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Title: The Montreal Medical Gazette, Volume 2, Issue 2
Date of first publication: 1845
Author: William Sutherland (1815-1875), Francis Badgley (1807-1863) (Editors)
Date first posted: Feb. 16, 2018
Date last updated: Feb. 16, 2018
Faded Page eBook #20180222

This eBook was produced by: Marcia Brooks, David T. Jones, Howard Ross
& the online Distributed Proofreaders Canada team at http://www.pgdpcanada.net




                                  THE

                       MONTREAL MEDICAL GAZETTE,

                                BEING A

                      MONTHLY JOURNAL OF MEDICINE,

                                  AND

                        THE COLLATERAL SCIENCES.

                 *        *        *        *        *

    Edited by Francis Badgley, M. D., and William Sutherland, M. D.

                 *        *        *        *        *

VOL. II.                 MONTREAL, MAY 1, 1845.                   No. 2.

                 *        *        *        *        *




              DR. F. C. T. ARNOLDI ON CHRONIC RHEUMATISM.


It has often occurred to me in early practice, to observe that the term
Rheumatism was frequently applied to a chronic painful affection of the
extremities, and in several instances, to parts of the body, which
really did not merit that mild term. I say mild term, because the
inveteracy as well as severity of such cases appeared to me to exhibit
characters which totally differed from what I conceived to be strictly
speaking Rheumatism. Rheumatism in its active form is easily known,
especially when of the articular character, so also is it easy to
distinguish it when seated among the muscles; but when these parts,
especially the latter, become affected with chronic severe pains,
accompanied with great nervous irritability of mind, insomnia, and
general derangement of the digestive functions, I then suspect that much
as the case may resemble Chronic Rheumatism, it is more correctly to be
referred to Neuralgia, or a spinal affection. In cases of Chronic
Rheumatism it is not so easy to trace cause and effect; I mean to say,
you cannot so easily perceive the pains to depend on a disordered
condition of the digestive apparatus, whereas the cases I now
particularly refer to, can on almost all occasions be referred to that
cause. In Rheumatism, the barometric state of the atmosphere has almost
invariably great influence in increasing or mitigating the pains,
whereas in the cases I now refer to, such changes produce little or no
influence; consequently, from these remarks it is easy to perceive that
some, if not a great modification, becomes essential in the treatment;
and for the better elucidation of that, I shall give a general sketch of
four well marked cases which came under my care.

1. Mr. C. R. about thirty-five years of age, had been for several years
a martyr to what was styled chronic rheumatism. He had been previously
attended by every physician of note in this city, and by some of the
first standing in London. His case had assumed such a malignant
character as to be deemed hopeless: His friends despaired of his
commercial prospects;—what rendered his case still more distressing,
his legs were affected with phagedœnic ulcerations, and these also took
on the painful as well as angry character. At first my plan of treatment
consisted in the usual remedies, which I thought, would tend to allay
irritation and assist the digestive organs. This continued for months
without effect, and I could not at last forbear concluding, that the
symptoms depended more on a neuralgic condition, reflected from the
spinal chord, than on ordinary chronic rheumatism. There was no
swelling, nor local heat,—but great pain, somewhat intermittent, but
never followed by diaphoresis. I then thought of a different plan of
treatment, based upon a suggestion thrown out by the late Dr. Robertson,
viz. the use of the hydriodate of potass:—I say, based upon his
suggestion, because he merely made mention of that medicine having of
late been recommended in cases of chronic rheumatism, in quarter grain
doses, repeated three or four times a day. On reflection, I considered
this as a medicine likely to take the place of calomel in many
instances, and this seemed to me to be one of a very well marked
character; but, like calomel in one respect, I inferred it could only be
advantageous in this instance, by being administered in sedative
quantities. It is very well known that calomel in very small doses,
frequently repeated, especially if combined with minute doses of opium,
will generally counteract the rheumatic condition; but my experience has
taught me, it will not so act in neuralgic affections. Again, we know,
that calomel in very large doses, acts almost immediately as a sedative,
and thereby may frequently allay the most excruciating rheumatism or
even neuralgic pains; but calomel is a medicine which cannot be safely
repeated in such doses,—not so with the hydriodate of potass; I
therefore concluded, that, if the hydriodate of potass was to be of any
use at all, it must be in sedative doses. I therefore determined on
trying the experiment with Mr. C. R.; but fearing it might act too
powerfully on the nervous system, I cautiously added full doses of
hyoscyamus. The result was truly miraculous. Mr. C. R. had by this time,
been for years, almost uninterruptedly afflicted, and by the third day
his pains ceased. His spirits returned, and daily he regained his
strength in a most conspicuous manner;—in short, he has since become
corpulent, and never from that moment, (June 1841) has he ever
complained of the least menace of his old disorder.

The form in which I prescribed the hydriodate was as follows:—

    Rp.  hydriod. potass, dr. i.
         aquae pur. oz. viii.
         tinct. hyoscy. oz. ½ mix.

Of this, one-third was taken every six hours, and for three days in
succession.

The next case which came under my observation, was that of a poor
Canadian man, named Labelle, to whom I was called by his neighbours, in
consequence of his long continued suffering, and inability to move hand
or foot. He had been for three months unable to convey either hand to
his mouth. At first, I tried the usual remedies, viz. purgatives,
alteratives, sudorifics, opiates, &c., but to no purpose. Then I
prescribed the hydriodate, as in the case of Mr. C. R., and by the third
day his pains left him, his sleep returned, and very shortly after, he
was enabled to dress himself, and go about.

This case is valuable in one respect, as proving the efficacy of the
hydriodate, in as much as it was administered, if possible, under the
most disadvantageous circumstances,—at any rate, under circumstances in
every respect opposite to those in which Mr. C. R. was placed, save the
severity of symptoms. This man lived in a wretched hovel, through the
timbers of which the wind entered with sufficient force to extinguish
the candle. He was miserably poor, and often had not a morsel to eat;
and by way of a climax, this occurred in the depth of winter. From the
time the hydriodate relieved him in February, 1842, to this day, he too
has continued in the enjoyment of good health, and has become somewhat
corpulent. His occupation as a fruit and oyster huckster has exposed him
to all vicissitudes of weather, but with impunity.

The third case, was that of a Scotchman, whose circumstances were
intermediate between those of the two former; but whose case was not
sufficiently severe, though very chronic, to prevent him attending, more
or less regularly to his avocation, which was of itself sufficiently
well calculated to counteract any remedial means, he being overseer and
engineer at a tobacco mill, where, in one apartment he was enveloped in
steam, and in the other, in minute snuff dust. After a dose or two of
purgative medicine, which produced no alleviation of pain, although it
improved the tongue, he took the hydriodate, and experienced the most
happy effects. But he soon again suffered another attack, and of his own
accord applied, as he styled it, "for the medicine which cured the
pains." Again, he derived the same benefit as before; but being
convinced that he would continue to relapse so long as he remained in
the same situation, he profited by his improved health and returned to
Scotland.

The fourth case was Mr. J. G., whose sufferings were almost of as
protracted a nature as those of Mr. C. R., and affected his head, arms,
and legs, especially towards evening, in a most excruciating manner.
Medicines of every description had been tried, and all literally in
vain. Not only his mind, but all the organs of digestion became
exceedingly irritable. Sometimes his evacuations would appear highly
charged with bile, at others, they would be just like mortar. His renal
secretions alternated from scantiness to abundance, and from high to
very pale colour. His appetite was at all times capricious; in short, in
addition to his great sufferings of mind and body, he had superadded
dyspepsia, in a very complete form. I resolved, in the summer of 1843,
to try the hydriodate with him, but feared the irritability of his
stomach; however, after explaining to him how it had acted in other
cases, he consented to give it a fair trial, notwithstanding its
horrible taste. The consequences were truly astonishing; as much so as
they had been upon Mr. C. R. All symptoms of pain and dyspepsia
disappeared. His spirits immediately returned, and very rapidly followed
the restoration of strength and flesh. This favorable change lasted for
nearly a year, since which he has been occasionally menaced with a
return of all his sufferings; but the occasional use of the hydriodate
always keeps them in check. However, Mr. J. G. resides some distance in
the country,—he may consequently suffer more from not knowing under
what circumstances he should have recourse to the medicine, as I do not
think it would meet with justice if given indiscriminately in all cases
of severe pains, from whatever cause arising.

                                                 F. C. T. ARNOLDI, M. D.

April 17, 1845.




                      DR. SPIERS' SPECIAL REPORT.


                                                       MARCH 17TH, 1843.

SIR,—You will pardon the liberty I take in addressing you somewhat at
large on the subject of the Medical treatment of the patients in the
Lunatic Asylum at Toronto.

It seems to me, with all deference, that the method of enquiry into the
Medical treatment must chiefly turn on a comparison of the number of
cures per cent. and of deaths in the Toronto and other Lunatic Asylums.
A mere question of numbers to be made and appreciated by any one, could
not, in my humble opinion, be made a report worth having, when founded
on a few visits to the patients in an Asylum; in all probability most of
whom would be, as at present in the Toronto Asylum, convalescent, and it
is impossible in the convalescent form of Mania to determine what the
symptoms were when it was acute. A Physician might find the remains of
bleeding and blistering in patients perfectly tranquil, and be
altogether at fault were he asked to point out from their present state,
the former requirements of treatment.

I have been round the wards of the Toronto Lunatic Asylum several times,
and I then understood from Dr. Rees, that the antiphlogistic treatment
as it is termed, is carried to its full extent, (exceptions excepted,)
the recent case I saw when admitted and the relief occasioned by copious
bleeding was manifest, immediate and durable; in another case I assisted
with my friend Mr. Beaumont at a post mortem; we found the vessels of
the inner membranes of the brain, and also of its substance highly
injected, and much serum effused; appearances generally considered to be
the result of active inflammation. We found also in the same brain
another and further result of inflammation, viz.: a complete
disorganization of its substance to the extent of about an inch and a
half superficial diameter, and about half an inch in depth.—These
appearances which of course can only be appreciated after death strongly
corroborate the opinion of those physicians, who extol reiterated blood
letting, local or general, above all other remedies in cases of recent
mania.

I have read the particulars handed to me by Dr. Rees of eleven other
post mortems made on those who had been patients in the Asylum, and all
of them, (minute differences excepted,) tallied with the case above
detailed. If we refer to Physicians of great experience and repute we
find that their testimony coincides with the foregoing. Brousais, in his
work 'Sur la Folie,' writes "on a trouvé apres les morts survenues au
milieu des transports de la fureur la substance cerebrale fort injectée
de sang, &c." We deduce, says Dr. Hawkins (see Medical statistics) from
the Statistical report of the deaths in the Lunatic Hospitals of Paris,
during three years the following.

          30 in 100 died from disease of the brain or membrane.
          17 in 100  "    "      "    of the Thoracic organs.
          20 in 100  "    "      "    of the abdominal     "
          10 in 100  "    "      "    of Cachexia          "
           4 in 100  "    "      "    from Surgical diseases.

i. e. 83 per cent. in all probability indicating in some period of the
disorder the antiphlogistic treatment.

