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most cases it is the first order of hyperemia which passes into inflammation, but the two others may also terminate in a similar manner. 4: Anemia, or Hypohemia.--This class refers only to local anemia, a disease observed only in a small number of organs--the brain and gastric mucous membrane, for instance.
5. Hemorrhage.-Of this class we will say nothing, having on a former occasion treated the subject in extenso. Hemorrhages may, like congestions, be divided according to their cause.
6. Fluxes are in most cases the result of appreciable organic alterations; in others, on the contrary, the discharge is the only pathological fact which can be detected. They are characterized by the similarity of the fluid secreted with that of the fluid eliminated during health by the same organ. Fluxes have, according to their seat, been divided into three orders:-1, fluxes of the skin. 2, of the mucous membranes; in this order some authors place cholera, and not without some good reasons; we prefer, however, classing that disease with pyrexia. 3 fluxes of glandular organs, primary or consecutive to congestion or phlegmasia.
7. Dropsies. We mentioned on another occasion that all dropsies might be referred to one of two causes: an obstacle to the circulation of the blood, or a change of its composition. Dropsy in no case can, therefore, be considered as a primary fact-as anything but a symptom; but it is a symptom of such magnitude-it is a secondary fact of such immense practical importance-that we consider ourselves fully justified in forming for it a special class.
8. Pneumatosis. In this class are placed all the gaseous accumulations within the cavities of our organs. We have reason to suppose that gases may even exist in the blood, and, whatever be their origin, they occasion symptoms and diseases which must have a place in all classifications.
We now come to the consideration of other diseases, in which the alterations of the solids is the primary pathological fact:
9. Trophopathies, or Diseases of Nutrition.-These may be congenital or acquired; hypertrophy, atrophy, softening and accidental productions (subdivided into homologous, heterologous, parasitical,) and the various genera of acquired trophopathies.
10. Gangrene is in itself a disease which may be brought on by many causes besides congestion and inflammation. It may be produced by an obstacle to capillary or arterial circulation-by the introduction of miasmata or morbid poisons into the system, as in the plague. It is, therefore, something more than a termination of inflammation, and deserves to be separately studied in a class peculiar to itself.
11. Traumatic affections form, with the two preceding, the group of diseases in which alteration of the solids is primary.
12. Hemopathies or Diseases of the Blood.-The first order contains the diseases resulting from changes of proportion of the natural elements of the blood, and in this order we find four genera :-The first of which refers to the changes of proportion of the globules,
which may be increased as in plethora, or diminished as in accidental or spontaneous anemia. In the second genus we place the changes of proportion of the fibrine-increased in inflammations attended with fever; diminished, on the contrary, and its diminution being a primary morbid fact, from which the other phenomena of disease may be derived as in scurvy, or purpura ;-or this dimunition being, as in pyrexiæ, not a cause but one of the possible results of the malady. In the third genus of the first order we place changes of proportion of the albumen in the blood; increase of the albumen has not hitherto been ever observed: its diminution is constant in one variety of dropsy. The fourth contains the changes of quantity noticed in the saline elements of the blood--a subject which has hitherto yielded to investigation only results of a negative nature.
The second order of hemopathies refers to diseases resulting from the introduction into the blood of principles not habitually contained in that fluid. This order is subdivided into three genera. The first, that in which the elements of our various secretions are found in the blood--for instance, tetanus; diabetes mellitus will probably, at a future day, be classed here. The second genus, that in which morbid products--like pus--are introduced into the blood. The third, in which it contains toxic principles, which may be modified in its constitution, or not changed in any appreciable manner. Here we must place diseases resulting from the passage into the blood of venous miasmata, virus of various sorts (rabies, syphilis, &c.,) or even mineral poisons, such as mercurial or saturnine emanations.
The third order of hemopathies is consecrated to asphyxia, in which, under the influence of various causes, the blood receives no oxygen, or an insufficient quantity of that gas.
13. Alterations of secreted fluids are mostly the result of other maladies; sometimes, however, they can be traced to no organic alteration whatever. Calculous affections of the bladder, kidney, and liver belong to this class, in which we must also place, for the present at least, diabetes mellitus. Albuminuria, when not connected with organic diseases of the kidneys, also should be classed here.
