOUS NOTICES.

1. Notice of a new Danish Medical Journal.

We have received the first number of the Bibliothek for Læger, edited by Professor Otto of Copenhagen, and published during the present year in that city. Its chief contents are-1. A paper on Phthisis and its treatment, with remarks on the use of Dr. Ramadge's inhaling apparatus. (The writer judges favourably of this mode of treatment! so much for his sagacity and judgment. We advise the doctor near Holborn to send a cargo of his little pipes forthwith to Copenhagen, addressed to the care of Dr. Giersing.) 2. Remarks on the most celebrated physicians of the French metropolis, and their characteristic methods of treatment. 3. A case of remarkable deformity of the male genital organs, by

Professor Svitzer. 4. On the advantage of silk ligatures by the same, &c., and also numerous clinical reports from the civil and military hospitals of Denmark. As we know nothing of the Danish language, we cannot do more than merely thank Professor Otto for his polite kindness in sending us the first number of his new periodical, and express our cordial good-wishes for its fame and success.

2. Successor of Larrey in the Institute.

The medical world in Paris had been, for some months before the day of election, in quite a buzz of expectation and quidnunc-ery, as to who should prove the fortunate candidate for the vacant place of the famous Larrey. The distinguished Professor of Montpelier, M. Lallemand, was the favourite, it was generally believed; and this idea was confirmed on finding that the committee, whose part it was to select a certain number of names out of the host of candidates, had placed him at the top of their list. The others followed thus: Lisfranc, Ribes, Velpeau and Gerdy (equal), Amussat, Begin, and Jobert. The indefatigable surgeon of La Charité, however, although only fourth on the list, proved at last to be the successful competitor. The French Journal, l'Experience, approves highly of the choice, and concludes its notice of the election with these words: “M. Velpeau, in point of professional fame, is one of the reigning princes of surgery. His works on operative surgery and topographic anatomy are known everywhere. He possesses in the highest degree a love for his art. His intellectual character is eminently progressive; if he errs in this respect, it is rather in the way of too much than of too little. His whole career has been one of labour and study; and no one has better proved by example the truth of the adage

'Labor improbus omnia vincit.""

(This eloge, we believe, is nothing more than true.)

M. Lisfranc does not fare so well. Some of the French journals are having a fling at him, for a very notable piece of puffery with which he is charged. It seems that the wealthy Marquis d'Aligre recently had the misfortune of breaking the neck of one of his thigh bones, and that M. Lisfranc was called in to attend him. This was all duly announced in the public journals, as a matter of course, at the time of the accident; and the profession naturally thought that there was an end of the matter, at least between the public and the doctor. Not so however; for we are told that many of the leading fashionables in Paris had the honour of receiving, some weeks after the accident, the following 'jolie petite lettre, fort coquettement lithographiée :’—

"The apparatus was yesterday removed from the limb of M. le Marquis d'Aligre. The fracture has healed, without any shortening of the member. From this time, the Marquis enters upon convalescence; he will soon be able to walk; his general health is excellent.

Paris, 23d February, 1843.

(Signed)

Lisfranc. Nauche."

3. Transmission of Glanders by the Blood.

M. Renaut recently exhibited to the Academy some morbid preparations illustrative of the effects of this disease, where it had been communicated by injecting into the veins of a healthy animal some of the blood taken from a glandered one. This fact however is not a new one; as Blaine, in his work on the veterinary art, expressly tells that when Mr. Coleman, on one occasion, bled an ass till it fainted, and then injected an equal quantity of blood drawn from the carotid artery of a horse affected with the glanders, the former animal exhibited in the course of a few days all the symptoms of the disease-a fact that was fully proved by the circumstance that the glanderous matter taken from it and inoculated upon another ass produced the usual effects of direct infection in this last.

Vibourg also, in his treatise on the Glanders and Farcy, has the following re

mark :-" Experiments have clearly shewn that the mass of the circulating fluid is really charged with the poisonous matter, and that, if glanderous blood is injected into the body of a healthy animal, the latter will become infected with the disease."

4. Decadence of a brilliant Operation!

How, in the name of all that is wonderful, comes it that we never hear now of dividing people's tongues-or, as we heard an elocution-professor once tell a public audience, of cutting people's throats-for the cure of stammering? This great achievement of modern surgery has lasted just about as long as a fashionable novel usually does: before a twelvemonth has expired, it is not even talked of. Last year the weekly periodicals teemed with cases of wonderful cures effected "slick off in a twinkling;" and now, alas! there is an utter dearth of any thing that excites curiosity. By mere accident we noticed the heading of an article in a late number of the Annales de la Chirurgie-by-the-bye, one of the best of the French journals—on the treatment of stammering by dividing the genio-glossi, and we were curious enough to see what the author would now say upon the defunct subject. With most praiseworthy candour, he tells his readers that, although he met with very decided success in some cases, the result of the operation in his practice, on the whole, was so unsatisfactory that for the last eight months he had entirely given it up. The editor of the journal, in a foot-note, remarks: "It is this conclusion alone that has induced us to insert the memoir of M. Cloesser; for it is more remarkable for its good faith, than for any importance of its statements.”

