NOTES ON THE disease with the early stages of some inflammatory conditions of the brain. There may be chilliness, vomiting, fever, with a rapid TREATMENT OF CURABLE DISEASES.* pulse, constipation, occasional drowsiness, restlessness BY W. S. OKE, M.D., Extra-Licentiate of the Royal College of Physicians, Physician to the Royal South Hants Infirmary, &c. OPHTHALMIA INFANTUM PUrulenta. THIS kind of inflammation is communicated to the conjunctival membrane of the child by its coming in contact with specific discharge during the passage of the head through the vagina. It takes place soon after birth, and is easily subdued in the incipient stage; but if neglected, and the corneæ are involved, the worst consequences will ensue; indeed, it may truly be asserted that the vision will be as certainly preserved by early and judicious measures as it will be lost by procrastination. The palpebræ are inflamed, swollen, and closed; and upon being slightly compressed a considerable quantity of purulent matter will be discharged. In this case, as in strumous ophthalmia, very much will depend upon the manner in which the local remedies are applied. Some competent attendant must be instructed to inject the lotion (1) betwixt the palpebræ and the globe of the eye twice a day, that it may be done effectually. After this the tarsi are to be lightly smeared with the ointment (2); folds of linen, made wet with saturnine wash, are to be constantly laid upon the swollen palpebræ; and the powder (3) is to be given in gruel or syrup three times a day. 1.-R. Argenti Nitratis, gr. viij. Misce. quotidie. Aquæ Destillatæ, f., oz. ij. Injiciatur pauxillum intra palpebras bis 2.-R. Unguenti Hyd. Nit. Oxidi, dr. j. Cum quo linentur palpebræ, bis die. 3.-R. Hydrargyri Chloridi., gr. ss. Pulv. Tragac. Comp., gr. iv. Fiat dosis ter die sumenda. FEBRIS JUNIORUM REMITTENS. I have used the word juniorum instead of infantum, as this remittent affects children from one year old to about ten. The cure of this disease is greatly promoted by medicine, if not wholly effected by it. The following is a sketch of the symptoms :-The bowels are irregular and generally inactive; there is a total loss of appetite, and a remarkably foul and undigested state of the focal evacuations; the urine is high coloured; the pulse is rapid; there is a burning heat of the skin at night, with restlessness or delirium, but during the day there are several remissions, in which the child appears to be comparatively better, and drowsy. The cheeks are often flushed; the hands tremble; the nose and lips are constantly picked, and the child becomes peevish, and cries if an atttempt be made to prevent it. It is sometimes scarcely possible not to confound this Continued from page 698 of last volume. No. II., January 21, 1852. and delirium in both. But if it be truly stated that this kind of remittent be derived from intestinal causes, then, by attentively observing whether, upon the whole, the symptoms point to the cerebral or abdominal functions, we shall be enabled to come to a sufficiently correct conclusion to direct the treatment. Acute headache, whether gestured or expressed, intolerance of light, starting in the sleep, and grinding of the teeth, would decide for the former; whilst the absence of these, irregular remissions of fever during the day, a burning skin in the night, and a disgust of food, would evidence the latter, and, therefore, the present disease. The indications of cure are:-1st, to clear out the alimentary canal, and reduce the fever; 2nd, to improve the digestive function, and strenghthen the system. The first will best be accomplished by Nos. 1, 2, and 3, and the second by 4. 1.-R. Hydrarg. Chloridi., gr. j. Pulv. Scammonii. Comp., gr. v. Misce fiat pulvis quartâ quâque horâ sumendus donec satis operaverit. 2.-R. Hydrargyri cum Cretâ, gr. vi. Antimonii Pot. Tart., gr. iss. Sacchari. Purificat, dr. ss. Misce et divide in chartulas sex sumat unam tertiis horis. After the bowels have been cleared, they may be moderately acted upon every morning by 3.