« 이전계속 »
results. No other malformation was ever observed in her other children. In the present instance labour was brought on at the eighth month by the passage of a probe between the membranes, as the child's heart was observed to beat slowly. The enlargement of the neck had the same influence in throwing the head back as the arm of the child when placed under the chin, the labour in consequence was tedious.
Dr Keiller had met with a similar case nine months ago, and the child, he was happy to state, was still alive. The mother came froin the neighbourhood of Cockermouth, where he (Dr Keiller) believed goitre was prevalent; she had at one time of her life been affected with the disease. The tumour in the child's neck had become smaller since birth.
Dr Simpson believed that there were different kinds of swellings met with in the necks of children. Large ranulæ were occasionally present from an enlargement of the salivary glands. A beautiful specimen of which existed in the late Dr Hamilton's collection; the tumour was fully half the size of the child's head. He had himself seen two other cases which occurred in the old town of Edinburgh, both of which proved speedily fatal from the gradual enlargement of the ranulæ.
ON SOME INTERESTING CASES AMONG THE WOUNDED FROM ALMA. BY JAMES JOHNSTON, M.D. (SURGEON TO THE HAMPSHIRE MILITIA.)- The
communication was contained in a letter to the Secretary, Dr Warburton 1 Begbie, and consisted of a detailed account of cases of gun-shot injury, which i had been drafted home to Portsmouth in the Himalaya, Cambria, and Avon.
Case I. was one of wound of the epigastrium, received on the 20th September, just as the patient, a private in the 55th Regiment, had crossed the river. The shot was the size of an egg, and entered the epigastrium at the edge of the cartilage of the tenth rib on the right side of the thorax. The man rolled over and struggled on the ground, and while so doing the shot fell out at the wound, and was afterwards found in his trousers. There was no hemorrhage, but intense dyspnea, which continued for thirty-six hours. He lay on the battlefield till the 22d, and partook only of liquids. He expectorated blood for a few days. The wound finally healed in November at Malta. The case continued to progress favourably up to February 1st, 1855, when Dr Johnston wrote that there had been sudden recurrence of the dyspnea, with profuse discharge upwards and downwards of bilious matter, and that hectic had set in. The right lung is condensed inferiorly ; and from the bilious symptoms, Dr Johnston regards it as probable that the shot had pierced the margin of the diaphragm, entered the right pleura, bruised if not wounded the lung and liver, and then, after rolling about the chest, had escaped by the entrance it had made.
CASE II. A musket bullet had penetrated the medullary canal of the tibia, and twelve days afterwards was successfully extracted. The bullet was peculiar, being cleanly cut through the centre for more than two-thirds of its diameter, for the purpose, it is believed, of increasing its destructive power by its possible division.
CASE III. was struck in the height of the action by a musket ball which entered to the right of the symphysis pubis, crossed the spermatic cord, and plunged deeply into the right thigh under Poupart's ligament. For the moment he was doubled up, and ten minutes after there was some bleeding. Great swelling took place in the abdomen, thigh, scrotum and right testis. "He never had pain in passing urine or fæces. Abscesses formed over the inguinal ring and underneath the scrotum; and fistulæ still remained. The bullet had not been extracted. It appeared to be very deeply lodged under Poupart's ligament and gave little uneasiness.
CASE IV. was one of bullet wound of the leg with splintering of the tibia. It was received as the patient, a sergeant, after a stumble on the moist ground on the Russian side of the river, was running to regain his comrades. Some pieces of bone were yet to come away.
Case V. had his limb amputated below the knee on the field of battle for gunshot injury. He was conveyed to Malta ; and the stump did well till on the receipt of a slight injury the entire flap sloughed. Since landing at Portsmouth, cicatrization had rapidly advanced.
Case VI. was one of amputation of the arm in consequence of hæmorrhage from a sloughing wound of forearm.
Case VII. was also a musket wound of the forearm. This man was in the act of pulling the trigger when he was struck. The ball entered the inner aspect of the right forearm below the elbow-joint, traversed the bend of the elbow, and passed out behind the head of the radius, which bone was much shattered. Hæmorrhage occurred; but the pulse was normal. The median nerve was injured. Pieces of bone had come away from time to time, and ulcers and sinuses at the points of entrance and exit of the ball, but under careful treatment since his arrival in England the arm had greatly improved, motion and sensation having perceptibly returned.
