390

Abdominal Cay~cer Simulatilzg Aneurism.

a fortnight, and my friend, Dr. Pollard, hinted at the possibility of finding malignant disease. T h e result of the post ~wrtem examination proved this opinion to be correct. Quite recently Dr. Scheele, of Dantzlg, has drawn attention to the increase of local pain caused by compression of the femorals as a valuable diagnostic point in abdominal aneurism. Now, I think it quite possible, had it occurred to us to employ this test in the present case, an increase of local pain might also have been found to occur, and thus still further evidence in favour of a faulty diagnosis would have been forthcoming. This method of examination, however, cannot be generally recommended, as several instances of rupture of the sac have occurred, apparently produced by the increased blood-pressure.

T H E P&THOLOGY OF ADDISON'S DISEASE.

Iz~ the Archives de _Phjsiologie Normal et Pathologique, 1878, Nos. 5 and 6, M. Jacquet arrives at the following conclusions :--1. In Addison's disease, the bronzed skin one finds only as a lesion of the sympathetic system, pigmentation widmut atrophy of the nervous cells of the ganglia which are in the neighbourhood of the diseased suprarenal glands. 2. The degeneration of a part of the nervous fibres attaching the same lunar ganglia to the nervous centres ought to be regarded as secondary and consecutive to the process of sclerosis which accompanies the tuberculisation of the capsules. 8. That lesion is insufficient to serve as the basis of a pathogenic theory of Addison's disease. 4. Hyperpigmentation of the nervous cells of the great sympathetic and of the cerebro-spinal system is a fact of the same order as the hyperpigmentatlon of the epidermic cells of the Malpighian plexus. 5.. This hyperpigmentatiou renders probable the existence of an alteration of the blood by the substances which a suprarenal gland would, in the normal state, be employed in utilising by transforming them. 6. The alteration of the blood by functional or organic insufficiency of the suprarenal glands is a pathological phenomenon analagous to that which exists in chronic urmmia. 7. Alongside of the melanodermia, by alteration of the suprarenal tissue, there seem to exist cases in which the melanodermia is due to the lesion of other blood-making organs. 8. Clinical researches in Addison's disease ought especially to be directed to the chemical analysis of the blood and the urine.--Lond. Med. Record, April 15, 1879.

398

Reviews and Bibliographical Notices.

is inserted a useful table of cases of aortic aneurism treated by this method. T h e author is cautious not to dogmatise upon a difficult problem, and he does not go too far in saying that in a disease so grave as aneurism, and one whose issue is inevitably fatal, the results obtained hitherto from electropuncture may be considered as relatively encouraging. W e can recommend Dr. Teissier's essay as a candid and temperate account of the subject, so far as it goes.

l-)u Froid en Th&apeutique. P a r le DR. F. LABADIE-LAGRAYE. Paris: Bailli6re et Fils. Pp. 284. 1879. T H E aim of the author of this volume appears to be to place the therapeutics of cold applications upon a sound basis, and in Chapter I. he gives a fair and tolerably full account of the physiological effects of cold. T h e work is mainly a compilation, and contains nothing of importance that is not easily accessible to English readers in the writings of their own physicians, and in some of the volumes of the translation of Ziemssen's Cyclopmdia.

GELSEMINU~I FOR HECTIC.

PRACTICAL experience with gelseminum in small doses has long shown its influence upon the circulation and its sedative effect in certain neuralgias. I t has also been shown to have a sedative effect upon the respiratory centres. From these facts it appeared to Dr. Edgar Holden that it should act favourably in the treatment of a respiratory affection characterised by irritation~ as Dr. Holden believes the hectic of phthisis is, and having its seat and origin in the pulmonary tissues. In a very large number of cases it has not failed, and Dr. Holden has found that~ even after the failure of favourite and well-known remedies~ doses of two drops of fluid extract~ or 10 to 12 of the tincture every two hours~ will~ in most instances~ within forty-eight hours, arrest the chill~ moderate the cough~ and allay the fever. The period of administration, however~ is not always so short. It may be used continuously if necessary to maintain sedation~ and without interference with other medicines or effect upon digestion or the excretions. It should be added that exceptions are likely to occur in cases with mesenteric complication and colliquative diarrhcea~ and while not contra-indicated, it may sometimes disappoint expectations.--~V. :Y. Med. Record~ March 1.

