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ing the body cool, the young man was well in a day or two.-Archives Générales.
CASE OF LITHOTRITY. BERENGER, aged 16, had laboured for many months under all the symptoms of calculus in the bladder, the presence of which was recognised by the sound. The instrument recommended by M. Civiale was used. It was introduced without difficulty, and only very slight pain was felt by the attempts to lay hold of the stone, whose diameter was two centimetres (nine lines.) When it was properly secured, the operator began to work the borer, by which the soon crushed to small pieces, and on withdrawing the instrument, it was found filled with the debris. The operation lasted only seven minutes. The patient was ordered a warm-bath, and while he was in it, he passed per urethram many calculous fragments, some of them being of the size of a pea, and causing considerable pain and smarting in the passage. Af ter a few days quiet, a sound was introduced but no vestige of calculus any could be found; and since the operation the patient continued well. This is one of the very few cases in which lithotrity has succeeded in curing a person at one sitting.-Archives Générales.
OBSERVATIONS ON A SPECIES OF APO-
tion; the pulse was weaker; she com plained of pain all over her body, and did not refer it to any particular inward part; her arms, however, if moved gave her much distress and even sharp pain, like that of rheumatism; and when she was provoked by questions, she began to acknowledge that she felt an uneasiness in her head. On the following day slight delirium and general restlessness, with great prostration, drowsiness, inability to protrude the tongue; a purplish red hue of the face; heat and slight moisture of the skin; frequent, full, but feeble pulse; an occasional cough; an almost complete paralysis of the upper extremities; when they were raised, they fell down if not supported, and no effort was made by the patient; the head if elevated rolled down again on the pillow when the hand was withdrawn; the urine was passed involuntarily; she became quite comatose, and died next day.
Dissection. No serous effusion under
any part of the arachnoid. At the posterior third of the left hemisphere near to the course of the longitudinal sinus was observed a patch of deep red colour, quite circumscribed, and of about the size of a shilling; the cerebral substance to the depth of two or three lines was involved in this patch, which appeared to be produced by a softening of the brain, and by being intimately and breaking-down of the substance blended with effused blood. When a small stream of water was allowed to play on this patch, an irregular excavation was left, the cerebral matter being washed away; the surrounding substance appeared quite healthy. A few lines distant from this spot, another not larger than the head of a large pin was noticed; and when examined at
SURFACE OF THE BRAIN. By M. tentively, it was discovered to be a mi
A YOUNG Woman, aged 21, complained at first of a shivering, and of feeling as if she had been well bruised and beaten. In a day or two the symptoms of fever shewed themselves, but yet there was no fixed pain in the head. She was bled and kept on low diet. On the following day there was greater prostra
nute clot of blood. On other places of the surface of this hemisphere were many more of these black points, in every respect like the former, and all presenting the mixed characters of ramollissement of the brain, and of hæmorrhage, as if small clots of blood had been infiltrated into the softened cerebral matter. This appearance was most conspicuous at the lower and back
part of the hemisphere where it rested on the tentorium. On the right hemisphere, and also on the cerebellum, one or two similar dark-coloured spots were to be seen. The medullary substance of the brain, the ventricles, thalami, &c. were healthy; vessels not gorged. No other morbid appearances in the head, thorax, or abdomen.
Case 2. A woman, aged 25, entered the Hospice Cochin on the 9th of May. For six weeks previously she had laboured under dropsical swellings of the limbs; and latterly there was general anasarca. After shivering, followed by heat, slight delirium, and drowsiness, symptoms of more decided cerebral oppression supervened; the patient would not or was unable to answer questions; she did not appear to suffer from pain; the heat of skin was somewhat increased, and the pulse was more frequent than in health; tongue natural; abdomen soft and yielding.
Next day the stupor was more complete; but yet she could be roused to open her eyelids and answer questions, though indistinctly; the limbs have lost all spontaneous motion. On the 11th, symptoms worse; dilatation of the pupil; breathing laborious, as if the muscles of respiration had lost their power. The patient died, soon after, comatose.
