WESTERN MEDICAL AND SURGICAL SOCIETY OF LONDON. FRIDAY, FEBRUARY 16TH, 1855.

293 Holmes Coote. Mr. Lawrence looked on it as primary vene- WESTERN MEDICAL AND SURGICAL SOCIETY real sore, for which mercury was prescribed; under its use the OF LONDON. induration was getting softer, but the remedy was taken irreMr. on the case as but looked in convenereal, gularly. Paget FRIDAY, FEBRUARY 16TH, 1855. equence of having some doubt on the point, recommended its DR. CAHILL, VICE-PRESIDENT, IN THE CHAIR. ranoval, which was accordingly done. Under the microscope, tlere were no appearances of a malignant character. DR. FIKCHAM read a paper Mr. PARTRIDGE was of opinion that it was decidedly syphiON CHOLERA. litic, as well from the history of the case as the appearance of the specimen. He commenced by stating that his experience was gained Mr. HUTCHINSON had every confidence in the patient’s moduring the first and third weeks of rality, besides being married; and, therefore, doubted its syphi- marking the climax and the decline of September-periods the epidemic. This litic character. He believed that the primary sorein the forpreliminary statement he considered necessary and fair, mer attack was indurated. because, in this late epidemic, as in all preceding ones, the Mr. HUTCHINSON also exhibited cases occurring at the decline were generally of a milder chaA rIBRO-CELLULAR TUMOUR, racter than those during the access or climax of the outbreak. taken from the prepuce of a child who had congenital phimosis. The author then proceeded to state, that the leading plans of The tumour was circumscribed, but adhered firmly to the pre- treatment proposed might be classified thus: 1. The antidotal, puce and left corpus cavernosum. The origin of the tumour was including Dr. Stevens’ saline plan. 2. The astringent. 3. The 4. The stimulant. 5. The said to be the pulling of the prepuce by some companions of eliminative, by castor oil, &o. the child. empirical, in which there was an administration of various substances, not apparently having any recognised remedial Mr. ASHTON exhibited a specimen of I relation between the drug and the symptoms; in this class he IMPEBFORATION AXD MALFORMATION OF THE RECTUM, included the by the administration of calomel. 6. This taken from a child five days old, which, when born, had class included plan the use of mustard emetics, to rouse the flagging The all the appearance of being strong and healthy. of the system, and the application of heat externally, child took the breast readily at first, but the act of suck- powers to excite the circulation. The author then proceeded to the ling was shortly followed by vomiting. After the third detail of his own experience in the treatment of the disease, day, this recurred as soon as nourishment entered the sto- and stated that forty-four cases of undoubted cholera were mach. On the fifth day Mr. Ashton was requested to see treated by him in the Westminster Hospital. Twenty-four of the child, in consequence of the foregoing symptoms, and no these were ina state of collapse, in fifteen collapse was imtaken anum. The abdomen was evacuation having place per and in fivethe symptoms were very slight. Of these, pending, much distended and tympanitic; slight pressure gave pain and of thirty-nine cases of true cholera, twenty recovered, and caused the child to cry violently; no hardness or increased size nineteen of recoveries as nearly as possible died-an of the abdomen be of in any part could detected indicative the similar to that met average with in other hospitals. However, five of seat of obstruction. The anus was perfect; but, on introducing these recovered from complete collapse. All these cases had a the finger, it was arrested three quarters of an inch from its warm bath on and this was repeated for two or admission, orifice; no bulging of the orifice could be felt, the anal cul de three times, if necessary. Mustard was applied to the sac being carried upwards into the cavity of the abdomen when in most of the cases, and ice given ad libitum. epigastrium pressure was excited. Operativeprocedure was rendered in- The first four cases, on admission, had an emetic of salt and expedient by the absence of all indication of the termination of mustard, followed by the administration of diluted sulphuric the intestine. The child died on the seventh day of its age. with chloric ether; they were all in a state of confirmed On post-mortem inspection, the small intestines, distended acid, and all died, without any attempt to rally. The collapse, with flatus, were found occupying the left and anterior portion next three cases were treated with castor oil and occasional of the abdominal cavity; the colon was normal as far as its doses of calomel; two recovered, and one died. The next which was the intestine revery short, descending portion, fourteen cases were treated with calomel, (five grains every crossing to the right side, and then terminating in a dilated quarter or half-hour,) and if the rice-water evacuations conpouch, distended with meconium, which reached to a little tinued, and were copious, half a drachm of diluted sulphuric below the crest of the ilium, and from thence was connected acid was added to the treatment; of these, eight cases of with the anal cul de sac by a membranous prolongation. On extreme and one recovered; and five of impenddied, collapse opening the intestine, it was found to be perfectly impervious. ing collapse recovered. All the foregoing cases occurred in the Had anv operation been practised, or thrust been made with a first week of September, 1854, when the epidemic was at its trocar, the peritoneal cavity and small intestines would have height. During the week beginning the 13th of September, been wounded, but the large intestine could not have been cases were admitted: of these, eleven recovered, and eighteen reached. seven died. All were treated uniformly, beginning, as before, Mr. PARTRIDGE.-What was the distance between the two with the hot bath and emetic, followed by the use of calomel parts of intestine ? in two-grain doses, every quarter of an hour, until the sympMr. ASHTON.-More than one inch. toms were ameliorated. Although under this plan of treatMr. ASHTON also exhibited a specimen of ment the mortality was less than during the first week of STRICTURE OF TtiE RECTUM, AND FIBROUS DEPOSIT EXTERNAL September, it would be forming a very erroneous judgment if this were attributed wholly to the treatment. The truth was, TO ITS COAT, that a large proportion of cases were of a comparatively mild removed from a woman, aged fifty-four, who had been ailing which would account for some of the improvement in for twenty years, and for the last three years had suffered from form, the rate of mortality. The conclusion at which the author relaxed bowels, occasionally passing blood. Ten days previous seemed to have arrived was, that there is no plan of treatment to death, she was seized with pain in the abdomen, but it which reliance can be placed in collapse. This was not, upon subsided in a few hours. After this, constipation followed, the case where collapse was only impending, and he and on the eighth day she took some castor oil. Vomiting however, considered that if, during this incipient stage, a brisk emetic supervened, with great distention of the abdomen and con- be administered, and warmth applied, the subsequent deadly siderable pain, but the bowels were not relieved. On the folcollapse may be averted in many cases. In conclusion, he lowing day, she was admitted into a public infirmary, in a urged the necessity of attending to the mode of applying heat, state of great exhaustion, and complaining of great abdominal as frequently this agent is so carelessly used as to be valueless. the and On examination pain, belly being large tympanitic. The bath must not only be used, but its effects kept up by of the rectum, contraction of the bowel was found to exist warm clothing, and as an efficient means of doing so, he reabout three inches from the anus, surrounded by a dense mass commended the use of thick, warm, woollen jerseys. of morbid structure. Death took place the day after her adCHOLERA IN ST. GEORGE’S HOSPITAL. mission, from exhaustion. On post-mortem inspection, the intestines were found greatly distended. No peritoneal inflamDr. BARCLAY then furnished the following communication mation existed. The rectum was contracted at the part the same subject :-He first alluded to the fact of the imupon already mentioned, and was surrounded by a large mass. portation of cholera from foreign shores, as proved by Dr. having the appearance of fat, and very dense, which, by aid Baly’s observations, its propagation amongst us being due to of the microscope, was found to be composed of fibrous tissue, some kind of contagion, independent of any atmospheric inThe tumour extended to the rectum. fluence ; this contagion may possibly be dependent upon the same laws as those that regulate the spread of small-pox and (To 5e continued.)

