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ample, the lungs, they begin to act as extraneous bodies, producing irritation in the immediately circumjacent textures. This irritation, it may be presumed, is speedily propagated to the tubercles themselves; and, as their vital endowments are comparatively feeble, and consequently incapable of much resistance, they soon yield to the invasion, the rapidity of their softening being always in direct proportion to the violence of the exciting cause and the density of the morbid growth. Those, on the other hand, who believe that tubercles are organic, maintain that their softening is brought about by the agency of the surrounding tissues, alleging that they are incapable of undergoing such a change by any powers of their own. If this explanation were correct, the process should always begin at the periphery of these bodies, which however, as was before stated, is not the case.
“ The softening takes place much more rapidly in some organs than in others, in which it does either not occur at all, or only after a long period. In the lungs, where the process has hitherto been chiefly studied, it may take place as early as the end of the first month from the time of the deposition, though generally not until much later. Upon this subject, however, it is obviously impossible to lay down any definite rule, as the production of the phenomenon in question must necessarily be influenced by a great variety of causes, such as the extent of the disease, the state of the patient's health, the density of the heterologous deposit, together with numerous other circumstances which will readily suggest themselves to the mind of the reader. Occasionally the softening goes on simultaneously over a large extent of surface, so as to break down one-third, a half, or two-thirds of an organ; but this occurrence is extremely rare, and is confined exclusively to acute cases. In the lungs, the degeneration usually begins at the summit of these organs, and gradually extends towards the base, as is shown by the fact, that if these viscera be examined in this direction, we successively find, at various heights, excavations and tubercles in different stages of softening, -the more solid being almost always lowest in the scale. Before the changes, of which we have now spoken, take place, the morbid deposit appears to create little disturbance in the general economy, and may exist, sometimes to a very considerable extent, without giving rise to symptoms indicative of its presence.”
With this extended extract we shall for the present number close our analytical notices. The section on tubercles running through nearly twenty pages, is replete with valuable information, and although we have questioned the soundness of some of its speculations, we feel it our duty in the strongest terms, to commend it to all our readers.
We observe that the Journals of the United States, generally, have expressed a favourable opinion of Prof. Gross's work. But the American Journal, for August, presents its readers with an extended review, the drift of which, from beginning to end, is disparagement. The means of this disparagement are the selection and array of minute imperfections, and the omission of almost every notice which might be given of rich and ample excellencies. The readers of that review, were they to rely upon its statements, could not fail to regard the work as unworthy of a perusal. The Reviewer admits that its plan is good, but insinuates that its author is behind the times, and writes like one who had made up his work in the dissecting room, in the midst of subjects, with whose history he was unacquainted. Now we affirm as a fact, that the authorities cited by Prof. Gross far outnumber those of Andral; and that they are with adequate fulness brought down to the early part of the year 1839, when the manuscript was completed. We do not, of course, intimate that all the facts in pathological anatomy are given, for these would fill a library"; but we say, that the object of the author-the production of an elementary treatise, on general and special pathological anatomy-has been most ably executed. The assertion, that he has not written like a practical man, is entirely gratuitous. We do not claim for our adthor the opportunities of personal observation, enjoyed by
Baillie, Andral or Louis, but we refer to the work itself, for evidences of a wide and diversified experience; not a little of which has been in hospitals, but much more in private practice, in a city of 40,000 inhabitants, in which, as we believe, post mortem examinations are oftener permitted—indeed proposed by the friends—than in any other city of the same population in the Union. In that place Prof. G. has not only had an extensive practice; but, as we have already stated, has for several years made inspections of the kind to which we are now referring, for nearly all his brethren.
