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that no energetic treatment be adopted during the paroxysms, not even in the convulsive intermittent affection of children. Quinine is his sheet anchor, given in large doses during the free intervals; he has found eight grains generally suffice for an adult, given about the middle of the free interval, or immediately after a paroxysm.
XI. I. On QSstrus or Affectio Bovina. By G. W. Sprnoe, M.D., Lerwick, Shetland. (Edinburgh Med. Journal, Nov. 1858.) 2. On the Occasional Occurrence of Bote in the Human Subject. By J. Matthews DunCan, M.D. (Edinburgh Veterinary Review, Jan., 1859.)
Alexander von Humboldt so frequently found the natives of South America affected with a number of the genus (Estrus, an insect of the order Diptera, that he established a distinct species, under the name of oestrus humanus. Kirby and Spence, Kirchenmeister and others, dispute the propriety of this distinction, and Dr. Spence and Dr. Duncan bring forward fresh arguments and facts as well as cases that fell under their own observation, in proof of the view that oestrus humanus is merely a transference of one of the varieties of the bots found on animals, to the human body. In our October number (1858), we quoted from the Archives Generales an interesting account by Dr. Coquerel of the development of the larva of a diptera in the frontal sinuses and nasal fossae of man. In Dr. Duncan's case, the symptoms were less severe; it is as follows:
E. C , a girl aged thirteen, came from Perthshire in September, 1858, to reside in Edinburgh. She had never been in bad health till shortly after leaving the conntry, when she began to suffer pains which she connected with the hots. She first felt a little lump on the back of tho neck, which slowly changed its position in various directions; then a hole opened over it, and a worm was squeezed out. Some weeks afterwards, another similar lump was felt on the right side of the trunk. It also wandered about subcutaneously, till a hole opened over it, and it was forcibly rubbed out A third made its appearance over the spine, high in the chest, then travelled up the neck, when for a time it was lost, and was supposed to reappear on the right side of the neck, where a hole formed over it. Dr. Duncan was now (3rd March) fortunate enough to be called, and observed a small, not inflamed tumour, of the size of a large field-pea, and having an opening on the top as big as a pin's head. In this hole, Dr. Duncan saw one or two black points rolling about. On squeezing moderately the little lump, there was discharged a living larva half an inch long, evidently of the oestrus bovis, and the same as those previously noticed by the girl. A little dirty-yellow juice issued with the animal, containing a few Mood globules and pus corpuscles. The girl said that while in Perthshire herding cows, she was much exposed to the air, and was frequently stung by insects.
It appears from Dr. Spence's paper, that in the Shetland Isles the human subject is peculiarly subject to being attacked by the skin-bots; the larvae occur in exposed parts of the body, and in women who are loosely dressed. They have generally been engaged during the summer in working with peats, in localities where cattle were numerous; in some instances they had lain down on the grass and fallen asleep. Dr. Spence's patients never remembered having felt a sting; they were engaged in the only occupation by which people in Shetland are liable to be detained in localities where the gad fly or bot-fly may be met with.
The patient's attention, according to Dr. Spence, is first attracted by a severe burning pain under the skin, in a circumscribed spot. It is next observed that the seat of pain shifts its position, and that the course between the two spots is marked by a reddish or ecchymosed line, which fades in a few days. This movement of the seat of pain, attended with a thin linear discoloration of the skin marking its track, may be almost considered as a diagnostic sign. The rate of progress varies; in one case, Dr. Spence traced it between the 29th September to the 10th October, from the left hip to above the left mamma. The larvae appear to drop out after a time of their own accord, but the safest and most expeditious plan is, as soon as their nidus is ascertained, to cut down upon and remove them.
XII. Case of Spontaneous Gangrene of the Fingers Cured by I.ocalized Electrisation. By M. Duval. (Quoted from Echo Medical Suisse, Sept., 1858, in Gazette Hebdomadaire, Jan. 28th, 1859.)
