illustrative of the benefits of a sojourn in this trans-Alleghany sanitarium under such circumstances.

We publish the following by request.

[Extract from the minutes of the Philadelphia Medical Society.] "Resolved.-That all discoveries or improvements in medicine or surgery should be freely promulgated through the appropriate channels of medical information for the advancement of medical science, and for the good of mankind. And that the appropriation of such discoveries or improvements by their authors, to their exclusive pecuniary emolument, by the taking out of patents or otherwise, is at variance with those principles of liberality and beneficence which should distinguish the medical character." Ordered to be published. HENRY KEIM, JR. Rec. Secretary.

27th March, 1839.

Morton's Crania Americana.

We are gratified to learn, that this splendid work, which is destined, we trust, to be as well known as the "Decas collectionis suæ craniorum diversorum gentium illustrata" of the celebrated Blumenbach, is rapidly passing through the press, so that it will be delivered to subscribers on the first of September next.

admirable.

We have seen some more of the plates, which are

We recommend the work in the strongest manner to our readers.

BOOKS RECEIVED.

From Dr. W. H. Rockwell, Physician to the establishment.-Second Annual Report of the Trustees of the Vermont Asylum for the Insane, presented to the legislature Oct. 1838. 8vo. pp. 16. Brattleboro, Vt. 1838.

A Catalogue of the Officers and Students in the Medical Department of the Cincinnati College for 1838-9, containing the Catalogue of Graduates in Medicine for 1839. 8vo. pp. 8. Cincinnati, 1839.

Transylvania Journal of Medicine extra. Annual Announcement of the Medical Department of Transylvania University, containing the circular for the present year, the Catalogue of Pupils of Session 1838-9, and the List of Graduates at the late commencement. Published by the Medical Faculty. 8vo. pp. 16. Lexington, Ky. 1839.

From Professor T. R. Beck.-Statistics of the Medical Colleges of the United States. By T. Romeyn Beck, M. D. From the Transactions of the Medical Society of the State of New York, vol. iv. 8vo. pp. 12. Albany,

1839.

From Dr. William B. Diver.-The first Report of the Hospital at Macao, under the auspices of the Medical Missionary Society in Canton, for the quarterly term beginning 5th July, and ending 1st Oct., 1838. By the Rev. Peter Parker, M. D. 8vo. pp. 12. Canton, China, 1839.

From the Author.-A Memoir of the Life and Character of Philip Syng Physick, M. D. By J. Randolph, M. D., Lecturer on Surgery, Member of the American Philosophical Society, one of the Surgeons to the Pennsylvania Hospital, Member of the Philadelphia College of Physicians, one of the Consulting Surgeons to the Philadelphia Dispensary, Honorary Member of the Philadelphia Medical Society, &c. &c. 8vo. pp. 114. Philadelphia, 1839.

THE

AMERICAN MEDICAL INTELLIGENCER.

Vol. III.

June 15, 1839.

No. 6.

ART. I.-ON THE SOUNDS OF THE HEART.

BY J. H. S. BEAU,

Chef de Clinique at the Hospital La Charité.

[This is a difficult subject of investigation, which we hope will be elucidated by the labours of a zealous and able friend, who contemplates instituting, at an early period, a set of experiments on animals on the normal action of the heart. Hitherto, experiments have yielded results by no means accordant. To many of these we have referred elsewhere,' and-for the reasons there given-have stated, that farther observations are necessary, but that in the present state of our knowledge, the view of Dr. Williams and of Mr. Carlile is most in accordance with observed phenomena. This view refers the first sound to the systole of the ventricles, and the second to the obstacle presented by the semilunar valves to the return of the blood from the arteries into the heart. The first sound, at all events, appears to be synchronous with the systole of the ventricle, and the second with its diastole.

M. Beau whose attention to diseases of the heart is well known to the profession, both from the mention made of him by M. Bricheteau in his "Medical Clinics of the Hospital Necker," published in the "Library," and from his own publications, gave the following account of the normal sounds of the heart in a paper which he published four years ago; and-from a recent communication-farther observation appears to have confirmed him in his views.-Ed.].

1. The succession in the movement of the cavities of the heart takes place as follows:-contraction of the auricles, dilatation of the ventricles, contraction of the ventricles, dilatation of the auricles; then a recurrence of the series, contraction of the auricles, &c.

