are particularly subject to it. In adult life the symptoms are more variable. Thus, in a case reported by Mr. Bullin, of Fleet Market, of an adult, in which the ileum and cocum were found invaginated within the colon in a manner precisely similar to that of those mentioned in this paper, the chief symptoms were, suppression of stools, and violent pains in the abdomen, quite unattended with vomiting. As has been already stated, the most frequent seat of the affection is at the termination of the small intestine in the cœcum. The next most usual situation is the ileum-the least the jejunum. The immediate cause would seem to be spasm of the invaginated part of the intestine. The exciting causes are probably such as would produce that spasm. The characteristic symptoms have been pointed out, but may be recapitulated : When an infant under a year old is seized with symptoms of strangulated hernia, the cause will most frequently be intus-susception. When dangerous intus-susception exists, its situation will most frequently be at the termination of the ileum in the cœcum. Hæmorrhage, with absence of all fæcal evacuations from the intestine of an infant, is rare, unless it have for its cause intus-susception. We will not say that Mr. Gorham has totally avoided the fault of generalizing very boldly on premises which cannot be considered sufficient to establish positive conclusions. Treatment.-Bleeding, quicksilver, forcible clysters, a long bougie, anodynes, strong purgatives, the warm bath, blisters, emetics, have all been recommended and practised, some with more and some with less advantage. It has been proposed to open the abdomen, and disentangle the intus-suscepted gut-a proposal which may have been acted on once or twice with success, but which, if generally adopted would certainly be most hazardous. Mr. Gorham speaks with favour of the method of treating the disease by inflation. This is effected by introducing the nozzle of a common bellows into the rectum, and gradually blowing up the intestines. Three cases in which this plan succeeded have been reported in the American Journal of Medical Science. The following is a condensed account of them. Case 1.-The patient was a female, aged 26. After having uneasy sensations in the stomach, obstinate vomiting succeeded, which consisted, at a subsequent period, of yellow matter. A violent screwing pain was also complained of, situate between the sternum and umbilicus: it came on in paroxysms, and ended in vomiting. Calomel, jalap, castor-oil, laudanum, the warm bath, and effervescents, were all useless; and after five days passed without a dejection, the common bellows was used; and it is stated, that "as soon as air entered the rectum the countenance lost its anxiety, and the patient said she felt quite relieved. In a minute she passed a stool; and complete recovery resulted."* Case 2.-The patient was a male, aged 35. The symptoms were, first, dry retching, and hiccup; afterwards, vomiting of a large quantity of green bile, mixed with feculent matter: violent pain was complained of in the umbilical region; the pulse was small, frequent, and irregular. Superficial examination detected no peculiarity in the form of the abdomen, till the fourth day, when an unusual fulness and firmness was first discovered in the right iliac region; but the hand lying upon the spot, a paroxysm of pain occurred, and an elongated tumor was felt to rise, with an erectile motion. Purgatives of croton-oil combined with laudanum, fomentation, enemata of tobacco infusion, and copious * American Journal of Medical Science, XXVI. 542. bleeding, were all of no avail; and on the fifth day, as a last resource, the bellows was used. After the first inflation, there was no occurrence of violent pain; the patient said he felt much easier, and wished to pass a motion: a large quantity of air, however, came away, and about a gill of very fetid bloody water. In about five hours after this, two copious dejections were passed; and complete recovery ensued.* Case 3.-The symptoms were, vomiting of a dark, fetid, oily fluid; hiccup; with severe pain round the navel: no motion was passed for four days, at the end of which time the bellows was used. Six dejections followed in the course of the day. The patient recovered. The method should be tried in any severe case. It cannot well do harm, and although it is by no means certain that the preceding cases were examples of intus-susception, yet they are calculated to give encouragement. "Mr. Finch, a general practitioner, residing at Greenwich, informs me he has treated cases successfully in the following manner. Injections of warm thin gruel are used; and if any advantage be expected to be derived from them, they must be prevented returning. In order to this, Mr. Finch causes the pipe to assume a conical shape, by binding lint, or some soft material, round it. The piston is then pressed with considerable force; and the return of the intestine is known to have taken place by the want of resistance suddenly communicated to the hand. Mr. Finch has treated two cases successfully in this manner." The action of the enema would be similar to that of inflation. But, probably, the latter would be most effectual. Mr. Gorham's paper is not undeserving of perusal. Dr. G. O. Rees communicates to this number of the Reports, two chemical analyses one of the liquor amnii-and one of diabetic blood. IV. CHEMICAL EXAMINATION OF THE LIQUOR AMNII. By G. O. REES, M.D. &c. The analyses hitherto made of this fluid have varied. Dr. Rees has examined it in four instances. It was procured with all precautions for its purity by Mr. C. W. Lever. 1. Labour induced at seven months and a half, by passing a female catheter through the os uteri, and drawing off the liquor amnii. 2. Patient died of phthisis at about the seventh or eighth month of gestation. EXAMINATION OF LIQUOR AMNII. Strongly alkaline.-Sp. grav. 1008. Contained in 1000 parts: * American Journal of Medical Science, XXX. 556. 3. Again obtained at seven months and a half, from patient No. 1, by the 4. Labour induced at seven months and a half, and liquor amnii drawn off by a female catheter. EXAMINATION OF THE LIQUOR AMNII. Strongly alkaline.