17. On Gouty Concretions, with a new Method of Treatment.-ALEXANDER Ure, Esq., in a paper on this subject, read before the Royal Med. and Chirurg. Soc., introduces to the profession a remedy, which he believes likely to prevent the formation of tophous concretions in gouty subjects. The remedy is benzoic acid, administered in doses of a scruple an hour after a meal. "In the course of a couple of hours (as the author has found by frequent experiments made upon himself and others) the urine voided, amounting to five or six ounces, will be found, on adding a small quantity of muriatic acid, to yield a copious precipitate of beautiful rose-pink acicular crystals, which weigh, after being allowed to settle for a day, about fifteen grains." The body thus produced by the agency of vital chemistry is hippuric acid, and is found to have taken the place of uric acid in the urine, none of the latter being discoverable. By thus substituting hippurate of soda, a salt of easy solubility, for the very sparingly soluble urate of that alkali, the author conceives that the formation of the tophous concretions may be altogether prevented. Mr. Ure stated that he had employed the plan recommended in his paper in two or three cases with decided success. He had not found the dose, twenty grains, to be at all too large, and had frequently taken it himself without any unpleasant effects.-Lancet, February 6, 1841. 18. On a Sedative Lotion in Headaches, Congestions, and Cerebral Fevers.PROFESSOR RASPAIL, in a letter to the editor of Expérience, (July 24, 1840,) gives the mode of preparing a lotion, the sedative effect of which, he says, is almost instantaneous. It is as follows: liquor of ammonia, (Qy. the strength?) 100 parts; distilled water, 900 parts; purified marine salt, 20 parts; camphor, 2 parts; essence of rose or some other scent, in the necessary proportion. The whole dissolved cold. A piece of linen is to be steeped in this solution and applied over the part of the head that the patient points out as the seat of pain, taking care, if it is on the forehead, to apply a thick bandage over the eyebrows, to prevent any drops of the fluid passing into the eyes. M. Raspail says he has seen headaches intolerably violent, accompanied by photophobia, and retraction of the globes of the eye, disappear completely, from a quarter to half an hour after the application of one wetted cloth. The linen is to be soaked as often as a new access of pain is threatened, and left on the head until it is necessary to soak it anew. In the numerous trials the author has made with this solution, first on himself and afterwards on others, he has been struck by two circumstances of interest in connection with organic chemistry, and symptomatology. When in a violent attack of cerebral fever, we apply on the principal seat of inflammation a concentrated solution of marine salt, an evident odour of chlorine is disengaged, the diseased reaction being analogous to the decomposing and deoxygenating action of manganese, in the elimination of chlorine from marine salt, by means of sulphuric acid. Is this sign constant in affections of this class? It is for experience to decide. When on the contrary we employ a solution of ammonia, a strongly characterized hircine (goatish) odour is manifested. The same odour has been disengaged on the application of hydrochloric acid to the skin. M. Raspail has drawn the attention of the profession to this subject in order that they may employ this formula, and fix their attention on the analyses of the disengaged substances, as they may become characteristic of special affections.-B. & F. Med. Rev., Jan., 1841. 19. Sulphur ointment in Smallpox.-Dr. MIDAVAINE recommends in an article in the Annales de la Societé de Médecine de Gand frictions with sulphur ointment in the treatment of Variola, with the view of arresting the development of the pustules, and consequently preventing the inflammatory fever which results from the turgescence of the skin or the secondary fever (fièvre de resorption), so fatal in the suppurative stage. "The ointment which I use," says M. M. "has the double advantage of preventing suppuration of the pustules, and the cicatrices which ordinarily result from them. This ointment consists of one drachm and a half to two drachms (the first for varioloid, the latter in cases of confluent smallpox) united with an ounce of lard, with which the whole face and those parts of the body covered with pustules are gently rubbed, three times a-day. The nearer the commencement of the eruption this is done, the greater the chances of success. The small pimples then contract and become completely indurated in place of enlarging, and the gastro-intestinal irritation completely disappears. It is rare, even in confluent variola, for the patients not to promptly recover their appetite and ask for food." Dr. M. relates sixteen cases in which he has employed this treatment and with the most entire success.-Journ. de Méd. et de Chi. Pratiques, Dec. 1840. 20. Treatment of Epilepsy by Cauterizations with Potash.