"In this table I have referred to the same species the particular cases in which this species was simple, and those where it was predominant." The actual frequency of the disease is dreadful. M. Bayle calculates that one-fifth of the deaths in Paris is caused by phthisis, and that, besides, one-tenth of those who die of other diseases was phthisical. The following table shews the mortality of phthisis at different ages. Age. No. dead. From 15 to 20 years 10 30 to 40 Age. No. dead. From 40 to 50 years 21 50 to 60 It appears that nearly the same number of phthisical patients die in every season of the year. Number of consumptive persons who died in autumn, 64—winter, 58-spring, 54-summer, 68.-Total, 244. In regard to the duration of phthisis, the following table gives satisfactory information: Deaths. 3 Months. Deaths. 6 Months. 2d......64. 3d ......301 "Tubercular phthisis seems to be the species which, under all circumstances, is the soonest fatal, by carrying through all the stages those who, in truth, had the seeds of the disease, but never till then felt any symptom of it." "Phthisis with melanosis appears to be that which commonly lasts the longest; but of those in whom the phthisis lasts a great many years, some are affected with tubercular phthisis. There are then but few tubercles, and the ulcerations produced by the tubercles seem to form a purely local disease, which does not affect the vital functions." The ninth and last chapter constitutes two-thirds of the whole bulk of the book. It contains a detail of the principal observations, 54 in number, from which M. Bayle has derived his opinions, and thus he enables others to judge how far they seem to be warranted, besides presenting us with very valuable materials for a history of this disease. The work is concluded with a recapitulation of some points of doctrine which M. Bayle considers as established in his treatise. "1st, When an accidental disease destroys a person affected with pulmonary phthisis in its commencement, or at its first degree, we always find the lesions of the lung I have mentioned, and no appearance of their tendency to get well. It is not from two or three insulated observations that I discovered this truth: it is from very extensive inquiry, and after numerous dissections of subjects in whom phthisis was at its first periods. "2d, Chronic peripneumony, obstruction of the lungs, chronic pulmonary catarrh, symptomatic catarrh, which accompanies diseases of the heart, and other affections of the chest, sometimes resemble phthisis pulmonalis. But when individuals die of any of these disorders, or when any other accidental cause brings on their death, we do not find in the lungs any of the lesions which are remarked in the first degrees of pulmonary phthisis. "3d, When phthisical persons have had partial inflammations of the parenchyme of the lungs surrounding the tubercles, or when they have experienced severe hæmoptysis which has endangered life, if they recover a better state of health, and after having been in marasmus, appear convalescent, they still retain a dry cough or some other symptom, which discloses the existence of phthisis, of which the progress is not interrupted, though the complication which made it. more alarming has been cured. Some individuals arrived at this state of apparent convalescence sink under some other accidental disease, and the state of the lungs demonstrates then most evidently that phthisis was not getting better. Tubercles in the lungs never termi. nate in resolution, any more than those which arise in other parts: they remain stationary, or have a tendency to grow soft and to suppurate, as I have always stated, as well before the publication of my remarks on tubercular degeneracies as since that time. "4th, Miliary granulations appear to be of a nature similar to that of cartilages; and when they have displayed themselves in the lungs, they produce there a state of irritation, permanent and impossible to be destroyed. "5th, Cancerous phthisis, in its first degrees, is not less incurable than granular and tubercular phthisis; for scirrhous tumours never terminate by resolution, any more than tubercular affections." "6th, I have shewn that we commit great error, when we take for a scirrhus the chronic inflammation of a glandular part; but the error is as great, when we take a chronic inflammation of the chest for a pulmonary phthisis. In both cases we arrive at false conclusions, particularly when the disease terminates in recovery. "But is it very certain, that the pulmonary phthisis is not a chronic inflammation? We have seen heretofore, that thetubercular degeneracy cannot be considered as a termination of inflammation: we have seen, that, after chronic inflammations which have lasted for a very long time, we did not find in general either tubercles or scirrhi in the lungs. In fine, I have made the remark, that, when tubercles are met with in an individual affected with chronic inflammation of the chest, they are sometimes in the lung of the opposite side to that which is the seat of the inflammation." "7th, It results from what I have stated, that chronic inflammations and catarrhal affectious may resemble phthisis, and that they may even contribute to its development. Hence it follows, that physicians of the greatest talents deceive themselves sometimes in the diagnosis of these different diseases; and in consequence of this mistake, we see some individuals get well, whom one would have believed to be affected with an incurable disorder. These cures have given rise to two opinions diametrically opposite, which divide practitioners; some regarding pulmonary phthisis as curable at the second, or even at the third degree-others being convinced that it is incurable at every period." IV. A Treatise on the Medicinal Leech; including its Medical and Natural History, with a Description of its Anatomical Structure; also, Remarks upon the Diseases, Preservation, and