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cele, treated Excision of a portion of the Scrotum. By Bransby B. Cooper, F. R. S.-Observations on Abdominal Tumours and Intumescence: illustrated by Cases of Renal Disease. By R. Bright, M. D. F. R. S.
Our object is merely to present in a brief abstract the most interesting matter contained in the above enumerated articles.
1.-On the Disorders of the Brain, connected with Diseased
Kidneys. By Thomas Addison, M. D.
In the first paragraph of his article, the author states the object of his communication' to be:
“First, To point out the general character and individual forms of cerebral disorder connected with interrupted function of the kidneys, from whatever cause such interrupted function may arise. Secondly, To shew, that, in recent as well as chronic disease of the kidney, the cerebral disorder is not unfrequently the most prominent, and occasionally the only obvious symptom present. And, Thirdly, To establish a means of diagnosis, in such obscure or in unsuspected cases, upon the peculiar character of the cerebral affection.”
After stating the general character of cerebral disorder connected with disease of the kidneys, to be “marked by a pale face, a quiet pulse, a contracted or undilated and obedient pupil, and the absence of paralysis”—he enumerates the five following, as the individual forms:
“1. A more or less sudden attack of quiet stupor; which may be temporary and repeated; or permanent, ending in death. “ 2. A sudden attack of a peculiar modification of coma and
a stertor ; which may be temporary, or end in death.
“3. A sudden attack of convulsions; which may be temporary, or terminate in death.
"4. A combination of the two latter; consisting of a sudden attack of coma and stertor, accompanied by constant or in. termitting convulsions.
5. A state of dullness of intellect, sluggishness of maRTET, and drousiness, often preceded by giddiness, dixness of sighi, and pain in the head; proceeding either to come alone, or to coma accompanied by conrulsions; the coma presenting the peculiar character already alluded to.
“With respect to the first mentioned form oi cerebral disorder connected with renal disease, that of quiet stupor, it is, in its most exquisite form, probably the least frecperty Det with; the face is pale, the pulse quiet, the pari natural, or at least obedient to light; and although the patient may be almost completely motionless, there is no paralysis; ior, on attentively watching him for some time, he wil be observed slightly to move all the extremities. By agitating bim, and speaking loudly, he may sometimes be partialy roused for a moment, but quickly relapses into stupor, as before: or it may not be possible to rouse him at all. There is little or no la. bour of respiration, no stertor, and no convulsions. Sight degrees of it, occasionally precede and pass into the desi or second form.
* This second form of cerebral affection is that of a sudden attack of coma with stertor, or, in other words, aporjesy: it is, nevertheless, different from ordinary apoplesy: it is the serous apoplexy of authors, and presents the usual general characters of cerebral affection depending upon renal disease; for the face, instead of being flusbed, is, in almost every instance, remarkably pale; the pulse, though sometimes small, and more rarely full, is remarkably quiet, or almost natural; the pupil, also, although occasionally dilated or contracted, is often remarkably natural in size, and obedient to light; and there is no paralysis. When the labour of respiration is very great, the general character is apt to be modified by an accelerated pulse, and occasionally by a slight flush of the countenance. The coma is for the most part complete, so that the patient cannot be roused to intelligence for a single moment. The stertor is very peculiar, and in a great measure characteristic of this form of cerebral affection connected with renal dis. ease; it has not, by any means, in general, the deep, tough, guttural, or nasal sound of ordinary apoplesy: it is sometimes slightly of this kind; bot much more commonly the stertor presents more of a hissing character, as if produced by the the air, both in inspiration and in expiration, striking against the hard palate or eren against the lips of the patient, rather than against the reluam and throat, as in ordinary apoplectic stertor: the act of respiration, 100, is usually, from the first, much more hurtiod than is observed in the coma of ordinary
apoplexy. The peculiar stertor coupled with the pale face has, in more instances than one, enabled me to pronounce with confidence the disease to be renal, without asking a single question, and in cases, too, in whcih no renal disease what. ever had for a moment been suspected.
