Imagens das páginas
PDF
ePub

liver, spleen, and encephalon, with slight elevation of the lower, solitary, and agminated glands.

The last three cases were all taken ill within about forty-two days, and belonged to the same regiment. Mr. Scriven, while attending them, suffered from slight febrile symptoms, lassitude, headache, loss of appetite, and diarrhea, which he attributes to the same poison.

5. G. H., spleen engorged, other organs healthy, excepting ilium ; 3 inches from cæcum showed solitary and Peyer's glands raised, hard, and surrounded by vascular zone; this condition increased downward ; irregular ulceration about two feet from cæcum, at the highest point of the enlarged glands, of a greenish colour. Three of Peyer's patches ulcerated over their whole surface, and partly covered with a greenish slough. A few ulcers in the cæcum.

6. J. K., aged seventeen, French sailor, May 6th, 1856, had been sick fifteen days with headache, vertigo, and pain in belly (diarrhea); pulse 120, thirst, furred tongue; on admission, slight tenderness in iliac fosse. On the Sth he became delirious, the deliriurn continued for above two days; rose-spots appeared on the 10th; the bowels became relaxed, and the tongue black and dry. On the 16th there was decided improvement, no fresh spots had appeared, and there was no delirium. The treatment consisted mainly in the exhibition of quina, opiates, and port wine; with slight variations convalescence went on favourably, and the patient entirely recovered. On June 4th he is reported perfectly well; with an enormous appetite, the bowels open once in twenty-four hours, and stools not perfectly solid.

7. L. M., aged seventeen, sailor, January 5th, 1857: Has had diarrhæa six days, little vomiting, no appetite, headache, tongue white, thirst. The tongue became brown; the abdomen full, hard, and tympanitic. Intellect confused; urine albuminous, sordes on lips, pupils dilated. On the 9th the countenance was vacant, there was great prostration, pulse 160, slight tenderness in right hypogastrium, drowsy and stupid. After this, gradual recovery for a few days, when erysipelas and death supervened. The small intestine exhibited “the first two or three Peyer's patches (proceeding from above downwards) healthy, the next three or four were congested and raised, of a dusky purple colour. Below this the mucous membrane itself was inflamed, and Þeyer's patches ulcerated. The solitary glands were likewise inflamed, and many of them ulcerated. The ulcers involved the whole of the surfaces of the patches, there was no slough present upon any of them, the ulcers were of a purple colour." The corresponding mesenteric glands were enlarged, and deep purple. The kidneys had numerous white granules scattered through the cortical substance; the lungs showed the remains of pleurisy and " lobular pneumonia ;" the other organs were healthy. • In addition to the above cases, the author adverts to three cases of " typhus with bowel complication,” which occurred in the practice of Mr. Payne, the details of which are not, however, given.

Mr. Scriven terminates his paper by brief remarks on the differences between the malarious, the ephemeral, the sun, and typhoid fevers of India, and on the treatment of the last-mentioned form. Upon this he remarks, that having no antidote, as for malarious disorder, "we must be content to sustain the patient's strength by wine, stimulants, and tonics, soothing the irritability of the intestines by chalk mixture with opium, and fomentations and poultices to the belly, quieting delirium by small doses of morphia, and treating local inflam. mations when they arise, though as a rule, not by depletion.”

VII. Puerperal Fever and Erysipelas. By J. LEVERGOOD, M.D. (The North

American Medico-Chirurgical Review, July, 1857.) Although the relation between puerperal fever and erysipelas is an established fact, it is useful to accumulate evidence, and remind practitioners of the danger incurred by losing sight of it.

