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ON THE PRESERVATION OF VACCINE LYMPH IN CAPILLARY GLASS TUBES.
262 Crust,
as exhibited by Thermometrical Returns obtained during the sinking of the deep Mine at Dukinfield," by the President of the Association. With regard to the last papfr, it may be observed that the mine is 700 yards in perpendicular depth from the surface, and the temperature of the air notably in-
PARISIAN MEDICAL INTELLIGENCE. (FROM OUR SPECIAL CORRESPONDENT.)
Two clinical lectures on Meningitis, lately delivered at the during the progress of descent, averaging about one Hotel Dieu by M. Herard (now doing duty for Prof. Rostan), degree in seventy-six feet. a very good idea of the care with which teachers in the The concluding general meeting took place at the Free Trade give French schools are wont to analyze particular cases for the sake Hall on the 10th inst., when it was announced that nextear of attaining correct diagnosis. The lectures in question were the Association would meet at Cambridge. called for by the occurrence in M. Herard’s wards of one of those puzzling and indefinite examples of disease which form the delight and triumph of the skilled pathologist and the perplexity of the novice. The patient, a youn man of twenty. one years of age, of good general health and sound constitution, "Audi alteram partem." was seized one evening with shivering, headache, pains in the back and lower extremities ; during the night severe bilious PARALYSIS AFTER DIPHTHERIA. vomiting, followed by exhaustion and collapse, occurred-an To the Editor of THE LANCET. eusemble of symptoms which caused the attendant physician to SIR,-Perceiving that a short abstract of a communicationregard the attack as choleraic in its nature. When reaction from M. Tomaselli in the Etneo, a journal of Catania, in Sicily, set in, deep-seated pain in the orbits, increased by pressure has been reprinted in your valuable journal (vide THE LANCET the eyeballs, and excessivemuscular pains in the limbs, nf the 17th ult., p. 174) stating that two cases of paralysis ofupon by movement, were complained of, and occasional aggravated the lower limbs, bladder, and rectum had occurred after diphdelirium was observed. On the third day of the attack, when he of the into the as from theria, absorption supposes poison blood, and thence affecting the nervous system, and believ- the patient entered the hospital, his condition was as follows :ing as I do that the blood through the nervous system, and He lay on his back in bed, perfectly motionless, apprehending vice versâ the nervous system through the blood, play a far an increase of suffering from the slightest muscular effort. The more important rôle in the nature and character of disease face was pale, excepting where the cheeks were patched with than has always hitherto been assigned them, I cannot refrain from furnishing a somewhat similar instance that has just oc- red. Acute headache, referred to the forehead, was present, and curred in my practice to a child recovering from measles: for this symptom was found to be augmented by pressure on the some days she was perfectly paralytic in the lower limbs. eyebalis. The pupils were contracted, and the impression of I should not have ventured to trespass on your space had it light was shunned by the patient, who kept the lids closed for not been for the analogy of the cases above mentioned, and the most part. Questions were answered readily at first, and from being unable to find any mention of such a sequel to the afterwards incoherently, as the man relapsed into unconsciousness. Well- marked rigi, lity was apparent in the muscles of the malady in some of our most excellent authorities. T Sir_ obedient servant. back of the neck and spine-a phenomenon rendered more apWM. G. CARTER, M.R.C.P. parent by raising the patient to a sitting posture, when the Bellevue, Clifton, Sept. 1861. ereases
.
Correspondence.
am
vonr
strongly
CONSERVATIVE
SURGERY.
To the Editor
of THE LANCET. of Dr. Nichols’ and Dr. Cory’s cases under SIR,-The reports the above heading have induced me to forward you the followwhich happened on board the Pli6enix during her passage from Liverpool to New Zealand. On the night of the 22nd November, 1859, I was called rather hastily to see one of the crew, Peter S-, who, whilst engaged at the pumps, had the middle finger of the left hand caught between the iron handle and a very strong hoop of a beef cask close by, causing a bad compound fracture of the second phalanx. The soft parts were badly lacerated and quite torn through; the end of the finger was hanging parallel with the stump by just a shred of integument. Thinking it of no
ing,
use
to
attempt
to
save
it,
I
was
going
to
remove
the skin with scissors, but he stoutly refused
it
condition ;
by snipping
to have it
done; accurately as possible with strappingand splints, fany expecting that sloughing would remove it for him; but on looking at it in three or four days’ time I found union had taken place, and in about three weeks or a month he was able to go about his usual work, with so, to humour
him, I replaced the parts
his finger nearly as good T
am
Wednesbury, Sept. 4th,
as
as ever.
Mi)’
1861.
yours
respectfullv_
HY.
HORTON,
M.R.C.S.
ON THE PRESERVATION OF VACCINE LYMPH IN CAPILLARY GLASS TUBES. To the Editor of THE LANCET.
