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WESTERN MEDICAL AND SURGICAL SOCIETY OF LONDON. FRIDAY, MARCH 30TH, 1855.
459 malignant disease, increasing progressively, and relieved or of the patient; alteration of the aggravated by the posture voice, varying greatly in its character in different cases and at different periods of the day, according to the position of the and the varying condition of the circulating system; dysphagia, unaccompanied by the rapid wasting, the sallowness of complexion, and the peculiar aspect characteristic of malignant disease, rapid in its commencement, uncertain in its progress, and varying greatly from day to day in its completeness and severity, aggravated by whatever tends to accelerate the circulation, relieved by perfect rest, and in many cases by free venesection, increased by certain postures, alleviated by others; pain in the back, constantly referred to one particular spot, not unfrequently a little below the junction of the neck and thorax, not increased by pressure, but often aggravated by percussion, greatly augmented by activeexercise, and usually relieved by an inclination of the body forwards, by perfect rest and by free venesection. These symptoms, together with haemoptysis and hasmatemesis, irregularity and inequality of the pulse in the two wrists, turgescence of the superficial tho-
patient
racic
veins,
or
of the veins of
one or
both upper
extremities,
accompanied by œedema. and more rarely by paralysis, together with the phenomena connected with disturbance in the centre
of circulation, and those referable to interference with the cerebral circulation, the sudden startings at night, the frightful dreams, the occasional syncope, were referred to by Dr. Fuller as often affording, in the strangeness of their succession, their variableness, and their complications, very conclusive evidence of the existence of aneurism, even when the most carefully conducted physical examination of the chest leaves us utterly at fault. This he elucidated by cases which have fallen under his care at St. George’s Hospital and in private practice. In conclusion, he stated that his object was not to underrate the assistance obtainable from the stethoscope in these cases, but to counteract the existing tendency to look upon the stethoscope as all important, and to disregard the general symptoms of the complaint.
WESTERN MEDICAL AND SURGICAL SOCIETY OF LONDON. FRIDAY, MARCH 30TH, 1855. DR.
BARCLAY, VICE-PRESIDENT,
DR. SEATON read
a
paper
IN THE
CHAIR.
whatever that might have been, extensively acid, and with a fœtid sulphurous smell. This fcetor has increased lately, and he has observed for some time that the matter vomited has fermented on standing. He has no pain, but for the last month has had a heavy dragging sensation at the stomach. During the whole nine months since the dyspeptic symptoms first set in he has been losing flesh. The abdomen was well examined: it was quite flat and soft; there was no tenderness; no tumour nor sense of resistance anywhere; there was extended stomach Some of the matter vomited was examined: it was resonance. a brownish liquid, intensely acid, in a state of fermentation. On standing, it divided into a thick scum of brownish yeasty substance at the surface; a quantity of semi-turbid fluid beneath, and at the bottom a deposit of half-digested food. A little of the scum was put under the microscope, and exhibited abundance of sarcinas. Although the history of the case, and the patient’s general aspect left little doubt of there being organic disease of the stomach, the discomfort arising from the vomiting and the fermentation was so great, that it was thought desirable to try the effect of hypo-sulphite of soda. This was accordingly commenced on the 4th of July, in the dose of ten grains, three times a day, in an ounce of infusion of quassia. This produced no effect on the frequency of vomiting, or on the quantity ejected, but it gradually diminished the acidity, the foetor, and the fermentation, and within eight days entirely put an end to them. Some of the matter vomited on the 18th was submitted to careful examination, without detecting any sarcinæ. He continued the sulphite to the end of the month without any return of the fermentation, but without any effect on the frequency of vomiting. He left town, and went to the sea-side for the month of August, during which he took no sulphite; but the fermentation did not return, except on one or two occasions, and then he attributed it to his having taken improper food. He returned at the end of the month, evidently sinking fast. A remarkable lull, however, took place in his symptoms a few weeks previous to his dissolution. The vomiting for several days had been almost incessant, and by the 8th of September was quite so, not a teaspoonful being retained for a moment on the stomach, while his strength was apparently ebbing away. But on that night he did not vomit at all, and had tranquil sleep. The next day he got up, and remained up nearly the whole day without vomiting, and for ten days he only vomited on one occasion, though he took a great deal of food. On the 18th he ate too heartily of improper
food
nnf!
