« 이전계속 »
Up to the present time we have, I believe, no clear Her husband also became affected. He had great insight into the origin of those periodic scourges irritability of the stomach and bowels, wandering paids which afflict mankind in the shape of epidemics.
in the limbs, white tongue, and an accelerated circola. “ The question of the origin of fever in such cases
tion. He dreaded confinement to his bed, and could not
| bo persuaded to remain quietly at home. Happily bis is far from being easily settled to the satisfaction of a
natural courage and pressing engagements as a prac. philosophical mind."* of this much we are certain,
tical engineer, employed on the railroad in adjusting that free currents of pure air dilute and dissipate aërial the telegraphic apparatus, kept him much in the open poisons, so as to render them little hurtfal, while con- air. For some days he endered much weakness, fined air is the medium in which they linger, and the
headache, and the concomitants of fever of the first effluvium of organic decomposition becomes, if not the
degree, but be was perfectly well in a fortnight. generator, the conductor of the fomites of infection.
Cases of this grade were occurring in all parts of It would be idle to occupy the attention of the reader
the town : young and old became afflicted. The by minute details, only so far as the febrile movement
febrile impression was not serious, though not soon we are now contemplating, exhibited certain general
subdued. features which we shall mention. Thus there were The epidemic in the second degree differed from the several degrees of intensity of fever, somewhat cor. first chiefly by its greater intensity. The patient al responding to synocha, synochus, and typhus; but as the early stage had a deep Aush on the cheeks, each class of cases was identical in its primary and alternating with paleness; dry skin; thirst; thick drabprincipal lineaments, still for convenience of arrange- coloured secretion covered two-thirds of the tongue; ment, we may consider them one and the same disease, the pulse rapid, i.e., from 110 to 130; urine turbid. simply acting with greater or less severity on the indi. Uniformly there was a certain amount of cerebral viduals attacked. Many encountered the first degree, disturbance, indicated by moaning or crying out, with the greater number the second degree, and not a few sudden sharp pains. A restlessness and delirium were affected by the third.
existed in most cases, and led one to saspect meninThe following outline may serve to give a tolerable gitis. After the subsidence of the latter symptoms conception of the train of symptoms constantly pre one might observe there was marked pervigilium, which sented, and by which the epidemic was immediately was succeeded by unusual torpor. recogoized :-The countenance expressed wretchedness! Sir H. E., aged 17, complained of headache, shiverof feeling, or stupefaction ; coldness diffusing itself ings, a total want of appetite, and great lassitude. He through the body very frequently, perhaps erery had white brown tongue, frequent pulse, and pain in quarter of an hour, was succeeded by beat, headache,
the epigastrium. This attack lasted three weeks, but
throughout the whole period his state might be confrequent pulse, thirst, furred tongue, epigastric and
sidered free from danger. He possessed a good con. abdominal pain, diarrhea or occasionally an opposite
stitution and could weather the storm. It was far condition of the bowels, the urine loaded with lithales.
Otherwise with those who had serious organic affections In all cases the fever, whether simple or more com-at the time of the attack of rever; with such there plex, had, as we may well suppose, many shades of were few chances of a favourable issue. intensity, and many varieties belonging to each division A lady, aged 29, of a lymphatic temperament, had of cases. It is not needful to give formal definitions been in delicate health for the last two years, from of the several gradations of fover, as each grade will chronic dysentery; but baving been on a visit into
Devonshire, she returned to her home, at Burbage, be best exemplified by the recital of a few instances.
