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titioner requires, ought to be obtaioable without! "This body is neutral, has a bitter, pungent, saltisb the necessity of passing before so many different taste, and readily soluble in water and alcohol. Heated examining boards, and paying so many different on platinum foil, it melts and burns slowly, evolving an inauguration fees. It is, moreover, but just and / odour of urine and ammonia. Chloride of zinc preciequitable, that the expressed wishes of so large
pitates it from its watery solution. It contains 54.02 a proportion of this branch of the profession as per cent. of nitrogen, and is said to exist in the prothe National Institute embodies should receive
portion of five grains in 1000 of urine, exceeding oneunbiassed consideration, and if found con
third the weight of urea!" sistent with a due regard to their own advan.
The formula of this new body is said by Dr. Birà to tage and to the exigencies of the public service,
differ“ only in the proportions of the elements of water should at once be acceded to. Under any cir
from that of uramil," —a body which it is stated,“ may cumstance no general measure of reform in be regarded as uric acid,
be regarded as uric acid, in which the elements of which the interests of the general practiti. area are replaced by those of ammonia and water." opers can be implicated ought to be allowed to This is, however, rather a loose mode of expressing pass without a distinct recognition of this body the affinities of the two compounds. It might possibly as constituting an independent branch of the be inferred from the passage as it stands, that the profession.
main difference between uramil and the new body, was from the presence of oxygen and hydrogen in the
proportions necessary to form water, whereas a comReview.
parisonof the formulæ for each shows a wide distinction. l'rinary Deposits, their
c. N. H. o. Diagnosis, Pathology, and Therapeutical Indications. By GOLDING BIRD, A.M.,
Uramil . .. 8 + 3 + 5 + 6 M.D., F.R.S., Fellow of the Royal College of
New Body ... 8 + 3 + 8 + 3 Physicians, &c., &c. Second Edition. London. The approach to alloxan, an artificial result of the 1846. Post 8vo., pp. 356.
oxidation of uric acid is more evident. An addition of The merits of Dr. Golding Bird's treatise on “ Uri.
eight atoms of oxygen to Petten kofer's formula being Dary Deposits,” are well known to the profession, and
the equivalent to one atom of alloxan united with one this early call for a second edition is in itself an evi.
atom of ammonia and one of water, and rendering dence of the work being justly appreciated. It may
probable Dr. Bird's suggestion that the new body may be well, bowerer, to state, that although the short time
be a transition between uric acid and urea. We would wbich bas elapsed since the publication of the former
however, observe, that the speculations connected with edition, precludes the idea of any change in the plan of
the formation and solution of these problems, and of the the work, or any extensive additions to its contents,
composition of many other organic quaternary com. the later researches on the urine have been incorporated
pounds, however ingenious and captivating to the with the text. Among these we find the following
imagination, must be received with some degree of hesipolice of a new nitrogenized body, discovered by
tation. Many of the analytical processes are difficult of Petter kofer, which, as Dr. Bird obserres, must be
execution, and the discrepancies in the methods purregarded as playing a very important part in the
sued and results obtained by different experimentalists, pbysiology of the kidneys :
render the valueof these atomic symbols, by no means so “When an alcoholic solution of the extract of mathematically precise as the algebraical appearance arine, previously neutralized by a little carbonate of of the formulæ might lead us to anticipate. sode, is mixed with a spirituous solution of chloride of In giving an account of cyanourine, a deposit of a zinc, an amorphous precipitate falls, followed by the dark blue, inodorous and tastless powder, first discovered slow deposition of minute crystals of a combination of by Braconnot, and since noticed by Spangenberg and chloride with this new body. Drain the whole on a others. Dr. Bird refers to a modification of blue filter, and pour on some boiling water, in which the colouring matter, recently described by Dr. Schmidt, as crystals dissolve, and may be obtained, by evaporation, in yellowish quadrangular crystals, not rery unlike
occasionally occurring in the urine of patients under lactate of zinc, for wbich they have been hitherto mis- |
hydropathic treatment, at Gräfenberg. taken. On adding barytic water to a selation of these “The deposit consisted of oroid globules, about onecrystals, oxide of zinc and colouring matters are pre. third the size of a blood.corpuscle, and of a fine blue cipitated, whilst chloride of barium, with the new bodr, colour. It was partially soluble in hot ether and remain in solution. The solution being evaporated to alcohol, forming blue solutions. Neither dilute sul. dryness, is dejected in alcohol, acidulated with sulphuric phuric acid nor ammonia acted on it. Oxalic acid disacid, by which baryta is separated as a sulphate ; and solved it, forming a blue solution. Potass, aided by any excess of acid being got rid of by agitation with heat, destroyed its colour. No uric acid could be oxide of lead, the filtered fluid, bs evaporation, leaves detected.” crystals of the new substanee in a pure form.