There was no puerperal fever at Wrightsville, in Pennsylvania, where the writer practised, nor in its neighbourhood, when, in 1853, Dr. B. C. Lloyd was called to attend a man whose entire left arm was affected with phlegmonous erysipelas. While this patient was under treatment, Dr. Lloyd was summoned to Mrs. D., in labour with her third child. “This lady lived more than a mile from town, in what is known as York Valley, renowned for its beautiful farms, fertile soil, and wealthy inhabitants, and proverbial for its healthfulness.” There was no epidemic in the locality, and the lady was in excellent health. The labour was normal and easy. On the third day puerperal fever set in, and death ensued on the fifth. A second female, who lived a mile from the former, was attended by Dr. Lloyd in her sixth accouchement about the same time. The labour was normal, and the patient healthy : fatal puerperal fever ensued on the third day. The third case occurred in a farmer's wife, who lived five miles from Wrightsville, and was safely delivered of twins. This succession of cases of puerperal fever, limited to Dr. Lloyd's practice, satisfied him that they were due to contagion, of which he was the bearer from the erysipelatous patient. He accordingly ceased attending upon the man, and no further cases of puerperal fever occurred.

VIII. Report on a Memoir entitled, 'On Gangrene of the Extremities in Typhoid

Fever, by Dr. Bourgeois.' By Dr. BEHIER. (L'Union Médicale, June

13-16, 1857.) Messrs. Barth, Hervieux, and Beheir were commissioned to report upon Dr. Bourgeois' paper, which was presented to the Société Médicale des Hôpitaux, and was based upon two cases of typhoid fever followed by gan. grene. The first was a young woman of sixteen, generally enjoying good health, who, after an indisposition of about a fortnight's duration, which was regarded by the author as slight typhoid fever, was seized with sudden pain in the right leg. The limb became cold, upon which the pain ceased. There was no general tumefaction, nor any along the vessels. The limb first became grey, and then of a coppery red, with purple spots. A circular boundary formed at the upper third of the calf: the limb separated, and the patient recovered. The second case occurred in a child, aged eleven years, who, while typhoid fever occurred in her village, was seized with symptoms of typhoid, During an apparent convalescence, sudden pain supervened in both legs, with. out any tumefaction. The limbs became cold and discoloured, as in the first case, and a line of demarcation formed; but erysipelas supervened, and the patient died. In neither case was a post-mortem examination made a cir. cumstance much regretted by the commission. The latter regard the symptoms preceding the gangrene as erroneously attributed to typhoid fever, and only a part of the disease which led to the gangrene. They observe that all cases of acute gangrene which are recorded by writers were preceded by such symptoms as those mentioned by Dr. Bourgeois, and then minutely enter into the literature of gangrene dependent upon arterial obliteration.

They sum up their general conclusions on this point as follows:

Arterial obliteration is the most frequent cause of spontaneous gangrene of an entire member.

It may be complicated with venous obliteration, in which case the gangrene is accompanied by ædema of the member.

When arterial obliteration exists alone, the gangrene presents the dry form.

Arteritis is one of the most frequent causes, if not the only one, hitherto proved to give rise to obliteration of the arteries.

Arteritis induces general symptoms, which vary much, but are generally analogous to typhoid fever. These symptoms, however, have never yet presented a sufficiently definite character to justify the assumption that spontaneous gangrene may thus be developed in the course of genuine typhoid fever.

If Messrs. Barth, Hervieux, and Behier do us the honour to peruse the ‘British and Foreign Medico-Chirurgical Review,'* we would specially direct their attention to the recent article, On Senile Gangrene, by Mr. Lee, which may possibly induce them in a measure to modify their views in regard to the cause of such gangrene depending upon arteritis. The views of Mr. Lee find a strong corroboration in the above two cases.

IX. On the Determination of the Amount of Albumen contained in the Urine,

Serum of the Blood, and Erudations, by means of the Polarizing Apparatus of Ventzke-Soleil. By Dr. F. HOPPE. (Archiv für Pathol. Anat., &c. Band xi. Heft 6.)

