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22nd. Induration disappearing---no ulceration.
Decoct. sarza co. zij. bis quotidie.
Ext. col. co. gr. V. p. r. n. 26th. General health very good-fat-tongue improves fast.
Feb. 2. Tongue is still rather hard, and of a glossy, smooth, red appearance. No ulcer in any part.-P.
May 11. Very slight induration of tongue now-it is touched with argent. nit. in the median fissure, where the ulceration was, as it feels tender.
Perstet. April 10. Has continued the sarsaparilla up to the present date. There is still a little hardness left in the tongue, but it is very slight, and he is to be discharged.
The progress towards cure in the preceding case was slow, as it generally is. But in some instances (they are rare exceptions) the patient recovers with rapidity.
A gentleman consulted me some time ago with the same affection of the tongue as the preceding patient. It had existed for three or four years, and he had tried many remedies in the country. He was dyspeptic, and had taken some mercury, but had nothing which could be fairly construed into secondary syphilitic symptoms. I prescribed sarsaparilla with the iodide of potassium-mild aperients, mercury being excluded from their composition-a very regulated diet and regimen-and the occasional application of the nitrate of silver to the fissures, which were daily washed with a lotion of bark and myrrh. In the course of two or three weeks the tongue was well. He had a relapse many months afterwards, but got well again with the same remedies.
The distinctive characteristics of cachectic ulceration of the tongue, are the irregular fissures--the yellowish ulceration, generally deepish, sometimes superficial—the induration limited to the vicinity of the ulcers--the glazed, red, and raw looking surface (not, however, constant) of the organ—the absence of any indication of malignant disease—the indifferent tone of the general health-the persistence of the complaint without other symptoms, save, perhaps, those which are common attendants on cachexia.
This condition of tongue seems to me to occur in two states of system, dif. fering in some respects, though allied in others. On the one hand, it is found in those who have been reduced to cachexia by mercury. It may then be combined, preceded, or followed, by the other symptoms of mercurial cachexiarupia, ecthyma, nodes, phagedænic and serpiginous ulcerations on the skin and in the throat.
On the other hand, this condition of tongue obtains in those whose systems are debilitated by dyspepsia, especially by that form of it attended with morbid sensibility and irritability of the gastro-intestinal mucous membrane. We shall be the less disposed to wonder at this, when we remember how readily, in all persons, slight derangements of digestion, lead to small, yellow, painful, and perhaps, obstinate ulcers of the tongue, and cheeks, and lips. The continuity of tissue, and of function readily enough explains the liability.
The affection, however it may have been induced, always seems to require tonics in some shape or other, regimen, diet, and all that can invigorate the constitution. Sarsaparilla has generally proved highly useful—the iodide of potassium not seldom 80—the ammonio-citrate of iron I have beneficially combined with it -in short, the alterative tonics are requisite. Of course, the secretions must be regulated, and in those cases dependent on derangement of the digestive organs, small doses of mercury may be serviceable. But I should doubt the propriety of its administration, nor would I readily be induced to exhibit it
, in such as may be found to display a connexion with the form of cachexia so often due to, and so frequently aggravated by that medicine.
NEW YORK HOSPITAL.
Renal DISEASE. By J. A. Swett, M.D. In our New York contemporary for July last, we have a report from Dr. Swett, of eight cases of renal disease, which we shall briefly notice in this article.
Case 1.-Mary Burke, 31 years of age entered the Hospital, 27th Nov. 1843. In the latter end of March preceding, after parturition, began to complain of dull pain in the loins and limbs--with pale urine--costive bowelsmand, soon afterwards ædematous feet, gradually extending to the abdomen. This state, with little variation, continued till her entry into hospital. The urine now evinced much albumen—tongue coated in centre, red and glossy at the sides, appetite good-bowels relaxed-skin dry-pulse 100 and weak. Morphia at night, with decoct. querci. Dec. 5. Passes from five to six pints in the 24 hours - bowels dysenteric--cough. Expectorants-morphia-nitrate of silver with opium. Dec. 24. Seized with severe pain in the lumbar region--epigastric tenderness—vomiting of dark matter-diarrhæa. Five grains of blue pill thrice a day. Jan. 1, 1844, seized with convulsions—death in a few hours.
