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We are told that cold air antagonizes consumption, alone or mixed with muous. The sanguineous discharge because there is no consumption in Russia. That is repeated two or three times during the day. As the damp marshy air also antagonizos consumption, because disease makes progress, the pasal discharge becomes there is no consumption in ague districts. ()

e districts. (1)

That

That more sanious, and irritating, causiog ulcerations and damp air is always warm. (?) And that the benefit

Assures of the alæ nasi and upper lip, which are

| covered with a dark tenacious scab. of warm air is due to its moisture, and not to its tom.

This specific disease must not be confounded ith peraturo, (i) The simple English of which is this:

the numerous non specific eruptions of the same parts That a cold damp atmosphere ought to be the most

which assail children at the breast. The latter do not favourable to the prevention and cure of phthisis !

necessarily commence in the nose, but sometimes We shall not pursue the analysis further. The extend to it from the mouth, or attack the nose, eyes, whole book is pervaded by a spirit of which we cannot and ears simultaneously. The true venereal affection approve, and which when connected with frequent always commenoes in the nostril, and generally spends inaccuracies, and the absence of any real information,

its force upon that part, having a tendency to spread leads us to wish most sincerely, for the sake of the

inwardly rather than externally. At a still nore writer, and of the profession to which he belongs,

advanced stage, the bones lose their support, and the

roof of the nose falls in, giving the infant' a strange that the desire of authorship had not in this instance

aspect. The breathing becomes more difficult and been gratified. - . .

snuffling, and sucking is almost impossible. If the

child attempts to take the breast, it is obliged to drop Foreign Department.

the nipple from a feeling of impending suffocation.

The time required for the disease to arrire et ABSTRACT OF A MEMOIR ON INFANTILE

this stage is very various ; sometimes a week or

two is sufficient, in other cases many months are SYPHILIS.

required. The mucous membrane at first appears By M. TROUSSEAU.

thickened, and more or less softened, of a reddish (Translated for the Provincial Medical and Surgical Journal.) brown colour, but without any trace of ulceration,

Constitutional sypbilis seldom declares itself in the Later, numerous small ulcers of variable depth are seen. infant at birth, and is still more rarely seen to have In some cases these extend to the bones, producing commenced during intra-uterine existence. Neverthe. caries and destruction of the romer, the turbinated less, some instances have been recorded of both occur. bones, and even in some instances, of the superior Tences. In the author's experience, the disease does not maxilla. In the more uncommon cases, we observe appear before the second week in life, which is the the lesions to have a scrofulous aspect; the septum limit commonly assigned to it by authors. The other narium is perforated, and the perpendicular plate of limit, or that at which constitutional syphilis ceases to the ethmoid is couverted into a semi-cartilaginous manifest itself in the infant, is not so readily ascertained, tissue. The connection of these lesions with the but M. Trousseau has never seen it appear for the first symptoms above enumerated is readily comprehended. time after the seventh month. Of course he alludes to Such is the origin, progress, and consequences, of secondary symptoms; tertiary symptoms in the infant, syphilitic coryza. It is one of the most constant of as in the adult, cannot be brought under any particular the constitntional manifestations of venereal disease; it

gives rise to discharges, at first mocous, afterwards Constitutional syphilis does not always begin under sapious and purulent, together with more or less the same form, hence any arrangement of symptoms bleeding from the nostrils. It ends by caries of the according to any supposed order of appearance, must be bones, and deformity of the features... EL futile. Sometimes it begins as a simple erythema, at Another appearance in infantile syphilis, which is others as a more deep-seated affection of the integument. almost as constant, is the peculiar tint of the integuCommonly, however, the disease first appears in the ments. The disease, in fact, induces a gradual wasting mucous membrane of the nostrils. Under sach circum. of the child,-a cachectic condition, in which iro stances, the child is in that condition which has received periods may be distinguished. The first of these is the popular designation of the “spufiles.” It breathes the initiatory stage, which is essential to the disease, with some little difficulty, and the expiration is whistling but which cannot be attributed to the mere length of when the mouth is shut. The disease is especially eridept its duration; the other is final, and generally is the when the child is taking the breast; it is then, in fact, near precursor of death. that we are able to measure the difficulty of breathing, From the earliest manifestations of the vepereal because the child cannot then breathe freely by the taint, even before the health suffers, the infant bas e mouth. At first the embarrassment is not greater than peculiar aspect. The skin, especially that of the face, in some non-specific affectious, as at the commence. loses its transparency; it becomes sallow, without ment of measles, for instance; but this mild stago paffiness; its pink hoe disappears, and is replaced by seldom lasts long, and symptoms of more significance a brownisb tint. This colouration is rarely absent, arise, in some cases without the parents having taken though it varies in degree, and in the date of its any notice of the precursors. At tbis time a few drops appearance. Sometimes it is general; at others it is of blood are soon to escape from the nostrils, either confined to the face, or to portions of it, as the forehead

