Quarterly Periscope,

PART II.

(GENERAL REVIEW OF PERIODICALS.)

1. RHEUMATISM-SPINITIS. M. DE M. aged about 50 years, had enjoyed good health till his 48th year, with the exception of a gonorrhoea, followed by a stricture of the urethra. He had never been addicted to intemperance of any kind, though he was fond of good living and the enjoyments of convivial society. Eighteen months before the date of report, he became affected with an intermittent fever, which continued some months, in spite of every treatment, and then disappeared, leaving him rather de

bilitated.

A second time he was seized with intermittent fever, which resisted the usual means, and Dr. Potain was called in. The fever gave way to leeching the anus, and afterwards the administration of quinine and opium. At this time, he complained of the difficulty in making water, but did not take any remedial measures for that affection. In the summer of 1825, this gentleman was again attacked by the intermittent, which soon gave way to the measures above-mentioned. Two months afterwards, he was suddenly seized with extreme dysuria. Leeches to the perineum-warm baths-lavements-diluents. The dysuria persisted-a catheter was tried to be introduced, but in vain, as the urethra was too irritable. By the soothing means above described, some water was made to pass, and, after a few days, a consultation was had, and the catheter again tried, but the stricture could not be passed. He now repaired to Paris, and was under the care of Dubois and Segalas. The latter applied the caustic bougie, and re-established the current of urine. The patient returned to St. Germain, (the place of his residence,) where he was soon afterwards seized with rheuVOL. VIII. No. 15.

matic pains in the upper part of his back, shoulders, and arms. These pains were disregarded for a week, but then became

so acute, that he could bear them no lonDr. P. visited him, and found him ger. suffering severely, but without any fever. Thirty leeches were applied to the shoulders, succeeded by emollient cataplasms. He was put upon milk and vegetable diet. Two No relief followed these measures. vapour baths were taken daily for five days, and although they were followed by profuse perspiration, they produced no mitigation of the pains. Every afternoon there was an exasperation of these pains, attended with fever, and preceded by some chilliness. These phenomena led to the quinine and opium once more, but they failed to arrest the disease. Twentyfive leeches were then applied every day for five days, followed by cupping-glasses over the bites. After the third day, the pains ceased entirely in the arms and shoulders, and were considerably diminished in the spine and neck. It was now discovered that, with the exception of the fingers, the upper extremities were paralyzed. Two or three days after this, there was experienced some difficulty in walking, and Dr. P. fearing that the paralysis would become general, applied a large blister to the spine, and demanded a consultation. The latter was held, and the physician called in, openly, before the patient, blamed the measures that had been pursued,* and prescribed tonics and nourishing diet.

*It is hardly necessary to express our utter detestation of such a diabolical proceeding as the above. If the consulting physician was certain that the preceding measures were entirely wrong, or even 25

56

Dr. P. objected to the former, but acquiesced in the latter. This new consultant attributed the gentleman's complaint to un vice vénérien," although he had not been in the way of any poison of this kind for ten or fifteen years! M. Potain thought, on the contrary, that there was some inflammation about the spinal cord, and that, consequently, the patient's life was in jeopardy. This opinion was not at all participated by his colleague, and the patient determined to put his trust in the latter. M. P. therefore, withdrew. Six days afterwards, M. P. was summoned to meet in consultation, to which were added M. Segalas and M. Dupont. The patient was found incapable of moving himself in bed. The pulse was quick, but the skin was not hot-evacuations could only be procured by injectionsand the urine, which contained puriform matters, was obliged to be drawn off by the catheter In fact, the poor patient was in a state of almost complete paralysis. Messrs. Segalas and Dupont coincided with M. Potain in opinion, and the liberal consultant above-mentioned could only be envied, we think, by a man marching solemnly to the new drop. All the measures proposed were resolutely resisted by the liberal doctor, and, in 24 more hours, the scene closed.

Dissection. At this disagreeable part of the business, the LIBERAL did not attend. M. Dupont, however, was witness to the dissection. The spinal column was laid open throughout. From the fifth cervical to the eleventh dorsal vertebra, the membranes of the spinal canal were seen to be intensely inflamed, and covered with a sanguinolent effusion. The membranes were also thickened. The spinal marrow itself was similarly inflamed, and for a similar space. It was also softened in consistence. The time occupied by this tedious dissection prevented an examination of the other parts of the body, as the priests now broke in, and immediately removed the corpse.

