Medical Obituary Notices.

DR. W. MARSDEN.

THIS physician died on Wednesday week, worn out by a disease of long standing. Dr. Marsden established himself in practice nearly forty years since, at Thavies Inn, Holborn. He was the founder of the Free Hospital, in Greville-street, Hatton-garden, since removed to Gray's-inn-road, and known as the Royal Free Hospital. Dr. Marsden also founded the Cancer Hospital at Brompton, and was senior surgeon to both those institutions.

DR. BRINTON.

We regret to announce that Dr. William Brinton, F.R.S., died on Thursday last, at his residence, 24, Brook-street, London. Dr. Brinton had suffered for a long time past from disease of the kidneys, and his general appearance too clearly showed the existence of some serious malady. The acute symptoms which immediately determined the fatal result followed exposure to the cold in the late severe weather.

DR. ARTHUR MITCHELL.

F. M. Wallis, G. T. Willan, F. W. Laslett, R. A. Painter, and A.
W. G. Atkins, of Guy's Hospital; G. S. Walker, H. R. Moullin,
W. H. Hubert, and W. E. Ledgard, of St. George's Hospital; J.
J. Roy, H. D. Shelton, J. O. Sankey, and W. A. S. Blue, of St.
Bartholomew's Hospital; R. D. Fox, and C. W. Calthorp, of
Charing-cross Hospital; J. A. Williams, and E. J. Barrick, of
Toronto; W. R. Davies, and J. B. Beavan, of University College;
T. M. Watt, and W. A. Walker, of Belfast; G. W. Tacon, of
London Hospital; W. H. Aston, of St. Thomas's Hospital; and
Oliver Penfold, of King's College.

The following gentlemen passed the same examinations on
the 17th inst.:

Charles Arthur Neason, of Guy's Hospital; John Levitt Davis, of the Charing-cross Hospital; Charles Turner Haddelsey, of the London Hospital; Henry Wintle, of Bristol; Henry Hemingway, of Leeds; and James Cornelius O'Grady, of Dublin. It is stated that out of the 85 candidates who presented themselves for examination no less than 24 failed to acquit themselves to the satisfaction of the Court, and were consequently referred back to their anatomical studies for three months.

APOTHECARIES' HALL OF LONDON.-The following
gentleman passed his examination in the Science and Practice
of Medicine, and received a certificate to practise, on the 3rd
inst.:-
Nettleship, Edward, Kettering, Northamptonshire.
On the 10th inst.:-

Stainthorpe, Thomas Edward, Hexham Abbey.
Summerhayes, Henry, Ealing, Middlesex.

Williams, William Edward, Llanhilleth, Monmouthshire.

first examination:

Walter Hart, King's College Hospital; J. C. M'Donald, Westminster do.

WE regret to learn that a further vacancy has occurred in the School of the Royal College of Surgeons of Ireland, by The following gentlemen also on the same day passed their the death of Dr. Arthur Mitchell, which took place suddenly on Monday last. Dr. Mitchell had for many years filled the Chair of Botany in the Royal College of Surgeons, and as a Private Teacher in Materia Medica and Botany had contributed to the instruction of a large proportion of the Surgeons issuing from the Irish School. About twelve months since he was stricken with a severe attack of a cerebral nature, which, after comparative convalescence, has resulted in his decease.

THE PALL-MALL GAZETTE TESTIMONIAL. THE proposition which was started in our columns by Dr. Wilson, for a Professional recognition of the services of the Pall-Mall Gazette, has assumed a practical form in the letter which appears in our columns to-day. Great as the public services of the Gazette in this matter have been, they have done still more for our Profession in ventilating, with the great prestige of its independent opinion a crying abuse which would have received little attention coming from medical sources. Whatever form the gratitude of the Profession may assume, we trust it will be liberally displayed. Perhaps the most eloquent recognition would be a unanimous patronage of the journal by a permanent subscription from every medical man who feels the onus of thankfulness towards its proprietors. We shall most willingly co-operate in any scheme for this purpose.

Medical News.