"2. The first sound of the heart, or inferior sound, or ventricular sound, is produced at the moment when the wave of blood, impelled by the contraction of the auricle has rapidly dilated the ventricle. It is the result of the shock of the wave against the paries of the ventricle which is situate opposite to the auriculo-ventricular orifice.

3. The second sound, or superior sound, or auricular sound, is produced at the moment of the dilatation of the auricle. It is owing to the arrival of the column of blood, which debouching rapidly from the venous trunks, strikes against the anterior paries of the auricle.

Human Physiology, 3d edit. 11. 160. Philad. 1838.

2 Archives de Médecine, Dec. 1835.

"4. The rhythm of the motions of the heart is composed of three regular and equal times. In the first, which is marked by the ventricular sound, there is contraction of the auricle, dilatation of the ventricle, contraction of the ventricle. In the second, which is marked by the auricular sound, there is dilatation of the auricle and depression of the semilunar valves, which retain in the arteries the blood first sent into the ventricles. Lastly, in the third time, which is marked by a silence equal in duration to one of the preceding sounds, the dilatation of the auricle continues until its repletion is complete.

"5. Consequently, the wave of blood sets out from the auricle, traverses the ventricle, and arrives in the artery in one third of the time concerned in the entire revolution of the heart. The two other thirds are occupied in the dilatation and entire repletion of the auricle.

"6. The shock of the apex of the heart against the paries of the thorax is the effect of the diastole of the ventricle, not of its systole."

[In the communication before referred to, published in the same journal' and entitled "Researches on Certain Points of the Semeiology of Affections of the Heart," M. Beau deduces the following inferences, basing them on the normal sounds described in his earlier paper.]

"1. Hypertrophy of the ventricles does not, of itself, give rise to the shock or impulse in the præcordial region. This shock exists only in a high degree when hypertrophy of the ventricles is accompanied by hypertrophy of the auricles.

"2. The abnormous sounds are produced by the increased friction which the blood exerts against the parietes of the cavities of the heart, which Occurs when there is a want of proportion between the wave of blood and the calibre of those cavities.

"3. The contraction of the orifices is not a necessary cause of abnormous sounds; for different circumstances may occasion the volume of the wave to be diminished in the same proportion as the diameter of the contracted orifice, and consequently there may not be any augmented friction.

"4. When the contractions are not accompanied by abnormous sounds, as frequently happens in old persons, there is, most commonly, irregularity in the normal sounds and in the pulse.

"5. The abnormous sounds of the first time are produced by the different kinds of polyamia; by the lesions which occasion a diminution in the calibre of the auriculo-ventricular and ventriculo-arterial orifices. To these may be added insufficiency in the auriculo-ventricular valves.

"6. The abnormous sounds of the second time arise merely from ventriculo-arterial insufficiency.

"7. The seat of maximum intensity of the abnormous sound of the first time, is commonly found at the part of the præcordial region which is opposite the inferior half of the heart, or its point. That of the abnormous sounds of the second time, is in the point of the præcordial region, which answers to the base of the heart.

"8. It is impossible to distinguish by the seat of the sounds in the præcordial region, which is the side of the heart whose orifices are affected.

"9. The abnormous sounds differ from the normal in their seat, mode of production and form: they have, consequently, a separate existence, and may be met with together; but they are never transformed into each other.

"10. Like the normal sounds, the movements of the cardiac cavities may be double, (se dedoubler,) and take place separately."

1 Janvier, 1839.

ART. II.-NUTRITION OF THE FŒTUS.

Professor Dunglison,

Spring Hill, Va. May 29, 1839.

Dear Sir,-If you think the remarks below are deserving a place in your valuable "Journal," they are for publication. I do not offer them as claiming originality, but merely as eclectic.

Very respectfully,

A. J. COONS.

The source from which the fœtus receives its pabulum for the growth of the same, has been a point of warm controversy among different authors; and one that has solicited the greatest diversity of opinion.

But in the absence of any thing of an absolute character, we should adopt the theory that will admit of the greatest amount of evidence. Then, for the first few weeks of gestation, before there is either placenta or liquor amnii to afford the pabulum, the new being receives its increment from a nutrient principle that descends to the uterine cavity through the fallopian tube at the time of the ovum itself. In fact, this gelatinous mass surrounds the embryo, and may be considered a part of the ovum. The process effected here is very analogous to the development of the chick in ovo, during the period of incubation.

From the time when the placenta is in esse, some distinguished authors are of opinion that the fœtus is nourished by the function of absorption ; and that the nutriment offered for the exercise of this function is the liquor amnii. This liquor, Professor Dunglison suggests, may be secreted by the maternal vessels, which would therefore call for a process of imbibition and transudation through the membranes.

