CHILDREN'S HOSPITAL, PARIS.

414 several hours, even up ducing the same effect, that is, the imperme. The day she had been bled, ability of the pulmonary tissue to air ;it was which was the third day before her death, evident from the stethoscopic signs, that there were a number of small incisions made neither of those diseases existed, so it mnst in her right thigh, as it was much more infil- have depended on some disease of the heart, trated than the other; there was a little However, M. Louis only diagnosticated quantity of a serous fluid which came from phthisis, as there were no exact stetho. where the incisions had been made. scopic signs of disease of the heart notwithstanding that the general symptoms of this Post-mortem Examination. disease existed ;for instance, the face pre. On the thighs and abdomen some black sented a violet colour, and there was infiltra. extremities. M. L. further spots, the skin on the other parts of the body tion of the lower of the natural colour. There was no ramol- remarked, that we often find dilatation of lissement of any part of the brain, nor any all the cavities of the heart ;however that morbid appearance which could account for it is tiore common to see one or two of its the paralysis which had existed. Larynx cavities dilated, as occurred in this case, offered nothing abnormal. Bronchia—inter- He also added that Corvisart states in his there is dilatation of the nally the mucous membrane of a deep-red work, that when its walls are thinner than in ventricle, right colour, and a little thickened. Lungs,-the its normal state ;.but M. Louis stated that right lung was emphysematous in some in forty-five cases he had examined of dila. points. At the superior part the tissue was tation of the right side of the heart, he has a little hardened; in the superior lobe there The left always found the walls thicker than they were some of the bronchia dilated. be; the same thing had occurredin lung was not emphysematous; but there ex- should the dilatation of the pulmonary isted, in the superior part of the superior this case; lobe of this lung a cavern of a considerable artery in this case was owing to the action size which contained a liquid of a yellow- of the right side of the heart being increased, brownish colour; the walls of this cavern M. Louis had already observed six cases of of the pulmonary artery corre. were of a yellow colour, mixed with strise of dilatation with dilatation of the right ventri, green ; the walls of this cavity seemed to sponding be nothing more than the pulmonary tissue cle. Haemoptysis never exists in this affection to M. Louis, except that there are hardened, and did not appear to be suffi- according in the lungs; and even then hæciently distinct from the lungs, so as to offer tubercles does not always occur, as ill the the appearance of false membranes. The moptysis heart was considerably increased in size, the case just related. right auricle was greatly distended and contained a great quantity of blood, as did also CHILDREN’S HOSPITAL, PARIS. the inferior vena cava; the cavity of the ventricle than it should be was larger right PURPURA HÆMORRHAGICA. in its natural state, its walls were also J. R., a girl, 14 years of age, was brought thicker and harder, the valves were healthy in the different cavities of the heart; the left to the hospital on the 9th of May, 1838, side of the heart was nearly in its normal She is of strong constitution ; the face full state. The pulmonary artery was thirty-six coloured ; health habitually good. The girl lines in diameter at its origin from the heart, has not yet menstruated. For the last eight whilst the aorta was only thirty. Liver pre- daysshe has experienced a general feeling sented nothing remarkable. Spleen was of malaise, &c., accompanied by pains about twice as large as in its healthy state ; it was the loins, headach, with alternations of not otherwise diseased. Stomach contained flushing of the face, and slight shivering a considerable quantity of gas. Small intes- which precede colicky pains and vomiting tine was scarcely half the volume which it The matter vomited was composed of ali presents in its natural state, its coats were mentary substances and blood ; the vomiliag somewhat thickened. Uterus was healthy, occurred five or six times a day, and continued two and a half inches in its largest diame- up to the day of her entrance into the hosters ; the cervix was not more developed pital. Since then she has complained much than it ought to be. of pain in the abdomen, augmented by pres. M. Louis remarked that there existed sure about the epigastrium and umbilicus ; every sign of tubercles of the lungs, at the constipation for 24 hours; thirst; the tongue same time that the dyspnœa, which had ex- red at the tip; pulse frequent; respiration isted was so intense as to lead a person to normal. These febrile symptoms have consuspect disease of the heart, because no af- tinued for the last four days; twelve leeches fection of the lungs could cause such a diffi. had been applied to the hypogastric and in’ culty of breathing except a double pneumo- guinal regions ; the patient has lost a good nia in an advanced stage, or a double pleu- deal of blood, and is now much reduced in risy with considerable effusion, which would strength. In addition to the symptoms just have existed for some time, both those dis- mentioned a number of spots appeared (on eases acting in different manners, but pro the 6th of May) over the legs and the lower

she

was

bled, during

to her death.

