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tical sagacity were so conspicuous. I do not so term that impassable inertia, which, decorated with the name of prudence, allows dangerous diseases to proceed on to their fatal termination, and then washes its hands of them; so that the disease may bear all the blame and the practitioner be protected from all reproach; the vulgar being always disposed to blame as culpable the active intervention of the physician when this proves insufficient to save the patient's life! In these most serious and difficult cases, Tommasini employed an unheard of zeal in combating the disease with boldness and vigour until the very limits of art were reached, and he frequently succeeded in triumphing over it in spite of the desperate circumstances amidst which he was employed. Tommasini was always in the habit of preparing statistical tables of his clinical practice, and first taught the true manner of turning these to practical account, protesting against, as a vain and inconclusive practice, the simple accumulation of figures.—Gazette des Hópitaux, No. 27.

[The fate of Brownism in Italy constitutes a curious feature in the medical history of our epoch. Rejected in this country and in France, it was welcomed in Germany, and especially in Italy, with the most flattering reception. Rasori constituted himself one of its earliest and most ardent interpreters; but his practical sagacity soon taught him that, however seductive from its simplicity the system of the Scotch theorist might prove; that so far from the vast majority of diseases being of an asthenic nature, proceeding from debility of tissue, and requiring stimulant remedies, the very contrary is far nearer the truth. Hence the re-action described by Professor Giacomoni in the above paper, which has since pervaded Italy, as it did France, under the prestige of Broussais. In both countries the other extreme was run into, and a far too indiscriminate bloodletting was the consequence : but while in France a more rational state of things now prevails, in Italy the antiphlogistic school seems still to exert undisputed sway. The charge of plagiarism brought against Broussais will be new to some of our readers, although it seems well-founded. Rev.]

PRACTICAL OBSERVATIONS UPON FOREIGN BODIES INTRODUCED INTO

THE EYE. By M. PETREQUIN, of Lyons. M. Petrequin divides these bodies into three categories, those which are arrested on the surface of the eye, those which become imbedded in the cornea, and those which, perforating the cornea, penetrate more or less deeply into the chambers of the eye. In a manufacturing town like Lyons these accidents are very 1847)

common.

1. Foreign Bodies arrested npon the Surface of the Eyje.—These often become hidden under the upper eyelid, and are of difficult removal by the usual plan of raising the lid upon a probe, &c. M. Petrequin employs a camel's hair pencil, and introducing it beneath the eye-lid, he passes it from the one commissure to to the other, so as to sweep any foreign body into the nearest angle of the eye. If he has not a pencil at hand he employs the feather of a pen. It acts best when used dry, the tears sufficing to moisten it. Extraction in children is ditiicult in consequence of the convulsive contraction of the eyelid, which often occurs, so that even opening these at all may be impossible. "M. Petrequin throws in an injection of rose-water to dislodge the body from the corner of the eye where he supposes it placed, and brings it thus easily to the free edge of the eyelid. Practitioners should always recollect that the sensations induced by a foreign body may continue after it has been removed, so that they may not needlessly make painful researches.

Foreign Bodies from the Eye.

275

the cornea.

2. Workers in iron or stone may have particles fix themselves to a greater or less depth in the substance of the cornea, and these are sometimes so small as to require a lens to see them in the little depressions in which they are seated. If the particle is metallic, we should try the effect of a magnet for their removal. M. Petrequin considers a forceps a bad instrument, for, however delicate it may be, we may try 20 or 30 times without being able to seize the body with it, irritating the eye more and more, and increasing the difficulty of the extraction. The case is rare for the body to be large enough to have a free portion sufficient for seizure. The bistoury is preferable, but it should be a rounded one, for with a sharp-pointed one, we might risk piercing the eye during one of its spasmodic movements. M. Petrequin prefers a large lancet, the front and edge not being too sharp, and its form resembling that of an abscess lancet. The patient should be seated in a chair, the arms of which he grasps. The light coming from above, he is directed to throw back his head until its long diameter becomes very oblique from above downwards, and from behind forwards. The surgeon placed behind supports it against his chest, and directs the patient to look upwards. After having raised the upper eyelid he directs the cutting edge of the lancet very gently and carefully upon the foreign body and slightly scrapes