Concerning the advantage of bleeding in Mania most Physicians are
agreed. Dr. Sydenham, I believe, was the first who noticed a sort of
mania very uncommon, which proceeded from weakness, and which for the
most part attacked patients who had for a long time suffered under
autumnal intermittents, which if treated, says he, in the _ordinary way_
by bleeding, brought on incurable idiotcy or death; but which was easily
cured by wine and tonics. But in general mania is an inflammatory
disorder, just as much so as pleurisy; you see it often under the form
of Phrenitis or of delirium combined with fever, again it is seen as
Broussais well observes, with an inflammation of the stomach, for which
he was accustomed to bleed till the symptoms changed and to use his own
language with the happiest effects. Again you find a very frequent
metastasis of pneumonia to the brain occasioning madness and also very
many examples of mania proceeding from the closure of varicose and for a
long period bleeding hemorrhoidal vessels all requiring blood letting
just as much so as any disorder whatsoever.

Dr. Rush, Professor of Medicine and Clinique in the University of
Pennsylvania, and Physician to the Lunatic Asylum there, whose work on
Insanity is held in great estimation in Europe, says "Blood letting is
indicated in mania by the occasional cures that have followed the loss
of large quantities of blood. Many mad men, who have attempted to
destroy themselves by cutting their throats have been cured by the
profuse hæmorrhages which have succeeded; of this several instances have
occurred within my knowledge.

The bleeding on the first attack of the madness should be copious,
twenty to forty ounces. The effect, continues Dr. Rush, are wonderful,
it sometimes cures in a few hours. This treatment to be continued if the
symptoms require. The quantity of blood drawn should be greater than in
any other organic disease. From among many cases of the successful issue
of profuse bleeding in madness, I shall select but two; one Mr. —— 68
years of age, from whom I drew nearly two hundred ounces of blood in
less than two months, the other Mr. —— of New York, who lost by order
four hundred and seventy ounces of blood by forty seven bleedings in
less than one year; were it necessary, I could add several other cases
communicated to me by my students." Mr. Haslam has recorded two hundred
cases in the Bethlehem Hospital in all of which he bled. Esquirol
strongly recommends bleeding in mania where severe headache exists.
Broussais, not only recommends bleeding, but affirms that bleeding,
especially by leeches applied during several days have cut short
incipient mania, and restored the patient to reason as quickly as we are
accustomed to see pneumonia or gastro enteritis removed by blood
letting. Dr. Burrows, whose testimony on this subject, before all other
Physicians ought to have weight, seeing that his cures of recent cases
of Insanity amounted to 90.32 per cent. nearly 3 per cent. more of cures
than any other known Asylum can boast of, declares, that he cannot
recollect a single case of mania, of what sort soever, in which the
abstraction of blood either from the head or neighbouring parts has not
been distinctly indicated; and he repeats it without hesitation so long
as excitement continues, even though it be requisite to give tonics at
the same time.

In fine if the cure of disease (where it can be obtained) be the great
end of all treatment, then in any given number of cases, that Physician
who cures the greatest number, must be allowed, ceteris paribus, to
adopt the best method of treatment.

Dr. Burrows, who always bleeds in cases of mania cures 91.32 per cent.
of recent cases and 35.18 per cent. of old cases. Dr. Rees 49 per cent.
of all cases, but 31 of the 161 patients were when admitted into the
Toronto Asylum incurable, deducting these we have 60 per cent. of cures.
Further, many of these cases were not recent, and the chronic form of
mania is by no means so easily removed as the recent. Now if from the
statement of Dr. Burrows we take the mean between the cures recent 91.32
and the old cases 35.18, we have a little over 63 per cent. of cures of
all cases, which number is about 14 per cent. above the cures performed
at the Toronto Asylum.

The Connecticut Asylum when under the able Dr. Todd sent out cured of
recent cases 88.66 per cent., of old cases, 14.14 per cent., which gives
a mean of all cases cured of 51.40 per cent. or 2.40 per cent. only
above the cures of the Toronto Asylum. The returns from the Principal
Asylums in England and France give the mean of cures in France 42. In
England 32 per cent.

The mortality in the Toronto Asylum is 7.5 per cent. of all cases. The
mortality in the Connecticut is 2.1 nearly per cent. of recent cases,
and 7.2 per cent. of chronic cases. The mean 4.4 per cent. less than the
mortality in the Toronto Lunatic Asylum. The mortality in the Paris
Lunatic Asylum is 1 in 13 or 7.7 per cent. of all cases or 0.2 more than
in the Toronto Asylum.

Again, I have stated that recent cases of Insanity are more easily cured
than those which are chronic. Esquirol has published a table of 269
cases cured at the Salpetriere from which it appears that 151 cases were
cured within the first six months; in the next four months sixty-five
cases were cured or a fewer number in proportion of time by fifty-two at
least; after and between one year and two years, twenty-three cures;
shewing, when reduced as near as can be to equal times, a decreasing
progression in cures, in equal increments of time from the first attack
of 50.32.4, nearly answering to the first, second, and third six months.
According to this table, the chances of recovery decrease between the
first and second six months 36 per cent., and between the second and
third six months 88 per cent. (this being premised) according to
Desportes the medium time of cure under the antiphlogistic treatment is
55 days, while according to Broussais under the non-antiphlogistic
treatment, the time of cure extends to 137 days. The antiphlogistic
treatment, being successful under two months; the non-antiphlogistic
treatment being successful in between four and five months. The
difference between these two methods as regards the number of cures,
cannot on account of the very insufficient data be calculated, but the
difference in the duration of the disorder is evident, or as five to two
in four of the antiphlogistic treatment.

Dr. Rees has been accused by some disingenuous person of salivating his
patients in cases of mania. Dr. Rees has assured me that he never
salivated a patient in the Asylum. But what if he had? "Too much,"
writes Dr. Rush, "cannot be said in favor of salivation in general
madness. I once advised Mercury," says Dr. Rush, "in a case of madness
in a female, after parturition, who had conceived an aversion for her
infant, on the day that she felt the Mercury in her mouth, she asked for
her infant and pressed it to her bosom. I have seen," continues Dr.
Rush, "two instances in our Asylum, in which a taciturnity of a years
continuance was removed by it; speech was excited in one of them on the
very day in which the Mercury affected the mouth, and the use of reason
followed a few days after." This is just what might be expected, for
Mercury diminishes arterial action, and equalizes the circulation in the
body; for this reason it is given in pericarditis, in Hydrocephalus,
acute inflammation of the larynx, trachœa, liver, &c.

In conclusion, I cannot help expressing a hope that this persecution may
redound to the great benefit of Dr. Rees, who has by his exertions, and
his medical and moral treatment, raised the Toronto Lunatic Asylum, with
all its disadvantages, to nearly a level, with all the most favored of
similar institutions.

                        I have the honor to be,
                                    Sir,
                          Your very obedient servant,
               (Signed)        ROBERT SPIERS, B. M. L. M.
             Cantab, member of the Royal College of Physicians,
                                        London.

To the Honorable Vice Chancellor, Chief Commissioner of the Toronto
       Lunatic Asylum.

                 *        *        *        *        *




                               APPENDIX.


_To the Report of the Provincial Temporary Lunatic Asylum, at Toronto,
1st September, 1844, by Dr. Rees._

As connected with the considerations which appear at the latter part of
this Report, I subjoin the substance contained in Jacobi's recent and
highly approved work "On the construction and management of Hospitals
for the Insane," also the views, on the same subject, of other writers
of eminence.

After alluding to the preliminary arrangements necessary in such
institutions, Dr. Jacobi observes "That as the second grand feature in
the character of the establishment, we must specify that energy in the
application of medical means for the restoration of the patients, which
seizes and applies all those auxiliaries which have an influence on the
various kinds of mental derangement, according as they are indicated by
the results of scientific experience to be applicable to each individual
case; no proof need be adduced to shew how indispensable it is that
these medical operations should be characterized by the utmost
indulgence of purpose, and that they should bear testimony to the same
spirit pervading and embracing the whole. For as we have already
remarked at the commencement of this work, the entire arrangements of
the establishment in all its separate parts should bear the stamp of the
idea from which it sprang, so that the medical spirit which suggested
its grand outline should be plainly recognized in it. So, also, there
can be no doubt that the same concentrated spirit should likewise be
manifested in the vigorous application of the particular means which it
has provided to every case that comes under its care."

The activity and energy displayed in the establishment, as we have now
depicted it, and which stands in the most immediate relations with the
treatment of the patients, is also clearly connected with that
department which relates to the domestic care, and that of the remaining
members of the family. To the repairs and replacing the furniture of the
establishment, the procuring and distributing of all articles of
consumption, the management of the receipts and expenditure, the keeping
of the books and other offices, as every operation in this department,
also must concur with the rest in promoting the ultimate object of the
establishment; and as the most perfect unity of purpose and unimpeded
activity must characterize all the exertions made to this end, so, it is
here again evident, that the supreme direction and control of all the
officers and servants, without exception, employed in this department,
must likewise be concentrated in the directing physician. That this
position is the only just one, and the most likely to advance the
interests of the establishment, will, I think, be fully acknowledged
from what I have said above in reference to the character of such an
institution. It is also very easy to perceive, and experience has
invariably attested the fact, that in all those establishments where the
opposite relations subsist, and the medical influence is placed on an
equality with the domestic stewardship or subordinate to it, there is
always an invariable want of harmony and singleness of purpose, so that
the highest interests of the institution have not been realized to the
extent that would be possible; for so soon as the farming and household
economy cease to be a simple instrument towards the cure of the
patients, so soon will the character of the institution sink into that
of a mere nursery establishment in which the economical principle
predominates, and the medical influence is subject to it; and though
there be many gradations from a tolerable degree of medical independence
and efficacy, yet the system itself leads necessarily to a state of
subordination and restriction, in which the physicians are utterly
deprived of all freedom in their exertions, and the steward will issue
from his account-desk, his peremptory mandates as to everything that
shall be done or left undone."

"Let us compare the state of such an establishment with that of one
conducted under the arrangements which I have just advocated. Let us
conceive the situation of a physician and philanthropist, whose whole
soul is wrapped up in the cause he has espoused, in such a state of
subordination. Let us imagine what would be the feelings of a Reil, a
Langerman, of a Willis, a Pinel, or an Esquirol, thus fettered and
clogged in their exertions. Let us read Horne's vindication, and then
take a glimpse into the interior of almost all the other establishments
of Germany as well as foreign, and we shall be immediately struck with
the conviction, that, the realization of that unity in the direction of
these institutions which I have recommended, can alone be in harmony
with their true interests. Hence, it follows, as a necessary
consequence, that one man must be placed at the head of the
establishment,—such an one as it has been indebted to for its origin
and existing rules. A kindred spirit must animate him in order to insure
the constant application of the means which the institution affords, in
strict accordance with the purposes of its foundation. His mind must
pervade the whole establishment; every auxiliary means which the science
of medicine and moral influence affords must be at his command and
disposal; but for these objects he will not only require all the
assistance which the mere arrangements of the establishment may confer,
but also the help of kindred minds, who, deeply impressed like himself,
with the spirit of the idea which is here to be realized, may, as his
organs, constitute with himself, a firmly compact, harmonious whole, and
may strengthen and diversify, and complete his powers and efficacy."

