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escaping in the urine could not be viewed as an absolutely safe index to the quantity formed in the system, unless taken in conjunction with other means of its elimination.
The cases might further be looked upon as furnishing an argument, if further evidence upon the subject were necessary, that the kidneys play no part in the formation, but merely in the separation from the blood, of the sugar.
Raspberry-like Nævus.-Mr. Thompson, of Stalybridge, presented four nævi, removed by ligaiure, which were interesting by reason of the proof they afforded of their here litary character. One was larger than a walnut, and three equalled raspberries in form and size. In colour they were bright blood red, and their surfaces resembled ex. actly the raspberry in appearance.
They were removed from the right shoulder of a very healthy woman, aged 44 years, who had borne eight children. She first noticed the large nævus in her eighteenth year. It was then like an ordinary brown mole, possessing
very little sensibility. After a time it increased in size, and at length became very sensitive and painful, and acquired the appearance described. It was attached to the skin by a peduncle about a quarter of an inch in diameter, which was occasionally excoriated, and discharged a very offensive fluid.
This woman's daughter, maternal grandmother, and great grandfather, have all had similar nævi.— Ibid.
Considerations on the Treatment of Typhoid fever. By M. GENDRIN.—Typhoid Fever,--the dothinenteritis of Bretonneau, and typhus abdominalis of the Germans, has lately become unusually common in Edinburg. It may be said to be the prevailing form fever of both in that city and in Glasgow, a circumstance sufficiently curious, when it is remembered that, for several years past, no intestinal lesion has accompanied the disease. It was first remarked by Prof.John Reid, when pathologist to the Edinburgh infirmary, that the few cases which appeared there, always came from the country, more especially from Linlithgow, or Fife, and never originated in the city. Dr. Hughes Bennett, the present pathologist, has, for more than three years, had occasion to confirm the truth of this observation, and lately stated (see report of Ed. Medico-Chir. Society, Month.. Journ., June, 1846), that during that time, only two cases had occurred in the infirmary. During the present winter, the disease has been very common, and he has examined upwards of twenty cases, in which the follicular lesion of the intestines has been more or less well marked. Under these circumstances, observations on the treatment of this affection, by so experienced a physician as M. Gendrin, condensed from a lecture he lately delivered, may be considered as particularly well timed.
According 10 M. Gendrin, typhoid fever' must inevitably pass through its three stages of increase, intensity and decline. He insists on this, because the practical rules which result from it, are, that the disease cannot be cut short, that the expectant system is the basis of our treatment, and that the active interference of art ought to be limited to accelerating the evolution of the disease, and to moderating the accidents which arise during its course.
Thus, in a slight case of typhoid fever, M. Gendrin only follows the expectant system of medicine. He causes it to consist in surrounding the patients with all the hygienic precautions compatible with their social position : submitting them to a dietetic regimen having relation to the state of their digestive organs, and removing all those moral influences which may act injuriously upon their minds or bodies. In this manner a cure is effected in a considerable number of cases.
When the disease is severe, a more active treatment is necessary, consisting of blood-letting, evacuants, baths, epispastics, alteratives, &c.
M. Gendrin believes it useful to practise one or two bleedings from the arm in the first stage ; but when this has passed, when the petechial eruption is developed, he considers no benefit is to be thus obtained. Local blood-letting, according to him, causes more injury iban benefit, for leeches or cupping applied to the abdomen, act at too great a distance from the inflamed intestine, to render them efficacious: and, on the other hand, a quantity of arterial blood is removed, which enfeebles the patient without doing any good.
In many cases, dyspeptic symptoms may be observed at the commencement, or during the progress of the first stage. All the individuals who enter his wards with stomach symptoms take an emetic with the best results. Typhoid fevers, accompanied at their commencement with symptoms of prostration, are transformed into a benign fever, under the influence of a vomit. Such was the treatment the French found to succeed completely at Vienna in 1809. It is only necessary that the emetic should be administered at an early period, for when the petechial eruption has occurred, and ulcerations have taken place in the small intestines, or an erythematous state in the stomach, the remedy is more hurtful than beneficial.