ROYAL COLLEGE OF SURGEONS OF ENGLAND.— The following gentlemen passed their primary examinations in Anatomy and Physiology at a meeting of the Court of Examiners on the 15th inst., and when eligible will be admitted to the pass examination :—

H. W. Diver, T. J. Pickburn, H. C. Hopkins, F. L. Thorne, George
Wilks, and D. K. Robertson, of St. Bartholomew's Hospital'; Philip
Thompson, Ratcliffe Nuttall, Charles Ogden, Thomas Wilson, and
J. A. Giddings, of the Manchester School; T. J. Gittens, C. E.
Wing, J. O. O'Brien, and J. P. Garlike, of Guy's Hospital; E. C.
Gamble, and C. J. Rhodes, of the Leeds School; George Payne,
and F. A. Helsdon, of Middlesex Hospital; T. C. Bailey, and R.
L. Edgeworth, of the Dublin School; J. W. Pratt, and J. G. Ander-
son, of St. Mary's Hospital; John Cascaden, and Titus Crooker, of
Toronto; Julian Willis, of King's College; Frederic Smith, of
London Hospital; J. E. Kenyon, of St. George's Hospital; Edwin
Peacock, of Birmingham; and E. F. Chinery, of Edinburgh.

The following candidates passed their primary examinations

on the 16th inst.:

THE cholera has disappeared from Carnarvon. THE cattle disease still continues in the East Riding of Yorkshire.

Ar a grand dinner recently given near Paris, the principal dishes were shark, horse, dog, and rat.

Two men have been killed by sulphuretted hydrogen, from working in a tank containing sulphate of ammonia, at some chemical works at Bow.

AT the Kent Annual General Sessions, held last week, it was stated there are now 758 lunatics in the Maidstone Asylum.

REMOVAL OF QUARANTINE AT GIBRALTER.-Free pratique is allowed upon arrivals from Southampton with clean bills of health.

A FEW weeks ago a man arrived in Ararat (Victoria), with 28,000 leeches, which, in three days, he caught in a large lagoon.-Sydney Herald.

AT the weekly meeting of the City Commissioners of Sewers, on Wednesday week, Dr. Letheby reported that 1109 houses had been inspected during the past four weeks, that 155 places required sanitary improvement, that 12 out of 150 ships were found in a filthy condition, and that 14,222 lbs. of meat had been condemned as unfit for food.

TEN cases of the cattle plague have been reported by the official inspectors, and it would appear that the disease is still confined to one district-the East Riding of Yorkshire. Since the outbreak of the plague 253,817 animals have been attacked, while 52,656 healthy cattle have been slaughtered to prevent the spread oi the disease.

THE Spanish frigate Resolution has put in at the Falkland Islands with upwards of one hundred cases of scurvy on board under treatment, and it is reported that thirteen of them had terminated fatally. This vessel had been engaged in blockading the coasts of Chili and Peru. It is also reported that all the Spanish vessels employed on that service had suffered greatly from scurvy, and had lost many men.

WE are informed, by one who ought to know, that last autumn a medical man of station drew the attention of the local police to a foul drain passing close by the house, at Wardie, of Mr. Alexander Smith, the poet, and assured them that cholera, diphtheria, or typhoid fever would prevail if it It was, we believe, by one of these diswere not cleansed. creditable disorders that Mr. Alexander Smith has been carried

off.-Builder.

CLINICAL LECTURES

DELIVERED IN

STEEVENS' HOSPITAL,

TOGETHER WITH

healthy standard in quantity; their appearance, however, under the microscope, is natural; and the fibrin, in the majority of cases, is normal in quantity, firmness, and cohesive power.

