is entirely subverted, alarm at once the friends of the sufferer, and therefore receive the prompt assistance of our art; but it is the slighter rather than the graver forms of these affections, that claim our sympathy and regard. "That man is but partially instructed in the business of his profession, who looks upon the practice of medicine as an art by which certain physica! agents are brought to act upon the purely physical aberrations of the human frame, and is neglectful of those physico-moral influences that modify, and occasionally disorder, the functions of every vital organ, and the not less remarkable reaction of organic disease upon the mental energy and moral responsibility of the individual. "Of the many causes of uneasiness and family disquiet which tend to embitter the current of domestic life, the most difficult of comprehension to common observers, as well as of correction, are those irregularities of temper and behaviour that result from the derangements of the uterine function. "To yield to all the follies of a morbid appetite-all the requisitions of an habitual self-indulgence-would be a silly and very culpable weakness on the part of those on whom devolves the duty of administering advice and exercising control; but unquestionably much unhappiness in domestic life occasionally originates from the incapacity of those immediately interested to appreciate rightly the physico-moral failings of the suffering female. The irritability of temper, the unreasonable demands, the vitiated appetite, and various troublesome affections very commonly observed during gestation, and occasionally during temporary derangements of the menstrual function, are but rarely viewed by the young and inexperienced as the evidences of disease. Too frequently, on the contrary, they are looked upon as mere indulgences of self-will, and a vicious disposition. The present, however, is not the time for enlarging further upon this interesting subject. The sympathetic disturbances-the functional derangements which occur-will be fully explained when we come to consider the conditions of the organs from which they result."-P. 21. MISCELLANEOUS NOTICES. Pennsylvania Hospital. Dr. Harris and Dr. Edward Peace.-Dr. Thomas Harris, who has long and faithfully and gratuitously afforded his valuable services to this institution, has resigned his office; and Dr. Edward Peace, one of the Surgeons to the Philadelphia Hospital, has been appointed in his place. On the Alterations which Nervous Fibres undergo after Division. By Professor Nasse, of Marburg.'—The results of the lengthened investigations which form the subject of this paper may be briefly stated. In frogs, the natural average thickness of the filaments of the ischiatic nerve is 0.000416 inch; the majority are much smaller: the filaments of the posterior tibial are of about the same size; those of the brachial rather less, viz. 0.0003835. The smallest size observed was 0.00027 or 0.00028, and this was so common that the author is inclined to believe it to be the true diameter of all filaments unaltered by external influences, or at least of one kind of them. The limits of size were 0.00027 and 0.00045. The filaments above the division, after it has healed (and usually about five months after the operation), are almost constantly larger than those below it. The average increase of size is 0.00005 to 0·00006. Müller's Archiv, 1839, Heft v. p. 405; and Brit. and For. Med. Rev., Oct. 1840, p. The average size of the filaments which are paralysed by the division is but little different from that of health; many months after the operation they are found only a little smaller. Their decrease in size is greatest when the animal is generally much emaciated; and is greatest of all when the main artery of the limb is divided at the same time as the nerve. After destroying the connection of a nerve with the spinal cord, its filaments first lose their cylindrical appearance, and from wrinkling acquire a transversely striated appearance, so that they seem to be divided into a number of short pieces. Next, small fat globules form from the breaking up of the medulla, and the filaments become darker and more opaque. Afterwards these fat globules unite into larger drops, and then the walls of the nervous tubuli gradually diminish in their size. The filaments that form in the substance by which the divided extremities are united are rather smaller than the old ones, but in all respects similar to nervous fibres; their average diameter is 0.000374. Similar observations made on rabbits had very nearly the same results; but it was remarked, that as in warm-blooded animals generally the nutrition of all the tissues is more under the influence of the spinal cord than in the cold-blooded, so here the destruction of the divided nerves was much more rapid in rabbits than in frogs; and that although kept without food for five months in the most unfavourable season of the year, the latter gave evidence of much more energy of reparation than the former, which were well fed. Although there was no doubt of new nervous fibres being formed between the extremities of the divided nerves, yet Nasse never found the motion or sensation return in the paralysed limbs, though he sometimes kept the animal for three quarters of a year. He imagines that in the cases in which others have seen such a restoration of power, the divided portions must have been at once placed in exact apposition, so that the filaments could not lose their oily contents; for he clearly determined that the least alteration in the structure of a filament is sufficient to destroy its conducting power. On Cramp of the Tongue. By Dr. Hoffman, of Suhl.'