PHAGEDqNIC SORES: USE OF CHARCOAL
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339 OPERATIONS FOR FRACTURE OF THE SKULL. 1. The operation of trephining the skull is not as often seen in hospital as formerly. Two cases of fracture, with com- pression, have lately occurred in St. Mary’s Hospital ; one was under the care of Haynes Walton, where there was exten- sive compound fracture of the skull, with depression of the left parietal bone. By means of Hey’s saw, rather than by the trephine, large portions of the depressed fragments were re- moved. The young man afterwards made a most remarkable recovery. 2. The second case was under the care of Mr. Spencer Smith. The symptoms of compression were not so well marked. Hey’s saw was also used. The dura mater was separated from the bone all round the fracture. This case also proceeded satisfac- torily. PHAGEDÆNIC SORES: USE OF CHARCOAL. The treatment of phagedsenio sores is always more or less tedious. -We have recently noticed two cases of this nature; one treated by Mr. Adams, very satisfactorily, with an appli- cation we have before noticed-balsam copaiba-a mild and useful stimulant. The other case was a large ulcer on the lower extremity, in a man in one of the beds at St. Bartholomew’s. In addition to the ordinary plan of carrot poultice, charcoal, opium, &c., we observed a contrivance suggested by Dr. Stenhouse-a sort of cage of open wire-work, hanging from the cradle placed over the limb,. and filled with I pieces of well-burned charcoal. When we remember the fatal rapidity with which hospital gangrene, or erysipelas, spreads from one bad case in hospital to others, and then call to mind the undoubted value of charcoal as a deodorant, if not disin- fectant, the plan of Dr. Stenhouse seems a good one. This cage or wire-work, we need only add, is not at all in the way, as it hangs under the bed-clothes. The chief objection to charcoal, in the shape of poultice, seems to be, that " dampness" destroys its power of absorbing noxious gases. TRACHEOTOMY AND LARYNGOTOMY. Various cases of this nature, during the quarter, have inte- rested us more or less; one especially, at Guy’s, where Mr. Cooper Foster, happening to be on the spot when the child was brought in, operated immediately, the foreign body, a plum- stone, at once being ejected. In second instance, at St. Bartho- lomew’s, Mr. Lawrence took occasion to remark on the diffi- culties attending all such cases. Even where the operation is done in the best manner, the foreign body may not be so easily extracted. The right bronchus being larger than the left, and more in a right line with the trachea, he believes, explains why the foreign body is oftener found in this than in the left bronchus, which is smaller, and connected with the trachea more at an angle. Mr. Lawrence cited a case where a child had got a shoemaker’s tack, or small nail, in the trachea, which was not ejected for several weeks after. The case of Mr. Brunel’s child, who swallowed a half-sovereign, was also noticed by Mr. Lawrence; and another, not so fortunate in its results, which he saw in private practice with the late Mr. Aston Key. A man had got a sixpence in his windpipe, or rather right bronchus. The operation of tracheotomy was performed, and a peculiar kind of forceps was tried, but the patient died on the table. A very obstinate case has also been operated on at King’s College Hospital, in which, though the trachea was freely opened, the foreign body remained several days in the larynx. A case has been recently noticed in America, and mentioned at King’s College Hospital, where a coffee-bean re- mained three years and a half in the air-passages, but proved fatal in the end. Tracheotomy seems a preferable operation to laryngotomy in all such cases of foreign body in the windpipe, as the crico-thyroid membrane will not allow an opening large enough for the expulsion of such large bodies as those men- tioned. Tracheotomy has been performed in croup, or rather in a somewhat different disease, not much known in this country-diphtherite-by M. Trousseau, not less than 200 times, and in one hospital in Paris, 216 times, with only forty- seven recoveries. POPULATION STATISTICS IN FRANCE.