In hæmorrhagic diseases, the chemical and physical characters of the blood are very different. Its specific gravity

OBSERVATIONS ON PRACTICAL MEDICINE. | is seldom much below, and occasionally even exceeds the

THE following general remarks on chlorosis and hæmorrhage were suggested by some cases of these diseases which were treated in the medical wards of Steevens' Hospital during the last session.

healthy standard; the separation into clot and serum is imperfect, and the clot bears too large a proportion to the serum; the quantity of fibrin is less than in healthy blood, or, at least, its proportion to the red corpuscles is less than is found in a state of health; the quantity of red corpuscles is either absolutely increased, or their proportion to the fibrin is larger than in healthy blood; and the quantity of solid constituents frequently exceeds that of the normal fluid. The clot is, in general, large, soft, and of a dark red, or almost black colour; sometimes the formation of a clot does not take place; a buffy coat is scarcely ever observed, except when fever or inflammation is present; and the serum is frequently tinged with red by the presence of red corpuscles in suspension. Under the microscope, the red corpuscles are most commonly seen of with these are numerous shrivelled, apparently empty, small size, with their edges lacerated and irregular; mingled colourless cells, the walls of which are of extreme delicacy.

with each other, serve to illustrate the distinguishing chaThe following briefly noted cases will, on comparison racters of chlorosis and hæmorrhage :

Mary Callaghan, aged 17, a domestic servant, of middle stature, spare habit, and chlorotic appearance, was admitted into Steevens' Hospital, August 2, 1845. The integuments are of a sickly white, waxy hue with a slight tinge of yellow ties are habitually cold and moist, especially the feet, which, on those parts which are most exposed to light. The extremi

Chlorosis is an affection of frequent occurrence and great interest; and though it has been repeatedly investigated by several distinguished pathologists, many points of conThese facts respecting the characters of the blood in chlosiderable importance in its history yet remain to be explored and explained. We shall retain the name chlorosis rosis and hæmorrhage are established by the well-conducted experiments and accurate analysis of Andral, Gavarret, as, perhaps, the best we can adopt; it is, doubtless, one Denis, Lecanu, Simon and others; and have been corroderived from a symptom, yet a symptom so invariably pre-borated by numerous observations made in the hospital by sent that it sufficiently designates the disease. This is not Dr. Hill, under my own superintendence. the only instance in which we deem it necessary or convenient to employ the name of a symptom, as expressive of the disease which gives rise to it; we may cite for example, jaundice, dropsy, and paralysis. It is sometimes better to retain even an objectionable word than to encumber science with new and often uncouth terms. We shall not speak of chlorosis as synonymous with anæmia; the former refers to a specific disease, the latter bespeaks a state of the system, either general or local, which may arise during the progress of several diseases; it was introduced into our vocabulary by the eminent physician Andral, and (though not etymologically correct) is too useful and convenient a term to be parted with. There are many cases of chlorosis marked rather by an increase than a diminution of the total amount of the circulating fluid. In chlorosis there is a change in the quality, but not necessarily a change in the quantity, of the blood; so that chlorosis must be looked upon as a peculiar and distinct disease, and not identical with anæmia. In like manner hyperæmia is a convenient term to express a surplus of blood, generally or locally, but it is not expressive of any particular disease; and in speaking of hæmorrhage in contrast with chlorosis, as we propose to do, it is necessary to draw a marked line of distinction between hæmorrhage-which sometimes arises even when general anæmia exists-and the state of hyperæmia.

she

frontal headache; pain, with tenderness on pressure in the says, are never warm. She complains chiefly of constant hypogastric region, chilliness, languor, and weakness in the back. The tongue is pale and moist, the appetite delicate, performed twenty times in a minute; no cough nor pain in nausea frequent, and bowels always confined. Respiration either side, and the respiratory sounds healthy. Pulse 96, feeble; heart's action tranquil whilst she is at rest, but any The first sound of the heart is accompanied by a loud, rough sudden exertion or emotion produces violent palpitation. bruit, which varies much in intensity at different periods, and under different circumstances of excitement, but has been present, more or less, at every examination. There is no evidence of hypertrophy of the heart, nor can any murmur be detected in the arteries or veins. There has been no appearance of the menstrual discharge for the last eight and she is unable to account for its cessation. She has months, previously to which time it was always regular, never suffered from leucorrhoea, nor observed any tendency to oedema in any part of the body.

