« ZurückWeiter »
covered with a cold perspiration, and trembling from head to foot, and apparently alarmed at everybody and everything about her. Her breathing was very laborious and hurried; her countenance perfectly wild, and the pupils dilated; the tongue was dry and cold; pulse ninety-six and full: the abdomen much distended, with extreme acute pain at the scrobiculis cordis, so much so, that the slightest pressure there caused her to shriek out. She did not know any one about her, not even her own children, nor had she any recollection of anything that had happened from the time of taking the vinegar, which was about 11 at night, not even of her having gone to bed, which she was the last in the house to do. About 1 o'clock the inmates were all awakened by her shrieking for cold water, of which she had drunk an enormous quantity before I was called to see her. There was not any pain, heat, or constriction of the throat or fauces, but there were slight efforts to vomit. Having procured some sulphate of zinc, I gave her two scruples in a cup of water, which soon produced full vomiting, with great straining. I had then to leave her, but ordered full and repeated doses of carb. magnesia, till I could see her again, which I did about six hours after, and found her much relieved, and only complaining of headache, which left her after the operation of a dose of castor oil. Two days after, she was taken ill with a slight attack of continued fever, but is doing well.
I should mention that the quantity she threw up from the effects of the zinc was very great, and smelt strongly of vinegar, which she still perseveres in saying she did not take, although she was seen with the bowl filled with it in her hands by some of the family, when they were retireing to rest, she maintaining that she used the whole of the vinegar in bathing her head. However, I think we have strong presumptive evidence against her having so used it, and are justified in concluding that she took the whole of it.
The only case of poisoning by acetic acid that I have been able to find, is the one related by Orfila in the Annales D'Hygiene, and quoted by both Beck and Christison. The experiments instituted by Orfila prove that common vinegar, in large quantities, was found destructive to dogs when vomiting was prevented.
Taylor, in his work on Medical Jurisprudence says, "Acetic, citric and tartaric acids are not commonly considered to have any poisonous action on the body. At least, as far as I know, there is no case reported of their having acted injuriously on the human subject; and he is the only modern writer on medical jurisprudence who takes any notice or makes mention of acetic acid.-British American Journal of Medical and Physical Science.
Nephritis from Calculus, Simulating Cancer of the Stomach.-A Captain of infantry entered the Hospital of Val-de-Grace, under M. Champouillon. For seven years, this officer, of a sanguine and robust constitution, had complained of pain in the epigastrium, increased during digestion, and attended with vomiting after a tolerably full meal. For these sufferings the patient consulted numerous physicians,
all of whom spoke of gastralgia, of chronic gastritis, and consequently prescribed for him repose, baths, and a vegetable and mik diet. This regimen always produced a notable amelioration of the symptoms, so as to give the patient the idea of recovery. However, a new and final relapse occurred at the end of March, and the captain determined to enter the hospital, which he did on the 7th of April. The vomtings were then very painful, and almost continual; the belly was dis tended; the feet and hands presented a moderate amount of serous infiltration. Leeches were applied to the epigastrium, and ice placed on, and which was also taken internally, with morphia. The vomiting was by these means suspended for a few days, and then returned. The tongue, previously dry and brown, began to be moist and white. The matters vomited, at first white and glairy, became on the 12th of April, of a blackish colour. On a microscopical examination, they were found to be composed of mucus, and of a granular matter, which M. Millon recognized as blood-discs, altered in form. On the 13th, a consultation was held. The physicians present attempted in vain to percuss the epigastric region. The abdomen, always distended, prevented a manual examination, and the slightest pressure also caused the most severe pain. This circumstance, coupled with the nature of the matters ejected, and the straw yellow tint of the countenance, gave rise to the opinion that, instead of chronic gastritis, there was cancer of the stomach; and this opinion was strengthened by the fact, that his mother had suffered from cancer of the womb. Ice and opium were given; but the vomiting persisted till death, which occurred on the 16th. A post mortem examination was made the next day. The mucous membrane of the stomach was found slightly injected towards the great cul de sac, but appeared elsewhere quite healthy. The intestines, liver, and spleen, presented no pathological lesions. The kidneys were very large, imbedded in a layer of compact cellular tissue, to which they were firmly adherent. The corti ca! substance, considerably atrophied, was of a decidedly black colour. Each kidney enclosed a calculus of lithate of ammonia, rugose and mamillated, and of the size of a pigeon's egg. Several smaller calculi were contained in the pelves of the kidneys.
