In the number for March 1826, of the Revue Medicale, M.Maudrurelates two cases in which large portions of tænia were expelled, and the patients cured, by means of a strong decoction of the bark of pomegranate. The first patient took, in one day, two pounds of the decoction made with four ounces of the remedy. The second patient took six ounces of the bark in decoction, in the course of forty-eight hours. In neither case did the medicine occasion unpleasant effects, with the exception, in the second patient, of slight colicky pains.
28.Action of the Oil of the Euphorbia Lathyris.—At a meeting of the Academy of Medicine, (section of pharmacy) M.Ballyread the results of some clinical experiments made by him at the hospital of La Pitié, on the action of the oil of the euphorbia lathyris. The preparation used by him, had been made by means of alcohol and expression. It appears to be a little more active than the other preparations. Administered to fifteen individuals of different ages, it did not produce very various results, nor prove very active in its purgative effects. As a purgative, indeed, it is far less active than the croton oil, and requires to be given in much larger doses; as much as six or ten drops. It has also the bad property of exciting emesis, by which it is rejected from the stomach. On the other hand, however, it does not, like the croton oil, produce salivation, and is, on the whole, regarded by M.Bally, especially when fresh, as a useful purgative in diseases of children.—Archives Generales, Decembre, 1825.
29.Medicinal properties of the Apocynum Cannabinum, or Indian Hemp.—In an essay on this plant, submitted to the medical faculty of Jefferson College, by Dr.M. L. Knapp, we are informed, that in doses of 15 or 30 grains it possesses emetic properties. It was besides, on trial, found to be cathartic, expectorant, diuretic and diaphoretic. It appears to have been generally administered in powder, and Dr. K. remarks, that "in decoction, it seems to lose some of its emetic properties, and to act more upon the bowels as a hydragogue cathartic." "The root possesses all the medicinal properties of the plant, and is active throughout, both in its cortical and ligneous portions. Water or proof spirit is its proper menstruum."
This article was prescribed with success in dropsy, by Dr.Knapp, andby Dr.Parrishof this city. It was likewise used in intermittent fever, in bilious affections, amaurosis, hernia humoralis, dysentery, chronic rheumatism, &c. Dr.Knappappears to have derived benefit from its use as an alterative in a case of fever in a child, attended with disordered bowels. "The powders (gr. ii. each at intervals of three hours,) were regularly persisted in for a week, and the child's health went on gradually improving. Neither vomiting nor purging was produced, but the morbid heat and thirst were allayed, the stools became natural, the skin soft and moist, and the functions of digestion and assimilation were gradually restored, and the child is at this time fat and healthy."—American Medical Review, &c. April1826.
30.Remarkable effects from the external application of the Acetate of Morphia.—M.Dubourghas recently published the result of an experiment made at the hospital de la Pitié, with the acetate of morphia, which we regard as sufficiently interesting to be noticed in this place. The patient had been affected twelve months before with puerperal peritoneal inflammation, complicated with cerebral symptoms, from which, notwithstanding a most energetic antiphlogistic treatment, she never entirely recovered. When she was admitted into the hospital, she presented the following symptoms:—"considerable emaciation; skin hot and pungent to the feel; pulse small and frequent; tongue of a pale rose colour, dry at the tip and edges, brown and smooth in the centre as far as the basis; severe pain on the least pressure on the epigastrium and over the whole abdomen; cardialgia, nausea, vomiting of all solid and liquid aliments, and during the empty state of the stomach, violent efforts to vomit occurring at irregular intervals; abdomen tense and tympanitic; violent intermittent pain along the course of the intestines; constipation; sensation of fatigue and lassitude in the lumbar region and in the extremities; dragging pains in the inter-scapular region; extinction of the voice; urine red and scanty; the face animated and bearing no marks of profound suffering; agitation, and total want of sleep."
The disease was regarded as a chronic gastro-entero-peritonitis, and treated accordingly, by the antiphlogistic regimen; but no benefit was derived from this plan. The patient continued to vomit almost every thing she took, with the exception of sugar and a paste made with the Iceland moss. A blister was applied to the epigastrium on the 15th of February, seven days after her admission. Called to her assistance on the 22nd of February, on account of an aggravation of the vomiting, M.Lambert, one of the house pupils of the hospital, endeavoured to calm the symptoms by means of the acetate of morphia in powder, applied to the raw surface of the blister. Half a grain was used in this way, and in a few minutes the vomiting disappeared, and the patient passed a better night than she had yet done. M.Serreshaving authorized the continuance of this method, M.Dubourgthe next day applied half a grain in the same way; and the patient slept the whole night. The remedy wasapplied every day with the same effect, and was gradually increased to two grains and a half. From the first application of the remedy, the symptoms gradually subsided; aliments were retained and properly digested; the pain and swelling of the abdomen disappeared, and on the 14th of March the patient was regarded as in a fair way of recovery.—Archives Generales, March1826.
In some remarks which accompany this interesting case, M.Dubourg, seems to doubt the correctness of the first diagnosis, and to view the disease as a nervous, rather than as an inflammatory affection of the abdominal viscera.
31.Cure of Urinary Calculi by means of the internal use of the Bicarbonate of Soda.—At a late meeting of the Academy of Medicine, Mr.Robiquetread a memoir on the use of this salt in cases of urinary calculi. Having learnt from Mr.Darcet, that the use of the waters of Vichy changes the quality of the urine from acid to alkaline, Mr. R. conjectured, that this effect should be attributed to the bicarbonate of soda contained in them; and from this circumstance, he was led to administer this salt internally, in cases of calculi composed of uric acid. In July last, he made the experiment on a man 74 years of age, who had laboured under symptoms of the disease since the month of February, and in whom, by means of the sound, a small and soft calculus had been detected. Mr. R. ordered him 10 grains of the bicarbonate in the course of the day, dissolved in two pounds of water—prescribing at the same time, hip baths, injections, &c. At the end of fifteen days, much benefit had already resulted from this treatment; and in a month, the patient appeared to be cured. Nevertheless, the remedy was continued until November, when the patient passed through the urethra, a small calculus composed of uric acid, which appeared to have been the nucleus of a much larger one, the exterior strata of which had been worn off. From that period, the patient has not experienced any unpleasant symptom; but the sound was not resorted to, to ascertain whether the first calculus before felt, could be detected.—Archives Generales, February, 1826.
32.Attempt to cure Abdominal Dropsy, by exciting Peritoneal Inflammation.—In the number of the London Medical and Physical Journal for April, 1826, a case of ascites is related byH. R. Oswald, Esq. in which the cure was attempted to be effected, by exciting peritoneal inflammation. The following symptoms were noticed at the time of application for advice: the abdomen measured nearly six feet in circumference, was exceedingly hard and tense; but not tender. The patient "could hardly walk across her cabin from dyspnœa and debility, and the weight and tension of the tumour; which caused her to bend the body much forward, leaning her hands on her knees. The emaciation was very considerable; the appetite good; thirst considerable; tongue clean; pulse 120, and small; skin dry, harsh, and rough; bowels habitually costive; urine scanty." "This affection commencedabout twelve months ago, after an obstruction of the catamenia for nearly a year, arising, as was supposed, from exposure to cold. The swelling was preceded by lancinating pains in the abdominal and lower part of the thoracic cavities, but which, after a few months, ceased entirely; and the disease had, in a chronic manner, gradually arrived at its present oppressive form."
