indications of cerebral disease, comatose symptoms unexpectedly appeared, and terminated fatally in a few days. Upon dissection a portion of the upper and anterior part of the posterior lobe of the right hemisphere, appeared like a red, vascular mass from the effusion, or exhalation of blood from numerous small vessels; and to the anterior extremity of the right olfactory nerve, which was much thicker than natural, a tubercle of the size of a large pea, and maturating in the centre was attached; while a similar body, but still larger, was imbedded in the optic thalamus of the same side. Tubercles were also interspersed through the lungs, which adhered to the costal parietes; and from similar depositions in the sub-serous tissue, the intestines appeared studded, as if with a thick crop of small pustules; which proved to be numerous tubercles of a yellowish colour, elevating the peritoneal coat.. The upper surface of the liver, which was intimately adherent to the diaphragm, also exhibited numerous patches of tuberculous depositions. Case of Phthisis with the Foramen Ovale open. This was one of those instances in which the communication between the right and left cavities of the heart had continued unclosed, without producing cyanosis; and in which state, indeed, the pensioner had completed his allotted period of servitude in the marines, and had attained the rank of sergeant; and, so far as I could learn, without having suffered any particular inconvenience; until from the increasing size, and weakness of the right auricle, with the adherent, and very condensed state of the diseased lungs, the functions of circulation and respiration became more and more embarrassed. The symptoms were, cough, increasing dyspnoea, with a puffing or blowing motion of the lips (which were not discoloured) during respiration; anorexy; emaciation; great prostration and faintness; latterly approaching to syncope, on attempting to get up; with the pulse generally about 100, but very weak, irregular, and intermitting. These distressing feelings were much relieved by wine and stimulants; but especially by the sustaining power of (the muriate of) morphia; and he always expressed himself much revived and comfortable after having taken the anodyne draught. Sectio cadaveris, 20 hours P.M.—The lungs, on both sides, were universally adherent, and studded with crude tubercles, particularly the right lung, which was besides so much congested with bloody serum, and so condensed in structure, as to weigh 2lb. 11oz., while the left weighed 1lb. 8oz. The heart was rather larger than natural; the walls of the right auricle, which was enlarged, were remarkably thin, and the septum which ought to have closed the foramen ovale was found to be partially open and cribriform in its anterior part. One of the openings was sufficiently large to admit the top of the little finger. The valvular apparatus did not seem to be abnormal. The abdomen contained some turbid primrose-colored fluid, and the intestines were agglutinated together by lymph, which was effused in large quantities in the pelvis. Incipient ulceration existed in the ilium. The stomach was large, as was likewise the liver, which was pale and friable, and weighed 4lb. 9oz. The gall-bladder was much distended, the kidneys were pale, the body was emaciated, and the limbs œdematous. Case of Phlegmonous Erysipelas remarkable for the great rapidity and extent of Disease in a short period. John Duncan, S. æt. 38, who was stated to be then in his usual health, had pulled from the flag ship, in harbour, to Plymouth Sound, in one of the cutters, on Thursday, the 4th April-went on shore, on leave, afterwards-was seized the same evening with severe pain in the left arm, which soon extended to that side of the chest-was prescribed for by the surgeon on Friday, and brought to the hospital on Sunday, at 11 A.M., in a dying state, and expired early next morning. The symptoms on admission were, great dyspnea and pain, with increasing tenderness and tumefaction of the left arm and side of the chest, cough, mucous rattle, cold clammy skin, pale countenance, great anxiety and restlessness, and a very weak pulse; which sunk so rapidly as soon to be im. perceptible at the wrist. Any measures which could then be attempted were of course only palliative, and afforded but little relief; and, after a night of great suffering and restlessness, he died on Monday, at 5 A.M. Sectio cadaveris, 30 hours P. M.-There was much diffused swelling above the clavicle, and extending downwards, as far as the lower margin of the great pectoral muscle, yielding a doughy feeling of indistinct fluctuation, as if from some fluid effused in the subcutaneous and intermuscular cellular tissues. On the first incision, purulent infiltration of the tumid parts became evident; and its extent was then carefully traced by Mr. Male. The loose reticular membrane connecting the cervical and brachial plexuses of nerves was saturated with pus. The disease pursued the course of the carotid artery and jugular vein, as far as the thyroid cartilage; extended under the clavicle; surrounded the subclavian vein; burrowed between and under the pectoral, subscapular, and latissimus dorsi muscles; and followed the course of the brachial vessels and nerves nearly as far as the elbow-joint. There was oedema, but little or no external discoloration during life, to indicate such extensive destruction of parts. The pectoral muscles were paler, and more easily lacerated than the unengaged ones. The thorax was then opened-the left lung appeared collapsed, and the secretion of some gaseous, as well as nearly a pint of bloody sero-purulent fluid had taken place in the cavity of the chest. The pulmonary costal and diaphragmatic pleuræ were intensely inflamed; but the lung which adhered slightly posteriorly was not much congested. The liver was large and engorged with blood. Case of Chronic Inflammation and Scirrhus of the Pylorus