convalescent. Fever prevailing in the village, soon Fever of the first degree, was manifested by such
after her arrival, she became affected by it, and although symptoms as above, and had but a comparatively short
the disease attained the second degree only, general
cedema was consequent, and she died the fourth week duration. In some persons the vis vitæ, or the right
from effusion into the head and chest. appliances of medicine, were sufficient to prevent the
A child, aged 4 years, with disproportionately large noxious influences going beyond theso limits, as the articulations of the limbs, always pale and thin, was following cases will illustrate :
seized with the same fever. On the 11th day there Mrs. H., aged 34, after undergoing much anxiety and was strabismus, dilated pupils and convulsive morefatigue from the illness of two of her children, was sud. ments of the right extremities. The case ultimately denly attacked with creeping chilliness down the spine, assumed the worst form of hydrocephalus, and termiaching in the loins, great thirst, loss of appetite. There nated fatally on the twenty-second day. was a scanty secretion of urine, which was remarkable, A young man, aged 19, had not long recovered from its being coloured with bæmatosine. Now, although from lambar abscess. He had slight cough, but he fever ranged no higher than the first degree in our was able to follow his employment as writer in the pyrexometer, and only partially confined her to bed, office of a solicitor. After falling with fever, a discharge yet it continued for five weeks, with little abatement,
| abatement, was reproduced from the old cicatrix in the loins, and by which time her health returned.
on the seventeenth day from his taking to his bed, ho
sank. An examination revealed grey tubercles in the • Dr. Christison, in " Library of Medicine," Art, Ferer. llungs, as the remote cause obstructing his cure.
· I have not known fover of the second grade carry patient were inclined to arouse them : they were wrong ; off tbe patient, unless, as in the cases just recited, it this deep sleep ought not to be interrupted, for invariably was complicated with a pre-existent morbid state of a favourable event followed. It was critical, and body. There mighi, however, be local disease, not marked that crisis which ended in copious perspiration, having any bad influences, as it respects the fever.
grateful sensations, and an abatement of vascular J. B., aged 20, had disease of the knee-joint for two
excitation. Indeed, this extraordinary repose and years, when he was seized with fever, which lasted for repeated diaphoresis was not uncommonly the prethree weeks. The one disease bad no apparent effect cursor of convalescence; the appetite at the same time on the other in retarding the cure. He soon afterwards
returning, the physical powers were gradually recruited. went to his work as a smith, with merely the incon
Nevertheless, it was from three to four months before venience of anchylosis of the joint.
the health was perfectly regained. " To form a right conception of the third degree of Another distinguishing feature of the epidemic was, this epidemic in all its circumstances, we ought to that in no case which came under my observation could soppose the patient to bare imbibed a concentrated
it be said to be ephemeral; in its mildest attacks it long malaria, subjugatiog every orgau and function to a held the sufferer within its grasp. We had also typhoidal influence.
abundant opportunities of remarking how much a pure I will transcribe from my notes the case of a fine young | air, and the habits of country life, give superior powers woman, aged 20, who, when I first saw her, had been of endurance under disease. That such circumstancos ill three weeks. Her face had the expression of sub
should modify, if not the material of fever, yet that it dued suffering; sordes on the lips and teeth of a deep
modifies the effects of fever, is more than conjecture. blood colour; longue covered by a thick and dry mucus of the same appearance. A dark sbade surrounding
There can be no doubt that the physical condition of a the eyes indicated the sunken contents of the orbits; rural population, living in comparative comfort, would at the inner angles the veins were blue and prominent; form a striking contrast with the physical condition and the pupils somewhat dilated, and the eyelids half powers of endurance of persons living in large towns. closed; alæ of the nose moved in each respiration ; Those who have been the subjects of the visitation of the expirations quite audible; crepitant rhonchus;
an epidemic, under wretchedness and privation, have cough, and a rusty mucous expectoration. It required considerable tact to count the pulse, as it was small,
their vital powers fail at the first onset. Whereas, in and between 130 and 140, certainly not less than 130. our neighbourhood, we have been frequently astonished She at one time complained of pain in the chest, at at the tenacity and conservation of human existence another in her bowels. The hpyogastric region was, under morbid phenomena so excessively enfeebling. on pressure, extremely tender. At a more advanced
When the subject of fever has been free from previous period of the disease this patient became deaf, and
organic change, and not greatly advanced in life, the took not the least notice of anything passing in her
epidemic bad a tendency to run its course without bed-chamber. Unconscious of her danger, wants, or necessities, she was unable to appreciate the concern
hazard to life. Cases in my practice have never been and attentions of her dearest friends. Thickly folded fatal, unless the patient at the time of the attack clothes were placed under her, and attendants admin. laboured under serious disease, or the disadvantages of istered to her comfort just in the same way as to the old age. most helpless infant. She could only take fluids ; as
(To be continued.) to food of any kind there was a total distaste, as also for every mental and physical enjoyment. The functions of the endermic system, being too feeble to throw off the secretions, the skin became dry. We might now
ON THE EMPLOYMENT OF THE POWER OF view this patient at the maximum of the epidemic, and
ELASTICITY IN SURGERY. altogether & worn.out emaciated being. This case recovered, although it was three months before the | By HENRY CLARK, Esq., F.R.C.S., Surgeon to the enervating effects of the malady disappeared.
