the supervention of organic disease of the kidneys. At the conclusion of the discussion the President, Dr. Murchison, announced the fact that the appointment of a committee of experts had been resolved upon to endeavour to decide between the

disputants. meeting interesting paper was At the last

of the read

by

Medico-Chirurgical Society, an Dr. Gaskoin on morphcea, a skin

affection often in the East confounded with the minor conditions of Dr. West, at the opening of the discussion, suggested whether the occasional appearance of the disease might not be a which prevailed in Europe in former legacy from the

leprosy.

leprosy majority

times.

But the

Fayrer, Mr. disposed to

of the

speakers, including

Sir

Joseph

Jonathan Hutchinson, and Dr. Tilbury Fox, were think that it was a skin disease sui generis having

no necessary connexion with either the anaesthetic or tubercular forms of true leprosy. Still the greater frequency of the

disease in India among the dark races, where it appears side by side with a great deal of leprosy, tends to justify further investigation as to its relation or non-relation to leprosy.

Mr. Howse, of Guy's, illustrated by means of a drawing the in which one of Baker's'lndia-rubber tracheotomy tubes

manner

had?during extraction for the purpose of being cleaned?broken off at the neck. The portion, an inch and a half long, left behind was out

NOTES FROM HOME.

(By a Correspondent on Furlough.) night I was present at a meeting of the Pathological Society, when a paper was read by Dr. George Johnson in reply to tlie doctrine of arterio-capillary fibrosis, in Blight's contracted or granular kidney, enunciated by Sir William Gull and Dr. Sutton at a previous meeting. These gentlemen regard the thickening of the arterioles and capillaries in this grave disease as being due to excess of fibroid material, the product of nuclear or cell growth, without any hypertrophy of the muscular element; whereas Johnson is positive in his declarations that the thickening is simply owing to increase or hypertrophy of the muscular Ihe

other

elements without any augmentation of the fibrous or fibroid The discussion was lively, heightened somewhat in matter. humour by a quotation by Sir William Gull from a French author, who was satisfied that both parties were in error. One important outcome of the papers and the discussion will probably be the demonstration that in many cases at least the contracted and granular kidney with albuminuria is merely one? perhaps the most grave?of the conditions peculiar to this malady, and that before it becomes confirmed it is preceded by other morbid states of the blood surcharged over long periods of time In a with the crude products of imperfectly digested food. conversation which I had with Sir William, he related a case which he had seen in consultation, in which the kidney mischief had not advanced to the production of albuminuria. He insisted on repeated examinations of the urine being made, and in a short time, albumen appeared. The family doctor one day called and told him that the patient had died suddenly, and requested him to guess at the cause of death, Sir William replied, apoplexy. This being the fact, the practitioner was surprised how he had arrived, as it were intuitively, at such au accurate conculsion. Whereupon Sir William declared that being certain the patient had had chronic morbus Brightii sudden death from apoplexy was, according to his experience, the ordinary or usual form of death, and hence the readiness of nis stating the exact cause of a fatal issue. There is reason to believe that increased arterial tension occasioned by the circulation of crude and unassimilable materials in the blood, is

one

of the constant precursors and concomitants of chronic

Blight's disease, and that the recognition of this fact by the physician may often enable him, by regimen, diet and drugs to purify the blood of its unhealthy material uud thus to pre\ent

drawn down to the bifurcation of the trachea, and fished successfully by Mr. Howse. It seems the India-rubber is

liable to grow brittle, and that much care and nicety are required to manufacture it, so that it may be devoid of this brittleness for a reasonable period of time. But to make assurance doubly sure, Mr. Howse

by having

a

has,

piece

I think,

of strong

improved upon Baker's instrument

canvas

inserted into the middle of the There is

India-rubber tube running almost to its termination. a

tube of

canvas

closed inside and outside with

a

substantial

covering of India-rubber. Thus the tube is materially strengthened, and as the India-rubber covering always cracks before the canvas gives way, sufficient warning is thus given to replace the old tube by a new one before any untoward accident has the chance of occurring. The adoption of the principle of flexibility in the tube used after the 48th hour is so important, and has already conduced so greatly to the conservation of human life, that its continuance is in every way desirable. Surgeons would have hesitated, however, to advise the employment of Baker's tubes by patients after leaving their supervision, unless security, against such an accident as happened to Mr. Howse's patient, could be guaranteed. Mr. Howse's improvement "affords this guarantee without interfering with the softness and yielding character cf the tube?properties which contribute materially to its being freely tolerated by the delicate mucous lining of the trachea. No inner tuba is required. It can be taken out, cleaned, and re-placed with the greatest ease. But as it causes little irritation it requires much less cleaning out than

a

do for

metallic tube.