434

Proceedings of the Dublin Obstetrical Society.

marked by greenish discharges, and in which the drug has been found to be of signal benefit. 7. That hippo, used a century since for the same purpose, will be found a very effective remedy in the diarrhcea of the young. 8. That astringents are of less value than aperients in the treatment of this diarrhoea. 9. That tonics, such as the pernitrate of iron, or oxide of zinc, are often of essential service, and above all, a complete change of air. DR. 3/~:CLINTOCKagreed with Dr. Kennedy with reference to the use of astringents. He himself had changed his practice in this respect. I n the case of diarrhoea there often was an accumulation of lineal matter that should, in the first instance be removed. There was a remedy that he had used with good effect of late years~ when obliged to employ an astringent~ and that remedy was oxide of zinc, in half-grain doses, i n a mucilaginous mixture, every three or four hours. The most important point in these cases was to regulate the diet, and to give the strictest directions to those having charge of the child. H e thought that hippo was a most valuable remedy, and not as often employed as it should be. As to the use of farinaceous foods before children are teething, it is to be shunned and avoided. The PRESID~NT considered all starch foods injurious to the child before the teeth came. I t was then a carnivor, and should get nothing but milk. The use of other foods was a fruitful source of disease. Dm KENNED]', in replying, said that Dr. Faussett~ of Clontarf, had used shell-cocoa boiled and given with half water half milk, with good effect, the child fattening on it very well. ttippo does not act as an emetic in the majority of eases, nor is it exactly an astringent; it is sometimes found to act as an aperient.

~IETttOD

FOR

THE

DISCOVERY

OF

SPER~&TOZO&

IN

URINE.

"

M. ROUVlER (Gaz. Hebdomadaire ; Le Praticien~ March 3, 1879) allows the urine to stand for twelve hours, adding benzine in summer to prevent putrefaction; he then decants it and collects the flocculent precipitate. This precipitate is put into a test-tube~ ether is added, and the mixture is well shaken. I n a few minutes the ether collects on the surface of the liquid as a gelatinous layer. The ether is removed by means of a pipette, and is placed in a conical glass containing a small quantity of distilled water. All the spermatozoa in the urine thus tested are found in a very small compass, and each microscopic preparation will contain at least five or six in the field.--The -Practitioner, April, 1879.

Reports of tlte Dublin Pathological Society.

445

case is whether the pouch given off from the intestine may not have been a congenital diverticulum. DR. FINN:~.--Paralysis of the bowel may be produced by other causes than a portion of it being nipped. According to Abercrombie, under the influence of strong purgatives a portion of the bowel may become paralysed. Dr. Stokes published a case showing the advantages of electricity as applied to cases of this kind, in which that agent proved the means of saving the life of a patient after the most determined and prolonged obstruction of the bowel.--.Februar?/8, 1879. oN THE VSE OF THV~fOL. DR. SEYFERTI=[ has published the results of his experience with thymol, which he has latterly employed exclusively in all surgical cases, and also in other cases requiring local antisepsis. In several cases of extensive burns it acted very satisfactorily, stopping at once the offensive discharge in cases that had been treated for days with carron oil, relieving the pain entirely, and producing a rapid recovery. The deep sloughs separated more rapidly than usual, and the granulations were not so exuberant as in cases treated by carbolic acid ; the resulting cicatrices also were not so deep and firm. A violent stomatitis, due to the inhalation of caustic vapour, which had been treated for two days without relief by potassium chlorate and solutions of boracic acid, was quickly cured by a solution of thymol, of the strength of 1 : 3000. The same solution proved very effective in seven cases of diphtheria, three of which were very severe, and accompanied by great fcetor of breath. Here it was used by injection into the nose, as well as into the mouth. Purulent coryza and suppurative aural catarrh do well under the thymol treatment ; solutions of 1 : 4000 are well borne, and do not irritate either the nose or the auditory canal. Two cases of ophthalmia neonatorum were cured by the thymol solution, with which the eyes were washed out every hour; between the washings the eyes were kept constantly covered, at first with ice-compresses, and later with compresses of cotton soaked in the thymol solution. In some puerperal cases with offensive lochia, the vagina was washed out repeate d l y - - a t first with solutions of 1 : 1000, and later with solutions 1 : 2000 and 1 : 4000; the results were rapid deodorisation and a favourable action in the general condition of the patients. In two cases of old vaginitis, with profuse, stinking discharge, a cure was obtained in fourteen days by irrigations with a solution of 1 : 4 0 0 0 , repeated three times a day, and followed by the introduction into the vagina of plugs of cotton dipped in thymolised glycerine. Dr. Seyferth keeps the following solution constantly on hand, and dilutes it to the desired degree whenever it is needed : - - T h y m o l , 1"0 ; spir. vini, 10"0 ; glycerin., 20"0 ; aquze destil., 70"0 M.--Allg. reed. cent. Zeit., ~'o. 62, 1878, and N. Y. Med. Record.

