546

had a small abscess on the labium, externally, which was nowwell. She complained of frequent desire to make water, withpain on doing so, and inability to retain the urine long. Shehad also a bearing down pain, but no prolapsus uteri. I hadno opportunity of examining the condition of the vagina, as towhether there was any prolapse of its walls, or hernialtumour, or uterine prolapse, in its cavity.

I have brought this case forward on account of the rarity ofthe curious accident which was so nearly proving fatal; andalso as an instance of the wonderful rallying powers of Natureafter severe losses of blood. The source of the haemorrhagemust either have been from the extreme end of the pudic veinitself; which, in the position of the wound, might possibly beinjured by a force compressing it against the pubic arch; or, ifnot from it, from one of the many veins which surround thevagina in a plexiform manner, previous to terminating in thebranches of the internal iliac.Bishopsgate-street Without, December, 1854.

Medical Societies.

HARVEIAN SOCIETY.

THURSDAY, DECEMBER 7TH, 1854.MR. COULSON, President, in the Chair.

MR. URE mentioned the particulars of a case ofCOMPOUND FRACTURE OF THE LEG,

which had been under his care in St. Mary’s Hospital. A

young and healthy-looking man, twenty-eight years of age,was brought into the hospital on the 24th of July, 1854, havingshortly beforehand sustained a compound comminuted fractureof the right leg. About three inches above the instep was anirregular gaping wound, nearly two inches long and one inchbroad, from which there was a discharge of blood. On gentlyintroducing the finger, it was ascertained that the tibia wasbroken obliquely about its lower third, and lying bare in thewound; while the fibula was shattered an inch and a-halfhigher up. For the space of upwards of four inches above thewound, the integuments were completely separated from thesubjacent structures. The accident was caused by the fall ofa heap of clay and rubbish, weighing eight tons, upon thelimb, while the man was standing with one leg before theother. When Mr. Ure saw the patient, not long after ad-mission, his countenance was good; pulse 108, soft; surface ofthe body natural; he did not complain of pain. The prominentsurgical features of the case were, comminuted fracture of bothbones of the leg, a bleeding wound communicating with thefracture, and extensive separation of the integument from itscellular connexions. The heamorrhage was stanched by theintroduction into the wound of a dossil of lint, soaked in asolution of perchloride of iron. Taking into consideration theage of the individual, the apparent soundness of his constitu-tion, and the fact that the haemorrhage had been stopped, Mr.Ure determined to use his best endeavours to save the limb.The fractured ends of the bone having been carefully adjusted,and a bandage applied, so as to maintain the loosened integu-ment in apposition with the subjacent parts, the limb wasplaced on a double-inclined splint. The patient was orderedordinary diet, with four ounces of sherry daily; ice to allaythirst; and an opiate at bed-time. On the 27th of July, assloughing had commenced in the part, he was allowed, besidesthe wine, a pint of porter every day. On the 31st of July, thesloughing process had ceased, as shown by a limitary lineround the margin of the wound; the surrounding integumentappeared natural. The patient felt well in health; hiscountenance was cheerful; appetite good; sleep sound; skincool; tongue clean; pulse soft, 120 in the minute. On the3rd of August, about a square inch of denuded bone wasvisible in the cavity of the wound; the discharge from thelatter was serous. The process of granulation was advancingsteadily from the circumference towards the centre. By the9th of August, the wound was nearly covered with granula-tions. The general health of the patient was satisfactory.The limb was placed in a suspensory fracture apparatus. Onthe following afternoon, the man was seized with acute painof the right side, aggravated on full inspiration; the tonguewas brown, but moist; there was urgent thirst; hot skin; thepulse was 108, full; the pain became so severe that night as toprevent sleep; the surface of the wound was rather dry and

glazed. This attack yielded to the application of leeches andcupping, followed by the exhibition of James’s powder, so thatin two days the man was convalescent. By the 24th of thesame month, the sore was reduced to one-third of its originaldimensions, and looked healthy. A month later, the sore wasnearly cicatrized. The limb was encased in pasteboard withstarched bandages, a small aperture being left, to permit theescape of any discharge. Before ten days were over, the mancould move about the ward with the aid of crutches. Aboutthis period, a splinter of bone, of irregular shape, not abovehalf an inch by a quarter of an inch in size, and half a linethick, exfoliated; after which the part rapidly healed. Heleft the hospital cured on the 2nd of November last. Mr. Ureexpressed his conviction, that had the posterior tibial arterybeen wounded in this case, the limb could not have been saved.He adverted to the fact of the minute extent of exfoliation.Considering how much of the surface of the tibia had been laidbare, he deemed it a most fortunate circumstance that,within little more than three months after the receipt of a.

serious injury of this nature, the man was enjoying good health,and able to move about with tolerable ease.

Mr. WEEDON CooKE exhibited a specimen of the uterus andbladder of a young married woman, aged twenty-nine, affectedwith scirrhus, in which was seen a large vesico-vaginal fistula.The disease commenced three years ago, after her confinement.

Mr. W. J. ANDERSON brought forward aNEW FORM OF PESSARY.

