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constantly presented themselves in the greater number of the prisoners, after they had remained a certain length of time in the jail, the occurrence of which from natural causes it was difficult to account for. In such circumstances it was natural for the medical officer to suspect the presence of something unwholesome in the water which the prisoners drank, and that such suspicions did occur to him is shown by the following extract from the journal of Mr Shaw, the surgeon, which is kept regularly at the jail. It is under the date of the 21st of January 1853, exactly six months before the use of the water was discontinued.
“ Examined every prisoner very minutely. The general health of the prisoners is good, but I am sorry to report that I find several prisoners have glandular enlargements in their necks. This swelling is not confined to men who are on low diet. Men in all classes are affected equally, therefore I see no reason to attribute it to the food of the prisoners. I am inclined to think that this affection is from the water, and the gas may also predispose them to it. I recommend all the prisoners to have their neckcloths put on so as to cover the neck and throat properly."
Nothing, however, was done in consequence of this entry. The enlarged necks were washed with solution of iodine, but no examination of the water was proposed with the view of ascertaining how far it was really to blame.
But in July 1853, six months after the above memorandum was inserted in the journal of the medical officer, the pumping machinery went out of order, and the water of the river Wear, filtered and supplied by the Durham Water Company, was temporarily introduced for the use of the jail. The effect of this change soon became apparent upon the health of the prisoners. In a note dated the 25th of September 1854, Mr Shaw informed me that when the use of the river water commenced, the affection in the neck immediately ceased, and now no more cases of this kind are observed in the jail than are usually met with in general practice. So striking, indeed, was the change, that the officers of the prison were not long in asking why the enlarged necks had disappeared; or, as they expressed it, why Mr Shaw did not paint the men's necks as he used to do.
With this apparent proof of the existence of an injurious quality in the well water, a return to the use of it was of course resisted by all those persons having authority in the prison to whom the above facts were known. Accordingly, when it was proposed, some months ago, to repair the pumping apparatus, it was resolved to have the water carefully analysed before any further steps were taken. This analysis was made in my laboratory with the following results.
An imperial gallon evaporated to dryness, left of solid matter, dried at 270° Fahr., ninety-four and a half grains. When dried at only 212° Fahr., the solid matter amounted to upwards of a hundred grains. This solid matter was found to consist of
Grains. Sulphate of Lime (anhydrous),
31:38 Carbonate of Lime, .
15:35 Sulphate of Magnesia, .
4.49 Carbonate of Magnesia,
1:48 Chloride of Magnesium,
14:01 Chloride of Sodium, .
1.28 Water, retained by the salts of magnesia after drying at 270° Fahr., 16:82 Nitric acid, ammonia, and oxide of iron, each a trace. Organic matter and loss, . .
94.50 The results of this analysis show how important it was that this water should have been analysed, and they are very creditable to the sagacity of the medical officer, by whom the water was supposed to be unwholesome. Thus,
First. The quantity of solid matter which the water contains alone shows it, according to our present views, to be entirely unfit for domestic use. Of such matter an imperial gallon left
100 + grains, dried at 212° Fahr.
941 , dried at 270° Fahr.
77 when entirely deprived of water. The reason of the great difference between the first and last of these numbers, amounting to 23 grains a gallon, is found in the large quantities of gypsum and of chloride of magnesium which the solid matter contains. Of these both retain their water at 212° Fahr. Only the gypsum loses its water at 270° Fahr., while the chloride of magnesium requires to be heated to incipient redness before it becomes quite anhydrous.
At present, waters are considered already somewhat impure for domestic use when they contain from 20 to 30 grains of solid matter to the gallon. That of the river Wear, supplied by the Durham Water Company, and those of the best wells in the city, contain about 18 grains to the gallon. It was by passing from the use of a water containing 77 grains to that of one containing only 18 grains, that the good effects observed in the Durham Jail were produced.
Second. The chemical nature of the solid contents of the water had, no doubt, quite as much to do with its observed effects as the quantity it contained to the gallon.
An inspection of the numbers above given shows that sulphate of lime, or gypsum, is the predominating ingredient. Of this substance an imperial gallon contains 31.38 grains in the dry state, which are equal to 38 grains of common crystallized gypsum. The main effect which this substance is known to produce when taken alone into the stomach in considerable quantity, is to induce costiveness. I am not aware that it has ever been accused of producing glandular swellings.
It is doubtful, however, if any sensible constipating effect could Bu s Se
va acaped. as it is in this TE:. *
S a e pesce sats of ragnesia. S IS : De
Te en, an inperial gallon con* =:- 2
s = daan as in the pertectly dry 53. Tescissele nde of magnesium, usually €Izrise a T2 =
the soses, and so far, therefore, ec: Lebene ea o ide sam. T E R:: Ostra circunstance in connection with trec iz: 1210 idee is constituents of the water, is
ses eori.100 w ibe observed swellings in the neck of te pers. siin resca to this point, it is curious that one ofice creare: obe nan bocsi indaences to which the goitres of the Ss5 T255.ar i of our own Derivatire mountain limestone districts Lave en ascribed is the large quantity of magnesia said to be containei in the waters tsere emploved for domestic purposes. Of cryorse this ext.anasign of tre occurrence of the disease has not been universis received, but neither has it been shown that such a chemical quality in the waters used, mar not, under certain circumstances have such an erect. And it is, at least, a remarkable coincidence that, in the jail of Durham, the occurrence of glandular swellings in the neck should appear with the use of a water containing an unusual quantity of magnesia, and should disappear when the use of this water was abandoned. It may be that the result is connected with, or is a consequence of, the united physiological actions of the gypsum and the chloride of magnesium taken together.
