WESTERN MEDICAL AND SURGICAL SOCIETY.
1
37 Over a small space near the lower angle of the left scapula a sound could be heard, of which it was difficult to determine whether the correct designation were subcrepitation or click. Dr. Andrew Clark, who also obligingly examined the expec- toration, reported that it contained shrivelled cells, large cells with shrivelled nuclei, and some earthy matter, and, without receiving any history of the case, offered the diagnosis of "Slight tubercular deposit, tending to restoration:" a diagnosis which was confirmed by the result. Thirdly: Dr. Thompson described some favourable indica- tions afforded by the microscope concurrently with ameliora- tion in the general condition. CASE 5.-Mr. -, aged twenty-two (introduced by Mr. Pinching of Gravesend), five feet nine inches in height, in the summer of 1854 had dull percussion and a murmur over the left pulmonary artery, but no crackle or click; the expectora- tion, however, exhibited lung tissue, tubercle corpuscles, and blood-discs. He took cod-liver oil freely, at one period to the extent of a pint and a half in a week; and had ioduretted neat’s-foot oil (a grain to the ounce) rubbed into the chest. After a time the expectoration became chiefly bronchial, dis- posed to fibrillate, and free from lung tissue. The weight of this patient increased from ten stone one pound to eleven stone nine pounds. He spent last winter in Madeira. Fourthly: the author noticed the important evidence some- times derivable from the sputum, indicative of rapidity in the progress of disease. CASE 6.-A lady in the country, aged forty-three, who had been for two years the subject of phthisis, but whose friends did not fully realise the danger, had a decided aggravation of cough and weakness. Some expectoration, sent to town for examination, contained blood, copious pus corpuscles, and numerous large meshes of pulmonary tissue, perfectly retaining their form and elasticity. A very unfavourable prognosis was consequently given, which was verified by the death of the patient a few days afterwards. The author, in conclusion, ventured to express the opinion that his statements, although brief, were sufficient to support his proposition, that the microscopical inspection of expectora- tion might often afford, at a very early period of consumption, definite information, not otherwise attainable, regarding the nature of the malady; that in later stages of disease it might assist us to estimate the rapidity and progress, and at all times might furnish valuable aid in forming a correct prognosis regarding the course of the complaint. He trusted these few suggestions would stimulate to the investigation some of his professional brethren more accomplished in the use of the microscope, or more fortunate in the enjoyment of leisure. WESTERN MEDICAL AND SURGICAL SOCIETY. MR. LANE, PRESIDENT, IN THE CHAIR. MR. MILTON read a paper ON THE TREATMENT OF COMPLICATED GONOORRHEA. The author divided his paper into three heads: 1. A brief review of the treatment best adapted for simple gonorrhoea, and those complications which do not delay its cure, such as chordee, painful erections, irritable bladder, swelled testicle. II. A brief enumeration of those symptoms which really complicate gonorrhoea, and interfere with the exhibition of remedies. III. The treatment of these. They are,- ’ 1. Excessive tendency to faint, so marked as to constitute quite an idiosyncrasy, the mere insertion of the tip of the syringe producing immediate syncope. Contrary to what might be expected, this symptom often showed itself in persons who rather prided themselves on their physical development. It did not necessarily interfere with the use of injections, which could easily be given, with the patient in a sitting posture. 2. Great natural, or induced weakness, the former being attended with sickness and headache, utter disgust for all medi- cines, languor, and costiveness; a very similar state, but accom- panied rather by wasting turbidity of the urine, eructations, &c., was sometimes induced by the prolonged use of copaiba. Both forms were best treated with active purgatives and qui- nine, injections being continued as usual. A moderately tonic diet, with a little wine, generally agreed with these patients. 3. Tendency to inflammation of the lacunae of the urethra; excessive sensibility of this canal, and strong disposition to- stricture. Inflammation of the lacunae rarely ensued if the case was treated with the acetate of potass; but if it had occurred before the surgeon was consulted, it was to be treated with a blister, frictions with blue ointment, saline aperients, and blue pill for the first few days, and the subsequent use of quinine or liquor potassse in some bitter infusion, as cascarilla or serpentary. This treatment had succeeded with patients who had always suffered severely from this complication in previous gonorrheeas. Excessive tenderness of the urethra was generally soon over- come if the injections were given very weak the first day or two; they might even consist solely of warm water till the potass had begun to act, and a sedative might be given every night. Strong tendency to stricture-i. e., when the canal began to contract within a week or two from commencing the treatment-had only occurred in three patients treated with potass, one of whom did his best to aid it by high living; in five cases it appeared to have followed the use of injections of chloride of zinc. Nitrate of silver, applied with Mr. Milton’s armed bougie, was generally effective. 