Bengal,

In my

I do not know how the invention will experience, all kinds of India-rubber

so soon undergo deterioration there that the surgeon might hesitate to employ these tubes. If, by some means of storing, this molecular deterioration could be prohibited, the instrument might be as great an acquisition to the cabinet of the surgeon in Bengal as in London. A large proportion bf the unsuccessful cases of tracheotomy, prior to the use of this soft and flexible tube, proved fatal from the irritation caused by the unyielding metallic tube setting up ulceration of the tracheal cartilages and mucous membrane, and extending along this to the bronchial tubes and the lungs. By the use of the flexible tube this is obviated and an important factor in the mortality of tracheotomy cases reduced to a minimum. Every effort ought, therefore, to be made to obtain safe elastic tracheouse would lessen mortaltomy tubes for India; because their and feasible "which would desirable and render ity, operations otherwise not be attempted. A week ago Mr. Bryaut tied the superficial and the common

articles

THE INDIAN MEDICAL GAZETTE.

158

femoral; the former on. a case of popliteal aneurism ; the latter for fibroid enlargement, simulating elephantiasis of thigh, and leg in a girl. In the case of aneurism, both digital compression and the application of Esmarch's bandages had been tried with some improvement, but without success.

repeatedly The patient declined to suffer the pain of either means of treatment any longer ; and as the tumour at one part was close to the skin and threatening rupture or to become diffused underneath the skin, Mr. Bryant resolved upon delegation of the common femoral, which he accomplished in the usual In the case of somanner at the angle of Scarpa's triangle. called elephantiasis he delegated the common femoral so as to command control of the circulation fairly above the morbid or hypertrophied structures. The vessel when approached ceased for a long time to pulsate, and as it was lying fully three inches deep, much patience, skill, and care were demanded, before it was fairly secured. Mr. Bryant, however, with his usual dexterity and patience, declined to tie, until pulsation returned, as in this vessel, especially with its surroundings, pulsation is the best of all guides. It would have been much easier to ligature the iliac, but Mr. Bryant gave in a short clinique sufficient reasons for preferring in this case to secure the common femoral. I have said so-called elephantiasis, because in a subsequent conversation with Sir Joseph Fayrer, I learnt that in some of the cases termed elephantiasis in this country, the disease is not the same thing as we meet with so commonly in Bengal. When Mr. Byrant was giving his clinique, I drew his attention to the absolute absence of any history whatever of periodic recurrences of elephantoid fever, with lymphatic inflammation and erythema of the affected parts. This is a most important distinction. And it may be true that the view of Sir Joseph Fayrer that most, if not all, the cases of so-called elephantiasis originating in pure Europeans here, are mere hypertrophy of the skin and subcutaneous areolar tissue, is the correct one after all. Be this however as it may, Mr. Bryant related the history and progress of three cases, in all of which, remarkable benefit resulted from deleof the femoral. Mr. Bryant kindly invited me to help him with a case of

gation

ovariotomy in a woman aged 37. "When the tumour was exposed, it turned out to be a fibro-cystic growth of the uterus involving the interior of the organ throughout, with incipient The mass was as large as the gravid disease of both ovaries. uterus at the 6th or 7th month of utero-gestation. The wound was enlarged and the uterus and ovaries turned out, the vessels of the broad ligaments secured, and a strong clamp applied to the cervix; the growth exised including uterus and ovaries; the clamp holding the pedicle was left outside, and the wound carefully brought together with stitches, care being taken to include in them peritoneum and to have the omentum spread over the bowels lying beneath the line of incisions. Morphia suppositories were employed to relieve pain and to quiet peristaltic action. The patient was rather flabby and fatty, and the prognosis is, therefore, not so favourable as

could be desired.

It is rare to see an enormously enlarged spleen without malaria as a cause. There is a case, at present, under the Wilks, at Guy's, and with this condition, he care of Dr. has leucocythaemia. Wilks is of opinion that probably leuco-

seldom occurs in enlargement of the spleen from that it usually accompanies non-malarious splenic but malaria; enlargement, or what he terms, pure splenic hypertrophy. I have seen enlargement the consequence of malaria

cythtemia

splenic

"without any history of intermittent fever j but the occurrence of a large spleen, such as exists in this patient under Dr. ^Yilks, without is, I confess, new to me. Perhaps, the patient

malaria,

has been in some miasmatic district in England. Wilks says, No! He has for some time recognized this as belonging to a

class of cases, and his opinion is that the

splenic hypertrophy

[June 1, 1877.

has no necessary connection with malaria. On any question of pathology and the practice of medicine the opinion of Dr. Wilks must be received with the highest respect; but one could not help thinking that there was a tendency to underestimate the possibility of malaria even of the Thames in and near London.

London,

5th

April 1877.

along

the oozy banks

Notes from Home.

Notes from Home. - PDF Download Free
4MB Sizes 0 Downloads 8 Views