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Dr. Combe and Dr. Saunders report a case of Stricture and Thickening of the sleum, which terminated fatally.
A paper of some length by Dr. Latham relates Cases of Tetonus in consequence of Wounds, evincing the Utility of relaxant Medicines, and more especially of the Pulvis Ipecacuanha Compositus in large and repeated Doses.' Seven cases of Tetanus are here reported, which occurred either to Dr. Latham himself or to his correspondents, and in four of which the remedy was employed with success. We are disposed to think that, in many instances of tetanus, the ipecacuanha may be an useful adjunct to the opium ; yet we conceive that the most considerable share of the benefit is to be derived from this latter substance, which abundant experience has proved to be a very powerful remedy in this formidable complaint.
Dr. L. also communicates some Remarks on Tumours, which have been mistaken for Diseases of the Liver.
A case of peculiar Affection of the Eyes, or night blindness, is related by Dr. Heberden; which, from its rarity, may deserve to be recorded. In the same point of view we regard the next paper, giving an account of some cases of Scurvy, which occurred to the same practitioner in the metropolis, and in which the influence of the usual exciting causes of the disease may be satisfactorily traced. Dr. H. takes occasion to make some interesting remarks on the present compared with the former condition of London, as to the existence of this malady.
Dr. Powell's paper, recommending the Nitrate of Silver in chorea, is , intitled to attention. We have next some statistical observations by Dr. Heberden, on the Mortality of London, which coincide with others of a similar kind, in evincing the increased salubrity of the metropolis, owing to the improved manners of the inhabitants with respect to ventilation and cleanliness.
We do not see much to detain us in the observations of Dr. Roberts on Phthisis Pulmonalis, except the information which we derive from a list of substances given by him in this complaint without success. This list we shall transcribe, in order that our readers
may obtain from it all the benefit of Dr. Roberts's negative experience :
. Among metallic substances the following were given : • Of silver, the only preparation in use, the nitrate.
. Of lead, the super-acetate combined with opium, which so successfully counteracts its deleterious effects.
• Of zinc, the following preparations were directed: the sulphate and oxide, and the precipitate from the sulphate by potash, combined with myrrh. Of arsenic, its neutral salt formed by combination with potash.
• Of Of manganese, the white oxide in the dose of ten grains every six hours; and the black oxide of cobalt, in the dose of from one grain to four.
• Ammoniated copper, muriate of barytes, the nitric and phosphoric acids; the vegetable narcotics, aconite, hyoscyamus, stramonium, belladonna, as well as toxicondendron, were administered without success.'
Dr. Powell's Observations on the comparative Prevalence of Insanity, at different Periods, seem to prove the correctness of the popular opinion that this complaint is on the increase. It is, however, consoling to learn that the aggregate number of the insane is considerably less than most persons would probably be disposed to believe, being only in the ratio of 1 to 7300 of all the inhabitants of England.
Case of Superfætation, by W. G. Maton, M.D.- Case of Tetanus arising from a Wound, in which the Affusion of cold Water was successfully employed, by G. G. Currey, M.D. - Sequel to the Paper on Tetanus, by J. Latham, M.D. - Case by Mr. Blagden, Surgeon at Petworth, of Hepatitis, in which an abscess was formed, and a large gall-stone discharged. The patient, a lady aged 66, recovered.
Dr. Warren furnishes an account of Two Cases of Diabetes Mellitus, in which opium was given in large quantities, at the same time that a diet of animal food was employed; in one of the cases, the opium was administered in the form of Dover's powder, and afterward united with kino. Benefit seems to have been obtained from this plan; the patients were relieved from their most urgent symptoms, and even appeared to be cured ; yet we are told that one of them died shortly afterward, of a pulmonary complaint.
Case of Inflammation, and subsequent Mortification, of the Adipose Membrane surrounding both Kidneys; with the Appearances on Dissection. By Thomas Turner, M.D.
Another paper is given by Dr.Warren, On the Head-achs which arise from a defective State of the digestive Organs. — The description of the different species is detailed with the greatest minuteness, and the most precise diagnosis is laid down between those which take place when the functions of the stomach, liver, and bowels will be found inactive or improperly exercised,' and those which arise solely from a faulty action of the stomach.' Head-achs produced by excess, those which proceed from congestion in the brain, or from disorganization of the brain, and nervous head-achs, all are distinctly described. The paper is so long, and the directions which it contains for the removal of the disease, as well as the detail of the symptoms, are so minute, that it would carry us beyond our boundaries to give a
satisfactory account of it: but it bears the marks of accuracy, and deserves an attentive perusal.
Dr. Baillie gives an account of a case of strong Pulsation of the Aorta, in the Epigastric Region, not depending on aneurysm. Dr.Latham offers Observations on certain Symptoms, usually but not always denoting Angina Pectoris;—and an useful communication is made by Dr. Haygarth, on the Discrimination of Chronic Rheumatism from Gout, acute Rheumatism, Scrophula, Nodosity, White Swelling, and other painful Diseases of the joints and Muscles
. —Sir Henry Halford next farours us with a paper on the Climacteric Disease : in which he observes that there is a certain period in the decline of life at which the constitution experiences a real morbid change, rather than a mere decay of the strength and declension of the vital powers. That this is properly a disease the author argues, because recovery often takes place from it, which could scarcely be the case if it consisted in a mere decay of the system. It is described ' as a falling away of the flesh in the decline of life, without any obvious source of exhaustion, accompanied with a quicker pulse than natural, and an extraordinary alteration in the expression of the countenance.'
