페이지 이미지
[merged small][ocr errors]

the air. R. Bebeerinæ Sulphatis, gr. iss.; Sacchari, the last two days has been opaque from an excess of gr. v. Fiat palv. ter die somenil.

lithate of ammonia; urine of last twenty-four hours 27th. Is less languid, but very restless at night; | deposits a light fawn-coloured, pretty dense, sediment, sighs very frequently; palse 106, lying down. Physical consisting of lithate of ammonia; the octohedra are etamination of the chest gives evidence of nothing less numerous; specific gravity 1034. morbid. Urine of last twenty-four hours full-coloured, lth. Has suffered more from languor, and has been rather cloudy, throwing down a cloud-like deposit, with more low-spirited since last visit; urine pale, very acid, a little red sand, of specific gravity 1030. The deposit of specific gravity 1024, and contains fewer and smaller contained an abundance of octohedra, somo very large; octohedra. the saddy matter consists of tables of uric acid. T 14th. No improvement; does not feel disposed to

30th. Appears stronger, and is more lively; the rise in the mornings; urine of specific gravity 1016, night sweats have ceased; urine contains scarcely a acid, presenting an excess of triple phosphates, and a single octohedron in a very slight deposit which occur. moderate amount of octobedra, with some fermentation red, bat still about the same quantity of uric acid. globules.

'Jane Ist. Improving; sighs less, and is less restless 18th. Mach improved in every respect; stronger, at night; urine presents a slight deposit as before, but and less low-spirited; urine of specific gravity 1021, acid, containing more octobedra, and an abundance of uric presents a moderate cloud-like deposit and uric acid acid, specific gravity 1035: it contains a slight excess crystals as before; the octo bedra numerous and mixed of urea.

with circular thin plates. . 4th, Was yesterday very low-spirited, and cried 21st. Bas been more low-spirited, especially on without any assignable cause, appearing to be very waking in the morning; urine acid, of specific gravity languid ; is much better to day; urine of this morning 1015, contains octo hedra as before, and only a few presents a considerable deposit as before, containing crystals of uric acid. Contin. haust. R. Camphoræ, an abundance of octohedra and uric acid ; specific gr. ij.; Conf. Rosa, q. s., pro. pil. com sing. haust. gravity 1033.

sumend. From this time to the 28th of July I saw her about 25th. Is in better spirits; urine presents the usual twice a week, and she continued to improve and to gain deposit, containing an abundance of octohedra, and a strength; her thirst entirely disappeared, and she slept | few dumb.bell crystals ; specific gravity 1024. guietly at night; the urine varied in quantity from a l 28th. On the 25th and 26th soffered from an attack pint to a pint and a half in twenty-four hours, its of vomiting and diarrhea, which has increased her specific gravity generally ranged between 1030 and languor; urine much as on 251h. Omitt. medicamenta, 1036, only one day falling as low as 1017, probably in Sept. Ilth. For the last ten days has been residing consequence of a temporary diminution of atmospheric a short distance from town, and has improved remarktemperature, especially at night. Tbe oxalates continued ably in strength and cheerfulness. The urine has during all this time very abundant, scarcely varying at deposited no red sand; that of the last twenty-four all, but the uric acid discharged was remarked to lessen hours presents a tolerably abundant cloud-like deposit, whenever there was a fall in the temperature, even of a consisting of octobedra, in great abundance, and very single day, and instantly to become more abundant as large perfectly-formed dumbbells; specific gravity it rose. The bebeerine was continued for some time 1035; considerable excess of urea. R. Acidi Hydrowith decidedly good results, and on July 17th Ac. chlor. dil., Acidi Nitrici dil, utrq. m. viij. ; Iaf. Nitrici dil., m. vj., with Inf. Calumbæ, oz. iss., were Calumbæ, oz. j. Fiat hagst. ter die sumend. directed to be taken three times a day. On the 21st the 22nd. Only took three doses of the medicine, and diluted nitric acid was increased to m. viij., and some then omitted it, on account of its producing vomiting; dumb-bell crystals appeared in her arine.