Post-mortem.- Pneumonia of the right lung-liver presented the first stage of cirrhosis-kidneys enlarged, of a uniform pale yellow colour, granulated, soft, and flabby--cortical portion hypertrophied-tubular portion livid red colour pelves natural.
The second Case was one of Phthisis in a young man, where no renal disease was suspected, and who died suddenly. Disease of the kidney as well as of the lungs was found.
Case 3.—This was also a case of phthisis, in a man, 37 years of age, where kidney disease supervened, exhibiting ædema, ascites, dyspnea, coagulable urine. He had no pain in the loins. Antipblogistic treatment was adopted. Blood drawn was highly buffed. Cupped on the loins—warm-bath-low diet. In three weeks the dropsy had increased-cough very troublesome--cupped again on the loins, and the bath and antiphlogistic means continued. This treatment lessened his sufferings, diminished the albumen; but increased the dropsy; Diuretics were tried and abandoned ; and diarrhea and erysipelas terminated life.
Post-mortem.--Heart and pericardium healthy-Jungs tuberculated in various stages—ulceration of the larynx-liver pale and granulated--kidneys rather enlarged, pale and flabby, but mottled with red spots-no granulations were found.
Case 4.-Elisha Lynch, aged 24 years, was admitted on the 27th January: Had had two attacks of intermittent fever. About Christmas previously noticed swelling of the ancles, which increased and reached the abdomen, with palpitation of the heart, occasional vomiting, and cough.
On admission, the anasarca was general--abdomen much distended-countenance pale-heart's action natural-mucous râle posteriorly in the lungs-urine abundantly albuminous—micturition—had had pain in the loins formerlytenderness now over the right kidney. Supertartrate of potash with digitalis, 6tis horis. Purged and nauseated by the medicine without relief to the dropsical symptoms. Decoct. apocyni canab. a wineglassful 6tis horis.* This was con
Indian hemp, which grows plentifully in America, and is much used as evacuant by mouth and bowels, especially in dropsy.
tinued for five weeks, the effect of which was four or five motions daily, without pain or griping, but without any diininution of the dropsical symptoms, or in. crease of urine. Bronchitis troublesome, with pain and dizziness in the head. Cupping, warm-bath, low diet. Complains of pain in the region of the left kidney. Mercury was now given till the gums were affected; but no relief followed. Then the oxymuriate of mercury with bark was given, which acted decidedly as a diuretic, and removed the dropsical effusions. In three weeks after this plan was adopted he was discharged cured.
We doubt whether this case could properly come under the term diseased kidney? Does organic change of structure in that organ ever admit of cure? May there not be disordered function of the kidney, with albuminous urine, and dropsy, and yet no diseased structure of the kidney or any other organ? We have little doubt that this last condition was that of Elisha Lynch.
Case 5.—Bright's Disease treated by Diuretics.-Nathan Beckwell, a man of colour, aged 28 years, came into Hospital 30th Jan. 1844. Had contracted rheumatisin twelve months previously, which continued two months. During the past summer had head-aches, night-sweats, and emaciation-more recently had cough, dyspnea, palpitation, and diarrhæa. Has now anasarca, irritability of bladder, and some effusion into the abdomen. Pulse 90, skin dry—urine slightly acid and five pints daily--deposits albumen copiously when tested-no pain in the region of the kidneys. Two drachms of supertart. potass. and 15 drops of tinct. digitalis, thrice a day.