Dr. Bird suggests that these blue pigments may arise
from some change in a protein compound ; and instance soon after passing, as to lead to the idea that their the fact, that albumen when boiled with hydrochloric germs must have existed in the urine whilst in the acid forms a bluish solution. They differ from indigo
bladder. All the urine in which I have found these and Prussian blue, both of which are occasionally found
minute creatures has been pale, noutral, of low specific in urine, by characters sufficiently marked. May not
gravity, and rapidly underwent the putrefactire fermeda
tation. the pigment observed in the urine of Gräfenberg patients
"I have only met with these animalcules in the urine be some form of altered blood-corpuscle? The continued
of persons in an excessively low and depressed state. transmission and transudation of large quantities of
In cases of syphilitic cachexia, where the prostration of aqueous fluid through the blood vessels and tissues can the strength is extreme and in mesenteric diseases. I scarcely lake place without the blood-corpuscles being
the blood.corpuscles being have repeatedly found them abundantly developed with ecled on, as indeed the peculiar sodden anæmiated remarkable rapidity. They appeared in great abund. appearance of some of the water.drinkers at bydro. I ance in the urine of a patient under my care in Guy's pathic establishments would seem to show. The ques. Hospital during the past summer. The subject of this tion is one deserving of further investigation, and case was a most miserable-looking young man, who may probably lead to carious results.
entered the hospital half starved, and labouring under In the former edition the opinion as to the frequent
polsdypsia, passing a very large quantity of urine of occurrence of oxalate of lime in the urine was advanced,
low specific gravity. He died of rapid phthisis. In a few
weeks the urine became full of vibriones in active theanthor stating, as the result of his own experience,
motion a few hours after being passed." " that the oxalute is of far more frequent occurrence in
The animalcules observed by Dr. Shearman, wero the urine than the deposits of earthly phosphales. This statement has been since confirmed by the experi.
probably of the same description, but contrary to Dr.
Bird's opinion, must have been generated in the urine ence of provincial practitioners. Dr. Shearman, of
previous to its evacuation from the bladder, as Dr. Rotherham, states, and as Dr. Bird believes correctly, " that next to the uraies small quantities of oxalate of
Shearman “saw the patient pass some urine into a
perfectly clear glass jar," which he “ immediately exlime are most frequently met with in the urine. Our
amined," and discovered the animalcules “enjoying readers will remember, in connection with this subject, the interesting observations on the influence of ibe
themselves very briskly." Those in some urine passed
in the evening, which speedily became alkaline died. rbubarb plant in producing oxaluria, published in the last volume of this Jourpal by Mr. Wilson, of Runcorn,
| Other specimens of urine remained the same as when and Mr. Bartrum, of Bath.
passed for several days, and in these the animalculæ
continued alive and active. The patient was a pale The discovery of cystine in the urine of chlorotic girls is an addition to our knowledge of this peculiar
scrofulous-looking man, emaciated and feeble, and
probably phthisical. In a patient whose case is reported deposit, for which we are indebted to the research of
by Mr. J. H. Stallard, of Leicester, in a subsequent Dr. Shearman, of Rotherham; and which, taken in
number of the Journal "the animalculæ were present connection with the probable deficiency of oxidation existing in chlorosis is, as Dr. Bird observes, a very
in urine directly obtained from the bladder, and died interesting circumstance. In a communication addressed
when decomposition had fairly set in." This patient
was also greatly emaciated and laboured under chronic to Dr. Bird, the following particulars are mentioned by Dr. Shearman :
disease of long standing. "Some urine passed by a chlorotic girl, after being
We cannot but recommend the study of Dr. Golding mixed with ammonia, and set aside in a white phial. / Bird's work to all who are called upon to be familiar evolved in a row days sufficient sulphuretted bydrogen with the important subjects of which it treats, in short, to to stain the glass black, When fresh; the urine bad a every medical practitioner, but before concluding this very peculiar odour, and deposited a white sediment notice we would direct atiention to the laws laid down unaffected by acetic or hydrochloric acid, but soluble in under the bead of therapeutical considerations. They ammonia. The solution left by evaporation six-sided will be found in both editions, but they cannot be too laminæ, which in all their microscopical and optical
strongly impressed on the practical physician, nor too properties resembled cystine. Two specimens of urine exhibiting these characters were passed by two
prominently kept in his recollection.