“The third form of cerebral disorder connected with renal disease is that of a sudden attack of convulsions. In this case, also, the countenance is, for the most part, remarkably pale, although, occasionally, slightly flushed at intervals: the pupil is often but little affected: in slight attacks of the kind, the pulse is sometimes singularly quiet; but when the convulsions are severe, and especially when there is such a degree of coma as to be attended with stertor, the heart often sympathizes, and the pulse becomes rapid, irregular, and jerking. This form of cerebral affection often passes into the fourth variety; or the cerebral affection shall take on the form of the fourth variety from the commencement: in the latter case, we have merely a combination of the second and third varieties—the coma, hurried breathing, stertor, and convulsions being so blended together, as often to have led to a dispute, whether the affection ought to be designated apoplexy or epilepsy. From what has been already stated, it may in general be very easily recognized as one of the common forms of cerebral disorder connected with renal disease.
“ The fifth variety is that in which the cerebral disorder makes its approach in a more gradual and insidious manner, usually commencing with dulness of intellect, sluggishness of manner, and drowsiness, gradually proceeding to coma, and more or less stertor, with or without convulsions; these states being, at the same time, distinguished by the general indications already pointed out. This form of cerebral disorder appears to be that which most commonly supervenes in the progress of the morbid change of kidney described by Dr. Bright; and is very frequently preceded by giddiness, dimness of sight, and pain in the head.”
After having thus given the symptoms and characteristics of cerebral disorder connected with renal disease, the Doctor devotes the remainder of his article to the consideration of a question essentially connected with and naturally growing out of the subject,-viz: “ Whether there really exists any discoverable relation between the character of the renal
affection and that of the brain-whether the form, permanence and violence of the cerebral disorder bear any relation whatever to the activity, duration, and extent of the renal disease.” Although he confesses himself unable to come to any definite and decided conclusion upon the subject, yet he takes the affirmative of the question with some confidence of its truth, and urges in support of it—" a tendency to a state of quiet stupor,” which varies from “ sluggishness of intellect, to complete insensibility to surrounding objects,” and which is observable in the milder and more transient affections of the kidneys. In connection with this, he gives a case in which these cerebral symptoms were strongly marked, but in which there were none of the ordinary symptoms of nephritis. Upon a post mortem examination, “the cortical parts of the kidneys were found highly injected, of a deep red, or almost chocolate color, and somewhat softened in its texture.” He again urges the peculiar convulsions, already described, sometimes proving fatal; from which in other cases the patient recovers, and which he has observed "most frequently in renal dropsy, subsequent to scarlatina," _" and in that form of renal dropsy,” which proceeds from cold, and is commonly termed idiopathic. Lastly, he urges the cerebral affection, and “peculiar liability to be suddenly seized with the most alarming and most fatal of all the forms of cerebral disorder occurring in connection with renal disease—profound coma and stertor, with or without convulsions," which are sometimes observed in those cases of granular degeneration of the kidneys, as described by Dr. Bright. In regard to this last, he confesses that many cases occur unattended by any cerebral symptoms. All of the facts adduced by the author may be coincidences, or they may not: and they require additional observation to establish their necessary connection.
2.-Perforations of the Stomach from Disease and Poison
ing. By Alfred S. Taylor.
This paper of Mr. Taylor's relates to the subject as connected with some questions in legal medicine, and his object is to point out the means of diagnosis in cases of death from, or attended with perforations of the stomach, in which poisoning had been or may be suspected.
In treating his subject, (which he does in a very perspicuous and satisfactory manner,) he considers separately, the different causes of perforation—lst. perforation from poisons. 2nd. perforation from morbid causes. 3rd. perforation by solution.
'In regard to the first he says: “Poisons are capable of inducing perforation of the stomach in two ways: 1. by corrosion-2. by leading to ulceration, and the destruction of the parietes in a circumscribed space by that process.". Perforation by corrosion is decidedly the most common, in this division of its causes: and is effected by the.“ concentrated mineral acids and alkalies, corrosive sublimate, nitrate of silver, and a few others ”--the action of which is "purely chemical.” The corrosive poisons when taken, immediately produce very severe symptoms, (which the author does not give,) such as those of the most violent gastritis; with excruciating pain in the stomach, severe burning in the throat, &c., most commonly terminating speedily in death. Taking sulphuric acid as an example, (as it is the one most commonly used,) the above symptoms are produced in a very aggravated form ; and the post-mortem appearances presented, will be extensive corrosion of the mouth, fauces, and esophagus; and a perforation of the stomach, sometimes of considerable size, having “rough, irregular edges, often softened and pul