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METEOROLOGICAL JOURNAL FOR APRILL PROVINCIAL MEDICAL AND SURGICAL 1847.
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The Secretary of the Suffolk Branch, would feel obliged by those members in his district, who have not paid their Subscriptions for the current year, to do
so either by post office order, made payable to Charles BOOKS RECEIVED.
Robert Bree, Stowmarket, or to pay the same to his A System of Surgery. By J. M. Chelius, &c. account, with Messrs. Dukes and Co., Stowmarket, Translated from the German, and accompanied with intimating to him when such payment is made. Additional Notes and Illustrations. By John F. Should any Member in the Suffolk Branch pot bare South, late Professor of Surgery to the Royal College received the last rolume of “ Transactions," Mr. Bree of Surgeons of England, and one of the Surgeon's would thank him to write to him upon the subject. to St. Thomas's Hospital. Part XVI. London: Slowmarket, June 22, 1847. Renshaw. 1847.
Cold and Consumption; or Consumption, its Prevention, and Cure, by Cold, as a Constitutional, and
TO CORRESPONDENTS. Inbalation, as a Local Agent, &c. &c. By Henry C. | Communications have been received from Dr. Campbell; Deshon, Member of the Royal Colleges of Physicians The Birmingham Pathological Society; Mr. W. and Surgeons of London, &c. London: Renshaw. ! Jackson; Dr. E. Ballard; Mr. Worthington; Dr. 1847. 8vo., pp. 153.
Shearman; Dr. E. Copeman; Mr. Crosse ; Mr, W. On Dyspepsia, with Remarks submitted in support
E. Crowfoot. of the Opinion that the Proximate Cause of this, and The withdrawal of the Medical Registration Bil of all other Diseases, affecting the General System, renders it unnecessary to insert the petition of the is Vitiation of the Blood. By John Burdett Steward, Council of the National Institute of Medicine, M.D., Fellow of the Royal College of Physicians. Surgery, and Midwifery. London: Churchill. 1847. pp. 106.
Mr. Lord's letter, and Dr, Shearman's reply to Mr. Observations on Aneurism, and its Treatment by Allison, are unavoidably postponed till the best Compression. By O'Bryan Bellingham, M.D., Edin., number. Fellow of, and Professor in, the School of the Royal It is requested that all letters and communications College of Surgeons in Ireland, &c. &c. London: be sent to Dr. Streeten, Foregate Street, Woro Churchill. 1847. Pp. 181.
cester. Parcels and books for review, may be Vaccination considered in Relation to the Public addressed to the Editor of the Provincial Medical Healtb, &c. By Jobn Marshall, Surgeon, &c. London: and Surgical Journal, care of Mr. Churchill, Princes Renshaw. 1847. 8vo., Pp. 35.
PROVINCIAL MEDICAL & SURGICAL JOURNAL.
THE RETROSPECTIVE ADDRESS,
1.-DISEASES OF THE NERVOUS SYSTEM. DELIVERED AT THE SIXTH ANNIVERSARY OF THE I am unfortunately enabled to present you only one READING PATHOLOGICAL SOCIETY.
case. The great interes: which attaches to the disBy EDWARD WELLS, M.D., Physician to the Royal orders of the nervous centres and their ramifications, Berksbire Hospital.
makes one regret that our reports are not richer in
details of this class of diseases, and might induce us Gentlemen,-In accordance with the wish expressed
to ask ourselves the following mortifying question:at your last mecting, I have ventured to nodertake
Is it because of the trouble which is necessarily inthe task of drawing up the report of our proceedings
curred in making examination into the state of the during the past year. Unqualified as I feel inyself to brain, spinal cord, &c., that this paucity exists? be for the due performance of this undertaking, I Hydrocephalus acutus. On the 3rd of March, 1847, will not waste your time in making fruitless apologies Dr. Woodhouse related the case of a child, aged for the manner in wbich it has been accomplished. fifteen months, who died from hydrocephalus, which I will only say that my desire has been to act the part came on in the usual insidious manner, and which of a faithful historian of what has been said and done, leeches, blisters, and purgatives, with mercury, both rather than that of a critic of the opinions promulgated.