-R. Magnes. Sulph., dr. ss. Misce fiat haustus. CYNANCHE TRACHEALIS: INCIPIENT STAGE. This disease is the result of inflammation of the mucous membrane of the trachea, and the deposit of false The respiratory appears to membrane upon its surface. be the only mucous membrane that is so frequently subject to fibrinous deposits; the conjunctival, the nasal, the oesophageal, and the urethral being almost exempt from such a result. It is difficult to explain why children should be so much more liable to croup than adults; it may be, that, as in the former the forces of physical growth are greater, so any inflammatory action of those B What- liable to a return of the disease: in such case he should forces are the more disposed to secrete fibrin. PETECHIAL SPOTS IN CHILDREN. ever may be the true explanation, it is an established be removed to a mild locality. This terrible disease usually invades the trachea at night. The child, probably after some slight indication of cold, is awakened from sleep by an impediment to the breathing, and every effort to inspire produces a crowing sound; after this the breathing becomes more and more stridulous and straitened, and is accompanied with a shrill hoarse cough. There is sthenic pyrexia, and an anxious and distressed aspect. It is scarcely possible to confound idiopathic croup with any other disease. In the spasmodic form there is no hoarse cough nor continuonsly stridulous breathing; neither is there much febrile disturbance or distress. In laryngismus stridulus there is also a crowing sound, but this is transient, returns at intervals, and is attended with a sense of suffocation, which greatly alarms the little sufferer, and makes him instinctively dread a recurrence of the attack, for in one of these he not unfrequently expires. A few years ago I was called to an interesting case of this kind in a remarkably fine boy, six months old. The spasms returned after intervals of several hours, and every recurrence threatened his existence, and dreadfully alarmed him, till at length, in spite of every remedy, the atmosphere was refused admittance through the glottis, and he suddenly expired. Laryngismus does not appear to be the result of inflammation, but rather of a spastic reflex action of the arytenoid muscles, which act in closing the rima glottidis, and this action is often caused by teething. The incipient stage of croup is amenable to treatment, if it be carly and decided; but if the inflammation be allowed to creep on till false membrane is secreted upon the internal surface of the respiratory tube, all remedies will be ineffectual in nine cases out of ten. Local bleeding, calomel, and antimony, are the remedies mostly to be relied upon. Leeches are to be applied over the trachea, the number to correspond with the age of the child; and the powder (1) is to be given every two hours, till the stools assume a spinach colour, and the breathing is relieved. 1.-R. Hydrarg. Chloridi, gr. xij. Antim. Pot. Tart., gr. iss. Sacchar. Purific., dr. ss. Misce et divide in chartulas sex, quarum detur una secundâ quâque horâ. This dose supposes the child to be over a year old. After the orifices of the leech-bites have ceased to bleed, a narrow blister may be laid along the sternum, and the warm bath may be necessary, if the skin be hot and dry. The diet should be low, such as barleywater, sweetened with honey, and the atmosphere of the room be of a genial temperature. Croup is most commonly met with in damp and cold districts; and if the patient recovers he is sometimes Petechiae are most frequently observed in febrile diseases of an asthenic character, and in such they are to be looked upon as a very unfavourable symptom. I remember one instance of continued fever, in which the skin of the whole body was literally spotted with large petechiae, and which soon terminated fatally. But petechiae may also exist independently of any febrile association, and with this kind the purpura hæmorrhagica may be classed, although the spots are so much larger. The case to which I allude in this place is unassociated with fever, and occurs to children from about six to twelve years old. Here also the petechiæ appear to be the result of a low power of the blood. They are generally seen on the inferior extremities between the knees and ankles, and are, for the most part, the size and appearance of flea-bites; sometimes, however, they are here and there interspersed with others of larger size, but all are of a deep purple colour. There is often, at the same time, pain at the epigastrium, aching of the joints, a foul and flabby tongue, a weak pulse, and a feeling of debility. The indication of cure is simply to strengthen the system; and this will be fulfilled, and the petechiæ speedily removed, by the hydrochloric acid (1), the alterative (2), and a generous diet. 1.