was extravasated into the cavity of the abdomen; and a few hours after the patient died. Upon examination after death, the prostate gland was found of the size of a child's head, but its substance was very much of its natural density. A tumour had formed on its under part, and projected into the cavity of the bladder. It pressed so much on the sacrum, that there was scarcely any room for the passage of the fæces. It had enlarged unequally at the sides of the urethra, by which, as well as by the tumour at its inferior part, obstruction was occasioned to the introduction of a catheter into the bladder, and to the direct transit of the urine. There was a false passage through the under portion of the prostate. In this case the mesenteric and the lumbar glands were enlarged; and one of the latter was converted into a mass of complete scrophulous matter. The bladder was thickened and highly inflamed, and almost in a state of gangrene; and a portion, of about the size of a shilling, at its upper part, had sloughed away, through which the urine had been extravasated. The death was produced by an excessive degree of peritoneal inflammation, which came on immediately after the extravasation of the urine." This affection of the prostate gland sometimes occurs, though under a less severe form, in young men of a scrophulous habit. It is generally attended with a great deal of irritation about the urethra and neck of the bladder, and by gleet, which is much increased by sexual intercourse. It commonly gets well by tranquillizing the constitutional disturbance, making use of mild local applications, and occasionally introducing a bougie, for the purpose of removing the frequent desire of voiding urine, which so often attends this complaint. When scrophulous abscesses form in different parts of the prostate, the matter sometimes makes its way into the bladder, near the urethral origin. Sinuses are thus left in the substance of the gland; and through these the urine insinuates itself into the cellular texture, around the anus and perineum. This accounts for the successive production of urinary abscesses, when there is a pervious state of the urethra, and they have not been preceded by retention of urine. Their treatment involves a two-fold object-immediate relief, and an ultimate cure. The former requires puncture of the bladder; a judicious use of the bougie will fulfil the latter intention. The important divisions of our author's work, embracing osseous, articular, and visceral scrophula, we must reserve for our next number.. Our readers are aware that we rarely divide the analysis of a work into two articles-and never unless there be such natural or artificial divisions in the work itself as will permit this separation without injury or inconvenience to author or reader. Under these conditions we take leave to stop here, for the present; and shall finish with a comprehensive review of the remaining subjects in our next. XI. Supplemental Review AND QUARTERLY PERISCOPE OF PRACTICAL MEDICINE, SURGERY, &c. &c. WITH COMMENTARIES. Paucis libris immorari et innutriri oportet, si velis aliquid trahere, quod in animo fideliter hæreat. SENECA. Duo vitia vitanda sunt in cognitionis et scientiæ studio. ***** Alterum est vitium, quod quidam nimis magnam operam conferunt in res obscuras atque difficiles, easdemque non necessarias. CICERO. 66 66 In opening our periscopic budget for this quarter, we shall quote a passage from the second volume of LACON, recently published. It is not inapplicable to our present purpose. "An æra," says the author, "is fast approaching, when no writer will be read by the great majority, save and except those, who can effect for bales of manuscript, what the hydrostatic screw performs for bales of cotton "--by condensing that matter into a period, which before occupied "a page." * The able author of Lacon goes on to state that, "he "has attempted to make an intelligible book, capable of doing some good to that valuable class of the community who have other things "to do, as well as to read; and who, when they snatch a few hours "from their occupations to devote to literary pursuits, must necessarily prefer that book which affords them the most knowledge, and "takes from them the least time."