internally and externally applied, failed to arrest. Even if I had thought of aspiring to the latter office,
On examination, the braia was found to be softened
about the posterior cornua of the lateral ventricles, the abundance of the materials placed at my disposal
which latter contained a considerable quantity of for insertion in this evening's address would have
serum. A brother of this child bad died at the same quite forbidden the idea. The few remarks I have
age about twelve months before. interposed have been made, either with the view of
It may be remarked upon this case, that as no connecting the reported cases, or of drawing attention notice is taken of the state of the membranes, it is to particula: facts which appeared more especially to be presumed that no tubercles were found in the worthy of notice. Before proceeding, however, to the meninges, and tbat therefore, as far as a single case specific matter of this report, I must bear witness to can do, it invalidates the view of M. Rilliet, and other the adinirable manner in which the ninutes of our French pathologists, who look upon hydrocephalus as meetings bave been kept by our excellent Secretary,
neither more nor less than tubercular meningitis. In Dr. Woodbouse. It is but justice to him to set out
opposition also to this view, your reporter may mention,
that in a case of hydrocephalus acutus, which he not by observing, that should this address fail to interest
long since examined, with Mr. Day, and in which the you, or to present a faithful portrait of the principal
lateral ventricles were much distended with serum, features of the transactions of our Society during the
be the membranes were carefully examined without dis. past year, the fault lies in your Reporter, and not in
covering any tubercular infiltration. your Secretary The arrangement which I have adopted in relating
II.-DISEASES OF THE RESPIRATORY ORGANS. the cases, &c., which have been brought before us, I hare but little to offer you on this head. On the 2nd is the same as that generally made use of by my of Sept., 1846, Mr. Harrinson read the case of a man predecessors,—that is to say, they have been arranged
in whom he had found great distension of the bronchial in reference to the various systems of tbe economy to
tubes. He had been treated previously for phthisis.
The lung was in a state of cirrhosis. Mr. Harrinson which they belong, independently of the period at
then gare the diagnosis between this disease and which they were presented to the Society. In only
phthisis, and pointed out why it could not be the latter. one point bare I ventured to depart from the established
Sonorous Inspiration. On the 4th of November, custom, and that is with respect to the papers and
| 1846, Dr. Cowan mentioned the case of a girl, aged communications, (very few, I regret to say, in number,) | 19, who a
| 19, who, after a fright, was seized with a curious kind whicb I have also arranged under the same heads as of sonorous inspiration, the seat of which appeared to tbe morbid specimens.
I be located in the larynx. It occurred regularly all No, 14, July 14, 1847.
day, but ceased at night, which wonld imply that it Rogers, a milkman, of sober habits, who was admitted was not spinal. Blisters to the nape of the neck, into the Hospital on Juno 9, 1846, witb aneurism of purgatives, &c., had produced no beneficial influence the posterior tibial artery. His countenance was It would appear to have been an hysterical constitution anxious; he had not been subject to gout or rheumaof the larynx.
tism, nor affected with sypbilis. Some little time
back, while carrying a load of milk, be felt something III.-Diseases or the CIRCULATING SYSTen.
give a popping sensation in the calf of the right leg, I am glad to say that in this division our materials followed by pain and swelling of the part. are not so meagre as in the two preceding classes of. On admission, the calf of the leg was found to be disease.
hard and swollen ; pulsation was felt over the whole Hypertrophied Heart.- On the 4th of November, swelling, synchronous with the heart. The aneorismai 1846, Mr. Harrinson presented a beart, which he had
bruit was very distinct. By pressure on the femoral removed a week ago from a man to whom he was
artery the pulsation was obliterated, and the sac much called in the night, but the patient had died before
diminished in size. The superficial veins were dis-, he could reach him. He had always enjoyed good health, excepting slight dyspnea on exertion. On
It being determined to treat the case by pressure, examining the chest some time previously, be had
this was applied over the superficial femoral in such found the pulsation of the heart so excessive, that it
á manner as to diminish, without interrupting, the shook the chair whereon the patient sat. There was
current of blood. This was accomplished by means of a soft bruit de soufflet all over the heart, and great
two tourniquets,-piz., Sanctorini's, and a modification regurgitation in the vessels of the neck. He diagnosed
of Dr. Oke's, made by Weiss. The former was found obstruction of the valves, with regurgitation probably
the more useful. Pressure was also inade occasionally
by the thumb on the common femoral artery. By through both the aortic and mitral valves. Os examination after death, the lungs were found
alternately tightening one, and then the other, tourquite healthy. The pericardiuin was perfectly ad
niquet, this treatment was continued without any herent; the heart enormously enlarged; the left
material discomfort until the 28th. At this time there cavities excessively dilated; the right very small; the
appeared a decided improvement in the condition of arch of the aorta dilated. The aortic valves contained
the aneurism. Compression of the artery was now soine gritty deposits, and were patulous, allowing
directed to be made more continuously, and so as regurgitation. His only ailment had been a rheumatic
completely to stop the circulation through the aneurism.