-Sp. grav. 1007. Contained in 1000 parts: "The salts, both of the aqueous and alcoholic extracts, consisted of chloride of sodium and carbonate of soda, with minute traces of an alkaline sulphate and phosphate. In the salts of the aqueous extractive, the carbonate resulted from the incineration of an albuminate; and in the alcoholic extractive, from the decomposition of a lactate, by the same operation. The salts obtained from the aqueous extractive in analyses Nos. 2 and 3 were not entirely soluble in water. The insoluble matter, on examination, proved to be phosphate of lime; which must either have been held in solution with the albuminate of soda, or have resulted from the decomposition of an alkaline phosphate at a red heat; some soluble earthy salt being present, to effect such decomposition. I lately observed the existence of phosphate of lime in the aqueous extractive of a specimen of blood drawn from a diabetic patient; and am inclined to think that further observations will shew a similar result in other albuminous fluids." The salts observed floating in the liquors are composed of caseous matter, containing cholesterine. "On examining the analyses, it will be observed that the liquor amnii varies greatly in proportional constitution in different individuals, at the same period of utero-gestation; which shews, that, like perhaps all the secretions of the body, it is affected by the temperament and diathesis of the mother. The specific gravity of the secretion, however, varies but little in the four specimens ; which is possibly a precaution on the part of nature to preserve a medium of fixed power, to oppose the motions of the fœtus in utero." V. ON DIABETIC BLOOD. By G. O. REES, M.D. &c. &c. It is only lately that the presence of sugar has been demonstrated in diabetic blood, a fact that was long denied by chemists. Mr. M'Grigor, of Glasgow, has shewn, or seemed to shew, that sugar is present, not only in the blood and urine, but likewise in several secretions and excretions. Ambrosiani relates a method by which he succeeded in extracting it in a crystalized state. But the mode which Dr. Rees has adopted will yield sugar of considerable purity, though it will not enable us to determine with precision the weight. We shall therefore present an account of this plan of procedure : : "The mass of blood* is to be evaporated to dryness, over a water-bath; the dried mass to be comminuted, and digested for several hours in boiling water : the aqueous solution is to be filtered off, evaporated to dryness, and the dried residuum digested in alcohol of sp. gr. 0.825: the alcoholic solution so formed is to be filtered, or carefully poured off, evaporated to dryness, and the dry mass treated several times with rectified ether, which dissolves out urea, and also some fatty matter; leaving behind the sugar, in admixture with osmazome and chloride of sodium: this mass, on being dissolved in alcohol, and the solution allowed to evaporate spontaneously in a flat glass dish, affords mixed crystals of alkaline chloride and diabetic sugar; which are easily distinguishable from each other, and allow of being separated mechanically, by shaking them up in alcohol, when the chloride sinks; and the sugar, being principally collected above, may be removed, for examination, by careful use of the spatula: the alcohol must not, of course, be allowed to remain long in contact with the crystals, as it would re-dissolve them. It is a matter of surprise to me, that sugar has not been long ago detected in the blood of diabetic patients, though not separated from it; for the alcoholic extract of the serum, when mixed with water, will, after a few days, give off carbonic acid; which, in addition to the sweetish taste, and, I may add, syrupy smell of the evaporated alcoholic extract, is a sufficient evidence of the presence of sugar. I subjoin the analysis of 1000 grains of diabetic serum, obtained for me by the kindness of Dr. Bright. The sp. gr. of this patient's urine was 1048; and the contents of the serum as follows: Albumen (yielding traces of phosphate of lime and oxide of iron, on incineration) of } 80.35 Alkaline carbonate, and trace of sulphate, the results of 4.40 incineration Loss 1.00 1000.00." * "12 ounces were used in these experiments." Dr. Rees observes that, on comparing this analysis with that of the serum of healthy blood, we perceive a great excess of matters soluble in alcohol, while the albuminate of soda is rather less than in health. The alkaline salts are also in very small proportion, being only 4.40 gr, in 1000 grains of serum, while in health they amount to from 7 to 8 grains per 1000. VI. SOME OBSERVATIONS ON THE CAUSE OF STRANGULATION IN HERNIA, and ON THE CAUSES OF DEATH, AND ALSO ON THE RULES OF TREATMENT, WHICH SUCH CONSIDERATIONS ENFORCE. By T. WILKINSON KING. This Paper, which displays much industry and reflection on the part of Mr. King, contains an application of the numerical method to the elucidation of some points connected with Hernia. There is a table of 100 cases, compiled from the best authorities, which required surgical aid on account of urgent syptoms. The principal deductions from the data thus collected and compared are as follows: 1. Most hernia exist for years, before they become subject to dangerous strangulation. Thus on analysing the Table, we discover that: In 2 cases, the duration is not mentioned. .. 3 or 4 cases we might determine, at once, that acute strangulation was the marked condition. ..15 cases, the hernia is said to be "old." ..18 cases. of "some, several, or many years'," duration, or to be "adherent in the sac." ..46 cases, the duration is defined in years; and the mean for the whole of these is about 18 years. The minimum, about 4; and the maximum, 44 years. ..15 cases, the duration may be inferred within a year or two: and the mean for these I make to be 25 years. The maximum near 60. 100 Hence, of 61 cases, the mean duration is about 20 years; and of 33 cases more, we may say they were indefinitely old: so that 94, out of 98, were in various degrees,“ old.” Making every allowance for some imperceptible source of fallacy, it will be readily admitted that the antiquity of hernia which become strangulated is surprizing. Mr. King advances some ingenious reasons for concluding that the cause is to be found in the morbid states and diminished vital powers of the old herniary protrusion. There is, no doubt, much force in this, whether it does or does not explain the whole of the phenomena. 2. Causes of Death. These are calculated from unpublished records of above forty fatal cases of hernia. In the majority of instances the patient died of peritonitis. The following is a tabular view of thirty-eight cases. In 1, the hernia was reduced by taxis: death by peritonitis: the gut red. 1 1 3 6 12.. peritonitis? recovering. sac and all, the stricture remaining. returned by operation was not returned: no operation: no gangrene: peritonitis. |