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Reviews and Notices of Books, AND ALSO Analyses of Papers in Manuscript SENT FOR PUBLICATION IN THE LANCET.
263 I have frequently seen in epileptic patients. I have also fre- The principal object, however, of Dr. Whittle’s Essay, is, to quently noticed an attack of epilepsy occur during meat-times, or use his own words, shortly afterwards. In the case occurring in the Asylum, a " To point out what appear to be the true indications for eoroner’s inquest was held, and a verdict of accidental suffocableeding, and to enforce them by a faithful detail of the tion" returned. cases," &c.-p. viii. "
__
____
Reviews and Notices of Books,
The Principles of Surgery. By JAMES MILLER. Second edition. 8vo, pp. 802. Edinburgh: Adam & Charles Black. London: Longmans. of in THE author, in this edition, has considerably added to the SENT FOR PUBLICATION IN THE LANCET. work, and the arrangement of the different subjects treated of has been made more complete. The size has been altered De la Folie causée par l’abus des Boissons Alcooliques. Par to the octavo form, and the volume altogether has a very C. N. S. MARCEL, M.D., &c. 4to., pp. 57. Paris. 1847. handsome appearance. It is profusely illustrated with exTHE monograph of Dr. Marcel is not alone worthy of the cellent wood-cuts. Mr. Miller’s " Principles," unlike many attention of those whose practice is chiefly confined to insanity, works of this class, not only gives us the very ample expebut merits that of practitioners generally, since the subject rience of the author, but contains the latest information on all of which it treats too often falls, alas! within the observation surgical points which have been published in this and other If we were inclined to direct attention to any even of those whose experience of cases of pure mental countries. aberration is not very extensive. M. Marcel admits that the particular chapter of this valuable work, it would be that on immediate and primitive effects of an addiction to spirituous the Constitutional Treatment of Surgical Diseases, in which the fluids have been, to a certain extent, studied, but not so fully author treats this most interesting subject with remarkable as the secondary and remote ones, and which he endeavours to ability. The chapter on Chloroform is also valuable; but we are surprised to see no reference to the extensive experience illustrate. of Dr. Snow on this subject. It has been proved by this book, " These are very different from the former, having nothing that the modern Athens is equal to the production of a work are in common with them but identity of origin. They in all the requisites of type and illustration which may fairly separated by a combination of characters which establishes a well-marked line of demarcation between them; in fact, we rival the most carefully " got up" books of London. may say we have a new phase of alcoholic émpoisonneAND ALSO
Analyses
Papers
Manuscript
ment."—p. 9. Or again,
Selection of Papers and Prize
Essays on subjects Connecteel with
Insanity. Read before the Society for Improving the Concc A man gives himself up to excess of drinking; after a dition of the Insane. 8vo. pp. 200. certain time he drinks less, but he becomes a madman. Here, IT would appear, from the contents of this volume, that the as we see, there is no drunkenness, no acute intoxication which directly induces the insanity. But the abuse of Society from which it emanates has been assisted in its alcohol has modified his constitution, and it is this action, pro- benevolent objects by some of the most eminent psychologists found, distant, but persistent, which has induced the mental of the age. Among the contributors are Haslam, Morison, aberration:"—p. 10. and Lockhart Robertson, who have severally written on reThe usual symptoms specially referred to are certain forms straint and coercion, the discrimination between crime and of hallucination, obscure ideas, tendency to suicide; the phy- insanity, and an essay on the improvements made by the sical symptoms, febrile erethism, and agitation. Under proper moderns on the medical treatment of mental diseases. treatment, the prognosis is favourable, but in two cases the author has known general paralysis to follow. The period of treatment is variable from some weeks to many months. For Annual Report of the Progress of Chemistry and the Allied H. KOPP. Taylor the nature of the treatment, and other interesting matter, & Walton. 8vo. we refer our readers to the work of M. Marcel himself, To every person who is in any way connected with chemistry whose treatise we recommend. this work must be essential. It has been most carefully edited by Dr. Hoffman and Mr. De la Rue. The Symptomatic Treatment of Asiatic Cholera. By Ewma WHITTLE, M.D., &c. Small 8vo, pp. 100. London. 1850. The New York Scalpel. No. VIII. For August. A SHORT treatise by one actively engaged in the treatment of the pestilence as it appeared in Liverpool during the last SLASHING, spirited, and humorous. 