She

It has been already remarked that there is no proof of deficiency of blood in chlorosis; on the contrary, there is strong presumptive evidence that an actual excess of blood, though of inferior quality, characterises some cases of the Urine is passed in natural quantity; is of pale, limpid disease; and it is worthy of remark, that in the treatment of chlorosis, the moderate abstraction of blood by the lan- appearance; specific gravity at 64° Fah., 1008; faintly cet, by leeches, or by cupping, not only does not aggravate states that, notwithstanding the derangement of the uterine reddens litmus paper, and is free from albumen. the symptoms, but so far from this, when incidental affec-functions, she enjoyed tolerable health until four months tions demand depletion, is followed by the best effects. since, when she began to suffer from headache, nausea, and The disease in reality consists, not in a diminished quantity general debility. Four ounces of blood were taken from of blood, but in an altered quality—a diminished consistency of this fluid; herein lies its very essence, and the arm, and the following observations made :-any term which signifies the former, not the latter condition, is at least objectionable as applied to chlorosis. In chlorosis the blood undergoes a very remarkable change; its specific gravity is lowered; the clot is small and firm; the serum bears too large a proportion to the crassamentum ; water is in excess; the red corpuscles are far below the

The Dublin Quarterly Journal of Medical Science, Nov. 1st, 1846. Reported by John Hill, A.M., M.B.

Temperature of atmosphere

under the tongue
in the axilla

of blood as it flowed

Specific gravity of blood at 75°, Fah.
Specific gravity of serum at 64°, Fah.
In 1031 grains of blood,

The weight of serum was
The weight of the clot,.

64° Fah. 100°

95° 97.5°

1.031. 1.025.

760 grains. 271

being in these proportions of 1000 to 356'5. These proportions were taken twelve days after venesection.

blood, and thence we hope to arrive at useful practical deductions.

The blood, when flowing, seemed nearly as thin as water, From the pathological state of the blood which characand was of a bright florid colour, resembling that of ar- terises chlorosis, many interesting phenomena spring; upon terial blood. The clot was very small, firm, of a dark red- | these, in succession, we shall make a few observations and dish colour, and without any appearance of buffy coat. practical remarks. The serum was transparent and colourless. Under the microscope the characters of the red corpuscles were normal. P. Conolly, aged 22, a weaver, of spare habit, but florid complexion, was admitted into Steevens' Hospital, July 17th, 1845. The entire surface of the body, excepting that of the face, hands, and feet, is thickly covered with brownish red petechiæ, mingled here and there with small, more deeply seated, and dark coloured ecchymoses. At the upper part of the forehead are several broad red patches, covered with furfuraceous scales. The gums are soft, spongy, of a purple colour near their junction with the teeth, and bleed freely whenever he masticates any hard substance. The tongue is clean and red; no petechia are observed within the mouth. He is very subject to epistaxis, a severe attack of which, two days ago, induced him to apply for admission into hospital. His appetite is good, and his bowels usually regular, but at present they are confined; in other respects his general health appears unaffected. Pulse 76; heart's sounds normal. Respiration 18 in the minute. He states that, during his childhood, he was occasionally subject to epistaxis, and that, about seven years ago, he first observed a number of small red spots upon his arms, which he, at that time, mistook for flea bites; these spread in successive crops all over his body, and shortly afterwards he became subject to frequent hæmorrhage from the nose, gums, and bowels. He says that the spots fade and die away sometimes, but that, ever since their first appearance, he does not remember having been totally free from them for more than a few weeks at a time. Previously to the commencement of the disease he was in very distressed circumstances; of late years, however, he has been able to earn a comfortable subsistence. Four ounces of blood were taken from the arm :

In 1054 grains of blood,

.

63° Fah.

97°

98°

1.054
1.027

238 grains.

816

The weight of serum was. The weight of the clot being in the proportion of 1000 to 3428′5. These proportions were taken twelve hours after venesection. The blood, as it escaped from the vein, appeared thin, and was of a florid red colour. The clot was very large, soft, black, and soluble in water. The serum held a great number of red corpuscles in suspension. Under a high magnifying power, the recent blood exhibited a great number of ruptured corpuscles; their general size was, however, normal. In a drop of the tinged serum were seen numerous red corpuscles, of which about one-fourth were of natural size and appearance; another fourth were of natural size, but with lacerated edges and irregular surfaces; whilst the remaining two-fourths were of small size, not exceeding the dimensions of the central nucleus of a normally-sized red corpuscle. There were, in addition, numerous thin, membranous cells, empty and corrugated, floating in the

ersum.

