554

when it is even, it is necessary to admit thatthe alcohol has been inflamed in the interiorof the body by the effect of the opposedelectricities of Berzelius ; it is necessary,I say, to admit also the presence of air inthe body to feed this combustion, whichis impossible, since air cannot penetratethrough the cutaneous tissue. We know,from the ingenious experiments of Davy onflame, that a simple metallic gause is suffi-cient to’intercept the heat and prevent theinflammation of the most inflammable gas.What we have said of the impossibility ofthe combustion of alcohol in the interior ofthe body applies also to hydrogen gas ; wesay more, it will happen, that the personwill perish without being incinerated. Iinflamed hydrogen gas, in which I placeda piece of meat, which was only slightlyburnt. It is a fact well worthy of remark,that hydrogen gas will not inflame by theelectric spark, however long Its action maybe continued, at least if it be not. in con-tact with oxygen gas ; and, surely, if it bemixed in the human body, it will cause anexplosion.

Conclusion.—From these facts, it appearsevident, that mere hypotheses on the theoryof spontaneous human combustions havebeen hitherto advanced. The parts of thebody the least combustible, such as theliver, spleen, lungs, &c., are always in-cinerated ; whilst, on the contrary, thehair, although extremely combustible, isnever burned.

If we now consider that a large quan.tity of wood, sufficient to incinerate a

house, is necessary to incinerate a body,we shall see that it is impossible that alco-hol, or hydrogen gas, which does not eveninflame linen, can produce this effect ; 2d,the products of animal combustion are a

spongy charcoal, very black, shining, fcetid,and only incinerating at a very great tem-perature, whilst spontaneous humau com-bustions only develop a low temperature,which does not inflame the most combusti-ble bodies. Human combustions are not

the effect of the combination of the ele-ments of the animal matter with oxygen ofthe air. Lastly, we think that, in somesubjects, especially in females, there existsa particular diathesis, which, joined to theasthenic state occasioned by age, by inactivelife, the abuse of spirituous liquors, maygive rise to spontaneous combustion ; butwe are far from considering alcohol, hydro-gen, or superabundant fat as the materialcause of this combustion. If alcohol has

any part in this affection, it is by producingthat degeneration of which we have beenspeaking, which engenders combustible pru-ducts, the action oi’ which causes the com-bustion of the body.

SURGICAL CLINIC OF THE HOTEL DIEU.*

M. DUPUYTREN.

Delirium Nervosum, or Nervous Det.

More than once, in the course of last wa-ter, we had an opportunity of seeing species of delirium in patients labouringunder fracture of the limbs, which M. Dj’

puytren has always succeeded in curing.

M. Dupuytren thinks delirium ne

very analogous to delirium ti-emens, it a un.accompanied with fever, often manifestsitself without any inflammatiou or nocnd,and cannot, therefore, in all cases be con-sidered as traumatic delirium. It is conse-cutive, without relation to age, sex, or tem-perament of the patient, on dislocations andfractures, which have, or have not been re-duced, on hernia, wounds, and all kinds ofoperations, during inflammation, suppura-tion, or the formation of a cicatrix.

Persons of a nervous temperament are

very subject to it; it attacks those indivi-duals who entertain a great dread beforean operation, or in whom the desire to showtheir courage has exalted the imagiaation;

. more especially those who are subject to

fits of despair, and to attempts at suicide.Its first appearance is marked by irregularand irrational gestures and movements, andby incoherent proposals. Persons labouringunder this disease are restless, both bymghtand dav.

s The superior parts of the body are cover-ed by a copious perspiration; the eyes

. become shining and injected, the face ani-i mated and flushed, and the patient utters, menaces and vociferations. Notwithstand-. ing all these symptoms, the pulse is calmand tranquil ; no fever exists; the fxces arevoided with the usual regularity, but the

, appetite is bad, and, at the end of two,three, four, or five days, this curious affec-tion terminates either in cure or death. Ifthe patient be cured, the calm returns with-out any apparent crisis ; a sound sleep comeson, and, at the end of ten or fifteen hours,the patients are quite well. This delirium

may return two or three times. On oper,ingthe bodies of those who have died fromdelirium nervosum, nothing is found whichcan satisfactorily account for the symptomsof the disease.

Sedatives of every kind, and in everyform, bloodletting, ad deliquium, and ailother means, have been used by 31. Dupuy-tren without any good efect.

The only means of cure, are injections upthe rectum of 16 or 13 drops of the une-ture of opium, repeated two, three, or fourtimes, every six hours.

