XIII.

Case of Preternatural Anus, found in a Portion of Ilium protruded at the Umbilicus. By J. PEAKE, Member of the Royal College of Surgeons, London.

E I. was delivered by me on the 1st July 1810, of a male child, in appearance healthy, and of a size as large as most children, after the full period of the utero-gestation.

At the time of its birth, my attention was much excited by the appearance of a tumor at the umbilicus, somewhat larger and longer than a walnut, and the cuticle from the abdomen growing over it, to the extent of about the fourth part of an inch. At the upper part of the tumor, the umbilical vessels were passing, and seemed altogether distinct from it. *Around them a ligature had been passed, and tied in the usual manner, at a part of the funis where its size was natural; about three or more inches, I should think, from the umbilicus.

Upon examining the tumor, it had the appearance of a protruded portion of intestine, within the umbilical cord; and at its lower part I could observe a fissure, but which, at the moment, I neither discovered or suspected to be pervious. Soon, however, after I left my patient, the women in attendance noticed something passing from it, of a thin consistence and dark in colour, which, no doubt of it, must have been the meconium.

Soon after its birth, the child was sick, vomited frequently, and was at times, until its death, which happened between two and three days after, much convulsed. What food was given it was either directly brought up again, or it afterwards passed at the aperture at the navel. Nothing seemed to pass along the regular course of the intestines. Just before its death, however, there was a discharge from the anus, of a small quantity of meconium, together with a little slimy mucus.

Upon dissection, I found that the passage from the stomach, along the course of the alimentary canal, to the protrusion at the umbilicus, was perfect, and the intestines so far of their natural and healthy appearance. But this was no longer the case after they had passed the umbilicus. A portion of the ilium was there protruded, in which was the aperture already described. From this there was an indirect communication along the course of

the intestines; but the orifice of the gut, in continuation, was much smaller than at its termination in the protruded portion at the aperture; and it was so situated to the one side the gut, at the same time twisting suddenly downwards, that nothing could readily pass. From this the intestines, along their whole course, were very much diminished in size, and both cæcum, colon, and rectum, were considerably smaller than the small intestines. Chipping Ongar, Essex,

22d November 1810.

XIV.

Appearances upon Dissection of two Dogs, which were killed while labouring under Rabies Canina. By J. PEAKE, Member of the Royal College of Surgeons, London.

IT

T is now about three years ago that the inhabitants of this neighbourhood were continually alarmed by the appearance of mad dogs among their cattle, and which, in several instances, did considerable mischief. One farmer had three of his cows bitten, and was afterwards obliged to kill them, while labouring under the disease. Several similar incidents occurred also at different places about this time; but I did not understand that the disease was communicated in any one case to the human species. One of the dogs being at length killed, I procured him afterwards for the purposes of dissection. But before I proceed to notice, more immediately, the appearances observable after death, it will be right, perhaps, to mention the extent of his depredation here, which led to a suspicion that he was mad, and consequently to his being killed.

The dog was observed, by a gentleman on horseback whom he had followed for the distance of two miles, to snap at, or bite every animal that came in his way; and he was seen to do this by many persons as he passed through this town. A large Newfoundland dog was the first he attacked, (this animal went mad and ran off about three months afterwards, and was killed.) He then bit a horse in the nose, and snapped at another Newfoundland dog which was running by the side of the horse, but his teeth could not be seen to have penetrated the skin. In the horse, the parts were immediately extirpated and cauterized, and he

has never been affected with the disease; the dog also has remained well. He snapped at several others, but no one of them except the Newfoundland dog above mentioned went mad. He was at length killed, after running some few miles further, and had been dead several days before I could procure him. From his emaciated appearance, he had run, I should think, a considerable distance, but from whence I could not ascertain, nor could I learn any further particulars than what have been recited.

I had been lately taught, that the seat of this disease existed in the mucous membrane of the stomach and oesophagus; these parts, therefore, alone, I minutely examined.

Upon opening the stomach, I found it nearly empty, containing, however, a little short oat straw, some dirt or grit, and a small quantity of the gastric juice. The mucous membrane itself appeared red and inflamed at different parts, as well in the stomach as in the oesophagus. The intestinal canal was for the most part empty, and of its natural appearance. In the rectum, there were some hardened feces, exceedingly fetid and offensive, and looked somewhat like earth, being gritty and of that colour. A small portion of it was, as is already stated, contained with the straw in the stomach.

I had, soon after this, a second opportunity of examining another dog, which had been killed while labouring under symptoms similar to the one in the aforementioned case. This animal had bitten a horse and several dogs; the latter (except one, and that went mad about five weeks afterwards), were immediately destroyed. In the horse, the parts were directly extirpated and cauterized, and he still remains well.