Paracentesis was performed several times; cathartics, diuretics, the lancet, blisters, and tonics were resorted to, with relief from some of the symptoms. The tumour, however, returned several times, so that M.Oswalddespairing of effecting a cure by following the same plan, and recollecting a case of ascites, which was cured apparently by an inflammation having supervened in the peritoneum, from the orifice made by tapping remaining open, attempted to produce the same effect in the present patient, by keeping the orifice of the wound open by means of a small tent. In this he partly succeeded, for in the course of a few months, all symptoms of the effusion had disappeared; health and strength had much improved, and the patient had experienced a return of the menstrual discharge, which had been suppressed for nearly three years.
About a year afterwards, however, the disease returned. Paracentesis was again performed several times, and a tumour was perceived to have formed in the lower part of the abdomen. The patient died in about five or six months from the re-appearance of the effusion. On dissection, much water was found in the abdominal cavity, which was lined by a dense, white, and rough looking membrane, of a fragile and diseased structure. The intestines behind this membrane, were unusually small, and of a dark leaden colour. The tumour above alluded to, was discovered to be situated in the region of the right ovarium; it was a tubercular, carcinomatous, and pale coloured fungus, possessing a structure not unlike that of the placenta, and was formed in the interior of the sac, which being traced further back, was found to be the cyst of a dropsy, originating in the right ovarium at the fundus of the sac, or "more properly speaking of its neck."
"The foregoing statement," Mr. O. remarks, "involves four facts and questions of considerable importance in pathology. 1st. The great quantity of fluids evacuated in so short a space of time: no less than ninety-six quarts in eight months, by four operations; and fifty-nine quarts from August to December, 1824, by three. 2nd. The variety in the nature, consistence and colour of these fluids. 3d. The possibility of curing ascites and dropsy of the ovaria, by exciting inflammation in the abdominal sac, either by the admission of air into it, or mechanical irritation; and 4th. The possibility of a thickening of the parietes of the abdomen by inflammation, or by an exudation of a carcinomatous sort, being mistaken for a tumour rising out of the pelvis."
33.Artificial Respiration.—Dr.J. Wareof Boston, relates in the New England Jour. for April last, that he was led by the experiments of thejustly celebrated physiologist Mr.Brodie, to employ artificial respiration in the case of an infant 9 weeks old, whose system was prostrated from an over dose of laudanum. "The action of the heart was reduced to an occasional throb; the pulse had entirely ceased, and the efforts at respiration, which for some time had consisted merely in an occasional gasp, became more and more unfrequent." The child had been afflicted for five or six weeks with hooping-cough, and had been very sick and feeble when the laudanum (about 15 drops) was administered.
By means of the stem of a tobacco-pipe, artificial respiration was excited, and continued for several minutes: the action of the heart was immediately renewed, and the pulse could be again felt. At the end of an hour, during which the artificial respiration was repeated at intervals; "the respiration became natural, the pulse distinct and tolerably strong, and the heat began to return." A fit of coughing, preceded by a livid appearance of the forehead and face, arrested the breathing, "which did not return till assisted by the artificial process." The child, assisted by these measures, and by attention to the more usual means of recovery, struggled through the night, but died during a paroxysm of coughing in the morning.
The conclusions of Mr.Brodieare, that narcotics destroy life through the organs of respiration, and hence, if respiration can be artificially carried on until the effects of the narcotic subside, life may be preserved. Dr.Ware'scase would seem to confirm this idea; for it isprobablehis patient would have recovered from the effects of the narcotic, if the paroxysms of coughing had not interfered.
34.Secale Cornutum.—Mr.Charles Wallerhas lately published (London Medical and Physical Journal, April 1826,) several cases illustrative of the action and efficacy of secale cornutum. We have not room for any of the cases, and content ourselves with transcribing Mr. W.'s inferences. These are: "That the secale cornutum is a remedy which is capable of increasing the force of the uterine contractions in a most remarkable manner, under certain circumstances; but that the effect is doubtful, unless there be some degree of action present. In other words, that, although it will increase the contractions when already present, it will not always renew them when they are suspended.
"That the effect is more certain if the infusion be of greater strength than is usually recommended; two drachms of the secale to six ounces of water being barely sufficient for the purpose.
"That it appears to be a stimulus peculiarly fitted for irritable, and what are generally termednervoushabits.
"That the fears entertained by some practitioners of its proving detrimental to the child, are groundless.
"But, although it is in general necessary, not only that there should be a disposition for labour, but that this process should have actually commenced, before we can expect the secale cornutum to have any effect uponthe uterus, still one solitary case has indirectly come to my knowledge (and I will vouch for the authenticity of it,) where this remedy was given for the purpose of producing abortion in a female, about the second month of utero-gestation; and this effect was accomplished in a few hours after its exhibition."
35.Animal Magnetism.—This strange doctrine begins to acquire considerable vogue in France, and other European countries, from which it seemed to have been expelled, by the contempt and ridicule which it met with, from most of the learned of the latter part of the last century.Anthony Mesmer, the great chorœgus of the magnetic mummers, was born in 1733, and excited a vast deal of attention, by the enormous pretensions which he set forth on the subject of magnetism.Mesmercame from Austria to Paris in 1778. He addressed the Academy of Sciences, and that of Medicine, but no attention was paid to him, till a commission was appointed to examine carefully into the merits of the question. This commission in 1784, so fully exposed the fallacy ofMesmer'stheories and practice, that he soon afterwards quitted Paris, and retired to England under a feigned name. He subsequently went to Germany, and died in obscurity, in the year 1815.
In December last, M.Husson(for himself, and MM.Adelon,Burdin,Marc, andPariset,) read a report to the Royal Academy of Medicine, on the question, whether it was fitting for the section to undertake new researches on animal magnetism, as it had been thought to be definitively settled by the decisions of 1784. The report concluded affirmatively, for several reasons; among which the principal seems to be, that magnetism has at present fallen into the hands of the learned, whereas it was formerly under the domain only of quacks and the vulgar.
M.Husson'sreport was discussed at subsequent sittings of the Academy, for the purpose of ascertaining whether a new commission should be appointed; and as this topic is certainly one of the greatest novelties of the day, we shall give some account of the discussions, making free use of the report of them, contained in the Revue Medicale, Mars. 1826.
M.Desgenettes, declared against the appointment of a commission, because he considered the magnetism of the present day, quite as much a matter of jugglery as that of 1784; and he informs us, that the publicity given to the report, had already increased the audacity of the magnetisers, who look on it as an approbation of their art.
M.Virey, regretted that the report had not spoken in strong terms, against the ridiculous practices, and shameful jugglery, which disgrace the cause of magnetism; he wished the committee had announced an intention, to make only physiological, or psychological researches, on the influence, which magnetism really appears to exercise on the nervous system; and gave his voice for the formation of a commission of experiments.
M.Bally, voted against it for several reasons, and among others, becauseof the fact announced by all the magnetisers, that the person who magnetises, acquires a sovereign power over the magnetisee; and he inferred from this, all the inconvenient and even dangerous consequences which may result to public morals!—Finally, he voted against it, because magnetism is ridiculed every where, because it is all darkness and confusion, and especially, because it being an inexhaustible mine of empiricism, the section ought not to lay open such a fertile field for those gentry who live by quackery.