7%e scalpel is as amusing year. The chief conclusions arrived at by the author may be as a novel: it loses none of its raciness. said to be the following. Cholera algida is in its nature a fever, of the continued congestive type. It has four stages, Twentieth Annual Report qf the Belfast District Lunatic Asylum a stage of invasion, of spasm, of collapse, and of encephalic for the year ending the 31st of March, 1850. but to a less extent than fever. It is an infectious disease, most other epidemic infectious disorders. When the result IRELAND, like England and Scotland, follows in the wake of of infection it generally assumes the most malignant type, improvement as to the treatment of lunatics and management and the security conferred by one attack against another, if of asylums. The official Reports published of several Irish any at all, is inconsiderable. The treatment recommended establishments show this fact satisfactorily, and from the is the following:-in the premonitory diarrhoea, the perses- document whose title heads this article, we are induced quinitrate of iron with tincture of opium, or calomel and to give one or two illustrations, which seem interesting, whilst opium; in the next stage, warmth, sinapisms, and bleeding; they indicate the movements of a well regulated insane instiand circumstances may require the iron and tartar-emetic to tution. During the year embraced in the above Report, 120 be given; in the stage of collapse, the principal reliance patients were admitted into the Belfast Asylum, the majority must generally be on the vismedicatrix naturce, but in some being females-63 females to 57 males; the recoveries re. cases bleeding, in others calomel, astringent enemata, and ported being 24 males to 28 females, the deaths 25 males and of the are useful. In stage encephalic fever, calomel, only 18 females; hence the rate of mortality ranged higher warmth, local bleeding from the head, and counter-irritation, &c. among men, whereas more cures were effected in the other
Sciences,1847-48. ByJUSTUS LIEBIG and
.
264 sex, the average population of the Asylum throughout the year being 267 patients. Respecting suicidal and homicidal cases, the present document makes an important and instructive announcement, well deserving the notice of psychologists - namely, the number of suicidal patients received during the year was 18, of whom four were men, and fourteen women; whilst the admissions of a homicidal character were 12, being nine males and only three females, hence indicating that a greater propensity to suicide prevailed amongst the latter sex, but to homicide amongst the insane male patients, and this conclusion is in accordance with our own experience. The health of the establishment appears to have been generally good throughout the entire year, although two deaths by cholera occurred, and the mortality was larger than the preceding, which, the Report says, might have been expected, seeing the general mortality was far above the usual average, and some of the cases admitted were of persons of so completely exhausted constitutions, that no human means could, in any degree, meliorate their condition. Dr. Stewart, the able resident physician, discusses several other important points, but as our limited space prevents us enlarging upon such topics, we must conclude this brief notice with quoting, in reference to the great question of restraint, the following paragraph, which will speak for itself :" The same principles as hitherto continue to be sedulously acted upon in the general treatment of the patients, and with equally satisfactory results. Every reasonable indulgence is freely afforded to them compatible with their safety and proper
soning à priori, that the exhibition of chloroform could have little or no influence on the conduct of this stage of labour. I grant that when the perinseum is supported, as it is said to be, by pressing against it with the palm of the hand, either with or without a napkin interposed, ruptures of the perinseum may be expected occasionally to occur, because, in fact, little or no resistance is made to the forcible passage of the head; but when the plan of supporting the perinæum, inculcated by the late Professor Davis, is followed, and which consists in receiving the occiput in the palm of the hand, resting the point of the thumb lightly on the edge of the perinæum, so as to judge of its dilatation, and resisting by the pressure of the hand on the occiput, the too forcible protrusion of the head through the outlet at each expulsive effort, is employed, I have no hesitation in affirming that not one case of laceration ought or need to occur in a thousand accouchements. The protrusion of the head is a purely physical action, so also is the rupture of the perinaeum. The party who promised exemption from this accident by the use of anaesthetic agents could not have well considered the phenomena of parturition, or must have trusted that the practitioners who employed anaesthetic agents would afford the necessary assistance; nor is it probable that these agents would either promote or retard the relaxation of the tissues of the perinaeum. The argument that the inhalation of chloroform does not always arrest the action of the muscles of expiration, and the physiological explanation of their action, does not seem to me to bear to any extent on the question at issue. We cannot suppose that the air would be retained in the chest for any great length of time, since, were this the case, suffocation would ensue. The influence of pain being abstracted, the danger of impending suffocation would suffice to cause the glottis to open, and the imprisoned air to escape, discipline, and no restraint, by mechanical means, permitted so as to remove the danger arising from the action of the that can possibly be avoided. One grand principle is ever expiratory muscles. Hence we cannot attribute to ’psychical’ kept in view, and that is, to act towards them and treat them pain that influence that Dr. Barnes has claimed for it in preas if they were perfectly sane-a principle which is of the venting laceration; nor can we admit that the glottis will utmost importance, not only as regards themselves, but also remain closed for a longer period than in the expulsive efforts and especially as regards the attendants, who are earnestly under circumstances." ordinary importuned to hold the same steadily in view in all their intercourse with, and conduct towards, them."
