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The author referred to the commonly accepted views in relation to the normal position of the epiglottis being considered wholly vertical or erect, and quoted Harrison, Knox, Bishop, Dunglison, Meckel, Cloquet, and even Czermak, in support thereof. Whilst admitting their correctness to a certain extent in the largest portion of mankind, he has discovered, in the course of his physiological investigations with the laryngoscope, that in eleven per cent. the epiglottis is not erect, but either oblique or nearly transverse, and that this condition is not necessarily associated with disease, occurs at all ages, and is occasionally congenital, being observed in parent and offspring. The ages of those examined varied from 6 to 90 years.

The effect of this position of the epiglottis is an alteration in phonation, and much inconvenience and danger in the event of disease, as well as inducing a predisposition to take on diseased action. Speaking and singing are much affected; some cannot sing in consequence. The shape and condition of the valve named in the 300 persons examined were then described.

The author summed up with the following conclusions:

1. Physiologically speaking, the epiglottis is vertical in the great majority of mankind; in a certain proportion it is oblique or nearly transverse.

2. The evils likely to arise from the latter at present appear to be so inconvenient, that it would be desirable that an inspection of the epiglottis should be made in every child, where practicable, between the ages of 6 and 10 years, for the purpose of ascertaining its correct position.

3. If it is found to be not vertical, a knowledge of the fact will prove beneficial through life in guarding against evils likely to arise, during the prevalence of epidemic sore-throat, or other diseases likely to involve the larynx.

4. No interference with the throat or larynx should ever be permitted without the aid of laryngoscopic inspection.

5. Whilst any imperfection in the voice or speech may be explained by the position of the epiglottis, independently of the vocal chords, a chance for the improvement of both is held out, by adopting some means that shall render this valve more oblique in direction than transverse, or possibly (but at present very doubtful) restore it to a vertical position.

On Secret Poisoning. By GEORGE HARLEY, M.D., Professor of Medical Jurisprudence in University College, London.

The author stated that although he had no wish to engender groundless suspicions or excite unnecessary alarms, yet he was sorry to say he could not but repeat the statement he made last year in a paper on slow poisoning read before the Royal Medico-Chirurgical Society of London-namely, that he believed the cases of secret poisoning that are discovered form but a small percentage of those that actually occur. Nay, more, he even went a step further, and declared that he not only believed that we magnified the difficulty of perpetrating the crime, but that we were also inclined to exaggerate the facility of its detection. No doubt, modern discoveries in physiology and chemistry had enabled us not only to distinguish between the effects of poison and natural disease during life, but likewise to detect and extract the poison from the tissues after death. But modern discoveries had also made known to us many poisons with which we were hitherto unacquainted. It was in toxicology as in naval warfare, no sooner was a projectile discovered that is considered irresistible than our engineers set about discovering armour-plates more invulnerable than their predecessors. So, no sooner does the criminal find a new poison that he can use with impunity, than the experts set about discovering a means for its detection. He remarked that the great desire of the poisoner was to get hold of a poison the effect of which would so closely resemble that of natural disease as to be mistaken for it. Fortunately, however, this was attended with extreme difficulty, as the effects of poison were generally sudden in their onset and rapid in their termination; for the poisoner seldom had time or opportunity of administering the poisonous agent in so small a quantity and for such a length of time as are requisite to produce an artificial state of disease which may be mistaken, at least by the unaccomplished physician, for real disease. It had been asserted that in all cases of poisoning where death occurred, the poison ought to be found in the 1862.

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tissues after death. He, however, pointed out that this was not strictly true; for even in the case of arsenic, which was supposed to be the most persistent of all poisons, if the patient only lived long enough, the mineral might be entirely eliminated by the excretions before death, and afterwards not a trace remain to be detected in the body. Such occurred in Alexander's case, when, although it was known that arsenic was the poison which caused death, none was found in the body. Alexander, however, did not die till the sixteenth day. For this and other reasons the author then said, "that as the not finding poison in the system after death is no absolute proof that the patient did not die from its effects, the symptoms observed during life, in conjunction with the morbid appearances observed after death, even when no poison is discovered by chemical analysis, ought to be sufficient to convict the poisoner; and even the symptoms alone, if there be good circumstantial evidence, especially if combined with proof of a motive, ought to convict, just as was done at Palmer's trial." The author concluded by saying that in all cases of suspected murder, great care should be taken to avoid telling the persons around the patient of the suspicion. The patient himself should be the first confidant; for if there was no motive for suicide, he was the most likely to be aware of a motive in the persons surrounding him. The next confidant should be the doctor, who, by obtaining some of the secretions and having them carefully analysed by a competent person, would soon be enabled to decide if it was a case of secret murder, and perhaps also give a clue to the detection of the criminal.