He, in the first instance, alluded to the old boxwood ballpessary, stating its good qualities, and the efficient support itaffords in cases of procidentia uteri; and then pointed out someof its imperfections, showing that the cavity of the instrumentoften becomes filled with the vaginal and uterine discharges, asthey do not pass through it, but between its external surfaceand the internal surface of the vagina; if it fitted firmlyenough to prevent this, it must produce injurious pressure, andprobably sloughing, if left in long enough. Such being the case,it occurred to him (Mr. Anderson) that an instrument might bemade, of the same shape, able to give the same support, butsufficiently elastic to avoid all pain when passing in and out ofthe vagina, equally light, if not lighter, and incapable eitherof becoming saturated with the discharges, or of retainingthem in its cavity. For this purpose, he showed a permanentair-ball pessary of indiarubber, made by Mr. Clarke, 225,Piccadilly, which was calculated to answer all the good purposes of the other, and avoid all its imperfections, it beinglight, elastic and firm, filling the vagina, without producinginjurious pressure, and beautifully clean, from the fact of itsbeing waterproof even to its string.

Dr. SIEVEKING then read a paper on some

CASES ILLUSTRATIVE OF SOME POINTS CONNECTED WITH THEPATHOLOGY AND TREATMENT OF EPILEPSY;

and commenced by alluding to the centric and ex-centric natureof the complaint. He did not, however, look upon it as adisease, but as a symptom. Several illustrative cases werethen mentioned, and especially one occurring after a mildattack of scarlatina, in which the fits were very severe, andwere stopped by the employment of anodynes. A table of caseswas next brought forward, to show the predominance of theaffection of the left side during the fit. Dr. Sieveking thenspoke of the use of the cotyledon umbilicus in the treatment ofthis affection, and brought forward several cases in proof of itsbeneficial effects. It was described as producing a slightlysedative and diuretic action, though its exact modus operanandihas not yet been discovered; it, however, appeared to him toexercise some control over the disease, and, at the same time,was innocuous to the constitution of the patient.

WESTERN MEDICAL AND SURGICAL SOCIETYOF LONDON.

SATURDAY, DECEMBER 2ND, 1854.DR. BARCLAY, Vice-President, in the Chair.

SEVERAL gentlemen were elected members of the Society.Dr.BAINES then read a paper on

DIURETICS, AND THEIR USES.

After some introductory remarks, he divided diuretics into twoclasses-the direct and the indirect. The direct were consi-

547

dered as local stimulants to the kidneys, their active principlesbeing conveyed by the capillary circulation to the glands, andthereby exciting them to increased action. Some directdiuretics excite the same action by being excreted entire bythe kidneys, as is the case with nitrate of potassa, which salt isalways found to be thrown out of the system in the same pro-portion as it has been administered. Other salts of this class,however, experience some change and re-arrangement of ele-ments, and are presented to the kidneys in different states tothose in which they were administered. Thus the acetates ofthe alkalies invariably become converted into carbonates, andin this latter state of chemical combination produce their

stimulating effects upon, and are excreted by, the renal

organs. Analogous facts were mentioned as occurring during the administration of mercury, when the bile has been foundto contain traces of the mineral; and also that ether andalcohol are found in the brain, an organ upon which theirspecific effects are produced. In the case of indirect diuretics,however, the case is different, their effects being caused throughthe system generally, rather than by any positive action on theglands in question. Some of these produce diuresis secondarily,the primary effect being manifested on the absorbent systemgenerally, whereby the blood becomes charged with water, andthe kidneys then are called upon to excrete it from the body.Mercury and iodine were adduced as examples of this class.Other indirect diuretics act primarily on the stomach, andsecondarily on the kidneys, this end being accomplishedeither by lessening arterial action, and thereby promoting ab-sorption, or by increasing the quality of the blood, and socausing the kidneys to share in the general improvement of thebody. Examples of this kind of action were seen in the effectsof digitalis, and in the preparations of iron. The beneficial,effects of digitalis in cases of dropsy were then discussed, aswas also the necessity of relieving the portal system, in caseswhere the liver and its veins are gorged and congested, beforewe "could hope to rouse the renal glands to increased action.Colchicum, mercury, and taraxacum were instanced as exam-ples of diuretics acting indirectly by relieving the portal con-gestion, if present. The circumstances modifying the action ofthese remedies were stated to be :-1. The state of the skin, aprofuse perspiration preventing the establishment of a fulldiuresis. 2. Active catharsis suspends the operation of thekidneys, by diverting the fluid of the system from the kidneysto the intestinal glands; a good instance of the kind beingseen in Asiatic cholera, where the kidneys do not and cannotact, simply because all the fluid of the body is evacuated bythe stomach and the bowels. 3. No obstruction must exist inthe course of the intestinal canal to prevent the flow of themedicine swallowed, as shown by Dr. Barlow. 4. If there beextensive disorganization of the kidney, the due secretion ofurine cannot take place. 5. If the anasarca or ascites be veryextensive, the pressure consequent upon it acting on the veinsand lymphatics prevents the absorption of the remedies or ofthe fluid to be evacuated-in these cases tapping or punctu-ration of the limbs must first be resorted to, and then, byremoving the pressure alluded to, allow of the removal of thedropsy by diuretics. The subject of the dilution of the salinediuretics was then alluded to, and as their absorption was con-sidered to depend upon the ordinary principles of endosmoseand exosmose, the opinion that, to be absorbed and so act asdiuretics, these remedies must be so far diluted as to be belowthe specific gravity of the serum of the blood, was upheld ;otherwise, in place of a diuretic action, a purgative effect wouldbe produced. The effects of acetate and bitartrate of potassawere instanced as bearing out this view. Blood depuration bythe kidneys was then considered, and viewed as possible insome cases. The various cases in which the blood in disease is,by means of the kidneys, thus depurated, were then mentioned.Thus in jaundice, where the flow of bile or its secretion is in-terfered with, the urine is often found charged with it, and bymeans of this secretion it is removed from the system. Again,in cases of portal congestion, the urine is often found loadedwith purpurine ; and, in extensive pulmonary disease, Dr.Hassal has detected indigo in the urine, both of which com-pounds are highly rich in carbon. In health, the solid contentscan scarcely be increased by the administration of diuretics,their effects being confined to the increase of the water only ofthe urine. Thus, if nitrate of potassa is given in a healthystate of the system, we shall find that in the urine secreted theamount of solids excreted only exceeds that under other cir-cumstances by the amount of the salt exhibited, the whole ofwhich passes out of the system by this secretion. This result,too, would be expected, when we remember that in health thetwo processes of repair and waste go on pari passu in direct