The quantitative determination of cane sugar by the rotation of the plane of polarized light is an acknowledged fact in technical chemistry: the circular polarization of albuminous fluids is stated by the author to present but little more difficulty. Bouchardat and Becquerel were the first to attempt the calculation of the amount of albumen contained in the animal fluids by this method. The apparatus employed by Dr. Hoppe is a modification of Soleil's polariscope by Ventzke, intended specially for the rapid measurement of the amount of sugar contained in diabetic urine. The first question-whether the rotation of the plane of polarization bears a definite ratio to the amount of albumen contained in a liquid ?-is answered absolutely in the affirmative. The second question was, as to the relation of the rotation produced by a solution of albumen to that of a solution of sugar, both solutions being of equal strength ? The answer afforded by the investigations of the author is, that the albumen contained in a fluid rotates the plane of the polarized light almost as much to the left as a similar per-centage of grape sugar rotates it to the right. Accord ingly, a scale attached to Ventzke's apparatus, which enables the observer to read off the weight of grape sugar contained in 100 cubic centimetres of fluid, also allows a direct determination of the weight of albumen.

If fluids that contain albumen, and whose rotation has been determined, are allowed to stand for several days, they become opaque, and the rotation is diminished : in many albuminous urines the former rotation, as well as the clearness, may be restored by the addition of a drop of acetic acid. This could not be done with serum; but the author has never observed an alteration in the rotation of an albuminous solution within from two to three days. An allowance must be made in this mode of determining the amount of albumen in a liquid where much soda is present, as it was invariably found that under these circumstances too high a result was obtained.

Dr. Hoppe sums up his conclusions thus: 1. The method proposed is easily executed with albuminous solutions which are not too dark in colour. 2. It possesses no greater sources of error thau those presented by the chemical determination. 3. Turbid fluids may be rendered clear by the addition of small quantities of soda or acetic acid without impairing the result; but if the soda be added in excess it will be too high. 4. The rotation with the albumen is nearly as much to the left as with sugar it is to the right, so that a scale inay

July, 1857, p. 214.

be constructed from which, without further calculation, the amount of albumen or grape sugar contained in 100 cubic centimetres of liquid may be at once read off.

X. Hemophilia. By Dr. Magnus Huss. (Archives Générales de Médecine.

Août, 1857.) Hæmophilia, a term which is scarcely naturalized among ourselves, was first employed by Grandidier to designate that peculiar tendency to hæmorrhage which characterizes some individuals and families. The following case, which is reported and commented upon at length by the well-known Professor Huss, of Stockholm, is almost unique of its kind.

Maria K., a servant, aged twenty-three, a country girl, the child of labouring people who had always enjoyed sound health, and exhibited no hæmorrhagic tendency nor other hereditary taint, was admitted into the Seraphim Hospitalof Stockholm, January 16th, 1851, of good complexion, healthy looking, and well built. Catamenia appeared without abnormal features at the age of fifteen; had never been ill, excepting convulsive fits in her infancy; there had been no remarkable tendency to hæmorrhage, but whenever she had met with an injury the parts had cicatrized as in any other person. She went into service when nineteen years old, and was maltreated on the 4th August, 1850. She was severely buffeted, and struck about the head, in consequence of which she was much excited and seized with convulsions, during which she screamed and strnck her head against the surrounding objects; she was insensible for about half an hour. On recovering herself she found that she had bled profusely from the head, without being able to find any lesion of continuity. She continued in a torpid state during the succeeding three days; she merely remembers that the hæmorrhage persisted, and that blood also flowed from the eyes, the left ear, and that she vomited blood. She continued very feeble after this time, the hæmorrhages recurring almost daily. They ceased after two months, when she recovered her health for a fortnight; without any cause, the hæmorrhage then returned one night from the cranium, and at the same time she vomited coagu. lated blood. The hæmorrhage from the cranium continued for a week, then stopped, and the patient was well for two months. After that, the hæmorrhage recurred every eight or fourteen days from the cranium, eyelids, and left ear. When examined after her admission, no traces of a present or previous solution of continuity could be traced on the craniuin; there was no trace of injury to the bones. The hæmorrhagic attacks continued to occur on the slightest emo. tion, but without special symptoms, except on one occasion, when, at the commencement of copious hæmatemesis, the patient was seized with violent delirium, then lost consciousness, and remained for eight days in a state of profound torpor. She then woke up, and the two left extremities were slightly paralyzed, and their sensibility somewhat blunted. After the lapse of three weeks these symptoms had entirely disappeared. "In March, 1852, she is described as being anæmic, pale, somewhat ema. ciated, and depressed, but the functions otherwise in normal condition; the kidneys, liver, sexual and other organs apparently healthy; emotion so directly influenced the occurrence of the hæmorrhage, that the patient by entering into a dispute could generally produce it at will. When it took place, she felt so fatigued as to be forced to lie down; the hæmorrhage occurred on each side of the coronal suture, on a space three centimetres by ten. The blood was seen to sweat out at the roots of the hairs, first forming a red point, which gradually augmented to a drop which coalesced with others; if wiped off, the surface would soon be again covered with blood; its colour was that of arterial blood. Examined by a lens, no lesion could be detected, but the blood could be seen issuing from the hair follicle; the root of the hair was not diseased.