Suggestions towards a Physiological Classification of Animals,
By JAMES HINTON.

It is scarcely necessary to remark that no system of animal classification has yet been accepted as entirely satisfactory, or that it is universally allowed that no linear series can possibly fulfil the requirements of the case. As bearing upon this subject, the author's attention has been drawn to the relation in which the Articulata and Mollusca stand to each other. It is manifestly impossible to place either group, as a whole, below the other; but there exists a marked physiological difference between them. In the Articulata, for instance, the organs of animal life preponderate, and give a decided character to the group, while in the Mollusca the organs of vegetative life are not less strikingly predominant. The two classes might well stand as representatives of the two great elements in which animal life consists. With this thought in mind, it appeared to the author that the whole animal series arranged itself (with certain difficulties and doubtful points of course, but still on the whole very readily) in conformity with this idea. Thus, for instance, between reptiles and birds a similar relation obtains.

The author further illustrated his views by reference to other classes.

On Simple Syncope as a Coincident in Chloroform Accidents.
By CHARLES KIDD, M.D., M.R.Č.S.

At two former Meetings of this Association, several reasons, chiefly obtained from the large field of clinical experience of London hospitals and their operatingtheatres, were stated, and given in detail, why we should regard deaths from chloroform administration as pure accidents; and deaths in hospital, as not to be considered exactly similar to deaths from overdoses in lower animals. The author is desirous at present to state, that the leading facts and reasonings then expressed have since been borne out by further experiments and explained, but that at that time part of the subject was purposely left incomplete.

There is reason to believe that a large percentage of so-called chloroform deaths arise from simple fainting-fits, or "shock" (as known long before chloroform was discovered at all), but that now chloroform gets the discredit of them. The deaths from sulphuric ether used as an anesthetic (at least twenty-five in number) were nearly all the result (most probably) of secondary hæmorrhage after operations, which it very much favours, as also a state of deep narcotism like that from morphia, previously misunderstood, and therefore not guarded against in sufficient time to save life. The accidents from simple syncope are of the nature of accidents

after chloroform-post hoc, but not propter hoc; they are very alarming, more so than the asphyxia cases, as it is very difficult to rouse up the reflex and cardiac nerves where syncope occurs, and, curiously enough, it seems to occur by emotion or fright irrespective almost of the chloroform.

The author, being a believer in the value of the deductive philosophy of Mr. Mill and Mr. Buckle in inquiries, like the present, of a physiological kind, wishes at present simply to state that he finds the immense mass of facts as to chloroform (chiefly experiments on the lower animals instituted by the Biological Society of Paris, as detailed in the very masterly essay of MM. Lallemand, Perin, and Duroya mass of facts of the highest importance, only very recently published) entirely agree with and corroborate the clinical views he had the opportunity of laying

before this Association.

It is a pleasure to be able to state, that every year's additional study of chloroform in London leads to a feeling of greater and greater satisfaction as to its value and safety; that this impression also agrees with clinical experience in other cities of Europe, and even in America, where chloroform has now nearly superseded the use of ether.

The author wished the present paper to be short, to be, in fact, complementary of former communications. The aggregate number of deaths from chloroform is very alarming; but there is reason to think that, in nearly all the cases, the points here discussed previously, as to the necessity of good respiration, good pulse, &c., still hold good for all cases. It seems very desirable that the results, however, of the hospital experience of the members of the Physiological Section of this Association could be obtained as to any new facts or observations that may have come under notice; for the entire subject of anaesthetics is, as yet, but in a tentative or rudimentary condition.

The physiological data of former discussions were left unsettled and incomplete, as said already, in order that a more full consideration might be given to the exact value of simple syncope as a source of danger.