The following are the remarks respecting the treatment of this complaint:
• Physicians will not expect me to propose a cure for this malady. In fact, I have nothing to offer with confidence, in that view, beyond a caution that the symptoms of the disease be not met by too active a treatment. It is not very improbable that this important change in the condition of the constitution is connected with a de. ficiency in the energy of the brain itself, and an irregular supply of the nervous influence to the heart. Whatever, therefore, would weaken the general system must be detrimental; and it seems in all cases of this kind more prudent to direct local than general evacuations for the relief of occasional congestions in the blood vessels.
• For the torpor of the stomach and digestive organs the warmer purgatives are generally, preferable to those of a saline kind; and I have often been better satisfied with the effect of the decoctum aloes compositum than that of other evacuants.
. If the system appear to be surmounting its difficulties, the Bath water may be recommended with probable advantage, particularly if the stomach has been weakened by intemperance, and still more especially if symptoms of gout shall have been blended with those of the climacteric malady in its course.'
We merely state the titles of the remaining papers. On Abdominal Tumour originating in Lumbar Abscess, by Dr. Latham. -Case of Intestinal Protrusion per Anum.- Case of Hydrophobia, by R. P. Satterley, M.D.
The volume is eked out by the Report of the Royal College of Physicians on Vaccination, which had already been given to the public seven years before.
From this brief report, our readers will conclude that this volume contains a few good papers, and several that are at least worth reading: but, when we consider it in connection with the length of time which has been occupied in its production, it certainly tends to give a low idea either of the talents or the exertions of the members of the College,
ART. IV. Observations on the distinguishing Symptoms of three
different Species of Pulmonary Consumption, the Catarrhal, the Apostematous, and the Tuberculous ; with some Remarks on the Remedies and Regimen best fitted for the Prevention, Removal, or Alleviation of each Species. By Andrew Duncan, Sen., M.D., of Edinburgh, &c. &c. 8vo. 6s. Boards. Longman and Co.
1813 This volume is written by a veteran in the profession, who
has had extensive opportunities of acquiring information on the subject on which he writes, and whose learning and assiduity enable him to profit by his advantages. Unlike too many of the publications which pass through our hands, - the productions of those who are only entering on their professional career, and who, if they are furnished with learning must be deficient in experience, - we have here the results of the matured and sober reflections of one who has devoted a long life to the study of the phænomena of disease. From the rank which he holds in the University of Edinburgh, and from the circumstance of his having been for many years the editor of a medical journal, it may be presumed that he is thoroughly acquainted with all the changes of opinion, and the revolutions of theory, without being himself bigoted to any sect; and, having no favourite doctrine of his own to support, he comes forwards to state his unbiassed judgment respecting the various circumstances which have passed before him.
The definition which Dr, Duncan gives of the disease is simple and comprehensive ; " by phthisis pulmonalis, or pulmonary consumption, is to be understood that affection in which a general wasting or consumption of the body arises from a disease of the lungs. From the structure and functions of the lungs, it might be supposed that they would be subject to many modifications of disease ; and, accordingly, systematic writers have been in the habit of making a number of species, depending partly on the supposed cause and partly on the symptoms. The present author maintains that a radical dif. férence exists beiwen different species, but conceives that they may all be reduced to three modifications, or varieties; to which he gives the names of catarrhal, apostematous, and tu.
berculous, berculous. These three species he deems it important to characterize and discriminate, as they lead to some difference in the prognosis and in the practice. He remarks that, in every variety of phthisis, the symptoms may be referred to three classes ; - the pulmonary symptoms, or those which arise immediately from the state of the lungs; -- those of the hectic fever, which always attend phthisis ; - and the supervening or consequent symptoms. It is principally in the first class, or the pulmonary symptoms, that the difference between the three species is most discernible; and, for this reason, the author proceeds to give an account of the phthisis in its first stage, as it manifests itself under the three forms mentioned above. The descriptions which follow are intitled to considerable commendation, as presenting an accurate view of the phænomena of the disease, and at the same time marking out the diagnosis between the three species which Dr. Duncan is anxious to establish. We regret that our limits will not permit us to transcribe the whole : but we shall select the account of the tuberculous variety, as being the most important, both from its more frequent occurrence and from its fatal tendency. After having observed that this modification of the complaint is always immediately produced by the presence of the peculiar tumours of the lungs which have obtained the name of tubercles, Dr. D. gives a description of the nature of these tumours, and examines the truth of the opinion that they are the consequence of scrophula. To this idea he strongly inclines, without yielding to it his decided assent.
• In support of this doctrine, there are many probable arguments; and, among other things, this opinion is corroborated from its being a well known fact, that tuberculous phthisis is often observed as a hereditary disease in scrofulous famílies ; from its occurring most frequently at a particular period of life, between the age of fifteen and twenty-five ; and from the striking resemblance which may often be observed between tubercles of the lungs and diseased mesenteric glands, producing tabes or phthisis mesenterica in those who are evidently subjected to hereditary scrofula : for in the mesentery, the diseased tubercles, though they were unquestionably at first lymphatic or lacteal glands, are equally inorganic as tubercles of the lungs.'
After these preliminary observations, the symptoms are thus detailed :
! Of all the modifications of phthisis, the pneumonic complaints which occur in the tuberculous are the least alarming. Hence, this species often subsists for a considerable time before it awakens the attention of the patient. This the rather happens, because the fever with which the tuberculous phthisis is attended at its commencement is in general accompanied with high spirits. And from this state of