Billeder på siden

walls of left ventricle thickened to five-eighths of an inch. All the valves healthy and closure perfect, except the mitral, whose edges were thickened, but not sufficiently to cause much interference with its movements. All the cavities were filled with clots, those in the left heart being the most firin. Continuous with that in the left ventricle was a clot extending into the aorta and its branches, even to their smaller divisions. When drawn out, this clot was over five feet long, and showed branches whose extremities must have come from the radial and ulnar arteries as far as the wrist, and the tibial and peroneal arteries as low down as the ankles. The clot was firm and light yellow in color, and must have been at least twenty-four hours in forming. A similar clot was drawn from the vena cava, but it was neither so consistent nor so long as that from the aorta. Large deposits of adipose matter existed within the thoracic and abdoininal cavities; the heart was overloaded with it and the kidneys were surrounded with it. The mesentery was from a fourth to a third of an inch thick from the deposit of fat between its layers. The liver showed commencing cirrhosis but was not materially affected. The kidneys were both small and contracted, the right one especially presenting signs of fatty degeneration. Some urine drawn from the bladder during the examination contained albumen, but not in great quantity.-Med. Gazette.

Longevity and the Causes of Death.

A CORRESPONDENT of the Lancet, writing on Longevity, says: Dr. Allbutt is of opinion that, “setting apart accidents from without, all men die of old age.” It is quite possible that such a large interpretation may be given to the phrase “accidents from without," that Dr. Allbutt and myself may prove to be of almost the same way of thinking. The bearing of Dr. Allbutt's sentence, like that of the oracular Bunsby, lies in its application. If, as the result of "accidents from without,” Dr. Allbutt includes, as I do, the majority of the diseases from which we suffer, he and I are much of the same opinion. If he considers “accidents from without” as exceptional causes of death, and holds that the majority of human beings reach the term for which they were con. structed to last, and perish eventually from the simple effect of time upon their tissues, he holds an opinion from which I dissent.

We may perhaps allow, using the language of paradox,

that all who die of disease which is purely hereditary or innate, die of age, though their years may be few. They have become the victims of change which only required time for its development. The majority of mankind, however, inherit, not disease, but a liability to disease, and die at last because they are vulnerable, and circumstances adverse. They die from accident as much as if their bones had been broken, or their necks dislocated. This conclusion can scarcely fail to force itself upon the mind of any one who has had much experience in post-mortem examinations. Most human beings die before they are in any general sense worn out. Causes, often distinctly traceable from without, have set up in certain organs processes which break some link in the chain of vital action. This may, and often does, happen, while the general structure of the body is not appreciably the worse for wear. When a child dies of scarlatina, or a robust laborer of typhus, is it possible by any abuse of language to describe them as dying of age ?

All epidemic and all contagious diseases, including syphilis with its thousand consequences, are not necessary, but accidental, causes of death. How large a proportion of humanity do these kill? Further, how many persons fall victims to the consequences, perhaps remote, but none the less certain, of unhealthy pursuits and injurious habits? The Sheffield workman who dies at thirty of grinder's rot, the painter who gets granular degeneration of the kidney from the absorption of lead, the abuser of alcohol, who has before him a choice of evils—all these are the victims of accident, not of age. The same may be said of all in whom fatal changes are produced by the effects of weather and climate. How many persons dead of bronchitis, pneumonia, or even of phthisis, would still be alive were it not that at a certain time they were exposed to influences which, to use a common phrase, "gave them cold?” How many have died of the remote sequelæ of an attack of rheumatic fever, which under different external circumstances would never have occurred ? In all these cases death has resulted from external causes as much as if the victims had been crushed in the recent earthquake; and I might protract the list almost indefinitely. The further we search into the causes of diseases, the more examples we find of morbid changes which are traceable to influences acting from without. Ilaving excluded them all, we may say with Dr. Allbutt, “ the rest die of age."--Med. Record.

Remedy for Intestinal Worms.

MR. E. C. HASERICK, of Lake Village, Mass. (Boston Journal of Chemistry), a chemist of some note, who has spent considerable time in investigating the habits of intestinal worms in animals, states that worms in horees may be treated by simply keeping the external orifice well anointed with lard, and that this remedy will completely cure every case of worms in the intestines in one week. From his observation he is satisfied that worms in the intestinal canal cannot propagate their species without access to light and air, and the prevalent idea that the parasitic ovum is deposited in the mucous follicles of the stomach and intestines is entirely incorrect.

The intestinal cavities are not the natural breeding-places for any variety of species, and the instinct of the worm leads it to crawl to the anus, and then outside the folds of the sphincter muscle the eggs are deposited and hatched. The process is a rapid one, the egg requiring but five or six hours after it is deposited, to germinate and produce a new animal, which at once enters the intestinal canal as its natural feeding ground and home. As the life of the worm dves not exceed six days, he claims that if the eggs can be destroyed so as to prevent repetition of life, the animal will in one week be entirely free of the trouble, the dead worms passing away in the faces.