“ Law Isl. All therapeutical agents intended to reach sisters; a third was oblained from a girl belonging to
the kidneys must either be in solution when adminisanother family."
tered, or capable of being dissolved in the fuids conA case was communicated by the same intelligent
tained in the stomach or small intestines, after being physician in this Journal, in which living animalcules
swallowed." were found in the human urine. Dr. Bird, in noticing I “ Luw 2nd. Bodies intended to reach the kidneys the occurrences of vibriones in the urine, makes the must, to ensure their absorption, hare their solutions so following remarks :
diluted as to be of considerably lower density than " Minute animalcules, belonging to the genus vibrio either the liquor subguinis or seram of blood (i.e., (V Lineola !,) are occasionally developed in urine, so I below 1.028.)"
" Law 3rd. If a sufficient quantity of water cannot larger tumour has usually near it several smaller. be received into the small intestines, or the circuit Many medical men are very familiar with them ; others through the portal system in the vena cava ascendens, are unacquainted with them : they are chiefly seen at or thence through the lungs and heart into the systemic Ophthalmic Institutions. In the last ten years, during circulation, be obstructed, or if there be excessive dis. which time 20,941 patients attended the Bristol Eye organization of the kidneys, the due secretion of urino Dispensary, eighty cases of these tumours occurred, cannot be effected."
being about eight in 1100 patients. The disease is This last proposition is deduced in an admirable probably that described by Mackenzie, as “ Albumi. paper by Dr. G. H. Barlow, published in the “Gus's nous Tumour of the Eyelids," and unencysted. The Hospital Reports,” and is quoted from them by Dr.
contents, however, are proved by the microscope to be Bird. The following conclusions are drawn from the
epithelial cells; and Mr. Estlin considers their investing consideration of these principles :
membrane well entitled to the appellation of a cyst. "]. Whenever it is desirable to impregnate the urine
Middlemore speaks of them as encysted timours,
arising from an enlargement of a mucous follicle. with a salt, or to excite diuresis by a saline combina.
Guthrie gives them no particular name, but calls them tion, it must be exhibited in solution, so diluted as to
encysted, and describes the appropriate treatment. contain less than five per cent, of the remedy, or not
Others regard them as of the nature of molluscum, the more than about twenty-five grains in an ordinary
third genus of Willan's Tubercula. Some consider draught. The absorption of the drug into the capil.
them as infectious. Mr. Estlin is inclined to this laries will be ensured by a copious draught of water, or
opinion, though he disbelieves the vulgar notion of the any diluent, immediately alter each dose.
infections character of the ordinary cuticular warts “2. When the urine contains purpurine, or pre
of children. They are probably diseased sebaceous sents other evidence of portal obstruction, the diuretics
follicles. or other remedies employed should be preceded or
Their treatment was the principal object Mr. Estlin accompanied by the administration of mild mercurials,
bad in view in bringing this point of minor surgery taraxacum, hydrochlorate of ammonia, or other
before the meeting. He met with medical men who cbolitic remedies. By these means, or by local deple.
were teased by the management of these litile tumours, tion, especially by leeches to the anus, the portal ves.
and he formerly was so too. Lunar caustic, though sels will be unloaded, and a free passage obtained to
freely applied, will often not get rid of them for weeks; the general circulation.