nn
thf morning of the1Qth vomited a a la-raP
fermented briskly. quantity,tillwhich the the
tinuing
22nd,
This state of things consulphite was given again, and the
fermentation was at once arrested. The sulphite was disconVENTRICULI, tinued on the 24th; the fermentation did not return. On the in which, after a short preliminary review of the opinions evening of the 27th he expired. On the 23rd, for the first which had been held on the nature of the sarcinæ, and a brief time, the vomit had the appearance of coffee-grounds. An examination of the body was made after death. There exposition of the various conditions under which they had been found to exist in man and in the lower animals, he gave the were some old adhesions of the left lung, otherwise the thoracic particulars of the following case, which first came under his and abdominal viscera were healthy, except the stomach; this care in June, 1853. The patient was a respectable tradesman, was enormously dilated, and occupied the greater part of the aged forty-eight, of moderate height, evidently thinned by abdominal cavity; its parietes were very thin, but healthy in ON SARCINA
stout; always of a strong constitution, appearance, except towards the pylorus, where there was, on suffered from any particular disease till the the anterior surface of the organ, an ulceration larger than a He had been married crown piece. This ulceration did not extend to the pylorus, one with which he was now afflicted. twenty-one years. He was a house-decorator, and had alwayss though it did to within two or three lines of it; but the mucous worked very hard, feeling the better for so doing. His habits membrane between it and the pylorus, and the whole circumwere temperate, but he had been irregular with regard to his I, ference of the pylorus itself, were in a state of colloid degenehours of meals, from devotion to his work; bowels generally ration. Only a moderately-sized quill could be passed through regular, or easily regulated. For the last seven or eight years the pylorus. In commenting on this case, Dr. Seaton observed that it conhe had felt at times peculiar languor, and this had increased so he had been occa- firmed the view taken by Dr. Todd, that the occurrence of much during thetolast two ortothree,andthat to quit his work and sarcinas in large quantities in yeasty vomiting, was indicative sionally obliged give way it, repose for awhile. About eight or nine months ago he first of dilatation of the stomach, generally the result of pyloric experienced symptoms of derangement of the stomach, mani- obstruction. But while this was undoubtedly so in the majority fested by loss of appetite, and flatulence, with increase of the of instances, from an analysis of published cases, he altogether general weakness and irregularity of the bowels. After several called in question the broad statement of Dr. Todd, that this months there came on acid eructations, occurring almost symptom might be considered pathognomonic of this particular directly after each meal; and soon after this, vomiting of the lesion. Again, while delay of food in the stomach, and subfood taken, along with a green acid stuff (the words of his sequent fermentation constituted undoubtedly the most favourdescription.) This occurred at first generally four or five times able conditions for the development and multiplication of a day, after each meal; but was somewhat mitigated by medical sarcinae, these may be found, even in large numbers, indetreatment, and, at length, about a fortnight ago, sank to about pendently of fermentation at all, and the immediate conditions once a day, mostly in the evening. On some days within the of their existence have yet to be ascertained. Finally, he ast fortnight he has vomited twice or thrice; sometimes he has alluded to the value of the sulphite of soda in putting a stop to passed an entire day without vomiting at all. But, whatever the fermentation and development of sarcinæ, and to the great the interval, it always seemed that, when he vomited, he comfort which the patient thence derived; also to the interestbrought up all that he had taken since the last time of vomit- ing fact, that when the fermentation had been once made to ing, so that the longer the interval, the greater was the quan- cease, it did not show any particular disposition to return, and tity ejected. The ejecta consisted always of the food taken, when it did occasionally return, was not permanent.
disease, though and
never
never
having
patient
racic
veins,
or
of the veins of
one or
both upper
extremities,
accompanied by œedema. and more rarely by paralysis, together with the phenomena connected with disturbance in the centre
of circulation, and those referable to interference with the cerebral circulation, the sudden startings at night, the frightful dreams, the occasional syncope, were referred to by Dr. Fuller as often affording, in the strangeness of their succession, their variableness, and their complications, very conclusive evidence of the existence of aneurism, even when the most carefully conducted physical examination of the chest leaves us utterly at fault. This he elucidated by cases which have fallen under his care at St. George’s Hospital and in private practice. In conclusion, he stated that his object was not to underrate the assistance obtainable from the stethoscope in these cases, but to counteract the existing tendency to look upon the stethoscope as all important, and to disregard the general symptoms of the complaint.
WESTERN MEDICAL AND SURGICAL SOCIETY OF LONDON. FRIDAY, MARCH 30TH, 1855. DR.
BARCLAY, VICE-PRESIDENT,
DR. SEATON read
a
paper
IN THE
CHAIR.