Dissection. The surface of the brain and its investing membranes appeared quite healthy; but, on separating the hemispheres from each other, the corpus callosum was seen to be studded with minute red points; it looked as if any white surface had been sprinkled with red paint. On examining these attentively, it was speedily found that they were not produced by simple rupture and effusion, for pressure on the surrounding substance had no effect in squeezing out any oozing of blood; and there was no vestige of clots; their true nature was an intimate blending of the medullary substance of the corpus callosum with the colouring matter of the blood. From their minuteness, it was not very easy to ascertain whether ramollissement, or any alteration of the cerebral matter, was existent or not. With the exception of a few scattered
red spots on the left thalamus opticus, similar to those just described, no other morbid appearance was detected any where.
Remarks. The attack in both cases has been sudden, and the progress rapidly fatal, unlike the instantaneous shock of apoplexy, arising from simple effusion. The embarrassment of speech, the lethargy and coma, increased from day to day, and death soon following to a state of general exhaustion and insensibility, are peculiar. The pathological appearances are to be considered as a sort of diffused capillary hæmorrhage, or circumscribed effusions of blood, which irritate and disturb the cerebral functions, instead of overpowering and oppressing them, as in ordinary apoplexy. Each of the bloody points described above is to be considered as a miniature of the extravasations which we observe so frequently contained in fissures or irregular cavities of the cerebral substance, after apoplectic and paralytic seizures. It is worthy of remark, that both of the narrated cases occurred in young persons, whose blood vessels are more resisting than in the later periods of life. M. Cruveilhier has alluded to this form of disease, in the article " Apoplexia," in the Dict. Pratiq. de Medicine.—Archives Génerales.
CHRONIC HYDROCEPHALUS CURED BY
A CHILD, aged four months, presented a well-marked case of this disease; the largest circumference of the cranium was 18 inches; the fluctuation was very perceptible at the fontanelles; for when pressure was made upon one, the other was distended and forced out. M. Graefe, compressing the larger fontanelle, plunged a large cataract-needle into the smaller one to the depth of the third of an inch. A little viscid fluid escaped drop by drop; he, therefore, introduced a very fine trocar, and immediately a transparent yellowish-brown
liquid flowed out freely-uniform pressure was made on the head as the water escaped. When an ounce and a half had been evacuated, the infant began to faint and became extremely languid; the canula, was, therefore, removed, and a firm bandage put round the head. Stimulants were given, but the child was restless and ill for two days. A similar train of symptoms followed each operation, which was repeated generally at an interval of 12 or 14 days, and sometimes between two and three ounces were discharged at a time; the size of the head sensibly diminished, and the general health im proved. The puncturing was repeated eleven times in the year 1829, on the following days-8th, 15th, and 23d of January, 19th February, 5th and 19th of March, 19th and 27th of April, 5th and 17th of May, 23d of June. The evacuated fluid was thicker and more coagulable towards the end of the cure. The smaller fontanelle and the sutures in course of time closed; the child became healthy and strong. When 10 months old it began to walk; and on the 26th of November, 1830, the child, aged 2 years, was presented well and active to the Society of Medicine at Berlin.-Graefe and Walther's Journ. der Chir.
THE ADVANTAGES of Revulsive BLEED
ING IN AFFECTIONS OF THE HEAD. FORMERLY, in the schools of medicine, it was much disputed whether bleeding, local and general, had or had not a revulsive power; that is, of drawing the blood from other parts to that part whence the blood was allowed to flow. This doctrine includes the idea of derivation as well as of revulsion; and when the terms are applied to bloodletting, we mean by the former the abstraction of blood from the diseased part itself, and, by the latter, from a part situated at a distance. M. Chauffard, the author of these observations, states that he has often seen an inflammatory affection of the head aggravated by leeches
to the temples or behind the ears, and relieved at once by drawing blood from the feet or ankles; he mentions several cases of acute ophthalmia, unchecked and uncured by local bleedings from the neighbourhood of the eyes, speedily disappear by the application of leeches to the lower extremities. The good effects are much enhanced by warm hip or foot baths; cold applications at the same time kept constantly applied to the head, and large doses of calomel. The following is an instructive example.
