MISCELLANEOUS NOTICES.

On the Persistent Nature of the Dental Capsule; with physiological and pathological observations. By ALEX. NASMYTH, Esq. (Read before the Med. and Chir. Society, Jan. 22, 1839.)-The author begins by observing that of the three stages into which the period of the growth of the teeth has been divided, namely, the follicular, the saccular, and the eruptive, it is his intention in the present communication to allude particularly to the eruptive stage only. Having been induced to investigate this stage very attentively, he is convinced that the capsule of all teeth is persistent; and that instead of its being a deciduous membrane, it is one whose functions continue throughout the life of the tooth. The author was led to attend to this fact many years ago, from having observed; while engaged in some very minute anatomical inquiries, detached portions of membrane floating from preparations of human teeth which had been subjected to the action of acid. By care and much practice he was at length enabled to demonstrate these membranes to be separated from the external surface of the enamel, being continuous with the membrane covering the fang, and this again with the pulp included in the chamber of the tooth; in fact, that this membrane was the crown portion of the original capsule of the tooth. The author's attention having been diverted from this point at the time by other matters, was again forcibly attracted to it, in pursuing some investigations for the purpose of verifying the microscopic observations of Professor Retzius, Purkinje, Müller, and others, the results of which he is preparing to bring before the profession. He concedes to Retzius and his contemporaries in Germany, the merit of having revived and made known the existence of an osseous investment, similar to the crusta petrosa, on the external surface of the fangs of human and many similar teeth, but which in such teeth is expressly described as ceasing where the enamel commences. As these substances must have derived their origin from the capsule or investing sac, and as the cementum on the crowns of the teeth of those animals that are endowed with it originates in the same membrane, the author inferred that the membrane which he had disengaged from the surface of the crown was no other than a production of the capsule itself.

After describing the structure of the capsule, the author proceeds to say, that during the growth of the enamel, the inner membrane retains a considerable degree of thickness, and that where the extent of enamel is limited, and its growth perfected, a cohesion of the internal layer takes place to its surface, and the exterior continues to be firmly attached to the elongating fangs, producing an osseous deposit over it, and enclosing its root. When teeth are subjected to the action of dilute acid, the decomposition being more complete upon the enamel through the adherent membrane than upon the neck of the tooth, its detachment is more speedily accomplished; but being very thin where joined to the neck, it is easily ruptured in human and other analogous teeth. It is, however, easy to obtain it in continuity in many of the lower animals. This capsular covering, which it is by no means diffcult to demonstrate, continues throughout life, except it be worn away by irritation. It would be impossible, within the limits of an abstract, to allude even briefly to all the confirmations of these anatomical facts, which were illustrated by an extensive series of preparations and drawings, not only of natural but also of morbid structure.

In concluding his interesting paper, the author expresses an opinion that the sketch which he has given will serve to reconcile many contending opinions concerning the vitality of the teeth. In the present state of our knowledge he thinks that we can only allow a very low degree of vitality to the enamel and ivory of the teeth, and that the phenomena of disease

1 Lond. Med. Gaz., Feb. 2, 1839, p. 681.

dwelt upon by those who maintain a higher order of vitality in those textures are due to the vital powers of the different portions of the persistent capsule.

Case of the Accidental Administration of Forty Grains of the Extract of Belladonna, by Oscar Clayton, Esq. Communicated by JAMES CLAYTON, Esq.-The author's motive in relating the above-named case, the subject of which recovered from the effects of the poison, was, that the order of succession of the symptoms differed from that described by Dr. Christison, for in it sopor preceded the delirium, which did not come on for six hours after the administration of the poison, whereas the reverse is commonly the case. The author considers it also worthy of remark, that the pulse, which was 160 half an hour after the poison was taken, fell in twenty hours to 58, and that it varied from 160 to 120 during the sopor, but did not reach more than 95 during the delirium.

Absence of Menstruation.2-Mr. Harrison, at a late meeting of the Westminster Medical Society, Jan. 5, 1839, enquired if any member had known an instance in which the mother of a large family had never menstruated ? He had known such a case.

Dr. Johnson had never seen an instance of the kind. He had, however, under his care at present some members of a family in which there were five daughters, the ages of whom ranged between twenty-six and thirteen, who, though all in excellent health, had never menstruated.

University of Pennsylvania-Medical Department.-The published catalogue contains the names of 202 matriculates.

Hospital for the Insane-Maryland.-We are pleased to learn from our friend, Dr. S. Collins, of Baltimore, that the legislature of Maryland has liberally appropriated forty thousand dollars for the endowment of a Lunatic Asylum.

Louisville Medical Journal.-By a Louisville Journal of the 19th ultimo, which has been recently sent to us, we learn, that the medical journal-two numbers of which had been published—has been discontinued.

BOOKS RECEIVED.

From the Author.-Introductory Lecture, delivered by H. Willis Baxley, M. D., Professor of Anatomy and Physiology in the University of Maryland, November 2, 1837. 8vo, pp. 29. Baltimore, 1839.

