WESTERN MEDICAL AND SURGICAL SOCIETY.

3. Dietetic treatment was that usually attended to ; general action of gluten; and, referring to the large amount of hydrogen and oxygen contained in fats, explained that when the author good eating and drinking invariably recommended. But there had used the term " respiratory phenomena" in describing the were kinds of food especially lactagogue in their effects: results, he meant to limit himself to the carbonic acid, and not lentils, beans, and peas, whiting soup, oysters and crabs, the fish called glaucisci and smarides; but Dr. Routh gave the to include the formation of water. Professor SHARPEY gave explanations and answers to Dr. to conger-eel soup. The lumbricus officinalis had Carpenter’s remarks, and stated that the author intended to amongst the ancients a very high reputation. Amongst drinks, determine the whole amount of oxygen consumed, but had porter, ale, milk, and fennel-tea should be pre-eminent. not at present decided upon the most suitable kind of apparatus 4. Medicinal agents or lactagogues. Dr. Routh enumerated for that purpose. He also referred to the corroboration which the following :-Echium vulgare, borago, saponaria, lactnca, this paper affords of the results obtained two years ago on the sonchus, eruca sativa, ricinus communis, gaultheria procnmquantity of air inspired in reference to the different action of bens, ocymum basilicum, melissa asinos, cytisus, coronilla, cicer, brandy and rum, which were read before the Royal Society; malva, quinquefolium, nigella sativa, anemone pratensis, pimand showed that we are all conscious of difference in the effects pinella anisum, anethum fœniculum and dulce, apium sativum, of alcohols. whilst the chemical differences had not been daucus carota, common salt, chrystall or crystal, iron, and codhitherto well ascertained by chemists. He also showed theliver oil. Some of these he had tried. The echium leaves had failed. great importance of attending to minute differences, and illustrated his remarks by a reference to the recent brilliant experi- Saponaria and sonchus were often very effective. The leaves ments in electricity by Mr. Gassiot. He thought that, as and stalks of ricinus were by far the most powerful, and he coronilla leaves were physiologists, they were under obligation to the author for dwelt at length on their efficacy. The having given his results to the Society; and, in answer to Dr. about as good as those of sonchns. ’1 he fennel was second and more easily obtainable. The iron (if the Carpenter’s observation, that experiments were required upon only to a larger number of persons, stated that the Society would be non-astringent preparations were given) and cod-liver oil kept glad to learn, in a future communication, that that learned up the system at par, so as to enable the patient to bear, without loss of strength or flesh, the action of the fennel seeds or physiologist had submitted himself for experiment. After a few observations by the PRESIDENT, and the thanks castor oil leaves, &c. By carefully administering these, and. of the meetinggiven to the author, the Society adjourned. watching their effects, he had been enabled to make mothers, who had failed before, continue to nurse their children successfully to the eighth month; in some cases, indeed, produced so. much milk as to render the artificial food given to the infant as an adjuvant unnecessary, so that the child was fed exdusively by the breast. The management of the child when so assisted he reserved for a future paper. MEDICAL SOCIETY OF LONDON.

I

specific

preference

ricinus,

Medical Societies.

-----

JAN.

DR.

MONDAY, 31ST, WILLSHIRE, PRESIDENT, IN

THE

CHAIR.

WESTERN MEDICAL AND SURGICAL SOCIETY. DR. FINCHAM, V.P.,

DR. RoUTH read

a

paper

-

1859. CHAIR.

IN THE

on

DR. MARCET related the results of his treatment of

DEFECTIVE LACTATION AND ITS REMEDY.

Referring to points previously proved-1st. That the experience of Foundling Hospitals proved that great success had followed the plan there adopted of feeding children partly artificially and partly at the breast. 2nd. That Drs. Merei and

CHRONIC

DISORDERS

RESULTING FROM

EXCESSES IN

LONG-CONTINUED

ALCOHOLIC BEVERAGES.

The symptoms that presented themselves to his notice were referable to a functional disturbance of the nervous systemWhitehead had shown in their tables, that in proportion as the as want of sleep, trembling, vertigo, tinnitus aurium, muscsæquantity of breast-milk provided was large as compared to volitantes, and occasional hallucinations. Many of the patients artificial food, so in proportion was the number of well-developed had abandoned the habit of excessive drinking for weeks,, children large. 3rd. That this occurred even when the food given months, and years previous to applying for advice. These was a slow poison, as was usually the case with aluminized pap. cases were effectually cured or relieved by the administration 4th. That the mortality was greatest amongst young infants of oxyde of zinc, in doses of two grains, twice a-day, an hour fed exclusively on artificial food during the early months oi after meals. The dose was gradually increased to six or eight life. Therefore he concluded it was most important to provide The action of oxyde of zinc appeared to. grains. human milk for such cases, in as large quantities as practicable; Dr. Mareet totherapeutical be connected with its physiological property of even when artificial food was also given. To show how thi, producing drowsiness, as many of the patients felt sleepy about could he done

was

the obiect of his

naner.

an

hnnr aftár t,a.kinrr it_ and slept fnr

an

hnnr

nr

two.