(Read at the Annual Meeting of the Bath and Bristol Branch The vital powers in persons of advanced age were
of the Provincial Medical and Surgical Association, held unable to contend with fever of this type.
at Bristol, July 22nd, 1847.) Mrs. G. B- , aged 77, fell with fever. In the
I am anxious to call the attention of the members second week her arms and legs became livid; there | of the profession to a power which may be advanta. was extensive sloughing over the sacrum, and on the geously exercised in surgery. Although it has not been fifth week she expired.
entirely overlooked, still its application has been very
limited ; in some of the cases to which I shall refer, From four to six weeks generally elapsed before there
I am not aware that it has ever been employed. was any permanent remission, when the grievous com.
The power I allude to is elasticity. This principle plaints of pain in the back, or limbs, or bowels, were is
vere is unceasingly exerted in the human economy. By succeeded by a profound sleep, which when undisturbed virtue of its influence the vessels are enabled to accom. lasted from six to eighteen hours. There were instances modate themselves to their varying contents. By its of quiet alamber for three days, The friends of the l instrumentality those slender encircling bones, the ribs, have their integrity maintained, and are enabled to are cases I know where these means are indispensable. defend from any rude concussion the important organs I only desire to express an opinion that in pumerous they surround. Whenever we flex the trunk, the instances where that kind of power is exerted, the niatervertebral elastic plates assist the muscles to restore elastic principle would be more appropriate, and that n the column to the upright posture, and afterwards to to this mode the motto may be most aptly applied i maintaia, that attitude without the expenditure of
"Cito rato el jacunde.” continual muscular effort. We walk upon an elastic
Hitherto the caoutchouc has been principally used in arch, and every section of the bony apparatus of our limbs has more or less of elastic material interposed
surgery as a compressor; the novelty of my idea---if it
have that claim-is in using it as a tractor, and in between and around them, so that when any member is
estimating its power in this respect at a much bighier exercised, by this agent it is greatly aided to resume
rate than others bare bitherto done. its normal position. The skin and other tissues partake of its advantages ; indeed, deprived of the I will without entering into detail enumerate a fer
principle, life would be almost intolerable, and instances in which it bas been found to act with marked our movements, which are now performed with celerity benefit. and comfort, would, in the absence of this agent, In lateral spinal curvature. become both irksome and dangerous.
la bending rigid joints and straightening them when
ontracted. I should however outstep my prorince were I to do more than illustrate the general use of elasticity by a few
In the removal of long portions of dead bone from ' leading particulars. I have glanced at a few, that your
the soft parts, and in withdrawing a sequestrum from minds may be suitably impressed with its extensive
its osseous shell.
In the removal of ligatures when they hare been agency, and that you may be induced to set a proper | estimate on the value of its influence.
detained beyond the accustomed period.
