1854 The Lancet  
518 cases of disease of the air-passages, and urged the necessity of constitutional treatment in most instances in which this application would be beneficial. Mr. DENDY objected to the treatment of aphonia resulting from syphilitic ulceration by the local application of the nitrate of silver. Constitutional treatment in these cases should be conjoined with mercurial fumigations. He thought it ill-judged to raise theoretical objections to the use of Dr. Green's plan, and remarked, that when the
more » ... robang had passed the larynx, it would be very easy to pass it down the trachea, as no spasm would result. Mr. HENRY SMITH mentioned two cases in which the application of the nitrate of silver to the upper part of the windpipe had been attended with very severe results. In one instance, tracheotomy had to be performed afterwards, and the patient sunk. In the other case, which was one of ulceration of the upper part of the larynx, the application of the caustic caused such severe symptoms that death was imminent. Tracheotomy was performed, and the patient did well. Dr. RADCLIFFE referred to a case in which a piece of sponge had slipped down the larynx to its bifurcation of the trachea, to show that it was possible to pass a probang down that passage. The difficulty of passing an instrument down the larynx would appear to be removed by the plan recommended by Dr. Green, of applying the caustic to the pharynx and fauces for two or three days previously. He related a case of aphonia, which two applications of the caustic had cured when other remedies had failed. Mr. HALE THOMSON objected to the use of the nitrate of silver of the strength which had been recommended in the paper. He contended that, in the case in which eighty grains were said to have been dissolved in an ounce of water, that it was dangerous to use such an application, for the nitrate could not have been dissolved. He contended that the merit of applying the remedy in cases oflaryngeal disease was not due to Dr. Horace Green, and that he had seen the late Dr. A. T. Thomson and Sir E. Home use it many years before it was employed by Dr. Green. He reprobated the treatment of syphilitic ulceration of the larynx by means of caustics, and was convinced that mischief must result from the use of remedies of such a strength as recommended in the paper. , Mr. ROGERS HARRISON called attention to the fact, that in ' , the case in which Dr. Green had used a solution of eighty grains to the ounce, the case was one of ulceration of the fossa at the root of the tongue. The usual strength recommended was forty grains to the ounce. With respect to the use of the nitrate of silver in aphonia arising from organic lesion, he (Mr. Harrison) said the late Sir C. Bell had recommended its employment of the strength of forty grains to the ounce as long back as 1816, and had discontinued its use for fear of the results. He (Mr. Harrison) had since this applied it of strength in many cases with perfect ease and safety. aged thirty-eight, applied to me on February 15, with a large excavated ulcer on the right side of his tongue, about one inch in diameter, with very rugged elevated edges, and an intensely hardened base. He comph:ined of excruciating ' , pain, extending to the root of the tongue and right ear, and I right side of the face, of a burning, shooting, and lancinating character. The glands of the neck were also beginning to be I slightly swollen. He stated that a few weeks before he had casually smoked out of a dirty tobacco-pipe, and a day or two afterwards he found a nodulated warty kind of excrescence on the side of the tongue. It gradually increased, became painful, and had slight shooting pains in it. Before applying to me, I understood he had been directed to use some astringent gargle, and had had it touched with lunar caustic, which had abraded ' , the surface, and aggravated all his symptoms, and the wound, ' , or ulcer, rapidly increased, with a foul, foetid discharge. Upon applying to me, it had a curdy appearance; from the hardened base, the peculiar character of the pain, the foul elevated edges, and the curdy appearance of the sore, I looked upon the case as one of a cancerous character. To operate by the knife or ligature appeared formidable, still imperative; but before resorting to either, I applied pure nitric acid twice on the first, and once on the second day. On the following day a large portion of the eschar was formed, and on the next day it came away. A deep cavity now remained on the side of the tongue, but the hardness and the pain had diminished, and deglutition rendered more easy. A wash of dilute hydrochloric acid to remove the fcetor, and small doses of iodide of potassium with decoction of sarsaparilla were ordered. As at the bottom of the sore several white bands appeared, the pure acid was again applied, and repeated twice a day until March 5, when the hardness, swelling, and pain disappeared, and then only a slight indentation marked the site of the original sore. He has continued at his usual employment, and is quite well up to this date, April 22. PHYSIOLOGICAL SOCIETY. MONDAY, MAY 8, 1854.—DR. SNOW, V.P., in the Chair. PROFESSOR MACDONALD read a short communication on the TŒTAL CIRCULATION, referring to a paper by Mr. H. Lee, communicated to the Society at the March meeting (see THE LANCET, March 18th), which Dr. Macdonald considered as corroborating the views he had long entertained as to the course of the fœtal circulation, and which he had brought before the British Association when at Birmingham. The blood, in the earliest stage of the foetns, even before the heart becomes a closed tube, is sent from the ovum to the organ which prepares it to return fitted for nutrition. The most direct course seems to be by the umbilical vein to the placenta, in the cells of which it terminates in the minute branches of the umbilical arteries, convoluted and bathed in the pure arterial blood supplied to the cells, but without any vascular connexion with the maternal system. These arteries, by means of the hypogastrics, convey the arterialized blood into the aorta, from whence it is sent to the head, upper and lower extremities, and the rest of the body, in the usual course, although reversed in the main trunk of the aorta. The valvular obstruction at the commencement of the aorta and pulmonary artery, may allow only a small part of the blood to enter the heart sufficient to stimulate its action. There may also exist a modified alternating motion of the blood in the pulmonary artery and the ductus arteriosus, as in insects, and the contraction of the heart, may aid the circulation, partly by the contraction sending the blood by the foramen ovale into the right auricle, where it is blended with the venous blood of both cavæ—of the porta, by the aid of the ductus venosus, into the umbilical vein, and so on as above described. In this way the blood, after being hepatized, is in the same relation as in the adult, as regards its arterialization-the placenta substituting the lungs. Thus the whole blood circulates through the placenta to prepare it for the nutrition of the fcetus, which is certainly not the case as the course is usually described, where it is represented as flowing by-the umbilical vein towards the fœtal heart, receiving the venous blood from the porta-vena cava as well as the visceral veins, and this mixed fluid is forced (without mixing, it is supposed) through the current from the superior cava in its way to the right ventricle and pulmonary artery ; while the fluid from the inferior cavæ, &c., passing through the foramen ovale, the left auricle, ventricle, the arch of the aorta, as far-as the left subclavian, supplies the upper parts of the body, while the rest of the trunk and lower extremities have only the venous blood supplied from the aorta, where the ductus arteriosus unites it with the pulmonary artery. Dr. Macdonald illustrated his views by a diagram showing both modes of the fœtal circulation. (To be continued.) HARVEIAN SOCIETY.
doi:10.1016/s0140-6736(02)40387-x fatcat:wzyhvc5s25c2rnn7zejs2jc63y