These cases exhibit in strong contrast the characters of the blood in the chlorotic and hæmorrhagic conditions. They are extreme cases, and are given as such; in other instances which we have examined were observed degrees of contrast, from the minutest shade of difference to the extreme amount now portrayed. The most striking distinctive character is in the specific gravity of the blood; in the chlorotic case it was 1031; in the haemorrhagic case 1054; but there are other remarkable differences, and these are at once recognized by a reference to the examination made. We do not profess to give a minute chemical analysis of the blood; our object is to mark the prominent and distinctive characters in each condition of the

The first important symptom which we shall notice, as a consequence of this imperfect sanguification-this deficiency of the red corpuscles-is the low degree of animal heat. Well-marked chlorosis is distinguished by an universal chilliness; the extremities are, in many cases, insuperably cold; and scarcely are they warmed by exercise or artificial heat till (the loss by radiation and evaporation not being supplied by the blood) they again become destitute of animal heat. Even in bed this coldness of the extremities remains for hours, and prevents sleep. Sometimes they are deadly pale and dry; at other times swollen, livid, and clammy; but in either case they are characterised by a very low degree of temperature. The whole condition of a chlorotic patient in many respects resembles that of a cold-blooded animal. There exists also a marked incapability to bear extreme ranges of atmospheric temperature. So long as the blood continues in the deteriorated state which constitutes the essence of this affection, the individual ceases to possess that power of adaptation to climatic extremes which distinguish the human race. To such persons summer heats and winter colds are distressing and intolerable; they thrive best in a dry, invigorating, and moderately warm atmosphere; and their sufferings would be much mitigated were the air they breathe always of an uniform and medium temperature. In the treatment of chlorosis much advantage is derivable from remedies capable of supplying this deficiency of animal heat: for example, from warm pediluvia, frictions, shower-baths, and such covering of the body as shall not debilitate, and yet prevent the too rapid escape of caloric by evaporation or radiation; but above all, from well-regulated exercise, both equestrian and pedestrian, not exceeding the then existing physical powers, but gradually augmented as these powers by habituation acquire force. To these should be added, when practicable, travelling and daily quick transitions through the air, as in an open carriage, so as to stimulate the lungs, and improve the respiratory and circulating functions.

The importance of this mode of treatment is shown by the following observations, quoted from Simon's "Animal Chemistry":"When there is a paucity of corpuscles, the necessity for the absorption of oxygen is diminished in a corresponding ratio, the circulation becomes slower, and there is less heat developed than in the normal state; on the other hand, blood with an excess of corpuscles, but which is circulated slowly, developes less heat than blood which contains a smaller proportion of corpuscles, but which is more rapidly circulated, for more oxygen may consumed in the latter than in the former case.'

be

The production of animal heat is unquestionably much influenced by the rapidity of the circulation, as well as by the quantity of blood corpuscles. Of this we may convince ourselves by a reference to the researches of Prevost and Dumas on the relation between the mass of corpuscles and the temperature in various animals. For instance, in the goat the amount of blood corpuscles is considerably less than in man; but the temperature of the former exceeds by four or five degrees that of the latter. This may be accounted for by the fact that, in the goat, the pulse is, by ten or twelve beats in the minute, quicker; and respiration, by six in the minute, more frequent, than in the human subject.

Becquerel and Breschet have also ascertained, by means of a thermo-electric multiplier, that each contraction of a muscle is accompanied by an elevation of temperature amounting in some instances to 26°. In this manner we may, perhaps, account for a portion of the increased temperature that succeeds active exercise.

When the blood has undergone the morbid changes described, when the red corpuscles are deficient and animal heat imperfectly supplied, it follows as a necessary consequence that the nervous and muscular systems, being sup