"Thus, is a sphere of exertion, even as relates to the physical
department alone, far too extensive for the energies of a single
physician; he stands in need of the aid and support of a man, who
associated in the closest union with him, and partaking in all his
views, may in common with himself, engage in the treatment of the
patients as his "_alter ego_;" and when sickness or absence withdraws
him from his office, may be confidentially entrusted with the discharge
of his duties."

"There should be at least two resident medical officers, who though not
equal in authority, should be united in the consideration of the plan of
treatment. I do not, however, see that according to what appears from
practice to be the general view of the profession in regard to the use
of pharmaceutic means in cases of insanity, the plan generally adopted,
of having a resident medical officer, and a non-resident physician who
attends twice or thrice a week, is incompatible with the efficient
carrying out of the present views of medical treatment in such cases."

"In addition to such an officer, he must also be supported by another
well informed and skilful medical assistant, who may undertake the more
subordinate, and especially the surgical duties of his profession,
besides rendering all sorts of assistance in the prosecution of his
various plans of observation and research, and particularly in the _post
mortem_ examinations of deceased patients. It is absolutely necessary
that a judicious arrangement of authority and subordination be
established, and that the physician should be superior to all in respect
of every thing that concerns the patients. The greatest importance is
attached to the selection of inspectors and attendants."

"Active and incessant inspection of both patients and attendants is
imperatively required, whilst the moral treatment requires the greatest
judgment and determination in all its relations."

On the external government of Lunatic Asylums, it is observed, that,
"the County Asylums of England are entirely under the government of the
Magistrates in Quarter Sessions, who appoint visitors from their own
body to inspect, from time to time, into the condition of the
establishment, and who meet at stated periods for the direction of these
affairs."

The general character of English magistrates, it is remarked, render
this system of peculiar value, and it is asked "is there any other local
class of persons who can be so depended on for this duty?" This plan of
visitation carries force of sound public opinion into these places, and
their business should be to collect and communicate information, to
advise and report to the government.


        OF THE POWERS AND DUTIES OF THE BOARD OF COMMISSIONERS.

1st. The superior or primary direction of every part of the economy of
the establishment.

2nd. Inspection of the general management of the funds, and examination
of the several amounts of receipts and disbursements.

They are expected to render all accounts of the expenditure quarterly,
according to prescribed forms, or as they see occasion.

The statements of receipts and expenditure must undergo revision by the
Director, previous to their being laid before the Board.

3rd. To make an annual examination of the property of the Institution,
and to report on its general condition and requirements, its finances,
&c.


            DUTIES OF THE DIRECTING MEDICAL SUPERINTENDENT.

The Medical Superintendent or Directing Physician "is the organ of the
Government in the management of the Institution, and is responsible to
it for the right conduct of every department,—in regard to the
management of the patients, the general direction of the concerns of the
Establishment, and of the functionaries to whom the carrying out of the
rules and orders are intrusted. To him, in all affairs of the
Institution, the whole jurisdiction is committed; all orders and
instructions of the Government are addressed, and the amounts and
reports of the various Officers rendered. All the Officers of the
Establishment, Medical, Clerical, and Economical, are under his control,
and they are in no respect which concern the Institution, to contravene
his instructions."

The Assistants of lower rank in the Establishment, of whatever class,
are of course, still more decidedly subject to the authority of the
Director; and all of them, from the upper male and female Attendants
downwards, are appointed and discharged by him.

He is limited as to the rate of wages, but can promote the most
deserving to places which yield the highest rate of remuneration. He is
required to report each year respecting those who are unfit for the
service. The weightiest duties of the Director are those which regard
his own numerous cares in the management of the patients. The
administration of all measures which can contribute to their cure marks
the limit to his medical duties.

The studies of the Director are principally directed to the treatment of
the insane.

He is to take care that the written document, which is given in with
each patient, relative to the symptoms of the disease, and the mode of
treatment which has been adopted be entered along with the result of
every subsequent consultation in the patient's case. As complete a
history as possible must be obtained of each case admitted within the
Hospital.

The Director is expected to furnish every patient, who is discharged
cured, with full instructions as to his future medical treatment.

The Director has to determine the period of the discharge of patients,
whether with reference to the stage of convalescence in which it may be
safe for them to leave the Institution, or as regards the probability of
benefit to be derived by those who are not recovered by any longer
detention; and although two years' continuance of disease may be
considered as a general indication of permanency, the Directing
Physician believes that the hope of recovery should by no means be
confined to that period; there are therefore, no absolute rules laid
down in reference to this matter.

The particular medical, moral, and dietetic management of the patients
is also the exclusive business of the Director of the Establishment.

                 *        *        *        *        *


                 INTERESTING CASE OF CONGENITAL IDIOCY.

[DR. CONOLLY, in the last No. of the British and Foreign Medical Review,
gives an interesting account of the Lunatic Asylums of Paris. Perhaps no
part of it is more valuable than that which relates to the department of
the Bicêtre Hospital, appropriated to epileptic and idiotic patients,
and to the wonderful improvement in one of these patients. This portion
of his account is given below.]

                 *        *        *        *        *

I was accompanied round this Asylum by M. Battelle, and by M. Mallon,
the Director, and had afterwards an opportunity of hearing from himself,
the exposition of the views of one of its able Physicians, M. Voisin,
whose singular zeal in the cause of the idiotic class of patients has
caused difficulties to be overcome, which appeared at first to be
insurmountable. The first part of the Bicêtre to which I was conducted,
was a school exclusively established for the improvement of these cases
and of the epileptic, and nothing more extraordinary can well be
imagined. No fewer than forty of these patients were assembled in a
moderate sized school room, receiving various lessons and performing
various evolutions under the direction of a very able school-master, M.
Seguin, himself a pupil of the celebrated Itard, and endowed with that
enthusiasm respecting his occupation before which difficulties vanish.
His pupils had been all taught to sing to music; and the little band of
violins and other instruments, by which they were accompanied, was
formed of the old almsmen of the Hospital. But all the _idiotic_ part of
this remarkable class also sung without any musical accompaniment, and
kept excellent time and tune. They sang several compositions, and among
others a very pretty song, written for them by M. Battelle, and sung by
them on entering the classroom. Both the epileptic and idiotic were
taught to write, and their copybooks would have done credit to any
writing school for young persons. Numerous exercises were gone through,
of a kind of military character, with perfect correctness and precision.
The youngest of the class was a little idiot boy of five years old, and
it was interesting to see him following the rest, and imitating their
actions, holding out his right arm, left arm, both arms, marching to the
right and left, at the word of command, and to the sound of a drum,
beaten with all the lively skill of a French drummer, by another idiot,
who was gratified by wearing a demi-military uniform. All these
exercises were gone through by a collection of beings offering the
smallest degree of intellectual promise, and usually left, in all
Asylums, in total indolence and apathy. Among them was one youth whose
intellectual deficiency was marked in every look, gesture, and feature.

I think a more particular account of this poor boy's progress deserving
of record, as an inducement to the philanthropist to enter on a new
field of instruction, presenting many difficulties, but yet not
unproductive of results.

In the school for idiots and epileptics, at the Bicêtre, a careful
register is kept of the psychological condition of each pupil, according
to a printed form, for the examination of their instinctive, moral,
intellectual, and perceptive state. I was obligingly furnished with a
copy of the register relative to the subject of my immediate
observations, _Charles Emile_, and also with a copy of the _résumé_, or
summary of his case, made by M. Voisin himself.

The age of Charles Emile is fifteen; he was admitted to the school in
June, 1843. He is described as being of a nervous and sanguine
temperament, and in an almost complete state of idiocy; the faculties
which remain being in a state of extraordinary activity, and rendering
him dangerous to himself and to others; but still idiot in his
inclinations, sentiments, perceptions, faculties of perception and
understanding, and also of his senses, of which some were obtuse, and
others too excitable. He was consequently unfit, to use the words of M.
Voisin, "to harmonize with the world without." As regards his
_inclinations_, he was signalized by a ferocious, indiscriminate,
gluttonous appetite, _un érotisme hideux_, and a blind and terrible
instinct of destruction. He was wholly an animal. He was without
attachment; overturned everything in his way, but without courage or
intent; possessed no tact, intelligence, power of dissimulation, or
sense of property; and was awkward to excess. His _moral sentiments_ are
described _null_, except the love of approbation, and a noisy,
instinctive gaiety, independent of the external world. As to his
_senses_, his eyes were never fixed, and seemed to act without his will;
his taste was depraved; his touch obtuse; his ear recognized sounds, but
was not attracted by any sound in particular; and he scarcely seemed to
be possessed of the sense of smell. Devouring everything, however
disgusting; brutally sensual; passionate—breaking, tearing, and burning
whatever he could lay his hands upon, and if prevented from doing so,
pinching, biting, scratching, and tearing himself, until he was covered
with blood. He had the particularity of being so attracted by the eyes
of his brothers, sisters, and playfellows, as to make the most
persevering efforts to push them out with his fingers. He walked very
imperfectly, and could neither run, leap, nor exert the act of throwing;
sometimes he sprang like a leopard; and his delight was to strike one
sonorous body against another. When any attempt was made to associate
him with the other patients, he would start away with a sharp cry, and
then come back to them hastily. M. Voisin's description concludes with
these expressions:—"All the faculties of perception in this youth are
in a rudimental state; and if I may venture so to express myself, it is
incredibly difficult to draw him out of his individuality, to place him
before exterior objects, and to make him take any notice of them. It
would not be far from the truth to say, that for him all nature is
almost completely veiled."

This description not only exemplifies M. Voisin's careful mode of
observation, but shows that an example of idiocy less favorable to
culture could scarcely have been presented to the instructor. This same
poor idiot boy is now docile in his manners, decent in his habits, and
capable, though not without some visible effort, of directing his vague
senses and wandering attention, so as to have developed his memory, to
have acquired a limited instruction concerning various objects, and to
have become affectionately conscious of the presence of his instructors
and friends. His general appearance is still that of an idiot. His
countenance, his mode of walking, all that he does, declare his very
limited faculties. Nature has placed limits to the exercise of his
powers which no art can remove. But he is redeemed from the constant
dominion of the lowest animal propensities; several of his intellectual
faculties are cultivated, some have even been called into life, and his
better feelings have acquired some objects and some exercise. In such a
case as this we are not so much to regard what is merely accomplished
for the individual. A great principle is established by it in favor of
thousands of defective organizations. After witnessing the general
effects of this school on the most imbecile human beings, and hearing
the particulars of Charles Emile's history, it was really affecting to
see him come forward when called, and to essay to sing a little solo
when requested; his attempt at first not being quite successful, but
amended by his attention being more roused to it. His copy-book was then
shown to me, and his writing was steady, and as good as that of most
youths in his station of life. The schoolmaster, who seemed to take
great pleasure in the improvement of this poor fellow, then showed us
how he had taught Charles to count, by means of marbles and small pieces
of wood, or marks made on a board, arranged in lines, the first
containing an 0, the second 00, the third 000, and so on. Charles was
sometimes out in his first calculations, but then made an effort and
rectified himself. He distinguished one figure from another, naming
their value. Large pieces of strong card, of various shapes, were placed
in succession in his hands; and he named the figure of each, as square,
triangle, &c., and afterwards drew their outlines with chalk on a black
board, and according to the desire of M. Seguin, drew a perpendicular,
or horizontal, or oblique line; so effectually attending to what he was
doing, that if any line was drawn incorrectly he rubbed it out and began
anew. He also wrote several words on the board, and the name of the
Director of the Bicêtre, without the name being spoken to him.