Employment of Chloroform in Parturition, and its Influence in Relaxation of the Perincettm. By DELTA. THE
On Carbonate of Soda as a Remedy and Prophylactic against Cholera. By JAMES MAXWELL, M.D., Surgeon Madras 3rd Cavalry. THE LANCET Office.
LANCET Office.
DR.
On the
DELTA states that he read with considerable interest in THE LANCET the first part of an analysis of twenty-seven cases of accouchement under the influence of ether and chloroform, reported by Dr. Sachs, from which Dr. Barnes draws very strong conclusions against the employment of anaesthetic agents in labour. He adds,-" Now, Dr. Barnes and myself are, I presume, in about an equal position in criticizing the use of chloroform in midwifery ; neither of us have probably ever employed this agent. It is not my intention to take up the entire subject, but simply to comment on one point, on which our opinions differ to a considerable extent. Out of the twenty-seven cases subjected to analysis, we find four in which greater or less laceration of the perinæum occurred. Such a proportion of cases of laceration of the perinæum must strike every one at all acquainted with midwifery as out of all character." Delta then quotes a long passage from Dr. Barnes’ remarks, which will be found at pages 40 and 42 of this volume, commencing with,In four cases there was laceration of the
perinseum,"
&c. " It would seem, from the line of argument pursued by Dr. Barnes, that he refers all these cases of rupture of the perinseum to the influence of anmsthetic agents, casting the whole blame on them, instead of on the miserable practice which could permit such accidents to take place. What should we think of any English obstetrician who would permit laceration of the perinæum in one-seventh of his cases under any circumstances? I should say that any English practitioner who allowed rupture of the perinæum to take place once in five hundred cases deserved reprobation for his unskilfulness, since there is no one stage of labour which we have so completely under our command as that stage where the head is bearing on the perinæum. Of this I can speak positively from extensive experience, and I should say, rea-
MAXWELL, who was lately in
the
performance of his duties
at Hyderabad in the Deccan, where, it may be presumed, he had sufficient experience in the treatment of the fatal disease which is held to have originated on Indian soil, has forwarded to us a communication, from which we extract the following
passages:"The carbonate of soda is a speedy and effectual antidote to the poison of cholera. It is safe and easy of administration in the hands of any one; it allays the burning and pain of stomach and bowels; takes off spasm, and speedily brings about the flow of urine, without which no case of cholera ever I give it at once, whatever the stage of the disease, recovers. in strong and hot infusion of tea, or of other bitter which may be at hand. The dose is about a small teaspoonful, and I repeat it as often as it is necessary till the disease is subdued. In recent cases the above doses alone suffice. In cases that may have been neglected, or where patients may not have applied early, I lose no time in combining the antidote with an effective aperient to make it speedily pass down to the small intestines, to the poison which rests there, and which is the The moment the antidote passes cause of death in cholera. down, the pulse commences, and heat returns to the surface, and then I give a full dose of laudanum with the antidote to procure sound repose, and assist the absorption of the bitter principle and the diffusion of the alkali throughout the
system." In explaining
the action of this remedy, Dr. Maxwell remarks that bile and soda are absent from the system in cholera, and their place is usurped by acid, the result of temporary terrestrial and planetary influence; and he at once concludes that the cure must depend on those principles being restored to the system. He says,-" Soda is invaluable; a few grains in the morning and evening in a cup of tea effectually secures the system from cholera."