The eye immediately becomes convulsed and is retracted beneath the lid. It is brought down again by looking at a fixed point, and the scraping again commenced. In this way the eye becomes accustomed to the contact of the instrument, and the foreign body is easily removed. It must always be shown to the patient, since, on account of the continuance of the pain for some hours after, he may doubt the fact of its extraction. After the operation, a plastic effusion takes place into the little cavity which becomes filled up by its organization, no trace of cicatrix remaining if the operation has been adroitly performed.

3. These cases are always grave, as the contusion produced may give rise to traumatic amaurosis, and at all events to inflammation. Two or three cases of this accident are related, one of which we abridge. A countryman, æt. 50, was admitted into the Hôtel Dieu on account of a foreign body which had entered his eye while cutting stone. This occurred some time before his admission, although how long is not stated, and the patient had been submitted to means for the relief of the attendant inflammation with little success. The cornea was entirely healed and offered no trace of cicatrix, and through it the bit of stone, not larger than a millet seed, was observed to be lodged in the anterior chamber between the cornea and iris, at its superior external part. The conjunctiva was much injected, and the iris inflamed. "It acted imperfectly, and some adhesions to the lens had occurred. Vision was defective, and attended with great pain in daylight. M. Petrequin made an incision four lines in length, into the upper and external fourth of the cornea. The aqueous humour flowed out, and the iris presented itself. He passed in a pair of Sichel's cataract forceps closed, and opening one blade above and the other below the body, he seized it with some

on account of the little support the iris furnished it, this receding from the instrument. A small portion of the iris which was prolapsed was removed by the scissors. The patient was bled after the extraction, and he went on quite well, perfect vision having been recovered. A small hernia of the iris was removed by cauterization with the nitrate of silver.-Annales d'Oculistique, T. 17, pp. 14-20

difficulty

On the Dentition of Children, From The CLINICAL Lectures

OF M, TROUSSEAU.

The most recent works upon Odontology contain some errors respecting this

process, which it is the duty of thc clinical teacher to indicate. The evolution of the milk teeth is not usually accurately described as respects the order of sequence. M. Trousseau represents it as occurring in groups, separated by pauses. 1. The first group is formed of the two lower median incisors which appear nearly simultaneously, after which there is a pause for one or two months. 2. The two upper median incisors pierce the gum from the 10th to the 12th month. 3. The third group follows the second in a fortnight or a month, so as often to be confounded with it, and consists of the two upper lateral incisors (not the lower ones as usually stated.) 4. Again is there a pause, and we then find the lower lateral incisors, and the four first molars appearing almost simultaneously: first a molar generally shewing itself, then an incisor, a molar again, and then the other incisor, and lastly the two molars. 5. After a pause of from two to five months the four canines appear; the 6th group, consisting of the second molars, scarcely ever appearing until five or six months still later. This is not a matter of mere curiosity; for the occurrence of these pauses should be borne in mind, c. g. in weaning. For this we should choose the intervals between them, and above all avoid attempting it just at the period of the evolution of the 4th group. The two first teeth generally appear from the 7th to the 9th month; the upper median incisors from the 10th to the 11th : the upper lateral ones at the end of the 1st year. About the 16th or 18th month the child should have 12 teeth ; 16 from the 20th to the 24th month, and upon the appearance of the second molars, generally about the middle of the third year, twenty.

