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PATHOLOGY.
784 process in absorption, the process by which foreign substances penetrate into
ve ssels, whether this be by an artificial opening, or through their pores, is placed exclusively under the influence of atmospheric pressure; and that the pasthe
sage of these substances to the heart is placed under the same influence, as well as that of other minor circumstances, which assist the venous circulation. Thus absorption is submitted entirely to the laws which preside over the course of fluids in animals which respire by the active dilatation of the thoracic cavities. 2. That in all the cases of poisoning by wounds, either by the simple deposit of the poison, or by its injection, as in the bites of vipers and other poisonous serpents, the application of the glass may save the individual, provided it be done with the necessary precautions, and before a sufficient dose to produce death be absorbed. 3. That as the local action of the poison and the imbibing power of the tissuesI take place under a vacuum, the parts ought to be excised after that the poison is concentrated in them by the effect of
wound, and every thingthat a fresh absorpbelieve leading tion commences in wounds even if they are cicatrized when they have been inflicted by rabid animals, the glass ought to be applied at the moment when symptoms of madness manifest themselves, the parts excised, burnt afresh and kept as much as possible from the effect of the air. 6. That in the case of wounds received during dissection, the wounded parts should be sucked to dryness, and then covered till complete cicatrization takes placed in
us
the
to
place. person in dissecting an animal which has died of carbuncle should have the misfortune to prick himself, a glass with a convenient edge should he applied to the surface of the 7. That if
a
pricked finger, and all the ulterior precautions be observed which we have already indicated. PATHOLOGY.
Observations
on
By
Abscess
of the Liver,
M. Louis.
glass. The glass ought to be applied In the second nitmber of the Repei-loire again for some minutes, to empty the d’Anatomie, which has just appeared, Al. divided vessels, after which the actual Louis has given five cases of hepatitis, cautery may be applied, but never be- accompanied with abscess of the liver, fore the application of the glass, because on which he makes the following obserthen it would be useless, the mouths of vations. Like almost every thing he has the vessels being hermetically sealed. written, they are worthy of attentive 4. That in the case of bite from mad perusal. of hepatitis were simple dog, we may presume from the nature If theseorcases if without being simple they diseases, of the local effect of the poison, that the had only presented slight modifications, application of the glass in the first place, capable of exerting but little influence the
and afterwards the excision of the part, on the progress and symptoms of the principal disease, we might dispose of and cauterization of the wound will pre- them in a short and general manner. With one exception, however, disease always vent every kind of accident. in the course of other diseases, 5. The experiments made with the appeared so that in relation to the symptoms, the vegetable and mineral poisons having general history of hepatitis ought to limit the consideration that the jannproved that the repetition of the tetanic us to and the pain in the right hypochondice, convulsions is produced by the continu- drium, occurred in four out of the five ance of the absorption of the cases, and the tension in the same part
poisonI
786
only twice ; symptoms which, when occur- I tacks the mucous membrane ring together, have been long recognized’ jejunum, it generally commences
of the up that portion nearest to the coecum, and but ill very few cases ever extends to the duodenum. It is the state of the lymphatic glands in inflaiilniation of the mucons membranes, to which they. correspond, that has given rise to duodenitis being admitted as the cause of inflammation of the liver ; but the analogy is far from being complete, and if it were complete, it would merely be a fresh proof that it is not an unfrequent cause of
as marking inflammation of the liver; but isolated, or even any two together when they occur in the course of an acute disease, possess little or no value ; for if we take the jaundice, we find it frequently present when the liver is not inflamed ; and in regard to the pain, it may. artse from so many diffe. rent causes, that it is also no decisive symptom of this complaint. But it is quite a different case when these symptoms, the pain in the right hypochondrium error. and the jaundice supervene in the course Wounds of the head have also been of chronic disease, (cancer and other or- enumerated by authors, as giving rise to ganic diseases of the liver excepted,) for abscesses of the liver. Without entering we. never saw the icterus in this case into a detail of the reasons which have without there being at the same