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CURE FOR BALDNESS.
443
For in order that the occiput should pass have considered so difficult; and, in fact, the outlet, it is necessary that the occipitorepeated observations, I feel satisfied mental diameter should be placed in the that the resilience of the aneurysm, after direction of the axis of the outlet, or in other each beat of the heart, produces a resiin the pulse. Thus, taking, as exwords, in the direction of a line passing three patients who have been for from the sacro-vertebral angle to the e some time in the hospital, one has aneucentre of this outlet; hence it would be making its way through the anterior necessary that the occiput should be of the chest, in which the resiand the chin forwards parietes upwards pushed against the angle of the sacrnm, but the licnt pulse is very distinctly marked, as it in all similar cases. Two neck of the child, placed between the chin will be and sacrum, renders such a motion impos- ’, others, in which I consider that aneurysm sible. j exists, though not yet showing itself exThis fact may be easily demonstrated on ternally, have the resilient pulse in difWhen the a pelvis and artificial foetus; but it be- ferent degrees of clearness. comes still more clear when we think on resilience is slight, it requires some praèthe direction of the uterine contractions. tice to feel it, and the fingers must be kept When the head is in the cavity of the pelvis, with a light elastic pressure on the artery the uterus acts on it in a line falling from at the wrist. There is occasionally a the umbilicus to the coccyx ; the eiforts of double pulse, from valvular disease (dethe uterus, therefore, all fall on the occi- scribed in THE LANCET, No. 455, page put, but as the perineum presents resist- 199), but different from this aneurysmal ance on the one side, while the chin can- resilience. not give way on the other, the occiput is I may observe, that one of the lastpushed in a direction where it cannot mentioned patients has fremissement cahave an exit. These considerations are taire, accompanied by a bruit so loud, applicable to cases in which the occiput that it may be heard without mediate auslooks directly backwards, but if we apply cultation, if the ear be held within about I am, Sir, them to oblique positions of the occiput, it ten inches of the sternum. is manifest that natural labour is still less yonrs, &c. A. BILLING, M.D. to be expected. London Hospital, Nov. Nov. 30, 30, 1833.
from
lience
amples,
rysm
found
EARLY DETECTION
OF CURE FOR BALDNESS.
ANEURYSM IN THE CHEST. To the Editor
of THE LANCET. will insert the following SIR,—If you SIR,—It has been a desideratum to as- description of a singular case of porrigo certain as early as possible the existence decalvans in your valuahle publication, you To the Editor
(1fTHE
LANCET.
of aneurysm in the chest, in order to the adoption of treatment and precautions to
will much oblige me. In the year 1808, I was affected with a retard the increase of that tremendous partial baldness of the scalp, in places not malady. exceeding the size of a shilling, unaccomWhen the aneurysm has attained such a panied with the slightest visible irritation size as to present itself externally, little can of the external skin. The patches, which be done to arrest its progress, without were as smooth as the palm of the hand, depressing the patient, to a great degree, soon displayed a fresh crop of hair after in the endeavours to keep down the pulse; using a stimulating ointment, composed for, unfortunately, the aneurysm is dis- of equal parts of ointment of tobacco and tended, not by the injecting force merely citron ointment. The disease, however, of the heart, but by that force increased recurred at intervals during twenty years; in proportion as the aneurysm increases but invariably yielded to the application beyond the caliber of the aorta, on the of the ointment in the course of a few principle of the hydraulic press, so that as weeks. Weekly recourse to shaving has the aneurysm enlarges, its tendency to at length completely removed this singuincrease, or the distending force, aug- lar affection. The efficacy of this invaments. luable ointment in most cutaneous affecAn aneurysm in an exposed part is seen tions (diluted according to the nature of and felt to pulsate, and it occurred to me, the case) cannot be too extensively known. that upon this known property might de- I have the honour to be, Sir, your obedient pend a state of pulse which might assist servant, us in the diagnosis of incipient aneurysm FELIX THORNBURY. in the chest, which Laennec and others Brighton, Nov. 27, 1833.
