« AnteriorContinuar »
on the subject of contagion arose from discussing the question too absolutely and exactly. From what he had himself seen of the yellow fever of the new world, he was quite convinced that no one could fairly say either that the disease was always contagious, or that it was never so.
The quality of contagiousness is not essential to perhaps any fever; it is merely an epiphenomenon, or adjunct character, which may be present or not, the disease remaining the same in either case.
DISCUSSION AT THE ROYAL ACADEMY OF MEDICINE ON THE ETIOLOGY OF CLUB-FEET.
M. Cruveilhier, in his report on a Memoir of M. Martin, expressed his assent to the theory which the author had proposed to explain the occurrence of this deformity, and which is based upon the idea that it is attributable to irregular and unequal pressure of the uterus upon the feet of the foetus, in consequence of a deficiency of the amniotic fluid. He (M. Martin) had very ingeniously adduced a considerable number of cases, which, he thought, went to prove the justness of this explanation. In all of them, according to his statement, the women experienced, about the fifth or sixth month of pregnancy, a fixed and often a very excruciating pain in the epigastric, or in one of the hypochondriac regions, according as the child lay vertically or diagonally-this pain he ascribes to the pressure of the uterine parietes against the feet of the child.
The varieties of the deformity are depending, according to this theory, on the relative situation of the one foot to the other at the time when the uterus is exerting its powerful pressure upon them. If but one limb is exposed to this pressure, there will be the deformity in one foot only; but if both suffer from it, the deformity will be double. Then too, according as the feet are in a state of flexion or of extension, the deformity will be either a varus or a valgus.
M. Martin has admitted another element into his ætiological doctrine of clubfeet. He supposes that there is a certain degree of atrophy or of tardy develop. ment in the feet themselves; in consequence of this, their joints do not acquire the ordinary cohesiveness and strength, and are thus more liable to be affected by the pressure of the uterus upon them. M. Cruveilhier intimated his dissent from this part of M. Martin's theory.
The concluding part of M. Martin's memoir is occupied with a statistical table of the cases of club-foot, which he has had an opportunity of examining. In 61 cases 26 were double, and 35 were single: of these 35, 18 were of the right, and 17 of the left foot. Of the entire number, 45 occurred in boys, and 16 in girls.
M. Capuron related the cases of two women whom he had attended in labour, where there was certainly no deficiency of the amniotic fluid, and yet who gave birth to children affected with club-foot. He was therefore obliged to withhold his assent to the theory proposed by M. Martin to account for this deformity.
M. Bourdon suggested another objection, viz. that club-foot is rarely a congenital affection, but usually occurs a year or so after birth.
M. Breschet expressed his surprise that an able physiologist like M. Cruveilhier could give his assent to such a mechanical theory as that proposed by M. Martin. Under what circumstances can the uterus exert the alleged compression upon the fœtus? If the amniotic fluid be present, such pressure is impossible; and again, if this be discharged or is very scanty, the expulsion of the child is almost sure to follow very quickly. And even if the child is retained for some time afterwards, every physician knows that its death is inevitable.'
• These obstetrical assertions of M. Breschet are not to be implicitly relied upon.
He (M. B.) attributed this and almost every other congenital irregularity to an arrested or interrupted development of the parts affected.
M. Velpeau,—after renouncing all belief in the doctrine of arrested development as an explanation of congenital deformities, and denying the very basis on which this doctrine is founded, viz. that of the coalescence of the two lateral halves of the body in the median line-expressed his opinion that the idea of M. Martin regarding the ætiology of club-feet might be partially, and, to a certain extent, correct. He alluded to two instances of this deformity in cases where the amniotic fluid had been discharged a month or so previous to delivery. Although not disposed to attach much importance to the mechanical action of the womb on the limbs of the child, he was still of opinion that it may be pour quelque chose, in certain cases of congenital irregularity.
The theory proposed by M. Guerin, and which had met with the approval of the Academy of Sciences, seemed to him the true one. This theory, based upon a great number of observations, referred the greater number of monstrosities, as well as of congenital deformities of the joints, to a foregoing organic affection of the nervous centres, and to the convulsive muscular contractions thereby induced. Add to this, that the muscles so affected are struck with a sort of consecutive arrested development, which retards their complete formation; and then you have the real and effective cause of such deformities as club-feet, &c. It is therefore to a disease in the origin of the nerves, or in the nerves themselves, that most instances of monstrosity and of congenital deformity are attributable.
Sometimes we find that the greater part of the encephalon and of the spinal marrow have been destroyed, and then all the muscles of the body are more or less rigidly contracted; at other times, a part only of these nervous centres is diseased-say the lower part of the spinal marrow, as in spina bifida, &c.— and then the muscular retraction is limited to the lower limbs. Every case of club-foot is, in my opinion, attributable primarily to some disease of the spinal cord, or of the nerves of the affected extremity. Certainly no rational physiologist can well believe that any interruption or arrest, to make use of the fashionable phrase, of the normal development of the member, can have any thing to do with the production of club-foot. Besides that at no period of intra-uterine life is there any semblance of the deformity in the foetus, the numerous varieties of this affection must surely quite remove it from the patronage of this theory.
