NORTH LONDON MEDICAL SOCIETY. WEDNESDAY, MARCH 11TH, 1857
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350 cessive morbid secretions ; 2ndly, as an antidote to organic poisons ; 3rdly, an antidote to, and eliminant of, inorganic poisons. With regard to the first class the author stated that although the iodide might be shown to act mainly as a diuretic, it could not be placed in the same category as those agents which operated solely by promoting copious secretions, as the amount of fluid discharged in consequence of its exhibition, did not always bear a definite ratio to the intensity of the disease, and the quantity of the morbid accumulation in one of the cavities. While acting as an eliminant, it also appeared to correct the morbid condition of the blood and the vascular system, which previously induced the disease. In illustration of the more extensively eliminant action of iodide of potassium, Dr. Sieveking brought forward a case of hydrothorax, of an aggravated character, in which the speedy cure appeared to be exclusively due to the salt in question. The author also re- ferred to the eliminative power which iodide of potassium ap- peared to exert uponhsemorrhagic effusions in the brain. Under the second head, Dr. Sieveking spoke of the action of iodide of potassium in counteracting and removing the organic poisons which appeared to constitute the materies morbi in numerous diseases. He adverted to syphilis in its different forms, to various scaly and other forms of skin disease, and brought forward cases in illustration; cases which, however, he admitted to be incomplete as proofs on account of the iodine not having been the sole remedy administered. He urged that the conviction which a multitude of small experiences wrought in the mind of a practitioner could with difficulty be illustrated by solitary instances of so complicated a character as many of the diseases were which might be classed under the second head. Under the third head the author explained his views with regard to the action of iodide of potassium in the cure of the various affections resulting from metallic poisoning. Cases of lead-poisoning were brought forward and a well-marked case of mercurial poisoning was also quoted, in illustration of the value of the iodide in such cases. Dr. Sieveking adverted to the importance of a correct diagnosis in cases of lead-poisoning; as symptoms which otherwise might induce a most unfavour- able prognosis, would, when regarded as the result of saturnine intoxication, justify a much more favourable view. The diffi- culties attending the detection of lead in the urine, where it was manifestly being eliminated from the system, were adverted to, and it was suggested that probably, at times, some, if not all, of the lead was evacuated by the intestinal canal. Dr. Sieveking concluded by observing that he had by no means alluded to all the various forms of disease which called for the exhibition of the iodide of potassium, but that he had merely desired to submit for the consideration of the Society some of the opinions which practical experience had induced him to form relative to the drug, and to extract from the stores of observation of the members, further illustrations in regard to its uses and effects. NORTH LONDON MEDICAL SOCIETY. WEDNESDAY, MARCH 11TH, 1857. DR. JENNER, PRESIDENT, IN THE CHAIR. MR. LORD read a paper on the INSIDIOUS APPROACH OF DISEASE; and noticed forcibly the little power which could be exercised over chronic disease as a motive for aiming to arrest early in- dications of illness, and to remove the remnants of acute disease, which so frequently pave the way to irreparable mis- chief. He argued that, although the application of remedies to the cure of disease was the obvious duty of the medical practitioner, it was his more sacred duty to aim at preventing all disease; and urged a far wider range of preventive medicine than that embraced in dramage, ventilation, and water supply, arguing that longevity is man’s natural right on earth, and that nature’s law in this respect is "health till death through ripe old age." Mr. Lord reprobated the wide doctrine of hereditary disease, observing that in few cases, except in direct contamination in utero, as through small-pox, lues, &c. &c., can more than the tendency to disease be established. This tendency should be eradicated or controlled by judicious care and management. In respect to acquired disease, particularly subacute, the author showed that every state