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The Treatment of labour, complicated with deformed pelvis, Ivaries according to the amount of impediment presented, andaccording to the risk in which the mother is placed by theenergetic action of the expelling powers when the foetus cannot

pass through the pelvis in the ordinary manner. The aids todelivery, under these circumstances, are the Vectis, the shortor long Forceps, according as the head may be arrested at theoutlet or brim of the pelvis; Turning, in cases of shoulder pre-sentation, and also in certain cases where the deformity is suchas to warrant the belief that the head may be extracted, butwhere the forceps are inapplicable; Craniotomy, in cases wherethe head of the living child cannot pass, or where the continu-ance of labour, without assistance, endangers the life of themother; and lastly, the Csesarian Section, in cases where thedelivery of the child by perforation and the crotchet is im-possible. But before and beyond all these means, except incases where the action of the Lever, or the compression and ex-traction exerted by the Forceps, is sufficient to give birth to thechild alive, the remedy, or rather the preventive of danger, isto be found in the Induction of Premature Labour. A great andbeneficent extension of the operation for the induction of pre-mature labour may be made in these cases, and it is question-able, nay, almost certain, that the fatal operation of hysterotomywould rarely, if ever, be called for, if this operation werealways performed in cases of distortion, and at the propertime.The cases and circumstances under which these several pro-

cedures become necessary, in the management of labour com-plicated with deformity, will be entered into fully when treatingof these operations themselves in a subsequent part of thepresent course.

LecturesON THE

HISTORY AND CONSTITUTIONALCHARACTERS

OF

PHTHISIS,DELIVERED AT THE

Hospital for Consumption and Diseases of the Chest.

BY JAMES E. POLLOCK, M.D.,SENIOR ASSISTANT-PHYSICIAN TO THE HOSPITAL.

LECTURE II.

GENTLEMEN,-When we last met, I endeavoured to illus-trate, by a rapid survey of the progress of phthisis, the factthat it is a disease of the system, of which the lung affectionis but an indication and a stage. We observed, in the ante-cedent period to that of deposit in the pulmonary structure,when symptoms alone reveal the threatened attack, very strongevidence that the blood itself is the seat of the disorder. We

remarked further proofs of this in the sequence of pathologicalphenomena in every case, in the sympathies of the cir-

culating and nervous systems, in the successive deposits in thelung, and in the remarkable difference which is found in thetoleration of the disease in various individuals-some sinkingrapidly in the first, and others outliving the excavation of thelast, stage. We observed that a similar amount of localdisease of the lung, when due to inflammation, or a compres-sion of the pulmonary space by liquid effusion in the pleuralsac, is not followed by the same constitutional disturbance asa tubercular deposit to the same extent. Finally, various caseswere cited which illustrated each period of the disease, andevidenced the progressive stages of blood contamination whichlead to a fatal result, or which illustrated, on the other hand,the power of the system to tolerate an extensive local destruc-tion of the lung, when the diseased material of the blood hasexhausted itself, and the softened tubercle has been broken upand expectorated. In the interesting local changes whichsurround such a "tolerated" cavity, it was also sought to find212

proofs of the comparatively harmless character of a simplelesion of the lung, when the disordered state of the blood hasceased. Without undervaluing the important assistance whichauscultation has conferred on diagnostic medicine, it was, Itrust, made sufficiently clear that there may be a phthisiswithout any physical signs whatever, and that, on the otherhand, the most alarming physical signs may be present, andthe patient present but few symptoms of disordered health.It was thus insisted on that in no case can the physical signsalone be the measure of the danger, and that even neither thequantity nor the stage of lung disease indicate, per se, anyinvariable corresponding amount of systemic derangement.I I would to-day proceed to consider what further arguments

are to be found to illustrate the constitutional origin and courseof the tubercular disease, in certain of its local symptoms, inthe positive and negative evidence which has been adducedregarding its O1’igin, and in the contrasts which it offers tocertain other chronic affections. The diseases which seem in-compatible with, or which are rarely found allied to, tubercle,will be next found to furnish some interesting points of

antagonism, and to illustrate the general principle laid down.Finally, the effects of remedies will be noticed as bearing onthe same point. Having a large number of subjects to touchon, I would beg your indulgence for the hasty manner in whichthey will be brought before you; but to such an audience asthe present, it is rather sought to throw out general views,illustrated by the reading and experience of all of us, than toenter on details which might possibly be irrelevant or prolix.