A young child had a very severe ophthalmia, which was treated by leeches to the temples, blisters to the nape of the neck, &c. The symptoms, however, did not abate, and the formation of pus in the chambers of the aqueous humour was the consequence. M. Chauffard ordered leeches to the ankles, followed by hot poultices, fomentations to the abdomen, a general warm-bath, while cold was applied to the head, and a dose of 15 grains of calomel twice a week. The pus was gradually absorbed, and vision restored.
As a general rule, our author states that, when a local bleeding near the seat of the disease does not at once relieve the symptoms by the evacuation of blood, and the depression thereby induced, the symptoms are always made worse. Otitis is uniformly most speedily cured by leeches to the anus, vulva, &c. or by opening the saphæna vein; cynanche will yield to one general bleeding, and will frequently resist a dozen applications of leeches to the throat. A hemicrania is often more severe after leeching the temples, and yet vanishes by a hot pediluvium; and every one knows that a neuralgia of the face is generally exasperated by local bleeding, for if the pain does not yield soon after the blood is drawn, the "engorgement fluxionnaire" of the cellular substance which surrounds the nervous twigs is increased, and the pain in consequence is agonizing. The excruciating headaches which succeed to a stoppage of the catamenia, are best relieved by the application of leeches to the vulva; an attack of coup-de-soleil, by opening the saphæna vein; the acute hydrocephalus of children by the same means.
We shall illustrate this by narrating a
A child, a year and a half old, was labouring under the symptoms of hydrocephalic disease. Pulse small, irregular, and thread like; dilatation of the pupil; occasional flushes of the face; confirmed coma and insensibility to pain, occurring after an attack of hot fever, with severe headache. Three leeches were ordered to each ankle, and the leech-bites to be covered with hot poultices for several hours. The little patient revived somewhat, and, on the following day, the symptoms were more favourable, and the infant gradually recovered.-Archives Générales.
Remark. We direct our readers' attention to the above remarks, as illustrative of the good effects of revulsive bleeding in many diseases, but especially in those of the head. We are aware that many may and will object to M. Chauffard's opinion of its superior efficacy, and allege that local bleed ing near the affected part would have probably been as successful, in the cases whose cures he ascribes to the revulsion of the blood to a distant part. It is a practice not common in this country, though much followed abroad, and, we are of opinion, with exceeding good effects, especially in those cases of cerebral disease dependant on an obstruction of any accustomed discharge.
ACCOUNT OF CHOLERA IN PARIS. THE disease in Paris, as in all other places, has committed far greater proportional ravages among the poor and ill-fed, than among those in more comfortable circumstances. Males have suffered much more from this scourge than females, and the aged and intemperate than the active and abstemious. Most of the victims have passed 30 years; still, however, many children and young preg nant women have fallen sacrifices. It has been remarked that in most, but certainly not in all, there were the premonitory symptoms of diarrhoea or some
irregularity of the bowels, before the violence of the choleric attack. The seizure, in almost every case, occurred between midnight and four or five o'clock in the morning. The usual course of the symptoms has been as follows:-Borborygmi, uneasiness and pain of the bowels, followed by watery or whey-like stools, ejected by frequent squirts, without any effort, colic, or tenesmus; then succeed the watery vomitings and cramps; but these last have by no means been constantly present. Most patients have complained of a distressing pain at the epigastrium, increased by pressure, and frequently extending over all the belly; urine very scanty; restlessness; extraordinary prostration, almost to the annihilation of vitality, even although the evacuations were not very profuse; feebleness of the voice; cold of the whole surface and of the tongue; pulse feebly or not at all perceptible; face shrivelled and blue. Most of the patients who were brought to the hospitals, after having been 10 or 12 hours ill, were cold, pulseless, and cadaverised. An instance has scarcely been known of a recovery, after the pulse had ceased at the wrist.
