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and complains of the light; if there is no history of difficulty, accompanied by a noise, as though it required typhoid fever, pbrenitis should be suspected and blood vest muscular effort to fill the lungs at all. His feet be taken from the arm. If the symptoms diminish, and hands were cold, and his body covered with clammy but again increase in intensity, it is probable that the perspiration. disease has an intermittent character, and quinine may When I saw him, which was not until two boors and be exhibited by the mouth and in an enema. But if a balf after the seizure, he was sitting on a chair, with to these symptoms, delirium or coma be added, and the his body bent forward, forcibly pressing himself disease has not passed the second or third day, active against a table, occasionally writhing and groaning treatment must still be persevered in. The bleeding | incessantly, still breathing with great difficulty. I is to be repeated, or leeches to be applied to the mastoid believe he both heard and understood my questions, bat processes, cold applications are to be continually was unable to answer them, or even to articulate in applied, and if there be no vomiting, and the bowels the least. The pupils of the eyes were perfectly are obstinate, croton oil may be given. If, however, dilated, and the pulse exceedingly feeble. The extreme the vomiting be urgent, we should endeavour to allay hardness of the abdomen bad been relieved when I it by a quarter of a grain of bismuth, given every arrired, probably from the unloading of the prime vie, half hour. In addition to this, mercurial ointment for it appeared a few minutes before he had passed a must be energetically rubbed in. This treatment is to copious loose stool, so extremely offensive that it was be carried out during the second and third day. If, removed immediately, and I had no opportunity of however, the pulse becomes feeble and irregular, the seeing it. : face livid, and the pupil dilates, the hydriodate of the case assumed so anomalous a character, that I potash should be given and blisters applied.
became impressed with a belief that it arose entirely 4. In the secondary and more insidious form of the
from the poisonous property of the particles of the disease, it is prudent not to abstract blood. A seda
dried aphis or pea-blight, with which the atmosphere he tive treatment offers the greatest chances of success. bad breathed bad been so fully charged; and considering (To be continued.)
it likely, as the harvest adrances, there may be other cases present themselves equally anomalnas, it occurred
to me that it might not be unworthy the attention of SEVERE CASE OF SPASM, ARISING PRO. the members of the Provincial Medical and Surgical
BABLY FROM BREATHING AND SWAL Association, pow assembled at Derby.
I administered ten grains of calomel and two grains PEA-BLIGHT.
of opium in a pill. I then left the patient for half an By EDWARD DANIELL, Esq, Newport Pagnell.
hour, after having first directed his feet to be bathed in
warm water, and the abdomen to be fomented with (Communicated to the Provincial Medical and Surgical
Association, at the Anniversary Meeting, at Derby, Aannels, dipped, and wrung out, in water as hot as be Thursday, August 5th, 1847.)
could bear it. On my return he was relieved; couscious. Thomas Coley, of Stoke Goldington, Bucks, a farm. ness and articulation returned. Prescribed an active labourer, returned from his work apparently in good aperient, composed of sulphate of magnesia and jalap. health, about seren o'clock last night, August 2nd. He Aug. 3rd. This morning a messenger was dispatched had been employed during the latter part of the day in to me to say he continues better, but has had no action a bam, unloading peas, which had been early cut in of his bowels. Ordered pills of calomel and croton oil. consequence of the blight; in fact, the peas were The pills of calomel and croton oil produced very nearly destroyed by swarms of the black ophis, by copious action upon the bowels, and entirely removed which the peas and beans are greatly affected in the painful symptoms under which the patient laboured. this neighbourhood. The dast produced by unloading He was able to return to his work in three days after and stacking in the barn was very considerable; in the seizure. short, the atmosphere he inhaled, and the saliva he A few days after this case, I made enquires of the swallowed, must have been impregnated to a vast extent farmer whether any of his other men were at all with decayed particles and excrementitious matter affected who had been employed in carrying or housing from the dead bodies of these insects. He had his the peas. I found that another man was so unwell usual quantity of beer, which amounted in the course the next day that he was unable to resame his work, of the day to one quart and half-a-piut. Of what his but the case passed over without medical treatment. food consisted I was not informed.