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root of the nose, eye-browe, and prominent parts / mucous membranes. The fissures are deep and wide, of the cheek; the deeper parts in the bottom of the close to the mucous membrane, but diminish gradually oyo generally escape. The intensity of this colour is from that point. Thoy are of a vivid red colour, and sometimes 80 deep, as to resemble ephelides. The their borders are tinged as it wore by coagulated blood; tingo at which it appears is not easily ascertained, the intervening cuticle is of a brown lint, giving the Hinor little or no reliance is to be placed upon the mouth. a peculiar aspect. The anal fissures are, history afforded by the mother. It is readily dissipated usually less red and deep. The cicatrization of these under treatments," says

| fissures is slow, either on account of their specific We have given the two above phenomena with some nature, or from the movements of the lip in saction. detail, because they are of great importance; because Fissures of the lips are almost always as

iated they are the first to appear, and are, moreover, closely with vesicular or postular eraptions in the immediateallied to the next, in the series of constitutional symp- neighbourbood; they are later in their appearance toms, viz., the cutaneous eruptions.

than the coryza, coming usually simultaneously with Almost all the types of skin disease are represented in the ochry tint of the face. These fissures are a source the veneroul eruptions of children, as in the adult, but of great inconvenience; they gise rise to great pain some are'of so rare occurrence, and when present are 80 during the attempt to suck, so much so that some indeterminate as to their specific nature, that they children refuse the breast altogether. The coryza adds need scarcely be mentioned. Others, bowever, deserre to the severity of the symptoms by embarrassing the a serious attention.

respiration. Under this accumulation of suffering the After having examined a great nomber of cases, we do infant falls into a state of marasmus, the combined not hesitate to say that there are many forms of eruption effects of the specific cachexia, and the inability to take of which it is very difficult to ascertain the venereal sufficient pourishment origin from their aspect alone ; and we have frequently

(To be continued.) asked ourselves the question, whether there are any general signs by which the specific nature of an eraption can be determined? Can the same confidence

ABSTRACT OF THE PROCEEDINGS OF THE be placed in the coppery tint, brown crusts, and circular

ACADEMIE DE MEDECINE. forms of the eruption in the infant, as in the adult?

LITHOTOMY AND LITHOTRITY. Although it is sometimes very manifest, the coppery in our last account of the proceedings of this hue is often far from being 80 ; in general it may be assembly, we stated that the discussion on the relative said that in robust well-fed infants, it is little apparent; merits of these operations had been revived. We and these frequently do not present the smoky com. proceed to lay before the readers of the Provincial plexion which has been alluded to. Moreover, certain Journal the continuation of the debate, and the argue forms of secondary erruption are never coppery, as the ments of the different speakers. mucous tubercle for instance.

M. Velpeau, who commenced the discussion, declared The alcerations of the macous membranes, those of that he had nerer called in question absolutely the the pasal fosse in particular, are of a colour sufficiently utility of lithotrity, he ouly wished to ascurtain the marked to prevent mistake, but unfortunately their exact limits of this utility. He conceded that in the characters are Bot ascertained until after death. The cases indicated by M. Civiale, it was less dangerous ulcers of the throat and mouth are simply red or than the ordinary operation ; bat, nevertheless, that whitish.

fact was not indisputably shewn by statistics, for in order : When scabs form on the surface of sypbilitic ulcera. that such should be the case, there should be means, tions, they are brown or nearly black. The latter of analysing, say at least a thousand cases, similarly colour is probably due to admixture with blood. situated in every respect. M. Velpeau, in continuation,

