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Analogy between Scorbutus and Typhus.
the globules do not leave their vessels but when these have been torn? This opinion, reproduced in our times, and which I myself have maintained, making the hæmorrhages of scorbutus and pernicious fevers dependent upon a dissolved state of the blood, arose at a period when it was believed that this took place from the destruction of its globules; but such destruction, supposed by Huxham and 80 many others, is a pure hypothesis. Many a time, in cases in which the blood presented different degrees of this dissolved state, have I examined it with the microscope ; and I have constantly found its globules with their ordinary appearance, and perfectly untouched. So, too, the globules in the blood from the hæmorrhages possess all their physiological characters. I repeat, then, it is not easy to understand how the simple diminution of the fibrine should render their issue from the vessels more easy. In considering the augmented portion of fibrine observed in this patient, we must bear in mind, however, that when the bleeding was practised there were symptoms of acute disease of the respiratory organs, with much febrile re-action, and I believe it is to this circumstance we ought to attribute so large a proportion of fibrine. Some days after this bleeding had been practised, and probably in consequence of it, we could discover no traces of inflammatory action. Although the blood, at least three weeks prior to death, had not lost its fibrine, the spleen, nevertheless, was none the less soft and reduced to a pulp; so that we here see a change which, although generally coinciding with a dissolved state of the blood, may yet exist without it. The highly congested lungs, containing here and there apoplectic kernels, contrasted by their dark colour with the extreme paleness of the liver and kidneys,”L'Union Medicale, No. 78.
M. Marchal (De Calvi) in a communication to the Academy of Sciences, expressed his doubts of the correctness of the conclusions recently arrived at, froin the fact of fibrine being sometimes found in excess in the blood in scorbutus. He believes the inflammatory element, to which this is due, has been overlooked. He lays down the following propositions :-1. There are two species of hæmorrhagic phenomena in scorbutus; sanguineous infiltration or interstitial hæmorrhage, and hæmorrhage properly so called. 2. Each of these may be external or internal. 3. In internal hæmorrhage the infiltrated parts may re-act and inflame. 4. It is such re-action that explains the maintenance of the normal or production of the excess of fibrine. 5. In hæmorrhage properly so called it is to be presumed that, as there is no local re-action, the amount of fibrine will continue less. 6. There is no reason, from our present information, to change our opinion of the defibrinated condition of the blood in scorbutus. 7. Even were this the case, it would offer no reason to deny the defibrination of tbe blood in the pyrexiæ, and the dependence of the hæmorrhagic phenomena upon this circumstance. 8. In the present epidemic, besides the changes introduced into the regimen, another indetermined cause has acted. 9. The albumen and globules are diminished in scorbutus, and yet, in general, there is neither dropsy or arterial murmurs. 10. As to the absence of dropsy, we may explain it easily, the deficiency in the formation of albumen being a very different thing from the loss of this principle. 11. Scorbutus and Typhus are not analogous. In the one there is impoverishment, in the other, a poisoning of the blood. --Gazette Medicale, No. 34.