The farmer himself was slightly affected; he complained About eight o'clock he was seized with severe pain in the same evening of severe pain in the stomach and his bowels, which gradually increased in severity until bowels, and (as is nsual with such men,) bad recourse the whole abdominal muscles swelled and enlarged, to stimulants to relieve it. He took, before going to becoming tense and hard, like pressing upon a board. bed, two tumblers of hot brandy-and-water, and found The spasmodic action then extended to the chest, which himself well in the morning. became equally rigid, accompanied with difficulty of It would appear from these cases that the dried breathing. In less than an hour from his first seizure the particles of the pea-blight, when mingled with the paroxysms of pain became so severe that it required salira and swallowed, or breathed into the lungs, parfour strong men to hold him, he rolling upon the floor ticularly in a close place like a barn, where the currents in the most intense agony, and breathing with much of fresh air are but slight, produce effects upon the
system analogous to certain poisons, influencing Cusack and Dr. Stokes, it would appear that, in mainly the nervous system. In Coley's case the ordinary times, nearly one half of the medical functions of the brain were decidedly disturbed, as practitioners in Ireland suffer from fever, and was evidenced by the dilated state of the pupil, and I that the medical profession of that country is the severe courulsive action, not only of the abdominal more than decimated by its ravages. The muscles, but of the muscles surrounding the pharynx
soldier in time of war is less certain of entering and larynx, the latter being compressed to suffocation,
battle, than is the Irish physician of being and the power of articulation becoming conseqnently
attacked by fever; while the prospect of ultisuspended.
mate escape with life is greatly in favour of the
former. What the actual mortality among PROVINCIAL
medical men, from the “famine-fever," may Medical & Surgical Journal. have been, we have no means of ascertaining,
but there is every reason to fear, that the deaths WEDNESDAY, SEPTEMBER 22, 1847.
which have taken place greatly exceed in num
ber those which have been recorded. It is with feelings of a very painful character The subject is one which challenges inquiry, that we feel ourselves again called upon to for there can be no question that a great public remark on the fatal course of the fever which debt is owing to the families of those who thus still continues to prevail in Ireland, and in many devote themselves to the general good, and that parts of this country. It cannot but have been although nothing can compensate to the surnoticed, that each successive number of this viving widows and orphans, it is at least in the Journal records the loss of promising members power of the Government to preserve them from of the profession, cut off in the prime of life, utter destitution, and to allow them such supdomestic ties severed, and their families, too, port as may enable the widow to live in tolerable often left entirely unprovided for. In a con. comfort, and to bring up her children in decency temporary journal, the Dublin Medical Press, of and in respectability. the 8th instant, we read the following testimony There are two points which urgently press for to Dr. George Vickers Dunne, one of the vic- consideration as regards the state of the medical tims of this fearful visitation :
staff in the public management of these fever “ Dr. Dunne was in the prime of life, and had institutions. To one of these we have just just laid the foundation of a successful, honour briefly alluded,- the making of some public able, and useful career; he had secured the provision for the families of those who fall a esteem of many attached friends; he had estab- sacrifice to fever in the discharge of their official lished for himself a high reputation; and was in duties. The other is the still more important the enjoyment of complete domestic and social point of endeavouring, as far as possible, to happiness. * * * * While at Maryborough (prevent the occurrence of such sacrifice. he won the respect of all classes by bis many “That medical men,” well observes our Dublin amiable qualities; and for his unwearied attend contemporary, “ must encounter the danger ance upon the sick-poor of the town and neigh attending the treatment of persons labouring bourhood, he will long be remembered with the under typhus fever, we of course admit, but we liveliest gratitude. At Errill, his late residence, deny that they are to be wantonly exposed to his skill, humanity, and attention, caused him this danger in a tenfold degree from negligence, to be generally beloved. He was kind and mismanagement, and parsimony." And shame courteous in his demeanour, generous and con- it is to the authorities, whoever they may be, fiding in his attachments, and sincere in his public or private, that any meritorious officer friendships. His loss will be deeply felt by that should be subjected to the certainty of becoming district, which had become fully aware of the infected with malignant disease by the want of value of his services; and particularly by the all fitting arrangemnents in the receptacles humbler classes, to whose assistance he devoted appropriated to those suffering from it. The the utmost attention during the late calamitous fever-hospital, in which Dr. Dunne endeavoured season, when the duties of the profession were to administer relief to the miseries of the poor doubly arduous.”
