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condition of brain unfavourable to be acted upon by pected to be the catamenial secretion, or the commence. the narcotizing process. The patient was of an irritable ment of the process of menstruation. There was no habit, and exhibited great impatience under the opera. appearance of any discharge in the vagina, and in order tion. The tumour being deeply imbedded in the angle to satisfy ourselves on the point as to whether she had of the eye, and closely adherent to the conjunctival been regular since the birth of the last child, we made membrano, required some caution in its removal. inquiry, and learnt from a female friend who lived in

There were present at several of these operations, the house with her, that she had menstruated once Dr. Wake, of Southwold; Jr. Garness, of Bungay; Mr. since her confinement, and she thought that she was Hanner, of Wrenthaw; Mr. Jeffrey, of Lowestoft; also expecting it again in a day or two. There is then indis. Messrs. Breame, and Prentice, assistant surgeons to the putable evidence, and the strongest corroborative proof Institution, whose experience and tact in the manage of the fact, that the source of the menstrual discharge, ment of the æther apparatus rendered their services once so much disputed, is the inner membrane lining particularly valuable to me.

the uterus, and I think the strongest case recorded. W. C. WORTHINGTON. As it is well known, and many remarkable cases are Ĩ

recorded, that hanging has a very curious effect on the organs of generation of the male,-Query, Did the apparently enlarged uterus, and the vascularity of the

external part of this organ, arise from the process going SOURCE OF THE CATAMENIAL DISCHARGE.

on within, or from the mode of death? Perhaps some TO THE EDITOR OF THE PROVINCIAL MEDICAL AND of your learned readers may be able to inform me. SURGICAL JOURNAL.

I am, Sir, SIR,

Your obedient servant, The physiology or the source of the catamenial

GEORGE KING. discharge, so peculiar to the human female, and the

Bath, April 13, 1817. functions of the interior of the uterus positively ascertained, are subjects comparatively of very recent discovery, and as the opportnities are so rare of our

Hospital Reports. having proof or of our obtaining any decisive means of determining the matter or establishing the fact, that

HÔPITAL DE LA PITIÉ, PARIS. the uterus is the source of this healthy and proper sexual secretion, I think the following evidence may be interesting to the readers of the Provincial Medical A CASE OF SCURVY, WITH PURPURA and Surgical Journal. Should you be of that opinion

HÆMORRHAGICA. perlaps you will find room for it in an early number : Communicated by Septimus Lowe, Esq., M.R.C S.E.,

On Saturday, the 27th ult, I was applied to by a medical friend to assist him at a post-mortem examina.

History of the cuse : present attack ; symptoms on tion, under an order from the city coroner, of a woman

admission ; continuation of the case; treatment.who had hung herself, the jury not being able to agree

Remarks ; actual condition of the system.-- Names in their verdict. It is not often that a inedical man is

applied by Professor Piorry, to express each organic called on to make a post-mortem examination for the

change ; alterations of the blood.- Andral's views.purpose of assisting the jury in coming to a correct

Difference between scurry and chlorosis ; causes of verdict after death fronı hanging, the cause of death

the symptoms ; differing from a case of true sea-scurry. being so palpably visible; and how that twelve wiseacres

Probablc causes; indications for trealment ; prognosis. could suppose that we should, by an examination after L. B., a man aged 62, was admitted into the death, be able to discover the motive that could have Hôpital de la Pitié under Professor Piorry, March 31st, induced this poor creature to commit such a rash act 1817. He is of the ordinary stature; of strong conforma. I cannot conceive. But their ignorance was bliss to tion; pale, dusky, sallow complexion; and GervoUs, as it gave us an opportunity of naking a very bilious temperament. He is a slocking.frawe worker. interesting examination,