Those authors who have maintained that the cutaneous surface of the fœtus has the power of absorbing, have denied such an office to the placenta, any further than oxygenating the blood of the new being. Now, it would seem an organ, so vascular in structure as the placenta, and so closely adherent to the uterus (another viscus of great vascularity) as to make a sensible indentation in it, must imbibe some part of the fluid that circulates in the womb.

66

An overwhelming argument in favour of the placenta absorbing nutriment for the fœtus is, that the fluid circulating contiguous to it is highly nutritious, which is not the case with the liquor amnii, as we shall presently show. Professor Dunglison in support of a different opinion from ours, remarks, "We have the most incontestable evidence, that neither the placenta nor umbilical cord is indispensably necessary for foetal development." Now every argument the distinguished professor brings forward in support of his position, it seems he concentres in the single case observed by Dr. Good in 1791. And to use his own words, in this case, a small shriveled placenta, or rather the rudiment of a placenta, followed soon after the birth of the child, without a funis or umbilical vessel of any kind, or any other appendage by which it appeared to have been attached to the child." As unimpregnable as this case seems, it may be asked might not some contingency relative to the same have existed, of which the sagacious mind of Good did not take cognisance? It may be, this separation of the placenta from the fœtus took place just before parturition-the cord having sphacelated; or from some cause still more occult. At least, I think these hypotheses are more plausible than some on the negative side of this question; such as the vivifying of the blood being accounted for, from the unusual quantity of

1 The views of the editor to which our correspondent refers, is contained in his Human Physiology, 3d edit. ii. 456. Philad. 1838.-Ed..

oxygen contained in the liquor amnii: and a supplementary function being assigned to the liver for the discharge of the same office.

But to proceed. Cases of this character are very eminently rare; and there are found very generally (if not always) some traces of a placenta. I am not aware of any clear case on record which leads us to conclude à priori, there must not have existed a union during some period of gestation; and to determine how long before parturition this separation took place, is involved in the deepest obscurity.

Indeed, how can the liquor amnii be of much aid, if any, in offering nutriment to the fœtus, when from chemical analysis it is little else than water? Containing, agreeably to MM. Vauquelin and Buniva, water 98.8; albumen, salts of lime and soda, 1.2.

There are other important functions assignable to this liquor without calling in the function of nutrition. If we admit this function more properly belongs to the liquor amnii, and that the placenta is not essential to fœtal life-fœtuses having been born without a placenta-then we had as well admit that nature, by a slight effort, might very handsomely have dispensed with this organ altogether. In opposing the opinion of those physiologists who have introduced the marsupial animals, as one case of animals breeding without a placenta, it is only necessary to say, they have introduced an example of analogy, like many others, that will not obtain between man and the lower animals.

But let us examine a little into the other side of the question. And first, it is an incontestable fact that children are sometimes born-and in a vigorous and healthy condition-when the liquor amnii is fetid. (Blundell.) Again, it cannot be denied that the liquor amnii is sometimes discharged several weeks before the extrusion of the child. In these cases it has been observed at birth, that the infant was plump and well nourished; "which (in the language of Blundell) could not have been, had the nourishment of the child depended upon the liquor amnii."

Now let us compare, for a short time, the validity of these two theories as to the source from which the new being receives its nutriment.

If we receive the liquor amnii as the source of nourishment, it may be asked, how is the blood vivified when there is no placenta? Here we are left profoundly in the dark. If we adopt the placenta as the means of nutriment to the child, and at the same time vivifying its blood, it is sufficiently intelligible how it is supported in those cases where there is no liquor amnii. And again, the discharge of this fluid previous to the time of labour is much more common than the separation of the child from the placenta prior to the same time.

A. J. COONS, M. D.

For the American Medical Intelligencer.

ART. III.-CURIOUS CASE OF PROTRACTED EXPOSURE IN A

DRAIN.

[We publish with pleasure the following singular case, obtained from the interesting relic of medical history, with which our esteemed correspondent has favoured us.-Ed.]

Sir, Herewith you will receive a very scarce, and, as regards Philadelphia, probably a unique copy of the Charleston Medical Register, for the year 1802, by David Ramsay, M. D., which I received from the author soon after its publication. I deem it worthy of a new dress, and hope you will agree with me in opinion on the subject. The advice contained in the in