In opposing the tendency of the cicatrix to contract We cannot accurately imitate muscular contraction;
| after burns. we cannot supply a principle precisely analagous to the nervous fluid; but we can supply the elastic property, and thus, in a variety of instances, help nature exactly in her own way. Nature abhors being treated abruptly. PURULENT OPHTHALMIA IN INFANTS. Where you cannot advantageously use coercion, you may beneficially exercise forcible persuasion. 10 By JAMES WHITEHEAD, Esq., F.R.C.S., Surgeon to the mecbanical surgery the rack and the screw I allow are Manchester and Salford Lying-in-Hospital. powerful and useful instruments, but still they are felt (Read before the Provincial Medical and Surgical Associa. as obnoxious agents, while the elastic media are recog. tion, at the Anniversary Meeting, at Derby, Wednesday, nized as the true natural allies. Vulcanized caoutchouc
August 4th, 1847.) has this desirable elasticity, and similates most closely Purulent ophthalmia, as it is met with in infants, this property of the living animal tissues. This is the is of such frequent occurrence, and occasionally so medium that I would propose to be used. In its disastrous in its consequences, that the subject will, operation it will be found to exbibit the fortiter in re, doubtless, be allowed to possess considerable interest and at the same time to exemplify the suaviter in and importance in a medical point of view; and the modo-a happy combination, which in physics, as well uncertainty which has hitherto prevailed respecting as morals, is the great clue to the attainment of our its origin, and the means to be employed for its object. By the great power of the screw or the rack | effectual prevention, appears to leave its history open we may suddenly overcome, and subsequently rigidly at least to further investigation. The facts which I maintain the position gained, but it is only by occa- have to addace are intended to bear directly upon this sional starts that progress is made, and there is nothing disputed question; and although scanty, and by no Datural in the process. The elastic medium on the means fully digested, I am, nevertheless, emboldened contrary, when once applied, is perpetually at work, to bring them under the notice of the Association on and, like the drop of water that excavates the stone, the present occasion, believing that any trifle capable of not by its own inherent force, but by its unceasing contributing to the elucidation of an obscure point in action, so the caoutchouc, not by its native strength, l pathology, may not be deemed unworthy of being
but by its untiring exertion, is enabled to accomplish communicated. * purposes which the fitful action of a stronger power is the first indication of purulent ophthalmia consists
incapable of effecting. The one is an energetic sleep- in simple turgescence of the vessels of the conjunctiva, - less sentinel ever active on duty; the other a powerful | upon which membrane granulations are soon after - but dormant guard requiring to be aroused to efficient seen to spring up in great abundance, and a very i service; and this is not the only distinction, for the profuse secretion of pus ensues. This product has presence of the one in the human economy is viewed
the property of generating a similar train of morbid as that of an enemy, while the assistance of the other
phenomena on being applied to the eye, or to the • is regarded as that of a friend.
mucous structure of some other organs, either of the -- I would wish to be clearly understood that I do not | same, or of another individual.
aim to discard the use of the screw and other similar The inflammation is generally found to attack, in al powerful mechanical instruments from surgery. There the first instance, the layer of membrane lining the
lower eyelid; at other times it commences in the another, - between simple catarrh consequent upon ocular, portion, and rapidly extends to some of the vascular exeitement, without abrasion of texture, and deeper structures of the eye. The cornea, owing, that which is occasioned by ulcerative of inflammatory perhaps, to ils peculiar anatomical construction, is action, resulting in the secretion of pus. All the especially liable to become early implicated. When cases of this affection which have occürred in my the affection is severe, lamella after lamella of this part practice, where an opportunity has been afforded for of the organ is destroyed, and in a very short space of prosecuting the necessary inquiries, have happened time the whole is perforated by the diseased action, in children whose parents laboured under such disand loss of vision is the inevitable consequence. I ordered state of the lower part of the uterus, visible have several times witnessed this lamentable con. to the eye by aid of the speculum. ! summation upon raising the eye-lid, on the occasion Secondary purulent ophthalmia appears, more of the little patient being first presented. for treatment, remotely, to be dependent, upon the same agency. on the fourth, fifth, or sixth day after birth. Perfora. The case marked, No. 18, which was said to have tion of the cornea is accomplished at an earlier date commenced at llie age of three weeks, was attributed in those cases wherein the disease commences in the by the parent to the application of cold. The child ocular, than when it has its origin in the palpebral was brought under treatment when between ten and portion of the conjunctiva.