people around him, consisted of the “ mud walls And this is a record which we feel assured, of an old cottage, eked out with boarding, and with some variation in circumstance, will apply covered with straw;" and in this wretched shed more or less to a very large majority of the nearly sixty persons were crowded together medical officers, whether in Ireland, Scotland, under treatment at the time he contracted the or England, who have been in like manner suf- fever of which he died. The shed was, it appears, ferers from the contagion of the “famine-fever.” constructed by himself, unprovided with the
From researches instituted by Professor | oecessary funds, out of the only materials which
he could command. This, however, is but one is added on the admission of air into veins; and instance of what is in general operation through there is also an appendix on the structure and out Ireland, for we are informed that there are diseases of the blood-vessels of the lower animals. “some three or four hundred of these temporary These subjects are illustrated with numerous cases, pest-houses,” scattered throughout the country, many of which were witnessed by the author; and “with a corresponding number of medical practi- scattered throughout will be found much interesting tioners in charge of them." The arrangements statistical information, and several valuable tables,
this country also have been by no means perfect in particular a table of 551 cases of spontaneous in their kind, for which Liverpool might be,
aneurism, selected indiscriminately from the British appealed to as an example, and many valuable
medical periodicals, from the year 1785 to the date of lives have been even here unnecessarily sacrificed publication. in consequence.
We quite agree in the opinion which has been Into the question of what is necessary to be
expressed, that the utility of this table is greatly done towards remedying such a state of affairs, it
lessened for reference for statistical purposes, by the is not in our power to enter on this occasion,
want of all arrangement of the cases, but we are never. but this one point we would seriously impress, that whenever such a calamity as has lately
theless obliged to the author for baring thus brought visited us, makes its appearance, whether it be in
together, under one view, a mass of valuable informaEngland, Ireland, or Scotland, there it should be
tion, which the exercise of a little patience and the promptly met; for independently of the common
expenditure of a little time will enable any one to tie of humanity, the claims of long and closest
consult with advantage. intercourse, of friendship, and family connection,
nnection The subject of arteritis is treated at some length, and which unite, or should unite, the inhabitants several interesting cases are given, but the chief attenof these countries into one true brotherhood, tion of the author bas been obviously directed to that we may rest assured that one cannot suffer of aneurism, and its several varieties. On referring to without the others suffering also, and that the the treatment of aneurism by pressure, which has of contagious disease which privation and destitu- late excited so much attention, we find the merits of tion generate in the cottage, will assuredly the Dublin Surgeons, in the revival and again bringing spread to the mansion, and thence also carry off into notice of this mode of treatment, acknowledged. its appointed victims.
The author expresses the opinion, “that this method of treating aneurisms of the femoral and brachial
arteries will, after a few years, be universally adopted," Reviews.
and that “a surgeon will not consider himself justified in using the knife, until pressure has had a fair trial.”