It will have been remarked that, in my former lecture, butslight reference was made to symptoms which were very plainlyin connexion with the local disease when established in the

lung, our object being rather to regard phthisis in its generaleffects on the system, and from these to deduce evidence of itsbeing a constitutional affection. Yet the local symptoms, in-asmuch as they are characteristic of a deep disorder of theblood itself, and of resulting impairments of nervous and vitalactions, have a general as well as a limited meaning, and, ifcarefully studied, can throw much light on the questions whichwe are now considering. Let us examine, as examples, thecough, the hsemoptysis, and the pains which occur in phthisis.

Louis remarks, that cough, not preceded by coryza, is cha-racteristic of phthisis. What is its character?

In the early stages it is short, dry, and irritating, and gene-rally referred by the patient, as pointed out by Graves, to theti-ac7bea. It occurs at all times of the day, or at night, and isobviously caused by tubercular deposit, irritating the bronchialmembrane. The type of all cough is bronchitis; and we haveno reason to believe that the proper capillary structure of thelung is endowed with very sensitive nervous powers. In thestage of softening, the cough is expectorant, and becomes moreperiodical. It attends on the hectic exacerbation, and is worseat night and towards morning. It is, therefore, we may pre-sume, somewhat dependent on the same causes which inducehectic, as well as a necessary act to get rid of secretion in the*tubes. It is rarely paroxysmal, suffocative, and in long fits,as in bronchitis, unless that affection or laryngeal disease besuperadded. The known effect of sedatives, as opium andconium, in relieving it-medicines which have a systemicaction through the nervous centres-point to the intimate vitalrelations of this symptom.

Again, in some patients there is scarcely any cough, and themoderate amount of it in this hospital, which is kept at apretty uniform temperature of 64°, is the subject of remark byevery visitor. The act of expectorating is not cough, properlyso called. Contrast the hysterical bark, or the laboured suffo-cative fit of bronchitis, with the cough of phthisis. The latterhas its analogies in the same symptom as caused by any irri-tative vital lesion, as hepatitis and intestinal worms. Thehectic caused by a suppurating joint will often be accompanied’

by cough, which frequently ceases at once after amputation.These are interesting facts, and argue, it would appear, some-thing more than a local cause for this symptom. The lzczmo-ptysis of phthisis has long been regarded with much interest.Very few now look on it as a cause of tubercle; but it hastaken its place amongst the consequences of that disease. Ifphthisis were congestion, the effusion of blood would be a pri- .

mary condition, which, if prevented, would ensure the safetyof the patient. Pulmonary apoplexy, with frothy, floridhaemoptysis, is no uncommon case, and is often recovered from.Within a few months I have had under my care such a case,

’

in which there was extensive dulness over both lungs, copious’

spitting of blood, but ultimate complete recovery, the chestbecoming resonant, and the health restored.

. 1 Again : I am now attending a case of injury of the lung

213

from fractured ribs, in which haemoptysis has occurred for

many months at short intervals, but there is neither sign norsymptom of tubercle. Haemoptysis, therefore, is not a causa-tive agent in phthisis; it is a sequence, and easily explainedby the deposit in the lung. In this hospital it has been foundto occur in about sixty-three per cent. of the cases. It is,therefore, a valuable indication of phthisis; but how often isit not vicarious in females ? It must plainly be weighed withother symptoms and collated with the physical signs, before itassumes any value as a symptom. But has it any further vital

meaning than the effusion from a vessel which has been pressedon or corroded ? I believe that such a meaning may be tracedto an effort to reduce the pulmonary circulation to a standardcompatible with the diminished capacity of the lung; and infavour of this view it is sufficient to recall the relief which allthe symptoms often undergo after a haemoptysis.With an oppressed circulation and an altered or lessened