+ If these observations are applicable to the community at large, they are peculiarly so to the class of medical society, whose daily avocations are of the most harrassing nature, and whose "literary pursuits" are not merely recreations that may or may not be indulged in, but essential requisites for the invigoration of their intellects and the performance of their duties. The farther we proceed, the more convinced we become of the great importance of this feature, (Quarterly Periscope), in a periodical Journal of Medical Science. But to make it practically useful, we find it necessary to restrict it within a certain range. Were we to attempt a general view of all that is going on in the medical world, we should 66 * Lacon; or Many Things in Few Words, Vol. II. p. 91. then, do little more than tantalize our readers with a steril catalogue of "insubstantial pageants," that would scarcely leave a single imprint of practical precept on the mind. Of those subjects then, which we notice, we shall endeavour to convey a clear idea to our readers -and more than this, we have neither inclination to promise, nor time to perform. It has been but too remarkable, of late years, that the taste of the present times does not lead many practitioners to contribute to the monthly medical journals, as was formerly the case. Into the causes of this change, we do not think it necessary to inquire; but we regret the fact, and we should be glad to see things come back once more into the good old channel. When a man contributes a paper or an observation to a periodical journal, his wish must naturally be, that it may obtain the greatest possible publicity. As a stimulus to the said contributions, we promise to notice in our Periscope, all the more interesting papers in the original departments of our cotemporaries; and we need hardly observe that, in this way, they will not want for publicity. Neither need the contributors be apprehensive. of that personal and malignant criticism, which has too often disgraced the periodical press in all countries. Candid commentary will be occasionally indulged in-waspish censure never. 1. Tic Douloureux.* A poor woman experienced the miseries of the damned, (if indeed the inhabitants of the nether world are subject to nervous disorders) for 20 years—that is, from the age of 50 to that of 70, with tic douloureux. She was blistered, purged, salivated, leeched, carved from ear to ear, where there were nerves, and we had almost said, where there were no nerves; poisoned with arsenic, greased with belladonna, conium, tar-varnish and soap-lini-ment-narcotized with opium-carbonized with iron-rust--edentified by the tooth-drawer-and all with scarcely a mitigation of her dreadful sufferings! At length, upon minute investigation, it appeared, that the alvine evacuations had long been in an unhealthy state" sometimes scanty, dark-coloured, and scybalous-at others, profuse, acrid, and mottled-her appetite either voracious or the reverse-her tongue furred-pulse feeble and quick-skin alternately affected with chills and hot flushes her nights tormenting, and her days but little better." She was first put upon the constant use of the mildest aperients until the evacuations were improved, when a strong decoction of cinchona infused upon quassia, was regularly taken in as full a dose as the stomach would admit, exhibiting, at the same time, a grain and a half of pure opium twice a day, constipation being guarded against by sulphate of magnesia. In this way, some ground was gained; but still the patient's sufferings were great. It was, therefore, determined again to have recourse to arsenic, be * Mr. George Nesse Hill. Ed. Journal, No. 71. ginning with doses of three drops of the arsenical solution, and gradually increasing it to twelve drops thrice a day, omitting the opium, except when severe paroxysms occurred. When arrived at nine drops, she was better, and expressed confidence in the plan. At the end of a month, being free from pain, and the system being evidently under the influence of arsenic, its further use was discontinued gradatim. She continued well for several weeks, until the bowels again became irregular. Then a ptyalismic soreness attacked the mouth. Twitchings soon followed-and lastly, a bearable degree of the old evil. But, on regulating the bowels and returning to the solution, all was speedily corrected, and the medicine a second time left off. Three months afterwards, the bowels were much affected with diarrhoea; but no shocks of the old misery returned. She is now in good health and spirits. Long may she remain so, pray we! But we have seen and known several instances of this deceitful remission in tic douloureux, and, therefore, we are doubtful of cures till many months have established their solidity. We have long observed that, although violent pain of a part, generally manifests itself in that part; yet, protracted irritation of a nerVous structure, more usually shews itself at a distance-and that, sometimes, with excruciating agony. Tic douloureux exemplifies this remark. How rarely is the cause of the pain seated in the nerve which expresses it! The splanchnic nerves being devoid of common sensibility, seem, very generally, to