March 9.-Urine materially increased—sometimes to 12 pints in the 24 hours, attended with diminution of the dropsy-cessation of cough-no tenderness orer the kidneys. The urine, however, is still albuminous, and began now to decrease in quantity. The diuretics were now discontinued, and a quarter of a grain of elaterium every four hours.
March 21. - The elaterium purged, griped, and vomited, it was therefore omitted. The decoct. apocyni also disagreed. The urine was now four pints in the 24 hours, but still albuminous. The legs were ædematous; but his general health was improved : and he requested to leave the hospital on the 19th April.
Unless albuminous urine and dropsy be unequivocal proofs of diseased kidneys, this case leaves us in doubt.
Case 6.—This patient was a Swede, aged 33 years, of good constitutiou, who entered the Hospital, 15th Nov. 1843. He had had chronic rheumatism in the hospital at Hamburg, for six weeks, and was salivated there he has now rheumatic pains in the shoulders and back--ædema of the lower extremities--tongue coated-pulse natural-bowels regular-tenderness of hypochondria—dyspnea. Took hydriodate of potash, which relieved the pains a little-be then had pur. gatives.
Jan. 17.-Had been examined several times. The urine always coagulablerather acid—and about two quarts in the day. Pain in the loins-pulse natural
- skin moist-digestion good. He had been still using the pulv. jalap. comp; which now failed. Elaterium twice a day. This did not diminish the cedema, and was omitted on the 27th Jan. when the pulvis purgans, with tinct. digitalis were substituted. Feb. 11. The urine very albuminous, and the other symptoms no better. Ordered an eighth of a grain of oxymuriate of mercury, with Zj. tinct. cinchonæ, ter die. This treatment was continued till the 11th of May, when he was last seen. His strength was decreasing—the urine highly albuminous, and below the natural specific gravity-some ædema of the ankles. In fact, he was in anything but a satisfactory condition, and the probability is that he has since died.
Two other cases of “ Bright's disease” are recorded, but we can do little more thak give a resumé of them.
Case 7.-A man of colour, aged 37, entered the Hospital 27th Dec. 1843. After severe rheumatism the legs became ædematous-pain in the loins—eight pints of urine daily, urine albuminous. He was treated by purgatives and elaterium, which diminished the ædema and the quantity of urine; but be thought hiinself weaker, and the albuminaria continued. 11th May. Little alteration, and he was now lost sight of.
The eighth case was one where there was hypertrophy of the heart, with dropsical effusions, and albuminous urine. He was treated with diuretics and purgatives, including elaterium. The case is not concluded.
In these cases the dropsical effusions were the most constant attendants on albuminaria. There were few evidences of inflammatory action going on, although the pulse was sometimes accelerated. The Reporter dwells much upon a “smoky appearance” in the urine as indicative of albumen. This phenomenon prevents the bottom of the pot from being clearly seen. The specific gravity was uniformly less than in health. The urine was alkaline in only one case. The causes of the disease could not be ascertained. Rheumatism not unfrequently preceded the attack; and only one patient confessed himself to be intemperate. In respect to treatment, Dr. S. candidly confesses that success was very indifferent. Dropsical swellings were occasionally reduced, but the albuminous state of the urine continued in all.
DANGERS INCIDENTAL TO OPERATIONS ABOUT THE Rectum. By Dr.
WATSON, Surgeon to the New York Hospital.
Our New York contemporary for July last, contains a useful paper on the above subject by a practical hospital surgeon. In the course of the last few years Dr. W. has witnessed four fatal terminations of operations about the anus-one after excision of mucous membrane-and three after ligatures-none of them with hæmorrhage. We shall glance at some of these.
Case 1.-A seaman aged 32 years, admitted into the hospital 10th May, 1841, for prolapsus ani and some stricture of urethra. The general health was not good. A prolapsus took place after each evacuation, but was easily reduced in general, except when inflamed. The stricture soon gave way to the armed bougie, and afterwards the prolapsus was included in ligatures and cut away. The patient suffered a good deal and had strangury; but appeared to be doing well for a couple of days. On the fourth day, however, after a relaxed motion, great prostration of strength occurred, and he died the same evening. Secondary abscesses or purulent deposits were found in the lungs.