SIR,-If due care be taken in selecting proper cases for the supply of lymph, and afterwards in carefully excluding the air and hermetically sealing the tube, I consider there can be no question of the superiority of Dr. Husband’s plan over all others. I have supplied large quantities of the lymph so preserved for the last four months to the profession, and have not yet heard of any unsuccessful cases, which speaks highly in its highly in its favour. I am, Sir, your obedient servant, WM. FAULKNER, M.R.C.S. Enddl-street, Sept. 1861.
head was seen to be drawn backwards, and the trunk curved as in opisthotonos. Pain, increased by pressure, and most acute in the lumbar region. could be traced all along the spine, and from the sacrum could be perceived to radiate towards the nates and sciatic notches. The sensibility of the skin seemed normal, whilst the muscles, and those more especially of the pelvis and thighs, presented a condition of hyperæsthesia -a fact readily ascertained by pinching up some of the superficial fibres between the finger and thumb. The pulse was regular, and averaged 75 beats per minute; the temperature of the skin slightly higher than in the normal the respiration was natural ; thirst was present, with complete loss of appetite ; the tongue white, with red edges; vomi:ing persisted, with constipation of the bowels; the belly was hard, and not tympanitic nor tender on pressure ; the urine was scanty and high-coloured, affording slight evidence of the presence of albumen on the application of heat and nitric acid. What then was the malady ? Not an on-coming attack of small-pox ; for though certain of the symptoms-the shivering, pain in the back, vomiting, and delirium - pointed somewhat in the direction of such a probability, the absence of high fever and the non-appearance of the eruption on this the fourth day of the complaint negatived this view of the case. Typhoid fever ? Again no, for the pulse indicated no fever; epistaxis, diarrhoea, and the usual train of characteristic abdominal symptoms were wanting. Clearly the affec,tion was connected with disorder of the nervous centres: the violent headache, increased by pressure on the ocular globes; the delirium alternating with coma; the vomiting, constipation, muscular spasm, and bypereesthesia,- all were in accordance with-this theory. Was the case one of myelitis? No; there was no localized pain in the spine, confined to and indicating the inflamed part; no numbness, nor sensation of creeping and pricking; nor did any cramps exist in the muscles of the limbs ; there were, on the contrary, stiffness and exaggerated action in the muscles of the neck and back only, together with general pain along the spine, branching down towards the lower extremities, and increased by movement or pressure on the muscles. The disease was decidedly cerebro-spinal meningitis. So far the diagnosis was made out, but it was incomplete. There were two forms of this malady- the one sporadic, and the other epidemic; the one strictly inflammatory in its character, the other typhoid in its type. The case
I
as exhibited by Thermometrical Returns obtained during the sinking of the deep Mine at Dukinfield," by the President of the Association. With regard to the last papfr, it may be observed that the mine is 700 yards in perpendicular depth from the surface, and the temperature of the air notably in-
PARISIAN MEDICAL INTELLIGENCE. (FROM OUR SPECIAL CORRESPONDENT.)
Two clinical lectures on Meningitis, lately delivered at the during the progress of descent, averaging about one Hotel Dieu by M. Herard (now doing duty for Prof. Rostan), degree in seventy-six feet. a very good idea of the care with which teachers in the The concluding general meeting took place at the Free Trade give French schools are wont to analyze particular cases for the sake Hall on the 10th inst., when it was announced that nextear of attaining correct diagnosis. The lectures in question were the Association would meet at Cambridge. called for by the occurrence in M. Herard’s wards of one of those puzzling and indefinite examples of disease which form the delight and triumph of the skilled pathologist and the perplexity of the novice. The patient, a youn man of twenty. one years of age, of good general health and sound constitution, "Audi alteram partem." was seized one evening with shivering, headache, pains in the back and lower extremities ; during the night severe bilious PARALYSIS AFTER DIPHTHERIA. vomiting, followed by exhaustion and collapse, occurred-an To the Editor of THE LANCET. eusemble of symptoms which caused the attendant physician to SIR,-Perceiving that a short abstract of a communicationregard the attack as choleraic in its nature. When reaction from M. Tomaselli in the Etneo, a journal of Catania, in Sicily, set in, deep-seated pain in the orbits, increased by pressure has been reprinted in your valuable journal (vide THE LANCET the eyeballs, and excessivemuscular pains in the limbs, nf the 17th ult., p. 174) stating that two cases of paralysis ofupon by movement, were complained of, and occasional aggravated the lower limbs, bladder, and rectum had occurred after diphdelirium was observed. On the third day of the attack, when he of the into the as from theria, absorption supposes poison blood, and thence affecting the nervous system, and believ- the patient entered the hospital, his condition was as follows :ing as I do that the blood through the nervous system, and He lay on his back in bed, perfectly motionless, apprehending vice versâ the nervous system through the blood, play a far an increase of suffering from the slightest muscular effort. The more important rôle in the nature and character of disease face was pale, excepting where the cheeks were patched with than has always hitherto been assigned them, I cannot refrain from furnishing a somewhat similar instance that has just oc- red. Acute headache, referred to the forehead, was present, and curred in my practice to a child recovering from measles: for this symptom was found to be augmented by pressure on the some days she was perfectly paralytic in the lower limbs. eyebalis. The pupils were contracted, and the impression of I should not have ventured to trespass on your space had it light was shunned by the patient, who kept the lids closed for not been for the analogy of the cases above mentioned, and the most part. Questions were answered readily at first, and from being unable to find any mention of such a sequel to the afterwards incoherently, as the man relapsed into unconsciousness. Well- marked rigi, lity was apparent in the muscles of the malady in some of our most excellent authorities. T Sir_ obedient servant. back of the neck and spine-a phenomenon rendered more apWM. G. CARTER, M.R.C.P. parent by raising the patient to a sitting posture, when the Bellevue, Clifton, Sept. 1861. ereases
.