On the 30th pounded ice was also applied to the gouty affection of the knuckles.
tumour. Cyanosis.- On the 5th of August, 1846, Mr. May
On July 2nd, Mr. May states, “At my visit this presented to the Society the heart of an infant who
morning I found that he had passed a restless night, was born cyanotic. A few days after birth floridity
with slight delirium; be was confused, and had some was somewhat increased, but about the seventh week
subsultus. Tongue furred; pulse frequent and sharp. the child sank. On examining the heart, the fora
He became quiet during the day, but towards evening men ovale was open ; and, as was usual in about
the cerebral symptoms were more pronounced; be half of these cases, the pulmonary arterial values
became unconscious, and the respiration muchemwere coarcted or obstructed; the right side was
barrassed." hypertrophied, evidently from an effort of nature to
On the morning of the 3rd, paralysis of the left side overcome the obstruction.
was observed, and he died at one o'clock p.m. This interesting case may be said to confirm the
Post-mortem. The vessels of the pia-mater were opinion of Dr. Craigie, that the anatomical cause of
much engorged; both ventricles distended with dark the open foramen ovale, and the hypertrophy of the auid blood. There was a large coagulum one and right ventricle, is to be found in the contraction of the la ball ounces,) in the posterior lobe of the right pulmonary artery, and that the open foramen ovale is
hemisphere. Lungs healthy; pleura adherent at the to be regarded in the light of a safety valve, to relieve
ive, to relieve apex of left side ; a chain of hardened glands were the impeded pulmonary circulation.
found dipping into the chest under the first lest rib. That the open foramen ovale is not, as was at one. Heart : the edges of the semilunar valves and opposing time supposed, the cause of death, is proved among surfaces of the aorta were irregular, thickened, and other instances by one which has been related by Dr. contained here and there bony deposit; the rest of Spitta, in the “Medico-chirurgical Transactions" for
the aorta vas healthy. The femoral arteries were 1846. He has there given an account of a case of
diseased alike, bony matter being deposited in each from cyanosis of 40 years' standing, in which the pulmonary half an inch below the profunda to their termination. artery was obstructed, the right side of the heart The two ends of the ruptured posterior tibial artery hypertrophied, and the foramen ovale patulous. could be traced into the aneurismal sac, which now
Aneurism. It is hoped that the interest of the appeared of the size of a duck's egg. It was invested by following case, in reference to the treatment of the deep fascia, and the posterior tibial nerve was aneurism by compression, will plead for the length tensely stretched over it. The sac contained two-thirds at which it is reported.
of firm fibrin, and one-third of dark coagulated blood; On the 8th of July, 1846, Mr. May presented the fibrin was deposited at the upper or cardiac side specimens of diseased arteries, taken from George of the sac, and the blood at the lower or distal; the
fibrin was in one solid mass, not laminated. The artery | suficient to remark ia this place, that the invention was much diseased both above and below. The femo received the unanimous approval of the Society. ral artery at the portion submitted to compression. Aneurismal Varix.-On the 30th of September, was flattened, and there was slight echymosis of the 1846, Mr. Harrinson presented a drawing of an aneumuscles of the thigh, as well as about the gastrocne- rismal varix. When the subject of it was three years mius and solæus.
old, another child threw a sharp knife at her, which In reference to this case, Mr. May observed, that he struck the temple. The mother withdrew the knife ; & had no doubt but that the deposition of the fibrin was little blood followed, and soon after a swelling appeared, the result of treatment, as before this was commenced, which is now daily increasing. A bruit of a very the sac could be emptied. The shape of the deposit, intense character is heard on applying the stethoscope the large end above the thin end, together with the to it. Mr. Harrinson diagnosed it to be a case of aneublood below, was a fact of the greatest importance. It rismal varix, and presumed that the knife had transfixed shewed that the blood probably entered from below, the vein, and wounded the temporal artery, and that and it strongly suggested the propriety of making coin-the, two now communicated with each other. It might pression in that situation. This peculiar modification be treated by pressure, ligature, or electro-puncture. in disease of the artery was noticed by Bizot, who Aneurism of the Aorta.-On the 28th of April, 1847, asserts that the posterior tibial artery and the cerebral Mr. Day presented an interesting specimen of aneurism arteries were the most liable to assume it. Bizot also of the aorta, with the following history. He was asserts the symmetrical occurrence of arterial disease to attending Mrs. A., aged 40; she had been a strong be an absolute law. These remarks would seem to active woman till eight months ago, when her health receive striking confirmation from this interesting first began to fail; had been married twenty years, and case.