REVUE MEDICALE.

detrimental, he had no right to allow his sentiments to become known in any manner to the patient or friends, unless the first practitioner obstinately refused to hearken to his suggestions.

Remarks. Two of the members of the Royal Academy of Medicine were ordered to report upon this curious and melancholy case, and the said reporters have learnedly discussed the question, whether the spinal inflammation was owing to the repeated attacks of intermittent fever, or to the rheumatism. They decided that it was to the latter, this phlogosis of the medulla spinalis and its membranes was to be attributed. For our own parts, we do not see any decided proofs that either of these maladies was the primary cause of the fatal inflammation above-mentioned; but, of the two, we should be inclined to take the intermittent as the most probable cause. This is the opinion of the original writer of the case, M. Potain. We were not a little surprised to find that no notice was taken by the Academy of the flagrant violation of medical etiquette and common ethics, committed by the second consultant in this case. It was an essential and important part of their duty to animadvert, in the strongest terms of reprehension, on his conduct. Indeed, it is a great pity that there is not some honourable tribunal to appeal to on such occasions. If our colleges and corporate bodies looked to any thing but their own private interests, they would take especial cognizance of all breaches of medical decorum and propriety in the classes of medical society over which they preside -or pretend to preside. But this seems to be no concern of the DIPLOMATIC

Corps. A formal, and often an imperfect examination of the candidate, is all the trouble they take-the other part of the ceremony, the reception of the fee, is quite a pleasure. The PRESS, however, will probably rouse them from their halpublic opinion may, perchance, so shake cyon slumbers-and the rising gale of the fig trees under which they placidly repose, as to disturb their

"Golden visions and romantic dreams."

2. HYPOCHONDRIAsis cured by AGUE.

The subject of this curious complaint was a gentleman, 55 years of age, meagre, nervous, and endowed with great sensibility of the digestive organs, (doué d'une vive sensibilité des organs digestifs,) which sensibility was less in cold, and greater

ger the quinine, which was accordingly administered. By the 24th, the period of the paroxysms was only marked by a slight cough and a loss of voice; on account of which it was not deemed neces sary to interrupt the quinine. In the be ginning of September the patient began to recover strength and spirits. He now took gradually increased exercise, and his appetite and digestion improved, and his amendment, corporeal and mental, was such as to surprise his friends as well as the doctor. Some months afterwards, he had a relapse of the intermittent, but not of the hypochondriasis, which soon gave way to the sulphate of quinine. He has since remained quite free from his hypochondriacal ailments, and enjoys perfect health-N. Bibliot. Med.

in warm weather. In the hot season of the year, he was teased with sense of distention in the stomach and bowels, loss of appetite, and tedious difficult dis gestion. As the winter approached, these symptoms diminished. He was fond of hunting, and pursued the exercise both in Summer and Winter. He had been subject to the above symptoms for some years previous to the date of report; but they had considerably yielded to time and very trifling means, when, during the Lent of 1824, he determined to live in the most rigid forms of that religious fast, subsisting chiefly on fruit and vegetables. At this time, also, he met with some moral afflictions, and the consequence of both these causes was a state of sombre and morose melancholy. He shunned society -became possessed of the most triste ideas-passed his nights without sleep, or in frightful and troubled dreams. In have maintained that fever has a powerThe author cites several writers, who this state he was, as usual, advised to cheer up enter into society-and make tions. Among others, he quotes Pugol ful influence in checking chronic affechimself happy-things easily said, but and Dumas. There may be some reason not so easily done! In short, this gen- to suspect that, in this case, the same tleman became completely hypochondricause which produced the intermittent acal. In July 1825, he consulted M. Bonnardiere, his morale being considering the affection of the stomach and the may have previously operated in producably improved, but the physique in a very depressed condition. The digestive functions were gradually impaired-he had pain and weakness in his ankles and wrists, with various other unaccountable

