Monthly retrospect of the medical sciences : February to December 1848 / edited by Alexander Fleming and W.T. Gairdner.

Date:
MDCCCXLVIII [1848]
Catalogue details

Licence: Public Domain Mark

Credit: Monthly retrospect of the medical sciences : February to December 1848 / edited by Alexander Fleming and W.T. Gairdner. Source: Wellcome Collection.

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    the formation of False Membrane in the Trachea and Bronchi, in xuhirh Tracheo¬ tomy was successfully performed. By T. A. Barker, M.D., &c.—At a meeting of theKoyal Medical and Chirurgical Society of London, Dr Barker read the following case:— A woman, aged twenty-two, four months pregnant, after delicate health, and symptoms of commencing phthisis for nine months, and pain on deglutition for three months, was admitted into St Thomas’s Hospital wdth chronic laryngitis, and signs of tubercles, in an early stage, at the commencement of January 1847. In a few days the symptoms became ur¬ gent, indicating the necessity of imme¬ diately opening the trachea. The oper¬ ation was performed by Mr B. Travers, junior, and the woman was nearly asphyx¬ iated before it was completed, in conse¬ quence of a false membrane formed in the trachea, where the opening was made, blocking up the tube below the opening, having, probably, been forced downwards by the scalpel. Five days after the oper¬ ation there was extensive hemorrhage from the wound, and, together with the blood, a large quantity of fibrinous mat¬ ter, evidently casts of bronchial tubes, was expectorated. The wound gradually closed, and there was no return of dysp- noia ; but as the tubercular disease in the lung advanced, there was incessant cough, and the stomach became very irritable. Si.x weeks after the operation the patient died exhausted. The mucous membrane of the larynx and upper part of the trachea was completely destroyed, and both lungs, especially the right, were thickly studded with tubercles in an early stage, As life was prolonged for six weeks, the death was not ultimately caused by obstruction in the larynx, the author considered this a successful operation, though performed under unfavourable circumstances. There was ulceration of the trachea at the part where the opening was made, which pre¬ vented the use of a trachea tube, on ac¬ count of the irritation it excited ; there was false membrane both in the trachea and bronchi; there were tubercles in the lungs ; the patient was exhausted by co¬ pious hemorrhage on two occasions, and was much depressed in mind ; neverthe¬ less, she survived for six weeks.—Medical Gazette, January 6th, 1848. [This case is valuable, as showing that the formation of lymph on the mucous surfaces of the trachea and bronchi is no contra-indication to the operation. In the discussion which followed, Mr Hilton stated, that the employment of the trocar and cauula was preferable to the knife. as tending more effectually to prevent the escape of blood. He asked whether the moulds expectorated, might not be the blood which had escaped from the wound, coagulated. Dr Barker, in reply, stated, that a microscopic examination by Mr Grainger had enabled that gentleman to determine them to be fibrine stained with effused blood. We should like to have learned, a little more particularly, how Mr Grainger was enabled to separate coagu¬ lated exudation on a mucous surface from the coagulmn of blood.] 19. —Varieties of Colic. By M. Andral. —Most intestinal pains bear the name of colic, to which is superadded an epithet— bilious, inflammatory, nervous, &c.— to designate its nature. Nervous colic, or enteralgia, may arise spontaneously, and is remarkable sometimes by its extreme intensity, and the faintness which it pro¬ duces ; it is occasionally the result of rheumatism ; and in the disease called “ colic of Madrid,” it is due to the sudden changes of temperature frequently noticed in the climate of that city. In the neigh¬ bourhood of the Ganges, a similar form of colic is also observed, under the influence of the same causes. In colica pictonum, enteralgia is also present ; it is not always relieved by pressure, but pressure cer¬ tainly diminishes the sufferings of the patient during their exacerbations. The form of the abdomen in this disease is not changed, nor its walls retracted, as it has been so often erroneously stated. Nervous colic has been known to assume an epide¬ mic form, at sea for instance, after the prevalence of cold winds. In the colic caused by copper, the pain is also very great, but is accompanied by diarrhcca, and the disease certainly participates more of the nature of inflammation than of that of neurosis.—Medical Times, December 26, 1847. 20. —Case of Convulsions depending on Tape-worm. By Mr Hutching.-—Mr Hutching relates the case of a girl, aged fourteen, who had suffered for three months from attacks of convulsions three times a-week. Tonic remedies were em¬ ployed for a month, with some benefit to the general strength, and the convulsions disappeared ; in another month, however, they returned with abdominal pain and diarrhcea. Worm powders, and 01. Tere¬ binth. in doses of twenty drops, were pre¬ scribed without effect. She w'as now or¬ dered, Ol. Tereb. 5iij ; Ol. Ricini, Siv 5 Gr. Opii et Tr. Card. comp. aa. gtt xij : Aqua-Menlh. virid. ^ ss. M. St. Ilaustus,
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