Commentaries on Diseases of the Kidneys.

465

for safety as for comfort. A n y inflammatory redness about the wounds may usually be removed quickly by the application of a lead lotion. I t is true that severe inflammation and sloughing have sometimes followed incisions or punctures in anasarcous legs, but this may, and often does, occur from over-distension of the skin, or from the mere pressure of the heavy dropsical limbs upon the bed. The result of Dr. George Johnson's ~ experience is that inflammation of anasarcous legs has been as often subdued as provoked by acupuncture or incision; that inflammation is much less likely to follow incisions in cases of renal than of cardiac dropsy, when the circulation is much impeded by valvular disease; and that incisions made with the spring scarifier are as safe as acupuncture, and much less painful. The capillary trocars invented by Dr. Southey form a convenient mode of withdrawing the anasarcous fluid. By using these instruments the fluid is kept from contact with the skin ; one may be introduced into each leg, and as much as over 140 oz. may be drained away by a single trocar in twenty-four hours3

AUSCULTATION

OF

THE

SKIN

FOR

CHIRURGICAL

PURPOSES.--DER.,~ATO-

PHONY.

C. HUETER (Centralblatt f. die medicinische Wissenschaflen, 1878. Nos. 51 and 52), having found that the vascular bruit of the pulp of the finger was clearly audible upon a microphone, constructed a cheap and efficient "dermatophonc," by stretching a piece of gutta-percha over the open end of a binaural stethoscope (Voltolini's, but Camman's might do). On placing this plate over certain vascular parts, such as the fingertips, malar eminence, eyeball~ &c., a peculiar sound, varying somewhat in pitch in different parts, is heard. This sound is the n o r m a l b r u i t of the subcutaneous capillaries and smaller vessels. If the hand be rendered bloodless by means of an Esmarch's band, the vascular bruit can no longer be heard in the finger-tips. In acute cutaneous inflammation (furuncle, paronychia), a louder but deeper note is heard. I n a case of partial stasis of blood in the foot, caused by a too tightly applied dressing for fracture of the thigh, the toes being dusky and cool, the vascular sound was weaker and hardly perceptible; but after loosening of the bandage, and a restoration of heat to the foot, it became louder, then normal. The instrument is also applicable to the muscles and t e n d o n s ~ myophony and tendophony. Applied to superficial bones while they are percussed (with a hammer or whalebone), according to Liicke's method, a distinct sound is heard. The author anticipates that these applications of auscultation will prove of help in medical and surgical diagnosis.-Archives of Medicine, Vol. I., ,No. 2, April, 1879. a Lectures on Brlght's Disease. 1873. P. 145. Carter. Urinary and Renal Diseases. 1878. P. 87.