ailings. M. B. now administered the cinchona in powder, by which medicine the appetite was restored, and the mind greatly relieved. He entered into society, and began to partake of his usual active exercises. In one of these, he over-exerted himself, and the whole of the dyspeptic symptoms returned, together with the hypochondriasis. On the first days of August, the patient had some febrile movements in the system, and became so weak that he could not walk without the aid of a stick. In fact, a marked intermittent fever was established, and our author, borrowing a hint from Hoffman, determined to let the fever take its course, for some time at least, with the hope that it might cure the hypochondriasis. During this experiment, there appeared some indications of mischief obtaining in the liver, as evinced by pain, tenderness, and some degree of fulness in that region-the strength was rapidly reduced by each paroxysm-and the Doc tor, on the 17th of the above month, considered it unsafe to withhold any lon

symptoms of hypochondriasis. The patient may have inhabited a situation where malaria abounded, and which shows its effects in various other ways be

sides common ague.

the hypochondriasis, in this case, was We suspect that cured rather by the remedy administered for the ague, than by the ague itself. But of this we will leave others to judge, having presented them the naked facts of

the case.

3. GANGRENE OF THE FEET FROM OBSTRUCTED AORTA.

Case. Count C, aged 66 years, of athletic constitution, keen appetite, and a very hearty eater, had always kept himself in a state of plethora, with tendency to cerebral congestions and gastric irritation. From these affections he was usually relieved by sangnineous depletion, especially leechings; but his appetite being too powerful, he was never sufficiently guarded in his diet. In the Autumn of 1826, the Count became subject to an unpleasant sensation of heat

in his feet, particularly when walking, which obliged him, after a promenade, to put his feet on cold marble to allay the heat. In the month of December, of the same year, the patient was seized with acute pain in one of his hams, which was removed by leeches. Next day, the pain settled on the tendo-achillis and neighbourhood, and appeared of a gouty nature, there being some swelling and redness. One evening, after a rather too free dinner, and a glass or two of strong wine, the pain became greatly exasperated, attended with quick pulse and hot skin. Leeches were applied without relief, and an attempt was made to bleed from the arm, but without success. The pain in

creased-delirium came on-with constant jactitation, and screaming. On examining the part, some vesications were seen, and soon afterwards gangrene manifested itself unequivocally. A troublesome hiccup now supervened, and could not be stopped. In the course of a few days the gangrene had invaded the whole of the leg-the patient became comatose-black spots appeared on the other extremity,

and death closed the scene.

bowels, with considerable serous infiltration into the ventricles and between the membranes of the brain.-Broussais' Journal.

had been blind for several years, without Remarks. It appears that the Count any appreciable lesion of the optical apparatus. In the examination of the brain, it was found that the tubercula quadragemina and the optic nerves were not more than one half their natural size. The propensity of the Count to good eating and drinking has been observed. The

state of the stomach accorded with this

propensity. The mucous membrane was in a state of hypertrophy, and presented a remarkable contrast with the state of atrophy in which were found the optic nerves. The obstructions in the aorta, and in other parts of the arterial system, were owing, in M. Broussais' opinion, to a general inflammatory condition of the vascular system. The gangrene of the lower extremities was also, no doubt, the

result of this obstruction to the regular supply of blood to those members.

PERICARDITIS AND HYPERTROPHY OF

THE HEART IN A CHILD.

Dr. Menara has published an interesting case of this kind, showing at how early a period the heart may become enlarged in children.

Dissection. The heart was found enveloped in a thick layer of fat, and intimately adherent to the pericardium 4. throughout. The organ was flaccid, softened in structure, and its cavities dilated. The semilunar valves of the aorta were Ossified, and the vessel itself considerably dilated, especially at its arch. About an inch and a half below the origin of the coeliac artery, the aorta became completely ossified, and its bore almost entirely obliterated. There were only two small passages for the transmission of blood, not more than half a line in diameter each. The iliac arteries were also interrupted, and nearly obliterated in several places The femoral, or rather the inguinal arteries, about the crural arch, were rather dilated, thickened in their coats, and much ossified. Below the crural arch, the left femoral artery was merely thickened, whilst that of the other side was red, and filled with clots of different degrees of consistency. The vessels of the mortified parts participated in the condition of the surrounding soft tissues. The veins of the lower extremities were thickened, and obstructed. There were various marks of inflammation and thickening in the stomach and

