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NORTH LONDON HOSPITAL.

EPILEPSY WITH BRONCHITIS.—SOFTEN-ING OF THE HEART.

HENRY WATTS, aged 30, coal-heaver,was admitted Aug. 28, under the care of !Dr. ELLIOTSON. He was in the hospital afew months ago with pericarditis, bron-chitis, and hypertrophy of the left ventri-cle of the heart, for which he received re- Ilief, and was discharged. He has sincebeen under the care of the surgeons forfistula in ano, and was operated on lastweek. At about eleven o’clock yesterday ’,morning he suddenly became insensible,and experienced violent convulsion. Hefoamed at the month, Ins eyes became pro-minent and turgid, and his heart beat withgreat rapidity and violence. He alsovoided the contents of the bladder. Theconvulsions only lasted three minutes, buthe continued in a state of insensibilityduring the whole of yesterday. He com-

plains to-day of pain in the head, whichfeels very hot; he seems confused, anddoes not answer questions readily. He

coughs frequently, his respiration is shortand quick. He complains of great painwhen pressure is made upwards under theleft hypochondrium. His respiration is si-billant and sonorous over the whole chest.The heart acts very violently and irregu-larly, but it is difficult to hear the sounds,on account of his respiration. Pulse 120,irregular in force and frequency; tonguewhite, bowels open, skin hot. To be bledto twelve ounces.

29. Still has severe pain in the head withconfusion of mind; to be again bled. Fivegrains of calomel to be taken every threehours, and blisters to be applied to thechest and back of the neck. The bloodtaken yesterday was both buffed andcupped.

30. His head was relieved by the bleed-ing, but the relief was only temporary.This morning squinting and convulsionscame on with constant muttering, and hedied at nine p.m.

Autopsy tlezrty hours after death.Head.—The scalp was very much con-

gested. The membranes of the brain were

exceedingly vascular, but there was notrace of lymph on them. The brain wasexceedingly soft, and the white portionpresented a grayish appearance, owing toa great number of small vessels. Therewas a small earthy concretion about thesize of a horse-bean on each plexus cho-roides.—Chest. The pericardium containeda quantity of bloody serum ; the heart wasdilated, and so soft that its structure could

be easily broken down. - The linipg mem-brane was soft, and much darker than na-tural. The mitral valves and the semilunarvalves at the mouth of the aorta were in-durated, but felt healthy. The tricuspidvalve was healthy. The lungs were soft,and enormously gorged with bloody fluid.The pleura pulmonatis could be separatedvery easily from the surface of the lung.-Abdomen. Liver of natural size, but verysoft, presenting a granular appearancewhcn broken down by the finger.—Sto-macle. The mucous membrane was healthv.

—The spleen was reduced to a dark pulpymass.—Kidneys very soft, the vas.cularparts darker than usual.

Dr. ELLIOTSON, in making some re-

, marks on this case, said that the statewhich gave general softness to the brain,heart, and vessels, arose from a suddenattack of passive inflammation. The ves.sels became relaxed and softened, and theblood was not propelled through themwith its usual activity. He had seen aman in St. Tltomas’s Hospital who hadgreat swelling of the hands, which hadbecome nearly of a mulberry colour fromthis cause; he was bled and relieved. TheI patient, whom they had just examined,had no great heat or pain in his head, yetthere was great redness internally; the

symptoms of inflammation frequently donot bear any proportion to one another;it was so in this case, the chief symptombeing the redness. It was a very myste-rious subject that solid parts should be-come suddenly soft; he had s.een an oldFrenchman with gout, with his legs quiteblack; he had never witnessed such a

symptom before in that disease, and wasat first inclined to believe that gangrenehad taken place, but the man recovered.

He knew no other plan of treatment incases of this description than the antiphlo-gistic, not for the purpose of lowering thesystem, but to unload the vessels. It wasa disease which, though often present, wasnot frequently recognised.

IMPETIGO ERYSIPELATODES.

Dr. THOMSON brought into the theatrea man recovering from an attack of thisdisease, which had assumed some anoma-lous appearances worth noticing. The

patient, who was of a sanguine tempera-ment, had been accustomed to indulgefreely in drinking, and had been drunkseveral times in the week preceding theattack of the eruption. It made its ap-pearance on the evening of a day in

which he had been working while ex-

posed to the extreme heat of the sun, andhad drunk a pot of porter when he,was

perspiring freely. He did not recollect

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having experienced any shiverings, but cede the psydraceous pustules which now,felt a stinging heat and sensation of in the present case, presented themselvestightness in the face, and, next morning, tQ the eye, and were already beginning tohe perceived that his face was swelled, discharge the usual acrid pns, which wasand that the eyelids were almost closed, inflaming and excoriating -the sound sur-whilst the skin of the face and neck was face over which it flowed. Another proofas red as scarlet. In this condition he of the accuracy of this opinion the Pro-was admitted into the hospital. fessor pointed out, namely, that where theWhen Dr. THOMSON first saw him, the crusts, which assumed a somewhat larnel-

fa,ce was red and puffy, and the (sdema- lar aspect, were beginning to separate,tous state extended to the eyelids. It the skin was left dry, shining, and brittle,appeared more like erysipelas of the head which is not the case in either porrigo orthan any other disease, but the constitu- eczema. He felt it, however, necessary totional symptoms did not accord with the modify this opinion as far as regar,leclthreatening aspect of the eruption ; and on porrigo in the usual acceptation of the

passing the fingers over the surface of the word, for in that species termed larvalisskin, a roughness was felt much greater the same appearances occurred ; but thenthan occurs in erysipelas. The bowels it must be stated, that that species waswere regular, the tongue was white and truly impetiginous, and should be placedfurred, and the pulse was 96. The erup- under the head of " impetigo," instead oftion was rapidly extending overthe thorax. 11 por-rigo," where it now stands in both