CASE VIII. was one of grape-shot injury of the leg. The patient was wounded towards the close of the action, just as he had gained the level on the top of the heights about one hundred yards distant from the batteries. The shot entered over the tubercle at the head of the tibia, and extensively shattered the bone, without however breaking it across. It passed out below the head of the fibula, which escaped injury. Hæmorrhage ensued, but was arrested by a torniquet. In the progress of cure, enormous quantities of loose portions of the tibia had come away ; but Dr Johnston hoped to preserve a useful limb.
CASE IX. was a curious one of injury to the abdomen ; the bullet had passed into the pelvis, a little way above Poupart's ligament, without wounding the peritoneum. There was numbness of the right lower extremity; and profuse hæmorrhage recurred from time to time. Difficulty in passing urine was occasionally experienced, and pain in defæcation, with the passage of mucus and blood. The ball was never traced. The wound was healing kindly. Dr Johnston regarded it as possible that the ball had either perforated the rectum and been passed by stool, or that it was even now in the bladder.
CASE X. presented a gunshot injury of the leg, without any very remarkable features. It was received as the man was in the act of putting on a copper cap alongside of the batteries, and at the close of the action.
Case XI. was wounded about three p.M., soon after the heights were gained, by a canister-shot, which struck him about the junction of the tenth rib with its cartilage on the left side, and made its exit nearly opposite to the transverse process of the last lumber vertebra of the same side. He fell ; and there was a gush of blood from the wound. The hæmorrhage continued from both wounds for two days. His breathing was unaffected, and he had no difficulty in urinating or defæcating. A portion of his trousers and a few small pieces of bone came from the posterior wound. The interesting point in this case was, that at Scutari fæces could be squeezed from the upper wound. Hitherto the case had done well.
CASE XII. was wounded at Inkermann, Nov. 5th, 1854, two hours after the action commenced, by a grape-shot which shattered the tibia. The case, beyond the suspicion of a portion of his drawers being still in the limb and protracting recovery, presented little novelty from the similar injuries recorded under cases viii. and x.
The poor men expressed a high opinion of the hospital arrangements at 1 Scutari. The hospital was comfortable, and the supplies excellent. Wounds,
however, did not make satisfactory cures; as many instances had occurred of soldiers returning to the Crimea with their sores healed up to all appearance, which, on relanding, became again open, and resumed their former characters. No complaints were made of want of attention to their sufferings when wounded on the field. Due alacrity appeared to be used in the transport of all the serious cases, which were at once conveyed on board ship. Dr Johnston, in his letter, incidentally also gave a denial to the sweeping charge made by the Times of neglect of the wounded landed the other day at Portsmouth. All cases which required immediate medical and surgical aid were promptly attended to, and by four P.M. were all safely housed in a comfortable hospital.
It was unanimously agreed that the thanks of the Society be given to Dr Johnston for his highly interesting paper, and for his kind proposal on some future occasion to favour the Society with another. The President instructed the Secretary accordingly.
NOTES ON THE ADMINISTRATION OF GALLIC ACID, CHIEFLY IN BRIGAT'S DISEASE, AND IN HÆMOPTYSIS. BY W. T. GAIRDNER, M.D.-Dr Gairdner had tried gallic acid in the sweating of phthisis, and had found it equally powerless with other remedies in effecting good results uniformly. In two cases of hcematuria, of very obstinate character, it was not of the slightest service. In simple diarrhoea he had not found it comparable to the ordinary astringents. In haemoptysis, although perfectly safe and possibly useful, Dr G. considered that the confident statements of its good effects, particularly in ordinary doses, have been based on insufficient grounds. In albuminuria it had totally failed in producing diminished albuminous secretion. Dr Gairdner concluded a narrative of some of his experiments with gallic acid in disease by a statement by no means favourable to its claims, either as a local or as a general astringent remedy. He had employed it in enormous doses with very little effect.