-From an official document published by the Ministry of Commerce and Agri- culture on the Statistics of France, it appears that there are ’, present for every 100,000 individuals: 105 persons blind, 82 deaf and dumb, 125 insane, 118 goitrous, 125 humpbacked, 25 having lost one or both arms, 32 having lost one or both legs, 62 with club-foot. QUERIES RESPECTING THE VARIOUS FORMS OF PARALYSIS. By MARSHALL HALL. M.D., F.R.S. I CONCLUDE my remarks on Paralysis, for the present, by the following series of questions; they will sufficiently explain the extent and difficulty of the inquiry. In my two former papers I have discussed the term Hemi- plegia, and shown that it must not be regarded as, in every case, one and the same disease. It may be limited in its influence, as in its seat, to the cerehrum; it may be extended in its in- fluence to the spinal marrow, and so constitute cerebral and .spinal paralysis respectively; a fact which explains at once all the supposed discrepancies in regard to the two laws I have established relative to the condition of the irritability of the muscular fibre in paralytic limbs. I have two other remarks to make in regard to hemiplegia. It is, in its evanescent and in its permanent forms, sometimes a result of epilepsy. It is then cerebral or spinal. It is some- times, in this case, complicated with spasm. It is then cer. tainly spinal. Hemiplegia is also sometimes, I believe, the result of spinal lesion. It is apt to complicate paralysis agitans and chronic chorea. It is by no means a simple matter. Pa1’CtplegÎct is not less obscure in some of its relations than hemiplegia. I wish it were as well understood. Paraplegia is sometimes organic, sometimes utterly inorganic in its origin. It sometimes involves the sphincters as well as the limbs. It is sometimes limited to one limb. Nothing is accurately known as to to the condition of the irritability, nutrition, or change in the muscular fibre. ’ Sometimes there is spasm with the paralysis : sometimes the paralysis exists alone. ’ In order that we may obtain an accurate idea of these differ- ences, we should expaiment and observe, as I suggested at the close of my first paper; and then cautiously obsel’Ve in the clinical ward. There is a form of paralysis which I have designated spasmo. paralysis. This spasm is sometimes perfectly symmetric-that is, it is the simple result of the contraction of all the muscles, of the arm and hand, for example, in which the flexors overcome the extensors. It is apt to be augmented during sleep. I think the case generally cerebral paralysis and hemiplegia. The spasm sometimes, on the other hand, induces asvinme- tric contraction, or deformity, and then, whether hecuplegio or otherwise, it is spinal. There is a third form of spasmo -paralysis ; it occurs in para- lysis agitans. I think it is the effect of emotion. It is not quite symmetric, and it is, like the other symptoms of para- lysis agitans, diminished during sleep. There is a state the very opposite to spasmo-paralysis. I have already alluded to it in my first paper. It consists in perfect flaccidity of the muscles. This condition exists in hemiplegia. It is, I think, the result of shock, and presents an example of hemiplegic spinal para- lysis. One such case, which I examined in the St. Marylebone Infirmary, in 1854, was of this kind. I have seen two cases, in which, without any complication of head affection, or affection of the other limbs, the anns hang down from the shoulder-joints, like two pendulums. The patient jerked his shoulders forwards when he wished to ad- vance his hands, which were not absolutely paralysed. There is a form of malady which 1 can only call paralysis, and which is specially emotional. The patient, on the slightest occasion, and without any sufficient reason, bursts into laughter, or still more frequently, into tears. What is the seat of this affection in the nervous centres ? And, what is the nature and seat of Paralysis Agitans? What is the nature and seat of paralysis from lead, (a form of spinal paralysis), and of mercury, and of alcohol ? I have twice during the past two days seen cases of general paralysis. It was indubitably cerebral. Are such case? spinal too, or is there a case cf spinal paralysis uncomplicatcd with cerebral affection ? My readers will be fatigued with my inquiries, which I mean as suggestions ; suggestions for the future true physician, for the investigator is alone such, and worthy of the exalted name and office. I must add still one more form of paralysis. It is the topical. This is best studied amongst the nerves, organs, and muscles of the face. Hemiplegia of the face is generally a case of cere.
Transcript of PHAGEDqNIC SORES: USE OF CHARCOAL
339
OPERATIONS FOR FRACTURE OF THE SKULL.