improving in every repect. Urine has again contained July 28th. Is more languid than she has been for red sand, but there is none iu that passed during the some time past, which she attributes to having suffered last twenty-four hours; it contains, however, an from slight diarrhea on the 25th ; her appetite has abundance of octobedra, and a few of the circular thin fallen off, and she is again as restless as ever at night; plates, but no dumb-bells. Omitt. medic. orine contains as much oxalate as before. Pergat. 29th. Gaining flesh and strength; urine presents

31st. Still complains of languor, and is very restless an abundant cloud at the bottom; specific grarity, at nigbt; urine as before. Auge Ac. Nitrici dil. ad. 1026. The deposit contains much fewer octobedra m. xij.

than before, but an abundance of dumb.bells in all August 4th. Was extremely alarmed at the storm on stages of development, from an oral plate with a the Ist, but has appeared better since the air has been darker point in the centre, to the perfeci form, along 80 much cooler, and has been less restless at night; with circular thin plates of all sizes. appetite is improving ; urine pale, of specific gravity | Oct. 8th. Improving in every respect; urine has 2016, acid, with less abundant deposit, but of the same contained no red sand, ibat of last twenty-four hours aspect as before; octobedra fewer and smaller, mixed contains an abundance of large octohedra, and a few with them are some circular thin plates, and some of the circular thin plates, but no dumb-bells. fermentation globales.

22nd. Is quite well; has improved in flesh, and her 7th. Gaining strength, and troubled less with languor; spirits are excellent; urine contains very few octobedra, appetito very good, and less thirst. The urine daring and no dumb-bells por other salipe deposit. Discharged. Remarks.-The history of a naturally weak child One word more upon this head : the circalar form exposed, during a summer remarkable for its continued appears connected with a specific gravity rather lower: high temperature, to the confinement and close atmos. than the average. In the three instances where it phere of a crowded school-room, and from that time occurred alone, the specific gravity was 1011, 1015, to the cool weather of autumn, labouring under symp- and 1019; when with octohedra, 1010, 1016, 1020, 1021, toms of marked debility, requires no comment. All | 1022, 1023; but when with dumb.bells also, 1026. that derolves upon me is to point out the connection I have met with dumb-bells in arine as low as specific between this state, and the condition of the urine for gravity, 1012, and as high as 1035. 4th. It has been the sake of which it is reported. During five months stated that the appearance of uric acid not uncommonly oxalate of lime was uninterruptedly discharged by the precedes the disappearance of the oxalates. It occurred kidney; it assumed at various times the octohedral, in seven out of the pineteen individuals mentioned, dumb-bell, and circular* form, and varied in quantity but in none could I perceive any relation of the kind, with circumstances which it shall be my business to The sudden discharge of a large quantity of lithate notice :-/st. Five months is the longest period during of ammonia, however, has appeared occasionally to which I have watched oxalates uninterruptedly dis. influence in a temporary manner the subsequent charged with the urine, and probably in this instance amount of oxalates. 5th. In connection with this case they continued in it for some time after the patient ceased I may observe, that in several instances where the to be under my notice. 2nd. We have an example specific grarity has been rather low, I have noticed the here of all three forms of oxalate of lime occurring in y occurrence of conferræ in oxalic arine, the presence a single subject, and their study accordingly may not of sugar pot being indicated by the application of be anjnstructive. As respects their relative abundance, Trommer's test. then it will be observed that the frequency with which

Case IX.-DEBILITY : Eczema. octohedra occurred was mucb greater than with the

M. C., aged four years and a half, of tolerably other two forms; and this is ordinarily the case. Out,

| healthy parentage, has generally enjoyed very good of nineteen individuals, whose cases I have analysed,

health, with the exception of suffering occasionally there was only one in which they were absent; and

from febrile disturbance for a few days, accompanied out of 139 specimens of oxalic urine, they were present

by constipated bowels. She was brought to the Disin all but three. In the present instance again the

pensary on the 2nd of September, 1846. It appears dumb.bell and circular forms each occurred five times

that three years ago she began to lose flesh and strength, in thirty-two specimens examined. This, however,

and two months ago suffered from one of her customary does not represent the relative frequency of these

attacks of feverishness, during which her debility forms, since, out of 139 specimens of oxalic urine,

increased, and since which she has remained pale and I have met with dumb-bells six times, but with the /

