Report on the progress of practical medicine, in the departments of midwifery and the diseases of women and children in the years 1845-6 / by Charles West.

  • Charles West
Date:
1847
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Licence: Public Domain Mark

Credit: Report on the progress of practical medicine, in the departments of midwifery and the diseases of women and children in the years 1845-6 / by Charles West. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    34/38 (page 32)
    Typhoid Fever. Dr. LSschner,* physician to the Children’s Hospital at Prague, lias written a paper on this subject, the materials for which are drawn from the observation of 104 cases that came under his notice among a total of 6500 children, at a time when fever was not epidemic. He ascertained the ages from 5 to 9 to be those during which the disease is most prevalent, while it attacks boys more frequently than girls. The mortality among the cases that he observed was 8 in 104. He notices a greatly enlarged and highly injected state of the mesenteric glands as having been much more constant than ulceration of Peyer’s glands ; and on this tendency to affection of the glands, he builds the hypothesis that what is called typhoid fever, is a kind of acute scrofula, though he adduces no other fact in support of this theory. Measles. An epidemic of this disease that prevailed in the neighbourhood of Glogau, in the spring of 1843, is described by Dr. Posner.f The disease did not cause any remarkable mortality, and presented nothing unusual in its course. Dr. BattersbyJ has related some very interesting cases illustrative of the complications and sequelae of measles, as he observed them during an epidemic in the autumn of 1844. The affection presented much of an asthenic character, and was often associated with diarrhea and dysentery, and with inflammation of the mouth and pharynx. In two or three cases also, where the powers of life were much exhausted, sloughing of the cornea took place. Unlike the affection of the eyes which comes on in phlebitis, it was attended with but very little increase of vascularity; [and it seems ques- tionable whether it was not due rather to the general impairment of nutrition than to any specific influence of the poison of measles.] Scarlatina. The pamphlet of Mr. J. B. Bro\vn§ on this subject has been so generally noticed in the various medical journals, as to render any further mention of it in this Report unnecessary. Dr. Merbach|| has described the dropsy that succeeded to scarlatina, in an epidemic at Dresden, and which sequela appears to have been extremely fatal, causing the death of nearly 1 in every 3 who suffered from it. The treatment adopted, which consisted chiefly in the administration of stimulant diuretics, with the neglect of depletion and of all decided anti- phlogistic means, will probably in some measure account for this mortality. Dr. Merbach confirms the statements of previous observers with reference to the characters of the urine, and the fluctuations in the quantity of albumen it contained without any apparent cause. Me notices, moreover, that the diminution in the quantity of urea was always in direct proportion to the abundance of the albumen, but that the increase in the quantity of the former always took place more slowly than the diminution of the latter. The work of M. Legendre*[I contains a valuable essay on the anasarca and the oedema of the lung which occasionally succeed to scarlatina. He first notices the frequency with which the eruption of scarlet fever is overlooked, in con- sequence of its being but very temporary, and insists on the importance of making very minute inquiries and examining the surface very carefully in all the febrile affections of childhood, in order to ascertain whether the rash is or has been present. He next lays down rules for the hygienic management of children during their convalescence from scarlatina. Lastly, he inquires into the nature and causes of the dropsy, which he regards as the simple result of the action of cold, and not as the consequence of renal disease ; the albuminous state of the urine being in his opinion produced by a simple nephritis or even by a congested state of the kidney, and not the token of an incipient stage of Bright’s disease. In support of this opinion he appeals to * J. f. Ktnderkr., Dec. 1845. t Ibid., Sept. 1848. J Dublin Journal, Sept. 1845. § On Scarlatina and its successful Treatment by the Acidum Aceticum Dilutum of the Pharma- copoeia. 8vo, London, 1846. || J. f. Kinderkr., May, 1846. ^ Op. cit., pp. 805-362.