Mr. Crisp had before expressed his belief, when writing A Trealise on the Structure, Diseases, and Injuries of the
on this sabject in 1844, that pressure might be more Blood. Vessels, 8c. By EDWARDS Crisp, M.R.C.S., &c. &c. London: 1847. Svo. pp. 354. Plates.
frequently adopted. At that time he was acquainted
with only six recent successful cases. The general We have great pleasure in commending to the notice table before referred to, comprises twenty-one cases, of the members of the Provincial Association this and others he says “have been treated successfully by excellent work of one of our Associates. It had already Messrs. Todd, Molloy, Duggan, Cusac, [Cusack, we received the approbation of the Royal College of presume, the President of the Royal College of Sargeons, as the essay to wbich the Jacksonian Prize Surgeons of Ireland,] Crampton, Harrison, Datnell, for the year 1844 was awarded, but has since been Armstrong, and O'Ferrall. Considering the vast revised and extended, so as to render it more complete importance of the inquiry, and the opposition still as a treatise on the subject to which it refers, and con. offered to this mode of treating aneurism, by Professor
nily more worthy of the attention of the profession. Syme, of Edinburgb, and some other distinguished After a short chapter on the structure of arteries and surgeons, the cases here alluded to, ought to have veins, we are successively led to the consideration of found a place in the general table, or what would have the morbid conditions of arteries, under the several | been better, all the recently-recorded instances, sucheads of arteritis, arterial deposits, diseases of the cessful or otherwise, in which compression had been aortic valves, of the pulmonary artery and its valves, | had recourse to for the cure of aneurism, might bave abdominal pulsation, aneurism and its varieties, been giren in a separate table, which would not have dilatation of arteries, ulceration, rupture, and wounds been surpassed in interest by any other in the work. of arteries. The diseases of reins are then treated It may be observed bere, that the author is not disof, including phlebitis, pblegmasia dolens, oblitera posed to place much reliance on the operation of galtion and obstruction, dilatation of veins, varix, hæmo. vano-puncture, lately recommended by M. Petrequin, rrhoids, ulceration and wounds of veins. A chapter 1 of Lyons, which indeed, is little more than incidentally
mentioned, and dismissed in a single brief paragraph of in some instances in which this abdominal pulsation some ten or a dozen lines..
had been noticed, but they throw little light on the As a subject of some interest and occasional embar. pathology of the affection. In one only of them are rassment to the practitioner, and at the same time, the coats of the aorta described as being “rather often the source of much alarm and anxiety to the thinner than natural," and the expression, it must be patient, we were desirous of ascertaining whether the admitted, is, to say the least, a very indefinite one. remarkable pulsation in the epigastriom, formerly so generally looked upon as depending on aneurism, had received any additional illustration in the work before | Observations on Aneurism, and its Treatment by Comus. The attention of the profession in this country was pression. By O'BRYAN BELLINGHAM, M.D., Edin., first called to the pature of this pulsation by Dr. Baillie,
Fellow of and Professor in the School of the Royal (“ Transactions of the College of Physicians," vol. IV.,)
College of Surgeons, in Ireland, &c., and one of the and since that time its non-connection as a symptom
Surgeons to St. Vincent's Hospital. London. 1847.
pp. 181. with aneurism has been very generally admitted. There is, however, some reason to believe, that a too We notice this little work here, for the purpose of ready reception of the views of Dr. Baillie bas, in recommending it as giving a compendium of the bistory some instances, led to an updue disregard of the symp- of the treatment of aneurism by compression. It tom, wbich we may observe whenever present should moreover contains a summary of the cases of aneurism receive the closest investigation on the part of the in which galrano-puncture has hitherto been performed, practitioner, however desirous he may be of giving bis together with a brief exposition of the mode in which patient the benefit of the more cheering views of its it acts, in effecting the cure of aneurism. On each of import which are unquestionably to be entertained in these subjects, and especially on the former, it will be many of the cases which present themselves.
found to afford interesting and useful information ; and Mr. Crisp classes the cases in which this pulsation is to the operative surgeon cannot but prove of much observed under three categories :- 1. “ Those depend assistance in directing his attention to the sources ing upon constitutional causes, such as chlorosis, where more ample details of the cases referred to bysteria, anæmia, from loss of blood, &c.; in short, may be obtained. any state of system inducing an impoverisbed condition of the circulating fluid, or derangement of the verr. ous functions.” 2. Mechanical obstruction, as from
. Proceedings of Societies. tumours of various kinds pressing upon the aorta, “enlarged pancreas or spleen, scirrhous stomach, dis.
