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INTERESTING CASE OF CALCULI IN THE BLADDER; REMOVAL BY WASHING OUT AND BY LITHOTRITY.
515 we are
driven to the conclusion that
a
dog
may
occasionally
A Mirror HOSPITAL PRACTICE,
communicate hydrophobia when not apparently suffering from rabies or any recognisable disease whatever. Whether there may be some especially noxious peculiarity in the saliva of these animals at times, may be a matter worthy of the attention of pathologists. To many it would seem more likely that in certain individuals, whether from being the subjects of a latent materies morbi, or of some hidden or unknown idiosyncrasy of temperament or organisation, hydrophobia may occasionally be developed if the saliva of a dog, apparently healthy, be brought in contact with a wound. The saliva of a rabid dog is, doubtless, much more dangerous; but the saliva of some dogs, not rabid, is not free from danger. The above argument, perhaps, is strengthened by the fact of so many escaping after having been bitten by rabid animals; for if peculiarity of constitution be not a principal factor in the production of the disease, upon what hypothesis can the escape of the large majority of those who have been bitten be explained? As regards the treatment of hydrophobia, is it not possible that atropine, if more courageously administered or injected than hitherto, would be capable of benefit? By its known action on the pneumogastric, it should be beneficial ; and scarcely less so if its action in congestion of the spinal cord or its membranes be as successful as indicated by Dr. Brown-Sequard. Pontefract. _____________
INTERESTING CASE OF CALCULI IN THE
BLADDER; REMOVAL BY WASHING OUT AND BY LITHOTRITY.
BY JOHN FOSTER.
A GENTLEMAN, aged seventy-six, consulted me, in the absence of Sir Henry Thompson, on the 16th of September. He had enjoyed perfect health, and had had no disturbance of his urinary organs until six months ago, when he passed several uric-acid calculi, varying in size from a pin’s head to a very small pea; but he had passed none for the last four months. He suffered no pain, slight irritation only, at the end of his penis; never passed blood, but had considerable frequency in making water. He had a narrow stricture at the orifice of the urethra, which I divided, and passed a No. 8 coudee catheter to ascertain if he emptied the bladder. With the urine came a large number of very small calculi; and, by injecting some warm water, I removed, I should think, about three or four hundred. On the 17th I used a larger catheter, and washed out as many more, some of the size of a small pea. Feeling sure from his symptoms that some more were still remaining in his blad 1,’1’, he was put under the innuknee of gas and ether, on 8-pt. 20th, by Mr. Bailey, and I crushed several calculi, one the size of a bean. Again, on the 22nd, under the same anaesthetic, I crushed two or three more, and removed all calculous matter with the lithotrite and Clover’s apparatus. On the 25th the irritation and frequency had greatly diminished, and he went home, having learned to pass his catheter twice a day to empty the bladder of the residual urine. The case is interesting from the fact that such a large collection of calculi (over a thousand) remained in the bladder, unsuspected, and causing so little inconvenience; and the reason of their not being easily expelled was the inability of the patient to empty his bladder by his own efforts.
Wimpole-street,
W.
INFANTILE MORTALITY.-Dr.
Hardwicke, Medical
Officer of Health for Paddington, in a recent report, makes the following observations :—" The deaths of young children are, as usual, very high, indicating some grave fault somewhere. 84 young children were taken off by measles; whooping cough, and bronchitis, no doubt deaths all ac. celerated by undue exposure to cold while suffering from attacks of these complaints; 86 more deaths are from th consumption class ; 28 deaths from violence or accidental and 3 from infanticide-these latter by persons unknown.
OF
BRITISH AND
FOREIGN.
Nulla autem est alia pro certo noscendi via, nisi quampJnrimas et morborum et dissectionurn historias, turn aliorum, turn proprias collectas habere, et inter se comparare.-MORGAGNI De Sed. et Caus. Morb., lib. iv. Procemium.
GUY’S HOSPITAL. CASES OF DISEASE OR OF INJURY OF THE ARTERIES.
