mally, since that irregularly. In summer, 1857, she became ill, with feverish symptoms, dyspnea, stitches in the right side of the thorax, and cough, with mucous expectoration. The fever and stitches continued twelve days; after the expiration of this time she recovered perfectly, and after four weeks returned to her former employment; but, after violent bodily exertions, she would suffer from difficult breathing. In the year 1859, she became pregnant; her pregnancy and labour were normal; her recovery after her confinement was interrupted by an attack of partial peritonitis, which obliged her to remain in the hospital for four weeks. At the middle of September, she returned to her employment; but on the 14th October, 1859, again became ill, with symptoms of fever, pain in the right side of the chest, dyspnoea, and teasing cough, for which after six days she was readmitted into hospital. When admitted, she appeared middle-sized, small-boned, the muscles badly developed, the subcutaneous cellular tissue poor, the integuments pale, dry, hot; the right side of the chest remarkably longer and narrower than the left; the respiration quickened, during which the left intercostal spaces were plainly contracted, and by forced respiration this side of the chest was more raised; the percussion sound on the left side anteriorly, from the clavicle to the fourth rib was clear, from this to the sixth dull, and from that downwards tympanitically clear; the heart's dulness reached to near the left nipple. On the right side, anteriorly, the sound from beneath the clavicle to the third rib was clear and tympanitic, then it became dull, and passed at the fourth rib into a perfectly dull sound; the same description applies to the axilla. On this side the dull sound, beginning in the region of the nipple, extended from the angle of the ribs downwards as far as the anterior superior spinous process of the ilium; in the median line, as far as half an inch above the navel. Percussion of the back yielded on the left side, from above downwards, the normal clear sound; on the right, in the upper parts it was somewhat dull, became then at the height of the third dorsal vertebra perfectly dull, and continued so downwards. Auscultation gave, on the left side, rough vesicular breathing; on the right, above, as far as the third dorsal vertebra, indefinite inspiration, with corresponding expiration sounds; from this downwards, the respiration sounds became weaker, and at the fifth dorsal vertebra disappeared entirely. The heart's impulse was clearly perceptible under the nipple, between the fifth and sixth ribs; the sounds of the heart and large vessels normal; the arteries small, pulsation 120; the abdomen sunken yet on the right it was somewhat more arched; palpation detected, corresponding to the dull percussion sound in the line of the nipple and in the median line, the deep-seated curved border of the liver; the spleen normal; the secretion of urine scanty; bowels confined; the patient felt herself weak, complained of stinging pains on the right side, showed little appetite, and had great thirst. The diagnosis was relapsed pleuritis of the right side. She was ordered an infusion of digitalis, which was stopped after four days, on account of the diminution of the pulse. From this time her appetite returned, and the pulse became perfectly normal; and a suitable diet, and the use of seltzer-water, were ordered. After eight days' use of this, a copious diuresis occurred; in twentyfour hours there were 2500-3000 cubic centimetres of urine passed. From this forth her appearance improved, her strength returned, and the difficulty of breathing disappeared. Notwithstanding the continuance of the improvement in her appearance and strength, shooting pains in the right side of the chest, extending from the spinal column, occurred in the course of the month of December; and some weeks afterwards, a curvature of the spine towards the left side was observed. For these pains a warm bath was ordered, which gave great relief; and the patient, who felt perfectly recovered, was discharged from hospital, after a treatment of four months, on 16th February, 1861. At her discharge, the percussion sounds of the chest were exactly the same as last described; and the liver was low down in the abdomen, as at her admission. Of the subjective symptoms, the oppressed breathing and the shooting pains remained. Eight days after leaving the hospital, she was attacked with repeated shiverings, followed by heats; her strength diminished, and her appetite failed, and finally the fever symptoms became continuous. She was now again obliged to seek admission. On the 26th March, 1861, she was readmitted; and at the examination on her entrance, this patient, who on leaving the hospital was tolerably strong, was found in the greatest degree depressed, weak, appetiteless, feverish; the percussion and auscultation symptoms were the same as when she left, with the exception that at the back, on the right side, the perfectly dull sound extended up as high as the second dorsal vertebra. Along