From the Author.-The Annual Address to the Candidates for Degrees and Licences in the Medical Institution of Yale College, Feb. 26, 1839. By Thomas Miner, M. D., Member of the Board of Examination, and late President of the Connecticut Medical Society. Published at the request of the class. 8vo, pp. 20. New Haven, 1839.

1 Lond. Med. Gaz., Feb. 2, 1833, p. 681.

2 Lancet, Jan. 19, 1839, p. 619.

THE

AMERICAN MEDICAL INTELLIGENCER.

Vol. III.

April 15, 1839.

No. 2.

ART. I.-CASE OF CHRONIC PLEURISY, WITH PNEUMO

THORAX, &c.

BY A. G. TEBAUTT, M. D., OF LONDON BRIDGE, VIRGINIA.

Instances of the simultaneous discharge of an empyema by a double lesion, through the bronchi and the parietes of the thorax, are of rare occurrence; in the Edinburgh Medical and Surgical Journal, No. LXI., a case of this nature is given by Dr. Hawthorn, and two or three others have been recorded by MM. Chomel and Lerminier, enriched by the report of a few more cases possessing the same features. In addition, it is hoped the following, extracted from my case book, will not prove altogether uninteresting.

On the 9th April, 1837, I was requested to visit S W- -, a carpenter, æt. 20 years, of temperate habits, and previously of a strong constitution. He stated that in consequence of unusual exposure to cold and moisture, he had been attacked about three weeks before, with a cough and pain in the right side of his chest; and that he had since submitted to an empirical treatment, in the course of which a severe diarrhoea had supervened.

He was pale; emaciated; with some oedema about the face and ankles; his body appeared considerably arched forwards, and the shoulders drooping. The least exertion, as in rising or walking, induced a hurried and oppressed breathing and great muscular agitations. Skin dry; pulse small, quick and thrilling; voice hoarse; cough frequent and teasing; sputa clear mucosity, intermixed with a few opaque whitish points, and expectorated with difficulty. On coughing and deep inspiration he experienced a diffused soreness, referred to the base of the right lung. The sound on percussion over the right side was dull, and the respiratory murmur and resonance of the voice feeble, especially towards its lower third; a dull sonorous râle was heard below the clavicle. In the left lung the respiration was puerile and attended occasionally by a mucous râle. Tongue red, pointed and tremulous. Pain complained of, mostly in the abdomen and chiefly in the direction of the transverse arch of the colon, increased on pressure; bowels excessively loose; discharges watery; urine highly coloured. R. chlor. hydr. mit. gr. x., acet. morph. gr. iv., potass. nitratis Di., M. in pulv. x., div. Un quart. hor. s. Mucilaginous drinks.

On the following day the abdominal symptoms were greatly relieved; cough less troublesome; pulse 90, improved in fulness. Contín. med. at lengthened intervals.

April 11th. Edema had disappeared, and he was able to move with much less inconvenience. Ordered a large blister to the chest, with a view to alleviate the cough and soreness, which still persisted. Murmur frictionis. In a day or two more the gastric affections having completely subsided, resorted to antimonials, opiates, and mucilaginous drinks with benefit. His health gradually amended in every particular, and on the 18th of April, a weak sonorous râle with some dulness on percussion over the right lung

inferiorly and posteriorly were the only signs appreciable. He still, however, experienced a sensation of oppression and constriction in the chest upon making any continued exertion, and a slight tickling cough during the night.

From this date, as he was able to leave the house and did not choose to confine himself, I lost sight of him until May 16th, when I was summoned again to him. I learned upon enquiry that he had continued to all appearance in much the same condition in which he left off the treatment (with the exception of a perceptible increase in his stoop latterly), until the night of the 14th, when fever and dyspnoea suddenly supervened.

Found him lying on his back with his head and shoulders considerably elevated. An attempt to assume the horizontal position or to turn on the left side was attended with a most distressing sense of suffocation.

Respiration short and hurried; cough almost incessant, and at times accompanied by a tenaceous muco-purulent expectoration. The right side of the thorax was notably distended, and the intercostal depressions obliterated; he also experienced in this situation a diffused soreness and a sense of oppressive weight. The sound yielded on percussion was morbidly clear at the summit, but became extremely dull on approaching the posteroinferior portion; respiratory murmur and resonance feeble and masked; metallic tinkling. Succussion revealed a distinct sound of fluctuation. Over the left lung the respiration was puerile.

The patient laboured under hectic pyrexia, and had a return of œdema; pulse small, rapid, and somewhat irregular; bowels regular; urine sparse, coloured, and sedimentitious.

Treatment.-Laxatives, opiates, and mucilaginous drinks.

The dema subsided, but the expectoration became freer, dusky and offensive.

May 20th. Pulse extremely feeble; profuse sweats; orthopnoea; cough urgent, followed at intervals and suddenly by a copious, fœtid expectoration, amounting to a quart or more daily. The chest yielded much the same signs, with the exception of an amphoric blowing sound, heard during inspiration, and most distinctly when the stethoscope was placed between the angle of the right scapula and the spine. Tonics, opiates, generous diet.