The discussion hitherto, in Dr. Snow's time, as to the nature of death from chloroform, with the consequent precautions to be observed to ensure its safety in practice, had been almost entirely confined to an examination of one questionwhether these accidents arise from what the late Dr. Snow named "cardiac syncope," with engorged state of the right side of the heart, or from simple syncope, the right side not engorged.

The more philosophical mode of regarding the subject now is to look on both causes as active: the "cardiac syncope" is a post-mortem result, however, as it is described by Snow, and is in reality death from apnoea or asphyxia, and arises in some manner, most probably from some error in the administration of the chloroform; but the second cause of death, or simple syncope, is due to idiosyncrasy. This advance in our knowledge is of importance as to saving life in these cases: we were before looking, like the knights of old, at only one side of the shield, but now we know the shield has two sides.

Having previously described at Oxford the mode in which accidents, by asphyxia or "cardiac syncope," occur through irritation of the laryngeal recurrent nerve, or other more recently described nerves, distributed to the mucous membrane of the larynx and air-passages ("Rosenthal's nerves"), it is only necessary to state that further experience helps to corroborate this view. This form of death by asphyxia or apnoea arises by stoppage of action of the respiratory muscles and diaphragm, and can also be brought about in experiments on the lower animals by any even mechanical irritation of these laryngeal nerves; hence the grave necessity of care, in the early stages of the chloroform administration, not to excite or irritate the larynx by acid or impure chloroform, which, like some gases, at once induces spasm of the glottis, with subsequent signs of asphyxia. This was fully entered into at the Oxford Meeting.

Indeed, so sensitive is the larynx, and so peculiar its tolerance of chloroform, that this fact of the irritation of its mucous membrane by a strange vapour is now taken advantage of, and where we have to fear simple syncope or faintness, as in formidable operations like ovariotomy, and where syncope is impending in the middle of such operation, the addition of a drachm or two of ether to the inhaler, or a few

drops of ammonia, seldom fails to rouse the most flagging pulse (as easily conceivable) through these very nerves. Explain it how we will, the clinical fact is of the utmost importance.

This is shown in another direction in this manner :-if we render an animal deeply narcotic by chloroform, in fact all but dead, and then allow it to come back slowly to its usual condition, there is one point where, if the laryngeal nerves be pinched with a forceps, it causes sudden spasm of the glottis, the diaphragm stops acting, and, for want of breathing, the animal falls back again into a state of narcotism or asphyxia, and may die.

With this recent discovery as to these nerves we may perhaps couple the group of facts that there is greatly increased danger attached to surgical operations about the larynx or neck (as observed in practice), arising from cutting or injury of its nerves, or catching them up in forceps whilst tying arteries, &c., some intimately associated with nerves of the cardiac plexus, others with the larynx itself, &c.

If the act of breathing freely continues during the administration of chloroform, we may be almost certain all is right, and the pulse good; but if the breathing becomes slow or intermittent, stopping and going on again, we are not so safe. Some patients, it is true, seem to take the chloroform slower than others, but it is a fatal error to push it on; the chloroform will accumulate in the system, and the aftereffects will be tedious, if the surgeon, for want of time or other causes, hastens the administration.

Is death from chloroform, so called, sometimes a coincidence?

It is well to remember that very marked syncope, and even death from syncope, may occur without the use of chloroform at all: intense sudden pain may cause death and syncope; injury of a tendon, or a large bleeding, or even such a trifling thing as touching the urethra in sounding for stone (as remarked especially by Heurtaloup), may induce most alarming syncope; great weakness from want of food, as in soldiers sometimes after a battle, will also give a great tendency to syncope: so that it is always of advantage to learn more or less of a patient's history when we are about to administer chloroform.

Accidents from syncope and chloroform may occur from apprehension of pain, rather than actual shock, or actual pain, or deep chloroform narcotism; hence so many accidents in the early part of the administration, before the patient is unconscious at all. Thus of 125 deaths carefully analysed, fifty-four occurred immediately before operation, forty-two during operation, but none as the result of long-continued narcotism or anæsthesia; yet chloroform has now to bear all the obloquy of all fatal accidents in the operating-theatre, a certain large percentage of which are obviously the effect of purely mental causes or fear.