Until within the last six years he was in very cumThe external appearance, and the gorged state of fortable circumstances, had sufficient employment, the blood-vessels of the brain, clearly proved that lived well, was well clothed, and always very regular death had been caused by strangulation, and it in his habits. During the last six years he has only also proved Dr. G. Burrows' theory on this subject been able to obtain a day's employment occasionally; to be correct. In removing the abdominal viscera he has consequently lived upon worse food, and been we were struck with the size and vascular appear.' worse clad than formerly ; he has also suffered conance of the uterus. As we understood she had been siderable anxiety of mind. He is a native of Paris. confined three nionths before, and the child soon For the last three months he has led a very irregular after died, we thought the uterus might be impregnated, life; he has not been able to obtain a single day's but on laying it open it presented to our view a most employment; he has wandered about from place to beautiful velvet-like appearance; the whole internal sur place, generally sleeping in a close, damp, dirty a partface was covered with a dark, sanguineous mucus, which meni, together with several other persons; and has seemed to be exudating from it and could be easily lived entirely upon browo bread (and that in insuffiscraped off. This unusual appearance we at once sus. I eient quantity,) and water. He was formerly very robust,

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and enjoyed excellent health, but for the last few years than natural. The spleen is normal. The urine is be has become much thinner and weaker. About thirty passed freoly; is of the usual quantity, pale in colour, years since he passed several tape worms, and was in free from albumen, of alkaline re-action, and contains a the hospital for about three weeks in consequence. flocculent cloud. The kidneys percussed from behind, Since then he has occasionally passed one; and the are found to be of their usual size. Ordered a simple last he remembers to have seen was about two years enema. To have full diet, consisting of fresh meat ago. They did not occasion him much incouvenience, and fresh vegetables ; to take three tablespoonfuls, and be only felt a slight degree of uneasiness in the of lemon juice three times a day; the legs and sides abdomen. During the excessive heat of last summer to be rubbed with sweet almond oil. bis feet became considerably swollen and ædematous, so April 2nd. The patient complains that he cannot that he could scarcely walk. After resting a few days sleep well at night; there is tenderness on pressure the swelling disappeared, and he continued well, until on the calf of the left leg; the roughness of the skin within the last three months. Since last January be on the legs is somewhat diminished; the bowels are has been gradually getting thinner and weaker. He regulur; pulse still weak, but less frequent. Ordered bas bad occasional diarrhea, lasting three or four days, to have a warm bath; the legs and feet to be elevated. and alternating with constipation of the same duration.

5th. The left leg is less swollen, and not so tender About six weeks ago he perceived his fcet become

on pressure; the urine is rather higher coloured and again swollen, and soon afterwards a discolouration of

still alkaline; the tongue is rather cleaner. Ordered the skin on the inner side of the left ankle and leg, as

in have a bandage applied from the left foot to the high as the knee; the skin in the hans became hard,

| hip; continue the lemon juice, &c. and the calf of the left leg painful on pressure; he had

7th. The yellowness of the scleroticæ has disappeared; & disagreeable taste in the mouth, the gums became

| the gums are still spongy, but more healthy in appearswollen and puffy, with occasional oozing of blood from

ance; the patient can see rather better in the evening, their surface. About a fortnight since he had frequent

but he cannot clearly distinguish objectz; the pulse attacks of dizziness; he found he was not able to see

is rather firmer; the urine is neutral; the bowels are at all in the erening, and was so feeble that he could

regular. Continue. Dot walk. From this time he has been confined to bed,

101h. The tongue is cleaner, and not so cedematous; and bas beeu gradually getting worse and worse. He

there is still a disagreeable taste in the mouth; the was not put under any treatment previous to his

breath is less offensive; the swelling and odema. of admission.

the legs are somewhat diminished. Continue. At present the surface is colder than natural; the 15th. The discolouration and roughness of the skin skin is dry, and in several parts rough and scaly, I on the sides of the trunk bare quite disappeared; the especially on the inper parts of tbe legs and thighs, the

tenderness along the course of the saphena vein is sides of the trunk, and the back. In the hams the

much less marked; the aspect of the face is greatly skip is excessively hard and thickened. The feet are

improred; the urine is slightly acid. Ordered to conswollen and ædematous, as well as the left leg and thigh.

tinue the lemon juice, and to take a drachm of subThere are large patches of ecchymosis around the ankles,

carbonate of iron three times a day. opon the legs, (especially the left one,) and on the sides

From this time he continued to improve daily, both of the trunk, from the axilla to the cristi ilii ; there are

; there are in strength and appearance. On the 21st the report also petecbiæ on the thighs and upper extremities.