-R. Acidi Hydrochlor. Dilut., m. xxxvj. Syrup. Croci, Tinct. Aurantii Co., sing oz. ss. Misce capiat cochleare largum ter die. Pulveris Radicis Rhei, gr. v. Misce fiat dosis bis hebdomedâ sumenda. INTESTINODYNIA IN YOUNG PERSONS. The assemblage of symptoms, to which I have ventured to give the above denomination, appears to be of a functional character, occurs before the age of puberty, and continues for a considerable time. It consists of a constant, dull, aching pain of the bowels, seldom accompanied with griping. The abdomen is enlarged, dull under percussion, and rather tender under deep pressure. There is no fluctuation to be discovered in the peritoneal cavity; neither is there any attenuation of the body. The pulse is quiet and regular; the tongue is not furred; there is no diarrhoea nor constipation; and the appetite varies, being sometimes excessive and sometimes altogether absent. It is difficult to point out, with any degree of accuracy, the cause from which these symptoms are derived. They do not appear to be connected with the presence of entozoa in the alimentary canal, nor with glandular disease of the mesentery. I have rather attributed them to a congested state of the portal veins, but I am not at all certain of the correctness of this opinion. Not having met with any fatal termination of the disease, I have had no opportunity of ascertaining any facts that could better explain its pathology. I have, in my experience, met with a considerable number of these cases, and they have yielded, in a remarkable manner, to the bichloride of mercury, after being taken a very few days. It may be given as in1.-R. Hydrarg. Bichlor., gr. iss. Tinct. Card. Comp., Syrup. Zingib., sing. oz. ss. Aquæ Mentha Pip., oz. v. M. Capiat cochleare largum unum ter quotidie. In this dose the bichloride will generally give about two stools in the day. If it should operate too much, the dose must be reduced to 1-12th of a grain; if it fail to affect the bowels at all, some aperient will be required to regulate the bowels, such as ten grains of rhubarb, or one of the pills (2) every other night. 2.-R. Pilula Colocynth Comp. (L. P.), scr. ij. Scam. Gum., Sapon. Duri, utrq. scr. ss. Extr. Hyos., gr. vj. Olei Caryophilli Guttam. Misce et divide in pilulas xij.; capiat unam duasve alternâ quâque nocte, vel pro re natâ. The two following cases are examples of this disease: Case 1.-C. B., aged 12, complained of a dull pain in the lower part of the abdomen, which had existed for some time; it was enlarged, and somewhat tender under pressure. The pain became worse about the middle of the day after his dinner. The bowels were neither constipated nor relaxed. The tongue was but little furred; the pulse did not exceed 90 in the minute, and the appetite not wholly absent. An eighth part of a grain of the bichloride of mercury, dissolved in peppermint water, was prescribed for the child three times a day, which at once relieved the pain, and in a short time reduced the size of the abdomen and removed the disease. Case 2.-W. P., aged 11, had complained of an aching and pinching pain of the bowels for two months, it was occasionally so severe as to make him roll upon the floor. The abdomen was in some degree swollen and tender under deep pressure. He had one stool daily. He was thirsty, and his appetite was sometimes voracious, and at others altogether absent. The tongue, however, was not much furred, and there was no febrile disturbance. The same treatment was adopted in this case, and in a week afterwards the child was convalescent. ENLARGEMENT OF THE ABDOMEN FROM MESENTERIC OBSTRUCTION IN YOUNG PERSONS. The obstruction of the mesentery, here alluded to, is not that which is caused by strumous enlargement of its glands, nor that which results from the agglutination of its peritoneal surfaces by organised fibrinous_deposits, both of which I consider to be incurable, but that which is occasioned by sub-acute inflammation, unattended with any great degree of febrile action. This disease is characterised by enlargement, severe pain and tenderness of the abdomen, which is dull under percussion, and sometimes infiltrated. If the symptoms have continued for any length of time, there is also extreme atrophy. The cases which have fallen under my observation have occurred from the age of ten to fourteen years. In the treatment of this disease, calomel, combined with opium, has been, in my own experience, successful beyond all expectation, not only in subduing the severity of the pain, but in curing the malady; indeed such a result, in several instances, both from the severity of the symptoms and the atrophied condition of the patient, has greatly surprised me. The pills (1) should be given two or three times a day, according to the degree of pain; and should ptyalism be produced, and the pain, nevertheless, continue, the opium is to be persisted in without the mercury, in such doses, and after such intervals, as the circumstances shall require. 