very languid. About a fortnight ago a few pimples circular form, ten; and out of the nineteen individuals

were noticed on the scalp, which have now formed mentioned, I have met with dumb-bells but in two,

crusts over a limited space upon the vertex, presenting wbile the circular form occurred in six. In one

the characteristic aspect of eczema. Her appetite is individual I have seen the circular plates as the only

defective, she can rarely be induced to eat any meat, manifestation of the oxalic tendency, during the time

and her bowels are disposed to be constipated, Abrad. he was under observation; but dumb.bells have, in

capillities. my experience, never presented themselves without

1 4th. No improvement; urine of last 24 hours cloudy, being accompanied, preceded, or followed by octohedra,

and presenting a cloud-like deposit, consisting of The circular forma again I have noticed to occur alone

phosphates, specific gravity, 1016. The scalp to be in three out of the ten examples of it; and in only

covered with an oiled-silk cap. Omni mane Ol. Ricini, one of the remaining seven were dumb.bells conjoined; Lori and although I am satisfied, from anrecorded observa.

1 7th. The eruption has spread extensively over the tion, that dumb-bells also may occur without octohedra,

vertex, and there is an appearance of the disease affectyet, in the six specimens alluded to above, they were

ing the corner of the mouth. She appears less ladguid; accompanied by them. These two remarkable forms

bowels have been purged; urine 1030, acid, presenting appear to be not very distantly allied. 3rd. As case IV.

a deposit of lithate of ammonia. Contin. 01. Ricini. illustrated the lowest, so this illustrates the highest,

Water dressing to scalp. specific gravity that I have noticed, in connection with

10th. Eraption extended over the scalp; complained oxalate of lime,-namely, 1036. The specific gravity of a little headache gesterday. Bowels not so much of the greatest number of specimens I have examined

purged; urine presents a moderate clouds deposit conranged between 1014 and 1031, the average between

taining an abundance of octobedra, mixed with prisms these numbers being 1022. Out of 127 specimens,

of triple phosphate. To continue the water-dressing e below specific gravity 1014, and 8 only above and castor oil. Ter die capt. Hydrarg. cum Crota, 1031. I have also remarked with other observers, that when oxalate of lime was in progress of being 14th. Eruption improved in appearance and more discharged, a diminution of it commonly took place limited in extent; bowels open once daily; urine of whenever the specific gravity was remarkably lowered the last twenty-four hours half-a-pint, with an ammoni. • The term circular is not to be applied too strictly, as aval vdo

cas, acal odour, alkaline re-action, of specific grarity 1015, the plates assume commonly more or less of the oval shape, presenting a whitish cloudy deposit which contains a

[merged small][ocr errors]

considerable number of phosphatic prisms and a few reporting to illustrate the oxalic diathesis, it may not be moderate-sized octohedra.

amiss to conclude it by an enumeration of the several 17th. Improving; eraption discharging less and morbid states which I have seen it accompany. They becoming more limited ; says that the castor oil causes are the following :-Hypochondriasis; delirium tremens; her to feel sick all day; urine contains no oxalate a disposition to this disease or mental derangement from

Pulv. Rhei, gr. iij. Fiat pulv, nocte maneque sumend. cerebral hæmorrhage; hysteria; spermatorrhæa; debility

21st. Eruption now confined to the vertex and line and cachexia connected with a scrofulous constitution; of coronal suture. Is less languid and rises cheerfully eczema ; acne; gastrodynia; acute, gonorrheal and in the mornings. Bowels regular; brine alkaline, chronic rheumatism; Bright's disease of the kidney, of specific grarity 1021, depositing a cloudy sediment, (shortly before the comatose stage ;) cancer of the containing some phosphatic prisms, but no oxalate. liver; cancer of the lung; cancer of the uterus and

24th. Has no languor now, but appears stronger; bladder; irritability of the bladder; enlarged prostate; appetite improved ; eraption confined to the vertex and hypertrophy, with valvular disease of the heart ; left side of the coronal suture; urine of specific gravity and aneurism of the aorta. Its occurrence with 1026, alkaline, presenting a very cloudy deposit, which granular kidneys and albuminuria is remarkable for contains much phosphate of lime and phoshatic prisus, its extreme rarity. In sume persons of unhealthy and a large number of octohedra, some, however, being parentage and scrofulous taint, I am disposed to very small. Capt. pulv, omoi nocto taptum.