Here, then, was a complete error in diagnosis. The symptoms were such as might, with the greatest probability, be referred to can. cerous disease of the stomach, with ulceration. In forming the diag nosis, no aid could be drawn from a manual examination of the epigastric region, and from palpation; but the same thing may happen in cancer of the stomach. M. Champouillon, indeed, in making his examination, and pressing on the lateral and posterior region of the abdomen, had excited acute pain. This pain, coinciding with the oedema of the extremities, and the frequent vomiting, at once led him to suspect nephritis from calculus, or with albumen. Consequently, he examined the urine of the patient to detect albumen, or an excess of lithic acid; but the re-agents employed gave no indications of either; and moreover, the patient never having complained of pain in the lumbar region, or of any derangement in the functions of the
kidney, the idea of renal disease was given up.-Dub. Med. Press, from the London Lancet.
Pathology of Elephantiasis.-M. Cazenave has now under his care, at the Hospital St. Louis, a case of elephantiasis affecting the entire right leg. The thigh is so enormously distended, that its circumference surpasses that of the woman's body suffering with it; but with this increased size there is no deformity. The leg, on the contrary, is not only enlarged, but deformed, presenting hard, projecting masses, extending down to the instep, and the foot is also large and deformed. According to M. Cazenave, this elephantiasis of the Arabs, consists in a pure and simple hypertrophy of the affected parts--hypertrophy peculiar so far as it is connected necessarily with inflammation of the lymphatics. Ordinarily, and such has been the history of the present case, the disease commences suddenly, by a sharp and deep-seated pain along the course of the lymphatic vessels, which are soon transformed into hard, knotty cords; the limb then becomes the seat of an erysipelatous inflammation, which disappears, but this only for a time, being again reproduced and continuing for a greater or less time. This state of things may go on for several years. The cellular tissue is consecutively inflamed, and a more or less considerable tumefaction is set up, which augments at every fresh outbreak of the disease. Although tolerably soft at first, and, as it were, œdematous, the swelling at length gets hard, and resists the impression of the fingers. It is then the knobs or lumps make their appearance, and which produce the characteristic deformity of elephantiasis, knobs which will extend onwards to the feet or hands, (according as the legs or arms are affected,) and are sometimes separated by deep circular fissures, the whole accompanied by the normal colour of the skin, or by a duller whitensss than is seen in the healthy state. The soft tissues alone are affected, unless the disease is of very long standing, and the deep fissures have degenerated into wounds and ulcers, which may bring on consecutive disease of the bones. It is very peculiar that elephantiasis is observed much more frequently in the lower extremities than in the upper. However, there was a case some years since under M. Sanson, at La Pitié, of a very bulky elephantiasis affecting a woman's right arm.
It is a difficult matter to determine the treatment to be adopted. In M. Cazenave's patient, compression has been tried by means of a wide bandage, with agaric placed under it, at places much tumefied. Internal medicines, as mostly happens, have proved quite ineffectual. Since the compression has been employed, certain parts of the limb have notably diminished in volume, although a perfect cure cannot be hoped for, on account of the old standing of the malady, and the enormous degree at which the swelling has arrived.-London Lancet.