Dr. THOMSON stated, that he expe- WILLAN’S and BATEMAN’S works.rienced much difficulty in giving a name With respect to the treatment of theto the disease in the state in which he disease, it was at first antiphlogistic. Thethen saw it. In determining the diagnosis, patient was bled to the amount of sixit was necessary to distinguish between ounces, and this was followed by a pillthree affections of the skin,-=for he had containing six grains of calomel, and nextno hesitation in saying that it was not morning a brisk purgative was given. Thetrue erisipelas. The question then re- analogy of the disease to erysipelas of themained, was it porrigo, or eczema, or im- head, in constitutions such as the pa-petigo ? It was evidently not the first, as tient’s, which cannot stand much deple-that is not usually preceded by fever, or tion, prevented Dr. THOMSON from pur.any diffused blush, but by an eruption of suing, any further, the lowering plan ofstraw-coloured fari which at once present- treatment; on the contrary he ordered theed themselves; distinct, although in groups, sulphate of quinine, with diluted sulphuricand in a day or two the fluid they con- acid, to be commenced immediately aftertained concreted into yellow or brown the bowels were freely opened; and thiscrusts; nor was any peculiar odonr ex- was taken three times a day until the

haled from the crusts. With respect to the patient was discharged.second eczema, it was more difficult to In reference to the local treatment,decide, as that species which is named which usually consists of simple ablution"solure" frequently attacks men of san - with warm water and the oxide of zincguine temperament, who use violent exer- ointment, Dr. T. remarked that he hadcise in the sun ; and although the erup- seen in the greater number of cases treat-tion itself is vesicular, there is often a ed on that plan, that fresh crops of pus-sprinkling of phlyzaceous pustules, which tules appear several successive times, andsuppurate slowly, and are not at first very all run the same course as the first, thusvisible. One objection which might be greatly annoying both the patient and theurged to its being eczema, was the very practitioner. The only application, there-slight fever which preceded the attack; fore, which he ordered, was a lotion of afor in eczema there is considerable gene- solution of nitrate of silver, in the pro-ral indisposition, the heat is so great as portion of eight grains of the nitrate toto amount to pain ; and when the pustules one ounce of water, with the addition ofappear they are secondary, and do not three minims of nitric acid. The use ofdisplay themselves until the third or fourth the acid was to prevent the immediate

- day of the eruption, which itself is truly decomposition of the nitrate, wliich al-vesicular. ways more or less follows its applicationThe second day after the admission of to surfaces exuding either lymph or mu-

the patient, all doubt as to the diagnosis cus; and when this occurs, its powers ofwas at an end; the eruption was evidently course become greatly weakened.pustular, and answered to the ordinary The beneficial result of this practiceappearance of that species of impetigo was evident. The man, as now presentedwhich WILLAN named " erysipelatodes," to the pupils, was in a convalescent state,on account of the diffused redness and although he had only been a week in thepuffy appearance of the skin which pre- hospital the crusts were everywhere fall-

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ing off, and leaving beneath them a soundcuticle, seemingly not at all disposed totake on any particular state, or any otherdiseased action.

This case Dr. T. considered instructivein two respects. It pointed out the ne-cessity of not determining too hastily thenature of an eruptive disease at its first

appearance, and the propriety of inquiringinto the previous habits of a patient be-fore deciding upon the treatment of a dis-ease, for, in this instance, the Professorwas certain that more depletion wouldhave been productive of harm ; and, lastly,the advantages of careful reasoning uponthe nature of diseases.

In this case the similarity of the symp-toms to those of erysipelas of the head inbroken-down constitutions, induced himto treat it nearly in the same manner ashe would have done a case of that disease.He left the pupils to make their own com-ments on the plan he had adopted fromthe results.

Erratum.—In report, page 793, line 40,for " choke up the lungs," read shakeup, &c.

To LECTURERS.-Prospectuses of the

Medical Schools &c. should be forwarded

immediately.

A History of British Quadrupeds isabout to be published by Mr. Thomas

Bell, "Lecturer on Comparative Anatomyat Guy’s Hospital," in one volume octavo,uniform with the History of British Fishespublished by Mr. Yarrell.

NEW PRINCIPLES IN OPIUM.-lvl. Pel-letier lately presented a paper to the Aca-demy of Medicine in Paris describing theproperties of two new principles which hehas discovered in opium by treating thatsubstance with lime and ammonia. He

designates them by the names ofpczrarrzor-phine and pseudomorphine.

ERRATA.- Page 552. last line of col. 1. fordome read object.

Correspondents may assemble any variety ofletters that is agreeable to them in adopting signa-tures to their communications, but it was probablya slip of the pen that subttituted 11 Multorum for" multis " in the letter at page 761.Page 612, col. 2, line 18, erase the not.

METEOROLOGICAL REPORT.

W. JACKSON.

(Extract from a Meteorological Journal kept at High Wycombe.

Lat. 51° 37’ 44" North, Long. 34° 45" West.)

Sept. 15, 1835.

END OF VOL. II., 1834-35.