This case was altogether the most interesting of those which I saw; but
there was one poor idiot standing a great part of the time in a corner,
to all appearance the very despair of art: even this poor creature,
however, upon being noticed and brought to the table, proved capable of
distinguishing the letters of the alphabet. Most of the others had
received as much instruction as has been described, and could count,
draw lines and figures, write, perform various exercises, and point to
different parts of the body, as the head, the eyes, the arms, the feet,
&c., when named to them. In all these cases, and pre-eminently in that
of Charles Emile, the crowning glory of the attempt is, that whilst the
senses, the muscular powers, and the intellect, have received some
cultivation, the habits have been improved, the propensities regulated,
and some play has been given to the affections; so that a wild,
ungovernable animal, calculated to excite fear, aversion, or disgust,
has been transformed into the likeness and manners of a man. It is
difficult to avoid falling into the language of enthusiasm on beholding
such an apparent miracle; but the means of its performance are simple,
demanding only that rare perseverance without which nothing good or
great is ever effected; and suitable space, and local arrangements
adapted to the conservation of the health and safety of the pupils; to
the establishment of cleanly habits; to presenting them with objects for
the exercise of their faculties of sense, motion, and intellect; and to
the promotion of good feelings and a cheerful disposition. The idiot who
is capable of playing and amusing himself is already, as M. Seguin
observes, somewhat improved. I can but regret that I had not time to
watch the progress of this interesting school from day to day, and to
trace the growth of knowledge in the different pupils; as of the first
ideas of form and color, in writing and drawing; the development of
articulation and the power of verbal expression; the extension of memory
to calculation; the subsidence of gross propensities, and the springing
forth and flourishing of virtuous emotions in a soil where, if even
under the best circumstances the blossoms and fruits are few, but for
philanthropic culture all would be noxious or utterly barren.




                              STATISTICS.


                 *        *        *        *        *


                         STATISTICS OF CANADA.

According to the Report made by the Select Committee, of the Legislative
Council on the Census returns of Lower Canada, there are of

                                _Males._ _Females._ _Total._
             Deaf and Dumb,          447        278      725
             Blind,                  273        250      523
             Idiots,                 478        472      950
             Lunatics,               156        152      308
                                     ———        ———      ———
               Total afflicted,     1354       1152     2506

                                                                   N. B.

                 *        *        *        *        *

Dr. Bell in his work on Regimen and Longevity, gives the following as
showing the absolute mortality within the last twenty years of the
inhabitants of different countries.

                        Russians,       1 in 27
                        Prussians,      1 in 36 2
                        French,         1 in 39 27
                        Dutch,          1 in 38
                        Belgians,       1 in 43 1
                        English,        1 in 43 7
                        Sicilians,      1 in 32
                        Greeks,         1 in 30
                        Philadelphians, 1 in 42 3
                        New-Yorkers,    1 in 37 83
                        Bostonians,     1 in 45.

                 *        *        *        *        *

According to the census of 1841, there are of Physicians in the United
Kingdom, 1,476; of Surgeons, Apothecaries, Medical Students, Cuppers and
Dentists 18,658. Midwives are included under the head of the Medical
Profession, and amount to 676 in England and 641 in Scotland.

                 *        *        *        *        *

_L'Almanach de Médecine pour 1845_ publie la statistique suivante sur le
personnel médical de Paris:

Le chiffre des docteurs qui y sont établis au 1er janvier 1845 s'élève à
1,430; il était en 1843 de 1,423; en 1841 de 1,360; en 1839 de 1,310; en
1836 de 1,220; en 1833 de 1,090.

Sur ce nombre de 1,430, 1,323 ont été reçus à la Faculté de Paris, 50 à
celle de Montpellier, 31 à celle de Strasbourg, 26 dans les Universités
étrangères et exercent en France en vertu d'ordonnances royales. Dix de
ces docteurs se livrent exclusivement à l'art du dentiste, 14 au
traitement spécial des maladies des yeux, 16 à la médecine homœpathique,
et 4 au magnétisme.

Sur les 1,430 docteurs résidant à Paris, il y a 320 membres de la Légion
d'Honneur, dont 4 commandeurs, 50 officiers et 266 légionnaires.

Paris renferme en outre 168 officiers de santé, 326 pharmaciens et 450
sages-femmes.

                 *        *        *        *        *

The average cost of the inmates in the Temporary Asylum at Toronto,
during the year 1843 was 17s. 2½d. per week; this has been reduced
during the last year, to 14s. per week; we have not seen the statement
of expenses incurred during the last year in our Lunatic _Cage_, but in
that terminating on the 31st Dec. 1843, stating the average number of
inmates at 45, their cost was rather more than 10s. 6d. each per week;
but rent does not form an item in the _expenditure, the Asylum being in_
the _City Gaol_. By a statistical table published in the annals of
Medicine of Ghent, and remarked upon in the Parisian Journal of Medicine
and Surgery of January last, we learn, that within the last 20 years,
the number of persons affected with Insanity in Great Britain, has more
than trebled. Their total number is 12,549, of whom are lunatics 6,808
and idiots 5,741 giving an average of 1 in 1000. In Scotland there are
3,652 lunatics, or about 1 in 700, and in Ireland their number exceeds
8,000.

                 *        *        *        *        *


 _Tables exhibiting the causes of the disease, the trade or occupation,
   the religious denomination, and the place of birth of such of the
        Patients as could be ascertained in the Toronto Asylum._


                                 No. 1.

                                            _Males._ _Females._ _Total._
Chagrin and Disappointment,                     2        2          4
Cerebral Disease,                              17       15         32
Disease of the Digestive Organs,               26       12         38
Irregularities and Exposure,                   25       15         40
Cold, while under the influence of Mercury,     1        0          1
Reverses in Life,                               9        7         16
Disappointment in love,                         1        2          3
Intemperance,                                  29       15         44
Inordinate Mental Exertion,                     1        0          1
Fright,                                         5        4          9
Domestic Affliction,                            4        7         11
Fanaticism,                                     9        7         16
Gambling, &c.,                                  3        1          3
External injury of the head,                    6        1          7
Jealousy,                                       2        1          3
Uterine Disease.                                0        3          3


                                 No. 2.

Church of England,                                                  9
Roman Catholics,                                                   47
Presbyterians,                                                     25
Methodists,                                                        30
Baptists,                                                           4
Menonists,                                                          2
Jews,                                                               1


                                 No. 3.

Natives of England,                                                54
     "    Ireland,                                                108
     "    Scotland,                                                19
Canadians,                                                         18
French Canadians,                                                   4
Germans,                                                            5
Americans,                                                          5


                                 No. 4.

Carpenters,                                                         5
Blacksmiths,                                                        4
Bricklayers and Builders,                                           5
Tinsmiths,                                                          3
Tailors,                                                            4
Shoemakers,                                                         6
Weavers,                                                            1
Tavern-keepers,                                                     1
Pedlars,                                                            3
Dyers,                                                              1
Sawyers,                                                            1
Butchers,                                                           2
Soldiers, (Military Pensioners,)                                    5
Plumbers,                                                           1
Tanners,                                                            2
Mercantile,                                                         9
Printers,                                                           1
Schoolmasters,                                                      2
Labourers,                                                         51
Seamstresses,                                                       3
Servants,                                                           7


                                 No. 5.


_Return of the Districts from whence the several Patients have been sent
                            to the Asylum._

_Districts._                                                    _No._
Home,                                                              56
Gore,                                                              17
Newcastle,                                                         19
Niagara,                                                           11
Midland,                                                           13
Wellington,                                                         7
Johnstown,                                                          7
Brock,                                                              3
Huron,                                                              3
Talbot,                                                             2
Simcoe,                                                            11
Western,                                                            4
London,                                                             4
Eastern,                                                            3
Dalhousie,                                                          2
Bathurst,                                                           5
Victoria,                                                           1
Colborne,                                                           2
City of Toronto,                                                   62
Canada East,                                                        1
Strangers,                                                         13

No information obtained respecting the remainder.




    _General Abstract of Annual Returns, from the commencement (21st
                January, 1841,) to 1st September, 1844._


Key: M. = Males. F. = Females. T. = Total.

--------------------+--------------+--------------+---------------
                    |Number treated|  Discharged  |  Discharged
                    |in the Asylum.|    Cured.    | Relieved, or
                    |              |              |   Removed.
--------------------+--------------+--------------+---------------
FORM OF DISEASE.    |  M.│  F.│  T.|  M.│  F.│  T.|  M.│  F.│  T.
--------------------+----+----+----+----+----+----+----+----+-----
Monomania           |  84│  51│ 135|  36│  15│  51|  18│   3│  21
Mania               |  85│  86│ 171|  37│  23│  60|   8│   8│  16
Dementia or Fatuity |  18│  11│  29|   2│   —│   2|   1│   8│   9
Idiotcy             |   9│   3│  12|   —│   —│   —|   1│   1│   2
--------------------+----+----+----+----+----+----+----+----+-----
Total               | 196│ 151│ 347|  75│  38│ 113|  28│  20│  48
--------------------+----+----+----+----+----+----+----+----+-----
                    | Convalescent.|    Died.     |  Remaining.
--------------------+--------------+--------------+---------------
Monomania           |   —│   1│   1|   3│   1│   4|  18│   7│  25
Mania               |   3│   3│   6|   8│   8│  16|  10│  21│  31
Dementia or Fatuity |   —│   —│   —|   1│   —│   1|   7│   2│   9
Idiotcy             |   —│   —│   —|   —│   —│   —|   3│   1│   4
--------------------+----+----+----+----+----+----+----+----+-----
Total               |   3│   4│   7|  12│   9│  21|  38│  31│  69
--------------------+----+----+----+----+----+----+----+----+-----




_Annual Report of Patients admitted, discharged, died, and remaining in
the Temporary Lunatic Asylum, Toronto, from the 1st of September, 1843,
                    to the 1st of September, 1844._


Key: M. = Males. F. = Females. T. = Total.

