ABSCESS IN THE POSTERIOR MEDIASTINUM.

385

of its

origin."

A sentiment echoed

i bycases

have been recovered

by judicious

I Quin. Dr. Whytt declares that he did treatment," which, from their very reconot save more than one in twenty cases.very, may have been presumed never to Cheyne observes, " when the disease ishave passed through the effusive stage of

discovered early, it is a dangerous, not an the disorder; nor, although I differed in incurable malady;" by implication saying,opinion, should I venture such an unquali: assertion as Dr. Dawson’s, when runthat when developed it is mortal. Ified Formey relates that, in the effusivening counter to the recorded testimony of stage, he has seen one child recover.the most experienced in the profession. Thomson, Golis, and many other eminentAgain, the brain, it may be, has" few absorbents, strictly so called, to be demonauthorities, assert that acute but it is most amply endowed lus, when fully formed-that is, when effusion has ensued, " yields to no reveins, and perhaps Dr. Dawson can medy." My own humble opinion is, that demonstrate" that those vessels in the the disease is, occasionally, remediable,head are deficient in a faculty pretty geneeven its rally granted to them in other parts of the although it may have third or effusive stage. That this is the body. The same author, in continuation case probably once in fifty examples, I subject, observes, "Nothing is more to the art of medicine than for feel, from extensive observation, satisfied; as I am convinced that in the forty-nine, practitioners to be smitten with the love a very great majority, the stage just al- of accomplishing great cures, since those luded to is but the harbinger of death. who are on the alert for them will seldom A child, particularly if not of strumous be disappointed." The remark, per se, is diathesis, should never be condemned and extremely just, and worded, as all Dr. left to its own unaided powers, even in Dawson’s sentences are, extremely well ; the apparently eleventh hour of its exist- but once admit it as universally applicable, ence. Although convinced of effusion, and as influencing our conduct, and the the medical attendant cannot estimate its injury to poor humanity, as well as to extent, cannot appreciate the power of science, would be incalculable. nature’s efforts, or, by possibility, know A lawyer pleading for his client, when what the cerebral mass, in the way of ab- ordinary means fail, has recourse to those sorption, is equal to, particularly if the: extraordinary measures which the law, or latter be aided by well-directed remedialhis own ingenuity, can afford. Similar I means. Hence, whilst considering allapprehend should be the conduct of the cases presenting the developed disease,, medical practitioner, whose anxious efas most unpromising, I would anxiouslyforts for recovery should only expire with advocate their not being regarded as3his patient. hopeless. But, to the particular treatment of hyIt is stated by Martinet (when speakingdrocephalus. of the anatomical character of this dis(To be continued.) ease), that " sometimes no fluid is found in the ventricles, though dilated, which arises from thefluid being absorbed imme- I ABSCESS IN THE POSTERIOR diately before death had occurred." Pro- I vided this inference, drawn by one of the MEDIASTINUM. most esteemed pathologists of our day, be correct-is cerebral absorption so imagiTo the Editor of THE LANCET. nary as some nosological writers would have us to believe ? send for insertion in your exSIR,—I " If by hydrocephalus," remarks a late cellent record of the medical weekly author, " be meant water in the brain, I sciences, the brief notes of what I deem hesitate not to assert that it never was, rather an interesting case. The details of and never can be cured, since admitting the dissection are from the note-book of the existence of absorbents in that organ, Mr. W. made the postHebb, who which 1 am not disposed to deny, although mortem examinationkindly at my request. they never have been demonstrated, it is I remain yours truly, physically impossible that, under such a DAVID CORBET, M.D. M.D. the the state of system, they can remove 1834. Worcester, 31, May deposition, and restore the inflamed parts to their integrity." Let us dwell a moG. G., set. four and a half years, residing ment upon the sweeping declaration of Dr. Pearson Dawson-that children, thusat Henwick, in the neighbourhood of this situated, havebeen cured, it is obviouslycity, complains of pain in the back, espebut with Dr. G. Gregorycially between the scapulae, which is impossible to prove; I may say, that " I am satisfied that manyr greatly increased by the least motion;

hydrocepha-i strated ;" I, with

"

developed

’

ofIinjurious the

’ medical .

