519

they take up, and the liver, receiving more blood, would be liable
to congestion. M. Bernard has shown that there is a peculiar Hospital Reports.
provision for preventing this engorgement: he has demonstrated
that the blood is carried direct from the portal vein into the cava SOMERSET COUNTY PAUPER LUNATIC ASYLUM.
by appropriate vessels, without passing through the capillary Two Cases of Scurvy.
system of the liver. These vessels are situated much below the Reported by ROBERT BOYD, M.D., Physician and Superintendent.
venæ,hepaticæ, and where the texture of the liver adheres to the
inferior cava. The existence of these veins has been clearly ScuRvy is now seldom seen in
shown in the horse. These vessels, by which the venous blood ordinary hospital practice,in
of the abdomen communicates with the general system, and this country, except in the hospital ship Dreadnought, where
which may be looked upon as a kind of diverticula, are intended sailors from foreign vessels are received. It has occurred in
to,facilitate the action of the liver, and prevent the engorgement some instances in our prisons, and in lunatic asylums in India.
of that organ, which engorgement would interfere with the work The late Dr. Prichard, in his Treatise on Insanity, p. 149,
of secretion. mentions it as occurring in the advanced stage of lunacy.
But the heart is likewise preserved from congestion by the We read of it in former times, as so destructive to navies and
that frequently half the men fell victimsto it; and
following phenomena :-The blood, under certain circumstances, armies,
after having traversed the liver, does not pass wholly through even a century ago, Anson was obliged to remain four months
the heart; it descends again into the inferior cava, after it has at the Island of Juan Fernandez, to recruit his crew, having
left the vense hepaticae, and flows into the renal veins. It is, only six foremast men of a crew of 470 able to do duty; one
his ships had lost eighty men in a month from this direful
indeed, difficult to conceive, that when a horse which has been of disease.
kept long without drinking takes from fifteen to eighteen pails of Our great circumnavigator, Cook, proved that by strict
water,.the whole of the liquid passes through the heart. Hardly attention to the diet of his men, and the state of his ship, he
a fifth of it takes that direction, and the other four-fifths take
could keep his crew in the highest state of health, in all
the course just described. This mechanism is to be noticed
climates; still, so slow were the naval authorities to adopt
principally with those animals which take a large amount of food
of slight nutritive qualities. Parts are disposed in the following his principles or to make any change, that scurvy continued
to be the scourge of the navy for fifty years longer, and sailors
manner in this extra circulation: the portal vein has the same
coats as the other veins, but its hepatic subdivisions are sur- by hundreds and thousands continued
to be its victims. So
rounded by a loose tissue called the " capsule of Glisson," and late as the year 1790, we read of 2400 sailors of the Channel
sucha disposition must of course facilitate the passage of the fleet being laid up with scurvy.
This disease is attributable to errors in diet, where vege-
blood; whereas the hepatic veins are closely connected to the
substance of the liver, and have an evident muscular texture. tables, particularly of
the class Cruciferae, such as cabbage,
The fibres are longitudinal; they thus retract upon themselves, turnips, cress, have been entirely excluded. The two following
cases occurred in persons of feeble constitution, they are
and carry the structure of the liver in the same direction. These
veins do not contract, but they become shorter, the object of I examples of scurvy resulting from a continued diet of bread
and cheese, and are worthy of attention, as this is a
this action being, to render the circulation more active as the
liver gets congested. The muscular structure is especially principal is food of the labouring classes of this country.
remarkable as having happened when a plentiful
noticeable in the inferior cava, the muscular parietes of which The first of cider was
are almost as strong as that forming the auricles. The contrac-
allowance taken, which is supposed to be anti4
the second is to be noted as showing that in three
tile fibres begin below the hepatic veins, and terminate imme- scorbutic; months a person may become affected with scurvy by abstain-
diately above the renal veins.
M. Bernard showed the inferior cava of a horse where the ing from vegetables, and taking one meal of bread and cheese
above-named structure seems to constitute another heart, and to daily. And they may both warn us how necessary it is that
be the starting point of another circulation. The vein, in fact, we should caution in yielding to the whims of the insane’,
use

presents pulsations when in the act of driving the blood back-
wards. In order that the latter, when forced downwards by the
contractions of the inferior eava, may enter the renal veins, there
are, below the latter, little valves which prevent the blood from
entering the iliac veins, the blood being forced to pass through
the renal veins, which vessels then assume the characters of
arteries. This hepatico-renal circulation is not constantly going but did not act in accordance with his
on. When a man is fasting, for instance, the amount of blood
reaching the liver is inconsiderable, and it passes altogether
through the hepatic veins and the heart. The arterial blood of
the kidneys experiences the ordinary pressure, and the renal
secretion is limpid, acid, and contains much urea. But things go
on differently during a plentiful digestion; for the blood, taking
a shorter course, is carried in great quantities to the kidneys,
which organs quickly free it from its more fluid parts; the urine
then increases, becomes dull, alkaline, gives saline precipitates,
and very little urea.