nor will potassa fusa, unless so employed as to destroy “3. In cases of valvular or other obstructions existing
the whole external surface of skin, which is firmly in tbe beart and large ressels, it is next to useless to
united to the tumour by vascular connection. This endeavour to excite diuretic action, or appeal to the
plan is tedious and painful. The most expeditious and kidneys by remedies intended to be excreted by them.
least painful method is to slit them quite through with The best diuretic will in such cases be found in whate la lancet or cataract-knife, passed perpendicularly to ever tends to diminish the congested state of the vas
their bases, and then forcibly to squeeze the separated colar system, and to moderate the action of the heart, halves, with the thumb-nails placed on the sound as digitalis, colchicum, and other sedatives with mild
skin, till the contents are fairly turned out of their mercurials."
lodgment; the force required to do this will sometimes
bruise the skin a little, but in two days the part is Proceedings of Societies.
usually healed. The tumours when thus removed are
found to be lobulated, appearing like miniature brains. BATH AND BRISTOL BRANCH OF THE
If they resist considerable pressure, the loosened PROVINCIAL MEDICAL AND SURGICAL
portion may be taken bold of with forceps, and thus ASSOCIATION.
the whole extracted. This practice may be employed
when the tumours have begun to inflame or suppurate. Quarterly Meeting, Thursday, December 17ıb, 1846, Smaller ones usually disappear without treatment ; Mr. ORMOND in the Chair.
| their chief annoyance arises from the inflammation WARTY EXCRESCENCES OF THE EYELIDS. they occasion in the eye and lids. Children are the Mr. Estlin read a short memoir upon tumours,
chief subjects of the affection. . resembling warty excrescences, that grew upon the Mr. Estlin has noticed that either the children with eyelids and face; he had been accustomed to desig. this malady bear pain with great composure, or the nate them in the Annual Report of the Bristol Eye tumours possess little sensibility, for it is remarkable Dispensary as “ Soft warts." They vary in size from bow little complaint is made, however roug a pin's head to a small hazle nut, their base not smaller tumours are treated. Specimeos of two tumours than the projecting part, the white tumours shining which had been slit open and expressed were exhibited, through the skin. A minute aperture is observable in as well as a drawing of their various sizes and tbem, from which in the larger ones a white substance appearances. of the consistence of butter can be pressed out. Their Dr. W. Budd had seen sereral cases of the disease, contents cannot, however, be thus entirely evacuated, and had distinctly ascertained its propagation by conas each excrescence consists of a cluster of minute tagion. He remembered particularly the case of a encysted tumours. When occurring elsewhere the aurse, who, froin nursing a child suffering under one,
bad a crop of similar tumours appear on her temple, be freely moved therein. The uterus was excited where the child occasionally laid its head. She then went to action by two doses of ergot, and the child, with home and conveyed the disease thither. Besides, it some difficulty, caused by the size of its body, brought was not unusual to find them on the necks of those down. At birth it measured round the waist sixteen who nursed children affected with them. Whether inches and a half. The next day the serum had drained the disease is a parasitic one, is a very difficult question. through the skin, partially denuded of its cuticle, and! The cells composing it are larger than the epitbelial saturated the clothes in which it lay. cells, and of such extreme tenuity as to break very easils, but he had never been able to discover in them
Mr. Soden mentioned a case of hæmorrhage of florid a nucleus. The principle of their contagion seemed to be
blood of some hour's duration, from the ear, after the the transplanting of these cells from one human being
removal of a small polypus, stopped by a short applicato another, which in its relation to cancerous deposits
tion of lint soaked in the tincture of matico. was very interesting. The pathological question is, Mr. Hetling gave the particulars and exhibited a Are they composed of enlarged epithelium-cells, or specimen of rupture of the uterus. of a parasitic nature ? He drew the attention of the members to an excellent account of them by Dr. MEDULLARY SARCOMA OF THE LIVER. Paterson, in the Edinburgh Journal.