is,-the face and general appearance are greatly Op the left leg the skin is in parts of a deep yellow

improved; the gums are quite natural; the tongue colour, Along the course of the internal saphena vein

is clean, but still rather pale; the heart, which measured of the left leg there is considerable tenderness on fire inches from base to apex, and three inches and pressure, and the discolouration is here more marked.

a half from above downwards, now measures three The face is of a pale, dirty, yellowish colour; the lips Linches in the latter direction, and four and a quarter are pale; the scleroticæ are yellow. The respiration

in the former; the swelling of the feet and legs has is natural; the lungs are healthy in front, but behind

entirely diappeared; the only discolouration of the skin there is slight emphysema on both sides; there is slight

now observed, is a slight yellowuess on the left leg; cougb; the sputa are scanty and frothy. The heart is

the bowels are regular; the urine natural. The patient somewhat enlarged; the bruits are normal; there is no

is convalescent. bruit de diable in the neck; the pulse is small, weak,

21th, The improvement still more marked; the frequent, and regular, 96 in tbe minute. The gums are

patient may leave the hospital in the course of a day swollen, with a dirty purple appearance; there is no

or two. onzing from their surface. The tongue is moist, furred, and very pale, and is marked along its borders hy the Professor Piorry, in his clinical remarks, observed pressure of the teeth; there is a disagreeable taste in that this was a case still called by most authors scurry, the mouth, and the breath is exceedingly offensive ; l with purpura hæmorrhagica; these terms, like a great the appetite is tolerably good; there is no thirst, no many others employed in medicine, were as unmeaning Dausea or vomiting, but slight uneasiness in the as absurd,- terms which presented to vs none of the epigastric region after taking food. There is solid seizeable circumstances of the disease, nor indicated in waller in the large intestines; the bowels are regular; the least degree the actual condition of the organs; the stools are solid and sætid. The liver is smaller but, if we studied the case carefully, symptomatically,

and scientifically, we should readily arrive at a just | and he affirms, that in a case of purpura, which appreciation of the exact nature of the disease, be resembled in its symptoms the most aggrarated case of enabled to apply a sound and rational treatment, and typhus, he found the blood continued in a state of be led to adopt expressions in accordance with the fluidity. character and situation of each lesion. What did we Again, it may be asked, is there not some other find to be the condition of the system in the case before alteration of the blood, which may produce this us? In the first place there was evidently bypo. diminution in its normal quantity of fibrin ? Before plastæmia or diminution of fibrin in the blood ; 2nd, the fibrin diminishes, may there not be some other hydrhæmia or a watery condition of the blood; 3rd, change of composition, of which the diminution of the byphæmia or diminution of the blood-globules, com- fibrin is only a consequence ? Majendie injected submonly called anæmia; 4th, cardiasia or dilatation of carbonate of soda into the veins of a living animal, and the heart; 5ıb, phlebemphraxia or obstruction in the after death he found a “dissolation" of the blood. In venous circulation; 6th, dermorrhagia or effusion of individuals who have died from putrid fever or scurry, blood under the skin; 7th, hydrethmia or effusion of where the blood is less coagulable than usual, some serum into the cellular tissue, &c. By applying these authors affirm that they have found a larger than terms we expressed clearly and succinctly the whole normal amount of alkaline substances. Professor chain of alterations in as few words as possible, and Andral in his researches has observed amongst other were enabled to seize at once each particular fact of facts that the blood which contained the most free interest in the case.

alkali was that taken from the scorbutic patient Besides these observations of Professor Piorry's, mentioned abore, and this observation is in accordance this case presents some points of considerable interest, with what M. Frèmy announced some years ago. and several of the important changes observed in it But these are not the only alterations of the blood obappear to be worthy of a more detailed account. served in the case before us. It is evident from the symp.