M.Orfila, (eheu!) defended the propositions of the reporters. It is opposed, said he, on the three grounds following: 1st. Because the section has not been invited to the examination now recommended. 2nd. Because magnetism is nothing but juggling. 3d. Because commissions will not commonly do any work. The first ground is not correct: M.Foissac, a physician of Paris, has invited our attention to it, and offered to subject a magnetic somnambulist to its exploration; and very reputable physicians, members of the Academy, MM.Rostan, (the ramollissement man, is his head soft too?) andGeorget, have in their recent publications called the attention of the learned to this subject. Secondly, if there be any jugglery, in the magnetic phenomena we are told of; it is nevertheless certain, that the whole of them are not simulated. The testimony of well taught physicians, ought to be received on this head. That the phenomena are extraordinary, is no argument; for those of electricity must have been quite as marvellous, at the period of their discovery, &c. &c.
M.Double, blamed the report as being nothing more than an apology for magnetism, which is tarred with the same stick as that of 1784, and only modified a little, by the esprit de notre temps, &c. &c. He said he had made magnetism a special subject of study, andnever saw a phenomenon produced by it.——He thinks the commission could only do injury to science, and compromit the Academy, &c. &c. He would vote against the appointment, and advised the section to wait until some scientific memoirs should be sent to it.
M.Laennec, agreed with M.Double, because after studying the subject for twenty years, he is satisfied, that it is almost nothing but deception and juggling; although, when he commenced the study, he was prejudiced in its favour. According to M.Laennec, among the magnetic influences, there are several, attributable to the impressions, which one individual naturally makes on another in correlation with him; and he cited a mistake, which he saw committed by a somnambulist woman. She was magnetised by two persons, one of whom was handsome, but anaphrodisiac, the other ugly, yet possessing in integrity, the genital faculties. She received no impression, except from the first individual; so that the impression which this female had received by the organs of vision, before the experiment, superseded that, which the pretended magnetic sense ought to have made on her. He thinks, the academy ought toobservethe magnetisers, butwhat he has seen, has convinced him, that nine-tenths of the facts in magnetism are supposititious. The phenomena effected by magnetism, and the oracles uttered by the somnambulist, vary with every magnetiser.Mesmerexcited convulsions;Deslineffected crises, such as are seen in diseases. The somnambulists of Mr.Deleuze, a learned man, are much better taught than those ofPuysegur, who is ignorant of the sciences, and finally, Mr.Laennechas seen a somnambulist under the direction of a pharmacien, who was quite distinguished, by the art with which she compounded the medicines, she recommended. The discussion was now adjourned to the next sitting.
On the 24th of January, it was resumed.
M.Chardel, bears witness to a reality of the magnetic phenomena, as he has witnessed them himself, in a case of what is called somnambulism. He dares not pronounce on the question of magnetism, as a therapeutical agent; but is disposed to think it ought, if ever, to be used with great reserve. Whether it consist of nervous phenomena of a particular order, or whether it be a product of the imagination, in either case, it deserves to be studied, &c. &c.
M.Ronchoux, thought the proposed examination would be impossible; for the magnetisers assert, that if one of the parties have a will opposed to that of the magnetiser, no phenomena can be produced. Their confessed inability to surmount any opposite will, seems to Mr.Ronchoux, an invincible obstacle to any exploration to be attempted by a commission.
M.Marc, gave some explanation of the labours undertaken in Germany. According to the opposition, nothing conclusive can be derived from these labours; because Germany is the native soil of sects and of thaumaturgæ but, Mr. M. proved by citations, that they are not to be attributed to excited imaginations, as has been urged, but to the most celebrated Savans of that country, as for example,Oerstdt,Klaproth, andHufeland, to learned bodies, and to governments. The Royal Academy of Berlin, offered in 1818, a prize of 3300 francs, for an essay on this topic.
The governments of Prussia, Russia, and Denmark, have founded medical commissions for the examination of it, and subjected its therapeutical application to certain regulations. He thought, therefore, that the Academy could follow without compromising its dignity, such good examples. He added, that the examination was absolutely necessary, unless they desired that every French practitioner should hereafter reject the whole subject, and for ever abandon its employment to jugglers and credulous fools.
M.Nacquartthought, that as magnetic somnambulism is something wholly independent of organical, physical, or physiological laws; that as the senses here have no need of organs; as time, space, and intermediatebodies, wholly disappear; we can avail ourselves of no method of appreciating magnetical facts, and consequently, the Academy ought not to trouble their heads about it—a very good joke truly: but M.Itardsaid, that jokes had nothing to do with the question, because they are meant only for the abuses and extravagancies of magnetism; but we want to get at the truth, and to eschew the folly. Magnetism, says he, is either a real or imaginary agent; it ought to be examined. To refuse this, is to despise the path of experiment, which can alone lead to truth, &c. &c.
M.Recamier, could add nothing to the observations of MM.Desgenettes,Bally, andDouble; but he wished the section to know, that he been a witness to the magnetic phenomena—he had been present at the oracles of the marichale of M.De Puysegur, who was represented as the most lucid of all possible somnambulists. He had reason to suspect a cheat in this case, as he was denied the means of dissipating his doubts; and heard this woman repeat what he had before said to the patient himself. How ridiculous, moreover, is it, to hear one drachm of glauber's salt prescribed as a transcendental remedy for phthisis pulmonalis! He also attended at the Hotel Dieu, at experiments made on one woman and two men. He saw the woman go to sleep (as was asserted,) at the simple will of the magnetiser, who for that purpose was concealed in a closet of the apartment. The only mode adopted, to prove that she was really asleep, consisted in some slight pinching of her ears, and some noises; yet, in the recital, these slight impressions have been transformed into most painful tortures. In the experiments made on the men, he employed a more powerful proof, which was the application of moxa; and that he did, because it was indicated by a coxalgia, with which the patient was affected: it isa fact, says he, that the man did not awake, or showthe slightest sensibility. Mr. R. believes, therefore, in magnetical action; but does not think it can ever be available in the practice of physic. In Germany, said he, where magnetism is so much employed, do they cure better than elsewhere? And has magnetism been the occasion of any therapeutical discovery any where? In somnambulism there is only a disordered sensibility, and not an increase of it; and the pretended clairvoyance of the somnambulists, has no real existence, &c. &c.
M.Georget, cited in proof of the existence of magnetic power, the names of many physicians, members of the Academy, as MM.RostanandFouquier—he cited the experiments made at the Hotel Dieu, by Dr.Duportet, in the presence of many members, who had signed the results, as MM.Husson,Geoffroy,Recamier,Delens,Patissier,Martin,Solon,BricheteauandKergaradec. If there be any analogy between magnetic and natural somnambulism, ought we to be astonished at the production of the former by certain practices? The magnetisers conceal nothing, but publish all their proceedings, and do you call these the tactics of jugglers and charlatans?
M.Magendiethought the examination expedient, and wished commissioners to be appointed to examine the somnambulist, offered by Dr.Foissac.
M.Guersentwas in the affirmative: he himself had magnetised, and witnessed several phenomena, &c.