__
____
Reviews and Notices of Books,
The Principles of Surgery. By JAMES MILLER. Second edition. 8vo, pp. 802. Edinburgh: Adam & Charles Black. London: Longmans. of in THE author, in this edition, has considerably added to the SENT FOR PUBLICATION IN THE LANCET. work, and the arrangement of the different subjects treated of has been made more complete. The size has been altered De la Folie causée par l’abus des Boissons Alcooliques. Par to the octavo form, and the volume altogether has a very C. N. S. MARCEL, M.D., &c. 4to., pp. 57. Paris. 1847. handsome appearance. It is profusely illustrated with exTHE monograph of Dr. Marcel is not alone worthy of the cellent wood-cuts. Mr. Miller’s " Principles," unlike many attention of those whose practice is chiefly confined to insanity, works of this class, not only gives us the very ample expebut merits that of practitioners generally, since the subject rience of the author, but contains the latest information on all of which it treats too often falls, alas! within the observation surgical points which have been published in this and other If we were inclined to direct attention to any even of those whose experience of cases of pure mental countries. aberration is not very extensive. M. Marcel admits that the particular chapter of this valuable work, it would be that on immediate and primitive effects of an addiction to spirituous the Constitutional Treatment of Surgical Diseases, in which the fluids have been, to a certain extent, studied, but not so fully author treats this most interesting subject with remarkable as the secondary and remote ones, and which he endeavours to ability. The chapter on Chloroform is also valuable; but we are surprised to see no reference to the extensive experience illustrate. of Dr. Snow on this subject. It has been proved by this book, " These are very different from the former, having nothing that the modern Athens is equal to the production of a work are in common with them but identity of origin. They in all the requisites of type and illustration which may fairly separated by a combination of characters which establishes a well-marked line of demarcation between them; in fact, we rival the most carefully " got up" books of London. may say we have a new phase of alcoholic émpoisonneAND ALSO
Analyses
Papers
Manuscript
ment."—p. 9. Or again,
Selection of Papers and Prize
Essays on subjects Connecteel with
Insanity. Read before the Society for Improving the Concc A man gives himself up to excess of drinking; after a dition of the Insane. 8vo. pp. 200. certain time he drinks less, but he becomes a madman. Here, IT would appear, from the contents of this volume, that the as we see, there is no drunkenness, no acute intoxication which directly induces the insanity. But the abuse of Society from which it emanates has been assisted in its alcohol has modified his constitution, and it is this action, pro- benevolent objects by some of the most eminent psychologists found, distant, but persistent, which has induced the mental of the age. Among the contributors are Haslam, Morison, aberration:"—p. 10. and Lockhart Robertson, who have severally written on reThe usual symptoms specially referred to are certain forms straint and coercion, the discrimination between crime and of hallucination, obscure ideas, tendency to suicide; the phy- insanity, and an essay on the improvements made by the sical symptoms, febrile erethism, and agitation. Under proper moderns on the medical treatment of mental diseases. treatment, the prognosis is favourable, but in two cases the author has known general paralysis to follow. The period of treatment is variable from some weeks to many months. For Annual Report of the Progress of Chemistry and the Allied H. KOPP. Taylor the nature of the treatment, and other interesting matter, & Walton. 8vo. we refer our readers to the work of M. Marcel himself, To every person who is in any way connected with chemistry whose treatise we recommend. this work must be essential. It has been most carefully edited by Dr. Hoffman and Mr. De la Rue. The Symptomatic Treatment of Asiatic Cholera. By Ewma WHITTLE, M.D., &c. Small 8vo, pp. 100. London. 1850. The New York Scalpel. No. VIII. For August. A SHORT treatise by one actively engaged in the treatment of the pestilence as it appeared in Liverpool during the last SLASHING, spirited, and humorous. 7%e scalpel is as amusing year. The chief conclusions arrived at by the author may be as a novel: it loses none of its raciness. said to be the following. Cholera algida is in its nature a fever, of the continued congestive type. It has four stages, Twentieth Annual Report qf the Belfast District Lunatic Asylum a stage of invasion, of spasm, of collapse, and of encephalic for the year ending the 31st of March, 1850. but to a less extent than fever. It is an infectious disease, most other epidemic infectious disorders. When the result IRELAND, like England and Scotland, follows in the wake of of infection it generally assumes the most malignant type, improvement as to the treatment of lunatics and management and the security conferred by one attack against another, if of asylums. The official Reports published of several Irish any at all, is inconsiderable. The treatment recommended establishments show this fact satisfactorily, and from the is the following:-in the premonitory diarrhoea, the perses- document whose title heads this