Dr. Elliotson, in speaking of scurry, says " that it toms that there is also a state of anæmia or diminution seems to be the universal opinion that it owes its origin in the quantity of the globules, and with this condition it to a morbid change in the Auids, and especially in the is also probable that the globules themselves are altered blood. Notwithstanding this general belief, there has in structure and conformation. Professor Andral been no attempt, up to the present time, at any chemical observes on this head, “It would be very interesting examination of scorbutic blood." But the late re. to know if the globules, ot the same time that they searches of Professor Andral appear to have thrown diminish in number in anæmia, do not also alter in considerable light upon this subject. He observes in his their structure, and if there is not a tendency to undergo, Hæmatologie Pathologique,” that this disease (scurvy,) complete destruction. It appeared to him in two cases resembles chlorosis in certain respects, and both have of chlorosis, that the globules had become much smaller many symptoms in common. In both we have the than we generally observe them to be, at the same time same feebleness, the same vertigo, the same aberrations a certain number had not their usual form, they were of sensibility, the same dyspepsia, &c.; but what as if broken up and dispersed, and resembled fragimmediately distinguishes scurvy from chlorosis is, the ments in the field of the microscope." facility with which hæmorrhages occur in the former, to Again, it is very probable that we have also in this such a degree indeed that it is one of its most charac. case, a diminution of albumen, with increase in the teristic symptoms. Why is there ihis constant tendency relative amount of watery constituents of the blood, to hæmorrhage in scurvy?-and why is it so compara of which the effusion into the cellular tissue is a clear tively rare in chlorosis? Because in the former there evidence; for Andral says that patients perer become is a modification of the blood totally different to what dropsical from loss of fibrin, but from loss of albumen; we observe in the latter. In scurvy the globules are and he asks whether it is a case of simple exosmosis, not generally diminished to such an extent as in chlo. favoured by the diminished density of the blood, or is rosis, but the fibrine is considerably below its normal is rather the serum of the blood which escapes more amount, and this has been found to be the case also easily into the cellular tissue, from being less charged in typhus fever of the adynamic or putrid kind, which, with albumen, and consequently being less unctuous from a consideration of the alterations of the blood, as in its character, glides less readily along the ioner well as the general nature of the symptoms, was called surface of the vessels ? by Bordeu acute scurry.

The difference we observe between a case of this Again, Professor Ardral says he bad long considered / kind and one of true sea-scurry, would appear to be, the fibrin of the blood to be deficient in quantits in that while in the latter we have merely (at least in scurvy, and be was enabled to verify this supposition the less advanced cases,) an increased amount of free in the month of April, 1811. A patient was admitted alkali in the blood, with a diminution in its fibrin, into the Hôpital de la Charité, with all the worst in the former we have, in addition to this, a diminution srmptoms of the disease. He was bled, and the blood both of the globules and the albumen. found to contain-119, globules; 86, solid matters of the These alterations of the blood may be well considered serum; and only 1.6, of fibrin. Professor Addral | to have induced the symptoms, and are amply sufficient further adds, that he has no doubt it will be found a.so to accuu:t for the whole chain of morbid conditions that the tibrine of the blood is below its normal amount observed in this case. Thus, the lack of fibrio, and in all well.pronounced cases of purpura hæmorrhagica; I the alteration in the structure of the globules, will

MEDICAL REGISTRATION BILL.

267

account for the effusion of the colouring matter under removed. In persons of still more advanced age, who the skin, causing the “ purpura," which is here merely become spontaneously anæmic, the production of the a symptom, and not as Dr. Elliotson believes, a globules is still wore difficult to obtain. As to scurvy. distinct disease; the deficiency of albumen, causing

if it arises from evident external causes, it generally edema of the legs, feet, &c., whilst the extremely

yields readily, when these influences no longer exist; impoverished condition of the blood in general would but if it comes on spontaneously, it will generally no doubt speedily induce dilatation of the heart, resist every possible means we may employ. Again, atrophy of the liver, vertigo, thickening of the skin,

the same author adds, “I have seen scurry cured, but I derangement in the digestive organs, sponginess of

have also seen a great number of cases in which, the gums, obstruction to the circulation in the super.

although the symptoms appeared to improve very ficial reins of the leg, &c. &c.