The discussion was then adjourned to the next setting, and on the 14th February, after hearing M.Gascagainst, and M.Lherminerfor the report, M.Hussonthe reporter was heard. The section then closed the discussion, and it was decided by a majority of ten, (35 to 25,) that a commission should be appointed to examine animal magnetism.
We are indebted for the above account to the Revue Medicale for March—the No. for February, also contains a review of M.Dupau'sLettres Physiologiques et Morales sur le Magnetisme Animal, 8vo. Paris, 1826. In order to show our readers how they manage these matters, we shall translate the following from p. 269.
"Here, says M.Rostan, is an experiment that I have often repeated, but which I was finally obliged to interrupt, because it fatigued my somnambulist prodigiously, who assured me, that if I continued, it would make her go mad. This experiment was made in presence of my colleague and friend, M.Ferrus. I took my watch, which I placed three or four inches from her occiput. I asked my somnambulist, if she saw any thing: "certainly, I see something that shines; it hurts me." Her countenance was expressive of pain, and ours expressed astonishment. We looked at each other, and M.Ferrusbreaking silence, said, if she sees something shine, she can doubtless tell what it is. "What do you see that shines?—Oh! I don't know, I can't tell. Look at it well—Stop, it fatigues me, wait—(and after a moment of great attention)It's a watch." More astonishment. But, if she sees the watch, said M.Ferrus, she will doubtless see what o'clock it is. "Could you tell me what o'clock it is?—Oh! no, it is too difficult." "Look at it, try." "Wait then, I'll try; may be I can tell the hour, but I never shall be able to see the minutes;" and after the greatest attention—"It wants ten minutes of eight o'clock:" which was exact. M.Ferrusnow desired to make the experiment himself, and repeated it with the same success. He made me turn the hands of his watch several times, and when presented to her (occiput we suppose,) without her having seen it, she never made any mistake."
These statements we have thought fit to lay before our readers, who will observe the respectable names which are connected with them. We shall seize the first opportunity to give the report of the new commission, and if they confirm the miracles, we can still say, credat Judaeus apella. If it will make no cure, it will probably make much pay; sinceMesmergot upwards of 340,000 francs for his mumming exhibitions, to thespectacleloving quidnuncs of Paris. The commission consists of 11 members, viz.Leroux,Bourdois,Double,Magendie,Guersent,Laennec,Thillaye,Marc,Itard,FouquierandGueneau de Mussy.
36.Sketch of the Medical Literature of Denmark, Sweden, and Norway—byDr.C. Otto,of Copenhagen, apud Bulletin des Sci. Med. Feb. and March.—"Denmark is richer in medical literature, than the other countries which in conjunction with it, composed the ancient Scandinavia. Although it does not in this respect, bear a comparison with France, Germany, England, and Italy, nevertheless, medicine, of all the sciences, seems to be that which is most successfully cultivated, and Copenhagen contains a great number of learned, and able physicians." In proof of what Denmark has done, Dr. O. refers us to the great names of the twoBartholins, ofSteno, ofWinslow, ofCallisen, &c.
"In the 16th century, Denmark possessed the anatomical works of the twoBartholins: (Instit. Anatomicæ de vasis lymphaticis, &c.) and other works of the same kind, which have been translated into all the languages of Europe.Steno, the disciple ofThomas Bartholin, followed the career of his master, with an equal success.Hallernever spoke of this anatomist, without the highest admiration.Rodeenriched the literature of Germany and Denmark, with works which have made his name illustrious, wherever science is cultivated. Among these, we may chiefly distinguish his Bibliotheca, and Materia Medica." The Danes are indebted to him for several popular works on medicine, which are in the judgment of Dr.Otto, chef d'oeuvres of this sort of writing. He published more than 13 volumes on these topics. "To the celebratedCallisen, who is recently deceased, we are indebted for 1st, aSystema Chirurgiæ Hodiernæ, a work of the highest merit, and which has reached a fourth edition. 2nd, a Medical Topography of Copenhagen, published in Danish. (2vols.8vo. Copen.1807.) 3d, the Director of the Academy of Surgery. He is also the author of several important memoirs, inserted in those of theRoy. Soc. of Sciences, of Denmark, and in some other collections. The late professorMath. Saxtorph, composed an excellentmanual of labours, for the use of midwives. A second edition with plates, appeared in 1804.T. L. Bang, has given aPraxis Medica, an excellent guide to young physicians in their first outset in practice.Herholdthas shed some lustre on Danish Physiology: his dissertations on the life of the fœtus, and on the question, whether vision is performed with both eyes, or with one only, bear testimony to his genius and penetration: he is also author of a memoir on penetrating wounds of the Chest, inserted, as well as the former dissertation, and many other pieces, in various medical journals.
"Tyschenpublished in 1804, aTreatise on Pharmacy, in Danish; and professorMynster, gave a work on Pharmacology, of which two volumes only had appeared, when death interrupted his useful labours. In 1794, he commenced the publication of a journal, theBibliothek for Physik Œconomic og Medicin, which was continued in 1799, byBahn, and afterwardsunder several names, till 1807. We now come to the existing state of Danish medical literature.
"The Royal Medical Society of Copenhagen, which, without contradiction, holds the first rank among those of Scandinavia, celebrated its 50th anniversary in 1822. It publishes at irregular periods, its memoirs, under the title ofNova Acta Societatis Medicæ Havniensis. The last volume appeared in 1821. ProfessorJacobsen, is ardently devoted to the study of Comparative Anatomy, and has published several works on the subject, inserted in the Mem. of the Roy. Soc. of Sciences, extracts from which have appeared also in several foreign journals. The collection we have just now cited, (for 1824, V. I.) contains a memoir of Dr.Gartner, which confirms the opinion entertained by the ancients, as to the presence of a glandular body in the uterus of some animals. The author has added a plate to this interesting dissertation. Dr.Ottohas enriched the physiological sciences with hisPhrenology, and is zealously occupied with all that relates to this subject. ProfessorWendt, physician to the General Hospital of Copenhagen, has recently published several small medical works. We may cite hisHistorical and Chemical Supplements, to the knowledge of some therapeutical agents, of the class Euphorbiæ; some notices onsmall pox,vaccina, andmodified small pox.
"Denmark possesses three periodical journals of medicine, without counting those of the Royal Societies of Sciences and of Medicine of Copenhagen. The first and best of these journals, is theBibliothek for Læger, published by a society instituted for the advancement of medical studies.Classen, the founder of this association, bequeathed to it a sum of money, to purchase annually, some foreign medical works. This collection is composed of original memoirs, extracts, and announcements of other works, and a review of thecourseof the faculty of medicine. It is specially consecrated to the practical department of the art—(three numbers per ann. of 70, to 100 pages each.) The 2nd collection, is theNye Hygæa, the editor of which, (M.Otto,) embraces in his plan, all the medical sciences. This journal, although specially devoted to physicians, is in reach of all those persons of education, who can be interested in a variety of important medical questions. It contains original memoirs, and extracts from foreign works, (five leaves per month.) The 3d collection, Archives for the History of Medicine in Denmark, (Archiv. for lægevidens kabens historie in Danmark,) does not appear periodically, but at indefinite times. ProfessorHerholdt, the editor, has only published one number, in 1823.