May 22d. Pulse stronger and more developed; appetite good; sputa greenish, still copious, though less offensive. Orthopnea relieved, so much so that he was able to lie in the horizontal position. The right side at its postero-inferior portion sounded clearer than it had done for some days previously; the distension of the parietes was sensibly lessened; and the respiratory murmur became partially audible in the infra-mammary region. The voice determined an imperfect pectoriloquy. When the patient coughed the sound traversed the tube to the ear in quick vibrations, and when the convulsive action ceased, a prolonged hissing and metallic sound was heard, which conveyed the feeling, as if the air in the cylinder had been forcibly sucked in. Med. ut supra.

May 26th. Cough less urgent; expectoration had gradually diminished in quantity since the last report; sputa of a thicker consistence and greenish hue; the amphoric blowing and metallic tinkling sounds had lost their intensity, and the respiratory murmur could be heard over a more extended surface. The hectic symptoms had somewhat abated.

May 31st. The right side of the thorax had again become greatly distended; its lower half sounded extremely dull, the superior portion gave a tympanitic clearness; gurgling; metallic tinkling; at times the blowing sound was very distinct; immobility of the side. The patient now lay easiest in a horizontal position. Whenever he attempted to rise he was seized with a violent fit of coughing threatening suffocation, which did not cease until a large muco-purulent expectoration (sometimes amounting to 4 or 5 oz.) had taken place. Fluctuation in the chest was heard whenever he coughed or moved. Respiration in left lung accelerated and puerile; hectic.

From this time to the 10th of June he continued in nearly the above state, using such means as tended to support his strength and alleviate irritation. His appetite, strange to say, never flagged a moment, and he appeared to digest what he ate. He ever cherished a lively hope and bore his sufferings with the most exemplary fortitude. June 10th. Countenance ghastly; great prostration of strength; colliquative sweats; pulse rapid, and the right side of the thorax still further distended, especially towards its inferior portion; the abdominal muscles of the same side retracted and tense; right thoracic parietes smooth; dyspnea; cough exhausting; sputa muco-purulent and offensive; thrown up with some serum. Used anodynes and diffusible stimuli freely. In a couple of days he appeared to rally in strength; cough abated in violence, and the sputa became thin and reddish. In a few days more his strength was more decidedly improved.

June 20th. An erythematic blush, sore to the touch, appeared between the seventh and eighth ribs, beneath which signs of fluctuation could be readily detected; sputa of a thicker consistence, and dusky red colour, still copious. He was able to sit up without urgent dyspnea; pulse quick and small. I resolved upon resorting to paracentesis the next day.

June 21st. On removing the instrument the fluid gushed out to the distance of two feet or more. About two quarts of a dark red muco-purulent matter, apparently intermixed with serum, were drawn when the patient felt sick and faint. I immediately closed the orifice by inserting a small tent of soft sponge, supporting the same with a compress of lint and a broad roller. The matter last evacuated was grayish red, owing to the quantity of minute flocculi diffused through it. Odour very offensive. Opiates and stimulants. June 22d. He had obtained great relief and rested some during the night; cough much less troublesome; pulse quick, somewhat irregular; skin moist discharge thinner; the distension of the right side had greatly subsided; the intercostal spaces were depressed, and the respiratory movements began to be developed (though obscurely) in the inferior portions. The right abdominal muscles instead of being retracted as before, now participated in the movement of respiration. Air was expelled with the fluid through the puncture, on coughing and expiration, and produced a loud gurgling, but on inspiration it was sucked in with a deep hissing sound. Sounds of the chest extremely clear anteriorly and superiorly, and dull posteriorly and inferiorly. On removing the dressings very little matter was expelled, but I conjectured from the appearance of the sheets under him, and the report of his attendant, that he must have discharged nearly as much as was drawn off at the operation. June 24th. Sputa now thick, whitish, and small: suction of air through the orifice in the side, much less forcible. A thin serous fluid of a dirty reddish hue, and containing a few shreds still continued to flow, but was now expelled in small quantities even when the cough was violent. The ribs projected outwardly, and his great emaciation was very evident. Pulse fuller; skin pleasant; appetite good..

June 26th. Discharge thin and slightly tinged, exuding occasionally through the puncture, which manifested a tendency to cicatrize; cough milder; expectoration still diminished in quantity. Percussion gave a less tympanitic sound over the right lung; dulness greater about the middle of the seventh rib and posteriorly. Metallic tinkling very distinct. A well marked murmur frictionis predominated towards the base of the right lung, over which region also the patient experienced a soreness; and when touched a sensation of tickling. Admeasurement of the right half of the thorax still gave an excess. His strength was so far improved that he could walk with little assistance across the room from one bed to another. June 30th. The discharge again assumed a semi-purulent character; cough frequent and hacking. July 2d. The puncture which had been gradually contracting now healed up. Dulness of sound more extensive over the affected side. July 8th. Matter having again accumulated in the chest, as evinced by distension, &c., I again resorted to paracentesis and discharged three pints of