Case 2.4" On the 6th June, 1843, I was requested to see Mr. B. a merchant from Kentucky, about 30 years of age, who was suffering from extensive disease of the right elbow and fore arm, and a similar affection of his right ankle, which had occurred suddenly a few days previous, and appeared to be the indirect result of an operation which he had recently undergone for the removal of hemorrhoidal tumors.
“ Just before the operation he had arrived here on business, and, with the exception of the hemorrhoids, in the enjoyment of tolerable health. For some time previous, however, he had suffered from a slight stricture in the urethra, which had affected his general system, and induced a deranged condition of his digestive organs; but of these symptoms he was pot then complaining.
* On the 20th of May, the Gentleman with whom I saw this patient in consultation, had applied a silk thread around the base of a small hemorrhois, which, in a few days, sloughed, and left the patient comfortable. On the 29th, a second hemorrhois having appeared, and the patient having completely recovered from the effects of the first operation, a ligature was applied around the base of this little tumor also. On the 2d of June, the patient had a chill, followed by severe pain in the right ankle, and soon after, by redness and tumefaction about this part. In the course of the next twenty-four hours, the right elbow and arm as far as the shoulder, were similarly attacked. Notwithstanding the most prompt and judicious treatinent, the application of nitrate of silver, blistering, and free scarification, and the internal administration of tonics, stimulants, and anodynes, for allaying pain and supporting the patient's strength, these local affections rapidly progressed to suppuration.
** When I first saw the patient, the whole arm to the shoulder was enormously swollen, boggy, and injected with serous and purulent deposits. It had been deeply and freely scarified ; and, from a puncture just below the elbow, pus and sloughy cellular tissue were issuing. The whole had been enveloped in a poultice
. The ankle and foot were in the same condition, except that the integuments had not yet given way to the accumulated fluids beneath. The patient was apparently free from arterial excitement; his pulse 88, and of moderate volume ; his skin of natural temperature ; his tongue clean, moist, and of natural color; his intellectual faculties somewhat subdued and heavy, but without delirium. He had no internal pain, with the exception of a dull, uneasy sensation under the short ribs, on the right side ; and this he attributed to having lain on the part. He had no special uneasiness about the anus, no tympanitis, no difficulty in evacuating the bladder, although he had suffered slightly from strangury, and the accumulation of gas in the bowels, for a short time after the application of the ligature. He was on the use of nourishing diet, with porter and repeated doses of Dover's powder. To these I added a grain of quinine every four hours, and small doses of camphor emulsion every hour, and suggested the use of brandy in case the patient should have any symptoms of sudden collapse before the next visit.
“ June 8th at 8 o'Clock A.M. - The patient's face is bathed in perspiration ; his features are sunken ; his left hand is cold, clammy, and purplish ; his pulse 130 and extremely feeble; his tongue dry, cracked on the surface, and red at the edges ; his intellect is clear; he is free from pain ; but he has a constant hiccough which has continued since last evening. He had been on the use of small and repeated doses of brandy all night. His condition was too critical to admit of any examination of the arm or ankle. His stimulants were continued : but he died about mid-day. No post-mortem examination could be obtained.”
Case 3.-In May, 1842, Dr. Mott operated on a gentleman of middle-age and good health, for prolapsus ani. He suffered but little from the ligature ; but on the second day he presented symptoms of collapse, and towards the close of the fourth day he sunk, with all the symptoms of typhus fever. No examination could be obtained.
The writer of this notice nearly lost his life by the excision of piles, which was followed by abscesses requiring twice the operation for fistula. Still we must not be deterred by some fatal results ; but we should always bear in mind that they may and do occasionally happen. Every precaution, therefore, should be taken to get the general health of the patient into as good a state as possible before the operation.