In pursuing his investigations regarding the habits of Worms, Mr. A. tried numerous agencies for an external application, before being sure of the virtues of lard for the purpose. He says he has observed the worms approach the external orifice, move about, and return to die, being unable to lay their ova upon the oily surface. No internal inedicine of any kind is necessary.

He also asserts that children can be relieved in the same way, by the application of lard to the anus.

The severe itching in that locality is caused by the parasites crawling to the surface to deposit their ova, and if this can be prevented, so that no new families may hatch and colonize, the old ones soon die out, and relief is given.-Med. Record.

Treatment of Diseases of the Ileart.

Dr. S. O. HABERSHON, Physician to Guy's Hospital (Guy's Hospital Reports, 1867), lays down seven principles of treat

ment for diseases of the heart: 1st. To lesson its work; 2d. To insure regularity of action in avoiding all excitement; 3d. To lessen the distension of the right heart by purgatives, diuretics, etc.; 4th. To prevent syncope attendant upon exhaustion; 5th. To strengthen the fibres of the heart by suitable out-door exercise; 6th. To prevent fibrillation of the blood by suitable remedies--for instance carbonate of ammonia; and, 7th. To prevent secondary complications, such as pneumonia, pleuritic effusion, etc.--Cal. Med. Gaz, N. Y. Med. Gazette.

On the Diagnosis of Accidental Hemorrhage from Placenta


Tue os nteri being unopen, and therefore a plıysical demonstration of the placenta impossible, any evidence by which we can determine between the two conditions mentioned at the head of this paper must be of valne: I speak of the diagnosis of placenta prævia from accidental hemorrlage in the later months of pregnancy.

We all know, who have had experience in midwifery, the soft, velvety, hot feel of a gush of uterine hemorrhage, when that takes place the land being in the vagina. It is from the character of the discharge we are to form our diagnosis in the present case.

In the case of placenta prævia-say at the sixth monththe discharge, if any, is blood “pur et simple," and on examination the vagina is most likely full of, or at least contains, clots. In a case of accidental hemorrhage, the discharge is liquor sanguinis, and the vagina free from clots; and it is easy to understand how this is. The blood in placenta prævia comes directly from the uterine or placental vessels, or both, into the vagina, and is there discharged as blood, leaving coagulations behind in the vagina ; whereas, in accidental hemorrhage, the blood before being discharged, has to find its way to the os ; separating the membranes as it comes down and depositing its fibrin, so that the discharge is liquor sanguinis, and the vagina is free from clots. How often, in a case of accidental hemorrhage arrested and gone to full term, do we not find, on the placenta being ex: pelled, a large mass of fibrin discharged with it (I have more than one in my possession, and have seen numbers). In like manner, after a confinement in which perhaps a small piece of membrane has been left behind in utero, serving as a nucleus, do we not find, the discharge “dirty water," as

the nurse says, the uterus large above the pubes, and the patient weak and blanched; the fibrin is deposited, and the liquor sanguinis discharged; and the mass, if allowed to remain in utero, prevents the proper contraction of that organ, and is often the precursor of disease, retroversion, &c., and may account for the moles, “false conceptions," &c., so frequently described. But this is scarcely belonging to my subject.

Finding no mention, then, in any anthority of this mode of diagnosis (one of many) between these most serious complications, and knowing, by experience, that it is fully to be relied upon, except in cases in which the placenta is very near the os, or the hemorrhage very profuse, must be my excuse for publishing these few rough notes.- Lancet.

Treatment of Vaginismus.

OF more than 100 cases of vaganismus that have fallen under the observation of Scanzoni Detroit Review of Medicine), he has been completely successful in the treatment of all to which he was able to give his personal attention, without in a single case having recourse to the knife. The first condition of success is complete sexual abstinence; for the first three or four days a tepid sitz bath should be used night and morning; warm local bathing with aq. Goulardi, or the same applied with lint, several times a day. Defecation must be regulated, and friction from motion carefully avoided. After a few days the sensibility of the parts will be so much allayed that a solution of arg. nitrati x.-xx. grs. to 3j. may be applied with a brush. After about eight days' continuance of this treatment, vaginal suppositories of ext. belladonna and cocoa butter may be placed behind the hymen and in contact with it, daily. These remedies, either alternately or simultaneously, must be continued until every trace of inflammation has disappeared, and the normal sensibility is restored. Generally two or three weeks will be required to attain these objects. Then dilatation must be commenced, but for this purpose sponge tents are useless. A graduated series of milk-glass conical specnla are best adapted to this object. After the first slightly painful attempt, the patient will generally be able to introduce it with facility, and it may be allowed to remain from one-half to one hour. Even when the hymen remains it will not be necessary to incise it, as dilatation can be effected withont recourse to that meas.

At first the dilator may be used every two or three


« ForrigeFortsæt »