A girl aged seventeen, without known cause felt violent pain in the hands; the four fingers of the right and two of the left hand became slate-coloured, cold, insensible—in short, exhibiting all the symptoms of incipient gangrene. Movement was almost entirely abolished in these fingers. The induced current was applied, giving rise at first to increased pain, but soon
arresting the sufferings of the patient. After ten or twelve sittings, at about the end of the week, the sensibility, the normal temperature and colour, as well as motion, were restored. The epidermis came off to the extent of the first appearance of the gangrene. During electrization, a foetid sweat was noticed over the electrified parts. The editor of the 'Gazette Hebdoinudaire' expresses some doubt as to the propriety of terming this a genuine case of gangrene, but admits the importance of the case, as showing the influence of induced electricity in restoring the circulation.
XIII. Researches into the possibility of Recalling to Life Temporarily, in Persons Dying of Disease. By Dr. Bbown-sjkjuabd. (Journal de la Physiologic, Oct. 1858.)
A considerable number of cases of transfusion have satisfied Dr. Brown-Sequard that in mainmiferffl dying of various diseases, and especially of peritonitis, life may be restored for some hours by the process, when the agony has all but ended in death; he concludes that in human beings who have already become unconscious, and in whom agony has commenced, the intellectual faculties, the senses, and speech, may be restored for some hours by the combined effect of transfusion, artificial respiration, and bleeding at the jugular. Dr. Brown-Seyquard does not give us the result of his entire experience, but he finds that of eleven experiments made upon dogs, cats, and full-grown rabbits, four animals came to life entirely for two, three, and four hours, that three others recovered the circulation, respiration, and reflex action for one or two hours without restoration of the voluntary movements or sensibility, while in the four remaining animals there was no result, except a slight increase of the movemenu of the heart. The following is a brief summary of one experiment, which the author gives in detail:
In October, 1851, a dog in whom the abdominal sympathetic had been divided was attacked with peritonitis and death was at hand. Voluntary and reflex movements had entirely ceased: there was no respiratory action, and the convulsions of death were limited to a few muscular tremors; the fteces and urine were expelled, the pupil was dilated, and no movement of the heart was perceptible. A silver T-shaped tube was [now inserted into the left carotid of the dying dog, -and connected with the carotid of another dog, which was attached firmly to a table. Tbe healthy arterial blood at once passed to the head and heart of the dying animal. At the same time, the left jugular vein and one of the femoral veins of the dying dig were opened. The jugular almost immediately, and the femoral after twenty or thirty seconds, yielded some blood. The period of transfusion lasted two minutes, and ligatures were placed on the carotids of both animals. The jugular vein was left open four or five minutes, during which the heart was felt beating. Gradually the pulse was restored as the blood flowed from the jugular. Artificial respiration was then had recourse to, and continued for half an hour. Eight minutes from the commencement of the insufflation, the cornea became sensitive, and soon after, respiratory movements were perceptible. After twenty minutes, the animal executed voluntary movements, and on leaving off insufflation, respiration continued regularly. The return to life was complete as regards all the chief functions of animal and organic life. Though feeble, the animal raised himself on his fore-feet and wagged his tail when caressed. The dog lived eleven hours and a half after the transfusion.
QUARTERLY REPORT ON SURGERY.
I. On Intraocular Hemorrhage consecutive to Extraction of Cataract. By Mr. W. Whits Cooper. (Annates d'Oculistique, tome xl. p. 1.)
This is a note by Mr. Cooper in reply to M. Rivaud-Landrauss paper upon the subject noticed in our last Report. He commences it with the narration of an interesting case that lately occurred to him. He performed the operation of extraction by the superior incision upon a lady, aged eighty-five. Notwithstanding .her great age, she was very active and in excellent health, her eyes being perfectly healthy; and, in fact, no contramdication being present beyond the fact of her having wept much of late in consequence of domestic sorrow. The operation succeeded completely, no force being required to extract the lens, and not a drop
of vitreous humour escaping. Everything seemed to promise a rapid convalescence, when, on the evening of the fourth day, while Mr. Cooper was conversing with her, and just after she had blown her nose, the patient complained of excessive pain in the eye. Nothing could be seen, and under the belief that the pain was only spasmodic, fomentations were applied. It kept increasing, and at the end of five minutes blood issued from between the eyelids, the edges of the wound having cicatrized with such solidity as to require this space of time after the rupture of the vessel before they yielded. A bloody mass now gradually projected, evidently consisting of the hyaloid membrane filled with blood, and to which, on examination, a portion of the retina was found adhering. The flow of blood, which was of a venous colour, was not considerable; but, notwithstanding the application of ice, it continued to ooze away during thirty-six hours. Much nausea and general uneasiness followed, and the patient's life seemed for some time in danger. She rallied from this condition, and is now well, the globe being distended by a coagulum. There has been but little suppuration, and the eye will probably undergo atrophy.