M. Gendrin strongly condemns the indiscriminate use of purgatives, more especially drastic ones, which he rejects altogether. The only agents of this class he employs are gentle aperients, emeto-cathartics, which, in addition to a local, conjoin a general action. He prescribes these remedies at the commencement, and sometimes during the decline of the disease, when there remains some flatulence, and liquid matters remain in the intestines, as is announced by gurgling. A saline purgative will then excite the action of the in. testines, and decide the convalescence.
M. Gendrin has employed cold affusion in typhoid fever for fifteen years, causing water to trickle over the surface, or to be applied with a sponge. He considers it most afficacious in moderating the symptoms of the first stage, and it is very grateful to the patient. T'he subtraction of caloric in this way causes the pulse to fall from 120 to 80 and even to 60 beats in the minute. It sometimes happens that the pulse very slowly rises again, and therefore it is necessary to proportion the subtraction of caloric to the reactive powers of the individual. It should only be applied in the first stage, for after the eruption, reaction is not possible.
Tepid baths, on the other hand, are applicable exclusively to the adynamic period. They then serve to re-establish the action of the skin. It is necessary to prevent their too prolonged use, and too high temperature, otherwise they becoine debilitating.
Epispastics, more especially blisters, are at present very little employed.
In the last stage tonics are often necessary, especially combined with nutritive substances. M. Gendrin gives, with beef tea (bouillon), the wine of quinine; which has the advantage of uniting a fixed tonic with a diffusible stimulus. Wine, associated with bitter and aromatic substances, he prefers to camphor, which is only useful when there are ataxic symptoms.
Lastly, M. Gendrin speaks of the medicines which act chemically. They are, Seltzer water, chloride of sodium, alkalies, and chlorine, administered internally. All these preparations, according to the Professor of la Pitié, have no great advantages to recommend them. The effervescing lemonade only constitutes an agreeable drink, the action of which, slightly stimulating, may be rendered serviceable. With regard to the chlorates and chlorurets, they have such an insupportable odour, as to be rejected for this cause alone, even were their therapeutic inutility not proved by experience.- Monthly Journal of Medical Science, from Journal de Medicine et de Chirurgie Pratiques.
Case of Pulsating Veins. By Sir H. MARSH, Bart.-Catherine Duffy, aged 28, was admitted into Steevens' Hospital under Sic Henry Marsh, 13th May, 1846, presenting the following appearance:
All the superficial veins of the right arm and hand are greatly die lated ; those on the back of the fore-arm, above its middle, being much convoluted as well as swollen. The veins on the back of the hand are much contorted, and in various places varicose. On the liule and ring fingers the veins present, in a well-marked manner, the appearance of aneurism by anastomosis, whereby these fingers are irregularly swollen to fully double their natural thickness.
A little before the axillary artery becomes brachial, or just above the lower edge of the tendon of the latissimus dorsi, the vessel be. comes abruptly dilated to fully four times its natural diameter. The dilatation is of the entire circumference, and extends about two inches along the brachial artery ; its calibre is tolerably uniform or cylindrical, except that on its anterior and internal surface it assumes a form somewhat irregular or nodulated. Above this dilatation, as far back as can be traced by the finger, the vessel, though not considerably dilated, feels larger than is natural, or than its corresponding portion on the opposite side. About two inches below the commencement of this dilatation, the artery as abruptly contracts. The contraction is
such as to convey the idea of a cord having been tied tightly around the vessel. Immediately below this contraction the vessel appears again to dilate, but not in its entire circumference; a pouch or sack, somewhat of the size and form of a split hazel-nut, occupies its anterior and internal surface. Between this sack and the vessel there is an obvious communication, the former being readily emptied by pressure. Below this last described tumour, till pretty near its bifur. cation, the artery is of uniform calibre. It is somewhat, but inconsiderably, larger than the corresponding portion in the opposite extremity. From just above the internal condvle to its bifurcation, the the vessel is again uniformly dilated to fully double its natural dimensions. The radial and ulnar arteries are distended to pretty nearly twice their natural size, uniformly throughout their entire extent.
