« 이전계속 »
On the Use of Creasote in Scorbutic Camp Dysentery. By John
BRAMSTON WILMOT, M.D. London, 1855. 8vo, pp. 16.
This pamphlet describes an epidemic of intestinal disease which occurred in 1844, under the observation of the author and of Mr Dakins, in the Union workhouse at Pembury. The facts on which it is founded were laid before the Medico-Chirurgical Society of London in 1845, and are now republished, we presume, apropos of the epidemic among our soldiers in the East. There are many minor points which would demand criticism in Dr Wilmot's observations, were we disposed to enter on a detailed discussion of them. Thus, “scorbutic” dysentery is a misnomer, or, at least, implies a totally unsupported hypothesis ; “camp” dysentery is improperly used as a term synonymous with epidemic dysentery. Many points in the descriptions, particularly of the post-mortem appearances, are confused; and we might even raise the question whether a disease in which the lower part of the colon was always unaffected, while the ilium and cæcum were disorganised, was, in the strict pathological sense of the term, dysentery at all. We are almost tempted to think that a typhoid fever of peculiar type may have been under the author's observation, although the symptoms described are unquestionably dysenteric. Be this as it may, we feel bound to say, that the author's statement carries internal evidence of an honesty and candour, which would give to his observations a very high degree of importance, were they somewhat more numerous; and that we have perused them with something more of a disposition to repeat them than their mere number would have led us to anticipate. There is nothing impracticable or absurd in Dr Wilmot's therapeutics; and we think that the injection of creasote in drachm doses, with a pint of gruel or starch, into the bowel in dysenteric affections, is a suggestion worthy of a more extended trial. According to the author, it caused in some cases a good deal of temporary irritation; in others, and these the worst, "a tingling sensation, but no pain.” Probably a much smaller quantity, suspended or dissolved by means of diluted acetic acid, and administered cold in the form of frequent large enemata, would be a preferable plan to that of the author. We think it due to him, however, to give the summary of results according to his own experience.
"I have thus given a true and unadorned account of the cases treated with creasote. The numbers were but few. For the sake of illustration, though not of humanity, I could wish they were more numerous. Every one was successful; no death occurred after the practice was adopted : and let it be remembered that, in order to test its efficacy, I purposely avoided directing it in any but the worst cases, where the ordinary remedies had been continued to the very verge of safety, and had proved ineffectual. I am as satisfied that these cases were saved by the plan, as I am morally convinced that some of those who died before it was adopted, would have been restored.
“ The number in the Union-house who were attacked by this epidemic ra thirty-four :-seventeen males, seventeen females. The deaths were eight:four males, four females. The cases were not all of equal severity. There were besides, four other inmates, who died with dysenteric symptoms; but as they were extremely decrepid and advanced in years, they sunk in the very earliest stage of the complaint, and could scarcely be returned as dying of dysentery."
Biographical Sketch of the late Dr Golding Bird. By Professor
BALFOUR. Edinburgh, 1855. This sketch of Dr Bird's history and character was originally prepared as an address to medical students, and delivered as one of a series of lectures at the instance of the Edinburgh Medical Missionary Society. The professor seems to have been led to the choice of his subject, as an eminently suitable one for the occasion, by the circumstance that Dr Bird's life, “while it encourages the student in his aspiration after professional eminence, and inculcates industry and perseverance as the means of advancement, warns, at the sametime, against overmuch exertion, points out the vanity of earthly distinction and fame, and shows by a living example the value of those heavenly blessings which are alone enduring." Much of the lecture is occupied by quotations from letters written by Dr Bird's friends, illustrative of various points of his remarkable character. Some of these show how singularly versatile, as well as active, were his intellectual powers. It appears, that after his health began to fail, during his occasional residences on the coast for the benefit of change of air and relaxation, he set himself very earnestly to the study of marine zoology, although he had not previously been conversant with the subject. The same diligence and acuteness which enabled him to produce the very valuable works on practical medicine, which laid the foundation of his fame and fortune, were brought into play even in his hours of recreation, and while labouring under fatal disease. And it is deeply interesting to learn, that in the observation of the habits, and the examination by the microscope, of the structure of the lowest forms of animal life, he experienced the greatest refreshment and pleasure.
Brief as this memoir is, Professor Balfour merits the gratitude of the profession for its publication ; and we hope that it may be inade very useful amongst that interesting class for whose benefit chiefly it has been prepared.