time an induced us to doubt this circumstance, inflammatory affection of the liver. None we will only state that-one of the explaof the patients felt the pain in the right nations for a long time put forth in supshoulder, and we even doubt whether this port of it, appears to us entirely devoid symptom mentioned by authors realty be- of foundation. It has been supposed inlongs to those marking hepatitis. Pro-’ deed that in wounds of the head there bably in the cases where it has been ob- has been a stagnation of blood in the right served there was, besides the affection of cavities of the heart, thence engorgement, the liver, some disease of the lung, or of and finally inflammation of the liver. But the pleura of the right side, to which the in the diseases of the heart, where this pain in the shoulder might be referred. engorgement is much more certain and Authors have endeavoured, as in most more considerable than in any other affecother diseases, to discover the causes of tion, the abscesses of the liver are not this disease, but with the usual want of more common than under other circumsuccess. Warm climates have been men- stances ; and to speak of the facts which tioned as one of the most active causes of have only come within our own observainflammation of the liver ; but this has tion, we should say that of forty-five perbeen denied by physicians of great talent, sons who died of disease of the heart, we as for instance, by Peter Frank, who have found an abscess of the liver in no practised himself in a warm country. It single case, so that the mechanical conhas also been recently said, that when gestion does not seem to be the cause of hepatitis has not been occasioned by ex- inflammation of this viscus more than ternal violence, its cause may be con- that of any other part. stantly traced to an inflammation of the In reference to the pathological anamucous membrane of the duodenum. We tomy, the cases present some interest, do not mean to deny that these two inasmuch as shew that the abscesses lesions may not exist at the same time, of the liverthey contain pus of frequently but the result of our observations has and that they may be engood quality, proved to us satisfactorily that this is far which is most commonly the case, from being constantly the case, since in cysted, or not, according to circumstances. Softenthe four cases where the mucous memof the liver has been already noted by brane in question was examined with ing several observers of nature, and among care it was found perfectly healthy, if others by M. Lallemand in a case of acute we except, in one case, a slight degree inflammation of this organ. But in respect of ramolissement, without any change of to the softening, we must here state that colonr. But perhaps doubt will be raised the consistence of the organs in the naon the accuracy of our observations, and tural state is not always the same, for it will be said that it is at least extraortha·. of the muscles ; and that in dinary, that having found the mucous several diseases where the heart is exmembrane of the stomach and the jejtxSOfl, one could not suppose that num inflamed, without that portion of tremety it had been previously inflamed. This is the gut placed between the two being with the womb which expands affected. To this we reply, that when the same
instance,
the
mucous
membrane of the stomach is
inflamed, the inflammation generally stops
a certain distance from the pylorus, Troisième lettre sur and that when the inflammation at. 351.
at
l’Encephale,
p.
786
and becomes softened during pregnancy, ABERNETHY, declare myself incompetent, by a process different from that of inflam- but continue in office. mation ; and if this be true of the musBy my exertions, great improvements cles, heart, and uterus, may it not be so have been made in the art of surgery; with the liver, the firmness, colour, and I have shown, as you know, my superior size of which are subject to such constant method of operating to my ignorant and great variation ? But a very remark- colleagues at the Middlesex, more than able fact in abscesses of the liver is, that once ; but it is all lost upon them, and to no cicatrices are to be met with in the say the truth, I am determined to cut parenchyma of this organ. We have never all connexion with them if they do I fear they are incorrigible seen them ourselves, though it is proper not mend. to mention that M. Merat in an interest- miscreants, and I see no alteruative, but ing paper on hepatitis in the Dictionnaire that of putting them upon the half pay des Sciences Medicales, says that these list, like poor Sir Ludtbrd and brother productions have a stetuated form, and Ben, or to give them a seat at Lincoln’s may be regarded as cicatrices. But it is Inn, by the side of brothers Lynn, Norris, evident that before this be admitted, the and Forster. You know I always was a cicatrices ought to have been seen in all good-natured fool, and I still like to be their stages. charitable, though I am sorry to say these cutters at the Middlesex have al.