The lumbar and azygos veins prevent obstruction in the in-
ferior cava, and are intended for the conveyance of the blood
from the lower extremity and the pelvis to the auricles. Birds,
4shes, and reptiles, have a renal portal vein, by which a certain
quantity of blood passes directly through the kidneys, whilst
another quantity passes through the lungs. Prussiate of potash
is eliminated by the urine five minutes after ingestion; but
Doering, having introduced this salt in the lower portion of the
jugular vein, observed traces of it in the upper part of the same
vessel only thirty minutes afterwards. This difference led
physiologists to suspect that there must be unknown means of
transit for the rapid passage of fluids to the urinary organs, and
M. Bernard has the merit of having shown by which vessels this
circulation is carried on. We recommend these views of a young
and eminent physiologist to the attention of our readers, and
sincerely hope that the subject will be thoroughly investigated in
this country. The matter is of sufficient importance to deserve
attentive consideration. We regret that want of room precludes
our giving a sketch of the experiments by which M. Bernard
strengthens his theory. It should, however, be noticed, that he
concludes his investigations concerning the functions of the liver
by.endeavouring to prove that the hepatic circulation is one of£
the causes of the evolution of animal heat.
particularly in those who are prone to persist in the use of an
improper diet.
CASE 1.-J. A-, aged fifty-nine. Had been nine months
in another asylum, whence he was transferred to this in March,
1848. He had been a farmer. The cause assigned for his
derangement was loss of property. He fancied himself a king,
kingly assumption.
His disposition was suspicious, temper stubborn, complexion
sallow, pulse seventy-six, tongue clean, skin cool, bowels
constipated. It was stated that he had lived exclusively on
bread and cheese; he obstinately refused any other food after
admission here, and it was supplied to him for breakfast,
dinner, and supper, with nearly a pint of cider at each meal.
In six weeks he complained of pains, which were worst at night,
with swelling of the right knee and leg, for which he was sent
to the Infirmary. After a few days, the swelling somewhat
subsided, but the pains continued. He could not be induced
to take medicine or to alter his diet. His appetite gradually
became bad; he passed sleepless nights, and always felt chilly.
In three weeks after he was sent to the Infirmary, he was so
weak as to be unable to leave his bed. There was
extensive
ecchymosis of the right leg, which was painful, and the swelling
had increased; the gums were swollen, livid, and bleeding.
He was now induced to take drauglits containing citric acidl
quinine was also given, eggs, and other nourishment in a fluid
state; and in a week afterwards, symptoms of amendment
appeared. The swelling diminished, the mouth was still sore.
As as he was able to chew, fresh meat and cabbage
soon
were given to him; he seemed to be aware of his dangerous
state, and became tractable. The improvement continued,
and in nine weeks after the appearance of the disease, he was
able to walk about. His mind also improved. He was soon
afterwards discharged, and has since been living at home.
CASE 2.-A. L----, aged thirty-eight; reported as having
been insane three years; had been six months in a private
asylum about two years before admission here. Her conduct
was obstinate, and occasionally violent; spare habit; sallow
complexion; in indifferent health; pulse 78; tongue clean; skin
hot; appetite good; bowels constipated; averse to take exer
cise ; generally occupied at needlework. After some months’
 520
residence, she refused to eat the meat and vegetables provided position of that uncertain starting point mentioned in a letter
for dinner, and expressed a wish for bread and cheese, which of Dr. Carpenter’s, "an average man:’ He proceeds thus :-
was given to her daily, at the same time continuing the usual
breakfast and supper of tea and bread-and-butter. In about
"
I should like to know, in the first place, what Dr. Car-
three months’ time, the left leg and thigh became black and penter means by the phrase average man,’ which he has
swollen from ecchymosis, presenting the appearance of a adopted; a very vague phrase indeed for a philosopher. I know
bruise at first sight, but which was very soon recognised as what is meant by average duration of life when called upon
scurvy, from its striking resemblance to the former case, as to certify for an assurance company; and used to know what
well as by the livid and swollen state of the gums. There was was meant by average price of grain in the days of the
a white margin round the teeth; the inner part of the lips was sliding-scale; but what to understand by ’average man’ I
pale ; the surface of the body cold; pulse 84, feeble; eyes know not. This I know, however, that the averages were
sunken, with an anxious expression. An acid mixture, with more than suspected to be tampered with, in the days of the
bark, was administered, and fresh meat, with cabbage or sliding-scale, by interested parties; and I can readily foresee
turnip-tops, daily. In ten days afterwards a marked improve- that humanasaverages will be tampered with by interested
ment had taken place, ecchymosis disappearing, and the gums parties; if, Dr. Carpenter has decreed, the average man
improving, and in a month she was convalescent. must have no drink; for it is well known that these pernicious
alcoholic liquors are very agreeable to take, and that absti
nence from them requires very strong exercise of self-
denial."
Reviews and Notices of Books, Dr. Chadwick, in contending for the necessity of a certain
AND ALSO amount of stimulus, holds, however, to the instructions given
Analyses of Papers inManuscript to Phaeton, when assuming the reins of the horses of the sun:.