We believe that the same objections are equally potent against the doctrine of arrested development, as explicable of anencephalism and other congenital irregularities.
PHYSIOLOGICAL AND THERAPEUTIC EXAMINATION OF VERATRIA,
BY DR. FORCKE OF HANOVER.
The seeds of the veratrum subadilla had been long in use as a vermifuge remedy, more especially against the tape-worm, before it was known that they acted in any other manner than as a powerful drastic purgative. They were employed also, as an outward application, to get rid of vermin about the scalp; and in some cases, when thus used in too large quantities, very unpleasant effects seem to have been produced. Schmucker and Herz had recommended small doses in various nervous complaints, as chorea, epilepsy, chlorosis, mania, &c. In consequence however of the uncertain effects of the drug, it had fallen very much into disuse, at the time when the experiments of MM. Pelletier and Caventon in France, and of M. Meisner in Germany, proved that it contained a salifiable alkaloid base of great power and activity: the name of veratrine was given to it. To M. Magendie we owe the first series of experiments to ascertain its phy
siological and therapeutic effects: these were recorded by M. Andral (the son) in the Journal de Physiologie Experimentale, No. 1, 1821.
A minute quantity of the acetate introduced into the nostrils excited the most violent sneezing; when applied to the throat, profuse salivation, accompanied with a sense of most irritating tickling, was the consequence. Administered internally, it produced violent colic, vomiting and purging; a large dose brought on tetanus and death. M. Magendie contented himself with recommending the external use of veratrine in chronic rheumatism, gout, neuralgia, and anasarca; but it does not appear that he had made many trials on the human subject with it.
Dr. Bardsley of Manchester first, and subsequently Dr. Turnbull of London, are entitled to the merit of having distinctly proved the powerful efficacy of this and some other cognate alkaloids in medical practice. As their works are however well known to the public, we shall now proceed to give a short summary of the researches of Dr. Forcke.
Taken internally, in the dose of a sixth part of a grain and repeated twice or thrice at the interval of a few hours, it causes, he says, a sensation of formication or tingling, and of heat in the epigastrium first, and subsequently in other parts of the body, as the limbs, feet and hands, the forehead, nose, &c. This most unpleasant feeling, as if a myriad of pins' points were kept being gently applied to the parts affected, is accompanied with a sense sometimes of heat, at other times, of cold; and the skin seems to be so very extraordinarily susceptible of the impression of either, that the slightest wave of warm or of cool air is quite painfully disagreeable. Dr. Forcke asserts, contrary to the statements of others, that the effects of the medicine administered for some time do not seem to increase beyond what are manifested during the first few days.
Along with the phenomena now noticed, there is another which is of occasional occurrence and is a very remarkable one: a pain, which has long occupied a certain part, suddenly vanishes altogether, or is replaced by one in some other part of the body. This influence seems to manifest itself de preference in organs which have been effected with paralysis or neuralgia.
There are some persons in whom the veratrine seems to be entirely impotent; but the number of these is few, and generally they are old people. The internal use of this alkaloid in most cases causes a certain degree of constipation of the bowels; and hence it may be necessary to have recourse to aperients during its administration.
In illustration of the therapeutic effects of veratrine, Dr. Forcke adduces the following cases.
Neuralgia. Five cases are reported: in all of them, the suffering was seated in some of the branches of the trigeminus nerve. In the first three, the patients were old women, who had for many years been subject to violent and frequently repeated paroxysms of pain in the infra-orbital nerves. The external use of the veratrine-a scruple of the alkaloid to an ounce of lard-succeeded in entirely removing the disease, which had baffled all other means of medication.
The fourth case occurred in a middle-aged woman, who had for thirteen years suffered from neuralgia of the supra-orbital nerve: the attacks usually came on before each appearance of the catamenia. Frictions with the veratrine ointment were followed by un succes durable.
In the fifth case, which was that of a man 38 years of age, the disease affected all the branches of the trigemini nerves, and was so severe that the patient, during the paroxysms of pain, was almost bereft of his reason. The external use of the veratrine was combined with the administration of colchicum in large doses. (The issue of this case is not specified).
Palsy.-Nine cases of partial palsy, affecting different parts of the body, are
related by Dr. Forcke in proof of the efficacy of the veratrine ointment. The first was that of a youth, who had quite lost all use of his left arm, without any appreciable cause: the limb was utterly powerless, and had become much emaciated. The internal and external use of strychnine, as well as various other methods of treatment, had been tried for a length of time, but without success. Frictions with the veratrine ointment were now employed, and ultimately the lad quite recovered the use of the arm.
We shall briefly notice another of the cases. A man of robust constitution presented the following appearances, when he first consulted M. Forcke. The left side of the face was much swollen; its muscles were in a state of complete relaxation; the eyelids were motionless, and the left one was always depressed, so that the eye was constantly exposed. The consequence of this exposure was that the conjunctiva had become much thickened and inflamed, and the sight of the eye was nearly abolished. The branches of the inferior maxillary nerve were affected with periodical paroxysms of most acute pain. The right side of the face was much contracted and wrinkled, the angle of the lip and the wing of the nostril being drawn upwards. The hearing too was dull, and the patient experienced a considerable degree of impediment in his speech.