In the course of the 6th year, and even sometimes not till the commencement of the 7th, but rarely before the 6th, we see a large quadricuspid persistent molar appear: so that at seven years the child usually has 24 teeth ; and it is at this time the milk teeth begin to be shed, generally in the order of their evolution. Thus the lower median incisors fall at 7 years; the upper ones at 8 ; the first molars in the course of the 10th year ; the second molars towards the 11th; and the canine between the 11th and 12th-all these teeth being replaced by the corresponding persistent ones. At 12 we see the second large molars appear, and the child has then 28 teeth: and towards the age of 20, 25, or even later, the wisdom teeth appear, and the number found in man (32) becomes complete.

It is commonly said that the first persistent molars appear at the fourth year ; but this is an assertion contradicted by daily observation; as neither their erup. tion or the shedding of the milk teeth scarcely ever commences prior to the 6th year.

The teeth whose eruption is least frequently attended by derangements of any kind are, beyond all others, the incisors, which is generally attributed to their cutting form; and the most difficult of all to cut, notwithstanding their conical form, are the canine. They are deeply seated, and, as it were, wedged in between the lateral incisors and first small molars, which they are obliged to push on one side. The eruption of the molars is rarely attended with much inconvenience. We should always discourage weaning during the period of the eruption of the canines.

Four or five days prior to the eruption of a tooth there is usually a slight catarrh, cough, some dysphagia. Frequently its cutting is accompanied by diarrhæa, loss of appetite, and great pain. The gum is usually inflamed over the tooth; and a little later this inflammation is also scen around the teeth already cut. Some children also do not cut any teeth without paroxysms of convulsion; and in some cases these form the first indications of what is taking place. It is a general practice to attempt relieving the inflammation of the gums by lancing them: but in 24 hours the incision heals, and the subsequent cutting of the teeth becomes more difficult and painful in consequence of the cicatrization. The tooth in fact, often appears far nearer the surface than it really is, and very erroneous views prevail respecting its mode of arriving there. They come forward so slowly that they have time to modify the tissues. They do not distend the gin1847)

Albuminuria in Pregnancy.

277

gival membrane, but inflame it. Frequently at the summit of a tooth which is not yet cut, we may see a little projection, which disappears after a while. It does not depend upon the pressure of the tooth, but upon an inflammation which renders the gingival tissue more permeable, and its absorption more easy. If this slight tumefaction was the result of pressure, the tooth would make considerable progress in a short time; while, after the gum has subsided, it is hardly apparent. If convulsions are present, we should employ immersion in cold water, antispasmodics, narcotics, or laxatives, according to circumstances. Diarrhæa is a more serious symptom, acquiring great obstinacy during dentition; and is especially to be feared if weaning has been performed just at the period of the eruption of one of the groups.

In young children the teeth become carious more easily than in adults, and the caries sometimes gives rise to most severe pain, and to the detachment of the dental follicles, rendering the caries of the persistent teeth also more easy of occurrence. Should we extract such teeth? If we extract milk teeth in a child of two years old, the persistent ones appear sooner, but the alveoli contracting, the arch of the jaw becomes diminished in extent. The persistent teeth have then little room, and lap over each other. If we want the second set to appear regularly, therefore, we must not draw those of the first-at least only in cases in which the caries gives rise to very serious symptoms.-L'Union Medicale, No. 33.

[Although accustomed to attach much weight to the opinions of so sensible an observer in the enjoyment of a large field of practice as M. Trousseau, we should feel very indisposed to abandon the practice of free lancing the gums during any of the disorders of dentitition.—Rev.]

ALBUMINURIA IN PREGNANT WOMEN.