In relation to one point, alluded to in M. Andral's communication, the analogy prevailing between Scorbutus and Typhoid Fever, we may notice a short discussion which recently took place at the Academy of Medicine. - An epidemic of Scorbutus having broken out in the garrison at Givet, M. Scoutteien was sent by the Government to investigate its causes. He considered that the causes of the disease were similar to those capable of inducing typhoid, the hospital being placed in a very unhealthy locality, and the regiinents whence the patients were derived having suffered under a defective alimentation. The patients were removed from the damp locality in which they were placed, and soon did well upon a good diet. The particulars of the diet the soldiers had been subjected to he was not at liberty to divulge. (This disgraceful fact has been well and severely commented upon by the entire Parisian medical press). M. Rochoux having stated his opinion, that a vitiated state of the air had always been the leading cause of the production of this disease, M. Scoutteten felt certain that, however much other causes might aid, defective alimentation was the principal one. Thus, when the new prison regimen, which included a diminished diet, was adopted, scorbutus quickly showed itself; and as quickly disappeared when the diet was improved, all other circumstances remaining the same. In reference to the present epidemics, two regiments occupied the same barracks, one being much better sed than the other, and the latter alone suffered from the disease. M. Ferrus observed that scorbutus much prevailed in prisons and lunatic asylums at the present time; and that, although bad diet was the principal, it was not the only cause. He had found it very often co-existent with other diseases, especially typhoid, owning common causes. “All these affections seem connected by one common tie-general debility, and are we to attribute this to humidity, alimentation, or over-crowding? To all of them united. We find in such places an assemblage of a great number of individuals in a too circumscribed space, an insufficient and too uniform a diet, a sedentary life for persons mostly accustomed to laborious occupations, and the demoralisation and despondency contracted by their situation.” M. Bouillaud. “ We have heard nothing but assertions unsupported by facts. It is quite evident to those who have meditated upon the causes of scorbutus and typhoid, that not only is there no identity, but not even any analogy. Daily may we see, in the hospitals of Paris, cases of typhoid fever, and for my part I have seen more than 700 in 25 years, and yet I have never seen a single case of scorbutus. If the analogy is so striking, why do not the same causes produce both effects? Some persons admit that typhoid fever is conta. gious, but no one will allow that scorbutus is so. In typhoid there is febrile reaction, none in scorbutus.” M. Scoutetten. “ I am much surprised to hear that M. Bouillaud has never seen scorbutus. He has only to visit the wards of Val de Grâce, where an epidemic now prevails; and he may there see typhoid fever and scorbutus developed in soldiers subjected to the same influences.” - Gazette Medicale, No. 29.
[The subject of Scorbutus has excited so much interest during the last few months in various parts of Great Britain-practitioners who had began to con. sider it as a mere traditional disease, having now had ample opportunities of studying its various features—that we have deemed it right to lay the above somewhat lengthy extracts before our readers. We cannot consider that the analyses here referred to definitively settle the question of the amount of fibrine ordidarily contained in the blood in this disease, and are disposed to adopt M. Marchal's suggestion. Our means of investigating the condition of this fluid are far superior to those possessed by the older observers; but they were as well able to estimate the mere appearance of the coagulum, as influenced by the presence of more or less fibrine, as ourselves. As to the causes of the disease, these, in common with those of other epidemic visitations, are enveloped in the obscurity implied in the phrase "epidemic constitution of the air ;" for, although a defective or ill-adjusted alimentation seems essential to the production of the malady, it does not alone suffice, as, did it so, the disease would have been found still more generally prevalent during the late season of distress and privation, and would have also frequently manifested itself on former similar occasions, instead of being a new affection for almost the whole race of living practitioners.-- Rev.]
Electricity as a Cause of Disease.
INFLUENCE OF ELECTRICITY IN THE PRODUCTION OF DISEASES. By M.
PALLAS, Principal Physician in Algeria.
Dr. Pallas has addressed a note to the Academy of Medicine prior to publishing a work he has undertaken upon the importance of electrical isolation in the treatment of certain diseases. The subject, he states, is especially important in relation to the etiology, nature, and treatment of the diseases of hot climates; and may be summarily stated in the following propositions.
1. The greater number of diseases, and especially those which belong to the class of neuroses, are occasioned by the exaggerated influence of general electricity, of which clouds, storms, and marshy regions are the most fruitful sources. 2. Marshes, in their geographical constitution, and the effects which they produce upon the economy, present the greatest analogy with the galvanic pile. Thus their action is so much the more baneful as they contain certain proportions of water, and their activity is considerably increased when the water contains organic or saline matters in a state of solution. This explains why salt marshes and such as are near maritime rivers are the most insalubrious. The drying up or submersion of marshes produces analogous conditions to those of a galvanic pile deprived of humidity, or which is under water, and the effects of which are then insignificant. 3. The researches of philosophers and physiologists have shown that the electricity produced by our machines exerts a special action upon the nervous system. Experience and rigorous observation of facts prove that the diseases which are produced in a marshy atmosphere are primarily nervous, and become inflammatory only by the re-action of the nervous upon the vascular system, inducing consecutive local or general irritation. 4. The neuroses are occasioned, generally, by the effects of electricity, and intermittent fevers have a similar origin, that is to say, they are due to the electrical emanations of the marshy pile, which are very active in hot countries, and not to miasmata, which have never been met with. 5. Electrical isolation is a rational means of modifying this morbid influence, and is accomplished by attaching to ordinary beds, sofas, or chairs, legs of glass or resin. A great number of cases prove that the patients whom I have thus isolated, have been cured or relieved, several of whom had resisted all the ordinary means of cure.