-Dr. FIEVEE, de Jumond, has published in the Gazette des Hôpitaux some cases of epilepsy cured by severe cauterizations, and he invites the attention of practioners to this measure, which he says he has resorted to successfully a number of times. It is well known that epilepsy has been cured by the patients falling in the fire and severely burning themselves, and we presume this fact suggested the remedy just noticed, at all events it seems to afford encouragement to try the measure. We shall notice one of Mr. F.'s cases. M. B. aged 45, strong constitution, has been epileptic for fifteen years. The attacks usually came on two or three times a month, and the patient had ordinarily two in the twelve hours. Nineteen deep and large cauterizations made with caustic potash on the neck, on each side of the cervical and dorsal vertebræ, in series of four each time and at intervals of six weeks completely cured this long continued and horrible disease. Three years has elapsed without a single attack to interrupt the security of the patient or the satisfaction of the physician. SURGICAL PATHOLOGY AND THERAPEUTICS, AND OPERATIVE SURGERY. 21. Partial Injury of one of the Halves of the Spinal Marrow. By M. BEGIN.L., a robust old soldier, ætat. 59, received a wound from a sharp-pointed cutting instrument in the back of the neck. He fell immediately, and being unable to raise himself, was obliged to be carried to an adjacent house. He said he had been knocked down by some heavy weapon, and that he had fallen not in consequence of the wound in the neck, which he thought insignificant, but from the violent stunning which he felt at the instant he was struck. He fell backwards and on his right side, and there was a slight bruise on the right elbow, but no other sign of external violence, although he attributed the impossibility of moving his right limbs to the shock and the bruises which he had received in his fall, or more still to the blows which he affirmed had been given him while on the ground. The wound was united by plaster, and the patient, regarding his injury as a slight matter, refused to be bled. On the next day he was taken to the Val-deGrace, where M. Begin first saw him, in the evening. He then said that he felt nothing but a little numbness of the right side. His pulse was slightly excited; the wound had healed, and he would not be bled. Cold was applied to the head and neck, and warmth to the feet, and antiphlogistic diet was ordered. He passed the night quietly. Next day, on examining the united wound more closely, it was found to be in a transverse direction, half an inch long, at the level of the fifth cervical vertebra, and nearly an inch from its spinous process. Its angles were nearly equally acute, rendering it probable that it had been made with a double-edged instrument; there was neither ecchymosis, nor swelling, nor heat, nor pain, nor hardness about it; the movements of the head and neck were perfectly free, and unaccompanied by pain, even when carried to a considerable extent. The patient felt a kind of weight in his right arm, and had creeping sensations in the hand; with a little difficulty, however, he could raise the arm, and move the forearm; but the fingers half-flexed could neither be opened nor closed completely. The right leg was absolutely motionless. A vague pain was felt along the right side of the chest, and there was perfect sensibility in every part of the body. The mind was clear: there was slight fever. The patient was bled freely both from the arm and locally; stimulants were applied to the feet, and cold to the head, and strict abstinence was observed. On the third day after the accident there was a slight power of moving the right great toe. But there was much more fever, and the patient was again freely bled. On the fourth day, after a very quiet night, he was a good deal better, but at night he became feverish, excited, and delirious. This condition was somewhat relieved by leeches; but next day he had a violent shivering-fit, followed by incomplete reaction; at night he had low delirium, with an unequal pulse, difficult, hurried respiration, and hiccup, and with these increasing, he died early in the morning of the sixth day after receiving the wound. At the examination of the body, the wound externally was scarcely discernible, but more deeply its course became more and more evident by the effusion of blood in the adjacent tissues. In the middle of the right lamina of the sixth cervical vertebra there was a fragment of a knife, which projected backwards for about a line, and had its back directed towards the median line. Having removed all the cervical portion of the vertebral column, and cleaned its fore-part, the point of the same portion of knife was found projecting about one-tenth of an inch between the sixth and seventh vertebræ. It had broken the upper edge of the body of the latter, and had stuck into, but not passed through, the poste rior wall of the pharynx. The left side of the column was cut away, and the vertebral canal being thus opened, the medulla spinalis was found surrounded by pus mixed with the spinal fluid, and its surface was softened above and below the wound. It had been