had one child nineteen years old. She complained Mr. May much regretted the attempt entirely to of pain and difficulty in swallowing, requiring duids to stop the circulation, as he had no doubt but that it accomplish it, with severe pains in both shoulders, and was the more immediate cause of the patient's death. a short hacking cough ; but she had no severe cough The proper object of the treatment was, by diminish | indicative of diseased lung. He considered her coming the impetus, to give time for the separation of plaints nervous, and treated her accordingly. Her fibrin in the sac, and thus to obliterate its cavity. chest was not examined. One day while eating ber Had more time been given in this case, the result dinner, a quantity of blood gushed from her mouth, would probably have been different. Ligature of the and she instantly died. artery at any point below the common femoral would | Post-mortem, a few hours after death. Present : bave failed by hæmorrhage in consequence of its | Mr. Harrinson. Pharynx, bronchi, &c., filled with diseased condition, and had a ligature been placed higher blood; lungs remarkably healthy. On turning out up, the risk of mortification would have been incurred. the left lung and examining the aorta, a dilatation of Mr. May considered that the case told strongly in considerable size-an aneurism-was seen at the comfavour of compression, if conducted in a more slow mencement of the descending aorta, after giving off the and gradual manner, and said that in a similar case, he left subclavian artery. The aneurism was intimately would apply pressure first on the cardiac side of the adherent to the bodies of the third and fourth dorsal tumour, and afterwards on the distal also, the object vertebræ, which were carious and indented. On being to diminish, but not to stop the current carefully laying open the @sophagus posteriorly, through it.
an opening was seen on its anterior aspect, large In confirmation of the practice which this important enough to admit a finger, and irregular in shape, case bas induced Mr. May to recommend, it will be communicating with the aneurismal sac, through its remembered that in the twelve cases of aneurism cured posterior wall. It was the establishment of this comby compression, which were related to the Surgical munication that had given rise to the hæmorrhage, so Society of Ireland, by Dr. Bellingham, and of which sudden and so fatal. Heart small; valves healthy; nine were popliteal and three femoral, the femoral the anurismal sac was lined by some layers of fibrin. artery could be traced nearly as far as the sac of the The rest of the aorta and the large vessels were aneurism, shewing that the artery was not obliterated apparently free from disease. It may be remarked at the point of compression. Dr. Bellingham then that the left vertebral artery arose from the aorta stated that the compression should not be carried so between the carotid and the subclavian. Stomach far as completely to intercept the circulation, as the much distended, reaching nearly to the pubes; it cona consolidation of the aneurism would be more quickly tained three or four pounds of blood ; the intestines effected by allowing a feeble current to pass through were also filled to a greater or less extent with blood. the sac of the aneurism.
Left kidney large; right small; both mottled ; bladder Instrument for the Treatment of Aneurism by remarkably contracted. Uterus larger than normal; Compression.-While on the treatment of aneurism by left ovary as large as an orange, forming a simple sac, compression, I may mention that on the 2nd of containing fluid ; right ovary beginning to degenerate September, 1846, Mr. F. Bulley exhibited to the Society in a similar manner. Liver small, contracted, hard; the model of a very clever instrument, which he hadgall-bladder confined and nearly obliterated by firma recently invented for this purpose. As a drawing of adhesions, which were numerous on the inferior surface this instrument, with a description of its use has been of the liver. It was interesting to note the condition of already published in the Medical Times, it will be the uterine appendages in CORRECTION with ber history. Mr. Harrinsot then referred to the diagnosis of thickened edges, in the lesser curvature of the stomach. aneurisms of the ascending and descending aorta. In He knew nothing of the prerious history of the case, the former, the trachea being involved, aphonia would but understood , she had been an out.patient at the be present; while, in the latter, the resophagus being hospital, complaining of an affection of the stomach pressed on, dysphagia would be the prominent symptom, and heart. as in the case just related.