whatever that might have been, extensively acid, and with a fœtid sulphurous smell. This fcetor has increased lately, and he has observed for some time that the matter vomited has fermented on standing. He has no pain, but for the last month has had a heavy dragging sensation at the stomach. During the whole nine months since the dyspeptic symptoms first set in he has been losing flesh. The abdomen was well examined: it was quite flat and soft; there was no tenderness; no tumour nor sense of resistance anywhere; there was extended stomach Some of the matter vomited was examined: it was resonance. a brownish liquid, intensely acid, in a state of fermentation. On standing, it divided into a thick scum of brownish yeasty substance at the surface; a quantity of semi-turbid fluid beneath, and at the bottom a deposit of half-digested food. A little of the scum was put under the microscope, and exhibited abundance of sarcinas. Although the history of the case, and the patient’s general aspect left little doubt of there being organic disease of the stomach, the discomfort arising from the vomiting and the fermentation was so great, that it was thought desirable to try the effect of hypo-sulphite of soda. This was accordingly commenced on the 4th of July, in the dose of ten grains, three times a day, in an ounce of infusion of quassia. This produced no effect on the frequency of vomiting, or on the quantity ejected, but it gradually diminished the acidity, the foetor, and the fermentation, and within eight days entirely put an end to them. Some of the matter vomited on the 18th was submitted to careful examination, without detecting any sarcinæ. He continued the sulphite to the end of the month without any return of the fermentation, but without any effect on the frequency of vomiting. He left town, and went to the sea-side for the month of August, during which he took no sulphite; but the fermentation did not return, except on one or two occasions, and then he attributed it to his having taken improper food. He returned at the end of the month, evidently sinking fast. A remarkable lull, however, took place in his symptoms a few weeks previous to his dissolution. The vomiting for several days had been almost incessant, and by the 8th of September was quite so, not a teaspoonful being retained for a moment on the stomach, while his strength was apparently ebbing away. But on that night he did not vomit at all, and had tranquil sleep. The next day he got up, and remained up nearly the whole day without vomiting, and for ten days he only vomited on one occasion, though he took a great deal of food. On the 18th he ate too heartily of improper
food
nnf!
nn
thf morning of the1Qth vomited a a la-raP
fermented briskly. quantity,tillwhich the the
tinuing
22nd,
This state of things consulphite was given again, and the
fermentation was at once arrested. The sulphite was disconVENTRICULI, tinued on the 24th; the fermentation did not return. On the in which, after a short preliminary review of the opinions evening of the 27th he expired. On the 23rd, for the first which had been held on the nature of the sarcinæ, and a brief time, the vomit had the appearance of coffee-grounds. An examination of the body was made after death. There exposition of the various conditions under which they had been found to exist in man and in the lower animals, he gave the were some old adhesions of the left lung, otherwise the thoracic particulars of the following case, which first came under his and abdominal viscera were healthy, except the stomach; this care in June, 1853. The patient was a respectable tradesman, was enormously dilated, and occupied the greater part of the aged forty-eight, of moderate height, evidently thinned by abdominal cavity; its parietes were very thin, but healthy in ON SARCINA
stout; always of a strong constitution, appearance, except towards the pylorus, where there was, on suffered from any particular disease till the the anterior surface of the organ, an ulceration larger than a He had been married crown piece. This ulceration did not extend to the pylorus, one with which he was now afflicted. twenty-one years. He was a house-decorator, and had alwayss though it did to within two or three lines of it; but the mucous worked very hard, feeling the better for so doing. His habits membrane between it and the pylorus, and the whole circumwere temperate, but he had been irregular with regard to his I, ference of the pylorus itself, were in a state of colloid degenehours of meals, from devotion to his work; bowels generally ration. Only a moderately-sized quill could be passed through regular, or easily regulated. For the last seven or eight years the pylorus. In commenting on this case, Dr. Seaton observed that it conhe had felt at times peculiar languor, and this had increased so he had been occa- firmed the view taken by Dr. Todd, that the occurrence of much during thetolast two ortothree,andthat to quit his work and sarcinas in large quantities in yeasty vomiting, was indicative sionally obliged give way it, repose for awhile. About eight or nine months ago he first of dilatation of the stomach, generally the result of pyloric experienced symptoms of derangement of the stomach, mani- obstruction. But while this was undoubtedly so in the majority fested by loss of appetite, and flatulence, with increase of the of instances, from an analysis of published cases, he altogether general weakness and irregularity of the bowels. After several called in question the broad statement of Dr. Todd, that this months there came on acid eructations, occurring almost symptom might be considered pathognomonic of this particular directly after each meal; and soon after this, vomiting of the lesion. Again, while delay of food in the stomach, and subfood taken, along with a green acid stuff (the words of his sequent fermentation constituted undoubtedly the most favourdescription.) This occurred at first generally four or five times able conditions for the development and multiplication of a day, after each meal; but was somewhat mitigated by medical sarcinae, these may be found, even in large numbers, indetreatment, and, at length, about a fortnight ago, sank to about pendently of fermentation at all, and the immediate conditions once a day, mostly in the evening. On some days within the of their existence have yet to be ascertained. Finally, he ast fortnight he has vomited twice or thrice; sometimes he has alluded to the value of the sulphite of soda in putting a stop to passed an entire day without vomiting at all. But, whatever the fermentation and development of sarcinæ, and to the great the interval, it always seemed that, when he vomited, he comfort which the patient thence derived; also to the interestbrought up all that he had taken since the last time of vomit- ing fact, that when the fermentation had been once made to ing, so that the longer the interval, the greater was the quan- cease, it did not show any particular disposition to return, and tity ejected. The ejecta consisted always of the food taken, when it did occasionally return, was not permanent.
disease, though and
never
never
having