relation to the wants of the system, and that, consequently,we cannot expect to do more than increase the fluids, withoutaffecting the amount of the solids, of the urine. But in disease,where the whole animal economy is involved, and sufferingfrom the various effects of faulty assimilation in pervertednutrition, it is possible that some of the morbid elementsmay be removed by the action of diuretics, as we know thepoison of lead is eliminated by the kidneys by the action ofiodide of potassium. The diseases most likely to be thusbenefited are gout, rheumatism, scrofula, and some, perhapsall, kinds of fever. In confirmation of this view, the treat-ment of rheumatism by acetate of potassa and nitrate ofpotassa, and the general good results obtained by the admi-nistration of the former salt in cases of ague, as reported by Dr.Golding Bird, was adduced. In the latter case, the quantityof solids excreted fluctuated with the occurrence or non-occur-rence of the ague fits. The salts most likely to produce thiseffect in the system are those which are known to exert che-mical changes in albumen and albuminous tissues.’ After some discussion on several points, the Society adjourneduntil January 19th, 1855, when Dr. Cumming will read a paperon "A Case of Disease of the Heart, in which the Dropsyalternated with Symptoms of Mania."

Reviews and Notices of Books.

Lectures on the Physical Diagnosis of the Diseases of the Lungsand Heart. By HERBERT DAviEs, M.D., Physician to theLondon Hospital, &c. &c. Second Edition. London. 1854.pp. 364.

WE are glad to draw the attention of our readers to this newissue of the very able treatise of Dr. Davies. For the studentwe know of no better manual, and the older practitioner willlearn much that is interesting from the physiological portionof the ’Lectures." It is perhaps the most facilely readableof all our manuals on the sp6cialiti of which it treats. In

addition to the alterations due to the progress of physicaldiagnosis during the last three years, the author has inserteda chapter in the present edition containing a resumé of theMorbid Anatomy and Corresponding Physical Signs of theDiseases of the Lungs, which will be found an admirable re-fresher to the memory. A lecturer on Medicine has here hisnotes ready-made for him; he wants, or should want, nofurther assistance in the class-room.

Painless Tooth Extraction without Chloroforrn. With Observa-tions OM Local Anaesthesia by Congelation in Genwal Sur-gery. By WALTER BLUNDELL, Surgeon-Dentist. London.1854. pp. 64.

THOUGH written in too party a spirit, Mr. Blundell’s tractmay be recommended to perusal as containing much interesting matter. Dr. Arnott’s proposal to produce temporary annihi-lation of local sensation by intense cold was at first disre-

garded ; but now almost every day furnishes us with some tes-timony of its value. We have no doubt the method here pro-posed will become still more general in respect to the minorand superficial operations, and it may be applicable, for aughtwe know, in the practice of dentistry. Nevertheless, we shallrequire far more evidence than at present exists in support ofits power of curing (!) cancer, its availability where deep in-cisions have to be made, and of its never-failing immunityas respects the devitalization, &c., of the tissues, to which it isapplied. Mr. Blundell has invented a particular apparatus forthe production of intense cold, capable of producing it in verylimited spots, and such as are difficult of access. Stumps andlarge molars are removed, according to the author, without theleast inconvenience.

Gas Poisons and their Remedy. Reprinted from the bliniiagJournal. London. 1854. pp. 23.

LIKE the pamphlet just noticed, of too exclusive a tone, yetaffording information every gas consumer should be acquaintedwith.