Lastly. Although four of the five per- most cut me out of all practice; such is sons were jaundiced, the biliary ducts had the consequence of associating with bad not ceased to transmit the bile into the company. Why, even GUTHRIE told me small intestine, even in a case where a the other day, he wondered how I could calculus of considerable size in the cystic stand it, and BRODIE and BENJAMIN were duct, pressed on that belonging to the both at me to intercede with you in their liver. It is not the first time we have favour ; poor fellows, it was a moving had the opportunity of observing jaundice sight to see their long faces; they swore take place without any mechanical ob- by Jupiter that they must give up cabstacle to the course of the bile ; in fact, keeping if you continue to pelt at them. in no case within our own immediate We have had no operation at our place observation have we been able to trace for the last five weeks, and God only knows when I shall ever have another the jaundice to this cause. opportunity of showing our lithotomist how to avoid the evils of an irregular distribution of arteries. I have a mind to go into the Borough twice a week, or, by my troth,I shall forget how to handle JOSEPHUS BURNS, ESQ. a chirargical instrument. It is of no use TO THE to write to you about the bustle of lecEDITOR IN THE COUNTRY. setting forth their blandishturers all ments, and declaring that they mean to treat
the "
subjects fully."
Heaven
You said last week you would write knows they have been very emptily
letters on the state of medical treated too long. Now as you may science in the country, as Mr. Cobbett depend on my services, I advise you does on the state of the turnips for the to remain awhile, where, Register; but you have failed to do so. You Nor rural sights alone, but rural said I had " ratted," because in the preface sounds exhilarate the spirits;" to my forthcoming work on Hospital Discipline and operations for hernia, (which to acquire fresh vigour for the ensuing by the bye you had no right to publish without my consent,) I reprobated the campaign, and above all things to stick to troublesome old fashioned manpresent system of electing and retaining ner your the truth. of-telling ignorant, decrepid, and incompetent men to fill the great offices of hospital physician and surgeon. Why you know, from the Yours, in the cause of Independance, first moment we became acquainted, I JOE BURNS. JOE BURNS. always told you that I disapproved of, such nefarious practices, and moreover, I said that I would give up my situation of hospital surgeon the moment I feltmyme some
self unfitted by age or infirmities you know there are many sorts of infirmities) from doing my duty, and not like Mr.
(and
ve ssels, whether this be by an artificial opening, or through their pores, is placed exclusively under the influence of atmospheric pressure; and that the pasthe
sage of these substances to the heart is placed under the same influence, as well as that of other minor circumstances, which assist the venous circulation. Thus absorption is submitted entirely to the laws which preside over the course of fluids in animals which respire by the active dilatation of the thoracic cavities. 2. That in all the cases of poisoning by wounds, either by the simple deposit of the poison, or by its injection, as in the bites of vipers and other poisonous serpents, the application of the glass may save the individual, provided it be done with the necessary precautions, and before a sufficient dose to produce death be absorbed. 3. That as the local action of the poison and the imbibing power of the tissuesI take place under a vacuum, the parts ought to be excised after that the poison is concentrated in them by the effect of
wound, and every thingthat a fresh absorpbelieve leading tion commences in wounds even if they are cicatrized when they have been inflicted by rabid animals, the glass ought to be applied at the moment when symptoms of madness manifest themselves, the parts excised, burnt afresh and kept as much as possible from the effect of the air. 6. That in the case of wounds received during dissection, the wounded parts should be sucked to dryness, and then covered till complete cicatrization takes placed in
us
the
to
place. person in dissecting an animal which has died of carbuncle should have the misfortune to prick himself, a glass with a convenient edge should he applied to the surface of the 7. That if
a
pricked finger, and all the ulterior precautions be observed which we have already indicated. PATHOLOGY.