1. The operation of trephining the skull is not as oftenseen in hospital as formerly. Two cases of fracture, with com-pression, have lately occurred in St. Mary’s Hospital ; one wasunder the care of Haynes Walton, where there was exten-sive compound fracture of the skull, with depression of the leftparietal bone. By means of Hey’s saw, rather than by thetrephine, large portions of the depressed fragments were re-moved. The young man afterwards made a most remarkablerecovery.
2. The second case was under the care of Mr. Spencer Smith.The symptoms of compression were not so well marked. Hey’ssaw was also used. The dura mater was separated from thebone all round the fracture. This case also proceeded satisfac-torily.
PHAGEDÆNIC SORES: USE OF CHARCOAL.
The treatment of phagedsenio sores is always more or lesstedious. -We have recently noticed two cases of this nature;one treated by Mr. Adams, very satisfactorily, with an appli-cation we have before noticed-balsam copaiba-a mildand useful stimulant. The other case was a large ulceron the lower extremity, in a man in one of the beds at St.Bartholomew’s. In addition to the ordinary plan of carrotpoultice, charcoal, opium, &c., we observed a contrivancesuggested by Dr. Stenhouse-a sort of cage of open wire-work,hanging from the cradle placed over the limb,. and filled with Ipieces of well-burned charcoal. When we remember the fatal
rapidity with which hospital gangrene, or erysipelas, spreadsfrom one bad case in hospital to others, and then call to mindthe undoubted value of charcoal as a deodorant, if not disin-fectant, the plan of Dr. Stenhouse seems a good one. Thiscage or wire-work, we need only add, is not at all in the way,as it hangs under the bed-clothes. The chief objection tocharcoal, in the shape of poultice, seems to be, that " dampness"destroys its power of absorbing noxious gases.
TRACHEOTOMY AND LARYNGOTOMY.
Various cases of this nature, during the quarter, have inte-rested us more or less; one especially, at Guy’s, where Mr.Cooper Foster, happening to be on the spot when the child wasbrought in, operated immediately, the foreign body, a plum-stone, at once being ejected. In second instance, at St. Bartho-lomew’s, Mr. Lawrence took occasion to remark on the diffi-culties attending all such cases. Even where the operation isdone in the best manner, the foreign body may not be so easilyextracted. The right bronchus being larger than the left, andmore in a right line with the trachea, he believes, explains whythe foreign body is oftener found in this than in the leftbronchus, which is smaller, and connected with the tracheamore at an angle. Mr. Lawrence cited a case where a childhad got a shoemaker’s tack, or small nail, in the trachea, whichwas not ejected for several weeks after. The case of Mr.Brunel’s child, who swallowed a half-sovereign, was also noticedby Mr. Lawrence; and another, not so fortunate in its results,which he saw in private practice with the late Mr. Aston Key.A man had got a sixpence in his windpipe, or rather rightbronchus. The operation of tracheotomy was performed, anda peculiar kind of forceps was tried, but the patient died onthe table. A very obstinate case has also been operated on atKing’s College Hospital, in which, though the trachea wasfreely opened, the foreign body remained several days in thelarynx. A case has been recently noticed in America, andmentioned at King’s College Hospital, where a coffee-bean re-mained three years and a half in the air-passages, but provedfatal in the end. Tracheotomy seems a preferable operation tolaryngotomy in all such cases of foreign body in the windpipe,as the crico-thyroid membrane will not allow an opening largeenough for the expulsion of such large bodies as those men-tioned. Tracheotomy has been performed in croup, or ratherin a somewhat different disease, not much known in this
country-diphtherite-by M. Trousseau, not less than 200times, and in one hospital in Paris, 216 times, with only forty-seven recoveries.
POPULATION STATISTICS IN FRANCE.-From an officialdocument published by the Ministry of Commerce and Agri-culture on the Statistics of France, it appears that there are ’,present for every 100,000 individuals: 105 persons blind, 82deaf and dumb, 125 insane, 118 goitrous, 125 humpbacked,25 having lost one or both arms, 32 having lost one or bothlegs, 62 with club-foot.