NEWTON BRANCH OF THE PROVINCIAL eased mesenteric glands, and collections of air and
MEDICAL AND SURGICAL ASSOCIATION. scy balous matters in the bowels." 3. Sympathetic
ANNUAL MEETING. affection of the aorta with otber diseased states, con
(Continued from page 471.) sidered by the author as the most frequent form under
GALVANISM IN UTERINE REMORRHAGE. which the symptom appears.
Dr. Radford reported the following instance of In reference to this last section we find the following successful application of galvanism to the uterus in & observations: Although," says the author, “I am case of accidental hæmorrhage, which shews that the disposed to agree with these authorities, (Dr. Baillie, stimulation of the uterus may be efficiently produced Dr. Fausset, and Dr. Stokes,) that stomach or intestinal mediately through the abdominal parietes:affection is generally the exciting cause of this malady, On October 13th, 1846, I was requested to visit I believe that it can only take place wbep the parietes Mary Daniel, who was said to be much reduced by of the vessel are in a weakened condition : this proba. continued fooding. The following are my notes of bly depending upon structural defect, or the derange. the case at the time:-She is thirty years of age, pent of nervous influence. It is difficult to imagine tall and thin, and of a leuco.pblegmatic constitution. that local pulsation can arise from nervous excitability She has a bad cough, and expectorates a quantity of alone, or that the upper part of the aorta can be mor. muco-purulent matter. She is now in labour of her bidly excited without the lower portion being in a fourth child. Her first labour was quick, and the similar state; if, huwever, the coats of the artery, from child a girl;-in her second, sbe was still more speedily want of innervation or structural peculiarity, lose their delivered of a boy ;- the third was also a boy, after a tone, and possess greater tenuity and extensibility incer. lingering labour. All these three laboars were attended tain parts, the phenomenon is more readily explained. with excessive post-partum flooding, in which extreme If functional disorder, or structural lesion of the syncope occurred, and were followed with great weakstomach alone, would produce inordinate pulsation in ness, from which she was a long time before she a healthy artery, these cases, instead of being rare, recovered. Her present labour (the fourth,) began would be of daily occurrence.”
at eleven o'clock p.m., October 12th, and regular pains Mr. Crisp gives the appearances observed after death continued at short intervals until half-past five the
Dext morning. When Mrs. Mather, the midwife, I bowels not moved; belly free from tenderness ; uterusvisited her, the on-uteri was nearly fully dilated, the felt to be firmly contracted; she had very slight after membranes had spontaneously ruptured, and a small pain, at which she expressed herself surprised, having quantity of liquor amnii was discharged. There was so severeiy suffered after each of her former labours; a continued dribbling discharge of blood, which was there was milk in the breasts. . Ordered child to be accompanied at times with gushes. The pains now applied; an enema to be administered. To take altogether ceased, and did not return for two or three Opii, gr. 88. ; Extr. Hyoscyami, gr. iij., three times a bours, and then so slightly as to be scarcely felt by day. Lioctus Papar. for cough. the patient.