struck by the back or rather by the blunt edge of the blade of the knife, and the cut extended obliquely on the right side, from the level of the origin of the posterior roots of the nerves to the anterior median furrow. The posterior column was uninjured from the line of origin of the posterior roots to the posterior median furrow, while the anterior column was divided from the same point to the groove occupied by the anterior spinal artery. The portion of the weapon that remained in the wound was an inch and three quarters long, and three-fifths of an inch broad at its base; it was part of a short and very sharp dagger-knife. The shock that must have accompanied the violent penetration of the arch of the sixth vertebra, and the intervertebral cartilage, as well as the part of the body of the seventh vertebra, perfectly explains the sensation of bruising and the stunning which the patient felt at the instant of receiving the wound. Neither during life nor after death was there any erection of the penis. [This case is interesting in every way, but especially in its obvious bearing on the functions of the columns of the spinal marrow, and the nerves respectively connected with them.]—B. & F. Med. Rev., from Bull. de l'Acad. de Méd., Dec. 15, 1840. 22. On the Removal of Foreign Bodies in the Joints by means of Subcutaneous Incisions. By Dr. GOYRAND, of Aix.-This new method of operating was sug gested by the fact, that incisions made into joints through such small external openings that the air cannot obtain admittance to the cavity, are never productive of that severity of inflammation which follows wounds with wide external apertures, and which, in the operations hitherto performed for this disease, has so often terminated fatally. The proceeding recommended by the author consists in pushing the loose body (if in the knee-joint,) into the synovial pouch above and to the outer side of the patella, beneath the vastus externus muscle, and while an assistant holds it fixed there, passing a narrow knife through the skin at some distance above the joint, and through all the intermediate tissues down to the foreign body. Without enlarging the opening in the skin, the synovial membrane and adjacent tissues over the loose substance are now to be freely divided, till, by the pressure on the latter, it slips out of the joint through the wound, and lodges itself in the subcutaneous cellular tissue, or in some of the other tissues between the skin and the joint. After this the patient must remain at rest for several days, (the small external aperture being merely covered by sticking-plaster,) till all chance of inflammation occurring has passed away. The foreign body dislodged from the interior of the joint, will form a cyst for itself, and remain in its new position without producing any annoyance; but, if it should be deemed necessary, it may easily be removed by a single incision through the skin over it, which will no longer be likely to excite any inflammation of the joint itself. The author details a case in which this method of operating was adopted with perfect success. Two loose cartilages were dislodged, and pushed into the tissues adjacent to the joint. One was subsequently removed by an incision through the skin; the other was allowed to remain, and it produced no inconvenience whatever. Through the whole course of the treatment the patient had not a bad symptom, although less precautions were adopted than are usual in this description of cases. [We understand that Mr. Syme, of Edinburgh, performed this operation, and with complete success, without previous knowledge of M. Goyrand's proceeding.]—Ibid., from Annales de la Chirurg. Française et Etrangère, Jan. 1841. 23. Successful Performance of Tracheotomy in a case of Croup. By M. SAUSSIER. The case occurred in the hospital of La Pitié, in a boy two years old, who had been operated on for hare-lip, by M. Sanson. The first croupy symptoms appeared ten days after the operation, and after the unsuccessful employment of leeches and emetics, the child seeming to be in imminent danger of suffocation, the operation was performed. White patches had formed upon the tonsils and arches of the palate, afterwards on the tongue and internal surface of the cheeks, and deglutition had become impossible. The operation was followed by instant relief. M. Saussier cleaned out the trachea with a sponge, which he introduced several times, and upon which he withdrew a transparent pellicle, about two centimetres broad. Ten minutes afterwards, the canula was introduced, and the child almost immediately fell asleep. During the three following days, eleven distinct, thick, yellow, false membranes were either expelled naturally by the patient, or withdrawn from the trachea by means of the sponge. The trachea was cauterized four times with a solution of sixty centigrammes of nitrate of silver in four grammes of water. The canula was changed thrice. The canula was finally removed on the thirteenth day, and the teazing cough and frequent expectoration of thick mucosities which had continued till then, immediately ceased. On the sixteenth day the wound was healed, and at the end of August the child was discharged, having been operated on on the 3d of June.