I need scarcely add, that my report in regard to this water was, that it was unfit for ordinary domestic purposes, and that in consequence the use of it has not been resumed in the Durham Jail.
ARTICLE II.-On Local Bloodletting in Inflammation of the Unim
pregnated Uterus. By J. MATTHEWS DUNCAN, F.R.C.P.E.,
Lecturer on Midwifery, Edinburgh, etc., etc. It is a very general belief, if not the doctrine of the profession, that inflammation of the unimpregnated uterus is a rare disease, and that its symptoms are of little urgency. “This disease," says Dr Churchill, “ is by no means of frequent occurrence, neither are the symptoms to which it gives rise at all so marked as might be expected.” Another distinguished author, Dr Bennett, observes that, “Inflainmation of the body of the uterus in the acute or subacute state, is not of very frequent occurrence.” These beliefs, erroneous and unfounded as we believe they are, cause obstetric practitioners frequently to fail in diagnosing this affection, and to pursue an injudicious line of treatment of it.
Of lato years so much attention has been directed to the relations, pathological and therapeutical, of inflammation, abrasion and ulcera
tion, of the uterine neck, that its importance has been in many quarters greatly exaggerated. The occurrence of the inflammatory process in the cervix uteri is undoubtedly a common and important condition. Moreover, treatment of it is imperative, and its cure frequently removes obstinate leucorrhea, and the other local and general symptoms attendant upon it. But we are sure that in confirmed cases of uterine suffering, and especially in those where the symptoms persist after continued treatment or removal of cervical disease, there frequently exists along with the morbid condition of the cervix, an inflamed state of the body of the uterus. This is generally characterized by more or less slight enlargement and increased heaviness of the womb, which is also tender to the touch, displaced, and does not perform its functions in a natural manner. In addition, there are present more or less of the lumbar, pelvic, and femoral pains of uterine diseases in general.
The over-estimated importance of the comparatively trivial diseases of the uterine neck is not the only cause of the neglect, of late years, of the chronic inflammatory condition of the body of the organ. One important symptom and element of the affection has been seized and described as if it were its essence and the cause of all the symptoms—we allude to the displacement which, in some direction and form, almost always accompanies chronic metritis.
Inflammation of the unimpregnated uterus may assume an acute form, inducing peritonitis, or abscess, rarely in its own tissue, oftener in the region of the roof of the vagina, or in the broad ligaments. The chronic form is more common, being very frequently the cause of the long continued illness of many females suffering from depraved general health, but more particularly from pelvic, lumbar, and femoral pains, difficulty or pain in walking, in urination, and in defecation, with irregular and often painful performance of the uterine functions, and unhealthy discharges from the organ. Cases of this kind are familiar to most obstetric practitioners, and occasionally baffle their greatest care and skill. Our object in the present article is to inculcate what we believe on theoretical grounds, as well as the results of experience, to be the proper method of use of a valuable remedial agent in cases of chronic metritis.
Unlike acute inflammation of the womb in the puerperal or unimpregnated female, the affection we are speaking of demands bloodletting only with a local aim and object. Various means are in general use in a variety of affections, for withdrawing blood from the uterus and its neighbourhood. The most important of these are cupping the region of the loins, leeching the hypogastrium, or groins, or perineum, or vagina, or the uterus itself. In practice all these different modes of bloodletting are found to be applicable and advantageous in proper cases.
For the purposes of a purely local bloodletting, however, in an inflammatory case, it is not a matter of indifference which of the above-named sites is selected for the operation. In a valuable paper
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n gue se atopa is ina's locai onls so i abe sa
i s ozotei, ard can act on the sisoera c oiberge zeseni. tooderdog. This observation is as assis Toe artistie pe sie riscus, whose affections We are 17 oraz C on te loins can, indeed, have Do local ectura de tierise cintiation, the blood-Tessels of the
9 pars beira disast trom each ver, and having their origin fra Com para o:ce meat stem of the circulation. Leeching on the Ton is scarcera tre direct form of local bloodletting than on tie viss, for the ons direct communication between this part and the uterus is through a series of small anastomoses of the epi. gastric artery, with arterial twigs descending to the inguinal opening with the roand ligament, and deriving their origin from the ovarian artery, which also sends branches into the uterus to anastomose with ramifications of the uterine branch of the internal iliac. The application of leeches to the perineum or vagina may have a much more direct influence on the womb, for there are numerous anastomoses of the uterine with the vaginal arteries, and of these last with the inferior hemorrhoidal and other branches of the pudic. Vore distant bloodletting in various parts of the leg or foot have, in former times, been recommended as having special influence over the womb. The profession in this country, at least, has lost all faith in this treatment, as well as in the corresponding doctrine regarding venesection of special veins of the upper extremity in disorders of the head. But enough remains in the well-known, and, it appears to me, well-founded belief in the value and efficacy of the pediluvium in menstrual affections to prevent us from regarding these therapeutics as absurd; and although not dreamt of in our modern and too self-sufficient medical philosophy, yet laws of sympathy between distant parts may be discovered which will explain and inculcate some such remedial measures which now appear to be unreasonable.
In describing what appears to us the proper, although not a novel method of using this valuable remedy, we shall take opportunity to compare it with plans at present in use. This will not only give point to our argument, but perhaps be serviceable in finally disposing of those modes of local bloodletting now too frequently employed, and which are certainly sometimes very injurious both in their local and general effects.
1. The Site Selected.—When a local bloodletting is desired, it is of course most effectually performed when that fluid is withdrawn from the affected part. Failing that, the parts nearest and most intimately connected by vascular ramifications with the inflamed part are the best suited for the purpose. It may be affirmed, that