14. Neuropathies are primary disturbances of nervous action. They may be subdivided into the modifications of intellect, of sensibility, of motility, and of that nervous power which presides over the accomplishment of the functions of organic life.
Such, at the present day, is the most complete classification of diseases. This grouping into classes we have already said to be indispensable to the science of diagnosis, and to that of therapeutics. London Medical Times.
Death from Starvation.-Dr. LEESON said he had been called upon on the previous Monday to make a post-mortem examination in conjunction with Dr. Brady, Professor of Medical Jurisprudence in the College of Physicians, on the bodies of two individuals, a man and woman, who had died suddenly, and, as was reported, from starvation. One of them died on Saturday evening, the other on Sunday
morning. Upon external inspection both bodies presented appearances of extreme emaciation. All the features of the female were remarkably contracted, the eyes sunk, nose pinched, and cheeks drawn. in, giving her the appearance of a person upwards of sixty years old. The rest of the body was proportionally emaciated; the spaces between the metacarpal bones were perfectly hollowed out; the abdominal parietes when cut were totally devoid of the fat always met with in other subjects, and all the abdominal contents were perfectly bloodless; every organ was completely anæmic.
On cutting into the stomach, its ruga were observed to be remarkably developed, and there was not a trace of food in it. The whole track of the intestines, though cut into in several places, had not the slightest trace of fecal matter-containing only a little fœtid mucus. There was some ulceration of the intestinal glands at the lower extremity of the ileum. When the chest was opened, both lungs were emphysematous and perfectly anæmic. The left ventricle of the heart contained half an ounce of remarkably thin fluid blood.
The body of the male presented similar appearances, but the ex. ternal emaciation was even much greater. The stomach contained a very small quantity of fluid, with a few grains of meal, but no trace of fæculent matter was observed until near the termination of the intestine, and even here its amount did not exceed a teaspoonful. The lungs were in a similarly emphysematous and anæmic condition, and the heart contained a small quantityof fluid blood. The gallbladder, as usually observed in cases of death by starvation, was remarkably full, and the liver was lobulated, its eminences, however, being of a healthy kind.
In giving an opinion as to the cause of death here, Dr. Leeson remarked that from hearing the facts of the case-that up to the last period of their existence these poor creatures had something to live on, it could hardly be distinctly stated that they died of starvation : nor indeed do we find death from absolute starvation to be by any means a common occurrence, taking as an example, for instance, death by starvation, in consequence of several weeks total deprivation of food, as in cases of shipwrecked mariners, &c. In the present instance, however, it appeared that this poor man and woman, with six children, lived in the county Leitrim, and seeing the destruction of the potato crop, made their way up to town, where the whole family were huddled into a miserable apartment, not more than six feet square, with a damp floor and a roof that admitted the rain, a wad of straw that might now have passed for any other material, being its only furniture. Reviewing all the facts of the case then-their destitution previous to coming to town-their bare subsistence while here, having only a sum of 1s. 3d. a day for the support of six children and themselves-life, in fact, as well remarked by Dr. Brady, gradually ebbing away,-the opinion given was that death had arisen. not from actual starvation, but from the state of general destitution in which they had so long existed--in want of lodging, fire, clothing, or proper nourishment.
He might here observe, that it is well known the soup obtained by such poor creatures as the above from the soup shops is entirely insufficient for the support of life without some addition of solid material, and this is more particularly true in reference to Paul's parish, where this man and woman lived, the soup there, from the poverty of the parish, being little more than meal and water, which, in the entire absence of solid food in the stomach, passes through the intes tinal tract as it is taken in, or gives rise to diarrhoea. The facts of these cases led him to suggest that a certain quantity of solid food might be allowed once or twice a week to the suffering poor in addition to the distribution of soup, and to hope that some notice of the subject might be taken by the public prints.