Case. A female infant had, from her birth till the age of five months, enjoyed apparent good health. Five of her brothers and sisters had died of cerebral affections. In the beginning of January, the little patient caught cold, which took on a more severe character than usual. On the 12th, her breathing was oppressed, pulse full and hard, skin hot, cough frequent, but moist. She sucked with avidity, but often vomited. 13th. Better in all respects; the chest sonorous throughout. 14th. A strong exacerbation, preceded by a cold stage. The abdomen became distended and tender-cough, attended with oppression and râle. Emollient drink-blister to the arm. Respiration more oppressed than ever. Blister to the other arm. The breathing was wheezy (ralante) in both lungs-and,

15th.

on percussion, there were some dull spots beneath the scapula-pulse 140. These symptoms increased in intensity, and the child died on the 17th.

Dissection. The cranium was more ossified than usual at so early an age, the sutures being firm, and the anterior fontanelle closed. The brain was sound, but very voluminous, as was the spinal

marrow.

The lungs adherent by layers of albuminous concretion, with some serous effusion in the right side. The lower portions of lung were hepatized-the superior portions sound. The mucous membrane of the trachea and bronchia was rather thickened, and the tubes loaded with mucosities. The pericar dium was found distended with gas, and also contained about two ounces of reddish serum. In several places on the internal surface of the pericardium, reflected and non-reflected, there were lay ers of an albuminous secretion, some of them three or four lines in thickness. The pericardium itself was considerably thickened. The heart was one third larger than natural, this increase of size being produced by an inordinate thickness of the parietes of the organ.-Tours

Medical Journal.

Remarks. The Editor of the Journal hazards some speculations on the connexion of the advanced ossification of the skull and developement of the brain, in this child, with the congenital hypertrophy of the heart. It is not impossible that the too vigorous circulation, resulting from this congenital hypertrophy of the central organ, may have had its influence on the cerebral mass and its bony envelopes; but, we were not a little astonished to find the Editor pass over the subject of treatment, in this case, without a single observation. There cannot be a doubt that the child's life was lost for want of depletion. Not a drop of blood was drawn, although the symptoms of thoracic inflammation were as clear as the sun at noon-day, and required the most vigorous system of blood-letting, especially leeching. The congenital bypertrophy was not necessarily fatal; for many people have large hearts through life, without much inconvenience. We trust that the above example will prove a lesson to all practitioners, not to neglect examining the chests of children affected with cough, or other symptom

of inflammatory action. The state of the thoracic organs can be very satisfactorily ascertained in children-much more so, indeed, than in grown people.

5. EPIDEMIC OF GRONINGEN.

By Professor Bakker.

The City of Groningen suffered a dreadful visitation of epidemic fever in the years 1825 and 1826-especially in the latter year, when 2448 men and women fell victims to the reigning malady. Looking geographically at the soil and climate of Holland, intersected as it is by innumerable rivers and canals, and with such a large portion of its surface on a levet with, or even below the level of the sea, one would be led to expect that the inhabitants, crowded as they are, would enjoy a much shorter range of existence than in other countries, as France and England for example. Yet, history proves to us, that the range of life is longer in Holland than in France--and that epidemics are comparatively rare. Thus, in France, it is found that, out of every 38 individuals, one will annually pay the debt of Nature, while in Holland, it is one in 42-in Belgium, one in 48-and in the province of Groningen, where the late mortality prevailed, it is only one in 49 and a half. This seems the more astonishing when we contemplate the many local causes which ordinarily give rise to fevers and other diseases throughout the world. The sources of miasmata must be more numerous in the low countries than in almost any part of the earth; but then, the low temperature of the atmosphere fortunately checks the evolution of these deleterious agents, and thus preserves the inhabitants from a terrible enemy, as nursed under brighter skies and more delightful climates. Every now and then, however, an inundation of the soil or an extraordinary range of atmospheric heat, calls the pestiferous miasma into full activity, and then, as at Walcheren or Groningen, the mortality is terrific.

During the autumn of 1825, mild tertian and quartan fevers were seen in the City of Groningen, which continued to prevail during the Winter, and also in