Dr. Cardew exhibited a case of medullary sarcoma FEVER.
of the left lobe of the liver. The man, aged 60, was Dr. W. Davies then read a paper on fever.*
admitted with a tumour in the epigastrium. Two Mr. Conway Edwards, from observations of the months previously, while at work, he was seized with pain peculiar fætor and foul state of the secretions, had been
in the epigastrium,-which pain gradually increased. induced with much apparent success, to use a solution
There was no jaundice por vomiting, till a fortnight of chlorine, which he found corrected that state, though
before death; the sickness was then controlled by be by no means ascribed to the chlorine any specific
salines, with prussic acid. On examination, the tumour effects on the virus of the disease.
consisted of curdy medullary matter, somewhat like Dr. Tunstall observed that the peculiar odour emitted
cream, mixed with blood. There was an ulcerated in certain stages of the disease was given out through
opening into the cavity of the stomach, and a comthe perspiration.
munication with the layers of the mesentery; the gallDr. W. Budd, in his many examinations of patients
bladder was filled with healthy bile; there was a dead of fever, bad not found the appearances nor
mass of the same disease beneath the pylorus obstructresults of in ammation ; there was no fibrin in the
ing it; the right lobe of the liver was unaffected, so brain, nor inflammatory exudation globules. The
that the bile was eliminated, explaining the absence of disease has all the characteristics of a poison, transmis- jaundice. sible from one individual to another, which is often
OVARIAN DISEASE. exemplified by an effected individual going into a com
ffected individual going into a com- Mr. Norman narrated a singular case of ovarian munity previously free of it, and from that single disease. He was called to examine a lady, with all person it very frequently can be traced to have spread the symptoms of ovarian dropsy. The abdomen was ynder circumstances often the most marked. In those large, tense, and fluctuation was most distinct. The cases characterised by drowsiness, the Auid in the swelling had begun at the right side, had lasted several carities of the skull will be found loaded with urea, months, and much impeded respiration. It was which circumstance has a direct influence on the decided in consultation, that tapping would afford treatment, wbich should then always be directed to
la then always be directed to considerable relief; the trocar was passed, but no fluid the elimination of the secretion of the kidneys. Louis came; and after clearing the canula, under the idea and Chomel had tried chlorine extensively, but had of some obstruction to the passage of the fluid, it was found it wholly useless; the first cases thus treated withdrawn without any fluid following it, or any were benefitted, but the later derived no advantage aggravation of the symptoms. She became weaker, from it, so that the result of their whole observation and after four or five weeks died. On post-mortem was that this gas is of no avail.
examination, the trocar was again passed, without INTRA-UTERINE DROPSY.
giving issue to any fluid. On opening the abdomen, Mr. King then narrated a case of dropsy occurring the cavity of the peritoneum was found full of a in a fætus of eight months. The mother had borne six gelatinous substance like glue, which could be drawn children, but did not menstruate between her first and out in long strings, and would not drop. This tenacious her fifth pregoancies; was “unwell" once when she fluid could with difficulty be removed, though a bucket became pregnant with this child. Between the fifth full was taken out. There was then found a cyst of and sixth months she became apasarcous, and at the the right ovary, not capable of holding a quarter of the time of parturition ber abdomen and lower extremities Auid taken out. The cyst appeared to have burst, were very large, tense, and hard. Some few days after then lessened in size, while the secretion still went labour her urine was not albuminous. The labour on from its lining membrane into the carity of the was natural but the child did not advance, thongh the abdomen, causing the sense of fluctuation. pelvis was large, and the head of the child could
Dr. Blackmore then gave the particulars of a case • This paper is given at length at page 36 of nodulated orarian disease. There could be felt
three distinct sacs fluctuating under the band, and the admission into the Infirmary, he was in very great pain. fluid could be pressed from one cyst into the other. and the hypogastric camour completely resembled a From the reduced and weak state of the patient, distended bladder. Mr. Thomas finding an abscess nothing but graduated pressure was recommended; existing in the perineum, opened it, and evacuated a . after a while, a quart of thick puriform fluid was at considerable quantity of purulent matter, on wbich
once discharged from the vagina; discharges of such the hypogastric tumour entirely disappeared, and the matter lasted for six weeks, while she gradually re- patient is now rapidly recovering. gained her flesh, lost her night sweats, bectic, &c.;
CANCRUM ORIS. and on her recovery, it was found that two of the
Mr. Micklethwait detailed the case of a child, aged cysts had disappeared, and that ihe smaller one alones
| 5, who suffered from hooping cough and tubular bron
chitis, to whom he gave, in the space of ten days,
Hydrarg. cum Creta., dr.j. The mouth became sore, SHEFFIELD MEDICAL SOCIETY.