4. Excessive irritability of the bladder or rectum. The first of these, generally dependent on extension of this disorder to the cavity of the viscus, required sedatives, tonics, and brisk purgatives. To remove the discharge, the author advised in- jections, with the long syringe exhibited. The similar affec- tion of the rectum was sometimes removed by using a strip of calico soaked in solution ’of nitrate of silver, as the irregular distension of the urethra by fluid seemed to bring the irrita- bility on. 5. Perinaeal abscess. An obstinate complication, which anti- phlogistic treatment often failed to subdue. Stricture, and a very irregular form of the canal had, in two instances, ensued. The treatment should be energetic, and not relaxed till the swelling was absorbed. Antimony in large doses, iodide of potass, and blisters, &c. 6. Inflammation of the prostate required to be treated in the same way as perinseal abscess. Leeches, however, were occa- sionally useful. In both cases injections might be continued.’ 7. Rheumatism and ophthalmia. The most formidable of all its complications. Mr. Milton objected to this being called a constitutional effect of gonorrhoea. The animal life might sympathize with the affection of the generative organs; it might participate in the disease. The structures of organic life (the constitution) neither sympathized with, nor partici- pated in, the disorder. He recommended the treatment of Mr. Lawrence--unsparing use of purgatives and colchicum, followed by the iodide of potassium. Reviews and Notices of Books. The Elements of Materia Medica and Therapeutics. By JONATHAN PEREIRA, M.D., F.R.S. and L.S., &c., &C. Fourth edition, enlarged and improved. Vol. II., Part 2. pp. 880. London: Longman & Co., 1857. THE appearance of the nearly 900 pages before us, consti- tuting the second revision of that portion of Dr. Pereira’s great work left unfinished (as regards its third edition) when he died, completes the fourth issue of the " Encyclopa?dia of Materia Medica." On the first publication of this portion of it, under the new joint editorship in 1853, we felt it our duty (THE LANCET, vol. i. 1854, p. 44) to animadvert on the r;;1,ther loose and unsatisfactory manner in which the important service en- trusted to such well-known names had been performed. We are happy to have it in our power now to say the same editors have greatly improved, and have given evidence of such labour and interest in their work as to make us regret we were de- prived of similar testimony on the appearance of the previous edition. The articles on Chloroform and Cod-liver Oil have been re-written, and several additions have been made to the history of the alkaloidal principles, some of which are for the first time described in the present volume. In illustration of these remarks, we may refer to the notices of conia, cotarnine (a product of the decomposition of narcotine), opianine, opianic acid, papaverine, helleborine, aconitine, berberine, &c. Short accounts of "amylene" and pepsin will also be met with. " To the pharmaceutical compounds described in the previous editions, many new preparations have been added from the
Transcript of WESTERN MEDICAL AND SURGICAL SOCIETY.
37
Over a small space near the lower angle of the left scapula asound could be heard, of which it was difficult to determinewhether the correct designation were subcrepitation or click.Dr. Andrew Clark, who also obligingly examined the expec-toration, reported that it contained shrivelled cells, large cellswith shrivelled nuclei, and some earthy matter, and, withoutreceiving any history of the case, offered the diagnosis of
"Slight tubercular deposit, tending to restoration:" a diagnosiswhich was confirmed by the result.Thirdly: Dr. Thompson described some favourable indica-
tions afforded by the microscope concurrently with ameliora-tion in the general condition.CASE 5.-Mr. -, aged twenty-two (introduced by Mr.
Pinching of Gravesend), five feet nine inches in height, in thesummer of 1854 had dull percussion and a murmur over theleft pulmonary artery, but no crackle or click; the expectora-tion, however, exhibited lung tissue, tubercle corpuscles, andblood-discs. He took cod-liver oil freely, at one period to theextent of a pint and a half in a week; and had iodurettedneat’s-foot oil (a grain to the ounce) rubbed into the chest.After a time the expectoration became chiefly bronchial, dis-posed to fibrillate, and free from lung tissue. The weight ofthis patient increased from ten stone one pound to eleven stonenine pounds. He spent last winter in Madeira.Fourthly: the author noticed the important evidence some-
times derivable from the sputum, indicative of rapidity in theprogress of disease.CASE 6.-A lady in the country, aged forty-three, who had
been for two years the subject of phthisis, but whose friendsdid not fully realise the danger, had a decided aggravation ofcough and weakness. Some expectoration, sent to town forexamination, contained blood, copious pus corpuscles, andnumerous large meshes of pulmonary tissue, perfectly retainingtheir form and elasticity. A very unfavourable prognosis wasconsequently given, which was verified by the death of thepatient a few days afterwards.The author, in conclusion, ventured to express the opinion
that his statements, although brief, were sufficient to supporthis proposition, that the microscopical inspection of expectora-tion might often afford, at a very early period of consumption,definite information, not otherwise attainable, regarding thenature of the malady; that in later stages of disease it mightassist us to estimate the rapidity and progress, and at alltimes might furnish valuable aid in forming a correct prognosisregarding the course of the complaint. He trusted these fewsuggestions would stimulate to the investigation some of hisprofessional brethren more accomplished in the use of themicroscope, or more fortunate in the enjoyment of leisure.
WESTERN MEDICAL AND SURGICAL SOCIETY.MR. LANE, PRESIDENT, IN THE CHAIR.