468

Sanitary and Meteorological Notes.

and the weather became calm and bright with a large diurnal range of temperature. On Sunday, the 9th, this fine weather system broke up, conditions becoming unsettled with sudden and extreme alternations of temperature. On the afternoon of the 12th the relative humidity in Dublin fell to 57 per cent., and at night frost occurred with a clear sky and N. wind. After th'e 18th barometrical gradients for easterly or polar winds became fully established in the British Isles. These E. winds were portion of the circulation in an anticyclone over Scandinavia and Russia, in which regions very intense cold prevailed. I n Dublin the thermometer never rose to 40 ~ in the shade from the-afternoon of the 22nd to the evening of the 28th. During this period the sky remained almost completely overcast, the wind blew strongly from E.N.E., E., or E.S.E., and snow and hail fell in frequent showers. The mean temperature of the week ending Saturday, the 29th, was 37"1 ~ or 7"9 ~ below that of the week ending Saturday, the 16th. On the evening of the 28th the wind drew round to S.W. after a severe, though transitory, S.S.E. gale, and the weather became mild and spring-like. Owing to the clouded state of the sky during the cold weather no very low temperatures or severe frosts were r e c o r d e d ~ i n fact, the shade thermometer fell to 32 ~ on only three occasions. A faint aurora was seen at 11 p.m. of the 10th. A solar halo was noted at 9 a.m. of the 13th. A lunar corona appeared at 7 30 p.m. of the 6th. Sleet fell on the 16th, 17th, and 29th ; snow on the 24th and three following days ; hail on the 23rd and six following days. There was a dense vapour fog on the night of the 18th, and heavy dews were remarked on the 7th, 8th, and 18th.

CREASOTE 1N P H T H I S I S ,

DR. BONNEFONTAINE (Union Mdd., March 11, 1879) has found that consumptive patients who are rather fanciful concerning their food and medicine will easily take creasote in the shape of Dartais' capsules. These are very small globules, containing each about five centigrammes of creasote, and quite tasteless. The drug must be taken three times a day, before every meal, in doses of three globules each time, and followed by a cup of chocolate or milk, a glass of win% or some soup.--Lond. Med. Record, April 15, 1879. COMPRESSED A I R - B A T H S I S W H O O P I N ' G - O O U G H .

)I. MOUTAaD-M~aTIZ~ says (Union M~d., March 11, 1879) that compressed air-baths are very efficient in every stage of whooping-cough. He has treated three patients, aged respectively seven, twelve, and fourteen, with compressed air in the incipient stages af the affection, and in every case it assumed a mild form~ and did not last long.--Lond. Med. Record, A p r i l 157 1879.

PERISCOPE. Edited by G. F. DUFFEY, M.D., F.K.Q.C.P. TREATlYIENT OF P]NEU~ONIA. W E extract the following from some notes on the treatment of pneumonia in Bellevue Hospital, N e w York, published in the Medical Record of that city "--" Hospital pneumonias form a class of diseases especially liable to elude statisticsregarding fatalityand treatment . . . . . . The majority of the patients brought to Bellevue trace their pneumonia to exposure. Owing to the previous bad habits and bad condition of the patients, as well as to the frequent virulence of the disease, the treatment of many cases of pneumonia soon resolves itself into the treatment of exhaustion, (edema of the lungs, and a nearly moribund condition. How to carry a patient through conditions of this kind, how much stimulants, and of what kind, are matters that text-books do not give very definite accounts of, and experience has generally to become the teacher. Many cases that come into the hospital have a record like the following : - - T h e patient is a tolerably strong man, in the third day of the fever. He has a temperature of 104 ~ respiration 50. His pulse is very good, and he feels pretty comfortable. He is given milk and eggs, and gr. xv. of quinine. This is in the morning. In the afternoon he is weaker, his face is a little blue, he breathes faster. On listening to the lungs, moist r~les~ fine and coarse, are heard. I-Ie is beginning to have (edema. He is at once dry-cupped for fifteen or twenty minutes, during which time 150 cups are put on. The (edema has now disappeared. He is ordered Vctx. of tr. digitalis every three hours, and ~ ss. of whiskey every two hours, with milk and eggs. He continues better for some hours. Towards evening the (edema again shows itself. He is again cupped, and gr. x. ammon, carb: is ordered every two hours, alternating with tim whiskey. Again the (edema clears up. I n addition, a can of oxygen is ordered for the night, and the patient inhales it for fifteen minutes in every hour. This relieves his dyspn(ea. But towards morning ~he cyanosis and (edema again appear. The cups are applied again, and the whiskey ordered, ~ ss. every hour, alternating with the ammonia, gr. x., every hour. By these measures he is carried through the.night, and in the morning is easier. ~ourishment, in the form of milk, is still kept up. I-Ie is not alIowed to sleep continuously, for during sleep the (edema comes on. By such fighting as this, the greatest reliance being placed on whiskey, milk, and dry cups, a patient is occasionally brought through. If, on the following day~ he is still wors% the resources in the way of

Periscope.