manifest their irritation through the medium of one of the common cranial or spinal nerves. Many of our readers may remember some notice which we published, in the 7th No. of our last, or Quarterly Series, (January 1820,) of a gentleman afflicted with dreadful tic douloureux in the ancle. We lost sight of him for a considerable time, after prescribing gentle and mild aperients, with a slight mercurial alterative, (four grains of the blue pill and four of rhubarb,) twice a week. We directed him, after persevering in this plan for a good while, to take five grains of the oxyde of bismuth three times a day, for two, three, or four weeks. We met him in the street about a fortnight ago, in comparatively good health. His old enemy now troubled him but seldom, and then with greatly mitigated violence. He still persevered with gentle aperients, and occasionally the blue pill. In a conversation which we lately had with Sir Henry Halford, on the subject of this complaint, that experienced physician mentioned several remarkable cases, many of them in high life, where it ultimately turned out, that some bone was diseased and kept up this sympathetic irritation in the fifth pair of nerves. This hint ought to be borne in mind, and may induce medical men to make particular enquiries of their patients whether they have had falls, or other accidents that might be likely to injure some part of the bony structure, or render it carious. One of the cases mentioned by Sir Henry Halford, was that of an officer who had lost a limb, and afterwards became affected with neuralgia facialis, which nothing could make an impression on. At length, a piece of bone exfoliated from the stump, and the neuralgia disappeared. Vol. III. No. 9. 2A 2. Cephalitis. Dr. Blicke, a zealous practitioner, has related an interesting case of inflammation of the brain, with disorganization of the corpora striata, and lastly, effusion of blood. The patient was an unmarried lady, 33 years of age, who had laboured for some years, under, what were termed, dyspeptic and bilious complaints; but, without any very manifest advantage from medicine. On the 21st November, Dr. Blicke was called to the patient, and found her complaining of great head-ache, attended with a train of dyspeptic symptoms. The pulse was 120, small, contracted, and weak. Venesection was proposed, but not acceded to. Regulated diet, alteratives, and enemata were prescribed: and under this treatment, the patient apparently got rid, not only of the head-ache, but of all the dyspeptic symptoms. On the 8th December, she complained of sore mouth-a crop of aphthæ appeared-and the bowels evinced an affection of the same kind, pervading their internal surface. These symptoms yielded to bark, cordial diet, and warm laxatives. At this time, however, Dr. Blicke perceived a quickness in her answers, attended with unusual irritability. Notwithstanding the use of aperient medicines, local evacuations, saline mixtures with antimony, and gentle sedatives, this irritability increased, the celerity of the pulse was on the advance-and her nights were restless. Dr. W. Philip met Dr. Blicke in consultation; at which time the patient was incoherent-the tongue red and glairy, with fur towards the centrepulse 130 and small-slight pain and weight in the head-stools dark and offensive. Leeches were again applied to the foreheadsaline mixture with hyoscyamus internally. She died that night, being about the 20th December. Dissection. A small clot of blood was found between the dura mater and tunica arachnoidea, over the right and posterior lobe of the cerebrum-about an ounce of apparently arterial blood rested on the tentorium. The effusion could not be traced to any evident rupture of a blood-vessel. There were a few opake spots in the arachnoidand on the top of the left hemisphere there was a piece of coagulable lymph, the size of a shilling. The sectio ovalis exhibited those numerous red points usually seen in inflammation of the brain. The lateral ventricles were somewhat distended with a reddish turbid The right corpus striatum was harder than usual, "and had evidently a scrophulous appearance, with a cheese-like feel.” Here a small excrescence, about the size of a very large pea, exhibited an apparent ulceration in its centre. The left corpus striatum was softer than usual, "and on cutting into it, an abscess was perceived, containing a small quantity of pus." The villous coat of the stomach, duodenum, and jejunum, was highly vascular. The pylorus was considerably constricted and indurated. serum. This case shews the obscurity, treachery, and fatality, of affections of the brain. The subject will undergo ample discussion in our next number. * Med. Repository, March, 1822. |