-A person suffering from chronic gout came to me in great distress for my immediate assistance, saying that since the previous day he had had four attacks of such severe cramp of the tongue, that it had been completely rolled inwards towards the frenum. The frenum itself also was extremely painful. During the attack, which lasted from ten to fifteen minutes, he was unable to speak, and could only utter hollow expressions of pain; he felt also considerable constriction of the chest. As he was a full-blooded man, I ordered him to be largely bled, to abstain rigidly, to take nitre with ipecacuan and aconite, and to use as a gargle an emulsion with laudanum. He had only one slight attack after the use of these measures. Case of Menstruatio Recidiva. By Dr. Petersen.-A healthy woman, aged seventy-nine, was seized on the 26th of March with uterine pains; these lasting a few days, were terminated by a hemorrhagic discharge. On the 23d of April she was again affected in the same way, the discharge appearing on the 25th, and continuing four days. Since that period, (twelve months ago) she has regularly menstruated. [There are several cases on record in which the menstrual periods have been regularly continued until seventy, eighty, and ninety years of age. It has been said (Locock) that such cases are not genuine cases of menstruation, but sanguineous discharges arising from uterine disease. But we have Medicinische Zeitung, June 3, 1840; and Brit. and For. Med. Rev., Oct. 1840, p. 2 Bibliothek for Læger, Feb. 1840; and Brit. and For. Med. Rev., Oct. 1840, p. 560, at this moment a lady aged sixty two under our care, who regularly menstruates without any symptom of uterine disease. A most extraordinary case, similar to that of Dr. Petersen's, is given by Velasquez, of Tarentum, of the abbess of Monvicaro, who, at the age of 100, after a severe illness, had a recurrence of the catamenia; and not only this, a new set of teeth and a fresh head of hair appeared!] On the Itch in Adults and in Children. By Dr. Krause, Physician to the Poor in Dantzic.'-The chief object of this paper is to prove the inseparable connection between itch and the acari, which many have supposed to be only occasionally present in that disease. The author gives examples to prove, what we believe has not been before noticed, that the disease may exist in those who wash themselves very often, or who have very tough skins, without any eruption; the itching and the power of communication may be present, but no visible sign of the disorder may exist except the burrows of the insects. The following are his cases: 1. A journeyman tailor had three weeks previously slept with a comrade who had the itch. He came to me with a burrow in his left index finger, from which I drew out an acarus, and I then examined him most carefully, but could discover no trace of any further eruption. 2. A servant-girl, the skin on whose hand and forearm was scarcely inferior to leather in colour and thickness, complained of itching in it. By the side of the finger I discovered seven burrows, out of which I extracted three acari; but there was not a pimple or a vesicle to be found on the whole body. 3. A washerwoman, the mother of a numerous family, remarked that her two youngest children were constantly scratching themselves and had an eruption on their hands. She showed me the children, and they had distinct itch, but she denied having it herself; she allowed, however, that she had sometimes felt an itching in the fingers and arms, but she had never remarked any vesicle. This statement was correct, for on the fingers, which had a kind of varnished appearance from the constant action of the hot water and the soap-ley, I could find no eruption, though there were several burrows, from which I pulled out four acari. On further questioning, it appeared that the woman had long noticed these, but had thought nothing of them because there were no vesicles. There are only two cases, the author says, in which one would not have a right to maintain that itch did not exist, when neither burrows nor acari can be found; namely, quite at the beginning of the disease, and when treatment has been employed for some days and the skin is partially scaling off, so as to destroy the burrows and the acari, but not the brood, which may soon after generate a new eruption. If one has the luck to draw an acarus by daylight, one may easily be sure of his existence by cracking him on the thumb-nail; he makes a noise just like, though weaker than, that which his near neighbour the fair hexaped makes in the same circumstances. But if one brings him close to the flame of a candle, he bursts with a distinct snap. 1 Casper's Wochenschrift, Juli 25, 1840; and Brit. and For. Med. Rev., Oct. 1840, p. 564. ART. I.