MEDICINE. ON THE ORIGIN OF RETRO-UTERINE HEMATOCELE. M. Laugier read a communication on this subject at the meeting of the Academy of Sciences of Feb. 26. After adverting to the imperfect state of our knowledge on this disease, he entered at some length into several interesting questions connected with it, and concluded with the following remarks as the result of his investigations:
1. The spontaneous evolution of the ovule is, as has been alleged, an occasional cause of retro-uterine hematocele.
2. The physiological state of congestion in the ovaries during this spontaneous evolution, and the persistence of the opening in the Graafian vesicle, do not occasion retro-uterine hematocele.
3. To produce this there must exist an increased degree of congestion, sometimes occasioned by accidental causes, during, or a few days after, menstruation. Abortion is not an immediate cause of hematocele, as has been erroneously supposed.
4. It is especially the recurrence of this spontaneous evolution which gradually increases the volume of the hematocele.
5. The ovarian vesicles successively opening into the cyst of the hematocele remain open there, so that the ovary is destroyed by a small number of spontaneous evolutions taking place in the condition which that organ presents at the commencement of hematocele.
6. The rupture of a Graafian vesicle affording a passage for the blood which escapes from the ovary, the cyst of the hematocele will be most frequently intra-peritoneal.
7. Spontaneous evolution of the ovule and hematocele have one character in common, namely, pain situated in one side of the abdomen, and the seat of which is the ovary where the vascular evolution occurs.
8. The rut may occasion ovarian congestion in animals, and may be followed by rupture of that organ, that is to say, by consequences simulating retro-uterine hematocele.-Gazette Médicale, March 10.
RETRO-PERITONEAL CANCER. Dr Stokes laid before the Society the morbid parts, illustrative of retro. peritoneal cancer, taken from the body of a man who died in the Meath Hospital on the previous day, and made the following observations on the case.
The patient, as far as we know, has been subject for about two years and a half to a wasting diarrhea; but we cannot say what was the nature of his first attack. He came into hospital under the care of my colleague, Dr Lees, in the early part of last spring. At that time he was greatly emaciated, and had been nearly a year labouring under the diarrhea. He exhibited all the symptoms of extreme anæmia; he was colourless, and singularly white-to a degree that I do not remember to have seen equalled even in young females. He had also a venous murmur in the neck, and a murmur in the carotids, and these were accompanied with a doubtful venous pulsation. The patient presented also at the heart a loud bellows murmur, which predominated at the apex, NEW SERIES.NO. V, MAY 1855.
and diminished towards the base of the organ. This bears directly on the question of diagnosis between organic and functional disease, and is on that account a point of great interest in the case. The abdomen was slightly enlarged. I did not see the patient at the first period of his admission, but when he came under my notice he had ascites, and I am inclined to think there w3s abdominal effusion throughout. He complained of pain under the false ribs, and on examination a tumour could be detected under the margin of the liver. This tumour was very variable, both with respect to size and to the ease with which it could be felt: these circumstances evidently depending on the condition of the intestines. During the whole of the long period in which he was in hospital there was scarcely any change either in his symptoms or in his appearance. After repeated examinations of this man, I came to the conclasion that he was labouring under a cancerous disease. He had certainly no external appearance of this affection ; but he had that collection of symptoms which lead to the diagnosis of cancer. In the first place, the diarrhea had resisted every attempt which could be made to check it; and, though the stools were diminished for a time, they afterwards returned, and were estáblished with the same persistence as before, which indicated that the cause of it was owing to some organic lesion. We felt satisfied, too, that the tumour in the abdomen was not a tumour of the liver; for, between the tumour and the natural situation of the edge of the liver, there was a deep sulcus to be felt. As the disease proceeded, the finger struck down on a tumour of extreme hardness, and at one time it was considered whether this might possibly be the liver in a state of cirrhosis. We concluded against this, first, because we had ascites preceding the existence of the tumour; and secondly, I was led to the opinion by the recollection that in the great majority of cases we have enlarged spleen; but we found no enlargement of the spleen in this case, and, therefore, we concluded that the ascites was not the result of cirrhosis. Having then a hard tumour with ascites, but no enlargement of the spleen, we came to the conclusion that it was a case of cancer.
I may now mention another circumstance in connection with the circulatory system. The bellows murmur, which was well marked last summer, latterly disappeared, so that the heart's sounds were presented without murmur. The bruit in the carotids had likewise ceased; but I am not prepared to say that the venous murmur had entirely disappeared; with respect to the state of the heart, however, there is not the least doubt. Now, presuming the murmur to have been anæmic, while the original cause of disease went on increasing, the question arises why the murmur should have disappeared when the patient was every day advancing in disease.