with the fever, and the extreme degree of marasmus, there was pain in the seventh and eighth intercostal spaces. On examination of these spaces in the line of the axilla, there was found evident fluctuation, without redness or heat of the integuments. The pain and fluctuation disappeared after some weeks. Under the continuance of the fever, she emaciated more and more, adema of the ankles set in; and she died on the 10th June, 1861. At the post-mortem examination, it appeared that the body was middle-sized; meagre; the skin generally white; the thorax long, uniformly flat; the abdomen slightly distended; the cranium compact; the arachnoid opaque, and the ventricles somewhat distended; the thyroid gland, large and hard. The mucous membrane of the larynx and trachea was slightly injected. The diaphragm stood on the right side at the upper border of the eighth rib, on the left at the upper border of the sixth, fluctuated on both sides, especially the right, and at this side was convex downwards; in the left pleural cavity there was about a pound of clear yellow serum formed; the left lung was free, but inflamed; the right lung was everywhere confined by short fibrous adhesions; the upper lobe was slightly condensed, infiltrated, and oedematous; the middle and lower lobes were compressed by false membrane, and dragged forwards; their tissue atrophied. Between the posterior surface of the lung and the pleura, there extended itself from the upper border of the middle lobe to the base of the lung (from the second to the eighth rib), an oval, thick-walled, fibrous sac, which enclosed a second thin-walled, white, albuminous, friable sac, which contained an opaque, whitish, glutinous fluid; on the inner surface of this second cyst, there were remarked, here and there, yellowish white dotted patches: these were recognised as fat, chalk-masses, and degenerated hook-crowns. Between the sac and the atrophied lung with which it was adherent, the pleura was plainly seen. The heart was pushed to the left side, and the liver downwards; there was bloody congestion of the liver, spleen, and kidneys, and ascites. The two last cases of acephalocyst sac growths in the lungs, extending to such a size, are, relative to differential diagnosis, not without worth; since a confounding of them with an encysted pleural effusion could easily take place. Although an acephalocyst sac of such size can never be diagnosed with precision during life, yet it is not unimportant to bear these cases in mind, that we may not be embarrassed in those cases where such a sac comes into contact with a bronchus, and its contents become evacuated through the bronchi, or when the contents pass into the cavity of the pleura, and produce a pneumo-thorax, or even make their way through the walls of the thorax, and are emptied externally; or, finally, through paracentesis, performed for a supposed chronic pleuritic exudation, are emptied artificially. In like manner as the two cases now described had originally developed themselves under the pleura, and from thence, through the removal of the lung, had increased in size, so it appears to me that in the majority of cases where the occurrence of echinococcus cysts, and especially acephalocyst sacs, is mentioned in the lungs, it is not in the lung-substance they have their origin, but under the pleura costalis; and therefore in the intercostal muscles, or in the diaphragm, that they have their germ-bed. Whoever takes the trouble to prepare acephalocyst sacs of the lungs, may exhibit the boundary between the pleura and the proper cyst with precision, and may separate the remains of the wasted lung from the cyst. I do not deny that acephalocyst sacs ever occur in the substance of the lungs; I only assert that in very many cases echinococcus growths, and their respective acephalocyst sacs, at first develop themselves under the pleura costalis and diaphragmatica, and have their primary development in the intercostal muscles and diaphragm. Wochenblatt der Zeitschrift der k. k. Gesellschaft der Aerzte in Wien, No. 25–26. Researches on Lead Poisoning. By Dr. A. GUSSEROW. It is not alone the importance of the lead disease, nor yet the variety in its symptoms, that excites scientific interest; but the peculiar circumstance, that, whereas the cause and the result are both so manifest, the middle term, namely, the comprehension of the process itself, is completely absent. Tanquerel, of Planches", concludes his endeavours to explain the lead disease with these words:-"In vain we try to raise the veil which shuts from our view the process of heterogeneous combinations, and thus learn the secret of their nature: we can only perceive the effects." At an early period the conjecture was received, that the lead was deposited in the organs, and so caused the various disturbances of function. It is true that lead has been found in almost every portion of the animal organism. Without permitting myself to enter on a critique upon these statements, this much is at any rate certain, they are ambiguous in the highest degree, frequently quite