"As to inaugural dissertations for the doctorate, the number amounts only to three or four in the space of ten years; because the title of M. D. is not requisite to the practitioner in Denmark."
The above is taken from the Bulletin for February, the ensuing portion of the sketch is contained in the March number of the same journal.
"The medical literature of Sweden, must have been very insignificant inpast ages, if we may form an opinion, from the total want of documents in relation to it. There existed no scientific lien between the physicians of that country, or even among those of the capital. A medical society might in vain have been sought for there, at a period, when they were common in all other countries. The Royal Academy of Sciences, published some essays relating to medicine, from time to time, but until 1807, a work on this topic was regarded as a sort of rarity. However, in the course of that year, seven physicians of Stockholm, united in order to found a society, which received the royal sanction, and took the title ofSvenska Lœkare Sœllskapet, (Society of Swedish Physicians.) This institution, seemed to communicate to the practitioners of Sweden a new existence, and then really commenced the æra of medical literature in that country. The number of works published since that period, has scarcely amounted to more than one or two per annum. Dr.Rabenis the author of three works, which, though not large, give evidence of considerable knowledge and penetration: Their titles are: 1st. De præcipuis causis mali Scrophul. ejusque remediis Commentation. Lund. 1807. 2nd. A second volume on the same subject, written in the Swedish language, Lund. 1819. 3d. Observationes in Syphilidem, ejusque curationem, ubi novæ quoque proponuntur curandi rationes. Lund. Goth. 1821.
"We shall also mention among the works recently published in Sweden, 1st. A biographical and literary gallery of the physicians of that country, from the reign of Gustavus I. down to our own times, by Dr.J. F. Saklen. 2nd.Flormann'sManual of Anatomy. Finally, a collection of the laws of the kingdom, which relate to medicine. The Medical Society of Stockholm, regularly publishes its transactions,Svenska Lœkare Sœllskapets Handlingar, the 10th vol. of which has just appeared. In it, are some remarkable cases, a table of the constitution of the atmosphere, and of the diseases which have prevailed at Stockholm, and in its environs; reports on the hospitals and baths of the whole kingdom; extracts from Medico-legal Examinations, recent discoveries, &c. M.Eckströmpromises to publish a complete description of the variolous epidemic, which prevailed last year at Stockholm, and in the provinces. Besides these transactions, the secretary makes an annual report, on what passes at the sittings. To this he adds, short notices of the most interesting recent discoveries and observations, which he derives from foreign medical literature. He publishes this collection once a year, and adds some nosological articles. In closing this review, we ought not to forget to mention the collection of theses, defended at the university of Upsal, which is published yearly by Dr.Zetterström."
37.Erysipelatous Mumps or Angina Parotidiana.—Dr.Behrof Bernberg, has published in theJourn. der Pract. Heilkund for July, 1825, an account of this disease, which we find in theBulletinfor Feb. 1826. Dr.Behr's"memoir is intended to pourtray the principal features of an epidemicprevalence of parotitis at Bernberg, in the months of December, 1822, and January and February, 1823. Dr. B. attributes it to the frequent and sudden variations of the atmosphere at that period." He says, "the disease is so rare in this country, that physicians of 30 years standing had never met with it before." Bernberg contains 6000 souls; it is divided into two parts by the Saale, and it is situated on the great road from Leipsic to Magdeburg, in a narrow valley, which runs from N. W. to S. E.
The precursory symptoms were rigors followed by heat, heaviness of the limbs, pains in the joints, especially in the evening, sense of tension in the region of the lower jaw, and sometimes a difficulty in mastication. The appetite was usually natural, with gastric symptoms only in the most severe cases. On the evening of the 3d day, there was an increase of uneasiness with chills and heat, after which the patient commonly enjoyed sweet sleep. The next day, on awaking, he felt tolerably well, and had no more sense of heaviness in his limbs, but his face was swelled on one or both sides. Speech and mastication were effected with difficulty; the lower jaw wascomme engourdie, and a dull pain was felt in the ligaments of the joints; the tumefaction increased and soon extended from the ear to the cheek. On a careful examination, it was found to affect the parotid gland, and the surrounding cellular tissue. The tumour was hard, diffused, and not very painful, except on pressure. The colour and temperature of the swollen part were natural. In the evening, the pulse became hard and accelerated, the tongue white, the stools more consistent than common, and the urine pale. The following night he was agitated, frequently awakened by lancinating pains in the affected part, and sometimes by a sense of tension in the head. The following day, the tumour reached its maximum of elevation, and sometimes comprised the submaxillary glands of the same side. From this time, the pains did not increase, and the skin became slightly red only in a very few examples.
The disease having thus reached its acme, a gentle sweat commenced behind the ears, then extended over the whole tumour, and remained as long as the swelling lasted. This evening there was no fever, but a gentle perspiration continued throughout the night. The day following, being the 6th of the disease, the tumour was evidently diminished, and continued decreasing until its final disappearance, which occurred on the 9th, and sometimes on the 7th day. Until this period, abundant local perspirations in the day-time, less abundant, but more general ones in the night, were observable. When the disease was critical by urine with sediment, the diminution of the swelling was dated from this appearance; but the resolution was not perfected in some cases till the 14th day, and in such cases, the integuments of the part were covered with a mealy desquamation. Dr.Behrdid not observe any metastasis to the genitals, but he saw cases, in which the disappearance of the swelling, was followed by considerable fever withaugoisse, and then an œdema, commonly situated on the head.
He often saw the termination by induration, but this soon yielded to a proper treatment. As to the contagion of mumps, the author thinks, it can only occur where there is desquamation of the integuments; and remarks on the analogy of this circumstance, with what occurs in scarlatina. Dr.Behrthinks, that antiphlogistics are rarely indicated in the treatment of parotitis.
38.Tænia.—In several cases in which gum. gutt., salts of tin, and other medicines, were unsuccessfully used for the expulsion of tape worm, Dr.Bougardsucceeded in expelling them with pills compounded as follows: Merc. dulc. Extr. aloes, aa. gr. iij. divided into three pills. This dose was given every evening for eight days, and gradually increased or diminished, so as to procure three stools per diem. A rigorous diet was observed during this treatment.—Rust's Magazin fur die gesamte Heilkunde apud Bulletin des Sci. Med. March, 1826.
39.Scrophula.—Dr.Wetzrecommends the employment of caustic potassa in scrophula. He dissolves x grs. of caustic potassa in one ounce of orange-peel water, and gives from xij to xx gtt. four times a day, in a cup of broth. A solution of caustic potassa in six ounces of distilled water, is applied as a wash to the ulcers.—Ibid.
40.Digitalis.—We find in the Propagateur des Sciences Medicales for Feb. 1826, an account of the directions of Dr.Neumannof Berlin, for the employment of digitalis in pulmonic diseases: they are said to be the result of long experience. Digitalis is useless, says the writer, in all cases of suppuration of the lung, consequent to tubercles of that organ. It is of no avail in those suppurations, which succeed inflammatory hæmoptysis. It is employed without success inlocalphlegmorrhagies of the lungs; but it almost invariably cures those chronic catarrhs, which depend on a state of erethism of the mucous lining of the bronchiæ. This disease is sometimes called chronic bronchitis, sometimes mucous consumption, pulmonic catarrh, and galloping consumption. If the diagnosis in this case be well made out, hopes may be entertained of a cure, one of the two following conditions being present:
A. The patient must be susceptible of the stimulant action of the remedy: this is often not the case. We may be sure the digitalis will not produce its effect, where the pulse of the patient remainsuniform and frequent after he has taken it for several days. It does not suit such persons.
