Imatges de pÓgina
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“ The liver, it appears from what has been said, is the part which most frequently suffers by sympathy in the second stage of indigestion. It therefore often happens, that when those labouring under this stage are attacked with fever, a train of symptoms similar to that detailed in page 271, supervenes, the proper treatment of which is essential to that of the fever.

“ The principle of the trentment of these symptoms, when they occur in fever, is precisely the same as where they supervene without it, but the actual practice is not altogether so. The fever, in its early stages, by adding to the severity of the inflammatory symptoms, renders more active means necessary. Hence, if the general symptoms do not indicate general loss of blood, a greater local abstraction of it is usually proper, than when no fever but that occasioned by the local affection attends.

The same observation applies to the use of cathartics. At the commencement of fever the free action of the bowels is particularly beneficial, and by such a state of the liver is rendered doubly so. It is thus that brisk doses of calomel at this period are generally more beneficial than other mercurials.

“ In the latter stages of fever, on the contrary, if this affection of the liver still continue, which is not uncommon, either from its. having been neglected in the early stage, or from its proving more obstinate than usual, I have always found the minute doses of blue pill above specified, given every six or eight hours, most beneficial. Combined, indeed, with moderate evacuations of blood from the part, or (when the tenderness is inconsiderable, and the affection of the liver rather betrays itself by a vitiated secretion of bile, than by inflammatory symptoms,) blisters applied to the re, gion of this organ, they rarely fail to restore due action to it, unless the nature of the fever, or constitution of the patient, be very unfavourable ; and thus often remove the fever, which, when its symptoms have become mild, is frequently at this period prolonge ed by the local affection alone.

“When the sympathetic disease, previous to the attack of fever, has chiefly affected other parts, the bowels, the lungs, the brain, &c. we still find the part most affected by that disease, suffering most in the fever; and the same plan of treatment, mutatis mutandis, is applicable, except that the same benefit is not to be expected from the specific operation of mercury.

“ When indigestion has not arrived at its second stage at the time the fever makes its attack, the accession of this disease, by increasing the inflammatory tendency, often induces that stage. The vessels, although they had not been sufficiently weakened to yield to the usual force of the circulation, yield to its increased force; and it particularly deserves attention, that an attack of fever, as I have repeatedly witnessed, is often the means of permanently converting the first into the second stage of indigestion ; so that the fever leaves behind it tenderness of the epigastrium, and more or less hardness of the pulse, where they had not previously existed.

“When this is the case to any considerable degree, the patient Vol. II. No. 8.

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generally becomes liable to a renewal of fever from slight causes; and if the morbid state of the digestive organs is not removed, he is often exhausted by repeated attacks of fever, which, as the debility increases, assume a more chronic form, and often at length terminate in typhus, or the more severe species of what has been called nervous fever.

“ Local congestion or inflammation, as might be expected, although none of the symptoms of indigestion have preceded, sometimes takes place in fever, that is, when the force of the circalation is morbidly increased. This is most apt to happen in the brain or liver.

The principle of treatment, as far as I have been able to observe, is still the same. In the latter case, however, the means of relief are generally sooner successful, and the patient bears them better. The treatment of fever, in those who have long laboured under the symptoms of indigestion, requires great circumspection. It is surprising after how moderate a degree of fever symptoms of danger often arise in them, and indeed death itself actually ensues. Both the vascular and nervous systems of some organ necessary to life have been previously enfeebled, and it wholly loses its power before the fever produces any very general effect. The patient dies as much of the disease under which he has so long la. boured, as of the fever which has supervened on it, and that at a time perhaps when his physician's mind is fatally abstracted from the former. These observations have been so often impressed on me in the course of practice, that I cannot help, in a particular manner, calling the attention of others to them. The more we see of disease, we shall, I think, be the more ready to admit that the digestive organs form so important a part of the animal system, and are so intimately connected with every other part of it, that there is no case in which their state can with safety be disregarded.” 311.


The rapid exhaustion of the first edition, (though not always an infallible criterion of superlative merit in a book) together with the very general expression of approbation which we hear from all quarters, sufficiently attest that Dr. Philip's work has passed the ordeal of criticism with triumph, and may now be ranked among the standard productions of the British press.


Medico-chirurgical Transactions. Vol. XI. Part 2, with


WERE we to say that the volume before us is equal, in interest or importance, to its earlier predecessors, we should certainly have the character of our judgment or veracity suspected. And as we do not deem it necessary to sacrifice this character for the sake of complimenting a public body, (which neither needs nor cares for compliments,) we shall candidly confess, that our disappointment and regret have, for some time, been excited by the “ falling off” of transactions which, at one period, commanded the respect, and called forth the admiration, of Europe and America. It is perhaps needless to inquire into the cause or causes of this decadence, since we perceive it to be an inherent principle in every human institution or production, whether of the head or the hand. Is it very astonishing, then, that the periodical transactions of the Medico-Chirurgical Society should bow to that universal mandate of Nature which deelares that

The seas shall waste, the skies in smoke decay,
Rocks fall to dust, and mountains melt away!

It would be much more astonishing, indeed, if these transactions presented an exception which would be the only one in the annals of the world and in nothing more srange than in the records of periodical publications on medicine.