and Pancreas—with Ulceration of the Duodenum, &c. Mr. James Keating, æt. 25, who had returned from the West Indies on the 30th of June, since which time he had been under the care of a private practitioner, was admitted into this hospital in the last stage of atrophy, from constant vomiting, of a dark bilious-looking fluid, on the 29th July, and died on the 1st August. Neither medicine nor nourishment could be retained; and it is needless to say, not the slightest hope of his recovery was entertained upon his admission. He had been subject to vomiting two or three times a day, and confined to his cot from May until the middle of October 1838, during which period he was reduced to the utmost degree of debility and emaciation, when he was sent to the hospital at Havannah. Soon after he rejoined his ship. On the 7th of November the vomiting returned; and during the passage homewards recurred generally twice a day; and since his arrival it had continued without intermission. Sectio cadaveris, 18 hours P.M.-The whole body was reduced to a state of extreme atrophy. The contents of the thorax were perfectly healthy. On opening the abdomen, the large size and streaky appearance of the stomach, and the turgid state of the intestinal veins attracted attention. The stomach, which contained a quantity of fetid dark green fluid, was hypertrophied, and extensively ecchymosed, especially towards the pylorus, which was thickened, but not contracted. The whole of the mucous surface of the duodenum, as far as the opening of the biliary and pancreatic ducts, was the seat of destructive ulceration and greenish sloughs; and immediately below this part, it suddenly contracted so much as scarcely to admit the little finger; but below, it reassumed its natu ral appearance. It was removed with great difficulty in consequence of its firm connexion with the pancreas, which was so indurated as scarcely to allow the knife to pass through its structure; while its greater extremity was so much enlarged as to displace the duodenum forward. The pancreatic duct, which was nearly as large as a goose-quill, and the radicles, were filled with pale thick pus; and several cells contained calcareous deposits in shape and size as large as peas. This mass of disease compressing the vena portæ accounted for the turgid state of the intestinal veins. The liver appeared healthy; but from the difficulty of emptying itself, the gall-bladder was distended to the size of a large winter-pear -its contents were thick, and of a hemlock green colour, not like healthy bile. The cystic was distended as far as its entrance into the common duct, where some obstruction had taken place. The spleen, kidneys, &c. were natural, and the mesenteric glands were not much enlarged. Case of Peritonitis and Scirrhoma. Although disposed to believe the heterologous formation to be described in this very curious case, (and which I have called Icthoid, from its resemblance to fish in colour and general appearance,) to be of constitutional origin, and its locale to be chiefly in the subserous filamentous tissue-and therefore in deference to the eminent authorities of Dr. Carswell, and other pathologists, I have classed it as a variety of scirrhoma, yet I do not feel altogether satisfied of the pathological correctness of doing so, or, at least, if rightly so classed, of grouping as mere varieties of the specific divisions many anomalous growths, differing in anatomical and physiological characters, and in malignancy, under the generic term of carcinoma: but as I have neither space to adduce my reasons, nor have had sufficient opportunities of investigation, to entitle my doubts upon the subject to much attention, I shall proceed, without further remark, to detail the remarkable case in question. Robert Burden, marine, æt. 32, was admitted from Pembroke Yard, on the 27th October, and died on the 26th December, 1837. He had suffered from influenza in the Spring, followed by severe dyspepsia, gastro-enteric pain, and progressive emaciation. The chief symptoms were great abdominal tenderness, and, except when under the influence of opium, that unhappy yearning, discontented look, so indicative of visceral disease; the pulse weak, and generally about 100; complete anorexy, and frequent sickness, but apparent inability to vomit; torpid bowels, with such extreme atrophy as to resemble, if not surpass, in extenuation " L'Anatomie Vivante; " indeed, latterly, when he could not lie down, with the eyelids closed, and a spot of hectic on the cheek, he might be compared to a sitting painted corpse. Sectio cadaveris, 32 hours P.M.-Besides the body being so atrophied, the eyes were sunk in their orbits, and sloughing of the cornea, &c. had commenced. A large rose-formed warty excrescence protruded from the navel, but did not appear to have any vascular connexion with the diseased parts within. There was a large quantity of fluid in both cavities of the thorax and abdomen, especially the former; but with the exception of slight pleural adhesion, the lungs, pericardium and heart, appeared to be healthy. In the abdomen the ravages of disease were manifested to an extraordinary extent. The parietal and visceral reflexions of the peritoneum exhibited a dark red, or purple, ecchymosed appearance; mottled with small white spots; and the intestines were agglutinated by the effusion of lymph. Indeed the stomach, liver, pancreas, colon, &c. were accreted into one mass, defying intelligible description. The stomach was contracted into deep rugæ, and marbled by tints of a yellow, vivid, and deep red, and black colours, and its capacity greatly diminished by the density of its coats, caused by a copious deposit of a scirrhous or semicartilaginous appearance. It was most abundant at the great end, and in the large intestines; the walls of which, and the duplicatures of the peritoneum, were much thickened by this morbid deposition. In a less, or earlier stage, it also existed