B. The medicine ought to be administered in a proper manner. To be good, the leaves, even in the dried state, should be perfectly green and free from any brown spots. Two ounces of the leaves, should be infused in six ounces of boiling water; and the patient may take a table spoonful every hour, until he feels nausea, or a sense of constriction in his throat, or flashing of the eyes, or irregular pulse. The use of the foxglove should then be interrupted for seven or eight days, in which interval, the full actionof the medicine is developed, the pulse remaining irregular, and the mucous secretion diminishing gradually. If the first trial does not remove it entirely, a second course may be commenced after a few days.
41.Dr. Physick's operation for artificial anus, denied to have been performed!—We have often had occasion to remark the claiming, and, we fully hope, the actual re-invention of American operations and practices among physicians on the other side of the Atlantic. As we are not a publishing people, it is, perhaps, not very strange that the French and English should be generally unacquainted with the discoveries and inventions which have been made among us; but here comes an actual denial of the invention having ever taken place!
Every American who has any pretensions to the character of a surgeon, is most probably familiar with the proposal and performance, by Dr.Physick, of a peculiar operation for those cases of artificial anus, where the two ends of the divided or opened intestine adhere laterally to each other, in the manner of a double-barrelled gun. We are now told that M.Richerand, in his new work "On the recent progress of Surgery," "avoids giving this the least confidence." (Archives Generales, Janvier, 1826.) The reviewer in the Archives, in a paroxysm of angry jealousy for the honour of French surgery, deeply wounded, as he conceives, in theadmissionsby M.Richerandof discoveries and inventions among the English and others, adds no small amount of ill-nature to this unworthy intimation, and makes the observations which we have translated below.
It is certainly an easy method of erecting reputations, to deny, directly, the priority of others in operations which a favourite has repeated. No matter though the knowledge of this priority be widely diffused; if readers can, by means of national predilections, be induced to place confidence in your denial, the effect, as far as relates to them, is completely obtained. Yet one would think it an ungenerous act, to call in question, and before partial judges, the veracity of such men as are here named. Where a physician reports cases which agree too well with his preconceived theories, we doubt the correctness of his observations; and with justice: for we know that an already formed belief will greatly tinge the most honest seeings and hearings of very sensible and honourable heads. But this is a far different thing from impeaching, in a manner entirely gratuitous, the moral honesty of the record of a historical fact, made by men at the head of their profession.
The reviewer, Mr. and probably Dr.L. C. Roche, comments as follows:
"1. Dr.Physicknever published any thing on this subject.
"2. Dr.Dorsey, who makes the claim for him, never published the work in which he does so, [the Elements of Surgery,] till 1813.
"3. In the English journal (?) and in that work, he contents himself with a simple assertion, without giving either the date of the operation, the name, age, or sex of the patient, the names of his assistants, or the details of the operation;all points which men never forget to make known, when treating of the first attempt in a new operation of this importance."
To the first of these comments we reply, that Dr.Physick, to the great regret of his countrymen, has never been in the habit of publishing; but still possesses many useful improvements in medicine and surgery, which he has not committed to the press. On the other hand, however, he has taught this operation annually, to from three to four hundred pupils, in his lectures, during about twelve successive years; and this is no mean substitute for a publication in types. M.Roche'smemory will supply him with an instance of an eminent French surgeon, whom we shall not attempt to defraud of his laurels, who also made it his practice to leave the publication of his observations and improvements to his pupils.
To the second remark, the above is also a sufficient reply; but we will add that it was recorded in the case book of the Pennsylvania Hospital in 1809.
Our comment on the third observation of Mr.Rochemay be brief. It is that we promise an account of the case for the next number of this Journal. In the mean time, the patient was well known to us and to many persons now living. The operation was performed in 1809.
In reply to that portion of the last observation, which we have marked with italics, we can assure the reviewer that he is mistaken; at least with regard to this side of the ocean. We Americans are a very peculiar people, and but little affected, as yet, with the cacoethes scribendi; a malady which the present work, in its humble sphere, is designed to disseminate. We are not in the habit of frequently publishing, and above all, of publishing volumes. Books are dear, private libraries small, public ones few, and encouragement for even the best original publications but limited. Of this we have known some melancholy instances. It is impossible for either a Frenchman or an Englishman to judge correctly of a country, which, in many important respects, is in such a different situation from his own.
It is a thing of by no means uncommon occurrence here, to make a valuable discovery or improvement in the healing art, and not to make it public. A striking instance of this fact, at least with the exception of the insertion of an imperfect account in the Eclectic Repertory, which very probably never reached England, is mentioned in our last number. We allude to the extirpations of diseased ovaria, by Dr.M'Dowall, of Kentucky. Here a unique and brilliantly successful operation was performed, successful as yet beyond European imitations, and still the inventor and achiever of it did not possess vanity or industry sufficient to treat the public with afull account of it. M.Rochemay find it hard to explain modesty of this species; but we can promise him, should these sheets ever reach his eye, and he still continue skeptical, abundance of proofs, and some more instances of the same kind.
42.Gangrenous Sore Mouth of Children.—Dr.Coatesbegs permission to add the following quotation fromFabricius Hildanusto the authorities quoted in his paper on gangrenous ulcer of the mouth, at the commencement of the present number.
"Gingivarum inflammatio maxime in infantibus in gangrænam interdum degenerat. Morbus enim magnus, vehemens et peracutus; magna quoque requirit remedia: sed quis illa in ore adhibere ausus?"—De Gangræna et Sphacelo, Cap. IV. p. 773. col. 2. Edit. Beyeri. Francofurt ad Mæn.1646.
"Gangræna in partibus humidis, gingivis, palato, naribus, &c. raro sanabilis; in sphacelum autem degenerans, insanabilis."—Cap. XI. p.781.col.2.
This is all I find in that author, relative to the subject.
43.Operation for Phymosis.—M. J. Cloquet, has so improved this operation that no deformity results. He recommends the incision to be made at theinferiorsurface, near, and parallel to, the frænum præputii. The longitudinal wound thus made, becomes transverse, as soon as the prepuce is drawn behind the glans penis, and cicatrizes in a line scarcely visible; so that the prepuce acquires in breadth what it loses in length. M.Cloquethas, in this way, perfectly cured many patients; the prepuce appearing to possess its natural conformation.—La Propagateur des Sci. Med. for March.