Dr Matthews Duncan had frequently employed gallic acid in pretty large doses in cases of profuse hæmorrhagia, or of hæmorrhage connected with the presence of fibrous tumours in the uterus ; and had always been disappointed in its reinedial effects. What he generally employed in preference, and with the best results, were the mineral acids, more particularly the sulphuric.
Dr Alexander Wood had long been convinced of the utter powerlessness of gallic acid in the treatment of hæmoptysis, and cited several cases in which he had ascertained its inefficiency. He considered that cases of copious and sudden hæmorrhage were not the ones which should be chosen for the purpose of testing the power of any astringent. There were too many elements of uncertainty to all of a satisfactory decision ; and in fact we possessed no such astringent that ensured arrest of hæmorrhage under such circumstances. Where, however, we had the loss of blood in small quantities, and continuing for a length of time, we might with some confidence put an astringent to the test, and institute a comparison with its rival congeners.
Dr Andrew Wood mentioned that many years ago he had prescribed gallic acid in very large doses, and that to him such a mode of adıinistration was no novelty. In hæmoptysis, he generally employed in preference small doses of ipecacuan. The modus operandi of this drug in such cases was not precisely known; but the remarkable effect produced by ipecacuan on the capillaries certainly pointed to an explanation. In the course of his experience, no harm resulted from the vomiting which occasionally followed. As regarded albuminuria, the records of his practice coinpletely confirmed the statements of Dr W. Gairdner. In purpura, however, gallic acid was certainly attended with beneficial effects; and, in cases where turpentine and other remedies had been given in vain, he was satisfied that the acid had powerfully contributed to the cure. NEW SERIES.-NO. IV. APRIL 1855.
Dr Simpson said, that the case which had first impressed his mind with the efficacy of gallic acid in the treatment of albuminuria was that of a brother practitioner who laboured under the disease, and was compelled to relinquist practice in consequence. Gallic acid was at length tried, and with the best results. He resumed practice some eight or ten years ago, and to this day remained comparatively well, and had no symptoms of albuminuria. The cure in this instance was very probably, however, a mere coincidence, as he (DSimpson) had never perceived the slightest benefit from the use of the remedy in any of his other cases. Besides, there were many sources of fallacy ; as, in acute cases of albuminuria, the patient generally got speedily well; and, in the more chronic forms of the disease, it was long before the health was seri. ously interfered with. One patient he knew who suffered from Bright's disease so long ago as 1826 ; and Dr Bright himself had predicted a speedy and s fatal issue. The gentleman was still alive, and one of the strongest individuals in his native town, though the albuminuria remained as before. Dr Gairdner had exhibited the acid with alkalies—a combination which, according to the observations of Liebig on the effect of gallic acid on the blood, must destroy its efficacy as an astringent. With regard to its administration in cases of hæmorrhage, he had formerly brought the subject under the notice of the Society, and stated, as the result of his experience, that it was only occasionally successful. Some ten or twelve years ago, he had occasion to treat a case of severe menorrhagia where all kinds of medicines had been used, but witboot effect. From the recommendation given by Sir Benjamin Brodie in bis chapter on Hämaturia, he prescribed Ruspini's styptic, and relief speedily followed. The disease recurred, however ; and the patent medicine was found to be too expensive. Acting on the hint of Dr Anthony Todd Thomson, he (Dr Simpson) gave gallic acid, and similar benefit was obtained. Dr Gairdner said that tannin had greater effect as an astringent in the treatment of hæinoptysis ; but this it was difficult to reconcile with the observation of Wöhler, that tanpin was converted into gallic acid in its passage through the circulation. Dr Andrer Wood had stated his experience of the efficacy of the acid in purpura; while it was well known that Garrod had as strongly recommended alkalies in that disease. Such statements he (Dr Simpson) thought could be reconciled by supposing that there might be several forms of purpura, each with their stronger affinity to particular remedies ; and he (Dr Simpson) believed that the uncertainty in the treatment of menorrhagia admitted of a similar explanation.