of Mr. BRYANT.) THIS week commence the report of a series of cases illustrating some points in the surgery of the arteries. The report will comprise cases of disease and of injury of the bloodvessels, of ligature of the arteries for wounds, injuries, and aneurisms, and will include one case in which the femoral artery was ligatured for elephantiasis Arabum of the leg. The subjoined were cases of popliteal aneurism: one case having been rapidly cured by means of digital compression; the other having speedily recovered after ligature of the femoral artery, although compression had failed. Some marked diference existed in the two cases. The first patient was acorndealer, and apparently a healthy man; and his aneurism seems to have been the direct result of an injury caused by overstraining. His family history was good, and he had not himself suffered from any malady likely to induce disThe treatment by digital comease of his arterial system. pression was well borne by this patient, and he soon recovered. In the second case the patient was about the same age as the man just referred to, but he was engaged in the unhealthy occupation of a fireman, and had suffered several constitutional shocks. He had had jungle fever; had fractured his leg while in Abyssinia; and it is almost certain that he had had syphilis-at all events he had a node on the sternum while in the hospital. In his case there was no history of injury or overstraining; the swelling showed itself spontaneously, and most probably as a result of disIt is, however, a noteworthy fact that, ease of the artery. although no distinct improvement declared itself from the treatment by compression, the patient rapidly recovered after the femoral was tied, the wound healed by primary union, and, as far as the aneurism was concerned, there was not an unfavourable symptom. It is not at all uncommon to find that speedy recovery ensues after the ligature of a vessel, although compression did no good, if indeed it did
(Under the
care
we
no
harm; yet treatment by compression should, we think, rule, be thoroughly carried out before the knife is had
as a
to. CASE 1. Popliteal anevrism;digital compression;cure.The following notes were taken by Mr. Rubt. Carrington :William R-, aged thirty-one, a corn-dealer, was admitted into Naaman ward on Feb. 15th, 1872, having on the outer part of the right popliteal space an ovoid, distinctly pulsating swelling, the size of a hen’s egg. The pulsations were arrested by pressure on the femoral artery ; there was no swelling of the leg or thigh. The largest circumference was in., the other leg at the same level being 14 in. Pulsation could be felt in the posterior tibial artery, but not in the anterior. The swelling was markedly expansile. The patient was a strong, healthy-looking man. He had never had rheumatism nor any similar disease, nor was there any history of consumption in the family. Three months before admission he was lifting a sack of corn, when he strained his right knee. He felt no further ill-effects at the time, but for a month after had occasionally pain and numbness in the leg, and then a small swelling appeared on the outer side of the right popliteal space, which increased in size, being sometimes larger and then smaller, but, was always larger after much walking. Digital compression was commenced on the femoral artery, and continued from 4 r M. to 12 P.M., and the pulsation was entirely arrested, but the patient got very little sleep, and the leg felt benumbed. Feb. 16th.-Compression was commenced again at 8 A.M. and continued till 12 P.M., the pulsation of aneurism not recourse
14i
being
so
strong.
driven to the conclusion that
a
dog
may
occasionally
A Mirror HOSPITAL PRACTICE,
communicate hydrophobia when not apparently suffering from rabies or any recognisable disease whatever. Whether there may be some especially noxious peculiarity in the saliva of these animals at times, may be a matter worthy of the attention of pathologists. To many it would seem more likely that in certain individuals, whether from being the subjects of a latent materies morbi, or of some hidden or unknown idiosyncrasy of temperament or organisation, hydrophobia may occasionally be developed if the saliva of a dog, apparently healthy, be brought in contact with a wound. The saliva of a rabid dog is, doubtless, much more dangerous; but the saliva of some dogs, not rabid, is not free from danger. The above argument, perhaps, is strengthened by the fact of so many escaping after having been bitten by rabid animals; for if peculiarity of constitution be not a principal factor in the production of the disease, upon what hypothesis can the escape of the large majority of those who have been bitten be explained? As regards the treatment of hydrophobia, is it not possible that atropine, if more courageously administered or injected than hitherto, would be capable of benefit? By its known action on the pneumogastric, it should be beneficial ; and scarcely less so if its action in congestion of the spinal cord or its membranes be as successful as indicated by Dr. Brown-Sequard. Pontefract. _____________
INTERESTING CASE OF CALCULI IN THE
BLADDER; REMOVAL BY WASHING OUT AND BY LITHOTRITY.
BY JOHN FOSTER.
A GENTLEMAN, aged seventy-six, consulted me, in the absence of Sir Henry Thompson, on the 16th of September. He had enjoyed perfect health, and had had no disturbance of his urinary organs until six months ago, when he passed several uric-acid calculi, varying in size from a pin’s head to a very small pea; but he had passed none for the last four months. He suffered no pain, slight irritation only, at the end of his penis; never passed blood, but had considerable frequency in making water. He had a narrow stricture at the orifice of the urethra, which I divided, and passed a No. 8 coudee catheter to ascertain if he emptied the bladder. With the urine came a large number of very small calculi; and, by injecting some warm water, I removed, I should think, about three or four hundred. On the 17th I used a larger catheter, and washed out as many more, some of the size of a small pea. Feeling sure from his symptoms that some more were still remaining in his blad 1,’1’, he was put under the innuknee of gas and ether, on 8-pt. 20th, by Mr. Bailey, and I crushed several calculi, one the size of a bean. Again, on the 22nd, under the same anaesthetic, I crushed two or three more, and removed all calculous matter with the lithotrite and Clover’s apparatus. On the 25th the irritation and frequency had greatly diminished, and he went home, having learned to pass his catheter twice a day to empty the bladder of the residual urine. The case is interesting from the fact that such a large collection of calculi (over a thousand) remained in the bladder, unsuspected, and causing so little inconvenience; and the reason of their not being easily expelled was the inability of the patient to empty his bladder by his own efforts.