470

stimulants are not exhausted. Other forms of ammonia are used. Hypodermic injections of camphor dissolved in sweet oll are given every three hours in four-grain doses. If the patient has persistent (edema and a full pulse, venesection is tried~ and is invaluable when digitalis and cups no longer avail. The oxygen cannot be pushed too much, as it causes unconsciousness. Hypodermic injections of ether to the amount of one or two drachms sometimes bring up the pulse. Teaspoonful doses of champagne every five minutes will help to tide a crisis. There is a limit to stimulation, of course. When g ss. of whiskey every half hour has no effect the patient will die. There is no use in increasing the amount unless it is desired to preserve the stomach afterwards. In the case of a man to whom ~ ss. q. 88h. was given for several hours~ the stomach was found at the autopsy to be considerably hardened by the alcohol and to smell strongly of it. In spite of all efforts, most of the cases in which (edema of the lungs occurs go on from bad to.worse. The extremities become cold and wet with perspiration ; hot bottles applied to them and to the breast, mustard to the epigastrium, accomplish only temporary good, the patient has long been stupid ; he now loses consciousness~ his breath is slow and laboured~ the air-passages are full of serum ; gradually the respirations grow slower and slower, and finally stop. The patient dies. A t the autopsy part of the lung will be found to have reached the stage of gray hepatisation." OBSTINATE S I N G U L T U S

CUllED BY

MURIATE

OF

PILOCAI~PINE.

DR. ORTILLEreports a case of persistent singultus, due to cerebral embolism, which proved utterly rebellious to all the usual methods of treatment. As the singultus persisted even during the sleep produced by morphine injections~ and the strength of the patient was becoming greatly reduced, a hypodermic injection of half a grain of pilocarpine was at last administered. This produced abundant perspiration and salivation, and the hiccough ceased at once.--A llg. ~led. Cent. Zeit., and N. Y. _~led.

Record. BELLADONNA

IN T H E

TREATMENT

OF INTESTINAL OBSTRUCTION.

DR. N O R M A N KER (~e 2ratic~en, March 3, 1879) reports five cases of intestinal obstruction which have been cured by the administration of large doses of belladonna. The treatment consisted in giving one or two grains of belladonna every hour~ together with opiate fomentations to the belly and warm applications. Nearly all the patients were in a dangerous condition, but were entirely cured~ the remedy taking effect in six to nine hours. One patient took sixteen grains of the extract. The author gives no precise account of the cause of the obstruction.--The _Practitioner, April, 1879.

Periscope. JABORANDI

IN TIlE

TREATMENT

OF

471 PUERPERAL

ALBUMINURIA.

DR. FORDYCE ]BARKER expresses the conviction, after the clinical observation of many cases, that the utility of jaborandi in /he treatment of puerperal albuminurla is more than doubtful, and that, after puerperal convulsions, its depressing influence and action, which is continuous and exhausting, prevents sleep and the repose of the nervous system, and thus renders it in these cases an unsafe and dangerous r e m e d y . - - N . Y. J~[ed. Record, March 1. CORYZA.