Of six-

three varieties usually observed of defective teencases which had come under his care amongst the outlactation-a, that due to hyperæmia; b, that due to anæmia.; ’ patients the Westminster Hospital, seven were dismissed c, functional paralysis or inertia of the breast, a. The first cured, three left off the remedy considering themselves well, occurred usually in gormandizing hired wet-nurses, and was to three had improved, and three remained under treatment. be treated by a mild antiphlogistic regimen. b. The second Mr. BARNES related a fatal case of chiefly amongst the poor, and required good food, tonic, and third he would It to treatment. the INFLAMED BOWEL, was, however, chalybeate especially allude. c. Inertia of the mamma was usually prebe enclosed in a band of adhesion. A girl, found to sent in masculine women, or those who married late in life. In these the breast might be partly atrophied, but this was by no aged twelve years, in the enjoyment of perfect health, was seized one night with severe pain in the bowels, accompanied means the general case, and was rather the result of the longfirst seen the following morning, when continued disuse of the female organs of generation. To re- by sickness. She was the countenance indicated great suffering, the pulse was quick medy this state of things, four modes of treatment were neces- and wiry, and there was tenderness over the whole abdomen. sary-1st, local or mechanical; 2nd, hygienic; 3rd, dietetic; Death took place that evening. The post-mortem examination 4th. medicinal. 1. a, to the breast; b, to the sympathizing genitalia. a. Suc- revealed an inflamed state of the peritoneum, investing the tion was a powerful agent, inducing milk even in withered jejunum and ilium; and, upon tracing the small intestine from, a portion of it, just before its entrance into the females, who no longer menstruated, and even in men. Breast- the stomach, was found to be in a state of almost sphacelus, having pumps were sometimes serviceable, but dangerous. Gentle titil- c2ecum, lation of nipple, local fomentations, and imitation of milking a band of adhesion surrounding it, apparently the result ot The obstruction at this point was complete. movement, frequently induced the draught. b. In evidence ofinflammation. the genitalialsympathy, Dr. Routh adduced several physiological The intestine on either side of the stricture was healthy; thewas loaded with scybala. The portion of strangulated facts, from which he showed that the separation of man and colon was exhibited. bowel wife during the suckling period was very prejudicial to lactaMr. CUMBERBATCH brought forward a similar case to the tion. 2. Hygienic treatment was admitted by all,-cleanliness, ex above, occurring iu the practice of Mr. Haig. A healthy child, vears of age, was taken on the morning of March 19th ercise, good air, &c. I. There

were

of

which was

.

four

217

with pain in the stomach, which lasted about ten minute:!. When seen an hour afterwards it was found pulseless and cold ! clammy perspiration was observed on the skin, which wa s livid breathing hurried; the legs drawn up towards the ab domen, and the countenance anxious. The urine passed uncon _ sciously; the bowels had been opened the previous evening. I t never rallied, but died in the afternoon suddenly. Post-mortem Examination.-The cavity of the abdomen con tained a small quantity of serum, darkly tinged with blood. II *the lower part of the abdominal cavity a portion of the small in testine, about a foot in length, was found highly congested anc dark-coloured, and a small part of this was much more con gested than the rest. This was found to depend upon s. band of false adhesion enclosing it, which produced complete strangulation of the gut. The band was attached by one ex tremity to the point of an appendix, by the other to the mesen. tery. This appendix was a congenital malformation, consisting .of an outgrowth from the small intestine, about an inch in length, and communicating with the cavity of the bowel at its attached end, but closed at its free extremity, to which the ,hand of membrane was united. These together formed a ring an inch in diameter, through which the intestine had passed, and had become strangulated. The intestine, with band of membrane enclosing it, was exhibited. Mr. KEEN related a case of