--------------------+-------------+-----------+-----------+------------
                    |   Remaining | Admitted. |Discharged |Discharged
                    |  last Year. |           |  Cured.   |Relieved or
                    |             |           |           | Removed.
--------------------+-------------+-----------+-----------+------------
FORM OF DISEASE.    |   M.│ F.│ T.| M.│ F.│ T.| M.│ F.│ T.| M.│ F.│ T.
--------------------+-----+---+---+---+---+---+---+---+---+---+---+----
Monomania           |    8│  7│ 15| 19│  3│ 22|  6│  1│  7|  3│  1│  4
Mania               |   12│ 12│ 24| 16│ 16│ 32| 12│  5│ 17|  3│  1│  4
Dementia or Fatuity |    6│  2│  8|  1│  2│  3|  —│  —│  —|  —│  2│  2
Idiotcy             |    3│  1│  4|  —│  —│  —|  —│  —│  —|  —│  —│  —
--------------------+-----+---+---+---+---+---+---+---+---+---+---+----
Total               |   29│ 22│ 51| 36│ 21│ 57| 18│  6│ 24|  6│  4│ 10
--------------------+-----+---+---+---+---+---+---+---+---+---+---+----
                    |Convalescent.|   Died.   | Remaining.
--------------------+-------------+-----------+------------
Monomania           |    —│  1│  1|  —│  1│  1| 18│  7│ 25
Mania               |    3│  3│  6|  3│  1│  4| 10│ 21│ 31
Dementia or Fatuity |    —│  —│  —|  —│  —│  —|  7│  2│  9
Idiotcy             |    —│  —│  —|  —│  —│  —|  3│  1│  4
--------------------+-----+---+---+---+---+---+---+---+----
Total               |    3│  4│  7|  3│  2│  5| 38│ 31│ 69
--------------------+-----+---+---+---+---+---+---+---+----

One of the most interesting institutions of Berlin, is that for the
instruction of the deaf and dumb, at which the new method is pursued of
teaching them articulation. The success with which it is attended is
certainly very astonishing, and, to an inexperienced observer like
myself, quite satisfactory. The pupils converse with the instructors and
with each other, so as to be intelligible to an ear as little practised
as mine in the German language. The older ones can also read aloud and
with a distinct enunciation, from an octavo volume of reading lessons,
any passage that may be selected. But notwithstanding that by a patient
imitation of the movements of the lips, tongue, larynx, and chest
involved in articulation, this system seems to have achieved an
impossibility; its expediency, as a general system of education for deaf
mutes, is doubted by many practical observers, who say that the great
length of time necessarily devoted by those who possess only ordinary
imitative faculties, to the mere acquirement of an articulation, leaves
not enough for more direct and important mental culture. A gentleman
from New York is now here for the express purpose of investigating the
method and merits of the system, and his report will undoubtedly be of
great value to those interested in the subject. But whether it be
destined to supersede the older plan or not, it must be considered a
very noticeable example of the ingenuity and perseverance of German
teachers. This is, I believe, the largest institution of the sort in
Germany; that at Leipsic, the oldest.

The schools for the instruction of the blind are here, and in the other
cities which I have visited, less extensive than the one in Boston,
which enjoys here a very high reputation. The education of the two blind
mutes is spoken of in the strongest terms of admiration, and regarded as
a much greater achievement than the teaching of the dumb to speak.
Attached to the Deaf and Dumb Institute, is a class of idiots, in the
instruction of whom great pains are taken, and a good deal
accomplished.—_Correspondent of the Boston Medical Journal._

                 *        *        *        *        *




                 THE NEW ANATOMY LAW IN MASSACHUSETTS.


The following Act which is officially styled "An Act concerning the
Study of Medicine," was passed during the last month by our Legislature,
being a modification of the Act passed in 1831 "to legalize the study of
Anatomy in certain cases."

"SECT. 1. The overseers of the poor of any town, and the mayor and
aldermen of any City in the Commonwealth, shall, upon request, give
permission to any regular physician, duly qualified according to law, to
take the dead bodies of such persons as are required to be buried at the
public expense, within their respective towns, or cities, to be by him
used within this Commonwealth for the advancement of anatomical science,
preference being always given to medical schools by law established in
this State, for their use in the instruction of students; and it shall
be the duty of all persons having charge of any poor-house, work-house,
or house of industry, in which any person required to be buried at the
public expense, shall die, immediately to give notice thereof to the
overseers of the poor of the town, or the mayor and aldermen of the city
in which such death shall occur, and the dead body of such person shall
not, except in cases of necessity, be buried, nor shall the same be
_dissected_ or _mutilated_ until such notice shall have been given, and
permission therefor granted, by said overseers or mayor or aldermen.

"SECT. 2. No such body shall in any case be surrendered, if the deceased
person, during his last sickness, of his own accord, requested to be
buried, or if within twenty-four hours after his death, any person
claiming to be of kindred or a friend to the deceased, and satisfying
the proper authority thereof, shall require to have the body buried, or
if such deceased person was a stranger or traveller who suddenly died;
but the dead body shall, in all such cases, be buried, and no body shall
be surrendered until the physician requesting the same shall give to the
board, by whose order the same is to be surrendered, the bond required
by the twelfth section of the twenty-second chapter of the Revised
Statutes.

"SECT. 3. The tenth and eleventh sections of the twenty-second chapter
of the Revised Statutes, are hereby repealed.

"SECT. 4. This Act shall take effect from and after its passage."

The Anatomy Bill passed in the session of our Legislature of 1843 would
be much improved by the adoption of some of the provisions contained in
the above.—_Eds. M. M. G._

                 *        *        *        *        *




                           ALCOHOLIC DRINKS.


The following certificate has been signed by 120 highly respectable
medical men in England. It is thought that it will yet be much more
numerously signed, though it has been found very difficult, thus far, to
draw up a paper which in _style_, _language_ and _phrase_ will suit all
minds.

    "We are of opinion that there is no principle of strength or
    nourishment for the human frame in alcohol, or generally in
    drinks of which it forms a part, such as ardent spirits,
    fermented wines, cider, ale, beer, porter, and others; that any
    trifling portion of nourishment contained in the last three is
    greatly exceeded by that of barley water, porridge, or gruel,
    made from an equal quantity of grain; that alcoholic beverages
    generate ultimate weakness instead of strength; that alcohol
    never entirely assimilates with the corporeal system; that
    intoxicating fluids are in no wise necessary to persons in
    ordinary health, nor are they required for any particular
    constitution: that the daily or habitual use of any portion of
    them (much more what has been generally, but erroneously,
    thought a moderate portion) is prejudicial to health; that the
    excitement or cordial feeling they create is mere stimulation,
    which departs in a short time, and is unproductive of any
    element of strength; and that, contrary to ordinary opinion, the
    health would be greatly promoted by their entire disuse as
    beverages."

We have read over the names and are perfectly acquainted with several of
the individuals whose signatures appear at the foot of this certificate.
But we would strongly suggest to them the propriety of inserting in a
second edition of the above, after the words "porter and others," the
following: nor should people at any time except under the authority of
medical attendants make use of any _medicine_, compounded of _alcohol_,
as _æther_, _laudanum_, or _spirits ammoniæ aromat_. We were informed
some years ago by a most intelligent druggist living in our immediate
neighbourhood, not many miles from St. George's Hospital, Hyde Park
Corner, that his sales of the three above articles had been increased
nearly tenfold, since his residence, (not 2 years) in that locality, a
neighbourhood be it remarked, in which the disciples of total abstinence
were daily augmenting in number in an extraordinary manner.—_Eds. M. M.
G._

                 *        *        *        *        *




                      VACCINATION AND INOCULATION.


[At a meeting of the Royal Medical and Chirurgical Society, in London,
Jan. 28, Dr. George Gregory, Physician to the Smallpox Hospital, gave
some account of the variolous epidemic of 1844, and also made some very
important suggestions in regard to the methods of preventing the
liability to contract the disease. The following is from the Lancet.]

    After noticing the remarkable freedom from smallpox which the
    metropolis enjoyed during the years 1842-3, the author adverted
    to the rise of the present epidemic, which he dates from the
    21st March, 1844, when the weekly deaths by smallpox suddenly
    rose from twenty to thirty, and have continued progressing (with
    some irregularities) from that period to the present.

    The admissions into the Smallpox Hospital, in 1844, amounted to
    647, and exceeded by one the admissions in the great epidemic of
    1781, being, with the exception of 1838 (when the epidemic raged
    throughout the entire year,) the greatest number ever received
    into the Hospital since its foundation in 1746. The character of
    the disease was severe. The deaths amounted to 151, being at the
    rate of twenty-three and a half per cent. In 1781, when the same
    number of patients was admitted, the deaths were 257, being at
    the rate of forty per cent.

    Of the total admitted, 312 were reported to have been
    vaccinated, and have cognizable cicatrices; 22 professed to have
    been vaccinated, but no scars were detected; two alleged, but on
    unsatisfactory grounds, that they had been inoculated for
    smallpox in early life.

    Among the 312 vaccinated, 100 had the disease in the very mild
    form usually called the varioloid; in a certain number no
    mitigation was observed; of the whole number, 24 died, being at
    the rate of nearly eight per cent. On this section of the
    admissions, many of the cases received during the year displayed
    features of individual interest. A variety of them were stated
    in detail.

    A remarkable feature in the history of the past year was the
    increasing desire on the part of the public for re-vaccination.

    Founding his views on the now indisputable fact that smallpox
    spreads as widely _without_ as with accompanying inoculation,
    and on the now equally established fact, that smallpox after
    vaccination proves fatal at the rate of seven per cent., while
    inoculated smallpox is fatal only at the rate of one fifth, or
    one in 500, the author proceeded to argue that it is unwise to
    prevent variolous inoculation _in toto_. Persons verging on
    puberty might, he said, with great prospect of advantage, be
    inoculated _after vaccination in early life_. If, as happened in
    the case of his own son, the inoculation failed to produce
    constitutional symptoms, the permanent security of the party was
    fully established; on the other hand, if febrile symptoms
    followed, the disease would probably be mild; and at all events,
    would be undergone under the watchful eye and care of parents.
    As it is, the disease is often received at a period of life the
    most distressing—as by young women on the eve of marriage, by
    mothers in confinement, or by young men just embarking for
    India.

    The author instanced a variety of other important objects which
    might be gained by a repeal of that part of the "Vaccination
    Extension Act" of 1840, which prohibits qualified medical
    practitioners from inoculating in England and Ireland, and he
    concluded by recommending to the legislature such a measure; and
    to the medical profession (where such permission may be
    granted,) the establishment of a system of infantile
    vaccination, strengthened and made doubly sure by adult
    inoculation.

    The practice of inoculation might usefully be restricted from
    the period of life extending from the age of 10 to 20.