parts of the thighs; these spots were at first cases which should be abstracted from the of a dark colour, but many of them have total number; the remaining 390 consisted now nearly disappeared, and the rest are of individuals from 60 to 90 years of age. becoming yellow. They differ in size from Of these

149 died of diseases of the respiratory

that of a flea-bite to that of a shilling. Several other spots, of more recent date, were discovered about the ankles. M. Guersent ordered the following remedies :Lemonade of citric acid, two quarts; lavement; hip-bath ; abstinence.

organs.

101 of diseases of the nervous system. 64 of diseases of the circulating system. 49 of diseases of the digestive organs. 8 of diseases of the liver. 19 of various disorders. A simple glance at the above table serves to show how false is the notion generally entertained that diseases of the abdomen are the most frequent amongst old people ; while they must be ranked in frequency; next to those of the respiratory and nervous

May 11. Yesterday evening the girl experienced considerable pain in the hypogastric region, and vomited about two pints of fluid containing a quantity of coagulated blood. The belly is now very tender ; the inguinal and hypogastric regions painful to pressure ; respiration short and quick; pulse 80 ; great thirst; face flushed ; slight headach. Warm bath; eight leeches to the anus ; purgative lavement ; abstinence. 12. The child feels much better after the bath, and the application of the leeches, which bled a great deal; no vomiting; pain of abdomen nearly gone ; pulse 66 ; four alvine evacuations; the spots have nearly

system. The frequency and gravity of organic lesions naturally leads to the question oj

mortality, which, as might be expected, is great in an old persons’ hospital. OJ

very 1345

patients

treated

by M. Prus, during

three years, he lost 430, but as has been no. ticed already, 270 of these patients had n01 reached the age of 60 ; hence the mortality disappeared. Decoct. of mallows ; lavement ; milk diet. of those above 60 years of age, was 390 it) 13 and 14. Patient feels well ; no vomit- 1075 : viz. ing ; no pain of abdomen; appetite good; little trace of the spots left. In the evening the child was removed by her parents. In the case just related the existence of hsematemesis, and appearance on the skin of spots of purpura, were evidently connected with the menstrual effort. M. Guersent commenced the treatment with his favourite remedy, citric acid, but on the second day perceived that this wasOf the patients which were cured, not a case to which the acid was suitable,, 216 were treated for disorders of the respiratory organs. and prescribed leeches with purgative ene151 for disorders of the nervous centres. mata. Some physicians would have hadI 144 for disorders of the digestive organs. recourse to a much more active treatmentt 54 for disorders of the circulating sys. than that of M. Guersent ; and certainly the tem. 22 for skin diseases. symptoms enumerated on the llth of May,, 98 for various disorders. would have justified the employment off of instead M. Prus concludes his memoir by some general bloodletting, leeching.— considerations on the general pathology of French Lancet. June. 1838. old people. The physician who is in the habit of treating old persons, is, above all things, struck with the absence of reaction in the diseased organ or system. The lung DISEASES OF OLD PERSONS. may pass into a state of gray induration, the stomach may become cancerous, with. By M. PRUS. THE first question which M. Prus has en- out any of the symptoms being developed, deavoured to resolve is that relative to the which announce their existence in the adult. frequency of different affections in old peo- Even, as Bichat has remarked, an old man ple ; and, for this purpose he has examined, may continue to live with a disease of the for three years consecutively, the bodies of heart which would quickly kill a young 430 patients who died under his care at person or an adult. Another remarli which Bicêtre.* Of these 430, 40 belonged to deserves attention is the state of isolation of organs in the old person ; the consent and * The Hospital of Bicetre, which is confined to with the diseased the reception of old men, and deranged persons ot. sympathy of other organs the male sex, contains a population of 3000 indivi.one, is not observed in aged people.—French duals.—ED. L. Gazette, -

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