The coppery tint is not equally perceptible at all stated that in the examination of M. Civiale's statis-, periods of secondary disease. In the adult it is well tics, he (M. Velpeau) had been led to quite opposite known to become most distinct as the cicatrix forms, or conclusions. The former, for instance, states that the as the erythematous patches disappear. It is not so, relapses after lithotomy were more frequent than after, bowever, with infants; the cicatrices which succeed to lithotrity. M. Velpeau from the same figures deter-, all forms of eruption are reddish violet, and seldom | mines the very opposite. He mentions also that M. assume the ocbry hue. The livid hue is, however, in Civiale has omitted to include in the fatal or unsuc. most cases, sufficiently distinctive. Such are the cessful cases, those in which death has followed the indefinite sigus wbicb authors have endeavoured to attempts to explore the bladder; but this be observes draw from the colour of the skin. The circular is not right, as it is not just to separate an operation direction of the patcbes does not merit particular from its natural consequences. It is not the incision. mention.

of the soft parts that constitutes the danger of lithotomy, Among the cutaneous affections to which infants are but the urinary infiltrations, and the inflammation of subject, two demand especial notice, on account of their the bladder. In the same manner it may be said of freqaency and regularity, these are fissures, and certain lithotrity, that the danger does not lie in the operation remarkable alterations of the bands and feet. These itself, but in the organic state of the parts where it is fissaros are observed at the angles of the mouth, and performed, and in the consequences induced by it. In at the apus, where they are seen to radiate as from a his recapitulation, M. Velpeau observed, that the centre, taking the course of natural folds of the 'inference in his own mind from the preceding discussion

1666

NOTES FROM A PRACTITIONER'S DAY BOOK.

was, that we are more ignorant of the circumstancos | satisfactory conclusiou. He examined first, the sta under which lithotrity was useful, or even preferable to tistics of lithotomy,which he ascertained to exhibita morlithotomy; that the success of the operation has been tality of one in four. He then took the statistics of lithogreatly exaggerated, and under the circumstances in trity, and shewed that M. Civiale had given much too which lithotomy would fail, would be unsuccessful also, favourable a view, for taking the consequences of

M. Amussat, who followed, held the opinion that exploring the bladder into account, wbich be maintains lithotomy ought never to be adopted until after the should be done, be declared the mortality to be one in trial and failure of lithotrity, unless special conditions eight, instead of one in forty-three, as stated by M. existed which contraindicated it,—such as a diseased Civiale. This, however, he declared to give so moch state of the bladder or urethra, the latter of which is advantage to lithotrity, that he himself would not be irremediable as far as to allow the introduction of operated upon in another manner. instruments. After a careful attempt at breaking the stone, if it proves too hard, lithotomy must be had Tecourse to, but with this exception, lithotrity may be ABSTRACT OF THE PROCEEDINGS OF THE generally performed, even in cases of paralysis, or

ACADEMIE DES SCIENCES, PARIS. catarrh of the bladder. In conclusion, M. Amussat. M. Serres read his memoir on the treatment of fever declares for the superior advantage of lithotrity, by mercury, of which we hare already given an account, and considers that ætherization much simplifies the

M. Gonillon exbibited a new apparatus for fracture operation.

of the clavicle, which appears to be intricate without The speech of M. Segalas, which was the next in |

affording any particular advantages. rotation, is of great length; so much so, that we can give but its salient points. The conditions which render

M. Plourier detailed his treatment of epilepsy, wbich lithotrity impossible, he says, are respectively those

consists in the exbibition of a combination of digitalis, of the stone itself, the bladder, the urethra, and of the belladonna, and indigo, in pills; cold baths, &c. prostate. The stone may be too large, or too hard; but a plurality of calculi is no impediment. Hardness

NOTES FROM A PRACTITIONER'S DAY BOOK. is seldom an obstacle to the operation. Some, as the