Wimpole-street,
W.
INFANTILE MORTALITY.-Dr.
Hardwicke, Medical
Officer of Health for Paddington, in a recent report, makes the following observations :—" The deaths of young children are, as usual, very high, indicating some grave fault somewhere. 84 young children were taken off by measles; whooping cough, and bronchitis, no doubt deaths all ac. celerated by undue exposure to cold while suffering from attacks of these complaints; 86 more deaths are from th consumption class ; 28 deaths from violence or accidental and 3 from infanticide-these latter by persons unknown.
OF
BRITISH AND
FOREIGN.
Nulla autem est alia pro certo noscendi via, nisi quampJnrimas et morborum et dissectionurn historias, turn aliorum, turn proprias collectas habere, et inter se comparare.-MORGAGNI De Sed. et Caus. Morb., lib. iv. Procemium.
GUY’S HOSPITAL. CASES OF DISEASE OR OF INJURY OF THE ARTERIES.
of Mr. BRYANT.) THIS week commence the report of a series of cases illustrating some points in the surgery of the arteries. The report will comprise cases of disease and of injury of the bloodvessels, of ligature of the arteries for wounds, injuries, and aneurisms, and will include one case in which the femoral artery was ligatured for elephantiasis Arabum of the leg. The subjoined were cases of popliteal aneurism: one case having been rapidly cured by means of digital compression; the other having speedily recovered after ligature of the femoral artery, although compression had failed. Some marked diference existed in the two cases. The first patient was acorndealer, and apparently a healthy man; and his aneurism seems to have been the direct result of an injury caused by overstraining. His family history was good, and he had not himself suffered from any malady likely to induce disThe treatment by digital comease of his arterial system. pression was well borne by this patient, and he soon recovered. In the second case the patient was about the same age as the man just referred to, but he was engaged in the unhealthy occupation of a fireman, and had suffered several constitutional shocks. He had had jungle fever; had fractured his leg while in Abyssinia; and it is almost certain that he had had syphilis-at all events he had a node on the sternum while in the hospital. In his case there was no history of injury or overstraining; the swelling showed itself spontaneously, and most probably as a result of disIt is, however, a noteworthy fact that, ease of the artery. although no distinct improvement declared itself from the treatment by compression, the patient rapidly recovered after the femoral was tied, the wound healed by primary union, and, as far as the aneurism was concerned, there was not an unfavourable symptom. It is not at all uncommon to find that speedy recovery ensues after the ligature of a vessel, although compression did no good, if indeed it did
(Under the
care
we
no
harm; yet treatment by compression should, we think, rule, be thoroughly carried out before the knife is had
as a
to. CASE 1. Popliteal anevrism;digital compression;cure.The following notes were taken by Mr. Rubt. Carrington :William R-, aged thirty-one, a corn-dealer, was admitted into Naaman ward on Feb. 15th, 1872, having on the outer part of the right popliteal space an ovoid, distinctly pulsating swelling, the size of a hen’s egg. The pulsations were arrested by pressure on the femoral artery ; there was no swelling of the leg or thigh. The largest circumference was in., the other leg at the same level being 14 in. Pulsation could be felt in the posterior tibial artery, but not in the anterior. The swelling was markedly expansile. The patient was a strong, healthy-looking man. He had never had rheumatism nor any similar disease, nor was there any history of consumption in the family. Three months before admission he was lifting a sack of corn, when he strained his right knee. He felt no further ill-effects at the time, but for a month after had occasionally pain and numbness in the leg, and then a small swelling appeared on the outer side of the right popliteal space, which increased in size, being sometimes larger and then smaller, but, was always larger after much walking. Digital compression was commenced on the femoral artery, and continued from 4 r M. to 12 P.M., and the pulsation was entirely arrested, but the patient got very little sleep, and the leg felt benumbed. Feb. 16th.-Compression was commenced again at 8 A.M. and continued till 12 P.M., the pulsation of aneurism not recourse
14i
being
so
strong.