On opening the abdomen we found that the peritoneum contained a large quantity of serous fluid. The deposit which you see here appears to be that form of cancer described by Lobstein, under the name of “nodulated," and which is formed in the retro-peritoneal cellular tissue exclusively, and infringing little on other parts. In this case we find it converting the cæcum into a hard irregular mass, but the intestinal canal is perfectly pervious. The term nodulated is very well applied to this form of cancer. The scirrhous masses are of great hardness, and fixed in the omentum, and of various sizes, from that of a grain of duck shot to that of a bean ; you see them in some places forming grape-like clusters, and all in the retro-peritoneal tissue. A very interesting fact, to which I beg to draw attention, is, that while there was this mass of disease in the cæcum, the ileum leading down to it, so far from being dilated, was the most narrow and contracted ileum I had ever seen, and was not, in fact, large enough to admit anything bigger than the little finger of a child. The mucous membrane of the colon presents a singular appearance. It is mottled with dark lines running in a transverse direction, and is marked by numerous white lines ; while at the same time it has a gelatinous appearance, and seems as if portions of it had been the seat of old ulcerations which have cicatrized, without having been afterwards provided with villi. On pursuing
the examination, we found the spleen extremely small, and a mass of cancer just at the insertion of the vessels, pushing the organ before it, but the spleen is itself healthy. The same thing occurred in the liver. The lungs were free from disease, and the kidneys presented a similar condition with that of the other organs of the abdomen.
The last observation which I shall make is in connection with the state of the heart. There is no valvular disease, and I had no reason to doubt at first that the murmur in the heart was anything but anæmic, but so far from predominating at the base, it predominated at the apex. It is asserted that murmurs at the apex occur only in connection with organic disease. I have long believed, however, that this doctrine is not to be trusted, and this case illustrates the correctness of that opinion, for here we had functional murinur occupying the same situation in which it is found in mitral disease. The heart, moreover, is contracted on itself, and very small. I think it probable that this condition of the heart existed for a considerable time before the patient's death, and was the mode which the heart took of adapting itself to the diminished stream of fluid it had to transmit. Can it be that to this concentric hypertrophy, which the heart has undergone, the loss of the murmur is due. If this be so, it is a new fact in the history of anæmic murmurs, and a point of no small interest in cardiac pathology. The heart appears to me to have adapted itself to the diminished quantity of blood it had to discharge ; and the fact itself throws considerable light on Dr Corrigan's theory, which attributes anemic murmurs to flaccidity of the vessels.- Pathological Society of Dublin,
FTID ABSCESS OF THE LUNG FROM PRESENCE OF A FOREIGN BODY. Dr Hughes exhibited the trachea and lungs of a patient who was admitted into Jervis Street hospital five weeks ago, complaining of great debility and constant cough, which was attended with fætid expectoration. He was generally wasted, had almost complete anorexia, a rapid feeble pulse, and night sweats.
Anteriorly the physical examination gave comparative dulness over the left side, with resonance of the voice, and bronchial breathing at the apex of the lung. Posteriorly there was muco-crepitating râle from the angle of the scapula to the base. The right side was normal.
The crepitating râle disappeared in some days. But there was no improvement in his symptoms, and little change in the physical signs, until ten days before his death, when well marked signs of a cavity under the left clavicle were present.
From that period the expectoration became more profuse, and he rapidly sank.
On a post-mortem examination we found adhesion of the pleura around the apex of left lung. This portion was solidified, and contained a cavity in which was found a small fish bone. (Dr Hughes then showed a fish bone about one inch and a half long, sharply pointed at one end, and curved. It was one of the bones of a plaice.) The cavity also contained some purulent matter, and communicated with several others which penetrated through the centre of the lung to its base.
The right lung was healthy : there was no trace of tubercle in either. The mucous membrane lining the trachea and left bronchus appears of a dusky red colour, and is softened. The æsophagus is perfectly healthy, and all the other organs were found in a normal condition, save the liver, which was large. -Pathological Society of Dublin. CASE OF ABSCESS OF THE LIVER OPENING INTO THE GASTRO-DUODENALIS ARTERY,
AND ALSO INTO THE PERITONEAL CAVITY AND DUODENUM. BY DR MʻDOWEL.
It is well known to practical physicians that there are various ways by which nature gets rid of the contents of a hepatic abscess.