“6. Just ae light and air are the essential agents of vision and respiration, electricity is the functional agent of innervation, whose injurious action may be modified by isolation, which is to electricity what a shadow is to the solar light.” - Bulletin de l'Academie, Tom. xii., p. 743.
ON THE DIAGNOSTIC SIGNS FURNISHED BY INSPECTION OF THE VULVA
AND THE ENTRANCE OF THE VAGINA. By M. HUGUIER. By the aid of this simple means we have often been enabled to recognize certain facts, and diagnosticate some of the diseases of the uterus, the nature of which were sometimes misunderstood, or could only be ascertained by long and repeated examinations, insufficient to the end, or even inapplicable in some cases. We meet with women who, whether from fear, excess of sensibility, or real or pretended modesty, will not allow of the finger, or any instrument whatever being passed within the sexual organs; while in virgins, and in women suffering from severe inflammation of the genital organs, or from original or acquired vicious conformation, it becomes impossible to carry our means of exploration beyond the vulvar orifice. These circumstances may often render the vulvo-perineal inspection a valuable aid to diagnosis in the cure of certain uterine diseases.
And it is so in certain physiological conditions bordering upon morbid states of the womb.
Inspection during Pregnancy.—The reddish-violet colour of the vulva in pregpancy has been very insufficiently indicated by authors. It is quite characteristic but is not uniform. Little apparent upon the internal surface of the labia, it becomes very sensible upon the inner surface of the nymphæ, near the meatus and clitoris, and upon the tubercle anterior to the vagina-wherever, in fact, the mucous membrane becomes more delicate, thin, and transparent. This colour cannot be confounded with that which is caused by the varicose state of the veins of the genital organs in some women, and which is inseparable from the course of the venous trunks whose form and direction it reproduces. The coloration of pregnancy is diffused, and differs in its shade. It is first seen at the end of the second month, and becomes very evident during the third, so that it precedes all other sensible signs of pregnancy. Moreover, we have never seen this state in persons who did not prove to be pregnant-a circumstance of importance in a medico-legal point of view.
Another peculiarity in the vulva of pregnant women is its humidity, which may amonnt to even a discharge. Its cellular tissue also becomes the seat of a slight serous infiltration. The piliferous follicles, moreover, become hypertrophied, and assume on the external surface of the labia a nipple-like, granular appearance. The sudorific apparatus and the sebaceous glands also secrete more actively, from whence results an anormal secretion, and a gluey, sticky condition of parts. On the other hand, in cases which only simulate pregnancy, the same parts manifest a withered, wasted appearance.
2. After Delivery:- In a female newly delivered, we find an anormal dilatation of the vulvar orifice, a depression and a kind of shortening of the perineum, an enlargement of the fourchette, with or without lacerations, or recent cicatrices; the vulvar folds, and the nymphæ are a little fuller than usual, and a dirty, earthy reddish fluid flows out, having its specific odour. The vulvar lacerations will be found especially at the back part of the vulva, at the fourchette, and next especially at the left side, and least frequently near the union of the nymphæ with the labia, especially on the left side. They are usually triangular in form, the apex looking towards the centre of the vulvar orifice, and the base towards the thighs; which is not the manner in which solutions of continuity are disposed that result from external violence from the introduction of foreign bodies into the genital organs.