Management of Leeches. By JAMES RAWLINS JOHNSON, M.D. F.L.S. Member Extraordinary of the Royal Medical Society, Edinburgh. (Illustrated with Two Engravings. J London, 1816. Longman and Co. 8vo. pp. 147. THE THE fulness of the title of this work precludes the necessity of a regular analysis of its contents. The utility of the leech in the practice of the healing art, especially in the country, where cupping is not commonly successfully performed, renders every thing connected with its history interesting. We must refer to the volume before us for what regards the medical, natural, and anatomical history of the leech, where the reader will find much information, and some novelty. As more immediately connected with the practice of medicine, the following observations on the application of the leech deserve to be generally known: "But, for my own part, I always trust to their application by the hand. Bring a leech toward the part whereon you intend to fix it, and as soon as it begins to extend the head, to seek an attachment, endeavour that it may affix itself to the place required. Some little dexterity is requisite to make the leech attach itself at the first point of contact, for it often happens that it will pass over a great extent of surface, without evincing the least disposition to bite. In this case, puncturing the part with a lancet offers the only chance of success. When the patient is fearful of the lancet, and one leech only shall have bitten, where several are required, it may be of use to remove it, which is readily done, by inserting the nail of the finger between its mouth and the skin. The blood then flowing from the orifice, will induce the remainder to bite with the greatest avidity. As soon as the leeches are gorged, they drop off; this usually happens within ten or fifteen minutes. Sometimes they remain affixed a considerable time, and become indolent; but they are quickly roused from this state by sprinkling them with a few drops of cold water. "The leech, when filled, contains from half an ounce to an ounce of blood; and what is worthy of notice, this fluid is preserved in its stomach, in an uncoagulated state, for two or three months, and without producing any offensive smell. The only change it suffers is that of becoming deeper in colour, and a little thicker in consistency. Under some peculiar circumstances the blood, however, will coagulate, and it is then productive of disease. What peculiar action takes place in the stomach of the leech, to preserve for so long a time the blood in a state of fluidity, we cannot well determine. It may, how ever, be urged as probable, that a fluid is secreted, capable of resisting the developement or play of those affinities which are essential to the putrefactive process. "When a leech quits the part to which it was affixed, and the blood continues to flow longer than is required, the application of a slight compress will usually restrain it; but should this at any time prove ineffectual, we must have recourse to a compress steeped in some styptic, as brandy or spirits of wine. "When from their scarcity but few leeches can be procured, advantage may be taken, according to an ancient custom, of snipping off their tail; the blood will then flow, drop by drop, from the artificial opening, as fast as the leech sucks it. But it is of no use to resort to this operation unless the leech is in the act of suction; for should the pressure from the column of descending blood be removed, this artificial opening would be immediately closed by the strong action of the circular muscles. With the same view, an incision may be made close to the tail of the leech with a lancet. "I have frequently performed this experiment, and, what is remarkable, have found them to suffer, apparently, so little from the operation, that they still drew the blood with as much freedom as before. In one instance, in a leech just fallen off and fully gorged, I employed this method of ridding it of its contents; and, severe as many might deem this treatment, the leech was no sooner returned to its former situation, than it began sucking with the same avidity as when first applied. Although the leech appears at the moment to suffer from this practice but trifling inconvenience, yet it afterwards becomes very languid; I would therefore only propose its adoption, at a time when, as before noticed, their scarcity might render such a measure expedient. "To make a leech disgorge, the most common practice is, that of strewing the muriate of soda, or common salt, over its body. In a few seconds the blood is rejected, the leech assumes a coiled form, and loses its activity and vigour; and we seldom find it again fit for use until the expiration of four or five days. As the salt frequently blisters the body, we are advised to apply it only to the mouth; but I must remark, that if the lips are blistered, the same obstacle is presented against its re-application. "To remedy this convenience, we are recommended to draw the leech between the thumb and finger of the left hand, keeping up a regular and uniform pressure, until the whole of the blood is removed This practice is certainly preferable to the former; for the leech continues active, and will again immediately affix itself. But the great disadvantage is, our being scarcely able to carry it into effect without injury to the internal structure. "In preference to any of these methods, and one from which the leech appears to suffer the least inconvenience, is that of pouring a small quantity of vinegar upon the head. Following this mode of treatment, I have succeeded in making a leech bite four times successively, coming off each time completely gorged with blood.. "It will be scarcely necessary to observe, that leeches recently applied should be kept by themselves, and should be allowed to retain, for their nourishment and support, about one-third the quantity of the blood they extract." |