believe that the secretion of oxalate of lime with 29th. Crusts falling from all the affected surface; the urine may become habitual, since I have noticed solitary sero-purulent vesicles here and there upon it continue in such a person for some months indethe neck; colour of lips and cheeks improved, and pendently of the presence of any active disease, and she is gaining strength. Urine of specific gravity 1025, unaffected by change of air, modifications of diet, or alkaline, deposit as before.

tonic medicine. So for as my own observations bare October 20d. No eruption now, and only a very few | been carried, the sexes appear to share equally ia crusts not yet fallen from the part first affected; the diathesis. continues to gain flesh, strength, and colour; urive of specific gra vity 1026, alkaline, deposit as before, but containing few and smaller octohedra. Omitt. pulv.

PROVINCIAL . 6th. Improving in every respect ; urine of specific M edical & Surgical Journal. gravity 1019, faintly acid, deposit slight, and contain.

WEDNESDAY, SEPTEMBER 8, 1847. ing phosphates as before, but scarcely any octobedra.

12th. Continues to improve; a few solitary resicles appear occasionally at the back of the neck; urine of It may not possibly at first sight appear that specific gravity 1022, moderately acid, presenting a the subject of emigration materially concerns moderate cloud-like deposit containing a large number the medical profession. A consideration of of octohedra of all sizes, but only a few phosphatic recent events-events arising out of the famine prisms.

which has so awfully ravaged many parts of 16th. Is in every respect well; urine contains no

Scotland and Ireland - however, but too clearly octobedra, specific gravity 1023.

shews that the immigration of destitute persons 20th. The eruption having quite disappeared, bas

exercises a most disastrous influence on the left the hair rather thinner over the affected parts, but

health of the population of those districts to there are no bald patches ; arine of specific gravity 1021, acid, presenting a cloud-like deposit containing

which they fly for refuge, and in the sanitary a very few octohedra. Discharged.

questions which arise out of such a state

the medical practitioner is greatly interested. Remarks.—This is the youngest patient in whose | The prevalence of a fatal form of fever amongst urine I have remarked the deposition of oxalate of the Irish immigrants into Liverpool, Bristol, lime, the oldest was 72 years of age. Although con.

Glasgow, and other towns on the Western coast nected with the debility, which accompanied the local

of Great Britain, and the rapid spread of the disease, it plainly fluctuated with the progress of the latter, the quantity of oxalates becoming increased

same disease through the general population, whenever the formation of new vesicles was proceeding,

not only in the sea-port towns, but in the towns and lessening or disappearing altogether as they died

in immediate or frequent intercourse with away or were converted into crusts. This condition

them, and in the surrounding villages, are of the urine is only occasional in the course of eczema,

among the well-known effects. The sacrifice of Alkalinity is shown by this instance not to be incom. life among the members of the medical profespatible with the presence of an oralic deposit; but sion, and others whose duties lead them into still it is not a common state of the urine, as I bare intimate connection with the sick, is an afflicting only met with it on one other occasion. The deposit truth, which admits not of question, and the of phosphates was observed fifteen times out of 137 clear evidence of infection which has attended specimens of oxalic urine.

this epidemic famine-fever, is such as to call for Since the above is the last case, which I intend I the best-directed efforts to provide by judicious

sanatory regulations against similar contingen- received from Canada, we learn that the cies for the future.