QUERIES RESPECTING THE VARIOUSFORMS OF PARALYSIS.
By MARSHALL HALL. M.D., F.R.S.
I CONCLUDE my remarks on Paralysis, for the present, by thefollowing series of questions; they will sufficiently explain theextent and difficulty of the inquiry.
In my two former papers I have discussed the term Hemi-plegia, and shown that it must not be regarded as, in every case,one and the same disease. It may be limited in its influence,as in its seat, to the cerehrum; it may be extended in its in-fluence to the spinal marrow, and so constitute cerebral and.spinal paralysis respectively; a fact which explains at once allthe supposed discrepancies in regard to the two laws I haveestablished relative to the condition of the irritability of themuscular fibre in paralytic limbs.
I have two other remarks to make in regard to hemiplegia.It is, in its evanescent and in its permanent forms, sometimesa result of epilepsy. It is then cerebral or spinal. It is some-times, in this case, complicated with spasm. It is then cer.tainly spinal.Hemiplegia is also sometimes, I believe, the result of spinal
lesion. It is apt to complicate paralysis agitans and chronicchorea.
It is by no means a simple matter.Pa1’CtplegÎct is not less obscure in some of its relations than
hemiplegia. I wish it were as well understood.Paraplegia is sometimes organic, sometimes utterly inorganic
in its origin.It sometimes involves the sphincters as well as the limbs.
It is sometimes limited to one limb. Nothing is accuratelyknown as to to the condition of the irritability, nutrition, orchange in the muscular fibre.’ Sometimes there is spasm with the paralysis : sometimes theparalysis exists alone.’ In order that we may obtain an accurate idea of these differ-ences, we should expaiment and observe, as I suggested at theclose of my first paper; and then cautiously obsel’Ve in theclinical ward.There is a form of paralysis which I have designated spasmo.
paralysis.This spasm is sometimes perfectly symmetric-that is, it is
the simple result of the contraction of all the muscles, of thearm and hand, for example, in which the flexors overcome theextensors. It is apt to be augmented during sleep. I thinkthe case generally cerebral paralysis and hemiplegia.The spasm sometimes, on the other hand, induces asvinme-
tric contraction, or deformity, and then, whether hecuplegioor otherwise, it is spinal.There is a third form of spasmo -paralysis ; it occurs in para-
lysis agitans. I think it is the effect of emotion. It is notquite symmetric, and it is, like the other symptoms of para-lysis agitans, diminished during sleep.
There is a state the very opposite to spasmo-paralysis. Ihave already alluded to it in my first paper. It consists inperfect flaccidity of the muscles.
This condition exists in hemiplegia. It is, I think, the resultof shock, and presents an example of hemiplegic spinal para-lysis. One such case, which I examined in the St. MaryleboneInfirmary, in 1854, was of this kind.
I have seen two cases, in which, without any complicationof head affection, or affection of the other limbs, the anns hangdown from the shoulder-joints, like two pendulums. The
patient jerked his shoulders forwards when he wished to ad-vance his hands, which were not absolutely paralysed.There is a form of malady which 1 can only call paralysis,
and which is specially emotional. The patient, on the slightestoccasion, and without any sufficient reason, bursts into laughter,or still more frequently, into tears. What is the seat of thisaffection in the nervous centres ?And, what is the nature and seat of Paralysis Agitans?What is the nature and seat of paralysis from lead, (a form
of spinal paralysis), and of mercury, and of alcohol ?I have twice during the past two days seen cases of general
paralysis. It was indubitably cerebral. Are such case? spinaltoo, or is there a case cf spinal paralysis uncomplicatcd withcerebral affection ?
My readers will be fatigued with my inquiries, which I meanas suggestions ; suggestions for the future true physician, forthe investigator is alone such, and worthy of the exalted nameand office.
I must add still one more form of paralysis. It is the topical.This is best studied amongst the nerves, organs, and musclesof the face. Hemiplegia of the face is generally a case of cere.