-CASE OF CANCER OF THE PENIS. REPORTED BY WILLIAM M. M'PHEeters, M. d., resIDENT PHYSICIAN. George Dentler, æt. 36, born in the state of Pennsylvania. Until the year 1837, followed the occupation of boatman on the Susquehanna river. In the fall of that year he discovered, on the side of the glans penis, a small speck about the size of a pin's head, which he describes as being firm to the feel, and filled with matter of a yellow colour. For six or nine months it gave him neither pain nor inconvenience, but continued to grow harder and larger-being now about the size of a bean. About this time he consulted a physician, who applied caustic to the tumour. He denies ever having had either syphilis or gonorrhoea. Subsequent to the application of the caustic, he had phimosis, which prevented his exposing the glans penis, or seeing the tumour, which, however, could be felt beneath the prepuce, but gave no pain. The tumour still continued to increase, until it became about half the size of a hen's egg, remaining hard, and discharging a thick yellow matter from beneath the prepuce, when, from undue exposure, the head of the penis became swollen, and of a dark purple colour. In a few days the tumour broke externally through the prepuce, and out of the opening the urine passed, as well as a small quantity of bloody, purulent matter. The urine soon resumed its natural passage, but the tumour remained hard, and discharged a sanious matter. When injured in any way, or when over heated from violent bodily exercise, it would bleed freely. In this state it remained four or five years, at the end of which time he had a severe attack of pleuritis, which, according to his own account, confined him to his bed for more than two months, during the greater part of which time he thinks he was out of his mind. He is unable to say what was the state of the tumour during this period, or whether any thing was done for it or not; but on a return to his senses, the tumour had almost entirely disappeared, leaving an opening in the prepuce, through which the head of the penis could come out. For eight or nine months it gave him but little trouble, when, without any assignable cause, it commenced growing again, sprouting from the margin of the opening, and gradually filling it up. In January, 1839, he went into the Poor House at Harrisburg, where he remained near a year. At the time of his entry, the tumour involved the whole of the penis, with the exception of about an inch next the pubes,-being hard, and having a rough surface. While in this establishment, he was put on a course of mercury, and the vegetable and lunar caustics were freely applied. On the 5th July, of the same year, it ate into a blood-vessel, which bled so profusely as to produce syncope ;-pretty soon after this, the tumour itself broke, and discharged a large quantity of purulent matter, and became an open sore. From this time it increased rapidly in size, and soon involved the whole of the penis, the testicles, and the adjoining parts. March 26th, 1840, he entered the wards of this hospital. At the time of his entry, the sore extended up the abdomen to within two inches of the umbilicus, covering the whole of the hypogastric and the iliac regions on either side, composed of a number of lobules of irregular size and uneven surface, of a light pink colour, not very sensitive to the touch, and discharging a thick purulent matter, exceedingly offensive. Throughout, his appetite has been good, and he has suffered comparatively little pain, except when some article of food disagreed with him, at which time the sore would swell up and become painful. Since his entrance his treatment has been altogether palliative. During the summer he had an attack of dysentery, from the effects of which he never recovered. Died Nov. 5th, 1840. Appearances thirty-six hours after death.-Throughout the upper lobe of the right lung a slight deposit of tubercular matter was found, together with strong adhesions between the pleura pulmonalis and the pleura costalis. Heart.-Effusion into the pericardium of about 3iss of serum, with albuminous patches over the surface of the heart. Liver slightly affected with cirrhosis, but of natural size. A minute injection of vessels of mucous membrane of the stomach; towards the cardiac orifice patches of congestion of the submucous coat, and softening of mucous membrane. Intestines slightly injected, and valvulæ conniventes enlarged. Mesenteric glands of natural size, and unaltered. Kidneys normal. It was a matter of surprise, in this case, that no appearance whatever of scirrhous deposit was found in any part of the body. It affords a strong example of purely local cancer,-where the disease spends its whole force externally, without in the slightest degree interfering with the more vital functions. For the American Medical Intelligencer. ART. II.-ON NEUROPATHIC EXCITEMENT. BY BENJAMIN R. HOGAN, M. D.' Cambridge, Dallas County, Ala., Dec. 6, 1840. We are told by high authority in medicine, that the term debility has slain its thousands;" and it has almost become an axiom, that increased heat and excited circulation of the blood require debilitating or revulsive remedies. Polyæmia or hyperæmia are supposed, erroneously, to exist in all cases of exalted vital actions. The influence of the sentient and motor systems, the cerebro-spinal axis, and the sympathetic, have been overlooked too frequently in the practice of medicine. To the labours of Marshal Hall, Abercrombie, &c., the profession is indebted for the means of a correct diagnosis of many conditions previously unknown. To your own most excellent treatise upon general therapeutics am I indebted for the principles, mainly, that have enabled me to discriminate the condition of neuropathic excite ment. The symptoms of this condition simulate those of power of the vital forces, or inflammation of vital organs. The vital actions and susceptibilities are greatly exalted, there is great impressibility to sedatives, and great tolerance of stimulants. 'Letter from Benj. R. Hogan, late Assistant Surgeon, U. S. A., Cambridge, Dallas County, Ala., to Professor R. Dunglison, M. D., on Neuropathic Excitement. |