44.Lunar Caustic on Wounds and Ulcers.—The practice of healing wounds and ulcers by natural or artificial scabs, to which the attention of the profession was first directed by Mr.J. Hunter, has been too much neglected, and the circumstances under which it is useful, have not been accurately stated. In a small work published by Mr.Higginbottom, in January last, at London, the practice of forming anescharby the lunar caustic over small ulcers and recent wounds, has been strongly recommended as saving the patient much pain, trouble, and danger. The whole surface is to be pencilled with the solid caustic so as to form an eschar, and where this remainsadherent, the wound or ulcer invariably heals with comparatively little inconvenience. When effusion occurs under the eschar, whether of serum or of pus, there is more difficulty; but if this fluid be evacuated by a puncture, and the caustic applied to the orifice, the eschar will often remain adherent. Sometimes the fluid must be frequently evacuated. If the eschar does not separate favourably, a cold poultice may be applied, which not only removes the eschar, but lessens the irritation and inflammation. Should the sore not be healed, Mr. H. recommends the reapplication of the caustic. To prevent effusion under the eschar, and to preserve it adhering, he advises the whole to be covered with a piece ofgold-beater's skin; but we may add, that as this effusion arises from too much inflammation, more powerful means may occasionally be employed, especially a solution of acetate of lead.Larreyrecommends with the same view, after the application of moxa, the use of the aq. ammoniæ. Indeed any evaporating, cold, astringent lotion will be advantageous.
The application of the caustic, of course, produces some pain, but this soon subsides, and the patient experiences more ease than under any other mode of treatment.
Particular cases in which the Caustic is useful.—In punctured wounds, it should be applied to the orifice and surrounding skin, and the eschar allowed to dry. The terrible effects of punctured wounds, are thus completely prevented, whether caused by needles, hooks, bayonets, &c. So also of wounds from saws; of bites from leeches and animals; of the stings of insects; and especially of those small scratches, and punctures, received inanatomical dissections. The danger of these last mentioned accidents may, according to Mr. H., be completely arrested by the prompt and free application of the lunar caustic. Even in neglected cases, when a small tumour has formed under the skin, attended with a smart stinging pain, he advises the tumour to be removed, and an adherent eschar to be formed by the caustic; and in still more neglected and advanced cases, where inflammation of the absorbents has supervened, "a free crucial incision is to be made, the caustic to be freely applied, and afterwards, the cold poultice and lotion; the usual constitutional remedies being actively enforced."
Inbruises, especially of the shin, the adherent eschar from lunar caustic, has, with Mr. H., always effected a cure; and even when a slough has been produced, the application of the caustic will moderate the inflammation.
Inulcers, which are small, not exposed to friction or motion, and discharging little, the cure by eschar will be preferable; especially in those little irritable and painful ulcers often seen about the ancle and tendo Achillis. Apply first a cold poultice, and then form the eschar, which may be freely exposed to the air. Should the matter, nevertheless, collect, it should be evacuated by puncture as often as necessary, until the eschar remains adherent.
This practice is recommended by Mr. H., in various other affections; as in inflammation of the fingers; in the fungous ulcer of the navel in infants; intinea capitis, &c. In this last case, we have ourselves used it with marked advantage. In all cases, the lunar caustic has a decided effect indiminishing the irritabilityof the parts to which it is applied; and hence should usually be preferred for the purpose of forming a "scab," for such the eschar really is, in a practical view; and we think that our author has hardly done justice to nature's methodus medendi by "scabbing;" while he so ably and strenuously recommends his own imitation of her process. Scabs may be formed by the coagulation of blood; by the drying of mucus or pus; and by the formation of an eschar, by the actual or potentialcautery. The surgeon may frequently reduce parts to the same situation, by the use of gold-beater's skin, court-plaster, or other unirritating applications, which prevent exposure and evaporation. In all cases, care must be taken to prevent the surrounding inflammation from transcending the adhesive stage.
45.Hæmorrhage from Lithotomy.—In the London Med. and Phys. Jour. for Jan. Mr.John Shawhas published an account of a patient, who unfortunately perished from hæmorrhage, in consequence of being cut for the stone. The parts being injected after death, it was found, that the bleeding proceeded from theunusual distributionof a branch of the pudic artery, which traversed the neck of the bladder, and lay directly in the way of the incision. The pudic artery was uninjured.
46.Extirpation of the Parotid Gland.—The best surgical writers have condemned this operation, if not as absolutely impracticable, nevertheless, as too dangerous to be ever attempted. Successful cases have however been reported, and Mr.A. Cooper, in a letter to the operator in the following case, avers, that he twice removed the parotid gland in one year. Mr.Kirby, late president of the Royal College of Surgeons in Ireland, in a work published in 1825 at Dublin, on hæmorrhoidal excrescences, has given the details of a diseased parotid, and of the operation for its removal. We condense from Johnson's Review for April, 1826.
The patient was a poor female, aged 40, who had a tumour extending from above the zygoma downwards on the neck, two inches below the angle of the jaw, stretching as far forwards as the anterior edge of the masseter muscle, forcing the ear backwards, and raising it outwards from its natural position. Above the surface, it was about the size of a goose-egg; immoveable; painful when handled; irregular on the surface, and of a deep livid colour over the prominent points. Pains of a lancinating character, extended over the head and neck, producing sickness and want of sleep.
The operation was performed chiefly by the fingers and the handle of the knife, after dividing the integuments by a crucial incision. The branches of the portio dura were of course divided, and great embarrassment arose from a copious hæmorrhage, caused by the bursting of the tumour, while Mr. K. was rooting it out from between the pterygoid muscles. The bleeding was restrained by the finger of an assistant, and the complete extirpation of the diseased gland was effected. Mr.Kirbysays, "the space between the pterygoid muscles was void—the auditory tube was fully exposed—the articular capsule of the jaw was brought into view—the finger could trace the length of the styloid process, and on sponging the wound of its blood, it could be seen by those who surrounded the chair." The hæmorrhage was restrained by a sponge firmly lodged at the bottom of the wound, covered by compresses of lint, and the whole secured by a double-headed roller.
The patient was much exhausted, slept tolerably well the next night,complaining of thirst and inability to swallow. On the 2nd day, inflammation, swelling, and fever followed—erysipelas appeared on the neck—patient lethargic—pulse small and frequent. Fourth day, suppuration—symptoms improving—no relapse. The patient completely recovered, without any regeneration of the tumour.
InFerussac'sBulletin Universel for Jan. 1826, we observe the following notice, from a German Medical Magazine, conducted by M. D. Schmidt.
A female, aged 33 years, had suffered for 9 years from a diseased parotid gland, which had gradually attained a large size. It was extirpated by Dr.Prieger, and the patient soon returned home in good health, and little disfigured. The tumour measured 8 inches in circumference, and weighed three and a half pounds. (Livres.)
Dr.Priegerhad previously extirpated a scirrhous parotid successfully. M.Wienholdaffirms, that he has extirpated three parotids; the details of these operations are published. M.Schmidt, however, suggests some doubts, as to thenatureandseatof the tumours removed.