I inspected this dog the day after his death, and upon opening the stomach, found it to be much distended with pieces of straw, hair, (which I suppose he had bitten off other dogs, and swallowed) and some grit or earth. The mucous membrane appeared slightly red and inflamed, generally; but at that extremity of the stomach, near to the pylorus, was a large spot about the size of a shilling, of a greenish appearance; a narrow line, also of the same colour, was seen extending upwards, and both I think resulting evidently from inflammation which had existed there. The oesophagus was of its natural and healthy colour. At the back part of the fauces, was a good deal of frothy liquid, and the intestines were much more full than in the other cases, containing feces of a thin consistence and bilious colour, Chipping Ongar, Essex,

Nov. 22d 1810.

MEDICAL EXTRACTS, No. IV.

The Croonian Lecture. By WILLIAM HYDE WOLLASTON, M.D. Sec. R. S.

TH

HERE is certainly no source from which we can borrow our Medical Extracts with so much advantage to our readers, as the transactions of those societies of learned men who have been appointed for the purpose of promoting the advancement of science and literature. Among these the Royal Society of London stands pre-eminent, both for the intrinsic value of its publications, and the regularity with which they appear. The great expense, however, of their volumes, and the very remote connexion which a large portion of them has with our science, prevent them from being generally in the hands of medical practitioners; and yet there is not a volume which does not contain much valuable information immediately interesting to us. Of some of the papers in which this is contained, a very short notice, or analysis, is sufficient, or a critique may be necessary; but others do not easily admit of condensation or argument, and require to be borrowed with very little abridgement. Of this nature are the second and third parts of Dr Wollaston's Croonian Lecture.

The first part treats of the Duration of Muscular Action. He conceives every effort, though apparently single, to consist in reality of a great number of contractions, repeated at extremely short intervals. He was led to infer this, from the sensation resembling most nearly the sound of carriages at a great distance, passing rapidly over a pavement, excited by pressing the point of the finger into the ear, when the finger is kept rigid by the

extensor muscles.

The second and third parts we extract entire.

"Part II. On Sea. Sickness.

"The second remark which I have to offer to the Society, relates to sea-sickness, the cause of which has not hitherto been fully explained; and although the explanation which I am about to propose, may not appear altogether satisfactory to persons who, when at sea, are also rendered giddy by the incessant motion of the waves, and are consequently liable to consider as cause and effect phenomena which in their minds are constantly associated, yet the observation on which it is founded may deserve to be recorded, on account of the degree of relief that may be obtained in that most distressing affection.

"After I had been harassed by sea-sickness during a short voyage for some days, and had in vain attempted to account for the difference between the inexperienced passenger, and those around him

more accustomed to the motion of the sea, I imperceptibly acquired some power of resisting its effects. and had the good fortune to observe a peculiarity in my mode of respiration, evidently connected with the motion of the vessel, but of which, in my then enfeebled state, I was unable to investigate either the cause or consequence. In waking from a state of very disturbed sleep, I found that my respirations were not taken with the accustomed uniformity, but were interrupted by irregular pauses, with an a pearance of watching for some favourable opportunity for making the succeeding effort; and it seemed as if the act of inspiration were in some manner to be guided by the tendency of the vessel to pitch with an uneasy motion.

"The mode by which I afterwards conceived that this action could primarily affect the system, was by its influence on the motion of the blood; for, at the same instant that the chest is dilated for the reception of air, its vessels become also more open to the reception of the blood; so that the return of blood from the head is more free than at any other period of a complete respiration. On the contrary, by the act of expelling air from the lungs, the ingress of blood is so far obstructed, that, when the surface of the brain is exposed by the trepan, a successive turgescence and subsidence of the brain is seen, in alternate motion with the different states of the chest. It is probably from this cause that, in severe headachs, a degree of temporary relief is obtained by occasional complete inspirations.

"In sea-sickness also, the act of inspiration will have some tendency to relieve, if regulated so as to counteract any temporary pressure of blood upon the brain; but the cause of such pressure requires first to be investigated.

"All those who have ever suffered from sea-sickness (without being giddy) will agree that the principal uneasiness is felt during the subsidence of the vessel, by the sinking of the wave on which it rests. It is during this subsidence that the blood has a tendency to press with unusual force upon the brain.

"If a person be supposed standing erect upon deck, it is evident that the brain, which is uppermost, then sustains no pressure from the mere weight of the blood, and that the vessels of the feet and lower parts of the body must contract, with a force sufficient to resist the pressure of column of blood, of between five and six feet from the head downwards.

"If the deck were by any means suddenly and entirely removed, the blood would be no longer supported by its vessels; but both would fall together with the same velocity, by the free action of gravity; and the same contraction of the vessels which before support. ed the weight of the blood, would now occasion it to press upon the brain, with a force proportional to its former altitude.

"In the same manner, and for the same reason, during a more gradual subsidence of the deck, and partial removal of support, there must be a partial diminution of the pressure of the blood upon its vessels, and consequently, a partial reaction upon the brain, which would be directly counteracted by a full inspiration.