DR. RUI)OLPHO RUDOLPnI recommends the use of eucalyptus globulus for the rapid cure of acute coryza, or cold in the head. He has found, by numerous trials on himself and patients, that after chewing a few of the dried leaves and slowly swallowing the saliva, the affection is promptly relieved, often disappearing in the course of half an hour. The remedy is useful in acute cases only.--Gazz. Med. ltal. ~Lorabardia, January~ 1879, and IV. Y. .Med. 2~ecord. POISONING FROM TItE EXTERNAL APPLICATION OF TOBACCO. DR. O'NEILL (Lancet, March 1, 1879) was called to see ~ robust woman of forty, who was represented as bleeding profusely from ~ wound on the leg caused by an accidental blow. The patient suffered from varicose veins. On arrival he found that the bleeding had stopped, but the patient had fainted, and had been only revived with great difficulty. She seemed to be extremely prostrated, having a pulse scarcely to be felt, and a pale, cold skin, wet with profuse, clammy perspiration. The pupils of the eyes were dilated, and in a faint whisper she complained of dizziness, dimness of sight, and confusion of thought. The patient suffered from pain in the abdomen, and from constant nausea and vomiting ; and on removing the bandages and examining the leg, a handful of chopped wet tobacco was found firmly pressed on the wounds, which were deeply stained by it. The surrounding skin was also stained by the tobacco, but in a slighter degree. Pinches of tobacco had been applied on previous occasions to stop slight bleeding, and after each application the patient had felt rather unwell, but had failed to connect the indisposition with the tobacco. The tobacco was immediately removed, the leg was well cleansed, stimulants were given and a mixture containing strychnia, which, according to the Rev. Professor Haughton, is the true antidote of tobacco. Under this treatment the patient gradually improved, but did not entirely recover for several days. Commenting upon this case Dr. O'Neill says the symptoms of poisoning were well marked, and are worthy of note when the mode of introduction of the poison into the system and the rarity of such a mode of introduction are taken into consideration. In Lincolnshire tobacco is occasionally

472

Pe~+iscope.

used as a domestic remedy for stopping bleeding. I n the case under consideration hmmorrhage was arrested ; but, as tobacco does not contain any astringent substanc% the handful of chopped leaves acted in all probability merely as a compress, or as a means of entangling the blood, and thus allowing it to coagulate on escaping from the injured vessel. The urgent symptoms in this case very soon set in, for the patient was seen about three-quarters of an hour after the application of the tobacco, and yet she had fainted in the interval. Absorption therefore must have been rapid, nearly as rapid as if the tobacco juice had been' injected subeutaneously.--The Practitioner, April~ 1879. ANEURIS]VI O F T H E

LEFT

VENTRICLE.

AT a recent meeting of the Soci~t~ des Sciences ~Iddicales a very interesting specimen of an aneurism of the left ventricle was presented. The patient had always been healthy, but much addicted to drinking. I n April, 1878, the first symptoms of the subsequent affection a p p e a r e d - anorexia, migrating pains in the groins, and rapid loss of flesh. Subsequently he began to vomit his food~ either at night or the next morning. On examination, a hard tumour, which occupied about four square inches~ was found in the epigastric region. The patient looked cachectic~ but no other disease or trouble could be discovered at the time. I n November a very small amount of fluctuation could be felt in the lower portions of the abdomen. I n December the turnout could no longer be felt~ the patient vomited his food about an hour after taking it~ and died on the next day. A t the necropsy it was found that the whole of the stomach was filled with alimentary matter. The small curvature was entirely occupied by a hard~ fibrous neoplasm, which surrounded the pylorus, constricting it to a considerable extent. This tumour was attached by adhesions to the posterior walls of the abdomen~ the pancreas, and spleen ; all the parts covered by it were hard. The most interesting object, however, was the heart~ which, although of normal weight and size, showed on the outside a turnout of the size of a nut~ which, on an incision being made, proved to be an aneurism of the left ventricle. Its walls were rugged, the whole of it was calcified~ and blood-clots and fibrin were found between the partitions of the inner walls. A n embolus originating from one of the above-mentioned clots must in all probability have been the cause of death. The diagnosis--alcoholic cirrhosis of the l i v e r - - h a d been made previous to the patient's d e c e a s e . Lyon Med, January 26, 1879~ and London Med. Record~A p r i l 15~ 1879. ERRATUM. In the "Transactions of the Medical Society of the College of Physicians," in the April number of the Journal, page 322, line 7 from the bottom of the page, the word "glycerine " should be "alizarin."