nutrition, the vitality of the lung and its important aerifyingfunctions are deteriorated. With diminished capacity for re-ceiving air, the oxygenating process is lessened, and the decar-bonising and exhalant functions are impeded. The effects onthe system are early seen, and are observable first in thewasting of the tissues. That a balance necessary to the com-plete health of an animal must be maintained between thesystemic and the pulmonary circulations, is a point of muchinterest. To maintain it under these circumstances of analtered capacity for respiration, and where secretion does notrelieve the irritated lung, a reduction, of the mass of the circu-lating fluid and of the solids of the body becomes a necessity.The mal-nutrition has preceded the deposit of tubercle; itscontinuance reduces the requirements of the system for avolume of respiratory space which is no longer obtainable, andthus the early adjustment of the balance leads to emaciation.The hemorrhage, where existing, has tended to the sameresult, and in both we can recognise (as in all diseased action)an effort of Nature to relieve and counterbalance, when shecannot cast off a morbid product.The pai .2is experienced in phthisis are of a very wandering

:and uncertain character. They may be present or absent, andare always deceptive, unless when caused by pleuritic inflam-mation and evidenced by its accompanying signs. They arefelt as often in the unaffected as in the affected side; are fre-quently in the base of the lung, the apex being alone diseased;and are, therefore, to be referred rather to a lesion of innerva-tion than to local disorder. Their occurrence in the calf of theleg, in the top of the shoulder, and in other distant parts,points to a systemic origin. On the whole, too, they are bestrelieved by general sedatives, such as morphine.

I would now consider some of the facts which have beenadduced with reference to the much-disputed question of theorigin of phthisis from such causes as climate, season of theyear, occupations, misery, bad or insufficient food, &c. Now

these points demand, more than any others, a very large ex-perience, such as alone can be furnished, by institutions likelihe one in which we are met, to skilled and unprejudicedobservers, or by the statistical results of extended observationsin different countries. We are as yet without that finishedarrangement of figures which genius combines from numbers toillustrate abstract questions, but there is sufficient to befound for our purpose in the records of this hospital, andin the labours of many intelligent inquirers in every civilisedland.

It is first to be observed, that the great mass of this evidenceis negative,’ and we may start with this proposition, that allexperience shows, that however the disease of tubercle may befound to predominate in any one class, or to flourish undercertain influences, yet that its universal prevalence in alllocalities, in all occupations, and under very variety’ of physicaland moral conditions to which man is subject, proves that tonone of these circumstances can we with reason refer its in-vasion. It is true that some states of social life may aggravate,and some retard it, but as causes-we might almost say, as

predisposing causes-all such conditions are, when analyzed,found to be insufficient for its production. In other words,you may expose thousands to the same bad climate, the samedepressing occupations, the same social misery, and the samemoral degradation, and the disease shall bear such averageproportions under these, as compared to more favourable cir-cumstances, that it becomes scientifically impossible to arguein favour of any given set of causes as originating or sustainingthis formidable affection. There are, it is true, such deviationsin the mortality as to show us what influences are least pre-judicial to the human frame, and least causative of tubercle;but where neither class, nor sex, nor occupation, nor locality

is exempt from a disease, we are compelled, in scientific im-partiality, to look for other exciting causes.Now, as regards climate, we are aware that no known region

of the earth is free from phthisis. It is found in our WestIndian islands in its most acute and rapid form; it is found inSweden and Norway about in the same proportion; in theAnglo-Saxon countries it prevails in somewhat of the followingorder as regards intensity, measured by its fatality: Scotland,England, United States, and Ireland. It is very fatal inAustralia. It is rapid in all its stages along the southernswamps of the Mississippi. It is prevalent in our Canadiancolonies with their sharp winters and pure air. In Italy, thecountry to which we are in the habit of exporting our patients,it is a disease of universal prevalence, and of great intensity,as I have myself witnessed; it is often "galloping consump-tion," and looked on by the Italians as a contagious disease ofgreat malignity. The figures quoted by Louis from the Englisharmy statistics well illustrate the universal prevalence of thedisease in all climates, and allowing for the uncertainty of allstatistical returns, they may be accepted as very fair evidenceof its relative fatality.In Canada, the mortality from phthisis was 6 per 1000 annually,