’

294 which view was borne out by the experience thE author met with in the wards of St. George’s Hospital Another point of interest in connexion with cholera is th( coincidence of epidemic diarrhcea at the same period. He ad mitted that he considered, during cholera vears, diarrhœa. wa: apt to put on an epidemic character, though the number of re corded cases at such a time might be increased by people gene. rally being alarmed and applying for relief, and from the faci that many cases recorded as deaths from diarrhoea, depended upon some disease, of which the diarrhcea was but the last symptom. Diarrhœa exists in connexion with cholerain three distinct forms-1, as the first symptom of the disease running into collapse, in spite of all treatment; 2, as a milder form of the disease, from which the system soon rallies when the discharge is stopped; 3, as an ordinary diarrhœa, caused by external causes or improper food, acting under these circumstances as a predisposing cause. Passing on to the consideration of its pathological history, the author thought that more than ever we had arrived at the fact that the disease depended solely upon blood poisoning, ignoring all the older hypotheses of its being an aggravated diarrhcea, &c. He still, however, advocated the necessity of attending to the bowel flux as a main point in the treatment, because he knew that, though a moderate degree of purging may be regarded as eliminative, yet when medicine is of use its operation is quite as frequently that of restraining the excess of Nature’s workings as that of stimulating them to increased activity. He considered cholera to be essentially a zymotic disease, excited by the introduction of a poison from without, and capable of reproducing itself in the system by a species of fermentation, and so widely differing from diarrhoea, whether as a symptom, or as caused by some other noxious poison in the blood. In cholera, he maintained, this symptom bore no relation to the amount of poison in the system any more than did the cutaneous eruption in scarlatina give us any information as to the severity of the disease. On the subject of treatment, Dr. Barclay remarked that he considered no treatment of any certain avail in cases of true collapse, except there be some rallying from this almost apparent death. Whatever means can possibly restore warmth and circulation, must of themselves necessarily be beneficial, because until these are established, remedies, properly so called, cannot act. Before collapse has set in, he advised the use of astringents, especially sulphuric acid, when the flux is attended with but little biliary disturbance, the tongue is clean, and the stools offensive. In ordinary cases of disordered biliary or enteric secretion, he has found so much value in mercury, that, arguing à priori, he considers it of equal use in cholera; but to be of service, it must be given with no niggard hand, as much will be rejected by vomiting, &c. As soon as reaction is established, he recommends the removal of the surplus mercury by gentle purgings by castor oil. In the record of cases in St. George’s Hospital, the cases of collapse were more fatal where no mercury was given at all, as will appear. Calomel was given in 74 cases of cholera, and the per-centage of recoveries was 45; it was not given in 50, and the per-centage of recoveries was 48. But taking collapse alone, it was given in 67 conjoined cases, and the per-centage of recoveries was 39; while in such cases, where no calomel was given at all, the like per-centage was only 28.