* La Clinique.

555

The injections, when retained up the rec-m, are sufficient to cure the most furiousum. It is a curious fact that the small

quantity of the medicine taken into the

stomach, produces no effect, whilst, thrownthe rectum, it is so eilicacious ; this

difference in the action of the same remedyin two different parts of the body, M. Du-ytren explains by the absence of thedigestise powers of the rectum, and the ab-sption of the medicine unaltered into thesystem.

POTT’S DISEASE—PLEURISY, EMPYEMA.

h this hospital, there is a young woman atpresent, of delicate constitution, who wasdamtttecl fur an affection of the spine, withprojection at the lower part of the dorsalregion. Moxfe were applied on the sides ofthe vrominence, by which means the an’ec-:t.huf the spliie appeared to improve, when,all of a sudden, the patient was attackedwich a severe pleurisy of the left side ; thest active treatment was employed with-out much benefit, the symptoms continuing,although in not quite so severe a form. Thefcvfr subsided, and the pain disappeared,but the left side of the chest became largerthan the right; the intercostal spaces in-ma3ed in size, and the pulsations of theheart were not felt in the accustomed spot,but ou the right of the sternum. Per-cussion afforded a dull sound in the wholeextent of the affected side, the respiratorymurmur cuuld not be heard, and the patientcould only rest on the left side ; that therewas efusion into the chest, could not be:uistaken. M. Dupuytren first entertainedthe idea of giving exit to the effused fluidbt puncture ; but, on more minutely exam-iaing the patient, lie found that the fluidin the pleura, communicated a kind of un-delatory motion, isoclirouous with the pulse,which could be perceived in the space be-tween the ribs, and he thought that this.Mifment was communicated to the fluid

by the heart and its vessels. May therenot be an aneurism, said ill. Dupuytren, ,,

and may not the fluid come from a ruptureof the sac? The patient’s symptoms were

’’

r.ther improved, and after the lapse of a!Loath, a tumour began to point in one ofthe intercostal spaces, in which the samepulsations could be felt as have been be-te mentioned.M. Dupuytren regards this tendency toentaneous opening as a very favourable,

symp tom, and favours it by the application- ’ ient eataplasms. He is finnlv con-d, that the spontaneous opening’ isless dangerous than incision in casesyema. The tumour, which is formedexternally, opens first, and gives exit to a quantity of liquid. The skin, which

was prominent, becomes flattened, its open-ing closes, and the tumour is thus repro-duced, and empties itself at repeated timeaby fresh spontaneous openings. In thiscase there is only a communication fromwithout with the cavity, the primitiveseat of the effusion, by means of narrowsiuusses, through which the air cannot wellenter. The matter is discharged in smallquantities, the pleural cavity remains alwaysfull, and the quantity of pus diminishes inthe same proportion as the cavity whichcontains it. Thus the air has no access tothe diseased cavity. It is well known,that the introduction of air has great influ-ence on the accidents which follow the ope-ration of empyema.

ABUSES IN ST. THOMAS’S HOSPITAL.

To the Editor of THE LANCET.

SIR,—In your Journal of this day I ob-serve two letters on the subject matter ofdispute contained in my previous commu-nication, and I shall now, with your permis-sion, pomt out their childish evasion of everypoint, save one, that I had advanced. Our" medical officer " commences thus : —" Itis not my intention to enter into any con-

troversy with J. W. as to how great or howlittle foundation he may have for his generaland sweeping charge of negligence of at-tention to the interests of pupils." With

regard to his declining to argue how greatfoundation I have, certainly I could not inthe common course of things expect thathe would. But as to his refusing to contro.vert the (juestion of how little foundationI have, I can only say that if lie pursuedthis line of conduct from a pure kindnessof intent towards me, I must express mygratiturle ; but if from a consciousness thathe could not for a moment produce any ar-gument to render the charge invalid-iffrom a self-persuasion that it was perfectlyjust in itself—then, although I deprecate theabsence of that generosity which ought tohave led him to express openly to the pub-lic this his opinion, yet, I must attribute tohim some considerable share of prudencein not having attempted a refutation of thatwhich no man can refute, and which evenin the present shameless state of the hos-pital affairs not one of the " officers, " Iam inclined to believe, will have the effron-tery to deny. The " medical officer" doesnot deny it ; on the contrary, he fullv ad-mits the foundation for a charge of negli-gence ; and this is not only seen by hissilently yielding the ground, but also by