1.-R. Hydrarg. Chlor., gr. vj. Conf. Rosæ, scr. ss. Misce et divide in pil. vj.; quaram capiat unam bis terve die urgenti dolore. I have found a plaster also an excellent adjuvant, and very conducive to the removal of the disease. It should be made of equal parts of the Empl. Ammon. cum Hydr., and the Empl. Thuris Comp, spread upon thin leather, and large enough to cover the whole abdomen. This remedy appears to act not so much by virtue of any medicinal property in the plaster as upon the principle of gentle pressure, by which it gradually softens and reduces the abdominal enlargement, whilst the calomel and opium relieve the pain and subdue the inflammatory condition of the mesentery and of such other viscera as may be involved. The following is a most remarkable case of the kind, and will give the symptoms more in detail: Her A young female, aged 15, and before her menstruation had begun, became gradually affected with fulness of the abdomen, accompanied with darting pains of the lower part of the bowels, extending to the back. The pain was generally severe but worse in the night. There was not much febrile action, although she was often thirsty. At the commencement of the disease there was sickness and vomiting but not afterwards. food gave her gastric pain; her urine was high coloured; and her bowels were irritable, acting always after every meal. There was also a frequent desire to pass the urine. This state of things continued five months, the greater part of which time she kept her bed. She was then brought into Southampton and placed under my care in the dispensary. The abdomen was now in some degree infiltrated, and so tender as not to bear the weight of the bedclothes. She was atrophied to the last degree, and could not stand without assistance. At the same time her appetite was ravenous and nothing could satisfy it. The pain of the belly was agonizing and it was distressing to witness her extreme suffering. With a view to mitigate the severity of the pain and without the least expectoration of curing the disease, a large opiate plaster was applied over the whole of the abdomen, and calomel combined with opium, was given every four hours :-one grain of the former and as much of the latter as the vehemence of the pain required. This treatment was continued for some time with manifest benefit, and under its continuance the pain, tenderness, and enlargement of the abdomen gradually subsided; in short, to my astonishment she completely recovered. She is now 27 years of age, and in good health. CHOREA. Chorea occurs from the age of about eight to fourteen years. Before or after this period it is seldom to be met with. It consists of an assemblage of sudden involuntary muscular actions, which are throughout the day continually distorting the features, and drawing the head, trunk, and limbs, into various abnormal attitudes. This strange malady seems to be the result of an atonicity and a morbid sensibility of the excito-motory nerves. It is difficult to state, with any degree of precision, from what source these irregular movements take their origin; but it is probable that they commence in the ganglionic or sympathetic nerve, and are thence reflected through the spinal chord, upon the muscular system. This is a mere opinion, and must be taken as such: or it might originate in some part of the cerebral function; and this view is in some degree supported by the fact that the involantary actions entirely subside during sleep. Chorea is generally curable by medicine in six weeks or two months; and the remedies which I have found most successful, are preparations of iron and smart purgatives, as 1.-R. Ferri Sesqui-Oxidi, scr. j.-dr. ss. Misce capiat æger hanc dosin ter die in theriacâ. Scammonii Gummi, gr. iv. Pulv. Zingiberis, gr. ij. Misce fiat dosis quâqua tertia nocte sumenda. In some cases the magnetic oxide of iron answers better than the sesqui-oxide, as in 3.-R. Ferri-Oxidi Magnetici, scr. j.—dr. ss. Pulveris Zingiberis, gr. ij., Misce fiat dosis in crasso vehiculo sumenda ter quotidie. Should the above preparations of iron fail to remove the disease, the iodide of potassium will be often found successful, especially if the strength has been much worn by the long continuance of the choreal movements. It may be given in the formula 4.