47.Aneurism from a Wound, cured by Valsalva's method.—This interesting and valuable case, is condensed from Le Propagateur des Sci. Med. for March, 1826. M. Antouard, a healthy female, æt. 18, was wounded on the 18th of June, 1825, by a poniard, in the left carotid artery, below the superior extremity of the sternum; the instrument passing obliquely inwards and downwards. The anterior and lateral portions of the neck, were enormously distended with blood, and syncope supervened. Four days after the injury was received, an aneurismal tumour was observed at the edge of the sternum, the surrounding effusion being greatly diminished by absorption; and at the expiration of a month, when she was first seen by Dr.Souchier, it was of the size of the two fists of the young female. The pulsations at this time, were nearly equal over the whole surface of the tumour; but rather more distinct over the orifice in the vessel. The surrounding blood was entirely absorbed. No pain was experienced, unless from the pressure of the swelling; from which cause also, resulted a troublesome and continued headach. Dr.Souchier, not believing an operation adviseable, during the warm season of the year, and on a tumour, situated so much under the sternum, determined to fulfil the following indications: 1st. To lessen the quantity of blood; and thus, to diminish the stimulus to the heart, the projectile force it exercises, and consequently, the rapidity with which the blood escaped from the ruptured vessel, and the impulse hence imparted to the sides of the tumour, preventing, in some degree, the coagulation of the blood. 2nd. To increase the effect of general and local bleeding by the use ofcold, ofpressure, and especially, of the digitalis purpurea: that thus the force of the circulation may be lessened, the blood allowed to coagulate, and a radical cure be accomplished.
Mademoiselle Antouard, determined to yield herself to this plan, and was directed: 1st. Rice-water, acidulated with lemon-juice, and an infusionof mallows, forfoodanddrink. 2nd. To employ frictions on the abdomen, and on the insides of the thighs, morning and evening, with eight grains of the pulverized leaves of digitalis, previously macerated for 24 hours in a sufficient quantity of saliva. 3d. To apply every day 12 leeches, near the aneurismal tumour, and after favouring the flow of blood by emollient fomentations, to cover the part with compresses, wet with a saturated solution of the acetate of lead, to be frequently renewed, so as to be kept below the temperature of the skin. 4th. The effect of these means to be augmented by pressure, made by means of the base of a glass tumbler, fixed by the hands of assistants; and 5th. To be kept at rest, and in perfect silence.
Fourth day of treatment, being 2nd of Aug. 1825. Pulsations more central; tumour very sensibly diminished; pulse less strong and reduced from 86 to 74 in the minute; the menses, which had been suppressed for two months, appeared on the 31st ulto. and still flow.Prescription, V. S. ℥xviij. next day, twelve leeches, on the lateral parts of the tumour; gr. xxiv. of digitalis in three applications through the day. Continue ut supra.
Aug. 8th. Patient tranquil; pulse 60, full, not active; face not flushed, but preserving a delicate tinge of red; headach now slight; no nausea; menses continued until the 6th inst.Prescription, V. S. ℥xij.—fifteen leeches to-morrow; increase digitalis to gr. xxviij. daily; the rest, ut supra. The tumour has diminished at least one-fourth.
Aug. 12th. Tumour reduced to 3-5ths of its former volume; pulse at 56; her nights are comfortable; has some headach, and lately, cardialgia; complains of hunger and weakness, and from the fatigue of her assistants, the pressure was made with a bandage less effectually than before. This was allowed, as the pulsations are weakened, and more and more central, while the elevation of the tumour is trifling. For fear her health might be injured, she was permitted to rise a little from bed, and to add to her rice water, some light jellies, (crémes) made from the same grain. V. S. ℥x. and every 2nd day, eight leeches around the tumour; digitalis increased to 32 grains daily; warm pediluvium for one hour, morning and evening; silence as complete as possible.
Aug. 18th. No tumour visible; pulsations can yet be felt; the skin is thickened; pulse at the wrist is at 50. V. S. ℥viij.—six leeches every 4th day until menstrual period; digitalis reduced to gr. xx. and still to the same parts; continue the pressure; allow some rice jelly, vermicelli soup, gentle exercise; silence to be preserved, continue pediluvium, and relieve constipation by simple enemata.
In 15 days, Dr.Souchieragain visited his patient. It required an experienced hand to distinguish, at the spot where the artery was cicatrized, an elevation rather more evident, than over the rest of the artery. Pulse 48 per minute; hunger great, and the remedies now unpleasant. Most of them were suspended, and fruit and the white flesh of poultry added to herdiet list. The digitalis reduced to 12 grains a day. Compression, silence, and moderate exercise, to be continued as before. The menses appeared at the expiration of twenty-five days, and were more abundant than at the last period.
At the end of a month, no trace of the tumour was discoverable. The young lady had carefully increased her nutriment and exercise without inconvenience, and all remedial measures were now omitted.
During the months of December and January last, she remained free from any inconvenience from the tumour, and the union of the parietes of the artery was therefore regarded as complete.
In the above account, we have only to regret that the state of the artery above the tumour, before and after the treatment, had not been noticed. Perhaps this may be supplied by Dr.Souchier, in the commentary, which he proposes publishing on the above case.
48.Protrusion and Wound of the Stomach.—Mr.Travers, in the Edin. Journ. of the Med. Sciences, for Jan. 1826, relates, that a female, aged 53, and the mother ofnineteenchildren, inflicted on herself a wound in the abdomen, three inches in length, and in a transverse direction. When admitted into St. Thomas' Hospital, at the expiration of six hours, the greater part of the large curvature of the stomach, the arch of the colon, and the entire large omentum, were protruded and strangulated in the wound. The omentum was partially detached from the stomach, which organ was wounded in two places; one, half an inch long through the peritoneal coat; the other, a perforation of all the coats, admitting the head of a large probe, and giving issue to a considerable quantity of mucus. Patient faint; pain slight; pulse 102, and irregular; some hiccup. A silk ligature was placed round the small puncture in the stomach, and the displaced viscera returned, after enlarging the external wound. This last was closed by the quill suture. Warm fomentations and abstinence from food and drink enjoined. 2nd day, some re-action; had been sick in the night from some drink given; is free from pain; pulse 120; pain on pressure; an enema ordered.Evening, a dose of castor oil, and twenty leeches to the abdomen. 3d, much fever; V.S. ℥xviij. and 20 leeches to the abdomen; bowels not opened. 4th day, two stools; pulse 98; tension of the abdomen; three more stools during the day. 5th, sutures removed; wound united, except at its right extremity, where a serous fluid is discharged in considerable quantities. On the 6th day, was allowed food, and on the 23d of Dec., about two months after the accident, was discharged cured.
49.Œsophagotomy.—This operation has been objected to, not only on account of the dangers attending its performance, but from the alleged difficulty of promoting the union of the wound in the œsophagus; as it is seldom at rest, the lips of the incision being often separated, and the mucous coat adhering with difficulty under any circumstances. Hence we are induced to notice the following case, in which the operation was successfullyexecuted on an inferior animal, by M.Felix, a veterinary surgeon of Bergelac. The account is published in the Feb. No. of Le Propagateur des Sci. Med.
ACowwas threatened with immediate suffocation from the lodgment of a potato in the œsophagus. It had shortness of respiration, an incapacity of swallowing even its saliva, which flowed from the mouth, was in great distress, and covered with a cold sweat. Being properly secured in a horizontal posture, an external incision was made on the inside of the sterno-mastoid muscle, and a cautious dissection practised until the tumour was completely exposed. The œsophagus was divided by "an incision extending the whole length of the foreign body, which was extracted without any force,which is almost always fatal. I immediately made two close sutures; and also two others in the skin, on each side, adapting to them two pieces of packthread, more easily to fix the dressings. I dressed the wound with brandy, filling the opening with hemp soaked with brandy." The animal was kept on very little food or drink. On the third day the wound was dressed for the first time, and a digestive ointment applied.