The difference to be noted here is very slight, while therange of temperature and the variety of climate is extreme,the prevailing atmospheric influences of the most opposite cha-racter, and the range of latitude very great. If we are to seek,then, in climate for an existing cause of phthisis, we shall be atfault. The remedial effect of climate is another question, whichI shall afterwards notice. Now, what effect has season of theyear on the commencement of phthisis? We reside in a veryfluctuating climate, where the ranges of temperature are verygreat and the changes sudden, and, above all, where moistureto a high degree is found in the atmosphere; and were con-sumption a disease of inflammatory origin, such as bronchitis,we should expect to find that it commenced at those periods ofthe year when the air is most cold and moist, and all the atmo-spheric influences most predisposing to irritation of the pul-monary organs. With a view to elucidating the effects ofseason of the year in inducing phthisis, I examined carefullyinto the history of 487 cases of well-marked tubercle, whichwere under my own care in this hospital, and in which I couldget reliable information, and I found the following results :-

We thus see that the spring and autumn originated by farthe largest number of cases, then the winter quarter, and finallythe summer. Now, the winter quarter, which ranks third inthe list, is the period of the year at which most cases of bron-chitis commence ; when, in fact, the influences of weather andits changes have most effect. The spring and autumn, how-ever, seem to hold the pre-eminence, and the summer stands atthe bottom of the list. As these figures have been preparedimpartially and with care, I think them worth presenting toyou; but allowing even for the deduction that the same seasonwhich produces the highest degree of irritation in the bronchialmembrane only ranks third in the production of phthisis, wemay perhaps say that they rather illustrate my general pro-position, that season of the year, as an originating agent, hasnot much to do with the essential cause which gives birth toconsumption. As regards the season of greatest mortality inphthisis, it has no relation to our subject, and so manifestlybears on other questions, such as the complica’tions of the dis-ease, and the vital resistance made by different individuals,that it has no place in this argument, nor would it be found inany degree to illustrate this discussion.

Next, what has sex to do with the production of phthisis ? Avery good answer to this question is to be found in the factthat Louis states that "it seems difficult to question the fact,that, in France, at least, and more particularly in Paris, phthisisis considerably more frequent in females than in males." Dr.Horne, in his Report of the Royal Infirmary of Edinburgh forthree years, (1834—36,) states that, out of 297 cases, 185 weremales, and only 112’ females; while the first medical report

213

214

from this hospital in 1849, gives 61 per cent. males and 32 percent. females. Again, for the provinces, the Registrar-General’s report is 28 per cent. females, and 24 per cent. males.Thus We have a greater number of females affected in Parisand the country towns of England, and a much larger propor-tion of males in London and Edinburgh. From these numbers,then, there is nothing to be gained with reference to the ques-tion of sex, if it be not that other social causes, dependent onthe aggregation of large numbers of persons together in greatcities, slightly turn the balance against the male sex, and thatslight preponderance is, probably, in the proportion of thepopulation of Paris to that of London.And what shall we say of constitution-of the weak and the

strong habit of body-as predisposing or remote causes of

phthisis? If we refer to authorities, we are met by a mass ofconflicting evidence. Louis says, "that an analysis of hiscases showed that phthisis passed through its stages as rapidlyin strong as in weak individuals-nay, even more quickly inthe former than in the latter;" and further adds, that " hefeels it to be his bounden duty to express his doubt as towhether the popular doctrine, that the weak constitution pre-disposes to tubercle, be true." In this hospital, the dailypractice affords grounds for the same doubt. Did opportunitypermit, I could present to you individuals of the most robustbuild, with large and deep chests, and great muscular develop-ment, who have tubercular cavities in the lung. Their physicalcondition attaches them to the class which I have designatedas " tolerated cavities." " They are, naturally enough, amongstthe out-patients, having no reason to come and reside in ahospital, and they follow their usual occupations with some-what less of vigour than they would have done before thetubercular attack. I may remark here that many such casespresent themselves but once or twice only in the out-patients’department, some coming long distances from the country tohave an opinion, after which we lose sight of them. They are,however, registered, and carefully noted; and I could, per-haps, produce a history, written on the spot, of twenty orthirty such cases, from my books.My colleague, Dr. Cotton, has observed, "I I have seen many

cases of phthisis overlooked, in consequence of a well-formedand, to all appearance, healthy chest, having been deemed in-compatible, not only with the existence of pulmonary tubercles,but even with the tuberculous diathesis. The life-guardsman,the pugilist, the blacksmith, &c., notwithstanding the fully-developed chests which their several occupations induce, are,caeteris paribus, quite as liable to the inroads of phthisis as themechanic or artizan whose daily task leads to the opposite re-sult. "

Now, such is our experience here; and it is at least negativeas far as regards the influence of the weak habit of body. ’

Occupation next stands on our list. Now this is a very im-

portant subject, and I confess that it needs more investigation.I have tabulated the results of an examination into this sub-ject, made by myself from my own cases at this hospital, andas it has been done with care, I offer it as a contribution tothe large and daily increasing mass of statistics which we arecollecting.