Persons with strangulated hernia, about to be operated on, are known to have died before any incision at all (without chloroform), the patients taking the shaving of the pubis for part of the operation. Bichât saw a patient die on the instant of passing a simple seton. Dr. Watson tells of a patient dying suddenly at the sight of a trochar about to be used in tapping the chest. Desault was one day about to perform the operation for stone; the patient did not present anything unusual in his manner, and was placed in the usual position: Desault traced simply a line with his thumb-nail on the perineum; the patient uttered a shriek, and fell stone-dead. Mr. Stanley used to tell of a similar case-Chopart was about to operate for circumcision on a lad, when the boy fell dead the instant the knife touched him. Garengot had a patient with a thecal abscess, who had a shudder and sudden death on seeing the tendon move.

Syncope thus becomes a complication, in modern surgical operations, of much greater seriousness than before. That death occurs not from over-narcotism is at once evident, as it arises from apprehension of pain, the patient being quite conscious when these syncope accidents have occurred.

These deaths (and they amount to about thirty in the hundred of all the deaths) are observed to happen while the patient is having the chloroform administered, before the surgical operation (at sight of knives, saws, surgeons' aprons, a crowd of students, dressers, strangers, &c., in the operating-theatre), showing how much wiser it is to have the patient placed under chloroform in the sick-ward, than to be exposed to this mental shock. In some London hospitals it is so, in others the point is not

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understood; but careful observation leaves no doubt on the author's mind that, next to apnoea or asphyxia, already minutely dwelt upon, this mere coincidence of simple syncope is most to be dreaded

Observations made at Sea on the Motion of the Vessel with reference to Sea-
Sickness. By J. W. OSBORNE.

The author stated that he had entered upon this investigation during a voyage from Melbourne, not with the interest of a physician, whose object it would be to cure this distressing malady, but rather for the purpose of establishing the nature of the connexion between mechanical movement of the human body, both active and passive, with the phenomena of nutrition and waste, functions which manifested many interesting and remarkable anomalies during an attack of sea-sickness. Many observations of a pathological and physiological character had been made and recorded; but it soon became apparent that to obtain results of real value, the nature, force, and direction of the movements to which the vessel subjected the body, and its several organs, required investigation. To express these mechanical influences, three instruments were contrived and used with satisfactory results. These instruments were exhibited by the author, and the following is a sketch of the description given to the Section.

The first consists of a spring balance, capable of suspension from any part of the ship. By placing a known weight in the pan of this instrument, the deflection indicated by the index would be constant under ordinary circumstances on shore. At sea this was not the case, the pan being there subjected to an unceasing oscillatory movement, while the index indicated at one time more, and at another less than the figure on the scale corresponding to the weight used.

The range thus obtained depended chiefly upon the severity of the pitching; and if the divisions of the scale represented fractions of the weight used, the alteration in weight of any of the viscera of the human body, with every wave, might be arrived at in fractions of their own weight; such alteration being, of course, apparent only, but acting, nevertheless, upon all supporting ligaments, muscles, &c. exactly as if it were real.

It was well known that the pitching motion of a vessel was very potent to produce illness, and in the instrument exhibited, the means were offered for measuring and expressing exactly the intensity of this motion; but it was necessary while recording these readings, to determine what the angular movement the vessel made amounted to. To effect this a divided arc was made use of, which, while its manner of suspension permitted of its accommodating itself to one of the angular motions of the ship, partook for the time being of the other. Opposite to this arc, and from the centre of the circle of which it was a part, a plummet or pendulum, made of a strip of metal, was freely suspended. The part played by the latter was to establish a point from which to read off the number of degrees through which either axis of the vessel passed in pitching or rolling. But as the inertia of the pendulum caused it to be seriously affected by the impulsive movements to which the vessel was subjected in passing through the water, it became necessary to neutralize these irregularities. This was accomplished by placing in rigid connexion with the pendulum a small disk, which travelled through a curved tubular receptacle containing oil, glycerine, or other viscid fluid, which, while it did not interfere with the obedience of the plummet to the action of gravity, effectually prevented the communicated impulses from manifesting themselves in the readings. The third instrument was designed to estimate the force of the impulsive move. ment above referred to, and was an arrangement of a somewhat complicated character, in which the oscillations of a pendulum, unaffected by the angular movements of the vessel, were read and recorded. These oscillations originate in consequence of the inertia or momentum of the pendulum itself, freely suspended in a ship varying in its rate of motion through the water.

Several extended series of observations had been made with these instruments which were not as yet reduced.

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