Observations
on
By
Abscess
of the Liver,
M. Louis.
glass. The glass ought to be applied In the second nitmber of the Repei-loire again for some minutes, to empty the d’Anatomie, which has just appeared, Al. divided vessels, after which the actual Louis has given five cases of hepatitis, cautery may be applied, but never be- accompanied with abscess of the liver, fore the application of the glass, because on which he makes the following obserthen it would be useless, the mouths of vations. Like almost every thing he has the vessels being hermetically sealed. written, they are worthy of attentive 4. That in the case of bite from mad perusal. of hepatitis were simple dog, we may presume from the nature If theseorcases if without being simple they diseases, of the local effect of the poison, that the had only presented slight modifications, application of the glass in the first place, capable of exerting but little influence the
and afterwards the excision of the part, on the progress and symptoms of the principal disease, we might dispose of and cauterization of the wound will pre- them in a short and general manner. With one exception, however, disease always vent every kind of accident. in the course of other diseases, 5. The experiments made with the appeared so that in relation to the symptoms, the vegetable and mineral poisons having general history of hepatitis ought to limit the consideration that the jannproved that the repetition of the tetanic us to and the pain in the right hypochondice, convulsions is produced by the continu- drium, occurred in four out of the five ance of the absorption of the cases, and the tension in the same part
poisonI
786
only twice ; symptoms which, when occur- I tacks the mucous membrane ring together, have been long recognized’ jejunum, it generally commences
of the up that portion nearest to the coecum, and but ill very few cases ever extends to the duodenum. It is the state of the lymphatic glands in inflaiilniation of the mucons membranes, to which they. correspond, that has given rise to duodenitis being admitted as the cause of inflammation of the liver ; but the analogy is far from being complete, and if it were complete, it would merely be a fresh proof that it is not an unfrequent cause of
as marking inflammation of the liver; but isolated, or even any two together when they occur in the course of an acute disease, possess little or no value ; for if we take the jaundice, we find it frequently present when the liver is not inflamed ; and in regard to the pain, it may. artse from so many diffe. rent causes, that it is also no decisive symptom of this complaint. But it is quite a different case when these symptoms, the pain in the right hypochondrium error. and the jaundice supervene in the course Wounds of the head have also been of chronic disease, (cancer and other or- enumerated by authors, as giving rise to ganic diseases of the liver excepted,) for abscesses of the liver. Without entering we. never saw the icterus in this case into a detail of the reasons which have without there being at the same time an induced us to doubt this circumstance, inflammatory affection of the liver. None we will only state that-one of the explaof the patients felt the pain in the right nations for a long time put forth in supshoulder, and we even doubt whether this port of it, appears to us entirely devoid symptom mentioned by authors realty be- of foundation. It has been supposed inlongs to those marking hepatitis. Pro-’ deed that in wounds of the head there bably in the cases where it has been ob- has been a stagnation of blood in the right served there was, besides the affection of cavities of the heart, thence engorgement, the liver, some disease of the lung, or of and finally inflammation of the liver. But the pleura of the right side, to which the in the diseases of the heart, where this pain in the shoulder might be referred. engorgement is much more certain and Authors have endeavoured, as in most more considerable than in any other affecother diseases, to discover the causes of tion, the abscesses of the liver are not this disease, but with the usual want of more common than under other circumsuccess. Warm climates have been men- stances ; and to speak of the facts which tioned as one of the most active causes of have only come within our own observainflammation of the liver ; but this has tion, we should say that of forty-five perbeen denied by physicians of great talent, sons who died of disease of the heart, we as for instance, by Peter Frank, who have found an abscess of the liver in no practised himself in a warm country. It single case, so that the mechanical conhas also been recently said, that when gestion does not seem to be the cause of hepatitis has not been occasioned by ex- inflammation of this viscus more than ternal violence, its cause may be con- that of any other part. stantly traced to an inflammation of the In reference to the pathological anamucous membrane of the duodenum. We tomy, the cases present some interest, do not mean to deny that these two inasmuch as shew that the abscesses lesions may not exist at the same time, of the liverthey contain pus of frequently but the result of our observations has and that they may be engood quality, proved to us satisfactorily that this is far which is most commonly the case, from being constantly the case, since in cysted, or not, according to circumstances. Softenthe four cases where the mucous memof the liver has been already noted by brane in question was examined with ing several observers of nature, and among care it was found perfectly healthy, if others by M. Lallemand in a case of acute we except, in one case, a slight degree inflammation of this organ. But in respect of ramolissement, without any change of to the softening, we must here state that colonr. But perhaps doubt will be raised the consistence of the organs in the naon the accuracy of our observations, and tural state is not always the same, for it will be said that it is at least extraortha·. of the muscles ; and that in dinary, that having found the mucous several diseases where the heart is exmembrane of the stomach and the jejtxSOfl, one could not suppose that num inflamed, without that portion of tremety it had been previously inflamed. This is the gut placed between the two being with the womb which expands affected. To this we reply, that when the same
instance,
the
mucous
membrane of the stomach is
inflamed, the inflammation generally stops
a certain distance from the pylorus, Troisième lettre sur and that when the inflammation at. 351.
at
l’Encephale,
p.