While believing in the probable correctness of M. Rivaud-Landrau's opinion, that the sudden issue of a portion of the vitreous humour may be considered, in the majority of cases, to bear a direct relation to intraocular haemorrhage supervening upon extraction, Mr. Cooper considers that there must also be some predisposing cause, some abnormal conditions of the vessels of the choroid—inasmuch as the issue of a portion of the vitreous humour during the operation is of frequent occurrence, while it is very rare to find this followed by haemorrhage. In the case just related no such escape had occurred. In Mr. Cooper's opinion, the most reasonable explanation that can be given of the occurrence of intraocular haemorrhage is, that in certain cases the sudden removal of the part, which serves as a support to the vitreous humour, determines rupture of the enfeebled, and perhaps congested vessels of the choroid. In other cases (as in the one here related) the diseased vessels give way from sudden distension or forcible compression of the eye. A case that occurred to Mr. Bowman demonstrates that rupture of the vessels may take place on the sclerotic surface of the choroid.* In a postscript Mr. Cooper refers to specimens in the Moorfields Museum, demonstrating the presence of coagula between the choroid and sclerotic, indicating that the vessels furnishing the blood in intraocular haemorrhage are those of the external surface of the choroid, and not those in closest union with the vitreous humour.
II. Statistics of Fracture. By M. Velpeau. (Gazette des Hopitaux, 1858, No. 102.)
M. Velpeau, in his annual summing up at his Surgical Clinic at la Charites, furnishes an account of the fractures admitted under his care during the last twelve years. These were 1497 in number, three-fourths of them occurring in persons of the male sex. There are, however, certain fractures to which females are as liable as males—e. g., fracture of the neck of the femur. Here occupation has nothing to do with the accident, a fall producing it in either sex, age exerting the same effect in modifying the condition of the osseous tissue of the cervix in both. We may regard also a special predisposition to this fracture in females as arising from the predominance of the fatty element, which is usually more abundant in them than in males. We also find a pretty equal number of cases of fracture of the lower end of the radius in either sex—the same cause producing it, usually a fall on the palm.
The following was the order of frequency of occurrence of the respective fractures: Radius, 165; femur, 157; fibula, 141; ribs, 134; clavicle, 132; humerus, 109; tibia, 60; olecranon, 34 ; ulna, 28; patella, 25; scapula, 10; fractures of the leg taken altogether, 104. Then came fractures of the cranium, spine, &c. From these figures it results, 1. That fractures of the radius are of most frequent occurrence; 2. Fracture of the leg comes next, but that is only when both bones are reckoned; 3. The femur comes thus immediately after the radius; 4. The fractures of the fibula alone amount to 141, but these figures do not represent all the instances of fracture of that bone, as it existed, in fact, in the greater part of the cases designated as fracture of the leg; 5. Fractures of the humerus are set down at 109; but causes of error may easily prevail here, as certain fractures of the glenoid cavity, anatomical neck, and of the olecranon, may have been mistaken for fractures of the body of the humerus, and vice versa. 6. Fractures of the tibia are set down at 60 cases; but it is probable that some of the cases set down as fracture of the leg were fractures of this bone alone. 7. Fractures of the forearm are put down at 52; but here the same difficulties from error of diagnosis may arise, as must be the case in any part of the skeleton presenting a complex composition and multiple bones. 8. There were 46 cases of fracture of the cranium; but the signs of this accident are
* TraniactloM of the Pathological Society, vol. lx. p. HI
not always sufficiently obvious. 9. Comparing the fractures of the upper and lower extremities together, we find that there were 564 of the former and 587 of the latter, giving a difference of 23 in favour of the lower extremities, in spite of the considerable proportion of fractures of the clavicle.