After finishing the post-mortem examination of the above cases, they proceeded to an adjoining apartment, the area of which was certainly not more than six feet square, and here lay (if he might use the expression) a mere living skeleton, stretched on a portion of straw, the eyes sunken, and their whites suffused, cheeks hollow, nose pinched-in fact, absolutely famishing, unable to move, and just able to call in a voice that reminded him of the voice in cholera for a little water, stating that her mouth was like the burning fire, and it was perfectly parched. The emaciation was so great that her arms were no thicker than candles, and the legs were swollen. She was unable to say when she had tasted food.
In reply to a question, Dr. Leeson stated that no urine was contained in the bladder in either case. Delerium, he believed, too, is only observed in cases of absolute starvation, not in those of gradual starvation, as here.-Dub. Med. Press.
On the Treatment of certain Surgical Affections by Elevation of the Diseased Parts.-M. Gerdy has for some time been in the habit of treating certain inflammatory affections by placing the limb, or part, in such a position as to favour the return of blood to the heart. This plan has this advantage, that it does not exclude the application of the usual means of treatment; but, as is shown by M. Dupuy, it is in many cases in itself sufficient to effect a cure.
The question meets us in limine. What are the phenomena which are induced by elevating a part of the body? If the hand, for instance, be allowed to hang down, we observe that it becomes engorged with blood. Place it in the contrary position, and the livid colour disappears, and the vessels empty themselves. It is evident from this experiment that in the first instance the blood accumulates in the most depending part; in the other the reverse occurs, the blood readily finding its way toward the centre of the circulation. What is thus seen to occur in a healthy condition of parts, also happens under certain modifications in disease. M. Dupuy gives the following account of the practical application of the above principles :
If the thumb or hand be inflamed, the patient is made to lie in such a position that the elbow is maintained in a position higher than the
shoulder. The fore-arm is placed perpendicular, supported by cushions, care being specially taken that the circulation is not impeded by bandages; the hand is then enveloped in bandages, to which tapes are fixed, and attached to the top of the bed. These means, with some simple modifications, are likewise made use of in inflammation of the lower extremities. M. Gerda raises the end of the bed by placing a chair under it, thus raising the foot upon the summit of an inclined plane. Once so placed, and care being taken that no injurious pressure is exerted, the patient must not move from the position even to satisfy natural wants; for he may destroy in a few minutes all the benefits which have been obtained by whole days of repose. Although elevation cannot be so efficaciously applied to the head and trunk as to the extremities, it yet may be employed to a certain extent. Supposing the eye to be inflamed,-the patient will lie with his head high, and on the opposite side to the one affected. Why are inflammatory affections and discharges from the womb so tedious in recovery, but for the stagnation of the blood in the organ? Let a woman, who has been accustomed to keep herself in the vertical posture, go to bed, and raise her hips by means of pillows, and she will soon find her case amended. The same principles apply to inflammatory affections of the face, breast, &c.
The advantage of this plan of treatment is not, however, confined to inflammation, but it is equally serviceable in ulcers, uterine hæmorrhages, and varicose veins. In many instances of the latter disease, in M. Gerdy's wards, elevation alone of the limb has been completely successful. The utility of the plan is also incontestable in varicocele. The communication of M. Dupuy terminates with these conclusions: 1st. That elevation of the diseased part is able, without the intervention of other therapeutical measures, to cut short certain inflammations, if it be employed sufficiently early.
2nd. That in phlegmon it relieves pain by diminishing the quantity of blood in the part.
3rd. That it advances the cure of engorgements and chronic profluvia of the uterus.
4th. That certain hæmorrhages may be suspended by it.
5th. That it is able to cure certain ulcers of the lower extremities. 6th. That varices and hæmorrhoids are advantageously modified by elevation.
7th. That where it is not sufficient in itself to effect a cure, it is always a potent auxiliary.-Provincial Med. and Surg. Journ., from Archives Générales.
Method for preventing the projection of the Bones in Fracture of the Leg.-The leg is to be placed in the bent position on the outside, with a common side splint placed above and below, slightly hollowed out to fit the leg. In addition to these, two straight splints are used, padded on one side,-one of sufficient length to extend from the patella to the upper part of the lower third of the leg, the other long 36*