786
and becomes softened during pregnancy, ABERNETHY, declare myself incompetent, by a process different from that of inflam- but continue in office. mation ; and if this be true of the musBy my exertions, great improvements cles, heart, and uterus, may it not be so have been made in the art of surgery; with the liver, the firmness, colour, and I have shown, as you know, my superior size of which are subject to such constant method of operating to my ignorant and great variation ? But a very remark- colleagues at the Middlesex, more than able fact in abscesses of the liver is, that once ; but it is all lost upon them, and to no cicatrices are to be met with in the say the truth, I am determined to cut parenchyma of this organ. We have never all connexion with them if they do I fear they are incorrigible seen them ourselves, though it is proper not mend. to mention that M. Merat in an interest- miscreants, and I see no alteruative, but ing paper on hepatitis in the Dictionnaire that of putting them upon the half pay des Sciences Medicales, says that these list, like poor Sir Ludtbrd and brother productions have a stetuated form, and Ben, or to give them a seat at Lincoln’s may be regarded as cicatrices. But it is Inn, by the side of brothers Lynn, Norris, evident that before this be admitted, the and Forster. You know I always was a cicatrices ought to have been seen in all good-natured fool, and I still like to be their stages. charitable, though I am sorry to say these cutters at the Middlesex have al.
Lastly. Although four of the five per- most cut me out of all practice; such is sons were jaundiced, the biliary ducts had the consequence of associating with bad not ceased to transmit the bile into the company. Why, even GUTHRIE told me small intestine, even in a case where a the other day, he wondered how I could calculus of considerable size in the cystic stand it, and BRODIE and BENJAMIN were duct, pressed on that belonging to the both at me to intercede with you in their liver. It is not the first time we have favour ; poor fellows, it was a moving had the opportunity of observing jaundice sight to see their long faces; they swore take place without any mechanical ob- by Jupiter that they must give up cabstacle to the course of the bile ; in fact, keeping if you continue to pelt at them. in no case within our own immediate We have had no operation at our place observation have we been able to trace for the last five weeks, and God only knows when I shall ever have another the jaundice to this cause. opportunity of showing our lithotomist how to avoid the evils of an irregular distribution of arteries. I have a mind to go into the Borough twice a week, or, by my troth,I shall forget how to handle JOSEPHUS BURNS, ESQ. a chirargical instrument. It is of no use TO THE to write to you about the bustle of lecEDITOR IN THE COUNTRY. setting forth their blandishturers all ments, and declaring that they mean to treat
the "
subjects fully."
Heaven
You said last week you would write knows they have been very emptily
letters on the state of medical treated too long. Now as you may science in the country, as Mr. Cobbett depend on my services, I advise you does on the state of the turnips for the to remain awhile, where, Register; but you have failed to do so. You Nor rural sights alone, but rural said I had " ratted," because in the preface sounds exhilarate the spirits;" to my forthcoming work on Hospital Discipline and operations for hernia, (which to acquire fresh vigour for the ensuing by the bye you had no right to publish without my consent,) I reprobated the campaign, and above all things to stick to troublesome old fashioned manpresent system of electing and retaining ner your the truth. of-telling ignorant, decrepid, and incompetent men to fill the great offices of hospital physician and surgeon. Why you know, from the Yours, in the cause of Independance, first moment we became acquainted, I JOE BURNS. JOE BURNS. always told you that I disapproved of, such nefarious practices, and moreover, I said that I would give up my situation of hospital surgeon the moment I feltmyme some
self unfitted by age or infirmities you know there are many sorts of infirmities) from doing my duty, and not like Mr.
(and