same fatal scenes are being enacted in that It can scarely be questioned, we think, even country, as of late we have witnessed here. The by the most pertinacious anti-contagionist, that emigrants who have fled from the famine and the fever which has carried off so many among the fever desolating their own country, have care the population of Liverpool, Manchester, Leeds, ried with them there also, the effects of both, and and other populous towns in the northern dis the mortality amongst them is fearful. Of nearly tricts, was introduced by the immigration from eighty thousand passengers to Canada, the Ireland, was decidedly contagious or infectious mortality is estimated to have reached to onein its nature, and was of pecular malignancy eighth of the whole number, and at the Marine even in healthy persons, when directly exposed to Hospital, at Quebec, and the adjacent sheds, its primary infection. The ferment of the which have been appropriated to the reception famine-fever, (if the expression may be allowed,) of the emigrants suffering under te whatever its true nature may be, like that of deaths out of a thousand patients are reported other transmissible diseases, (the vaccine for to amount to one hundred per week. As yet, instance,) seems to have acted with greatest the fever, though spread through the country, effect in its primary or earlier transmissions wherever the emigrants have have proceeded, through the system of healthy individuals, and has been chiefly confined to them, but there is the whole of the phenomena attending it, as it too much reason to fear that unless some seems to us, clearly point out that a well-devised measures, more efficient than those hitherto system of precautionary measures, with early adopted, are had recourse to, it will here also separation and isolation of the sick from the extend its ravages to the general population. healthy populatiou, might have put a stop to But it will be asked, what are the measures the ravages of the disease, at least among which should be adopted to prevent the exten, those who were not themselves, by previous sion of this fever to the healthy, and extinguish privations and suffering, strongly predisposed it in the diseased ? Precisely the same as expeto it. Many valuable lives might thus haverience has shewn to prove successful in other been preserved, and very many others spared cases of contagious diseases ;-separation of the the risk attendant upon exposure. That a sick from the healthy-isolation of the sick very large proportion of those who had themselves, by avoiding over-crowding in the previously suffered from destitution and famine hospitals and buildings appropriated to their must unavoidably have become the subjects of reception-and the attempt at least to remedy the fever, is evident, not only from what has the condition of those predisposed by previous occurred in Ireland, and in this country, destitution, by supplying them with good food, but elsewhere, but the permitting of large by enforcing cleanliness, and generally by numbers of a population, thus carrying, with affording to them such comforts of clothing, &c., them and in them, the seeds of malignant as their condition rcquires. It may be, that to infectious disease, to throw themselves, indis- carry out these objects, would demand a considercriminately and without restraint, into the able amount of expenditure, but we are well heart of densely populated towns and districts, I assured that such expenditure in the first instance was surely sowing to a fatal harvest of disease is the truest saving in the end, and most thankful and death, the effects of which cannot but be should we be, that whatever were the threatening felt for years to come. Such an event ought to aspects with which the present year commenced, have been foreseen and provided against in time; the abundance which now promises, places much and the expense of constructing a few tem- in our power towards the supply of a sufficiency porary hospitals, or places of refuge, for the of nourishment to all. We shall conclude these sick and destitute, whom want and suffering of remarks by quoting from the Quarterly Return every kind had thus driven on our shores, would of the Registrar-General, the account given of have been amply repaid, and in the end, indeed this fever by Mr. Leigh, of Deansgate. a measure of pure economy. The expense too, “The fever," he observes, " is of an exceedmight have been borne, in part at least, by the ingly low type, the subjects of it becoming country at large, and the local districts have been typhoid, with a dry brown tongue, within a very relieved of what, upon some classes of the few hours after the attack. In many, the brain inbabitants, has proved a most serious burden, is oppressed from the beginning, the pulse and aggravation of the calamity.

continuing slow (ranging from 70 to 80,) It is not yet too late to profit by the throughout, the pupil being large; whilst in sad experience which we have attained, if some there is great abdominal irritation, pot in our own case certainly in the case vomiting and diarrhea ushering in the attack. of some of our colonies. From the accounts. This is followed by great tenderness over the

[merged small][ocr errors]

abdomen, intolerance of pressure, and consider of their President, Mr. Nathaniel Smith, who was able distension from flatus. So far as my own suddenly obliged to go to London, he had been observation has extended, and as far as I can requested to continue in the chair.