article, we are induced quinitrate of iron with tincture of opium, or calomel and to give one or two illustrations, which seem interesting, whilst opium; in the next stage, warmth, sinapisms, and bleeding; they indicate the movements of a well regulated insane instiand circumstances may require the iron and tartar-emetic to tution. During the year embraced in the above Report, 120 be given; in the stage of collapse, the principal reliance patients were admitted into the Belfast Asylum, the majority must generally be on the vismedicatrix naturce, but in some being females-63 females to 57 males; the recoveries re. cases bleeding, in others calomel, astringent enemata, and ported being 24 males to 28 females, the deaths 25 males and of the are useful. In stage encephalic fever, calomel, only 18 females; hence the rate of mortality ranged higher warmth, local bleeding from the head, and counter-irritation, &c. among men, whereas more cures were effected in the other
Sciences,1847-48. ByJUSTUS LIEBIG and
.
264 sex, the average population of the Asylum throughout the year being 267 patients. Respecting suicidal and homicidal cases, the present document makes an important and instructive announcement, well deserving the notice of psychologists - namely, the number of suicidal patients received during the year was 18, of whom four were men, and fourteen women; whilst the admissions of a homicidal character were 12, being nine males and only three females, hence indicating that a greater propensity to suicide prevailed amongst the latter sex, but to homicide amongst the insane male patients, and this conclusion is in accordance with our own experience. The health of the establishment appears to have been generally good throughout the entire year, although two deaths by cholera occurred, and the mortality was larger than the preceding, which, the Report says, might have been expected, seeing the general mortality was far above the usual average, and some of the cases admitted were of persons of so completely exhausted constitutions, that no human means could, in any degree, meliorate their condition. Dr. Stewart, the able resident physician, discusses several other important points, but as our limited space prevents us enlarging upon such topics, we must conclude this brief notice with quoting, in reference to the great question of restraint, the following paragraph, which will speak for itself :" The same principles as hitherto continue to be sedulously acted upon in the general treatment of the patients, and with equally satisfactory results. Every reasonable indulgence is freely afforded to them compatible with their safety and proper
soning à priori, that the exhibition of chloroform could have little or no influence on the conduct of this stage of labour. I grant that when the perinseum is supported, as it is said to be, by pressing against it with the palm of the hand, either with or without a napkin interposed, ruptures of the perinseum may be expected occasionally to occur, because, in fact, little or no resistance is made to the forcible passage of the head; but when the plan of supporting the perinæum, inculcated by the late Professor Davis, is followed, and which consists in receiving the occiput in the palm of the hand, resting the point of the thumb lightly on the edge of the perinæum, so as to judge of its dilatation, and resisting by the pressure of the hand on the occiput, the too forcible protrusion of the head through the outlet at each expulsive effort, is employed, I have no hesitation in affirming that not one case of laceration ought or need to occur in a thousand accouchements. The protrusion of the head is a purely physical action, so also is the rupture of the perinaeum. The party who promised exemption from this accident by the use of anaesthetic agents could not have well considered the phenomena of parturition, or must have trusted that the practitioners who employed anaesthetic agents would afford the necessary assistance; nor is it probable that these agents would either promote or retard the relaxation of the tissues of the perinaeum. The argument that the inhalation of chloroform does not always arrest the action of the muscles of expiration, and the physiological explanation of their action, does not seem to me to bear to any extent on the question at issue. We cannot suppose that the air would be retained in the chest for any great length of time, since, were this the case, suffocation would ensue. The influence of pain being abstracted, the danger of impending suffocation would suffice to cause the glottis to open, and the imprisoned air to escape, discipline, and no restraint, by mechanical means, permitted so as to remove the danger arising from the action of the that can possibly be avoided. One grand principle is ever expiratory muscles. Hence we cannot attribute to ’psychical’ kept in view, and that is, to act towards them and treat them pain that influence that Dr. Barnes has claimed for it in preas if they were perfectly sane-a principle which is of the venting laceration; nor can we admit that the glottis will utmost importance, not only as regards themselves, but also remain closed for a longer period than in the expulsive efforts and especially as regards the attendants, who are earnestly under circumstances." ordinary importuned to hold the same steadily in view in all their intercourse with, and conduct towards, them."