15tb. Slept well; tongue clean; pulse 84; bowels I arrived with the galvanic apparatus at the patient's once mored; passed water; slight lochial discharge ; house at twelve o'clock at noon, and was kindly accom: plenty of milk; belly free from pain. Continue the panied by Mr. Runcorn, the resident medical officer medicine. of the Lying-in Hospital. She was very much ex. From the above date she continued to gain strength, haasted, her countenance ghastly pale; her lips and and her cough to improve, and when last seen was tongae were also very pale; the pulse was very frequent, I quite well.. and 80 feeble as sometimes not to be felt. The os Remarks.There is no apparent cause for the uteri was nearly fully dilated, and included a portion bæmorrhage; it may, however, have been produced of the head which had passed through it; there was a by the violent cough acting mechanically upon a dribbling palo sanguineous discharge; there had been portion of the uterine parietes, thereby inducing local no pain of consequence for a considerable time as spasm, which very frequently tends partially to separate above reported. I now applied my band on the the placenta from its attachment. Rupture of the abdomen over the uterus, and was immediately struck / membranes in case of accidental hæmorrhage, in with the excessive thinness of the abdominal and general effectively arrests the discharge; but in this uterine parietes. The rotundity of the breech, and case, as in many others which have fallen under my the sharp and projecting parts of the child's limbs, observation, it failed to bring about complete uterine were easily felt, and one part could be as readily traced contraction. What plan can we depend upoo under to another, as if only covered with two thin folds of such circumstances ?- Artificial delivery I-Secale corcotton cloth. In fact, I could easily grasp a limb. Datum ?-Galranism ? I now mentioned to Mr. Runcorn, that I considered The first or artificial delivery is liable to serious it a very good case for the application of galvanism; objections in the great majority of cases; and there. and I also mentioned our plan to the patient, who at fore we ought only to bare recourse to it when some first felt a little objection, but was readily persuaded extraordinary circumstance exists to demand this pro. 1o its use. The power used, at first, was slight, but cedure. gradually increased until the lever was placed at the The second means which may be employed is the highest point. The two hand conductors were only Secale corputum. This drug is liable to great deteriora. used, and applied externally on opposite points on the tion; its operation is not always certain ; its failure abdomen, varying from time to time their relative depending sometimes, perhaps, on its inert qualities, positions, thereby carrying the galvanic Auid through but frequently on a constitutional idiosyncracy which the longitudinal, transversal, and oblique diameters resists its powers. There are organic states which of the uterus. The beneficial influence of the remedy forbid its use;—when the ns uteri is undilated or was soon apparent, and the extreme atonic state of undilatable, the child being still alive, it ought not the uterus was now gradually exchanged; its parietes to be adminstered. If in such a case it induces power. became firmer, and the edges of the organ, which ful tonic contraction of the uterus, it destroys the before were so soft as to appear to float amongst the child; we cannot control or confine its action, and abdominal viscera, from not being traceable, now therefore it is totally unsuitable to cases in which we became defined. This favourable organic condition only want a limited effect. Again, if exhaustion is proceeded; and the induced pains, at first grinding an element in the case, it is wholly inapplicable, as and slight, became powerfully expulsatory; and the we ought not to adopt any means which tend farther child (a girl,) was born alive at half-past one o'clock, to depress the vital powers. about an hour after we began our operations. As soon The powerful and sanatory influence of galvanism as the Oterine energy was fully roused, the child was was most decidedly obtained in the preceding case Tapidly and forcibly expelled. The band was applied and the great advantage of this agent is, that its effects over the uterus, which was found firmly contracted. I may be carried to any degree, from first only exciting The discharge of blood ceased as soon as tbe uterus the uterus so to contract that its diameters are lessen ed began to contract. The placenta was expelled in and that its tissue comes to be applied to the body of about five minutes; the uterus had further firmly the child. These however may be at pleasure increased, contracted; there was not the least bæmorrhage, so as to accomplish the expulsion of the child and and the constitutional condition of the patient was placenta. The gradual changes produced upon the much improved, and indeed much better than could uterine tissue were admirably seen in the foregoing reasonably have been expected.
case; and also its great power, developed by its conOctober 14th. No flooding; slept well; passed urine; tipued application, to arrest the discharge, expel the tongue moist; pulse 90; cough very troublesome; child and the placenta, and leave the organ safe from