-R. Potass. Iodidi, gr. xxiv. Syrupi Aurantii, oz. ss. Aquæ Mentha Pip., oz. iiss. Misce capiat æger, cochleare largum unum ter die ex aquæ pauxillo. I saw this medicine succeed in a remarkable manner after all other remedies had failed, in a young man, 21 years of age, and six feet in height.* I have known chorea affect several members of the same family as they came to an age susceptible of the disease, in some of whom it proved fatal in spite of every means employed to subdue it. There are forms of chorea in which the • The case was published by me in the Provincial Medical and Surgical Journal, May 1st, 1944. spastic actions of the muscles are so violent and incessant as to make it absolutely necessary to combine opiates with the above treatment. The following is an example of the kind. J. C., of Romsey, aged 16 years, was admitted under my care, into the Royal South Hants Infirmary, on the 28th of August, 1848, for chorea. The spastic actions were so universal, violent, and incessant, that neither personal clothing nor bed-clothes could be kept on her for a moment, nor could she lie upon the bed without the risk of being jerked off it. Under these circumstances it became necessary to lay her on a mattress upon the floor of a small ward, taking care to pad the walls that she may do no injury to herself, and directing the nurse to keep a blanket on her as best she could. She was then ordered the following medicines :-The opiate (5) to be given every night; the magnetic oxide of iron with Dover's powders (6) three times a day; and the purgative (7) alternate mornings. 5.-R. Liq. Opii Sedativ., m. x. Mist. camphoræ oz. ss. Fiat haustus omni nocte bibend. 6.-R. Ferri Oxidi Magnetici, gr. xv., Pulv. Ipecac. Comp., gr. iiss. Misce fiat pulvis ter die capiend in crasso vehiculo. 7.-R. Pulv. Scammonii Comp., gr. x. Fiat dosis omni alterno mane sumenda. This treatment at once succeeded. The spastic movements were speedily controlled, in two days she returned to her bed, and on the 25th of September, (twentyeight days from her admission,) she was discharged cured. Southampton, January 2, 1852. [To be continued.] ON PROLAPSUS UTERI. WITH A DESCRIPTION OF A NEW INSTRUMENT FOR ITS TREATMENT. BY JOHN JONES, Esa., DERBY. Read at the Quarterly Meeting of the Midland Branch, December 4, 1851. AMONGST the various infirmities to which the female constitution is subject none is more entitled to the grave consideration of the profession than the abnormal positions of the uterus. The displacement of this organ, when connected with pregnancy or the puerperal state, as in retroversion or inversion, require manual assistance, and if not speedily relieved, become highly dangerous; but the most frequent of all displacements is the descent of the womb, which, although not immediately dangerous, is productive of great and continued suffering. It occurs in three different degrees, thus defined by Dr. Ashwell: 1. Relaxation implies that the uterus has lost its central projecting position in the upper part of the vagina, and has descended sufficiently far to obtain a bearing on the perineum, without, however, any material shortening of this canal or any marked alteration in the uterine axis. and the immediate and great relief afforded by welladapted means for supporting the abdominal parietes. Treatment. In prolapsus and procidentia, mechanicel means for supporting the uterus have hitherto been alone depended upon by the profession generally, as affording the most approved mode of relief; and these supports have consisted almost exclusively of pessaries, 2. Prolapsus signifies that the uterus has sunk nearly or quite down to the os externum. Under this state the vagina is considerably everted, and the womb losing the axis of the brim, which is down-modified in shape and the material of which they are wards and backwards, assumes the axis of the outlet of the vagina, which is downwards and forwards. composed, according to the ingenuity and fancies of different practitioners. The inconveniences, however, produces by pessaries, the untoward symptoms which they sometimes induce, and the inefficient relief they afford, render their use exceedingly unsatisfactory. Sir Charles Clarke, who is a strenuous advocate for the use of the pessary, relates the following case:— 3. Procidentia implies complete protrusion beyond the vulva. The uterus forms a tumour, often very large, hanging out between the thighs, and the vagina turned inside out, constitutes the external covering. In the sac thus formed, especially if of long standing and large, there is contained the bladder, rectum, and some portion of the small intestines; the mesentery being stretched, and the omentum occupying any