The internal as well as the external use of the veratrine was commenced; but the amendment proceeding very slowly, Dr. Forcke applied three grains of the alkaloid to the denuded dermis over the places, where the facial nerve and the first and second branches of the trigeminus make their escape from the cranium. Severe pain and irritation were induced: three days afterwards, another grain was applied. The patient began to move his eyelids, and the paralytic state of the face became gradually less and less. The patient, contented with the improvement he had already made, ceased his visits to Dr. Forcke.-L'Experience.
The preceding notice of Dr. Forcke's "Physiologisch-therapeutische Untersuchungen ueber das Veratria," quite confirms all that we have previously said, in this Journal, respecting the medicinal powers of this alkaloid. That it is a most active and potent remedy, admirably calculated to relieve many cases of neuralgic suffering, is a fact that cannot be disputed by any one who has given a fair trial to it, provided the remedy be genuine and it induces its remarkably peculiar effects on the body. It is however proper to observe that, in some cases, where it has succeeded in relieving the most intense paroxysms of facial neuralgia, this happy result has proved to be of only temporary duration. Still it is of no little importance to be able to mitigate, if not to cure, pain.-(Rev.)
INCONTINENCE OF URINE SUCCESSFULLY TREATED WITH THE NUX VOMICA.
The attention of medical practitioners has of late years been called to the very decided effects of this potent remedy in stimulating the palsied fibres of the urinary bladder.
Signor Cerchiari has published two very satisfactory cases treated in this manner. In one of these, the incontinence was attributable to the contusion of the neck of the bladder by the passage of the child during parturition. The patient could not retain her water night or day. The following pills were prescribed.
Take of extract of Nux Vomica 8 grains, Martial æthiops and simple syrup, as much as may suffice to make a mass, to be divided into 24 pills. One of these to be taken three times in the course of the day. A perfect cure was obtained in a fortnight.
The second case occurred in a youth, 19 years of age, who had been subject from his infancy to involuntary discharge of the urine during sleep. The above
pills were prescribed; and a complete cure was obtained in less than fourteen days.— Bulletino delle Scienze Mediche di Bologna.
ON THE USE OF CHLORINE INHALATION IN CATARRH.
Dr. Toulmouche, a physician resident at Rennes, and one of the medical officers of the Maison de Detention there, has been engaged for the last five years in ascertaining the virtues of chlorine inhalation in the various forms of bronchitic disease.
He usually commences with advising ten or twenty drops of the concentrated solution to about half a pint or so of warm water, and he increases this quantity, by daily adding five drops or more, to sixty or even eighty, according to the susceptibility of the invalid. The solution, it is to be remembered, should always be kept secluded from the light.
The chlorine inhalation he recommends even in acute catarrh, provided there be no co-existent pulmonary engorgement or tuberculous induration. As long as the disease is limited to the mucous surface of the air-tubes, the practice is not only safe, but salutary; and it never seemed to aggravate the inflammatory action.
When however the cough and dyspnoea were very great, or when the idiosyncracy of the patient was opposed to the use of the chlorine, Dr. Toulmouche strongly recommends the inhalation of the steam of hot water in which opium or belladonna has been infused. Blisters applied to the thighs are also highly useful in such circumstances.
As a useful expectorant drink, Dr. T. praises a solution of the chloride of soda; 3ss-3j. in a pint of water. The unpleasant taste and smell of this solution are however objectionable to most patients.
Before we give a decided opinion on any case of old catarrh or chronic bronchitis, and before therefore we decide upon any line of treatment, it is most important that we satisfy ourselves as to the real nature of the existing disease, and as to the complications which may happen to be present at the same time. We have already alluded to the not uncommon complication of pulmonary en gorgement or tuberculization-two morbid states of frequent occurrence, and on which a bronchitis is very often engrafted. As a matter of course, whenever such a state of things exists, our prognosis must be much more guarded, not only as respects the issue of the case, but also as far as the mere temporary alleviation of present distress is concerned.
Another frequent complication is asthma, depending upon emphysema of the lungs. Whenever this state of the pulmonary tissue exists, we can never hope for an entire restoration of the patient's condition.
A dilated state of the bronchi also is of not unfrequent occurrence in cases of chronic catarrh we may likewise add partial or circumscribed pneumonia in a latent form, pleuritis, effusion into the chest, &c. &c.
Dr. Toulmouche informs us that chronic catarrh regne habituellement in the Penitentiary or central house of detention at Rennes; and that it and pulmonary consumption are by far the most frequent diseases in its infirmary. He attributes this to the dampness of the locality, to the cold humid state of the workshops in the Penitentiary, and to certain unwise regulations on the clothing of the inmates.
The number of cases, in which Dr. T. has used the chlorine inhalation in the course of four years and a half, has been 309; of these 228 occurred in females and only 81 in males. This appears certainly rather strange, as from most clinical tables, the number of men affected with the various forms of catarrh