of mere anemia demanded vigilant care and discriminating succour, since what are called trifles often mark the advent of malignant disease and premature degeneration. Under the idea of "mere de- I bility," no efforts are made to arrest incipient change of struc- ture or impurity of blood. The humoral pathologists were to be highly regarded, since more disease and needless death occurs through vitiated blood than from any other agency; that this dyscrasia should be prevented from a crisis in gout or rheumatism, in anthrax or pyaemia; that even phthisis pul- monalis, insidiously approaching through diminished vital action in the air-cells, may be foiled, as is contended for by Dr. E. Smith, before tubercular deposit has taken place; that through simple chronic dyspepsia and imperfect sanguification, or fxcal fermentation, factories of blood-poison from within, equally with others from without, the body, engender and cir- culate their deadly products over the brain and nervous centres, giving rise to cancer, blastema, and other such-like malignities. Diabetes, "Bright’s disease," and that of the supra-renal cap- sules, were given as instances of the treacherous advance and hopeless character of confirmed disease. Of these, as of fatty degeneration and atrophy, it was of small value to be only able to say, with Mr. Paget, " the explanation probably lies far among the mysteries of the chemical physiology of nutrition." Mr. Lord noticed the approach of morbid conditions of the nervous system, quite distinct from recognised organic lesion, which creep on most insidiously, such as the "petit mal" of epileptiform character, chorea, and insanity. The opinion of Dr. Forbes Winslow, who referred insanity " in all cases to some lesion or disturbance of the medullary matter," was con- trasted with that of Dr. Burnett, who regarded the blood as the seat of the disorder. Finally, that in respect of mental diseases, as in most others more essentially physical, a timely caution could avert, or quite prevent, if, as was said by Dr. Currie in 1797, ’’ we could rely as much on the wisdom as on the power of our species." Provincial Hospital Reports. GATESHEAD DISPENSARY. CASES UNDER THE CARE OF T. W. CRASTER, ESQ., M.R.C.S.E. & L.S.A.E., LATE LECTURER ON CHEMISTRY AND M.ATER1A MEDICA AT THE COLLEGE OF PRACTICAL SCIENCE, NLW- CASTLE. CASE OF MALPRESENTATION. ABOUT three months ago, I was called in to visit a married woman, about thirty years of age. On my arrival, I found that she had been in labour for three days, the case being under the care of a midwife. The pains had been regular and tolerably energetic throughout, the membranes ruptured the previous evening, and the liquor amnii completely evacuated. The patient was considerably exhausted, and the pains had undergone a marked change, having become much weaker, and not so frequent. On examination, I found the umbilical cord in the vagina, with two arms and one foot presenting; the head of the child could be distinctly felt. Both arms and the right foot were completely impacted with the head in the pelvis,, so as to render it impracticable to bring down the foot or feet in order to convert it into a foot presentation. The midwife, who had attended the case for two days, was perfectly ignorant of the dangerous nature of the presentation. Mr. Featherstonhaugh, one of the surgical staff of the dis- pensary, was called in to assist in the delivery, and by our united efforts we succeeded in effecting the delivery of a still- born male child. The plan resorted to consisted in securing the foot by means of a bandage attached to the ankle by a clove hitch-knot. Steady and continued traction was used, but turning was not effected, until the head of the child was steadily pressed upwards by the hand, in order to allow the breech to descend. The placenta came away almost immediately afterwards, and the case subsequently did well. This case illustrates the necessity of manual interference at the outset of the labour, and forcibly demonstrates the difficulty sometimes encountered in displacing the head when completely impacted in the pelvis. FOREIGN BODY POUND IN A BULLOCKS HEART AFTER DEATH. From time to time, we hear of remarkable cases of foreign bodies traversing many parts of the animal economy, being afterwards found in peculiar situations, and frequently causing little or no inconvenience during life. This case in point presents an example of this description. A few months ago, a stout, healthy bullock was slaughtered by a butcher residing in this town. On removing the thoraic viscera, a pack pin,