The pathognomonic phenomena have been generally, great internal congestion; the stomach and intestines have been uniformly found abnormal in some respects, exhibiting either numerous red injected patches, or large ecchymoses; the secretory follicles were always enlarged. No feculent matter was ever found in the intestines; but, in its stead, the rice or barley-water-like liquid, which was sometimes tinged of a brown or reddish colour in those cases in which the intestines were ecchymosed. The blood had probably exuded and mingled itself with the watery secretion. In one or two, not the slightest trace of disease could be found on. dissection. The urinary bladder was always contracted. No lesion has hitherto been remarked of the nervous plexuses and ganglia in the abdomen.
Treatment. The employment of stimulants has generally been followed in the stage of prostration and cold, but not with much success. M. Recamier
and some other physicians have used the cold affusion as a stimulant; and it is reported that this method has had better effects in restoring warmth and circulation, than frictions and external heat. The above short sketch is taken from the Archives Génerales de Medecine for March; and we shall now lay before our readers, a more particular and circumstantial report of the disease, as it has been observed in the different leading hospitals of the French metropolis; and first we select one, or two cases from the Clinique of M. Broussais.
Case 1. F. Belleval a soldier, was brought to the Hôpital du Val de Grace at 9 P. M. on the 31st March. Extremities cold and livid, &c.; pulse threadlike; tongue red; intense thirst. He had been seized five hours before with cold shiverings; severe pains in the head, borborygmi, cramps, vomiting, but no purging-there was great prostration and stupor; but intellect unclouded. Treatment-dry frictions; 20 leeches to the mastoid processes, and 40 to the epigastrium; iced water to drink. The patient expressed himself relieved, in proportion as the leeches fastened. On the following day all the dangerous symptoms had vanished, and he gradually recovered.
Remarks. Though the above case may not be deemed one of concentrated cholera, it is worthy of being studied in connexion with the treatment pursued. If not the disease itself, it is only one degree of kinship removed from it.
Case 2 of cholera, or choleroid disease occurring at the same hospital, a month before it invaded Paris as an epidemic.
Aman, aged 29 years, presented most of the symptoms of cholera: his extremities cold; his aspect cadaverous; racking and unintermitting pains of the bowels; borborygmi, profuse diarrhœa, and severe vomiting of a yellowish green matter-great tenderness of the epigastrium much encreased by pressure pulse small, frequent and intermitting: skin cold; great thirst; very considerable
exhaustion. Leeches were ordered to the epigastrium, and blood was drawn from the arm-the vomitings and diarrhoea soon ceased; and the pain was much mitigated; and the other symptoms gradually gave way.-Hôpital de la Pitie.
OBSERVATIONS AND EXPERIMENTS ON RESPIRATION.
THERE is a condition of the parts composing the organ of respiration, a knowledge of the influence of which on the function, must very materially modify the prevailing theory concerning it. This condition is the permanent patency of the air-passages and cells. It pervades every portion of the passages. The mouth nose and larynx having bony walls it cannot be denied to them; the trachea and main trunks of the bronchi being occupied by cartilaginous rings, must also have it awarded to them; but as the cartilaginous rings occur less and less frequently, the farther the tubes dip into the lungs, and, as at their terminations, none are to be found, so that the extremities of all the tubes are entirely membranous, their claim may be doubted. Yet it must be borne in mind that these tubes are strictly attached to the air-cells, and therefore must remain open as long as the cells continue so. It is well known that the cells are open after death; for they are found to contain a large quantity of air, at that period when the lungs are under the greatest degree of compression of which they are susceptible, whilst the thorax is entire and atmospheric pressure is excluded. They must be more expanded during life, to which state attention is at present solicited. In further proof of this point, it may be observed that, after death, when the utmost degree of compression which the ribs can permit exists, the tubes are not closed; for if the thorax be opened, the lungs shrink considerably, and air is expelled from the cells through the tubes, which it is clear could not be effected, were they closed.