SENT FOR PUBLICATION IN THE LANCET.
in medias res tutissimus ibis, and seeks, in conclusion, to im-
press the great importance of his conviction, that
On the Structure of the Membrana Tympani in the Human " Medical men ought in practice always to bear in mind the
Ear. JosEPH TOYNBEE, F.R.S., Aural Surgeon to St. narcotic action of alcohol. For example, when a man’s
By
Mary’sHospital. strength is reduced by sickness or overwork of mind or body,
WE have already given an abstract of the principal part of it is customary to advise him to take the benefit of change
of in so to derive good from pure
the investigation, but in the appendix to the present publica- air,air; expecting him,cheerfuldoing, and rest of mind. Now
pleasant scenery, society,
tion we observe that Mr. Toynbee has recently made an all the benefits he derives from these things he gets through
important addition to our knowledge of the anatomical struc- his nervous system, and if he blunts the susceptibilities of
ture of the drum, of which the following is a short descrip- that system by taking too much wine, or by taking it out of
tion. season, he defeats his own object.
I have believed for some time that the narcotic action of
"Between the epidermoid and radiating fibrous layers of alcohol is overlooked
the membrana tympani, there is distinct and by the public, and in a degree also by
a complete the profession; and it was in order to awake attention to it
lamina of membrane which is continuous with the dermoid that I
published an essay some sixteen months ago. I found,.
layer of the meatus. The presence of this membrane, to as I stated in the preface, that this part of its action was quite
which, account
on of its structure and functions, I have given lost sight of in common temperance literature; and likewise
the name of dermoid layer, is best demonstrated by carefully in an article by Dr. Carpenter, in Dr. Forbes’ Review, on the
dissecting, under water, the membraneous meatus from the subject, in which he says: ‘It appears, then, that the physio-
upper surface of the osseous tube, as far as the attachment of logical influence of alcohol upon the system under all ordi-
the membrani tympani; at this point the periosteum of the
meatus is seen to become continuous with the radiate fibrous nary circumstances, cannot be attributed to anything else,
than its stimulant character, and though he has since admitted,.
lamina; this being cut through, the dermoid layer is seen at section 14 of his prize essay, the narcotic influence of
passing down over the outer surface of the radiate fibres, and alcohol, he does not seem ever to have allowed this fact ta
separating them from the epidermis. If the upper portion of before his notice."
this layer be drawn gently downwards by one hand, by means come fairly
of a fine needle in the other, the delicate cellular tissue con-
necting it to the fibrous lamina can be broken up, and it may
be removed entire. The presence of the dermoid lamina may New Inventions
also be shown by the introduction of a fine bristle between it
IN AID OF THE
and the radiating fibrous layer, at the superior part of the
membrana tympani, and then by passing it down, the cellular
tissue is lacerated. In a healthy state, when uninjected by blood PRACTICE OF MEDICINE AND SURGERY.
or by artificial means, the dermoid lamina is thin and transpa-
rent ; examined by the microscope, its structure is found to AnPersons Apparatus for Adnzinistering 2V-ou2-ish?7zent to Insane
who refuse Food. BYJOHN FOSTER REEVE, Esq.,
resemble areolar tissue. When injected, this membrane is
observed to have numerous bloodvessels ramifying through it, M.R.C.S.E., Kensington.
and they form an elaborate plexus; when these vessels are MR. REEVE, who is the resident medical officer at Kensington
enlarged, they give the red appearance to the surface of the House, remarks:-
membrana tympani which is so frequently met with during
life. It is upon the supply of nerves to this membrane that "One of the common difficulties embarrassing the medical
the exquisite sensibility of the membrana tympani depends. practitioner in his treatment of the insane arises from the
A knowledge of the existence of the membrane here described invincible determination to refuse sustenance, which dis-
is of interest to the anatomist, who recognises in it the tinguishes a certain class of lunatics. This peculiarity we
secreting organ of the epidermoid layers of the membrane cannot explain by reference to physical causes, especially
tympani; and to the surgeon, whoin by its presence is able to when no evidence exists of disease or derangement of the in-
understand phenomena occurring certain diseases of the ear ternal organs. Suchabstain patients generally labour under par-
from food with a suicidal inten-
which have been hitherto incomprehensible to him. ticular delusions, or
tion ; and although the majority of these unfortunate cases
terminate fatally, notwithstanding our utmost care, they must
not be abandoned as altogether hopeless; for if a certain
The Merits of Teetotalism and Partial Abstinence. By JOHN amount of nourishment is administered
CHADWICK, M.D. Edin., Bury, Lancashire. 12mo, pp. 17. most unfavourable circumstances, it may daily, even under the
THE LANCET Office. prolong life suffi-
ciently to afford time for the delusion to alter its character,
AN essay, bearing, as its name implies, upon the subject of or pass away entirely, or in suicidal cases to overcome the
the relative merits of partial and total abstinence from propensity to self-destruction.
alcoholic fluids in their relation to the vital forces. The Amongst the various methods used for feeding insane
author, feeling the patients, the stomach-pump has been very generally adopted,
necessity, under certain circumstances, for a and judged effectual; but the operation of pumping is not
due administration of stimulants, seeks to ascertain the true
always unattended with danger. Dr. Conolly altogether de-