3. The aspect of the genital organs allows us likewise to indicate other particularities in certain pathological and constitutional conditions of women. In fair, flaccid, lymphatic women; in those who are chlorotic or scrofulous, or who are liable to a habitual amenorrhea, the labia, nymphæ, and clitoris are but slightly developed; the vulva is covered with little hair, the mucous membrane is pale, shining, and cool; the papillæ and follicular prominences are but little marked; the colour of the entrance of the vulva differs but little from that of the labia and nymphæ (as I will show you upon two women suffering under uterine affection, who I will submit to your examination after lecture !); and the skin of the vulvar region is destitute of that more or less abundant pigment which we observe in dark and well-constituted women, and which contrasts very sensibly the colour of this part with that of the abdomen and thighs. It is also in these lymphatic and chlorotic women that we find the vulvar orifice and the entrance to the vagina frequently bathed with a hypersecretion of the vagina resulting from atony, or an uterine catarrh of the same nature-cases in which tonics and ferru. ginous preparations are indicated.
Stricture of the Intestine in Hernia.
4. A few words may be added concerning the Auids which bathe the vulva. If on separating the labia we see a reddish, sanguinolent, abundant, strongsmelling fluid flow out, we may suspect the existence of a cancer, a polypus, or a fibrous body projecting into the cavity of the uterus. If the fluid is creamy, of a yellowish-white, more or less consistent, and neither clinging or elastic, it proceeds from the vagina. If there are albuminous, whitish, tenacious, transparent, hyaloidean flocculi
, of a greenish-white or yellow, the liquid proceeds from the uterus, and results from a simple hypersecretion or a purulent uterine catarrh. It is to be remarked, however, that in the case of cancer, polypus, or fibrous tumour of the uterus, the folds and wrinkles of the mucous membrane at the entrance of the vulva are almost entirely effaced; the papillæ and follicles have, so to say, disappeared; the parts take on a smooth, polished and shining aspect, and a pale colour.-Gazette des Hôpitaux, No. 74.
[Although we imagine the modesty spoken of by M. Huguier as occasionally preventing women allowing of an examination per vaginam by the finger, would in this country certainly likewise extend to the ocular inspection of its entrance, we may as well make use of the information derivable from the proceedings of patients and practitioners among whom objections upon this ground must obviously be of rare occurrence. Some of the conclusions are of too disgusting a character, such as those relating to the habits of intercourse, &c. of the patient, to be here referred to, but others may be useful occasionally.--Rev.]
ON STRICTURE OF The InteSTINE IN HERNIA. By Louis Chapel, of
An enfeebled old woman, (æt. 74), unable to give any account of its prior history, was brought into the surgical ward of the Hôtel Dieu, St. Malo, with a strangulated femoral hernia upon the right side. After the taxis had been repeatedly tried, and frictions with the belladonna ointment employed, the operation was performed. She seemed to be doing very well for some hours after the operation and had an evacuation ; but she sank within 48 hours of its performance. At the post-mortem, slight injection of the convolutions and some recent adhesions between these and the parietes were observed; and, at one point, a portion of the intestine was observed to be extremely strictured, just as if it had been compressed by a ligature. It felt just like a fibrous ring, and its circumference was not above 27 or 28 millimetres, although that of the portion above and below was respectively 96 and 70 m. The mucous membrane near the softened part was slightly inflamed, but no other change in the rest of the canal was observed. The neck of the hernial sac was found thickened.
M. Chapel, in commenting upon this case, remarks that authors have made very few observations upon the circumstance, which he does not doubt is of more frequent occurrence than is generally believed. Ritsch, in 1765, presented an account of a case to the Academy of Surgery, which he believed to be unique, but in its discussion before that body, others, related by Mertrud and Cutavoz, in which marked stricture likewise existed at the point corresponding to the seat of strangulation, were referred to. John Hunter, in his Treatise on Inflammation, states that he has met with an occlusion of the intestinal cavity by plastic lymph, as a consequence of strangulated hernia ; and Pelletan, in his “ Clinique Chirurgicale,” relates the fatal termination of an operation for strangulated hernia induced by stricture of the intestine. M. Cruveilhier, in his “ Essay upon Pathological Anatomy,” even divides such strictures into chronic and acute, and believes they may be induced by the continuous pressure of a badly applied truss. Boyer, treating upon the symptoms which may follow the operation, states that