IIL On the Preliminary Treatment of Affections of the Urethra. By M. Civiale.
On the occasion of presenting the new edition of his work "On the Diseases of Genitourinary Organs" to the Academie des Sciences, M. Civiale draws its attention to procedures as yet but too little known, having in view facilitating operations practised on the genitourinary organs, and rendering them less painful and more successful. They consist in a special preparatory treatment . The lming membrane of the urethra is, in the normal condition, so sensitive in the majority of persons that the simplest instrument cannot be passed along it, even with the greatest care, without exciting a painful sensation of burning heat, which may go on to that of excessive pain. The sensibility of the neck and body of the bladder is less developed than it is usually supposed to be; but under the influence of inflammatory action it may become so exaggerated as to render all operative procedures impossible. When in a state of disease, in place of a simple catheter we have to introduce instruments into the urethra which, by reason of their form, volume, or rigidity, induce distension or friction of the part, the suffering excited will be much increased; and when, in place of a mere temporary passage of an instrument, we have to leave it in contact with the surfaces, to execute prolonged and extensive movements, or to invade the texture of the parts by means of caustic or a cuttmg instrument, the severest suffering and alarming reaction may be the result. Moreover, the practitioner, disturbed by the cries and involuntary movements of the patient, and fearing the possible consequences of too great irritation, sometimes either renounces a desirable operation, or desists from its performance before he has completed it.
Speaking from the multiplied experience of many years, M. Civiale states that this sensibility of the urethra and bladder may be most effectually subdued by the methodical employment of soft wax bougies. A very small, smooth, soft bougie is to be passed into the urethra and immediately withdrawn, and the same operation is to be repeated daily. If the urethra is very irritable, the bougie is to be withdrawn as soon as the patient begins to complain, although it may not have passed far in. Sometimes the bladder is not reached until after four or five days. By proceeding with extreme slowness, and never by irregular movements, both in passing in and withdrawing the bougie, and never letting it remain, the instrument causes very slight pain, and this even is diminished every day. Very gradually the size of the bougie is increased until one is reached which fills the normal capacity of the urethra with <nt producing distension. During this local preparation, which usually requires from eight to twelve days, any general irritation or morbid conditions that may exist should be remedied.
To appreciate the benefit of this simple procedure, it requires a person to be present at'a series of operations practised on patients, who have, and upon those who have not, been so prepared. Not only in the former are the operations executed with far less suffering and much more facility, but they are followed by much fewer of the consequences of violent reaction.
This procedure is not to be placed on the same line with opiates and anaesthetics, for by it we seek to obtain a slow and progressive diminution of the sensibility of a determinate organ, the action being exclusively local and in no wise changing the general conditions of the organism. When we resort to opiates or anaesthetics, we leave out of view the organ on which we are to operate; and it is upon the nervous system, the centre of life and perception, and consequently upon the entire economy, we seek to make an impression. In the one case we effectually diminish the irritability of the organ, in the other we disguise or suspend it. The one leaves the patient in the full exercise of his faculties, the other plunges him into a temporary state of intellectual and moral annihilation. "The inconveniences of opiates are well known, and I have not here to discuss the utility of anaesthetics in the general practice of surgery; but I cannot too forcibly protest against the abuse that has been made of them in the treatment of the diseases of the urinary organs. With the exception of cystotomy, external urethrotomy, and some other rare operations, the employment of chloroform is not only useless, but liable to cause the committal of grave mistakes and to give rise to great misfortunes."
IV. On the Treatment of Aneurism by Digital Compression. By Dr. Samuel Gboss. (North Amer. Medioo-Chir. Rev., voL hi. pp. 78-86.)