(Continued from page 583.) phosphate of lime calculi, yield almost to simple pressure. The bladder can only impede the operation SYMPTOMATIC AND SPECIFIC TREATMENT COMPARED. by its great eontractility, and in this case the stone T'he practitioner that adopts an exclusive symptomatic may be destroyed if it be small. Moreover, this es. treatment, is like the mariner, who, forgetful of his aggerated contraction of the viscus is usually a distant port, steers only to avoid the dangers which temporary phenomenon. A want of action in the coats immediately beset him; whilst he who prescribes that of the bladder is still less of an obstacle, and is only his medicines may produce a specific effect alone, is prejudicial in requiring a more careful removal of the like him who, blind to the rocks and shoals which detritus. The existence of pouches in the bladder are a obstruct his course, sails straight to the desired harbour. serious impediment to lithority. Inflammation and The one thinking only to clear the impediments with ulceration of the bladder are contra-indications, only which he meets, sails away from his baren; whilst the inasmuch as the great sensibility of the bladder leads to other, intent only upon reaching it, is shipwrecked in forcible contraction of its coats. The diseases and | his course. But as the skilful navigator, with his eye obstructions of the urethra are only temporarily contra- fixed upon his distant home, steers his vessel clear of indicatory of the operation. Diseases of the kidneys the intervening impediments; so will the able predo not interfere with the mechanical part of the scriber, whilst he directs his remedies with a specific operation, and are equally an objection to lithotomy. / intent to the first cause of disease, attend also to the As regards the volume of the stone, M. Segalas con. symptoms which it has secondarily produced. siders that all small and middle-sized ones (i.e., not BITARTRATE OF POTASS IN ALBUMINURIA. surpassing in diameter ten lines,) ought to be litho.

In that diseased condition of the general system tritized; of large stones also, the phosphates may be which has been denominated albuminuria, not only broken down. Uric acid calculi cannot be so satisfac. does albumen exist in the urine, but it is found in the torily managed. The number of the calculi is, accord fluid which fills the interstices of the areolar tissue, and ing to M, Segalas, no argument against litholrity, accumulates in the cavities of the serous membranes, provided they are not large at the same time.

whilst an undue quantity exists eren in the serum of M. Blandin agreed with M. Velpeau, in placing the blood itself. Now, in this disease I have seen the little or no confidence in M. Civiale's statistics.most decided benefi: follow the daily administration of This surgeon had stated that lithotrity did not irritate cream of tartar in purgative doses; patients under this the bladder, and that relapses were less frequent treatment have gradually become less anasarcons, and than under lithotomy. This M. Blandin refused to oy a sufficient continuance of the remedy, the albumen acknowledge.

'.. . has, for a time at least, ceased to appear in the urine. The speech of M. Malgaigne appears to have | How can we explain this effect? The experiments of excited much attention. He strongly insisted upon Poisseuille have proved that the purgative action of the necessity of accurate statistics, without which he certain neutral salts depends upon their attracting to stated that it would be impossible to arrive at any tbem, by endosmosis through the tissues, the serous

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part of the circulating fuid, and the liquid evacuations bowels torpid. These paids, bowerer, had no resem. produced by a salive purgative, are found to contain a blance to those which occar so frequently in the large quantity of albumen. If, then, the albuminous hysterio constitution, and they were entirely confined fluid is carried off by the bowels, it ceases to accumulate to the cutaneous textures. in the areolar tissnes, and the sorous cavities, and is no

A healthy active old gentleman, of about sixty-five, longer excreted by the kidneys.

sought my adrice concerning a pain round the right EXCESSIVE CUTANEOUS SENSIBILITY PRECEDING AND side of the chest. He had suffered, he told me, some FOLLOWING HERPES ZOSTER.

months before from an eruption, and this pain bad A healthy-looking country.woman consulted me remained in the part ever since. It was described as about a pain accompanied with excessive itching and of a smarting, buroing, shooting, and itching character, smarting round one side of the back and chest. The and extended from the median line behind, to a point parts were extremely tender, but presented no redness in front of the nipple before. These sensations were or other aboormal appearance. I tried a variety of almost constant, and usually kept him awake for some local and constitutional treatment without any advan. | hours at the beginning of the night; but when once tage. At lengib & rather severe eruption of herpes asleep they rarely disturbed him, though they returned zoster made its appearance, and on the subsidence of as soon as he arose in the morning. Every movement of this the pains ceased.