5. Iodine Injections in Hydrocele.

The use of the tincture of iodine, more or less diluted, in cases of hydrocele as an injection, in lieu of wine, &c. is becoming more and more generally adopted by the French surgeons. M. Velpeau has recently written a long memoir, strongly recommending it; and we observe that M. Pasquier, surgeon of the Hôtel des Invalides in Paris, reports most favourably of its effects. It seldom produces much pain, even when the injection is strong; and, according to the experience of several surgeons, it seldom or never fails in producing the wishedfor adhesive inflammation.

The action of the tincture of iodine on the skin appears to be very similar to that of a strong solution of the nitrate of silver; it stimulates the part for a short time, and then soothes irritation and pain. We have seen good effects from applying it daily to the integuments covering scrofulous and other indolent abscesses. Recently it has been recommended as very useful in strumous, and other kinds of, ophthalmia, when applied on the outside of the eyelids. It seems to act as a gentle counter-irritant or derivative, in the same manner as the nitrate of silver does.

6. Affectation of would-be Savans.'

A short time ago there was a long and unmeaning article by M. Guerin, in the Gazette Medicale, of which he is the 'redacteur en chef,' with this extraordinary heading" of the scientific unity and solidarity (!) of anatomy, physiology, pathology and therapeutics in the study of the phenomena of the animal organism." We have rarely met with such a tissue of pompous absurdity—it possesses the rare union of German unintelligibility and French verbosity. As a matter of course, the refrain' of the whole is something about muscular retraction, deformities, and subcutaneous section of muscles, &c. A brick will suffice as a sample of the building: "The anatomy of ages has shewn me that, from early foetal to adult life, the fibrosity of muscles in all animals alike goes on incessantly increasing, in relation to the fleshy constitution, that is to say in the ratio of the antiquity and the intensity of action of the cause." Reader, can'st

thou tell us poor mortals what lingo this is; for we frankly confess that we do not understand one word of it? Surely this is the " darkening counsel by words without knowledge," that the wise Man of old hath so well exposed.

7. Sulphate of Iron in Agues.

In 1808, there was a great deal of intermittent fever in the low districts of Paris. The supply of cinchona in the metropolis at the time was nearly expended, and the drug was therefore to be had only at a very exorbitant price. This was owing to the circumstance that a most strict embargo had been laid by the French Emperor against every thing imported in British vessels from abroad; and it is well known that the French had scarcely a ship at sea. The Polish physicians had set the example of trusting chiefly to the use of the Arseniate of Soda; but this was found on experience to be a rather unsafe remedy to have recourse to in all cases. Dr. Marc-long one of the ornaments of French medicine-happily thought of the sulphate of iron, and used it in a great multitude of cases with the most decided success. Indeed in several instances it effected a cure of the disease, after bark had failed. M. Corvisart, the leading physician of the Court, wrote to Dr. Marc in the most flattering terms of compliment on the importance of his discovery. He received moreover a handsome reward from the Emperor. We hear nothing in the present day of the use of Iron or indeed of almost any remedy save cinchona and its alkaloid basis, in the treatment of intermittent fevers. Perhaps this is to be regretted, as similar circumstances to those, in which M. Marc and his professional brethren were placed thirty years ago, may often recur to different nations. Some of the French physicians in Algeria report very highly of the substitution of arsenic for bark. One, for example, goes so far as to say :

"It is the best febrifuge with which I am acquainted; for seventeen chronic cases, which had resisted the action of quinine and sulphate of iron, successively yielded to its employment. The average duration of the arsenical treatment was five days. I have seen a good many cases of the disease in Africa, in which bark and its various preparations failed in putting a stop to the morbid accessions.

"One great advantage of the arsenical solution is its tastelessness, and another, of even greater importance on many occasions, is its trifling expense. Every year France pays to South America considerably more than a million francs for the supply of cinchona; whereas the price of arsenic, as every one knows, is exceedingly small.”

It is always well, in medical as well as in other matters, to have more than one string to our bow; and it is therefore much to be desired that the comparative efficacy of different anti-periodic medicines-either alone or in conjunction with bark-should be fairly tested on a large scale.

How strikingly does the action of those remedies, that have been found on experience to be really useful, shew that there is a marked analogy between Ague and Neuralgia.

8. Droll Request of a learned Academician.

"M. Baudelocque requests of the Academy that it will appoint a committee, before which he undertakes to prove that he never loses either a woman or an infant after delivery, whether this has been natural, or complicated with hæmorrhage, convulsions, præternatural position of the child, &c., provided he has been called in from the very commencement of the accident, and before any attempt has been made to terminate the accouchement. As a matter of course, he excepts from his proposal all cases of deformity of the pelvis, and of extra-uterine pregnancy.

Well, this modest request out-herods all the regular professional puffs we have ever met with. Hide your diminished heads, all ye Hygiests, Homœopathists,