In this paper, Dr. Samuel Gross relates the case of a negress, aged thirty-two, who applied to him on account of an aneurismal tamour sitantcd within Scarpa's triangle, in the femoral
region. The tumour was •H inches long and 5} broail, the signs of aneurism being well marked. An instrument for making compression not being found to fit well, it was determined to employ the fingers in effecting this. The aid of several assistants was procured, and a system of continuous compression of the femoral artery, as it passed over the pubic bone, was commenced on June 10th. The considerable pain produced at the point of pressure compelled its temporary suspension, and the administration of occasional doses of morphia. However, the ultimate result was highly satisfactory, for she was discharged well on the 6th of July, and when seen on the 13th October, the tumour was very solid, and had diminished to the size of a walnut. The total amount of time during which the compression was continued was forty-five hours and fifty-five minutes—viz., thirty-one hours and twenty minutes at the first lianee, and fourteen hours and thirty-five minutes nt the second. The compression was almost total, preventing the blood from entering the tumour at all; and the whole time during which the blood did traverse the sac did not exceed two hours.
Dr. Gross refers to 23 other cases, in which digital compression has either partially or solely constituted the means of treatment, 15 of these being popliteal, 4 femoral, 2 inguinal, and 2 nrtero-venous aneurisms. Of these 23 cases 15 were successful, and 8 failed. In the successful coses, in 5 digital compression was applied principally and alone, in 4 it succeeded after apparatus bad been abandoned, in 5 it was employed alternately with apparatus, and in 1 it succeeded when combined and alternating with apparatus and direct compression of the tumour.
The following are the conclusions the author arrives at:—1. Digital compression, uncombined with apparatus, was first attended with success in the hands of Dr. Knight (of New Iluven); but to M. Vanzetti is due the merit of having first introduced it into practice. 2. It has never been followed by bad consequences, and when not successful it so modifies the tumour and the collateral circulation us to render a cure by other means almost certain. 3. It has been employed alone, either previous or subsequent to mechanical compression, in 14 cases, 8 being failures. 4. In only 7 cases has it been employed primarily and alone, and in 5 with perfect success. 5. When double and alternating, it has effected cures in every cose (5 in number), and therefore deserves special attention. 6. In most of the cases, the compression has been total, but this is not necessary for a favourable result. 7. It has effected cures, whether it was continued, interrupted, or intermittent; in some cases the patient applying the pressure. 8. When properly employed, and continued for a sufficient length of time, and in suitable cases, it can scarcely fail to accomplish a cure. Inguinal aneurisms are not fit cases for this procedure. 9. It is less apt to give rise to inflammation of the integument, and has been borne when mechanical pressure has produced an eschar. 10. It can be used when apparatus has failed or become intolerable. In a majority of such cases, a cure has been accomplished 11. In certain situations it can be made to bear upon the artery alone, It is far less painful, and requires a much shorter time for the cure than any other method of treatment.
[Dr. Gross is not aware of the extent to which Professor Yanzetti has carried the practice of intermitting compression.]*
V. On Labial Cancer. By Peofesror Rirem. (Omodei's Annali, vol. clxvi. p. 831.)
In a notice of the forthcoming third volume of Professor Riberi's 'Lezioni Orali,' an account is given of his experience with respect to labial cancer at the Turin Clinic. The ages of the 81 patients were as follows:—2 between twenty and thirty, 3 between thirty and forty, 11 between forty and fifty, 28 between fifty and sixty, 20 between sixty and seventy, and 17 between seventy and eighty. Of these, 69 belonged to the peasantry cla«s, a predominance perhaps attributable to their unnutritious food, their abuse of peppers, garlic, vinegar, and the like condiments, their neglect of personal cleanliness, and their exposure to vicissitudes of the weather. Another predilection of the disease was for the male sex and the lower lip, inasmuch as only 8 of the cases occurred in women, and in only four instances was the upper lip affected, two of these occurring in men and two in women. In all but one patient, the sanguineous temperament was manifested in a greater or less degree, showing the influence of the conditions of the bjoodvessels and of the blood in this disease as compared with that of the nervous system. In 76 of the subjects, the constitution was good, robust, or even athletic. This confirms the observation made by Pravas, that the general belief is erroneous, which supposes that lymphatic, delicate, cachectic constitutions, are most liable to can
• See Brit, and For. Med.-Chlr. Ber, Jen. 1859,