For in order that the occiput should pass have considered so difficult; and, in fact, the outlet, it is necessary that the occipitorepeated observations, I feel satisfied mental diameter should be placed in the that the resilience of the aneurysm, after direction of the axis of the outlet, or in other each beat of the heart, produces a resiin the pulse. Thus, taking, as exwords, in the direction of a line passing three patients who have been for from the sacro-vertebral angle to the e some time in the hospital, one has aneucentre of this outlet; hence it would be making its way through the anterior necessary that the occiput should be of the chest, in which the resiand the chin forwards parietes upwards pushed against the angle of the sacrnm, but the licnt pulse is very distinctly marked, as it in all similar cases. Two neck of the child, placed between the chin will be and sacrum, renders such a motion impos- ’, others, in which I consider that aneurysm sible. j exists, though not yet showing itself exThis fact may be easily demonstrated on ternally, have the resilient pulse in difWhen the a pelvis and artificial foetus; but it be- ferent degrees of clearness. comes still more clear when we think on resilience is slight, it requires some praèthe direction of the uterine contractions. tice to feel it, and the fingers must be kept When the head is in the cavity of the pelvis, with a light elastic pressure on the artery the uterus acts on it in a line falling from at the wrist. There is occasionally a the umbilicus to the coccyx ; the eiforts of double pulse, from valvular disease (dethe uterus, therefore, all fall on the occi- scribed in THE LANCET, No. 455, page put, but as the perineum presents resist- 199), but different from this aneurysmal ance on the one side, while the chin can- resilience. not give way on the other, the occiput is I may observe, that one of the lastpushed in a direction where it cannot mentioned patients has fremissement cahave an exit. These considerations are taire, accompanied by a bruit so loud, applicable to cases in which the occiput that it may be heard without mediate auslooks directly backwards, but if we apply cultation, if the ear be held within about I am, Sir, them to oblique positions of the occiput, it ten inches of the sternum. is manifest that natural labour is still less yonrs, &c. A. BILLING, M.D. to be expected. London Hospital, Nov. Nov. 30, 30, 1833.
from
lience
amples,
rysm
found
EARLY DETECTION
OF CURE FOR BALDNESS.
ANEURYSM IN THE CHEST. To the Editor
of THE LANCET. will insert the following SIR,—If you SIR,—It has been a desideratum to as- description of a singular case of porrigo certain as early as possible the existence decalvans in your valuahle publication, you To the Editor
(1fTHE
LANCET.
of aneurysm in the chest, in order to the adoption of treatment and precautions to
will much oblige me. In the year 1808, I was affected with a retard the increase of that tremendous partial baldness of the scalp, in places not malady. exceeding the size of a shilling, unaccomWhen the aneurysm has attained such a panied with the slightest visible irritation size as to present itself externally, little can of the external skin. The patches, which be done to arrest its progress, without were as smooth as the palm of the hand, depressing the patient, to a great degree, soon displayed a fresh crop of hair after in the endeavours to keep down the pulse; using a stimulating ointment, composed for, unfortunately, the aneurysm is dis- of equal parts of ointment of tobacco and tended, not by the injecting force merely citron ointment. The disease, however, of the heart, but by that force increased recurred at intervals during twenty years; in proportion as the aneurysm increases but invariably yielded to the application beyond the caliber of the aorta, on the of the ointment in the course of a few principle of the hydraulic press, so that as weeks. Weekly recourse to shaving has the aneurysm enlarges, its tendency to at length completely removed this singuincrease, or the distending force, aug- lar affection. The efficacy of this invaments. luable ointment in most cutaneous affecAn aneurysm in an exposed part is seen tions (diluted according to the nature of and felt to pulsate, and it occurred to me, the case) cannot be too extensively known. that upon this known property might de- I have the honour to be, Sir, your obedient pend a state of pulse which might assist servant, us in the diagnosis of incipient aneurysm FELIX THORNBURY. in the chest, which Laennec and others Brighton, Nov. 27, 1833.