Employment of Chloroform in Parturition, and its Influence in Relaxation of the Perincettm. By DELTA. THE
On Carbonate of Soda as a Remedy and Prophylactic against Cholera. By JAMES MAXWELL, M.D., Surgeon Madras 3rd Cavalry. THE LANCET Office.
LANCET Office.
DR.
On the
DELTA states that he read with considerable interest in THE LANCET the first part of an analysis of twenty-seven cases of accouchement under the influence of ether and chloroform, reported by Dr. Sachs, from which Dr. Barnes draws very strong conclusions against the employment of anaesthetic agents in labour. He adds,-" Now, Dr. Barnes and myself are, I presume, in about an equal position in criticizing the use of chloroform in midwifery ; neither of us have probably ever employed this agent. It is not my intention to take up the entire subject, but simply to comment on one point, on which our opinions differ to a considerable extent. Out of the twenty-seven cases subjected to analysis, we find four in which greater or less laceration of the perinæum occurred. Such a proportion of cases of laceration of the perinæum must strike every one at all acquainted with midwifery as out of all character." Delta then quotes a long passage from Dr. Barnes’ remarks, which will be found at pages 40 and 42 of this volume, commencing with,In four cases there was laceration of the
perinseum,"
&c. " It would seem, from the line of argument pursued by Dr. Barnes, that he refers all these cases of rupture of the perinseum to the influence of anmsthetic agents, casting the whole blame on them, instead of on the miserable practice which could permit such accidents to take place. What should we think of any English obstetrician who would permit laceration of the perinæum in one-seventh of his cases under any circumstances? I should say that any English practitioner who allowed rupture of the perinæum to take place once in five hundred cases deserved reprobation for his unskilfulness, since there is no one stage of labour which we have so completely under our command as that stage where the head is bearing on the perinæum. Of this I can speak positively from extensive experience, and I should say, rea-
MAXWELL, who was lately in
the
performance of his duties
at Hyderabad in the Deccan, where, it may be presumed, he had sufficient experience in the treatment of the fatal disease which is held to have originated on Indian soil, has forwarded to us a communication, from which we extract the following
passages:"The carbonate of soda is a speedy and effectual antidote to the poison of cholera. It is safe and easy of administration in the hands of any one; it allays the burning and pain of stomach and bowels; takes off spasm, and speedily brings about the flow of urine, without which no case of cholera ever I give it at once, whatever the stage of the disease, recovers. in strong and hot infusion of tea, or of other bitter which may be at hand. The dose is about a small teaspoonful, and I repeat it as often as it is necessary till the disease is subdued. In recent cases the above doses alone suffice. In cases that may have been neglected, or where patients may not have applied early, I lose no time in combining the antidote with an effective aperient to make it speedily pass down to the small intestines, to the poison which rests there, and which is the The moment the antidote passes cause of death in cholera. down, the pulse commences, and heat returns to the surface, and then I give a full dose of laudanum with the antidote to procure sound repose, and assist the absorption of the bitter principle and the diffusion of the alkali throughout the
system." In explaining
the action of this remedy, Dr. Maxwell remarks that bile and soda are absent from the system in cholera, and their place is usurped by acid, the result of temporary terrestrial and planetary influence; and he at once concludes that the cure must depend on those principles being restored to the system. He says,-" Soda is invaluable; a few grains in the morning and evening in a cup of tea effectually secures the system from cholera."