Transcript of NORTH LONDON MEDICAL SOCIETY. WEDNESDAY, MARCH 11TH, 1857
350
cessive morbid secretions ; 2ndly, as an antidote to organicpoisons ; 3rdly, an antidote to, and eliminant of, inorganicpoisons. With regard to the first class the author stated thatalthough the iodide might be shown to act mainly as a diuretic,it could not be placed in the same category as those agentswhich operated solely by promoting copious secretions, as theamount of fluid discharged in consequence of its exhibition, didnot always bear a definite ratio to the intensity of the disease,and the quantity of the morbid accumulation in one of thecavities. While acting as an eliminant, it also appeared tocorrect the morbid condition of the blood and the vascularsystem, which previously induced the disease. In illustrationof the more extensively eliminant action of iodide of potassium,Dr. Sieveking brought forward a case of hydrothorax, of anaggravated character, in which the speedy cure appeared to beexclusively due to the salt in question. The author also re-ferred to the eliminative power which iodide of potassium ap-peared to exert uponhsemorrhagic effusions in the brain.Under the second head, Dr. Sieveking spoke of the action of
iodide of potassium in counteracting and removing the organicpoisons which appeared to constitute the materies morbi innumerous diseases. He adverted to syphilis in its differentforms, to various scaly and other forms of skin disease, andbrought forward cases in illustration; cases which, however,he admitted to be incomplete as proofs on account of the iodinenot having been the sole remedy administered. He urged thatthe conviction which a multitude of small experiences wroughtin the mind of a practitioner could with difficulty be illustratedby solitary instances of so complicated a character as many ofthe diseases were which might be classed under the secondhead.Under the third head the author explained his views with
regard to the action of iodide of potassium in the cure of thevarious affections resulting from metallic poisoning. Cases of
lead-poisoning were brought forward and a well-marked caseof mercurial poisoning was also quoted, in illustration of thevalue of the iodide in such cases. Dr. Sieveking adverted tothe importance of a correct diagnosis in cases of lead-poisoning;as symptoms which otherwise might induce a most unfavour-able prognosis, would, when regarded as the result of saturnineintoxication, justify a much more favourable view. The diffi-culties attending the detection of lead in the urine, where itwas manifestly being eliminated from the system, were advertedto, and it was suggested that probably, at times, some, if notall, of the lead was evacuated by the intestinal canal.
Dr. Sieveking concluded by observing that he had by nomeans alluded to all the various forms of disease which calledfor the exhibition of the iodide of potassium, but that he hadmerely desired to submit for the consideration of the Societysome of the opinions which practical experience had inducedhim to form relative to the drug, and to extract from the storesof observation of the members, further illustrations in regard toits uses and effects.
NORTH LONDON MEDICAL SOCIETY.
WEDNESDAY, MARCH 11TH, 1857.
DR. JENNER, PRESIDENT, IN THE CHAIR.
MR. LORD read a paper on the
INSIDIOUS APPROACH OF DISEASE;and noticed forcibly the little power which could be exercisedover chronic disease as a motive for aiming to arrest early in-dications of illness, and to remove the remnants of acutedisease, which so frequently pave the way to irreparable mis-chief. He argued that, although the application of remediesto the cure of disease was the obvious duty of the medicalpractitioner, it was his more sacred duty to aim at preventingall disease; and urged a far wider range of preventive medicinethan that embraced in dramage, ventilation, and water supply,arguing that longevity is man’s natural right on earth, andthat nature’s law in this respect is "health till death throughripe old age." Mr. Lord reprobated the wide doctrine of
hereditary disease, observing that in few cases, except in directcontamination in utero, as through small-pox, lues, &c. &c.,can more than the tendency to disease be established. This