On the posterior and internal portion of the fore arm, corresponding to about the middle of the ulna, is a soft, compressible tumour, slight: ly pulsating, and in size somewhat about that of half an ordinary sized walnut. In the palm of the hand, immediately beneath the pisiform bone, is an ill-defined pulsating swelling, which resembles an aneu. rism by anastomosis ; beneath this, and corresponding to the cleft between the middle and index finger, is a tumour of a similar nature, somewhat less in size, and less distinctly pulsating.
Pulsation is visible immediately above the sternum, along the bra. chial, the radial, and the ulnar arieries ; in the tumour on the back of the fore-arm, and in those in the palm of the hand. Pulsation is not visible in the carotids, nor in the tumours on the little and ring fingers.
By pressure applied to the axillary artery all pulsation in the tumour is arrested. Fremissement is well marked along the brachial, less distinctly along the radial and ulnar arteries. On taking the patient by the hand, and using gentle pressure, a tremulous purring sensation is communicated by the tumours in the palm.
On applying the stethoscope immediately beneath the acromial end of the clavicle, there is heard an intensely loud continuous murmur. This sound becomes somewhat augmented at every ventricular systole. As the stethoscope is moved towards the sternum, the murmur becomes less and less audible. At no part of the sternum can this murmur be heard. The heart's sounds appear perfectly normal. A bruil de souflet is audible along the entire course of the brachial, radial, and ulnar arteries. A murmur exactly resembling the placental soufflet is heard in the various pulsating tumours. Nothing abnormal can be recognised in any of the other vessels in the body.
The pulse at both wrists is 72, and regular; being, however, on the affected side considerably fuller and somewhat stronger than on the other.
The temperature of the affected limb (one of the symptoms the patient complained of as most distressing), was, when measured by ihe thermometer, always several degrees higher than that of the other. The amount of the difference was found to vary with the
condition of the circulation, being augmented by whatever produced an acceleration of the heart's action. Any slight excess of exercise, she states, causes the limb to be bathed in perspiration.
There is a dull, aching pain, of variable intensiiy, at all times present in the arm, from which some relief is experienced, as also a partial emptying of the vessels, and slight diminution in the size of the various tumours, by holding the arm in an elevated position.
The patient's general healih does not appear to have suffered much; her strength is but little impaired, her appetite good, her bowels regular, and her sleep undisturbed. Her catamenia did not appear the last two menstrual periods, but had always been previ. ously regular.
The patient's history is briefly as follows:
Her parents, and numerous brothers and sisters, are healthy. She has been married eight years, and has had five children, nothing remarkable as to hæmorrhage or otherwise having occurred at her confinements. Her circumstances being independent, she has never pursued a laborious life, nor employed her right arm in any way calculated particularly to fatigue it. She has ever considered herself healthy and strong, except that intestinal worms have been to her for some years a source of much trouble. She states that from childhood, so far back as she can recollect, she thinks she had observed the veins of the effected arm and hand to have been larger and more swollen than those of the other; but having experienced from this no incon. venience, she never attached to it any importance. About a year and a half ago, she, for the first time, observed a throbbing to occur in the effected arm after exertion, or increased exercise of any kind. Somewhat about the same time, as well as she can recollect, she first felt a sharp stinging pain occasionally shooting down the arm, commencing, as she describes it, at the inferior angle of the scapula, and shooting through the arm to the hand. For some time she attached but little importance to these symptoms, the pain being but occasional and momentary, and the throbbing caused alone by exertion. Since then to the present time they have been gradually becoming more distressing; the occasional sharp stinging pain has been replaced by one constant, dull, and aching; while the throbbing and distressing sense of heat, which at first was brought on alone by excess of exercise, is now ever present, even while at rest. She can give no definite information as to the period of the first appearance, or the progress of the various tumours, but is of opinion that they have all formed within the last eighteen months. She has had much medical advice, having consulted several physicians, and having been for some time in hospital previously to coming into Steevens', but is of opinion that she has derived but little benefit from treatment.
For the sake of brevity, a detail of the daily treatment has been omitted, the more especially as it appeared to exercise but little control over the disease. It consisted for the most part, of general sedatives, with the local application of refrigerating lotions, and the occasional employment of pressure,-pressure generally of the entire