M. Devilliers recently communicated to the Society of Medicine of Paris the results of the investigations which M. Regnault and himself have been engaged in making concerning the Albuminuria of Pregnancy. In this condition the affection presents much less distinct and well-defined symptoms, most of which may be readily confounded with those of other diseases of pregnancy. Sometimes no morbid phenomenon manifests itself; and at others there may be heavi. ness, headache, general uneasiness, some characteristicless derangements of the digestive organs; but no febrile action belonging to this disease in particular. Lumbar pains are so common in pregnancy, that we are unable to distinguish them either by their seat or nature from those which are developed during the acute stage of albuminuria. As to the dropsy, sometimes it does not exist, which however is rarely the case ; sometimes it is limited to the lower extremities, resembling the simple ædema of pregnant women; and sometimes it is general, and may be mistaken for anasarca dependent on affection of the heart, which, during gestation, is frequently increased to a great extent. There remains then the albuminous condition of the urine : and, notwithstanding what various writers have stated, these enquirers have never been enabled to detect albumen in the urine of the pregnant women who have been presented to their notice under ordinary circumstances. In examples of the disease the quantity of albumen has been found very variable, increasing sensibly during notable disturbance of the circulation, e.g. during the development of intercurrent febrile affections, the period of accouchment, puerperal diseases, or the approach of death.

The affection which especially presents itself as a frequent and important complication of albuminuria is eclampsia. Most of the subjects of puerperal convulsions exhibit evident marks of serous infiltration. In some, however, this symptom is absent; but the authors of this memoir have constantly found albumen in their urine. Of course all the women exhibiting albumen do not become the subjects of convulsions ; and the authors have found these absent eight times in twenty cases ; but they believe that more than a mere coincidence exists between the two diseases, founding their opinion upon the fact, that in ordinary albuminuria various cerebral and nervous phenomena are exhibited, and that during pregnancy these last acquire a special development.

Contrary to what is observed in ordinary cases, the albuminuria of pregnancy may terminate in a rapid and complete cure after confinement, however grave the case may have appeared. It may pass into the chronic state, but this is more rare. It predisposes to the same affection in future pregnancies, it may induce abortion, seems to favour the development of puerperal diseases, and at the very least must be considered as a powerful predisposing cause of eclampsia; but of itself, and alone, it does not seem capable of inducing a fatal termination. The prognosis for mother and child is therefore only grave in proportion to the amount of complications. The authors observed '11 deaths in 20 albuminuric women.

Besides the various cadaveric lesions derived from the complications, the authors almost always found renal lesions of various kinds, and not exclusively such as are described as characteristic of Bright's disease; and they feel much disposed to acord to these organic lesions much less importance than is ordinarily attributed to them, and to regard them rather as the effects than the causes of the disease. Indeed, in pregnant women its causes seem to be different to those generally admitted in ordinary albuminurea.

The researches of the authors have proved to them that the blood of women during gestation exhibits a remarkable diminution of albumen, especially in the latter months; a condition which Andral has shown to be favourable to the production of dropsies in general, and one which bears the relation of cause to effect in respect to the present disease. The albumen dissolved in the blood is, in the normal state, combined in certain proportions, with a certain number of saline materials, which allow the blood to traverse the canalicules of the breast, to be there submitted to depuration, without the transudation of a single trace of albumen; but if from any general cause, from a disturbed condition of the asssimilatory powers, the static equilibrium is destroyed, the renal parenchyma may become traversed by anormal elements, and albuminuria induced.- Revue Medicale, Vol. I., 1847, p. 449-52.

HYGIENIC RULES TO BE OBSERVED IN Myopia. By Dr. Sichel. Congenital short-sightedness exists seldomer in an advanced degreee than in a condition of simple predisposition or slight commencement; and experience proves that it generally diminishes with the progress of age, if nothing be done to increase it, and if, so far from opposing the physiological actions of the organ, we favour their evolution. To this end the power of accommodation of the eye should be continually exercised, by removing the objects upon which it is habitually employed to as great a distance as possible. Especial care should be taken not to fix the sight for too long a time upon too small objects, or to employ it in reading too small letters, whether printed or written. "These negative conditions are not sufficient. The sight must also be much exercised on large distant objects, the use of spectacles must be delayed as long as possible, or those of the weakest powers chosen, so as to give merely a greater clearness to objects without altering their size. They should also, even when the myopia is much advanced, be employed exclusively for seeing at a distance, laying them aside for reading, writing, or working. They are not required in the house or in

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