Dr W. T. Gairdner, in reply, stated that he had only on one or two occasions employed the mixture of the acid with alkalies. In comparing the effects of gallic acid with those of tannin, he of course referred to their local; action only; and, for the very reason that gallic acid had little local effect on the tissues, he did not regard it as a true astringent. The question which he had brought under the notice of the Society was, he held, of importance, as it was of great consequence to settle the claims of a remedy which was so much employed, and which, if it should prove worthless, was certainly attended with this evil consequence, that it supplanted remedies of possibly greater efficacy. Again, in the case of the poor, it was no small matter to be able to discard a medicine which was expensive, if it was at the same time inefficacious.
MEDICAL EVIDENCE BEFORE THE SEBASTOPOL COMMITTEE. The Earl of Cardigan was examined, and deposed to his landing at Scutari on May 23, and then proceeding to Devna. Whilst there, his men were very healthy till the cholera broke out ; he only lost ten by it. A beautiful clear
river ran close by. The rations were good. He subsequently embarked with his men for the Crimea; the weather was very bad A sad want of forage was experienced after the battle of Balaklava ; about 360 horses of his brigade were killed in the charge at Balaklava ; and, as a proof of bad arrangement, 400 more had to be shot, as they had no food! In November, the sickness of his division increased to a fearful extent; the sick soldiers had no fuel, and they had to lie on their second horse-blankets and cloaks. Two or three medical officers resigned. It was not at first believed, from Lord Aberdeen's peace policy, that the army were to remain in the Crimea for the winter. Nothing could be worse than the state of the harbour at Balaklava, in a sanitary point of view. The original number of his inen was 1250, but there were not more than 300 remaining when he left the Crimea.
Mr Macdonald, who had distributed the Times fund, was next examined, chiefly as to the state of the two hospitals at Scutari—the General Hospital and the Barrack Hospital. A Turkish ship and an English transport were also engaged as convalescent hospitals. They were all under the care of Dr Menzies, who had a very inadequate staff until the arrival of nurses and medical inen in November from England. The General Hospital was the best ; it was quieter, and there were bedsteads for about half the patients ; there was little hope, however, of patients recovering in the usual time. The men were very poorly clad; many had nothing but their coats and a single blanket. There were 2800 patients, but this was before the battle of Inkermann; after that engagement, the hospitals were greatly overcrowded. The purveying department was very bad ; indeed, not worthy of the name. The first purveyor was a person upwards of seventy years of age, who was exhausted by a walk from one hospital to another, a distance of a quarter of a mile; he had two assistants and two boys-a most inefficient staff. The things he found deficient in the hospitals were tea, arrowroot, sago, sugar, port wine, and brandy. No proper means of conveyance were provided for the wounded ; requisitions had to be made to the purveyor through the medical officer. The washing was frightfully deficient ; even the hospital floors required it, and he gave 200 scrubbers for the purpose. The laundry had got filled with chopped straw; the washing department, of course, did not belong to the surgeons, but to the purveyors. Opium was very deficient, though Constantinople was the finest opium market in the world, it was the purveyor's duty to supply this also. The French orderly system of men for attending the aimbulances was better than that of England; they were trained to it, and originally chosen for the work; but, in our army, directly the medical orderlies or hospital-sergeant knew their business, they were removed to some other employment, and thus gave the surgeons additional labour.
Mr Stafford visited the Scutari hospital in November, and remained several days; never met any opposition as to admission to see the sick. Wrote to the War Department at home to open the hospital now at Smyrna, which he looked upon as a most healthy place, except in June, July, and August. (This witness gave a fearful account of the water-closets, but no blame was attachable to the surgeons.) He did not know whether Dr Menzies or Dr MÖGregor was head surgeon; the latter always evinced the greatest anxiety to promote the reform of the hospital. The wounded spoke in the highest terms of the medical officers, but there was a unanimous expression of condemnation of their treatment in the transport ships.
Mr Roebuck.- Did you see any of the poor fellows as they were landed ?
Mr Stafford.-I did; and could not find words to describe their ghastly and filthy appearance ; they were covered with lice, as thick as letters on a sheet of paper! The naval hospital was in better order. At Balaklava hospital, after going twice, I was turned out, on the ground that if everybody were admitted, it would put an end to all military arrangements. In this hospital there were fourteen men in one room, and eleven in another, on the bare floor, though there were bedsteads in the passage, but no one to fix them in their