tendency should be eradicated or controlled by judicious careand management. In respect to acquired disease, particularlysubacute, the author showed that every state of mere anemiademanded vigilant care and discriminating succour, since whatare called trifles often mark the advent of malignant diseaseand premature degeneration. Under the idea of "mere de- Ibility," no efforts are made to arrest incipient change of struc-
ture or impurity of blood. The humoral pathologists were tobe highly regarded, since more disease and needless deathoccurs through vitiated blood than from any other agency; thatthis dyscrasia should be prevented from a crisis in gout orrheumatism, in anthrax or pyaemia; that even phthisis pul-monalis, insidiously approaching through diminished vital actionin the air-cells, may be foiled, as is contended for by Dr. E.Smith, before tubercular deposit has taken place; that throughsimple chronic dyspepsia and imperfect sanguification, or
fxcal fermentation, factories of blood-poison from within,equally with others from without, the body, engender and cir-culate their deadly products over the brain and nervous centres,giving rise to cancer, blastema, and other such-like malignities.Diabetes, "Bright’s disease," and that of the supra-renal cap-sules, were given as instances of the treacherous advance andhopeless character of confirmed disease. Of these, as of fattydegeneration and atrophy, it was of small value to be only ableto say, with Mr. Paget, " the explanation probably lies faramong the mysteries of the chemical physiology of nutrition."Mr. Lord noticed the approach of morbid conditions of thenervous system, quite distinct from recognised organic lesion,which creep on most insidiously, such as the "petit mal" ofepileptiform character, chorea, and insanity. The opinion ofDr. Forbes Winslow, who referred insanity " in all cases tosome lesion or disturbance of the medullary matter," was con-trasted with that of Dr. Burnett, who regarded the blood asthe seat of the disorder. Finally, that in respect of mentaldiseases, as in most others more essentially physical, a timelycaution could avert, or quite prevent, if, as was said by Dr.Currie in 1797, ’’ we could rely as much on the wisdom as onthe power of our species."
Provincial Hospital Reports.GATESHEAD DISPENSARY.
CASES UNDER THE CARE OF T. W. CRASTER, ESQ., M.R.C.S.E.& L.S.A.E., LATE LECTURER ON CHEMISTRY AND M.ATER1AMEDICA AT THE COLLEGE OF PRACTICAL SCIENCE, NLW-CASTLE.
CASE OF MALPRESENTATION.
ABOUT three months ago, I was called in to visit a marriedwoman, about thirty years of age. On my arrival, I foundthat she had been in labour for three days, the case beingunder the care of a midwife. The pains had been regular andtolerably energetic throughout, the membranes ruptured theprevious evening, and the liquor amnii completely evacuated.The patient was considerably exhausted, and the pains hadundergone a marked change, having become much weaker, andnot so frequent.On examination, I found the umbilical cord in the vagina,
with two arms and one foot presenting; the head of the childcould be distinctly felt. Both arms and the right foot werecompletely impacted with the head in the pelvis,, so as torender it impracticable to bring down the foot or feet in orderto convert it into a foot presentation.The midwife, who had attended the case for two days, was
perfectly ignorant of the dangerous nature of the presentation.Mr. Featherstonhaugh, one of the surgical staff of the dis-pensary, was called in to assist in the delivery, and by ourunited efforts we succeeded in effecting the delivery of a still-born male child.The plan resorted to consisted in securing the foot by means
of a bandage attached to the ankle by a clove hitch-knot.Steady and continued traction was used, but turning was noteffected, until the head of the child was steadily pressedupwards by the hand, in order to allow the breech to descend.The placenta came away almost immediately afterwards, andthe case subsequently did well.
This case illustrates the necessity of manual interference atthe outset of the labour, and forcibly demonstrates the difficultysometimes encountered in displacing the head when completelyimpacted in the pelvis.FOREIGN BODY POUND IN A BULLOCKS HEART AFTER DEATH.
From time to time, we hear of remarkable cases of foreignbodies traversing many parts of the animal economy, beingafterwards found in peculiar situations, and frequently causinglittle or no inconvenience during life. This case in pointpresents an example of this description. A few months ago,a stout, healthy bullock was slaughtered by a butcher residingin this town. On removing the thoraic viscera, a pack pin,