typhus,

of special education, are together necessary to qualify a man for any important calling; and that the conditions aforesaid being fulfilled, the appropriate place has only to be found, and we have achieved the end so desirable to be attained. Now, it has appeared to us, that the little work under COLfa sideration affords an illustration, by no means uncommon, of a. own vocation. his ts very worthy gentleman mistaking author is one of a set of practitioners who have, time out of mind, practised pretty largely on and amongst the British public, by the application of engineering principles and appli. the human spine in ances to remedy of that condition which it deviates to some extent, laterally, from the absolute, perpendicular,-a condition chiefly found to affect the youthful portion of the better educated classes amongst her Majesty’s lieges. These ingenious mechanists have brought to the highest possible perfection sundry instruments of torture, consisting of steel bars, divers pads and screws, adapted to the many curves which they have detected in the spinal column, or, to use the words of our author, not only to lumbar, but to " sacral and dorsal compensating curves; and, finally, to cervical and coccygeal (!) curves." (p. 36.) All that we have to regret is, that for the sake of engineering science in general, and for the comfort and well-being of spinal patients in particular, the authors of these elaborate (and, we suspect, somewhat expensive) contrivances, had not directed their faculties to the application of forces to inert matter, as it is met with in the formation of mines, railways, or, it may be, military trenches of investment, rather than to the human form divine. Thus we are not surprised to find how very briefly the subject of general or constitutional therapeutics is treated in this little book. But the particular instrument which it is the author’s design to commend, and the honour of inventing which he divides with Mr. Evrard, the maker, is duly described, figured, and exemplified in so many lithographs, that one might fairly imagine, at first sight, that the honest manufacturer’s " illustrated catalogue" had fallen into our hands. One word in sober earnestness to conclude. Wehave a rooted aversion to little books with one idea,-the more so if that idea is not a particularly good one. The fact is, these " cases of lateral curvature of the spine require no special" " and be or will best treated study special" practice, generally do so on and have no men who broad by general principles, crotchets in their heads relating to complicated machinery as a part of their therapeutic scheme. But a very few cases require the mechanical treatment, and in these neither Tavernier’s belt, nor the instrument recommended by Mr. Brodhurst, will do any service, unless its adaptation and employment be well looked after by the surgeon. Given this attention by any good practical man, and we have no doubt that either of these machines will be found as useful as the other.

EXPERIMENTS

Reviews

and

Notices of Books.

On Lateral Curvature of the Spine: its Pathology and Treatment. London: By B. E. BRODHURST, M.R.C.S., &c. John Churchill. 1855. pp. 67. WE have heard a good deal lately about the importance of bringing together, in all offices of the state, " the right man and the right place." The British nation, it appears, is just awakening to the very palpable truth, that for matters of public service it is quite as necessary to fit a government minister or a government clerk for the duties these gentlemen have respectively to perform, as it is in commercial or professional engagements to secure somethinglike an appropriate education for those who are to undertake them. True, a "heavenborn minister" may appear once in a century, and less frequently so may a heaven-born surgeon; but, in these matterof-fact days, it may safely be laid down as a rule, that the existence of a certain natural bias, together with a good deal

of

the

ments with

WITH

CHLOROFORM.-Â series of experi-

hundred and fifty in number, have been recently tried in Paris on the lower animals, which promise some valuable results. Mr. Bickersteth, of Liverpool,who happened to be in Paris, we believe, was invited to the operations. The chief animals were birds, reptiles, dogs, and rabbits. The birds were easiest affected, and fell long before. lizards or snakes into a state of sleep, mammiferous animals occupying an intermediate position as to time ; the relation being very marked in all animals according to the force or development of the respiratory and circulating systems. The irritant action of chloroform was very marked in snakes, their forked tongues being thrust out, though apparently torpid previously. Birds, on the other hand, fell asleep immediately. ’’’ The slowness of etherization," the Society d’Emulation reporters think, is in proportion to the previous stage of excitement. The posterior extremities in all animals are first insensible. This is constant, even in reptiles and birds. The eyelids are the parts last effected. Fresh chloroform added to the instrument, when the animals were on the point of falling into anaesthesia, woke them up again, by what was thought a reflex action transmitted from the air passages. The heart wasfound beating in some animals after death from chloroform.

chloroform,

one