386 upon the slightest percussion over this re- wise healthy, and did not contain any tugion the child screams, and gives other in- bercles. dications of acute suffering; it is unable In the abdomen nothing remarkable to raise itself into the erect posture was found, except the distended state of without much aggravating the pain, and the gall-bladder, which contained more upon stooping to reach anything on the than an ounce of bile, although the comground it tumbles forward; the right arm munication with the duodenum was peris partially paralysed; the bowels are out fectly free. The intestines were distended of order; it has difficulty in making water; with flatus. occasional palpitation of the heart; and W. H. irregular hectic fever. About two years ago the child began to fall off, failed in its appetite, and looked yellow, and at that ON THE time the stools were clay-coloured and the water pink. Since then it has never been TORSION OF ARTERIES in good health, and for the last few months been into the state has gradually declining To arrest Hemorrhage in Veterinary above described. A few days after the Operations. the child died sudwere noted, symptoms denly, vomiting, or rather expectorating By W. YOUATT, Esq., Professor of Veterilarge quantities of purulent matter.—D. C nary Medicine, University of London.

Dissection Twenty-four Hours after Death. The body was considerably emaciated. The lips and teeth had an appearance similar to that which is presented when death is produced by fever. No other peculiarity was observable externally. On opening the chest and abdomen, the contained organs were found to be generally in a healthy condition. The pleura, covering the lungs and chest, was healthy, but there were a few very delicate adhesions between the inferior lobes of the lungs and the pleura lining the diaphragm. The pericardium contained rather more than an ounce of serum, and the veins on the surface of the heart were unusually turgid. The cavities of this organ were

A FEW days after the appearance of Mr. Costello’s excellent paper on torsion, in April last, a pointer bitch was brought to my infirmary with a large scirrhous tumour near the anterior teat on the left side. It had been gradually increasing during the last five months; it was becoming more irregular in its form, and on one of its tuberculous prominences was a reddish spct, soft and somewhat tender, indicating that the process of suppuration was about to commence. I had often, or almost uniformly, experienced the power of iodine in dispersing glandular enlargements in the neck of the dog, and also those indurated tumours, healthy. On dividing the windpipe and of various kinds, which form about the œsophagus, for the purpose of removing joints of some domesticated animals, parthe contents of the thorax, a gush of pu- ticularly of cattle ; but frequent disaprulent fluid took place, which did not pointment had convinced me that it was, issue from the lungs, but continued to ap- ;f not inert, yet very uncertain in its effect pear in considerable quantity, increased in causing absorption of tumours about by pressing on the side of the spine, from the mammse of the bitch. Having also behind. On dividing the pleura, which been taught that the ultimate success of forms the left wall of the posterior medi- the excision of these enlargements deastinum, an abscess was penetrated, which pended on their removal before suppuraextended upwards to the first dorsal or tion had taken place, and the neighbourlast cervical vertebra; below to the dia- ing parts had been inoculated by the virus phragm; bounded posteriorly by the bo- which so plentifully flowed from the ulcer, dies of the dorsal vertebræ, which were I determined on an immediate operation; exceedingly carious ; and, laterally, by and as the tumour was large, and she was the layers of the posterior mediastinum. in high condition, I thought it a good case The quantity of pus which had escaped, for thefirst trial of torsion. She was well with that remaining in the cavity, was physicked, and on the third day was proabove three ounces. The structure of the duced before my class, and properly sebodies of the vertebræ was so softened as cured. I had not provided myself with to admit of being broken down by the the torsion forceps, but relied on the hold finger. There was matter in the wind- I should have on the vessel by means of a pipe, a connexion having been established pair of common artery forceps ; and al. between it and the abscess behind the top though I am not prepared quite to justify of the sternum. The substance of the apparent carelessness, I am very glad

lungs was

rather

congested,

but other-

this that

I used the instrument which I did,