As a bright side to this sombre picture we are happy to be able to state that, while the papers read at the Medico-Chirurgical Society have declined in value, the Society itself has risen and is still rising in numbers, respectability, and influence. It is also gratifying to add that, while the communications are not unfrequently of an inferior character, the discussions arising out of them very often assume the highest interest and importance.

We have one remark to add, before we proceed to our analytical labours. We imagine that the society would do well to imitate the conduct of many societies on the Continent, by publishing atstracts of those papers which cannot be admitted, in their original forms, into the transactions. Many important hints and valuable facts would then be preserved for the profession at large—nor do we believe that the writers of these papers would feel displeased at the publication of their communications in a condensed form-on the contrary, we imagine they would prefer this to their entire suppression.

We shall make a point of giving, in future, a regular and rather detailed account of all papers appearing in these transactions, and we hope that on this, as on every other occasion, we shall carefully, abstain from mixing private feelings (however they may be excited) with public duties, a practice dangerous to the writer, affronting to the reader, and inimical to the interests of a liberal and enlightened profession.



1. Cases of Bronchocele or Goitre, treated by Seton, with

Observations, by A. P. COPLAND HUTCHISON, Esq. In the tenth vol. of the Medico-Chirurgical Transactions Dr. Quadri published a paper on the Treatment of Bronchocele by Setons, which induced Mr. Hutchison to adopt the practice. The case, which he selected for experiment, occurred in a woman, who had first perceived the disease thirteen years before. It appeared

. a few days after labour, which we have found a frequent cause of it, by producing a retardation in the reflux of the blood, and a consequent enlargement of the vessels of the neck. The tumour was of the size of an orange, and of rather a firm and hard structure. Mr. H. passed a long and narrow seton-needle armed with half a skein of silk thread, obliquely through the substance of the gland, from the left lobe upwards, that being more enlarged, leaving a space of nearly two inches between the entrance and escape of the instrument. The trachea being pushed backwards upon the esophagus, the trunks of the thyroid arteries escaped the needle, which, it must be observed, was carried through the gland midway between the integuments and the wind-pipe. No hæmorrhage of importance followed. At the end of a few days an erysipelas appeared, which was followed by a profuse discharge of thin acrid matter. The discharge from the wound was kept up by the occasional application of sabine-ointment; and at the end of three months the seton was removed, and another introduced from the lower part of the right lobe of the gland, so as to cross the course of the former. The latter seton having remained in its situation during two months, accidentally escaped ; but it was not deemed necessary to replace it, as the discharge from and gradual reduction of the tumour continued-afterward to proceed in -a favourable manner. A slight oozing of kind pus having been thus spontaneously supported for several months, about twelve from the time of the operation it subsided, and the disease was scarcely perceptible.

The seton seems to be better adapted to the soft and yielding species of bronchocele, than to that which is firmly indurated and Tobulated. In the former, Mr. Hutchison says tbat the operator may boldly pass the instrument throughout the substance of the morbid mass with perfect safety. In the latter, it might be more prudent to perforate a smaller portion of the gland, and to prevent the opera


tion on different parts of it in succession, in order to guard against inflammation in the mucous membrane of the trachea.

The deformity succeeding the cure has been found to disappear


great measure in a few months. It has been asserted by Mr. Nerman, a student from Sweden, that in Denmark it is a common pra tice to make incisions into the substance of the diseased glind, and that bronchocele is thus frequently cured; but we are not informed whether the suppurative process is afterward established or not. This disease has also been successfully treated by Dr. Coindet of Geneva, with solution or tincture of iodine; and Dr. Straub, of Howfyl, asserts, that this medicine may be advantageously used in all cases in which burnt sponge bas been employed.

To the above case, in which the seton was employed, Mr. Hutchison adds one by Mr. Gunning, surgeon to St. George's Hospital, three by Mr. A. T. Thompson, and one by Mr James, of the Devon and Exeter Hospital. In Mr. Gunning's case, eight days after the operation, the ston was removed, the parts contiguous to it being in a sloughing state ; and in a few days after the separation of the sloughs, the patient's health having gradually declined, she died after one of the severe attacks of tracheal irri. tation, to which she had been su'ject. The remaining portion of the thyroid gland was in a sloughing condition, and some slight streaks of inflammation were discovered in the lining membrane of the trachea after death.

In the first of Mr. Thompson's cases the operation was successful. A considerable discharge of blood followed immediately, and a slight one continued during two or three days. The seton was removed at the end of two months The result of the practice in the second experiment was not known. The third case occurred in a man, aged sixty-one. The swelling was of the soft kind. The seton was withdrawn in three weeks, the tumour being greatly reduced.

Mr. Thompson was partly induced to try the effects of the se. ton, baving witnessed the cure of a very large bronchocele by the application of a caustic, which occasioned the whole of the diseased gland to separate at the end of five months.

Mr. James's case was a most interesting one. The patient, a man aged 35, had received the best assistance which could be afforded him, without experiencing any benefit. The tumour was firm and elastic, and of the size of a flattened orange. The progressive increase of it and the accompanying symptoms threatened his destruction. The seton was introduced through the centre of the swelling from the upper to the lower part, The next day, the obstruction returning and the face being flushed, he was bled and purged. The dyspnoea increasing, attended with distressing cough, suppression of the voice as in laryngitis, copious expectoration, baggard countenance, and a frequent, small, and weak pulse, the seton was taken out about ten days after the operation. At this time the patient expectorated transparent firm lymph, having the appear

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