-Ibid, from L'Expérience, Dec. 3, 1840. 24. Chloride of Zinc in the Treatment of Acute and Chronic Gonorrhea. By M. GAUDRIOT. After a large number of observations the author of this memoir concludes that the chloride of zinc, properly diluted, has a remarkable power in curing simple gonorrhea of the urethra and vagina, also in dilating the urethra, and thereby ameliorating strictures. He believes that it is always by an inflammation sui generis that the discharge is cured, and that injections of the chloride of zinc determine a series of phenomena not produced by other caustics. It is only necessary to use a few drops of injection, as the extremity of the urethra is the only part to which it should be applied. To combat vaginal gonorrhoea in women, M. Gaudriot proposes a new proceeding, which consists in the use of solid vaginal suppositories, composed of a paste made to melt easily, and containing a certain quantity of liquid chloride of zinc and sulphate of morphine. In men the author employs the following formula: Liquid chloride of zinc, 24 to 36 drops. Distilled water, four ounces. Agitate and filter through paper. A small quantity of this solution should be injected about an inch along the urethra, two or three times a day. The vaginal suppository which he employs is formed of Liquid chloride of zinc, 5 drops. Sulphate of morphine, half a grain. Mix with three drachms of the following paste! 3 66 9 66 To cure radically a gonorrhoea in man, it will ordinarily suffice to apply two injections a day for two or three days. The first injections are almost always followed by a more or less swelling of the glans penis, but this does not prevent their continuance. In women, four or six suppositories, one being introduced every day, or every second day, suffice to obtain a cure. The first introductions frequently occasion a swelling with more or less heat of the vulva, but these phenomena are soon completely dissipated. Emollient baths have in most of the cases been employed for this purpose.-Ibid., from Journ. des Connaiss. Méd. Prat. et de Pharmacologie, Sept. 1840. 25. Ligature of the common Carotid Artery, and Experiments on the Ligature of both Carotids in Animals.-M. JOBERT, de Lamballe, has addressed a memoir to the Royal Academy of Medicine, containing a case where he tied the common carotid to cure an erectile tumour of the orbit, and also the result of his experiments on living animals, to determine the influence that ligature of both carotids would have upon them. Ligature of the common carotid on either side does not stop the course of the blood through the ramifications of the tied artery; how then can it effect the cure of erectile tumours of the face and head? M. Jobert replies, 1st, by the sudden subtraction of a large quantity of blood from the tumour; 2, by giving an obstacle to the transmission of the impulse of the heart, in its full energy towards the tumour. He has convinced himself by his experiments, that beyond the ligature, the blood runs in a continual jet, waving, and without jerk (saccade). His conclusions are, 1st, that erectile tumours of the orbit, destroy the bones after the manner of aneurisms; 2d, they have the characters of aneurismal tumours, and are cured by ligature of the common carotid of the same side; 3d, the cure is not owing to obliteration of the artery beyond the ligature, but to diminished impulse of the column of blood arriving in the tumour; 4th, the vertebral arteries suffice for the cerebral circulation after ligature of the carotids; 5th, dogs, sheep, and rabbits do not experience ill effects after this operation; 6th, horses on the contrary do not survive it, dying with pulmonary apoplexies; 7th, blood-lettings before or after the ligature, diminish the intensity of the pulmonary lesions; 8th, perhaps in man, the loss of a certain quantity of blood after the operation, would have good effect.-Rev. Méd., Sept. 1840. MM. Berard, Gimelle, and Larrey, who were appointed as a committee to examine the memoir of M. Jobert, consider it of importance; 1st, as adding two cases of cure of erectile tumours, one in the orbit by ligature of this carotid, to four other cases previously recorded; 2d, as the experiments prove the harmlessness of ligature of both carotids, in those animals whose vertebral arteries enter the cranium of a calibre sufficiently large to keep up the cerebral circulation and avoid pulmonary congestion; 3d, as it proves that the brain and the organs of the senses preserve their functions entire after this ligature; 4th, as it places beyond doubt, that animals who from their anatomical construction survive the ligature of the common carotid arteries, are not affected with lesions of the organs of the senses as described by authors; 5th, as these experiments and their results will exercise a great influence on the surgical therapeutics of diseases, for the cure of which ligature of the common carotids might be proposed. -1bid., from Bull. de l'Acad. Royale de Méd., Oct. 15 and 30, 1840. |