Correspondence.
am
vonr
strongly
CONSERVATIVE
SURGERY.
To the Editor
of THE LANCET. of Dr. Nichols’ and Dr. Cory’s cases under SIR,-The reports the above heading have induced me to forward you the followwhich happened on board the Pli6enix during her passage from Liverpool to New Zealand. On the night of the 22nd November, 1859, I was called rather hastily to see one of the crew, Peter S-, who, whilst engaged at the pumps, had the middle finger of the left hand caught between the iron handle and a very strong hoop of a beef cask close by, causing a bad compound fracture of the second phalanx. The soft parts were badly lacerated and quite torn through; the end of the finger was hanging parallel with the stump by just a shred of integument. Thinking it of no
ing,
use
to
attempt
to
save
it,
I
was
going
to
remove
the skin with scissors, but he stoutly refused
it
condition ;
by snipping
to have it
done; accurately as possible with strappingand splints, fany expecting that sloughing would remove it for him; but on looking at it in three or four days’ time I found union had taken place, and in about three weeks or a month he was able to go about his usual work, with so, to humour
him, I replaced the parts
his finger nearly as good T
am
Wednesbury, Sept. 4th,
as
as ever.
Mi)’
1861.
yours
respectfullv_
HY.
HORTON,
M.R.C.S.
ON THE PRESERVATION OF VACCINE LYMPH IN CAPILLARY GLASS TUBES. To the Editor of THE LANCET.
SIR,-If due care be taken in selecting proper cases for the supply of lymph, and afterwards in carefully excluding the air and hermetically sealing the tube, I consider there can be no question of the superiority of Dr. Husband’s plan over all others. I have supplied large quantities of the lymph so preserved for the last four months to the profession, and have not yet heard of any unsuccessful cases, which speaks highly in its highly in its favour. I am, Sir, your obedient servant, WM. FAULKNER, M.R.C.S. Enddl-street, Sept. 1861.
head was seen to be drawn backwards, and the trunk curved as in opisthotonos. Pain, increased by pressure, and most acute in the lumbar region. could be traced all along the spine, and from the sacrum could be perceived to radiate towards the nates and sciatic notches. The sensibility of the skin seemed normal, whilst the muscles, and those more especially of the pelvis and thighs, presented a condition of hyperæsthesia -a fact readily ascertained by pinching up some of the superficial fibres between the finger and thumb. The pulse was regular, and averaged 75 beats per minute; the temperature of the skin slightly higher than in the normal the respiration was natural ; thirst was present, with complete loss of appetite ; the tongue white, with red edges; vomi:ing persisted, with constipation of the bowels; the belly was hard, and not tympanitic nor tender on pressure ; the urine was scanty and high-coloured, affording slight evidence of the presence of albumen on the application of heat and nitric acid. What then was the malady ? Not an on-coming attack of small-pox ; for though certain of the symptoms-the shivering, pain in the back, vomiting, and delirium - pointed somewhat in the direction of such a probability, the absence of high fever and the non-appearance of the eruption on this the fourth day of the complaint negatived this view of the case. Typhoid fever ? Again no, for the pulse indicated no fever; epistaxis, diarrhoea, and the usual train of characteristic abdominal symptoms were wanting. Clearly the affec,tion was connected with disorder of the nervous centres: the violent headache, increased by pressure on the ocular globes; the delirium alternating with coma; the vomiting, constipation, muscular spasm, and bypereesthesia,- all were in accordance with-this theory. Was the case one of myelitis? No; there was no localized pain in the spine, confined to and indicating the inflamed part; no numbness, nor sensation of creeping and pricking; nor did any cramps exist in the muscles of the limbs ; there were, on the contrary, stiffness and exaggerated action in the muscles of the neck and back only, together with general pain along the spine, branching down towards the lower extremities, and increased by movement or pressure on the muscles. The disease was decidedly cerebro-spinal meningitis. So far the diagnosis was made out, but it was incomplete. There were two forms of this malady- the one sporadic, and the other epidemic; the one strictly inflammatory in its character, the other typhoid in its type. The case
I