the body or limbs increased the pain : whenever bo

raised his arm, he felt the movement in his side; A gouty old farrier, with a broken constitution,

whenorer he put his right foot to the ground, it quite suffered from an attack of berpes round one side of the loins and the lower part of the abdomen and groin.

jarred the painful part. Moderate pressure, however,

relieved bis sufferings, and after lying for some time The eruption, though of more than ordinary severity,

upon the painful side, it became tolerably easy, whilst soon yielded to appropriate treatment, but the pain

at night he was always obliged to adopt this posture remained in a very severe degree for many months

before he could get any sleep. As he lay talking to afterwards, causing great and constant suffering. He

me on the sofa, I could observe the old gentleman described it as a combination of the sensations of

pressing his side for relief against the pillow on which burning, tingling, itching, and smarting, and at one

he was reclining. An examination of the part showed visit said:-"I feel at this moment as if a number of

no abnormal appearance with the exception of some dogs were gnawing away at my side.” The eruption

reddish brown stains of the skin. They resembled had left some copper-coloured stains in the situation

those which are left after herpes zoster, when the of the patches, and here and tbere a solitary papilla

vesicles have been ruptured, and, moreover, terminated seemed somewhat enlarged, but thero was no other

behind exactly at the median line. There was no abnormal change. All the local sedatives I used only

tenderness on pressure, but the skin he said felt sore, increased his torment; & belladonna plaster and an

and my manipulations greatly increased the annoying ointment containing veratrine almost drove him mad;

sensations. The thoracic cavity emitted no dull sound an essence of aconite and a solution of morphia in oil

on percussion, and the respiratory murmur was everyoply produced an intolerable smarting. The only

wbere distinctly audible. His health at the time of occasion on which I found him easy was whilst he was

the eruption was much deranged, but now he felt as poisoned witb belladonna. I had prescribed this

well as usual, and I could in fact find nothing to be remedy in small doses internally, and, deriving some

rectified by prescription. benefit, he, of his own accord, took the pills more and

I directed a linimentum opii to be rubbed on the more frequently uptil he was seized with giddiness and

chest every night at bed-time, and as he thought, after stupor, with slight delirium. He, at this time, told me

a few days, that he had derived some benefit from the he felt nothing of his pains. They, howerer, returned

application, I advised its use also in the morning. The on bis recorery from the symptoms of poisoning, and a

evening friction ho considered relieved the pain, but by recurrence to the remedy produced no amelioration.

: that in the morning it was decidedly aggravated. His appetite and general health were better than they

Another examination deciding me in the opinion that had been for years before, and when once asleep, he

the pain was of a nerous character, I determined upon rested well.

using counter-irritation. To the right of the spinal A young woman presented herself to me for advice column over a space three inches in width, and about an abrasion of the skin, caused by the rabbing corresponding to about eight of the dorsal vertebræ, of ber dress. She told me that three years before, she I applied the glacial acetic acid with a camel's-hair had suffered from the shingles round the right side of paint-brush. Finding the skin not very sensitive of her abdomen and loins, and that ever since this time the irritant I used it freely, charging the brush several the parts bad been affected with pains of a burning, successive times with the acid. Two days afterwards cutting, and smarting character. They were not he was complaining a good deal of the application, but constant, but were excited by the slightest irritation or the former pains were easier, and in a week he suffered change of temperature. She generally suffered most from them only in the most trifling degree, and as they when she dressed or undressed, and could never at any continued to get better, he declined any repetition of time bear her clothes in the least degree tight. Indepon. the treatment. dently of these pains, her health was much deranged;

C. ARNECAPLE. the monstraal functions were much disordered, and the l

(To be continued.)

We are,

POOR-LAW MEDICAL RELIEF.

General Retrospect. [The subjoined circular has been issued to the Medical Officers of Unions by the Committee formed

PATHOLOGICAL ANATOMY. at the late meeting.)

CONGENITAL DEFICIENCY OF THE GALL-BLADDER." Committee Rooms, 4, Hanover Square.. 22nd November, 1847.