eleven months old. Its mother had yellow leucorrhea, Purulent ophthalmia, as regards the date of its with all the sympathetic disturbances usually attendant commencement, appears under two different aspects. upon uterine disease, the symptoms having existed In the first place, its invasion is observed at any upwards of eighteen months previously. She had period from the moment of birth, to the end of the fissured ulceration and induration of the cervix ateri. fourth or fifth day; secondly, it commences from the | It is highly probable that the fatal system becomes last-named age, to that of ten or twelve weeks, or imbued with the morbid prodact during its intra-uterine later. The great majority of cases, however, are life. - In such instances the mischief may manifest brought under treatment on the second or third day itself at any period after birth, its seat being determined after birth; and I have often witnessed evidences of by the application of cold or other cause to the part the existence of the malady a few hours after delivery. upon wbich the diseased action becomes détermined. The two forms of the complaint now mentioned, which, or the virulent nature of the secretion furnished by for the sake of distinction, may be designated primary diseased surfaces situated near the lower part of the and secondary purulent ophthalmia, are also different, uterus, independent of specific causes, there cannot be the one from the other, in character, the disease being a doubt, as may be proved by the occasional occurrence much more acute, more rapid in its course, although of all the phenomena of blenorrhagia in the male at the same time, perhaps, more easily controlled by subject from inoculation, under such circumstances, remedies, if early applied, in the former, tban in the effected during coition. The fact is further proved, latter form. Under both circumstances, it owes, its moreover, by my own experiments upon dogs,* in origin to the same agency; but this, in the one case whom a similar form of inflammation was produced on and the other, operates in different ways.
the matter being directly transferred from the human The causes of purulent ophthalmia bave been variously uterus to the eyes of these anipals. A similar form of stated by authors who have written on the subject. inflammation is sometimes witnessed in the ear, the The cases which I now adduce, however, happened nose, the vagina, or around the adus, instead of the in the children of parents in whom a particular morbid eyes, in infants; and it is highly probable tbat this condition of the uterus existed previously to the birth also originates from the same species of inoculation, of the child. In the thirty-five cases, an abstract of With a view to the prevention of this destructive the histories of which is given in the appended table, malady, it is of the first importance, whether disease of inflammation or ulceration of the lower part of the the maternal organs be suspected or not, that the eyes uterus of the mother was known to have been pre. of the infant be perfectly cleansed and washed immeviously present. It is reasonable to presume therefore, diately after delivery. If it be possible, the uterus of that the disease, in its primary form, owed its existence the mother should be restored to a healthy state before to the direct application of the morbid secretion to the delivery takes place. For subduing the inflammation organ affected, and that the inoculation took place on when once established, the most efficient plan with the transit of the infant through the uterine orifice which I am acquainted, is the free application of the during parturition.
solid nitrate of silver to the inside of the lower eyelid, Mackenzie appears to have been spfficiently aware as first recommended by my esteemed and lamented of the fact, that purulent ophthalmia in infants de- / friend the late Mr. Walker.*. It may be remarked that pends, in many instances, upon virulent inoculation cases of this character generally require constitutional during parturition, as he states, at page 432 of his. as well as local treatment. work, second edition, that “it will in general be found, that when the child becomes affected with this
See " Abortion and Sterility," case xxxi. ophthalmia, the mother has had leucorrhea before and
"Oculist's Vade-mecum." at parturition, and that the eyes have not been cleared for some time after birth." This author does not dis. tinguish, however, between one kind of leucorrhoa and
an TABLE, EXHIBITING AN ABSTRACT OP THE HISTORIES OF THIRTY-FIVE CASES OF PURULENT OPHTHALMIA IN INFANTS.
Age of the Number of preg-Number of Children
ing Abortions, with Ophthalmia.
Age of the Child.
Character of the
Nature & alleged Origin
APARANET W VOODOWA OD O. VW GOR MAA vueoer og er al NOON
Exposure to cold.