Lever and Professor Simpson proved-as was to be 1840, inferred from the researches of Dr. Bright-that this anasarca was connected with the existence of albuminuria; and, until the investigations of Dr. Brann, we really learnt but little Even now there is much to be done; and we have yet more. to ascertain, amongst other points, the various circumstances which give rise to the albuminuria and the retention of urea in the blood. That puerperal convulsions are not always due to actual renal disease is certain, because we have two classes of cases in which they occur-viz., those in which the albumen entirely disappears from the urine two or three days after delivery, and those in which it is permanent from structural affections of the kidney. The uræmic fits do not arise, as was formerly thought to be the case, from the blood being poisoned by urea. The views of Frerichs are confirmed by Dr. Braun; and it now appears highly probable that the phenomena of uraemic convulsions are not produced by urea nor any other ingredient of the urine, but that they commonly originate from the urea retained in the blood being transformed into carbonate of ammonia under the influence of some peculiar ferment. Hence can be explained those cases, where women suffering from Bright’s disease pass through pregnancy and labour-their blood being saturated CONVULSIONS, with urea-without any ureemic phenomena taking place; which occurred to a married woman, aged thirty-seven, aboul because the unknown ferment, by means of which the six months advanced in pregnancy. She was suddenly seizec simply urea can be changed into carbonate of ammonia, is absent. If ’one evening with severe pain in the epigastrium, having pre these are correct, and many reasons induce us to eaten and of boiled and hypotheses She viously heartily rapidly pork greens. was seen at ten o’clock, and at one she complained she could believe that they are so, the indications for treatment are clear not see, and immediately afterwards was seized with violent and simple. When the existence of albuminuria is discovered - convulsions, and soon became comatose. The pupil of che left during pregnancy, medicines should be administered which will eye was dilated, and the right fixed. She died at three o’clock, five hours from the commencement of the attack. The os uteri prevent the decomposition of the urea, or rather will neutralize remained undilated throughout. Mr. Keen regarded this case the carbonate of ammonia if it be formed in the blood. For this to be one of epileptic convulsions, excited by a large quantity purpose Frerichs strongly recommends benzoic acid in five or of undigested food in the stomach, and predisposed to by the ten grain doses, with iced drinks which have been acidulated pregnant state. That the undigested food was the exciting with tartaric acid, lemon-juice, &c. To obviate congestion of ’cause, he substantiated by narrating two cases, which had oc- the costiveness should be head, prevented by assafœtida and curred in his practice, of children who had died from convulsive fits, and in whose stomachs large quantities of undigested food vinegar injections, jalap, calomel, or croton oil; while ice may In both the brain was found slightly congested be also used locally, or the cold douche may be cautiously tried if were found. with some serous effusion. The treatment of the first case con- any cerebral symptoms actually show themselves. In the cases - sisted of mustard poultices to the epigastrium, with the in- which have come under our own observation we havefound ternal exhibition of laudanum and antimonial wine for the benefit from the early employment of tonics, and particurelief of the pain. Venesection was put in force when the con- great from the cautious use of steel. When convulsions have vulsions came on, and an attempt was made to rupture the larly membranes. occurred, or when a paroxysm seems impending-during either Mr. J. R LANE exhibited a testicle which he had removed pregnancy, labour, or childbed-chloroform is invaluable, since from a man, who after a blow had had an abscess formed in it, its inhalation weakens the fit, and diminishes the reflex exciand from the cavity of which a fungoid mass sprouted out. To tability of the nervous system. Moreover, Dr. Simpson has Temedy this, Mr. Syme’s operation of dissecting up the skin, that the beneficial effects of chloroand bringing the edges together over it, was performed. The very ingeniously suggested form are due to its producing a temporary diabetes mellitus; pressure so brought to bear upon it was, however, ineffectual for it has been demonstrated that sugar in small quantities in restraining its growth. Mr. WEBB exhibited a deformed fgtus of about seven months’ added to the urine out of the body prevents for a time the ordinary decomposition of urea into carbonate of ammonia. growth. Dr. MARCET exhibited some excretine, and an apparatus for Dr. Braun states, that in sixteen cases of eclampsia, occurartificial respiration. ring in succession, which he treated with chloroform and acids, complete recovery always took place-a result which is much more favourable than has hitherto been obtained by any other course of remedies. The last, and certainly the most important remedy, is the of the uterus. This must be accomplished The Urœmic Convulsions of Pregnancy, Parturition., and Child. prompt emptying the use either of the forceps, or by turning, if the conby bed. By Dr. CARL R. Pnnw, Professor of Midwifery, Vienna. Translated by J. MATTHEWS DUNCAN, F.R.C.P.E., vulsions occur during delivery at the full term; or by the inNew York, 185S. &c. duction of premature labour, if the dangerous symptoms of Tins volume consists of a translation of one of the most in- ursemia, take place in the latter months of pregnancy. Supteresting chapters of Dr. Braun’s excellent text-book of Mid- posing that there are indications of the death of the fœtus, wifery, and is reprinted from the Edinburgh Medical Journal there can be no doubt that the sooner it is expelled the better. After emptying the uterus, it will be advantageous to continue for the years 1856-57. The very gradual manner in which valuable pathological facts the administration of the benzoic acid, so as to prevent any return of the paroxysms; while opium may be freely given to are brought to light is well illustrated by a consideration of the of inasmuch as it is now some subject the present volume, fifty procure complete repose of both body and mind. In all insince the clue to a correct Hamilton first years gave recognition stances, Dr. Braun asserts that general depletion does mischief; of puerperal convulsions, by showing that they were often pre- because by bleeding the anasmia is increased, the nervous fits ceded by the occurrence of anasarca during pregnancy. About are not improved, the spasms are often aggravated, and puer-

Reviews and Notices of Books.

218

Dr.