without any flow of saliva. The soreness became con
fined to the left cheek, which soon presented the appear. Seventh Meeting.– December 23rd, 1846.
apce of cancrum oris, which destroyed the cheek, The PRESIDENT (Mr. TURTON,) in the Chair. opened the commissure of the lips, and destroyed the MENINGITIS.
gums, teeth, and part of the tongue of that side, and Mr. Beckitt exhibited the brain of a man, aged 37,
terminated fatally in five days after the appearance of an ostler, who had laboured under epilepsy during
the gangrene. The child complained of excruciating the last eighteen years, and who died of subacute
pains of the bands and feet, which directly after death meningitis, of one week's duration. The brain was
became very black. It had suffered from erysipelas very heavy and firm; there was a cyst in the anterior
of the same cheek three years ago, and ever since, that part of the left hemisphere, and the choroid plexuses
side had been less in size than the other. were large. He was, at the commencement of the
Mr. Skinner mentioned two cases of cancrum oris, attack, violently delirious, but effusion taking place,
one of which was in a child to whom he had given he became comatose and died in that state.
mercury for pericarditis, and which recovered with some
deformity; the other in a child who had measles, to ANEURISMAL VARIX. Mr. Thomas related the particulars of a case of
whom no mercury was given, which terminated fa:ally. aneurismal varix, at present under his care in the
| [Some yoars ago, we had occasion to witness the Infirmary. The man, aged 25, was closing the sheen. occurrence of cancrum oris in counection with measles. foot blade" of a common pocket knife, by pressing it
Mercury had not been given in the cases alluded to, against his thigh, when it slipped and penetrated the
and one of the cases terminated fatally. ED.) limb, piercing the artery and rein midway between Poapart's ligament and the knee. Profuse hæmorrhage occurred, which was stopped by carefully applied | MEMORIAL OF THE NATIONAL INSTITUTE pressure. A few weeks after the accident, he was OF MEDICINE, SURGERY, & MIDWIFERY. : brought to the Infirmary, at which time the limb was
AS To the Right HONOURABLE SIR GEORGE GREY, in a very atonic condition, exhibiting a number of
BARONET, Her Majesty's Principal Secretary of unhealthy ulcers. The patient's general health was
State for the Home Department, $c., &c. suffering. There was a very loud continuous bruit, resembling the bruit de diable, increasing with each
The Memorial of the President, Vice-Presidents, and pulsation,) audible over the cicatrix, when the ear
Council of the NationAL INSTITUTE OF MEDICINE, was four inches from the stethoscope, and exļending SURGERY, AND MIDWIFERY, ulong the whole course of the femoral artery. By the
SHEVETA: continued use of pressure, and a generous diet, with
That your Memorialists are Legally qualified Mem. stimulants, bis general health had been much improved,
bers of the Medical Profession and are General Pracand the limb also, the ulcers having healed, but the
titioners of Medicine, Surgery, and Midwifery. That continuous bruit is still very loud.
the National Institute is a voluntary Association of ABSCESS IN THE ABDOMEN.
General Practitioners in Medicine, Surgery, and MidMr. Thomas then detailed a case of abscess of the wifery; that your Memorialists have been duly elected abdominal parietes, which simulated distension of the the representative Council of the National Institute; urinary bladder, in a boy, aged 5. His health had and that they represent the opinions of above four been very good until about sixteen months ago, wben thousand of the General Practitioners of England and an abscess formed in the perineum, which, on being Wales. opened, discharged a small quantity of pus, and soon That Medicine, Surgery, and Midwifery, are depart. healed. Last month he suffered from an attack of ments of the same Profession; which Profession-10 & measles, and since then, a tumour formed in the hypo- scientific and educational point of view --is essentially gastrium; the scrotum became cedematous; has had one and indivisible; although, for the convenience of great pain about the region of the bladder, and some the Public, it has for a long time past consisted of three difficulty in passing urine. His medical attendant classes, viz.,-Physicians, practising Physic only; suspected that there might be a calculus. On his Surgeons, professing to practise Surgery only; and the