in the small, but to a much greater extent in the large intestines. The liver was con gested, and the spleen small, but the internal structure of these organs and of the kidneys appeared normal. On making a transverse section of the large intestines, and especially of the descending colon, the calibre of the gut appeared much contracted, as already observed; being encircled by a broad ring of the same dull-white, yet glistening fish-like substance, resembling skate, but fibriform, and of a firmer consistence, and which varied from half an inch to upwards of an inch in thickness. Except slight intervening traces of tuberculous matter between the mucous and muscular coats, they seemed to be healthy, and their cohesive and cellular connexion unaffected; but these subjacent coats were so completely disconnected from the serous coat, by the interposition of this icthoid product, that large portions (I might even say yards,) of the former could be drawn out from the latter with the utmost facility: and, taken altogether, this was perhaps one of the most extraordinary cases on record. Royal Hospital, Plymouth, 22d August, 1839. DAVID J. H. DICKSON. CARBONATE OF IRON AS AN ANTIDOTE TO ARSENIC. (To the Editors of the Medico-Chirurgical Review.) Gentlemen,-Being a subscriber to your valuable periodical, since 1820, I have had an opportunity of becoming acquainted with the principal discoveries connected with medico-chirurgical science, as well as the opinions of the leading members of it, for which I take this opportunity of offering you my small tribute of acknowledgement. I was aware of Dr. Bunsen of Gottingen's plan of administering the hydrated peroxide of iron as an antidote to arsenic. I have also read the case of M. Deville, successfully treated by the tritoxide of iron and the experimental researches on the oxides of iron from the Revue Medicale. As the two following cases, which have fallen under my own observation and management, may prove useful in farther illustrating the effects of iron, as an antidote to arsenic, I think it may be of some practical benefit to have them generally known, and if you think them worth publishing you are at liberty to do so. Case 1.-J. Davis, aged 12 years, brought by his mother to my surgery, April 26, 1839, twenty minutes after eight A.M. having swallowed, by mistake, about a teacupful of a solution of white oxide of arsenic, which had been prepared to cure the itch, with which some of the family were afflicted. Symptoms.-Violent retching and vomiting, (he fortunately had taken his breakfast just before.) Excessive thirst, and intense sensation of burning in the throat and stomach; breathing difficult; great tremor of the whole body and inability of controlling the muscular action of the limbs. Treatment.-B. Ferri carbon 3ij. p. g. acaciæ 3j. aquæ Oss.* ft. haust. s.s. Immediately rejected. Ferri carb. cretæ pptæ aa 3ij. p. g. acaciæ 3j. aq. et liq. * The reason of administering so large a quantity of water, was to diffuse the antidote over a larger surface of the coats of the stomach. calcis aa iij. were retained in the stomach. He took four such doses, but after the third, all symptoms of poisoning ceased. The lad drank the solution out of the bottle, which was previously full, and contained 3j. of oxide of arsenic and about 3xxiv. of water. Water, I believe, at the common temperature, will dissolve about of arsenic, and I suspect the boy might have swallowed about a scruple of the oxide in the teacupful he took. Case 2.-Mr. T. O. (a respectable tradesman,) thinking he had the itch, (which he had not, but a common eruption to which he is subject every Spring,) washed his body and limbs very freely, on the evening of May 8, 1840, with a strong solution of arsenious acid and sulphate of copper, but he did not know what the solution was, as it was given to him by a friend. Saw him about eleven o'clock A.M. of the 9th, complaining of thirst, dryness of the fauces, great uneasiness of the stomach and abdomen, and at times of a burning sensation and acute pain in the stomach; pulse hard and about 70; bowels constipated, and general uneasiness and restlessness. Treatment.-V. sectio ad 3xviij. and prescribed magnes. sulph Ziss. d. aloes co. et ess. sennæ ãà 3ss. aquæ viij. Two table spoonsful of which were to be taken every four hours with three of warm water, till free action of the bowels was produced. At about five o'clock, P.M. found him with all the symptoms much more intense, with the addition of retchings; great soreness in the stomach; anxious countenance; in short, with all the symptoms of poisoning by arsenic. Directed to drink decoction of flax-seed very freely, and to take immediately, ferri carb. 3i, p. g. acaciæ 3ss. in thick gruel, with directions to repeat the dose in half an hour, and then every hour till quite relieved. About two minutes after the first dose, his throat and mouth became moist ; the pain ceased entirely; he dropt asleep, and slept soundly all night. Of course took no more medicine, and was quite well the following morning. The subjects of these two cases are now living in health, and are evidences of the action of carbonate of iron in cases of poisoning by arsenic. In country towns and villages, the hydrated peroxide of iron cannot be obtained. Even in this, which is a considerable market town, we have no practical chemist, and the nearest is Messrs. Blunt, of Shrewsbury, 18 miles distant. Carbonate of iron is kept by every practitioner and druggist, and if future trials prove as successful as the above two described, the antidote will be within the reach of every one. I have the honor of remaining, Welshpool, 15th May, 1840. Gentlemen, Your very obedient and very humble servant, SOUPE A LA MINUTE. At page 239 of No. 59, January, 1839. Six pounds of butter, &c. &c. &c. fried with a handfull of onions and the same quantity of aulx, you inquire what are these? Aulx is the plural of the word ail (garlic). |