    Dr. Webster thought the Society and the profession were much
    obliged to Dr. Gregory for the excellent paper just read, which
    contained so many important facts and statistical details upon a
    subject of great interest. He did not at present intend to enter
    upon the various points alluded to by the author; indeed, it
    would be difficult to controvert many of the conclusions come to
    by Dr. Gregory, who had such ample opportunities, and was so
    well qualified, to form correct opinions respecting vaccination.
    However, there was one important inference which he (Dr. W.)
    drew from the paper, namely, that the public, notwithstanding
    the doubts of some on the subject, now appeared to have greater
    confidence than previously in the protective influence of the
    cowpox, as shown by the larger number of applications for
    re-vaccination at the Smallpox Hospital, during the past than
    any previous year. This was very satisfactory, and induced him
    to ask the author, whether many cases of smallpox occurring
    after re-vaccination had come under his own notice, as that
    would prove the efficacy of re-vaccination, from rendering the
    individual less susceptible of smallpox than previously. He (Dr.
    W.) was most unwilling to disbelieve in the protective influence
    of vaccination, when properly performed; and, in proof of its
    efficacy, he would mention a strong instance which lately came
    under his immediate observation in a large establishment he
    frequently visits. In March last, one of the criminal lunatics
    confined in Bethlehem Hospital was attacked with symptoms of
    variola, but having been previously vaccinated, the disease
    assumed a mild form. One or two other inmates were then
    affected, and the complaint subsequently extended to the other
    wards. Of the patients attacked, unfortunately one had never
    been vaccinated. In this case the disease assumed a most
    virulent form, and terminated fatally in a few days. This was
    the only death met with; and although five or six other
    instances occurred, despite the strictest surveillance and
    seclusion of the patients, the malady did not spread further,
    which would have been a most serious matter in an institution
    like Bethlehem Hospital, having a population of about 700,
    including the lunatics and the residents of the house and
    occupancies. How the smallpox was first introduced into the
    criminal wing it is difficult to determine; for although every
    inquiry was made, it was impossible to trace its origin. The
    person first attacked had held no communication beyond the walls
    of his own division of the establishment, excepting by a letter
    he received from a distant part of the country; but this could
    not have produced the disease. It is, however, right to mention,
    that smallpox then prevailed at a little distance from the
    Hospital, in South Lambeth, and as westerly winds prevailed much
    at the time, perhaps the infection might have been wafted in
    this way to the prisoner. He would like to ask Dr. Gregory's
    opinion on this subject. Respecting the important proposition of
    the author to resume the old and now illegal practice of
    inoculation, that was a very grave subject, and required most
    mature deliberation. He (Dr. W.) acknowledged, although disposed
    to pay every respect to an act of the legislature, that he did
    not consider parliament to be the best tribunal to settle
    disputed points in medical practice; cases might arise, when
    inoculation might be advisable; of course, only qualified
    persons should be allowed to perform such an operation, whilst
    the greatest care and precautions were always taken to prevent
    the dissemination of so virulent a disease as smallpox sometimes
    appears, even when artificially produced.

    Dr. Gregory, in reference to one of the questions of Dr.
    Webster, remarked that the paper contained the case of a girl
    named Eagle, which in itself was an answer to the query. This
    girl had been vaccinated in infancy, and subsequently
    re-vaccinated with great care; she nevertheless became a patient
    of the Smallpox Hospital. These cases were not uncommon. It
    might be urged against the validity of these cases, that neither
    vaccination nor re-vaccination had been properly performed.
    These objections were easily made and difficult to contradict.
    With respect to the mode of introduction of the smallpox into
    Bethlehem Hospital, as mentioned by Dr. Webster, he thought it
    hardly probable, though it might be possible.

    Mr. Davis (Hampstead) had, in 1798, received orders to inoculate
    every man in his regiment, in whom there was not some
    unequivocal mark of the smallpox. Two of the soldiers informed
    him that they had had the cowpox, having been employed in
    Yorkshire as cow boys, and that therefore it was useless to
    inoculate them. Neither of these men took smallpox, although he
    inoculated them a great number of times. He attributed the
    failure of vaccination either to the careless mode in which it
    was performed, or to the carelessness of parents in failing to
    give the surgeon an opportunity of verifying the success of the
    operation. He related a case in which he had vaccinated an
    infant sucking at the breast of its mother, who was suffering
    from smallpox; the infant did not contract the disease, though
    it continued at the breast; the mother died from the attack. He
    related an instance to show the importance of vaccinating from a
    _proper vesicle_. He had vaccinated several members of a family,
    and re-vaccinated them a few days after. He was subsequently
    requested to vaccinate other children from an arm, the
    appearance of which he did not approve of, and declined to
    operate. The children were subsequently vaccinated from this arm
    by another practitioner, and every one of these suffered
    afterwards from smallpox, whilst those he (Mr. D.) vaccinated
    all escaped.

    Mr. Streeter inquired the experience of Dr. Gregory in reference
    to the occurrence of smallpox during pregnancy. He had seen two
    cases of the kind—one in 1838, and one since; the patients were
    six months advanced in pregnancy, and recovered.

    Dr. Gregory had met with cases of smallpox occurring during
    pregnancy on more than one occasion. The violence of the
    disease, since the prevalence of vaccination, had fallen on the
    parents and adults generally, rather than on the children. He
    did not agree with Dr. Williams as to the identity between
    smallpox and vaccinia, and thought that that gentleman had
    committed two main errors in his pathology. Natural and
    inoculated variola were in no degree different in their power,
    as had been frequently proved in cases of consecutive smallpox
    after the natural or inoculated disease. He believed that there
    was only an approach to identity between smallpox and vaccinia,
    but not more than between measles and scarlet fever. He related
    a case in which an aged couple were vaccinated to preserve them
    from smallpox, although in early life they had been inoculated.
    Perfect vaccine vesicles were produced on their arms. If
    vaccination were thus successful at an advanced age, and
    subsequent to inoculation, he thought it a strong proof of the
    non-identity of smallpox and vaccinia. Many facts, indeed, might
    be adduced in support of this non-identity.

    Dr. Williams alluded to the experiments of Mr. Ceely, as
    conclusive evidence in favor of the identity of the two
    diseases. The cases related by Dr. Gregory did not militate
    against this identity, any more than did the occurrence of
    smallpox after vaccination.

    Dr. A. P. Stewart made reference to a number of cases which had
    occurred in his practice, all tending to prove that vaccination
    was a sufficient preventive to smallpox, when it was properly
    and efficiently performed. When it failed, it had not been
    properly applied. In confirmation of this view, he referred to
    the lately-published report of the Royal Jennerian Institution.
    His experience at the Glasgow Infirmary enabled him to confirm a
    statement of Dr. Cowan, that smallpox in that city was
    perpetuated chiefly by the unvaccinated Highland population. M.
    Chomel had well said, that we "could not expect more from
    vaccination than from smallpox itself," for in many cases
    smallpox, and that of the worst kind, had attacked the same
    person twice or thrice, and terminated fatally.

    Dr. Gregory remarked, that, even if his plan were fully carried
    out, still nearly one half of mankind would be under the
    protection of Jenner's discovery, for one half of the children
    born in Liverpool died before puberty, and 300 out of every 1000
    born in London did not reach adult age. The remaining portion
    only would be subjected to inoculation.

We have transcribed the above article entire as well as the remarks made
on the discussion of the paper. Our reasons for doing so are, because
opinions offered on this subject by Dr. Gregory cannot but be received
as authority, not only from his having the charge of so large an
Institution as the smallpox Hospital of London affording as it does,
such ample scope for observation, but also from his being possessed of
such extensive knowledge of the disease of which he treats—for it is
far from being always the case, that men the best informed in the
pathology and treatment of particular classes of diseases, are those
intrusted with their management.

We entirely agree in opinion with the learned writer of the above paper;
as to the propriety of inoculation after early vaccination, our
confidence in the perfect immunity from smallpox by vaccination only,
having received a shock seven years since in England, from which we have
not recovered. While remarking on this subject we may be permitted to
observe, that in our opinion, the use of the liquified crust, so
universally employed in Canada for vaccination, appears to us to be a
very questionable means of securing the individual from an attack of
smallpox. We have heard of several cases of smallpox in this town
occurring after vaccination performed in this way, and of which more
than one assumed the type of confluent variola, and more than one also
proved fatal.—=Eds. M. M. G.=

                 *        *        *        *        *

                     THE MONTREAL MEDICAL GAZETTE.

                 *        *        *        *        *

   Omnes artes, quæ ad humanitatem pertinent, habent quoddam commune
  vinculum, et quasi cognatione quadam inter se continentur.—_Cicero._

                 *        *        *        *        *

                         MONTREAL, MAY 1, 1845.

                 *        *        *        *        *

OUR readers will doubtless be surprised, when we inform them, that the
present is the last Number of the Montreal Medical Gazette that will
issue under our management.

Many and various surmises will no doubt be entertained by individuals,
as to the real causes which have induced us thus suddenly to relinquish
an undertaking, upon which we entered only some fifteen months since,
and more especially, after having secured for our bantling, a
subscription list, not only adequate to meet all the necessary expenses
attendant on its publication, but promising moreover, for ourselves, a
certain and increasing remuneration for the outlay of capital in the way
of time and trouble; this, with some men, would certainly have acted as
a strong inducement for the continuance of the work; to ourselves,
strange as it may seem, it holds out no such alluring charms.

The circumstances which prompted us to originate a Medical Periodical at
our own _private_ cost, and subject to _all_ the loss which its failure
of success must inevitably have entailed upon us, were these:—1st. A
feeling of deep astonishment, that, in a country over whose surface
upwards of six hundred Medical men were scattered, there was not to be
found any other channel for the interchange of ideas on professional
topics, the communication of anomalous or interesting cases occurring in
practice, or the exposition of original views in reference to disease,
as influenced by peculiarity of climate, than the daily Journals. 2nd.
Our being informed that such a Journal was not _needed_ here, that as
there was nothing new under the sun, so there could arise nothing in
this _wilderness_ of ours, worthy of being submitted to the professional
world's eye, and that a mere unit of these six hundred men would be
found willing to contribute to it, seeing that the greater number of
them were totally _unable_ to do so. 3rd. That it would never pay its
expenses, because the country Practitioners would never be tempted to
become reading men; they would never therefore subscribe to it; and the
consequence would be, that the scheme must involve its projectors in
heavy loss. Feeling convinced that the assertions contained in the two
last heads of our reasons were totally unfounded, and that a libel had
been pronounced upon many men fully as well educated, and as able to
furnish contributions as those who gave utterance to the sentiments,
(provided opportunities were afforded to them,) we resolved alone to run
the risk and put their conjectures to the test. And what has been the
result? That the opinions which we formed on the subject have been fully
confirmed; that country Medical men will read, and moreover, that they
will _pay_ for their reading! _Our_ subscription list has very much
exceeded our most sanguine expectations. In our first Number, we stated,
that in undertaking the duties which we had assumed to ourselves, we
looked not for _profit_, nor did we seek _notoriety_; but that we sought
"that higher recompense resulting from our having been the humble means
of elevating the character of our profession, by the dissemination of
more extended observation and knowledge." This we already feel has
fallen to our share; the _Montreal Medical Gazette_, "_utterly
contemptible_" as it was, has begotten in many men, who, but for it,
would have remained in the same state of hibernation with the majority,
a taste for knowing what is going in the Medical world,—it has had the
effect of proving, that not only can _one_ Medical Journal be supported
in Canada, but that even _two_ may,—it has roused into action the
energies of men with regard to their profession's status in this colony,
which would never otherwise have been dreamt of,—and lastly, it has
called into existence a determination on the part of many men in
different portions of the Province, to place the Medical Profession of
Canada on that footing to which it is so justly entitled, by raising the
standard of qualification in its members, by increasing the facilities
of education, and by insisting on a more liberal, and less exclusive
mode of electing to offices. The _Montreal Medical Gazette_ has effected
all this, and our object in originating it has now been fully attained.
May our successor effect as much! We feel perfectly happy in having
acted as pioneers in the work. Had a Journal been originated in Toronto,
or in Quebec, at any period since ours saw the light, we would willingly
have withdrawn it, (and this we have repeatedly stated,) for it was not
ambition that caused us to undertake the Editorial chair,—it was a
desire to have a Medical Journal in Canada. To the Editor of the
_British American Journal of Medicine_, &c. we offer our best wishes for
success; and however opposed his opinions may have been to ours in some
matters, he shall not have reason to complain of our attempting to
thwart him in firmly establishing a Periodical of Medical Literature in
Montreal.