The American Journal professes to be a National Review, and often breathes a patronizing spirit. It regards itself as the official of our ancient Alma Mater—the organ of the American profession—the Messenger of the New World to the Old ! We certainly have no disposition to question these high pretensions—we even feel proud of its fame, and wish it long life and wide dominion. But the sun himself has spots, and the humble inhabitants of our earth can discover and note them as blemishes. They cannot tell what occasions the dark places; nor can we exactly divine the motive which has prompted the great censor of our medical literature, to aim at the destruction, in the first year of its existence, of the first extended and systematic work on a new and difficult branch of the profession, which our country has brought forth. Nevertheless as every effect has its cause, so every act of deliberate injustice has its object, and that which, on this occasion, justice requires us to condemn, will no doubt be revealed in due time.
(To be continued.)
Selections from American and Foreign Journals.
Fatal effects from acetate of lead given in large amount for Phthisis Pulmonalis. By Dr. BICKING, of Mulhouse.
, ALTHOUGH we possess a large number of observations in which the acetate of lead has been given with success, or, at least, without serious accident, for phthisis pulmonalis, there are others in which troublesome results have followed from the prolonged use of this medicine, and, on this point, Dr. Bicking, cites the following case : Ferdinand Raged fifteen years, subject, during his
R- -, younger days, to attacks of scrofula, suffered several times from affections of the chest, and finally became consumptive. Having arrived at an advanced stage of this affection of the lungs, accompanied with hectic fever, sweats, and colliquative diarrhea, without any remedy having power to arrest or alleviate its course, Dr. Bicking commenced with the use of acetate of lead.
I gave, says he, to the patient, a quarter of a grain of acetate of lead reduced to powder, along with sugar of milk, four times a day, during a certain time. Under its influence I obtained a marked amendment in the course of the morbid symptoms; the fever, the sweats, the dejections, and cough diminished. The purulent expectoration likewise diminished without any increase of oppression; this advantageous result induced me to continue the treatment, and, during six weeks, I successively increased the dose of the medicine, so that at the end of this time the patient took two grains of the acetate of lead during the day.
At this period, the patient experienced a marked relief, troubled from time to time with some returns of the same general symptoms from which he had been relieved, and, at each return, I employed, with success, the same means. In twelve weeks every trace of phthisis had disappeared, and the child who returned to school, was no longer subject to medical treatment. He had taken, in the course of the disease, nearly an hundred and thirty grains of acetate of lead, without any poisonous or even hurtful effect.
In the meantime, he could not regain entirely, his health; his strength declined, he became thin and pale, and his pulse frequent ; frequent difficulty of respiration, pains in the chest, and an obstinate cough of irritation. I was apprehensive of an immediate renewal of the consumptive attacks. My fears were realized, but in another manner.
One month after the appetite gradually failed, the hypochondrium became affected with painful spasms; the stools were rare and painful; the skin over the whole body became blueish; the conntenance became puffed up and hot, the hair fell out; soon a convulsive cough supervened, accompanied by great difficulty of respiration, and burning pains in the chest, to which succeeded partial paralysis of the feet. This state remained fourteen days. One evening he experienced a violent access of fever, with heaviness of the head, paralysis of the eyelids, and convulsions in the face and extremities.
All remedies were unavailable; the patient remained insensible, in stupor or delirium; he died the third day after, but no autopsy was made.-C. W. Hufeland's Journ. des Practs. Heilk. 1839.
The publication of this notice should not, however, lead to the belief that the medicinal use of acetate of lead is always followed by fatal effects. We believe that it is necessary to study the therapeutic action of this acetate; we know that large quantities of this salt have been taken, in several cases, and we have seen Dr. Bricheteau treat, with pills of acetate of lead, Mademoiselle C-S-, who was considered to be affected with consumption. This treatment was followed by great success, and the lady is now married, and has several children, and enjoys a good state of health. A. C.
Journ. de Chim. Med.
The above case is one of those rare occurrences in which a remedy, in many cases of great advantage, has been followed by lamentable consequences from its prolonged use. It may be advantageous to enquire to what cause such effects may be owing. In addition to the observations in the note of M. A Chevallier, it may be asked, may not this effect arise from the