greatly at intervals, they never entirely disappeared, In considering the causes which may have produced

and after gradually increasing, finally terminated this condition of the blood; we may ask if it is not

fatally.” In the case before us, although the patient probable that the deleterious nature of the food which

appears to be perfectly cured, yet Professor Piorry the patient has taken may have contributed towards

affirms, that if on his dismission he is not very circuminducing it! The browu bread on the Continent often

spect,-if he is not allowed sufficient wholesome food, contains a large proportion of rye, and consequently

and employment in the open air, &c., it is very evident, also the ergot. Dr. Wright observes, that “the long

on considering the age of the patient, and the length continued use of the ergot often produces a cachectic

of time the disease has continued, that he will be liable state of the body, indicated by extreme muscular

to a speedy relapse. wasting and weakness, loss of appetite, frequent pulse, Paris, April 26, 1847. fætor of the secretions and excretions, congestion of the alimentary mucous membrane, excessire contraction of the spleen, &c." But although this may have con.

PROVINCIAL tributed in some degree towards the production of M edical & Surgical Journal. these alterations, it is evident thas the want of fresh

WEDNESDAY, MAY 19, 1847. animal and fresh vegetable substances, the long con. tinued use of the same kind of food, and that in insuffi.

It is with much satisfaction that we learn that cient quantity, together with the irregular manner of

Her Majesty's Government have consented to liring, was amply sufficient, in this case, to determine the accidents observed ; and doubtless the frequent

the appointment of a Select Committee of the occurrence of diarrhæa, by removing the healthy con.

House of Commons to investigate the subject of stituents of the blood, would greatly accelerate the

“ Medical Registration and the state of the results.

Law relating to the Practice of Medicine and Treatment.--Here the indications are very evident.

| Surgery” in this country. The second reading In the first place, improve the condition of the blood;

of Mr. Wakley's Bill, originally fixed for Wed. secondly, encourage the free circulation in the skin, and nesday, May 5th, and then for the following farour its return from the inferior extremities. The Monday, is again postponed to Monday, 31st, first indication is fulfilled by attention to diet, which on which occasion will be brought forward a must consist of fresh meat and fresh vegetables, in motion for referring the Bill to a select Comorder to increase the quantity of fibrin in the blood; mittee. lemon juice to destroy the too large amouut of free Whatever views may be taken of the several alkali in the blood; and afterwards gire iron to provisions of the Medical Registration Bill, and improve the condition of the globules, and render the of the manner in which it is proposed therein to blocd more invigorating.

carry out its objects, there can be no question To fulfil the second indication, we employ warm

that the two leading principles of the Bill,-1st baths, to soften the integuments and determine the

the distinguishing of qualified from unqualified blood to the surface, friction with almond oil, &c.; and

practitioners; and 2ndly, the giving to the for the obstruction in the venous circulation, elevation of the legs, and bandaging from the foot to the hip.

qualified practitioner a general legal recogni

tion, and sanction to practise, are equitable and Prognosis --Dr. Elliotson obserres that this disease

sound, calculated to be of genuine service to is of a chemical nature, if any one be so. In one sense

the public, and deserving of the warm support the constitution is not at all in fault; all the duids and all the solids appear to be changed; but we have only

of the profession. The inquiry into these ques. to give a different chemical state to the body, and the

tions cannot but be fraught with beneficial disease is cured. This may be true in a great number

consequences, and we trust that no attempt of cases, but Professor Andral says that vobing is

which may be made in any quarter to shelve more difficult than the definite cure of those diseases

or otherwise defeat the motion, will be perin which the blood is robbed in a slow and spontaneous / mitted to be successful. manner, either of its globules, or its fibrin. We Any equality of privilege actually possessed know how easy are relapses in young chlorotic females, by, or proposed to be bestowed on, the entire and how often the symptoms are long in being entirely profession, or any section of it, or corporate or

a wom

een delivered abou

other body belonging to it, on the ground of marking the gradual development of a compressing equality of qualification must, under existing cause, wnich in such a case could be no other than circumstances, be futile in the extreme. To look hæınorrhage. The situation of the injury, and the to England alone, what can be more heteroge- absence of tenderness over the course of the middle neous as respects qualification, than the elements

meningeal artery, Mr. Gore considered sufficient to of which either of the Royal Colleges of Phy

contraindicate operatire interference. sicians and Surgeons are composed ; or to take Case II. - Frequent comiting, with pain referred to the non-corporate bodies, than those of the Pro region of the stomach, occurring at from two to three vincial Medical and Surgical Association, or hours after taking food. Dissection :- Evidences of of the National Institute of Medicine, Surgery,

inflammation of the duodenum near the pylorus, and and Midwifery. Equality of qualification, were

partial atrophy of both kidneys. it attainable, could not be preserved for a single