A parting word to our own friends, our subscribers, and supporters. To
all those who have forwarded their subscriptions for the past year, we
offer our heartfelt thanks, for having enabled us to carry on our
_Gazette_ without the risk of being half yearly called upon by our
Publishers to draw upon our own private resources for work done; to such
as have not yet done so, we would take the liberty of suggesting, that,
as all the demands against us are not yet liquidated, and as they may
have derived some profit or amusement from the labour devoted by us in
catering for them, we trust that they will soon give us substantial
proof of their appreciation of our endeavours, by remitting. For the two
Numbers of the new Series it is not our intention to make any charge.
Those of our subscribers who have forwarded their subscriptions for the
current year, will please inform us of their wishes,—we shall be most
happy to hand the amount over to the Publisher of the British American
Journal, and this, we trust, will be the instruction of most of those to
whom we allude; or we will return them by post, deducting only unpaid
postage of letters. To the Editors of the valuable Journals which we
have been in the habit of receiving in exchange from England, Scotland,
and the United States, we tender our most sincere thanks, for we are
fully sensible how much the advantage has been on our side.—

To all we say,—Valete.

                 *        *        *        *        *

We beg to direct the particular attention of our readers to the valuable
Articles in our present Number by Drs. Rees and Spiers, on the subject
of Lunatic Asylums generally, and of that in Toronto in particular. When
we remember, that provision is not furnished for one-eighth part of that
afflicted portion of the community in this division of the Province, and
the presumption is, that the same ratio obtains in the sister division;
when we think, that another session of the Legislature is past, and that
no individual Member of either House rose in his place to take action on
that part of our noble minded Governor's speech, which recommended the
earnest attention of our country's representatives to the subject; when
we see further, that in other civilized countries, unwearied efforts are
being made for the amelioration of the condition of the most miserable
class of that sympathy claiming family, (idiots) as evinced in Dr.
Conolly's graphic account of the case of Charles Emile, in the Bicêtre
of Paris,—that Bicêtre, be it remembered, where the clanking chain, the
thonged whip, and the fettering clasp were first struck off and
dispensed with by the immortal Pinel; when we think of all these things,
we repeat, what ought to be our feeling of humiliation, as a body, that
petitions without number have not been laid upon the table of the House,
to shew that we have hearts attuned to others' woes. As a parting
legacy, we commend this subject to the Profession, especially to the
General Association about to be formed in this Province.

                 *        *        *        *        *

The first Number of the British American Journal of Medical and Physical
Science, edited by Dr. Hall, was circulated in town on Saturday the 19th
instant. It contains four original Medical communications; an
excellently written Geological article, by the Rev. Mr. Leach, of this
city; a Meteorological Table for portions of this and the last two
years, by Staff-Surgeon Smith, of Kingston; and the residue is made up
of Extracts from other Journals, and Editorial remarks. It is published
in the form of the London Lancet. This, we consider a pity, for on
binding it, it will neither form an octavo nor quarto volume. We may
also be permitted to suggest to the publisher, the use of types of a
more uniform character. It looks too much as if it were made up of odds
and ends.

                 *        *        *        *        *




                         "WHAT IS HOMŒOPATHY?"


Since our last issue, a brochure consisting of thirty-two pages, bearing
this title, and stitched in a gamboge-coloured cover, has reached us.
Thirteen pages are taken up with the absurd attempt at defining what is
Homœopathy, _alias_ Humbug, with which the _world_, or rather the
Cheesemongers of London, were favored, in 1838, by John Epps, M. D.
Allopathist, Antipathist, Phrenologist, and Homœopathist. We could not
refrain from again looking over, with Reviewers' eyes, this tissue of
words strung together like beads, and we did so to refresh our memory on
certain events connected with the reading of passages in the Pamphlet at
the date of its publication. Five pages are occupied with microscopic
observations of Dr. Mayerhoffer on Homœopathic Triturations. These are,
_no doubt_, all correct; but the infinitesimal results of trituration at
which he arrives, are quite beyond the powers of our finite
speculations, as regards their efficiency as remedies. The Homœopathic
practitioner of Montreal introduces a Preface of twelve pages, in which,
while with one hand he deals heavy blows against the prescribers of
Calomel, &c., and indeed, against all the prescribers of medicines for
internal complaints, because, forsooth, they prescribe in the dark; he,
as a matter of course, defends with very strong language, the arguments
on which Hahnemann based his system of invisible agents and
imperceivable results. We regret to be obliged to say, in our capacity
of Reviewers, that we consider this Pamphlet got up purely with a view
_ad captandum vulgus_,—in the vernacular, as a catchpenny.

"A trial _is_ worth a thousand pages of argument."—ROSENSTEIN.

                 *        *        *        *        *




                          MEDICAL MISCELLANY.


Two new metals are reported to have been discovered in Bavaria, by
Professor Rose, of Berlin, for which he proposes the names of Pelopium
and Niobium. Dr. Schreiber states, that he has found Iodine, internally
administered, a preventive against the infection of smallpox; with this
view, he orders a teaspoonful of the following mixture to be taken
morning and evening,—Rp. Hydriodate Potass, gr. viij. Tincture Iodine,
gtt. xvi. Aq. font. oz. i. M. The best method of emptying Leeches after
their removal from a part, according to Dr. Boyce, is, by immersing them
in a little mistura Camphora,—having remained in this for a few minutes
and discharged their contents, they are to be put into clear water.
Professor Ghrenberg has just made some new discoveries of infusoria,
more wonderful, according to Baron Humboldt, than any hitherto announced
by him. Two new systems of medical practice are starting up in
Germany—one is called the Trauban cur, (grape cure) consisting, as the
name indicates, in living chiefly on grapes, of which several pounds are
to be eaten daily. The other goes under the name of Aeropathy,
consisting in alternate perspirations and exposures to currents of cold
air. This is, to our mind, only a modification of Hydropathy; and
although the former is said at this moment to be the more popular in
Germany, as it is in a modified form in every country where total
abstinence does not obtain, yet the term seems to claim from the
profession more consideration, in as much as it is open to more
speculation. There are in Havana, eighty-five Medico-Chirurgians, twenty
Physicians, ninety Surgeons, and fifty-seven Sub-Surgeons, who in urgent
cases, are permitted to render assistance to the wounded or sick, until
a Surgeon or Physician can be brought. There are eighty-eight Barbers,
who are regularly licensed to bleed, cup, leech, draw teeth, and apply
blisters and setons.

                 *        *        *        *        *




               CONSULTATION SUR UN CAS DE MORT VIOLENTE.


Il arrive souvent dans les enquêtes judiciaires que les experts
confondent avec des altérations purement cadavériques des lésions faites
pendant la vie et réciproquement. Nous trouvons dans les _Annales
d'Hygiène et de Médecine légale_, une consultation de MM. Foullioy et
Ollivier (d'Angers), qui fournit un nouvel exemple de cette confusion
déplorable et prouve combien il importe de connaître avec exactitude
tous les phénomènes produits par la putréfaction.

Le nommé Piriou était disparu depuis vingt et un jours, quand son corps
fut rejeté sur le rivage de Penhors, canton de Plogastel (Finistère). Il
resta ensuite exposé à l'air libre pendant trente heures environ. A
cette époque le soleil était vif, et la température notablement élevée.
Des experts furent appelés et constatèrent ce qui suit:

Le cadavre encore couvert de ses vêtements était dans un état de
décomposition putride très-avancée, surtout à la tête, au cou et au
ventre. Les parties molles avaient été rongées, détruites sur divers
points de la surface du corps. Les arcades alvéolaires étaient
dépourvues de dents et laissaient passer dans leur intervalle la langue
qui était brune et d'un volume énorme. Cet organe dépassait les
mâchoires au delà de l'insertion du frein, et par suite de son
renversement en haut, s'appliquait sur l'orifice antérieur des fosses
nasales dont il obstruait le tiers inférieur. Aucune trace de blessures
ni de constriction du cou par un lien n'était apparente. Le cerveau
était putréfié sans signe de congestion sanguine dans son tissu au
moment de la mort; les os du crâne étaient intacts. La membrane muqueuse
de la trachée et des bronches avait une couleur lie de vin. Les poumons
étaient emphysémateux, remplissaient exactement la poitrine. Les cavités
droites du cœur étaient gorgées de sang noir demi-fluide. L'estomac
était vide et la couleur de sa muqueuse lie de vin rouge.

De ces faits, les experts concluaient que Piriou était mort
_probablement strangulé_, appuyant leur opinion, _1^{o} sur la sortie
excessive de la langue_; _2^{o} sur la vacuité complète de l'estomac_,
rien d'ailleurs, suivant eux, n'autorisant à penser qu'ici la mort fût
le résultat de l'asphyxie par immersion.

C'est à l'occasion de ces conclusions et des circonstances qui précèdent
que MM. Foullioy et Ollivier ont reçu l'invitation de donner leur avis.

Une courte discussion sur la signification des faits précités a suffi à
ces médecins pour établir que les conclusions dont il s'agit n'étaient
pas fondées.

Ainsi, par exemple, un phénomène _exclusivement_ cadavérique est devenu
pour les experts un des faits qu'ils invoquent pour admettre la
strangulation: c'est _la saillie excessive de la langue hors de la
bouche_. Mais, selon MM. Foullioy et Ollivier, il est évident que cette
saillie est le résultat constant de la tuméfaction produite par les gaz
chez les individus qui, ayant séjourné un certain temps dans l'eau, ont
été exposés ensuite à l'air libre, et sont dans un état de décomposition
avancé. Or, c'était là le cas dans lequel était le corps de Piriou, et
chez lui la putréfaction avait encore été hâtée par les nombreuses
solutions de continuité des parties molles. Cette circonstance seule
expliquerait donc la saillie de la langue, si l'absence complète des
dents ne venait pas faire comprendre que son expulsion a dû être
d'autant plus facile qu'il y avait moins d'obstacles opposés à sa
sortie.

Qu'on ajoute à cela l'_absence de traces de constriction du cou par un
lien, l'absence d'une mobilité insolite de la tête sur le tronc,
l'absence de congestion sanguine dans le cerveau_, et il y aura lieu de
conclure que la saillie de la langue n'a pas été le résultat de la
strangulation.