1 Mr. Canton relates the following rare case. . In The Committee of the Poor Law Medical Officers examining the body of a female aged 65, his attention submit to you the enclosed return; and they beg the was directed to the circumstance of the trilling exuda. favour of you to fill it up, and return it to them with

tion of bile upon the neighbouring intestines, and on

raising the liver he discovered that the gall-bladder was the least possible delay. · In order to support the representations which they

absent, there being only a small indentation in the lirer are about to make to the government, they feel it

l at its usual position. Suspecting malformation Mr.

Canton searched for the viscus or its romains, but without necessary to be in possession of the most full and accurate information as to the preseet state of medical

success; and on making slices of the liver without

finding traces of it he was convinced that it was con. relief throughout the country; and the only means of

genitally deficient. The liver was small, the right and arriving at that information is, by the general trans.

left hepatic ducts of their usual diameter, uniting at mission to them of the enclosed return. Where medical officers have not attended their districts 80

an obtuse angle just below the transverse fissure to long as for the last five years, it will be sufficient to

form a ductus choledochus, which was the common make the return for the time only that they have

hepatic duct, larger than usual and double its ordinary attended. Their attention is also particularly requested

calibre. The lining membrane of this trunk reto the questions regarding the best mode of remunerating

sembled the mucous membrane of the gall-bladder.

The cystic artery, vein and nerves, were wanting. medical attendance on the poor. The committee beg also to remind you, that consider

In his comments upon the case, the author remarks

upon the fact that the gall-bladder is often deficient in able expenses have been, and must be, incurred, in the

the lower animals; in mammalia, birds and fishes. He prosecution of their enquiries; and they earnestly

also notices the occasional degeneration of the viscus request, that you will forward a subscription, by

from disease, which might lead to the idea of its absence post office order, or otherwise, to the treasurer, Thomas Martin, esq., Reigate.

in consequence of its conversion into fibrous tissue; the

mistake is, however, rectified by the presence of the On behalf of the Committee,

cystic artery and vein. The author further observes, Your's respectfully,

that no specimen should be set down as one of conThomas HODGKIN, M.D., Chairman.

genital deficiency of the gall bladder, until careful T. PIERS HEALEY, Hon. Secretary.

sections of the liver have been made, to ascertain

whether or not it is situated in the substance of the All communications should be addressed to the

latter riscus, either in a perfect, contracted, or condensed Honorary Secretary, 4, Hanover Square.

state, in other words, still occupying the position of The questions submitted in the form of return are as

the early sætal period. Again, the condition of the follows:

cystic duct should be noted, and its presence eren in 1. District. 2. I'nion.

the modified state referred to, would justify the infer3. Population. 4. Acreage.

ence that the gall-bladder had at some period been 5. Total number of sick as per weekly return.

present, though imperfectly developed, and that from 6. Number of sick attended but not included in weekly imperfection of function had gradually disappeared. return.

That the case under consideration is rare, is acknowledged 7. Amount of annual salary, exclusive of extras. by Mr. Kiernan, who is justly regarded as a high 8. Amount received for extras.

authority in matters connected with the anatomy of 9. Payment for midwifery :-Rate per case. Amount the liver.-Lancet, October 16th.

received. 10. What is your opinion as to the propriety of payment

PRACTICAL MEDICINE. per case, and the amount ?

INSANITY CURED BY THE USE OF TAR TREPHINE. 11. What is your opinion as to a fixed salary, based on Dr. Robertson, resident physician to the Yarmouth

the number of cases attended, and the mileage? Military Lunatic Asylum, has furnished us with the 12. What is your opinion as to payment for extra cases following instructive case :exclusively of midwifery?

A sailor, aged 23, was admitted into the Cumberland 13. What is your opinion as to fixed payment founded on Lunatic Asylum, February 10, 1845. Ten years prior

the number of population and area, to be settled he fell from the mast of a ship, which accident was by the Poor-Law Commissioners ?

followed by an attack of acute mania, In six weeks The returns to embrace the five years ending Lady he recovered his intellectual faculties, but continued Day 1847.

-50 ungovernable in his comper and violent in his conduct, as to render him anfit to be at large, and to necessitate bis removal to the Asylum. .

On admission he complained of frequent pains in

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