Occupations in 652 Cases of Phthisis.

Domestic ......

Servants ....

Open-air pursuits-Gardeners, Cab- tmen, Grooms, &c....... )Needle-workers ......

Labourers ......... ..

Carpenters ......... -.

Shopkeepers .........ShoemakersHouse-painters... -,

Clerks .............Teachers -........

Printer ...Tailors .........Policemen .........

Millers and dusty occupations .

Beershop-keepers .......

Bakers .............Sailors ....._ .......Hairdressers ....... _..

Soldiers ......Glassblowers ......... ,

Butchers ..........

You will observe, from the table, that I have noted 652 cases214

of phthisis. They were all well marked, and I have excludedfrom the list those on which there was any doubt as to thenature of the affection. It is remarkable, from this, that thedomestic, homely, and sedentary occupations vastly outnumberall the rest ; for if we throw together the domestic cases (orthose who are attending to household concerns, and who are.generally females in a class of life which demands that theirtime shall be spent with their families indoors) and the ser-vants, needle-workers, those occupied in shops, tailors, shoe-makers, and clerks, we shall find that they amount to 393 outof 652, or more than one half the entire number-seven occu-pations furnishing this result, out of a total of 22. I shall haveoccasion to notice again how this fact helps us towards a solu-tion of our question of the nature of phthisis, and will onlystop here to remark that sedentary pursuits imply two thíngspre CTTMHeMy——M.’CM of fresh air, and a minimum of muscularwaste and renewal. It is also important to observe, what hasoften been remarked here, that butchers are singularly exemptfrom phthisis. In my table only one appears, and when weconsider that this class is remarkably supplied with abundanceof animal food, which they generally consume twice or thricea day, that their shops are open to the air, and that their busi-ness necessarily requires much exercise and driving about, wemay gather how important an influence a highly-stimulatednutrition, and these conjoint conditions, exert in opposition toany chronic disease. Dr. Copeland says that he would adviseany one threatened with phthisis to become a butcher ; norcan we wonder at this when we remember the well-fed speci-mens which may be seen in this metropolis, in their shops. Itis fair to state that this opinion is opposed by Louis, who says,"that out of thirty phthisical cases, only twelve had been

, badly nourished, and eighteen had been well-fed ; yet the dis-’

ease occurred at almost identically the same period in both-a result which" (he says) " afforded me no small surprise." Inreply to this we may observe, how limited was this experienceas compared with that which we can offer here !

The influence of anxiety, the depressing passions, of socialmisery, of a life of seclusion from the healthy stimulus of

society, of habitual intoxication, of chronic indigestion, and ofa number of other causes allied to these, is recognisable inmany of our cases, and will ever form a subject of deep studyto the scientific physician in his investigations into the originand indicated treatment of every individual case; but untilwe can ascertain that these causes tend to produce phthisismore than other chronic disease, we are much in the dark re-specting their influence and their import in connexion withconsumption. But it may be remarked, that they are causeswhich, as a class, affect the vitality of man, the nervous con-trolling power which presides over organic life, and that theyare intimately connected with the last changes which elevatealiment into tissue, and with the functions of secondary assi-milation which lie at the root of organization. They are of

deep importance, and are receiving daily more attention; andin this hospital we are, I trust, accumulating materials for theirelucidation, but their consideration is outside our present