Mr. Hunt exhibited part of the duodenum, including week: but a given sufficient amount of qualifi. the pylorus, the kidneys, and part of the uterus, of

who had b cation is attainable, and ought to found the ground-work of all future admissions within the

death. She first came under Mr. Hunt's care in

February, 1846, at which time her symptoms were, pale of the profession, while for the past, the

serere and constant vomiting, with pain referred to the possessers of genuine qualification, duly certified

region of the stomach, for the most part occurring at to by any British University, or corporate

from two to three hours after taking food, with con. body empowered to grant licenses to practise,

siderable emaciation. These symptoms continued more are entitled to be legally recognized as such,

or less up to the period of death, which took place in and registered as members of the profession, 1 September. On dissection, the mucous membrane of and of the several sections of it to which they the duodenum near the pylorus was found much may belong,-it being always to be borne in thickened, and admitted of being easily torn off. One mind, that between the very lowest in point of of the kidneys was greatly atrophied, and the other attainments of any individual so qualified, and slightly so, apparently baring undergone granular the highest in point of pretension of any of the degeneration in different degrees. The urine bad not unqualified mountebanks who live by the gulli. been examined. The uterus was merely exhibited in bility of the public, there is a vast and order to illustrate the condition of that viscus at the immeasurable distance, which ought to be dis

| above mentioned period after delivery. tinctly marked.

Case III.- Frequent vomiting, with gradual emaciation;

no pain, but some difficulty of swallowing. Dissection:Proceedings of Societies.

Soft cancer involving the cardiac orifice of the stomach.

Mr. Norman exhibited the csophagus and stomach BATH PATHOLOGICAL SOCIETY.

of a man who had been for some months under his care, First Meeting, October 5th, 1846, Mr. NORMAN at first with symptoms somewhat equivocal in their in the Chair.

nature, but for some time before death the existence CALE I. -- Injury of the head from a fall; insensibility of cancerous disease of the cardiac orifice of the

coming on gradually, and death following in forty-eight stomach was diagnosed. When the patient first came hours after the accident; the right pupil dilated under Mr. Norman's care, he was suffering from and immoveable. Dissection :- A large clot beneuth constant vomiting on taking food, attended with the dura mater; a small coagulum on the right optic gradual emaciation. No tumour could be felt, and he nerre after it leaves the commissure.

suffered no pain. There was some difficulty in swalMr. Gore exhibited the brain of a woman who died lowing. A full-sized esophagus bougie was passed, in consequence of a fall on her head; the part of the which met with some obstruction at the junction of the bead which received the injury was the right parietal pharynx with the esophagus ; this, with the other protuberance. She remained conscious, and with the symptoms, rendered the idea of stricture probable, power of motion for some hours after the accident; which was further confirmed by finding that the insensibility gradually supervened, and she continued passage of the instrument was attended with marked comatose until death, which took place forty-eight hours relief to the vomiting, and also to the difficulty of after the receipt of the injury. The right pupil was swallowing. Matters went on thns until within a dilated and immoreable. On dissection after death a month of the patient's death, when it was found thal the large coagulum, two or three ounces, was found bougie would no longer pass into the stomach, in conbeneath the dura mater, in the right parietal region ; sequence of obstruction at the cardiac orifice. On the precise source of the blood did not appear. On dissection after death, the lower end of the esophagus the right optic nerve, after it leaves the commissure, and the cardiac end of the stomach were found involved there was found a small coagulum. Mr. Gore remarked in an extensive cancerous deposit, of the soft or on the importance of one of the symptoms of this encephaloid kind. The disease bad not attacked any case, as guiding to a just diagnosis-namely, the con other organ of the body. The cause of the obstruction sciousness of the patient continuing for some time to the passage of the bougie at the junction of the after the accident, total insensibility then following, pharynx and esophagus, was found to be an ossified

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