contradictory, and the means employed to obtain the results most uncertain; and thus, the numerous researches allow of no exact conclusions. How far the results of my analyses permit of these, I must postpone for the present; their absence I by no means wish to conceal; and can only apologize for the fragmentary form of this communication, other engagements having hindered a further prosecution of these researches. It was necessary, in the first place, to make use of a process by which not only the presence of the smallest quantity of lead could be discovered, but that it should be obtained in the metallic form. Electrolysis appeared to me to present the greatest advantages for these ends. It is true, scientific researches are wanting, as to the degree of exactness of this process for separating metals from organic fluids; the works of Kletzinsky, Reder and Schau, Schanenfels, Waller, and recently Overback, however, have sufficiently pointed out its very great certainty. I employ electrolysis as given by Bloxam, for the detection of arsenic. As the value of results is in proportion to the correctness of the process by which they are obtained, I will here give a short description of it. The organic substances having been destroyed with muriatic acid. and chlorate of potash, the filtrate is introduced into a large bottle, the bottom of which is covered with a tightly stretched membrane of vegetable parchment. The bottle is closed with a cork, through which a platina-wire is passed, carrying a plate of the same metal, so that the latter is held close over the membrane. This apparatus is placed in a basin of water, acidified with SO,: the fluids should stand equally high in both vessels. a Bleckrankheiten, Bd. i., Sei. 141. Wiener Wochenschrift. 1857. e Ibid. 1858. No. 44. No. 45. d Mercur n. Syphilis. 1861. e On the Detection of Poisonous Metals by Electrolysis. Quarterly Journal of Chemical Society, No. 49: London, April, 1860. VOL. XXXII. NO. 64, N. S. 2 K A battery, consisting of four of Grove's elements, is connected with this apparatus in such a manner that the platina-wire, in the fluid to be examined, is in connexion with the negative electrode, the positive electrode, consisting of a platina-wire and plate similar to the other, is placed in the acidified water, so that the two plates may be separated from each other by the parchment only. The time during which it is necessary to keep the chain closed varies with the quantity of fluid to be examined; it never was under eight hours, and only in a few cases over fifteen. The lead is thrown down on the negative electrode, in the form of a dark grey to a black coating, according to the quantity. In order to be certain that all the lead is removed from the fluid, it is only necessary to change the plate so long as any coating presents itself. To recognise this as lead, it is sufficient to dissolve it in NO, evaporate to dryness, and pour over the residuum water impregnated with sulphuretted hydrogen, and, having separated the black precipitate by filtration, examine it in the reducing flame of the blowpipe: the lead is thus obtained in the form of a metallic globule or scale. With regard to the quantitative analysis, I have weighed the deposit directly after careful washing and drying, along with the plate; and after removal of the coating, ignited and reweighed the latter. It is easy to understand that this method is uncertain; I have, therefore, estimated the lead according to the method of Fresenius as PbO, SO, and then calculated the metallic lead present. It is scarcely necessary to add, that from the minute quantities of lead dealt with in these analyses, the reagents should be perfectly pure. The principal reagents employed, namely, the KO, CIOs, and CIH, and the SO, were tested by Professor Hoppe for some legal examinations. In the filtering paper of the laboratory there was not found a trace of lead in six quires, contrary to the statement of Wicke, that he found in every quire of the ordinary filtering paper 0·159 per cent. of lead. It is necessary to clear up one point more, before I proceed to the analyses. It is well known that for a long time the question has been in dispute, whether copper and lead are normal constituents of the animal organism: since Devergie and Henry endeavoured to demonstrate copper and lead in all the organs, the most opposite statements have been published, sometimes for, sometimes against this assertion, by numerous chemists, more especially French. Lead is placed by them in a second series; and it is asserted that its presence is much more rare, and less distinct. That copper may be present in the healthy organism, can be no longer doubted; not, however, as a constant constituent, but dependent on the food, as shown by the analyses of Bechamps. In this Meissner demonstrated copper in abundance; and recently, Odling and Duprè1, more par a Annal. d. Chemie n. Pharm., Bd. cxii. b Le Montpell. Méd. Oct., 1859 Journal de Physiolog. iii., Jan., 1860. e Schweiger's Journal, xvii., 1861. d Guy's Hospital Reports, 3, ser. iv., 1858. |