The Secretary read the report of the Council. . gather from my professional friends, I think

Mr. Flower, of Chilcompton, was unanimously it may be stated generally that the mildest

| appointed President-elect. treatment has been the most successful. The Some ordinary business was then transacted. present epidemic is essentially a famine fever,

COMMUNICATIONS. imported into this country by a class reduced to the lowest condition consistent with the

Dr. Edwards, of Bath, read a paper “ On Ulceration

of the Cervix and Os Uteri, and its occasional Cause of carrying on of the vital processes. In such a

Dysmenorrhea. (This paper will be found in the state of the system, general derangement takes present number of the Journal.] place, the body lives upon itself, furnishes its

Mr. Prichard read the account of a case of cataract, own materials for respiration, abnormal pro- which had come on in infancy, and wbich was cured ducts are formed, partly retained and partly by operation when the patient was twenty-seven years eliminated, producing disease in the system of age. In this case the phenomena attending the which forms them, and communicating it by

process of learning to see and to compare the results the eliminated matters to others. Want com

obtained by the sense of touch with those obtained by

vision were very well marked. pels the destitute to live together, whilst the

Dr. Daniell read a “Case of Disease simulating deficiency of water, and the great personal Canine Rabies." uncleanliness of the Irish poor, gives to their | Mr. T. Barrett, read a “ Case of Obstruction to sordid skin a morbid coating, and the tainted | Labour, from Rigidity of the Neck of the Uterus, air they breathe carries its poison abroad, and successfully treated by Incisions.” the well-fed and the wealthy fall victims to the Mr. Clark read a paper “On the Power of Elasticity famine they felt not. A better supply of good in Mechanical Surgery." He first alluded to the food, a greater abundance, more water, the

great influence of the elastic principle in the liuman

economy, and then stated that this essential property separation of the poor from each other by

| in the living animal tissues could be simulated. removing them from the low lodging houses in

Vulcanized caoutchouc was the mediuin he proposed. which they congregate, often to the number of It had frequently be

It had frequently been used as a compressor. As a eighteen or twenty in a single room, and the tractor it had rarely been employed, though in his inculcation of greater cleanliness by the priesthood opinion it would in many instances prove more efficient of all denominations, will, better than all mere than the screw or the rack. He stated many cases in medical treatment, subdue the fever which is illustration, as, the withdrawal of dead bone, removal now sweeping so many to the grave.”

of ligatures, lateral spine curvature, rigid joints.

Proceedings of Societies.



Dr. Fletcher brought forward a specimen of carcino: ANNUAL MEETING.

matous stricture of the pylorus, which had been taken The Sixth Anniversary of the Bath and Bristol

from the body of a man aged 65, wbo had become a Branch of the Provincial Medical and Surgical Associ

patient at the General Dispensary a short time previous ation was held at the Medical Library, Bristol, July

to his death. When admitted he was labouring under 22nd, 1846.

marked symptoms of the disease, wbich bad originated Among those present, were Mr. Ormond, Mr. Cox, Dr. Cardew, Dr. Edwards, Dr. Wheelwright, Dr.

some months previously. There was a tumour in the Daniell, Mr. Bartrum, Mr. Norman, Mr. John Barrett,

region of the pylorus, and the region of the stomach Mr. C. Edwards, Mr. T. Barrett, Mr. King, and Mr.

was very much distended and tympanitic. At the John Soden. Bath: Mr. Vicars. Warminster: Mr. I post-mortem examination the stomach was found very Crang, Timsbury; Mr. Fowler, Chilcompton; Mr. much dilated, and a carcinomatous tumour compressing Washbourne, Corsham; Mr. Barrow, Dr. Kaye, Dr. the pylorus, of the size of a small orange. All the Budd, Dr. Trotman, Dr. Symonds, Mr. Prichard, Mr. other organs were healthy. Surrage, Mr. Ruddock, Mr. Morgan, Mr. Coe, Dr. G.

| RETROVERSIO UTERI: SUPPURATION OF THE KIDNEY, Fripp, Mr. Green, Mr. Colthurst, Mr. Mayor, Mr. Godfrey, Mr. Neild, Mr. Clark, Mr. Hetling, and Dr.

Mr. Francis Elkington exhibited the kidneys, and Ogilvie, Bristol.

bladder, and the uterus and its appendages, of a woman Mr. Ormond, the retiring President of the Branch,

who had suffered from retroversio uteri, followed by baving taken the chair, expressed briefly the pleasure

suppuration in the right kidney, of wbich the following and gratification be bad experienced during his year of is the history :office, and returned bis thanks to the members for Mary David, aged 28, of a fair complexion and their kindness to him on all occasions. In the absence sanguineous temperament, was admitted a patient of

« 이전계속 »