The hæmorrhage lasted from a few hours to two or three days; the skin of the bleeding part was not tumefied, but slightly tender, and its temperature elevated. The attack was generally preceded for one, two, or three days, by a sense of weight on the head and vertigo, with a feeling of heat and pulsation at the spot immediately before the bleeding occurred. Hæmatemesis and bleeding at the left ear were only occasional concomitants of the attacks; but the former was always accompanied by stupor, alternating with delirium.

The treatment, which consisted in the administration of tonics and astringents of all kinds, with nutritious diet, only caused temporary arrests of the hæmorrhage. Strange to say, that in spite of the peculiar tendency to hæmorrhage from certain parts, there was no predisposition to it from others, for contusions and solutions of continuity were not followed by unusual hæmorrhage. On the application of local astringents to the head, such violent symptoms of cerebral congestion were manifested as to render venesection necessary.

All treatment failing, the patient was sent home in the same state in which she was admitted. The details of this interesting case are followed by an analysis of the theories applicable to the hæmorrhagic tendency, and Professor Huss arrives at the conclusion that it is due to spasmodic contraction of the veins passing from the capillary network of the parts, in which this form of hæmorrhage was manifested.

QUARTERLY REPORT ON SURGERY.

By Joun CHATTO, Esq., M.R.C.S.E., London.

I. On the Treatment of Club Feet. By Dr. BROWN. (Boston Journal,

vol. lvi. pp. 89-94.) In this paper, Dr. Brown lays down some practical rules derived from eighteen years' attention to this branch of practice. He observes, that although the division of tendons, fasciæ, &c.—the contraction of which keeps the foot in its abnormal position is a requisite preliminary, it constitutes but a small portion of the cure. The subsequent treatment is difficult and tedious, requiring, upon an average, two or three months' daily attention and manipulation. This treatment must be attended to by the surgeon personally; and the author has always had cause for regret when he has trusted it to another, finding that all his experience and daily attention are none too much for the cure of a bad foot. It is a great error to content oneself with dividing the tendons, and then handing the patient over to the care of his friends and the machinist, it being very doubtful whether a cure was ever so effected. Many of the cases that have come under Dr. Brown's care had been already operated upon by other surgeons, and so left.

When a patient is old enough, and has used his foot much, Dr. Brown first advises rest. He then divides all the tendons and fasciæ that keep the foot in its false position, employing for the purpose a very small tenotome, its cut, ting portion being less than half an inch in length, while its shank, 17 or 11 inch long, is very small and round. When the cutting edge is too long, the slight sawing movement during the section of the tendons may cause unnecessary division of the skin, leaving the external orifice too large, and notched. Only a drop or two of blood issues from the punctures, which are always healed next day. Court-plaster or small cotton compresses are applied to the punctures, a bandage is passed around the foot and ankle, and the apparatus is then applied—the author preferring its immediate application, owing to the support it affords, but taking care not to strap it too tightly. The patient is seen again in the course of the day and next day, and on the third day the 40-xx,

•17

« AnteriorContinuar »