object, and the limits of a lecture would but feebly outline thetruths of which we are in possession regarding them. So far wemay state, that our present knowledge is insufficient to classthem as originating causes of tubercle; that the same con-ditions will produce other widely different affections; and thatwhile this is the case, it would be incorrect to attribute muchvalue to them as causative agents. Phthisis may be found,and is found, in the well-ventilated, well-warmed, and luxuri-ous dwellings of the rich, where food of the best kinds is un-limited, and where hygienic measures are the rule of daily life.It is a mistake to suppose that over-luxury involves, now-a-days, so many breaches of sanitary laws as it formerly did.The truth is, that our middle classes are in the most favour>able condition for health, and extreme cleanliness, good food,regular exercise and sleep, and yearly changes of air, are thehabits of thousands in this metropolis. Are they exempt fromphthisis? Or, can we select the numerous cases which occurin this class and assign to them their predisposing cause in thebreach of any hygienic law? If we know anything whichwealth can buy it is this-the timely and prudential require-ments which, in the form of wholesome food, fresh air, andfrequent changes, may assist the vital energies of the delicateand scrofulous child; but with every resource which moneycan command, can we always, or even often, succeed in ourobject?To select from our professions those which seem most prejn-

dicial to health is indeed not difficult, but we want here thelarge statistical numbers which such institutions as this supply.Yet, perhaps, if we said that the clergy and our own profession

215

hold the first places in the fatal list, we should not be farwrong. And if we argued from this, that those who are hardestworked in the great struggle of life, and whose energies andfeelings make daily demands on the vital power of which Ihave spoken-while their bodily exertions are often pushed tofatigue-are undergoing the conditions most favourable to theproduction of tubercle, we should not greatly err. It has been

remarked on this subject, that the main element of success

in professional life in London is health for the first fifteen

years. These are the fatal years-the fatal period of life asregards phthisis, when the inherited taint, or the disorderedblood, leaves the system unequal to the requirements of hardwork of mind and body. Why are they the fatal years ? Theyare the period at which the waste and repair of the tissues is

most active; when growth has ceased, but nutrition should bein the greatest vigour as a sustaining agent of the animal sys-tem. They stand intermediate between the mere perfectingof the vital machine and the time when organs which havebeen fully worked repose, as it were, and permit of an accu-mulation of the material of the fabric. The deposit of fatwhich takes place in most men after forty years of age, marksthis transition. The stage of growth is eminently fatal in thephthisical habit; the nutritive period second in danger; andmiddle life to age constitutes the third, and least dangerous.All statistics, in every climate and under every physical andsocial condition, tell this story; and we can learn many deeptruths from a study of these successive periods and this

sequence of processes in the animal history.Now this cursory view of the influence of predisposing causes,

however it may fail to account for the tubercular crasis, has animportant bearing on our proposition, that phthisis is essentiallya systemic disease-that its origin is not local, but connectedwith the most deeply-seated vital processes. Let us look nextat the evidence relative to its origin from local inflammatorycauses. There is no reason -to believe that a simple catarrhleads to phthisis. Its commencement, at the season of the yearwhen bronchitis is most commonly at its minimum, as shownby the tables before referred to, is opposed to this view. Be-sides, the cough is not the earliest symptom, and there may bea consumption without any cough.eM;’My, with eiMsion, often leads to tubercle, now in the

affected side, and occasionally in the opposite; but this is anexception. Out of 200 cases of pleurisy observed by Louis, notone left behind any trace of tubercle. And so of pneumonia;out of 72 cases recorded by Grisolle, only four had previously-years before-had inflammation of the lung. That inflamma-tory symptoms arise in the course of phthisis is undeniable, butthey are rather congestive than active, and leave no traces afterdeath of true inflammation of the proper lung tissue. Thelocal complications of phthisis are generally pleural, and tend toinsulation of the disease, when limited, as it commonly is, tothe parts near the deposit.

(To be continued.)

HEALTH OF LONDON DURING THE WEEK ENDINGSATURDAY, August 16.-The inhabitants of London are not inan average state of health. 1250 deaths were registered in theweek that ended on Saturday, August 16th, whereas the cor-rected average of the corresponding eight weeks of previousyears, when cholera was not epidemic, is 1127. In the secondweek of August 1849 and 1854, cholera was epidemic, and thedeaths amounted to 2230 and 1833. Summer cholera nowprevails to a slight extent, and was fatal in 22 cases; diar-rhaea was fatal in 253 cases. 242 children died of these dis-eases under the age of 10; 11 of the adults were under 60years, and 22 were 60 years and upwards. Of 1250 per-sons of the various stated ages, 760 were under 20 years ofage; 150 were of the age 20-40; 145 were 40-60; 156 were60-80; 39 only were of the age of 80 and upwards. 620 of thepersons whose career was cut short under 60 years of age diedeither of zymotic diseases or of diseases of the respiratoryorgans and consumption. These diseases are natural to man,but their ravages are greatly aggravated by the physical im-purities of the atmosphere seen from a distance hanging in acloud over London.The meteorology of the week underwent great changes. The