Influence of Quinine on the Volume of the Spleen in Ague.-M. Valleix, physician of the Hotel Dieu, has directed his attention to the action of the sulphate of quinine on the volume of the spleen in inter
mittent fever. He has done so to test the accuracy of a statement made by M. Piorry, that the disappearanec of the paroxysm coincides with the diminution of the volume of the spleen; that this organ sensibly diminishes in thirty or forty seconds after the administration of a full dose of quinine, in solution, and acidulated; that the diminution goes on very rapidly if the quinine be continued in a sufficiently large dose. M. Gouraud having examined into this matter, however, states that he has not found the spleen thus diminished, but that, in consequence of an accumulation of gas in the stomach, from the ingestion of the quinine, the left hypochondrium is rendered sonorous, and the dulness over the spleen becomes masked. These opposite statements M. Valleix has kept in view in making some fresh observations. He narrates a case, and its course; quite a simple case of ague, occurring in a young and robust man, who had never suffered before. It was a recent case, and there were no evidences of organic disease in any organ: the spleen had undergone very considerable enlargement, being readily perceived through the abdominal wall, and therefore its size could be estimated with the greatest precision. The sulphate of quinine, although given in a very strong dose of thirty grains, and acidulated, so as to render the salt a bisulphate, did not act as represented by M. Piorry, on the volume of the spleen, neither at the end of forty seconds, nor of twenty minutes, nor even of twenty-four hours. The medicine also had no such power when given in still greater quantity, but divided, during the day, into several doses, and continued on succeeding days. But after the application of cupping-glasses and leeches over the splenic region, the volume of the spleen, on the contrary, diminished rapidly, although the dose of quinine was abated. Lastly, notwithstanding the persistence of the splenic engorgement, the fever was cut short, and there was no trace of a recurrent paroxysm.
Another equally uncomplicated case occurred to M. Valleix, and the same method being tried, was attended by the same results. It must, however, be mentioned, that three days after the first dose of quinine, a slight diminution of the spleen was noticeable; but this little decrease, which perhaps, too, was partly owing to a bottle of eau de Vichy which the patient took, was lost sight of when compared with the rapid diminution which followed two days afterwards, when cupping glasses were applied over the spleen, and which continued to go on. In this case, also, as in the preceding, although the enlarged spleen remained, the fever was removed.
The third case differed from the two preceding, in that it was of older date; but there was no essential difference in the effects of the treatment. The spleen remained unaffected in size during the first day, when quinine alone was given; but quickly decreased after local bleeding, although the dose of quinine was lessened. The fever was removed before the engorgement of the spleen had subsided.
Thus these observations contradict the assertions of M. Piorry, both as to the coincidence of the disappearance of the fever and the decrease
of the spleen, and as to the immediate and prolonged influence of quinine in diminishing the splenic congestion. M. Valleix also confirms the observation of M. Gouraud as to the formation of gas in the stomach upon the quinine being swallowed, augmenting the resonance over the left hypochondrium, and so hiding the dulness over the solid spleen beneath to a slight extent; not so much so, however, but that palpation and percussion will readily detect the engorged organ.Ibid.
Suicides in France. The report of the criminal justices of France, for the year 1845, contains the following details respecting the fre quency of suicide, the means employed, and the motives. Of the number of deaths of the cause of which there has been suspicion, 11,049, there have been 3084 by suicide. The number of suicides in 1845 exceeds by 111 that of 1844, and by only sixty-four that of 1843. Of the 3084 suicides, 2332 were males, 725 females. Sixteen of the males and four of the females had not attained their sixteenth year; and among the number we find children of seven, eight, and ten years of age; 123 were between sixteen and twenty-one, 462 between twenty-one and thirty, 1201 between thirty and fifty, 945 between fifty and seventy, 203 between seventy and eighty, and forty-one above eighty. If we look to the relative number of suicides in the different months, we find 922 during the three summer months, June, July, and August; 861 during the three months of spring, March, April, and May; 756 in the three autumnal months, September, October, and November; lastly, only 545 in the three winter months, December, January, and February. The most common modes of suicide are hanging and drowning. 1110 suicides had recourse to the first of these ways, in 1845; 995 to drowning; 432 despatched themselves by firearms; whilst 213 asphyxiated themselves by the vapour of charcoal; this last named plan is most common in the Department of the Seine. The motives of suicide resemble those of other years: crosses in love, jealousy, the consequence of debauchery, misery, reverses of fortune, domestic troubles, the desire to rid themselves from physical sufferings, are the most common-Ibid.
Sanitary Measures in Egypt.-The Egyptian government, to give the fullest effect to quarantine regulations, has ordered the number of European and Arab physicians to be doubled throughout the country. Until the present time, there was one Arab and one European physician to fifty villages. Now there are to be four for the same locality, and this number may be increased when they are procurable. At the school of medicine at Cairo, the number of pupils has been doubled, as also the class of inferior medical officers. Such a demand for medical men in Egypt surely offers an opportunity to some of our over-numerous body to exercise the healing art in that country, and in a more profitable manner than they can hope to do at home, under the tender mercies of Boards of Health and Guardians, who