En second lieu, les experts, regardant la _vacuité complète de
l'estomac_ comme un fait qui infirme la submersion pendant la vie, ont
émis une opinion qui n'est pas vraie d'une manière absolue. Il n'est pas
douteux que la présence d'une quantité plus ou moins considérable d'eau
dans l'estomac, ne soit, en général, une preuve qui concourt à établir
la réalité d'une asphyxie par submersion, et qu'un expert doive toujours
la prendre en grande considération quand il est appelé à rechercher les
causes de la mort d'un individu dont le corps a été retiré de l'eau;
mais c'est encore ici qu'il faut savoir tenir compte des exceptions
assez nombreuses que l'expérience a constatées. On pourrait, en effet,
citer beaucoup d'exemples de suicides incontestables, dus à l'asphyxie
par submersion, dans lesquels l'ouverture du cadavre n'a fait découvrir
aucune trace appréciable de liquide dans l'estomac. Si l'on remarque, en
outre, que dans l'espèce le corps avait séjourné vingt et un jours dans
l'eau, n'est-il pas possible, ainsi qu'on l'a vu dans quelques
circonstances bien déterminées, que le peu de liquide avalé au moment de
la mort ait pu disparaître par le fait d'une imbibition cadavérique? Et
d'ailleurs, n'est-il pas constaté dans la science que, dans certains
cas, l'individu peut éprouver, au moment de la submersion, une perte de
connaissance qui paralyse alors tous les mouvements de déglutition et de
respiration, de telle sorte que la mort est due à une asphyxie par
suffocation?

Ce qui prouve, du reste, que Piriou a pu succomber à l'asphyxie par
submersion, c'est la quantité abondante de sang noir fluide qui
remplissait exclusivement les cavités droites du cœur, et la couleur
rouge lie de vin de la membrane muqueuse de la trachée et des bronches.
Par tous ces motifs, MM. Foullioy et Ollivier se croient autorisés à
penser: 1^{o} que rien, dans l'état du cadavre de Piriou, n'indique
qu'il était mort au moment de la submersion; 2^{o} qu'il n'existe aucune
preuve que la mort ait été le résultat de la strangulation; 3^{o} que
les circonstances dans lesquelles le corps a été retrouvé, et les
observations faites sur le cadavre au moment de l'autopsie, concourent
plutôt à établir que la mort a été le résultat de l'asphyxie par
submersion.—_Journal de Méd. et Chir., Février, 1845._

                 *        *        *        *        *




                         ACADEMIE DES SCIENCES.


—M. Nathalis Guillot a adressé une note sur le charbon qui se produit
dans les poumons de l'homme, pendant l'âge mûr et la vieillesse. En
voici les conclusions:

"Il se produit et s'accumule continuellement dans les organes
respiratoires de l'espèce humaine pendant la durée de l'âge mûr, et
principalement dans la vieillesse, du charbon en nature dans un état
excessif de division. Ce fait est général sur tous les hommes quelle
qu'ait été leur profession.

"Ce charbon, déposé dans l'épaisseur même des tissus, ne provient pas de
l'extérieur.

"Partout où cette matière existe en quantité suffisante pour former des
amas de 1 millimètre de côté au moins, les canaux aériens, les conduits
sanguins artériels et veineux sont oblitérés en vertu de sa présence, et
les tissus pulmonaires sont alors transformés en une substance colorée
en noir qui peut occuper jusque plus de la moitié des organes.

"La respiration ne s'opère plus dans ces parties qui servent de gangue
au charbon; les phénomènes de la circulation ne s'y produisent plus, et
dans l'état pathologique les phénomènes inflammatoires ne s'y
développent point.

"L'accumulation successive de ce charbon au delà d'un certain terme
cause la mort des vieillards. L'excès de ce charbon produit la mort en
tendant le poumon imperméable.

"La présence constante de ce produit chez tous les vieillards, rend
souvent fatale la terminaison des inflammations et des congestions
sanguines de l'organe respiratoire. L'oblitération par des molécules
charbonneuses des canaux aériens et sanguins, explique la fréquence de
l'asphyxie rapide dans les maladies de poitrine pendant la dernière
époque de la vie.

"Ces molécules de charbon paraissent avoir une grande influence sur les
phénomènes qui se succèdent dans l'épaisseur et autour des masses
tuberculeuses. Lorsque des tubercules se produisent dans les poumons et
que le charbon se dépose abondamment autour d'eux, ils ne subissent
point les changements successifs propres à la phthisie, lorsque cette
maladie suit régulièrement son cours.

"Ces tubercles deviennent calcaires, sont privés de graisse, et ne
s'accroissent point. Aucun vaisseau de formation nouvelle ne se
développe autour d'eux, ou bien lorsque ces vaisseaux ont déjà pris de
l'accroissement, avant le dépôt des molécules de charbon, ils
s'oblitèrent par suite de ce dépôt, et les progrès de la phthisie
s'arrêtent.

"La production du charbon dans les poumons humains, indépendante de la
profession et ne résultant que de l'âge et très probablement de la
nourriture des individus, est un fait qui doit être étudié sous le point
de vue physiologique, et qui mérite également d'être considéré au point
de vue de la pathologie, puisque s'il peut en résulter l'aggravation des
affections les plus communes chez les vieillards dont les poumons ne
peuvent plus fonctionner complètement, il paraît aussi quel l'apparition
de cette matière dans les tissus pulmonaires en enveloppant les
tubercules, en les isolant du reste de l'organe, arrête complètement la
marche de la phthisie tuberculeuse."

Dans un travail annexé à cette note, l'auteur rend compte des analyses
exactes qu'il a faites, et qui prouvent en effet la réalité de la
présence du charbon.

                 *        *        *        *        *

—M. Amussat a présenté un second Mémoire sur les blessures des
vaisseaux sanguins, qui se termine par les conclusions suivantes:

"1^{o} Lorsque les deux artères carotides sont coupées en même temps
dans une grande plaie traversale du cou, la mort n'est pas instantanée
comme on le pense généralement; l'hémorrhagie dure plusieurs minutes,
pendant lesquelles l'animal conserve toutes ses facultés.

"2^{o} Les artères carotides ne restent pas béantes après leur division
ainsi qu'on pourrait le croire; et malgré le volume de ces vaisseaux, il
se forme des caillots obturateurs comme après la division d'une seule
carotide.

"En examinant les planches qui représentent des artères de chiens, et
surtout des artères carotides de bœufs sacrifiés d'après la méthode
juive, on voit que l'organisation du caillot est la même que celle
indiquée dans mon premier Mémoire.

"3^{o} La section simultanée ou à court intervalle des nerfs de la
huitième paire et des deux artères carotides, faite au milieu du cou
n'exerce aucune influence immédiate sur la coloration du jet du sang, ni
sur la formation des caillots spontanés, ou bouchons obturateurs des
artères carotides coupées complètement en travers.

"4^{o} Le caillot spontané formé aux extrémités des artères divisées se
composé de deux caillots, l'un extérieur, déjà décrit dans mon premier
Mémoire; l'autre intérieur, qui n'est autre chose qu'un coagulum
organisé absolument comme celui qui se forme après tous les les moyens
artificiels d'obturation, compression, cautérisation, ligature ou
torsion.

"5^{o} La rétraction des membranes interne et moyenne, qui est le
produit des trois propriétés artérielles si bien décrites par M.
Flourens, permet d'expliquer la formation du caillot et la difficulté de
le retrouver au milieu des tissus dans lesquels il a été entraîné.

"6^{o} Le caillot spontané obturateur est souvent fort difficile à
reconnaître. Pour le retrouver, il faut se rappeler la disposition
anatomique de l'artère divisée, et observer les pulsations à l'extrémité
du vaisseau. En outre, on peut reconnaître, par le toucher, la petite
masse sanguine qui constitue le caillot.

"7^{o} Enfin, je crois avoir suffisamment démontré que c'est bien
toujours par un caillot, ou bouchon obturateur, que les hémorrhagies
s'arrêtent spontanément, soit que l'animal meure ou qu'il résiste à
l'hémorrhagie.

"Ainsi, la doctrine du _caillot spontané_ extérieur et intérieur, comme
obstacle à la sortie du sang des artères complètement divisées, est la
seule véritable: et, contrairement à l'opinion de Jones et de Béchard,
l'artère seule peut suffire à elle-même.

"Sans doute le fait établi dans mon Mémoire n'est qu'une bien petite
addition à la théorie de T. L. Petit, considérée au point de vue
physiologique; mais au point de vue de la chirurgie pratique, il est
d'une grande importance, comme le prouvent toutes les hémorrhagies
graves, et même funestes, qui ont eu lieu, parce qu'on n'a pas pu
trouver l'artère défigurée et masquée par un caillot."

                 *        *        *        *        *




                         CROTON OIL IN DROPSY.


Dr. Fife has narrated in the _Provincial Medical Journal_, several cases
of ascites, originating from or complicated with, organic lesions, in
treating which he derived great benefit from the sustained exhibition of
croton oil, which, he observes, possesses one very decided advantage
over Elaterium, that even when its extreme action is manifested, it is
not followed by the depression inseparable from the effective action of
the latter; but that where the greater _vis inertiæ_ has prevailed,
accompanied by absolute incapacity for exertion, a sensible amelioration
in these respects has followed its continued exhibition.

                 *        *        *        *        *

                     THE MONTREAL MEDICAL GAZETTE,

                         IS PUBLISHED MONTHLY.

                 *        *        *        *        *

               SUBSCRIPTION, FIFTEEN SHILLINGS PER ANNUM.

                 *        *        *        *        *

Correspondents are requested to address the Editors, and in every instance
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                 *        *        *        *        *


                          TRANSCRIBER'S NOTES

           The following printer errors have been corrected:
           p. 275 occured -> occurred
           p. 277 dissappeared -> disappeared
           p. 278 membranee -> membrane
           p. 278 DR. SPIER'S -> DR. SPIERS'
           p. 278 antiplogistic -> antiphlogistic
           p. 279 Broassais -> Broussais
           p. 279 proceding -> proceeding
           p. 280 answerieg -> answering
           p. 280 monts -> months
           p. 280 antiplogistic -> antiphlogistic
           p. 281 prevading -> pervading
           p. 282 prevade -> pervade
           p. 283 phamaceutic -> pharmaceutic
           p. 284 Goverement -> Government
           p. 284 convalesence -> convalescence
           p. 285 Bicêtre -> Bicêtre
           p. 285 sung -> sang
           p. 286 nnderstanding -> understanding
           p. 286 wus -> was
           p. 287 developement -> development
           p. 288 Legisative -> Legislative
           p. 288 statisque -> statistique
           p. 288 excluslvement -> exclusivement
           p. 288 Asylnm -> Asylum
           p. 289 Fanatacism -> Fanaticism
           p. 289 Milatary -> Military
           p. 294 Corrrspondent -> Correspondent
           p. 294 MASSACHUSETS -> MASSACHUSETTS
           p. 295 stiimulation -> stimulation
           p. 295 œther -> æther
           p. 296 accoount -> account
           p. 298 aud -> and
           p. 300 vaccinatiou -> vaccination
           p. 301 occuring -> occurring
           p. 301 hybernation -> hibernation
           p. 302 one-eight -> one-eighth
           p. 303 festering -> fettering
           p. 303 espeeially -> especially
           p. 304 Pelopinm -> Pelopium
           p. 303 small-pox -> smallpox
           p. 304 assistence -> assistance
           p. 306 rempllssait -> remplissait
           p. 307 trendant -> tendant
           p. 307 succèden -> succèdent

Additionally a small number of punctuation errors have been corrected.
Otherwise, the text is as in the original.


[The end of _The Montreal Medical Gazette, Volume 2, Issue 2_ edited by Francis Badgley and William Sutherland]