It is much to be regretted that Mr. Workman was, This case shews the necessity of exercising great owing to circumstances, unable to furnish the Society caution in the use of the probang in instances of with more accurate data of this case. It would have dysphagia. Had that instrument been used in the been interesting to know whether it confirmed the present instance, there is little doubt that a fatal result opinion at which Mr. Crisp has arrived, “that uterine would bave immediately followed its application, and derangement is, in the majority of cases, the predisignorance might have attributed death to the manipo. posing cause of this affection.” Unfortunately, howlation of the surgeon.
ever, the age of the subject is not stated, and we are,
therefore, unable in the preseni instance, to connect the IV.–DISEASES OR THE DIGESTIVE System.
| disease with the period of the catamenia. It will be Acute Glossitis, Pharyngitis, &c.--On the 2nd of observed that the perforation was situated in the lesser September, 1846, your reporter mentioned the case of curvature of the stomach, which is almost always the a young lady, to whom he had been called, who had point of election wbere females fall victims to this during an bysterical fit swallowed an ounce of pure fearful disorder. Since the above was written, I hare spirit of hartsborn. Violent inflammation of the ascertained that her age was about 45. tongue and fauces followed. She was unable to
Perforation of the Ileum.-On the 2nd of September, swallow lemonade, but managed to take some iced
1846, Mr. Walford presented a portion of the ileum of water, by holding the ice in her mouth, which evidently
a man aged 28, who was seized in the night with violent relieved ber distressing symptoms. Leeches were
pain in the bowels. He lived from the 25th to the applied to the external fauces, and aperient enemata
27th, (forty-eight hours.) A perforation of the bossel administered, and after a few days she perfectly
was suspected, and on examination after death, the recovered,.
ileum was found to be ulcerated, an ulcer at one point Convulsions and Death after over-feeding in a Child.
opening into the peritoneal cavity. The coats of the .-It, may be doubted whether the following case
intestine were thickened, and traces of peritoneal should stand where it does, or should have been
inflammation were discovered. Mr. Walford had not arranged among the diseases of the nervous system.
attended the patient previously, but learnt from his On the 3rd of March, 1847, Mr. Harrinson related a
wife that he had never been well since an illness he case wbich bad occurred to bim about a month pre
experienced in February last, the nature of which could viously. It was that of a child, three years of age, who
not be satisfactorily made out. after being feasted on the anniversary of its birth-day,
Mr. May remarked that these cases generally occur. became sick in the evening, with slight paralysis of one side. On the following evening when he saw it,
red in connection with tubercles or typbus fever. This
was the rule; their occurrence, independently of these there had been violent convulsions. Supposing it to be a case of indigestion from over-loaded stomach, he
complications, was the exception. prescribed calomel and jalap, which operated freely. I Congenital Contraction of the Intestines.-On the 3rd The child, however, passed a restless night, and on the of February, 1847, Mr. Harrinson presented the intesfollowing day he found it moribund, with profuse per- tines of a cbild, apparently healthy when born, but spiration of the head and face. No examination of wlio soon began to decline in strength, and to vomit. the body was allowed, and Mr. Harrinson, doubted He examined the anus and rectum, and found it perwhether the symptoms were attributable to the stomach vious for two inches, but above that point he could or head.
pass no instrument. Vomiting of the meconium In reference to this case, Dr. Woodhouse mentioned continued, with inability to retain the milk it sucked, that of a girl, which had been reported to him by a or any other fuid on the stomach, and it gradually sank, medical friend, where after a hearty meal of cold beef with all the appearance of strangulated or obstructed and carrots, coma supervened. Bleeding, cupping, &c., | bowels. were used without benefit. His friend suggested the On examining the abdomen the intestines presented exhibition of an emetic, which instantly restored her the following curious appearance :-The upper por. to consciousness.
tion of the jejuoom was contracted, this contraction Perforation of the Stomach. On the 3rd of March, gradually extended along the ileum and colon, until it 1847, Mr. J. Workman exhibited an ulcerated stomach, ended in the rectum in an almost perfect cul de sac. and gave the following outline of the case. He was Mr. Harrinson regretted that be had not persevered in called in great haste to a female, whom he found lying the use of enemata, as they might possibly bave disbefore the fire complaining of great pain over the epi- tended the rectum. He did not consider the congastric region. He administered some anodynes, but traction as pathological, but as physiological; it appeared on the next day found that po improvement bad taken to be due to a want of secreted matter to pass downplace. She gradually sank in thirty-six hours. Upon wards, and he regretted that he had not examined the examination he found the abdomen filled with effused liver more minutely, to ascertain if there was a proper matters. There was a large ulcerated opening, with 'secretion of bile.