MR. MILTON read a paperON THE TREATMENT OF COMPLICATED GONOORRHEA.
The author divided his paper into three heads:1. A brief review of the treatment best adapted for simple
gonorrhoea, and those complications which do not delay itscure, such as chordee, painful erections, irritable bladder,swelled testicle.
II. A brief enumeration of those symptoms which reallycomplicate gonorrhoea, and interfere with the exhibition ofremedies.
III. The treatment of these. They are,-’
1. Excessive tendency to faint, so marked as to constitutequite an idiosyncrasy, the mere insertion of the tip of thesyringe producing immediate syncope. Contrary to what mightbe expected, this symptom often showed itself in persons whorather prided themselves on their physical development. Itdid not necessarily interfere with the use of injections, whichcould easily be given, with the patient in a sitting posture.
2. Great natural, or induced weakness, the former beingattended with sickness and headache, utter disgust for all medi-cines, languor, and costiveness; a very similar state, but accom-panied rather by wasting turbidity of the urine, eructations,&c., was sometimes induced by the prolonged use of copaiba.Both forms were best treated with active purgatives and qui-nine, injections being continued as usual. A moderately tonicdiet, with a little wine, generally agreed with these patients.
3. Tendency to inflammation of the lacunae of the urethra;excessive sensibility of this canal, and strong disposition to-
stricture. Inflammation of the lacunae rarely ensued if the casewas treated with the acetate of potass; but if it had occurredbefore the surgeon was consulted, it was to be treated with ablister, frictions with blue ointment, saline aperients, and bluepill for the first few days, and the subsequent use of quinine orliquor potassse in some bitter infusion, as cascarilla or serpentary.This treatment had succeeded with patients who had alwayssuffered severely from this complication in previous gonorrheeas.Excessive tenderness of the urethra was generally soon over-come if the injections were given very weak the first day ortwo; they might even consist solely of warm water till thepotass had begun to act, and a sedative might be given everynight. Strong tendency to stricture-i. e., when the canalbegan to contract within a week or two from commencing thetreatment-had only occurred in three patients treated withpotass, one of whom did his best to aid it by high living; infive cases it appeared to have followed the use of injections ofchloride of zinc. Nitrate of silver, applied with Mr. Milton’sarmed bougie, was generally effective.
4. Excessive irritability of the bladder or rectum. The firstof these, generally dependent on extension of this disorder tothe cavity of the viscus, required sedatives, tonics, and briskpurgatives. To remove the discharge, the author advised in-jections, with the long syringe exhibited. The similar affec-tion of the rectum was sometimes removed by using a strip ofcalico soaked in solution ’of nitrate of silver, as the irregulardistension of the urethra by fluid seemed to bring the irrita-bility on.
5. Perinaeal abscess. An obstinate complication, which anti-phlogistic treatment often failed to subdue. Stricture, and avery irregular form of the canal had, in two instances, ensued.The treatment should be energetic, and not relaxed till theswelling was absorbed. Antimony in large doses, iodide ofpotass, and blisters, &c.
6. Inflammation of the prostate required to be treated in thesame way as perinseal abscess. Leeches, however, were occa-sionally useful. In both cases injections might be continued.’
7. Rheumatism and ophthalmia. The most formidable ofall its complications. Mr. Milton objected to this being calleda constitutional effect of gonorrhoea. The animal life mightsympathize with the affection of the generative organs; itmight participate in the disease. The structures of organiclife (the constitution) neither sympathized with, nor partici-pated in, the disorder. He recommended the treatment of Mr.Lawrence--unsparing use of purgatives and colchicum, followedby the iodide of potassium.
Reviews and Notices of Books.The Elements of Materia Medica and Therapeutics. By
JONATHAN PEREIRA, M.D., F.R.S. and L.S., &c., &C.Fourth edition, enlarged and improved. Vol. II., Part 2.pp. 880. London: Longman & Co., 1857.
THE appearance of the nearly 900 pages before us, consti-tuting the second revision of that portion of Dr. Pereira’s greatwork left unfinished (as regards its third edition) when he died,completes the fourth issue of the " Encyclopa?dia of MateriaMedica." On the first publication of this portion of it, underthe new joint editorship in 1853, we felt it our duty (THELANCET, vol. i. 1854, p. 44) to animadvert on the r;;1,ther looseand unsatisfactory manner in which the important service en-trusted to such well-known names had been performed. Weare happy to have it in our power now to say the same editorshave greatly improved, and have given evidence of such labourand interest in their work as to make us regret we were de-prived of similar testimony on the appearance of the previousedition. The articles on Chloroform and Cod-liver Oil havebeen re-written, and several additions have been made to thehistory of the alkaloidal principles, some of which are for thefirst time described in the present volume. In illustration ofthese remarks, we may refer to the notices of conia, cotarnine(a product of the decomposition of narcotine), opianine, opianicacid, papaverine, helleborine, aconitine, berberine, &c. Shortaccounts of "amylene" and pepsin will also be met with." To the pharmaceutical compounds described in the previous
editions, many new preparations have been added from the