vacant space. The descent of the womb, even in the first or slightest degree, is attended with much pain and consitutional irritation, the cause of which may readily escape notice. These symptoms are soon followed by those induced by mechanical pressure, constituting prolapsus, difficult micturition, which is performed most easily when in the recumbent position; a feeling of sinking of the abdominal contents, accompanied with a painful bearing down when walking or standing, which are immediately relieved by lying down; and leucorrhoea. In actual proci-ingly in the introduction of the instrument (because, dentia, the tumour is sometimes of immense size and altogether irreducible. I have seen a permanently protruded uterus forming a tumour as large as a child's head. Another occurs to my recollection in which the uterus protruded beyond the vulva, and exposed to friction, became ulcerated to the extent of a crown piece, and of course was productive of long-continued and grievous suffering. "A lady, seventy-five years of age, who had borne children, came under the care of the author, on account of considerable pain in the vagina, attended by a very offensive discharge. The pain was constant, and was compared to that produced by a sharp instrument. | Thirty-five years before she had a prolupsus uteri, for which a pessary had been introduced, and which had never been removed. The author having reason to fear that some diseased structure existed, examined the patient and found that the pessary had lost its original form, being corroded in several places, and that many irregular portions of it were left, which pressed upon the vagina, and had produced ulceration of its internal surface. This lady having, as she said, suffered exceed This infirmity is most frequent amongst the lower ranks of society, with whom it is induced by exposure to hard work and privation. Such patients, believing that their malady admits of no remedy, seldom complain, and thus they pass through a life of suffering, embittered by concealment, often without medical aid, and deprived even of the soothing sympathies of friendship. Persons, however, of all ranks, are more or less subject to this disease, especially those who have borne many children, and even virgins are not exempt. Causes.-These are :-weakness and undue expansion of the broad and round ligaments, together with relaxation of the levator ani and perineal muscles; but particularly as observed by Dr. Ashwell, "and extension and slackness of the pelvic fascia in its connection with the uterus and vagina." The principal cause, however, and which will account for most of its painful symptoms is, I conceive, the superincumbent weight of the abdominal viscera pressing on the uterus, deprived of its usual supports by the relaxation of the vagina and neighbouring parts. That such pressure is a powerful agent in producing the disease, is proved by the freedom from all uneasiness when the patient is in the recumbent position perhaps, it was incautiously performed) would not consent to its removal, particularly after some of her symptoms had been relieved by fomentations and injections." The great inconveniences attending the use of pessaries have induced some practitioners to discard them altogether, and to substitute for them a painful if not dangerous operation, for the purpose of contracting the vagina, so as permanently to prevent the descent of the uterus, and thus effect a radical cure. Dr. Marshall Hall is amongst those who advocate this mode of treatment. It is, however, too formidable an operation to be generally adopted, and to which few patients would be willing to submit, more particularly as the results are not always satisfactory, and, at least, partial relief can be obtained by less severe means. Some years ago Dr. Hall invented an instrument for the purpose of keeping in situ the procident uterus by external pressure, and thus to supersede the use of pessaries. Dr. Ashwell gives the following description of it:-"A pad, elastic but firm, is made to bear upon the perineum, without interfering either with the rectum or vulva. A belt round the waist, and a connecting strap, passing from before to behind, aided by springs and hooks, secures sufficiently firm compression to prevent the descent of the replaced womb. of my patients have worn this pad comfortably, and with tolerable success; but in most cases the pressure has induced pain, heat, and leucorrhoea; and they have gladly exchanged it for the of The pessary. these more elaborate instruments is to poor woman, in Several expense |