barometer stood at 29 ’763 in. on an average. The mean tem-

perature of the air was 66’9° during the week; it was 69’3 onSunday, 71’1° on Monday, and fell gradually to 62’5° on

Saturday. The highest temperature of the air in the shaderose to 87 ’0° on Monday. The lowest temperature of the air48.5° was observed on Saturday night. The thermometer inthe sun rose every day to 100° and upwards, attaining 1055°on Wednesday. The temperature of the Thames was 70.4°.

ContributionsTO THE

PHYSIOLOGY, PATHOLOGY, AND TREATMENTOF

SPERMATORRHŒA

BY MARRIS WILSON, M.D.

PART I.

IN bringing before the notice of the profession the subjectof Spermatorrhcea, some curiosity and regret must be felt

that, according to the sentiments hitherto expressed with re-spect to this disease, it has been generally thought necessaryto commence with an apology. When so little was known ofthe pathology of the malady, this proceeding might have beenperhaps excusable; but I now intend to adopt a differentcourse, and, on the contrary, demand for my subject a con-sideration, which the acuteness of its symptoms and the im-portance of its results, deserve. Were I to look for the causeswhich have kept our knowledge of this disease at so low anebb, as up to the present time has undoubtedly been the case,I should find them probably in the obscurity of the physio-logical and pathological conditions in which the functions of thevarious organs of generation have been allowed to remain, andthe difficulties in the way of research, that have left unexplainedthose phenomena which are known.The absorbing question of the physiology of generation has

naturally attracted more of consideration than the mere patho-logical condition of the organs whence that generation emanates,since in relation with that great function it bears only a kindof mechanical connexion.

Generation has been viewed usually as depending upon thefulfilment of certain functional attributes, of an apparatus com-posed of different parts, but entire and single in its action. Onthe contrary, a careful examination will teach us that the sepa-rate portions of this one great system have a distinct and in-dependent functional capability, consentaneous, it is true, in ahealthy state, but in one class of diseased conditions, exertingtheir specific actions independently and with abnormal activity,while in others they are more or less completely deprived bothof functional and structural force. The truth of this statementis open to demonstration by a careful examination of the rela-tions of the organs, such as Nature has displayed them by herevidences in comparative anatomy, as well as in the remarkableconsequences which have been well known to result from par-ticular diseases, and from some surgical operations.

I was led, indeed, in the first instance, to form this opinionfrom the effects produced on a patient who had submitted tothe removal of both his testicles, for the purpose of eradicatingthe disease. As I have more particularly detailed this case inmy work which I have recently laid before the profession, I shallonly take a cursory glance of it, sufficient to elucidate myposition.Mr. A- suffered early in life from spermatorrhoea, brought

on by evil habits acquired at school. For remedying this, heplaced himself successively under almost every system of treat-ment, reasonable and unreasonable, which was in any waybrought under his notice, and, in the end, without derivingpermanent benefit. Not until after a great struggle, how-ever, he arrived at the conclusion, that the only chance oferadicating a disease which rendered life hateful to him, was bythe removal of at least one half of the set of organs, which atthat time was considered as the basis of the affection.

This bold treatment did not arrest the malady for anylengthened period, for as soon as the irritation occasioned bythe operation ceased, the emissions returned. Lallemand’splan of cauterization was then resorted to, but without avail;and as he had adopted the notion that removal of the testiclewas the only prospect of radical relief, the second testicle wasamputated at his particular request. For a few weeks onlydid this most heroic treatment succeed in its object, for at theend of that term the emissions reappeared, making the unex-pected fact stand out clearly, that to the testicles alone wasnot to be attributed the disease for which he had sacrificed somuch. The emissions did eventually disappear under a courseof issues in the perineeum, applied with the purpose of removingover-action ef the vesioulte seminales. The phenomena attend-

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