Read before the Suffolk District Medical Society, Sept. 24th, 1870.J. S., of Irish parentage, five years and two months old, was admitted into "The Children's Hospital" on the 2d September, 1870. To the age of three years ho was quite a healthy child, but at about that period he began to move and act as though he had less strength than usual, and by degrees his mother came to acknowledge that such was really the case ; this condition increased and the spinal column became very weak, and the " inward crook " of it was noticed by her.. Two weeks before admission ho had a whitlow upon the fore-finger of his left hand, and one week before, he had a fall while attempting to run upon a sidewalk ; from the first event the mother dated the special failing of his health, which she thought was increased by the second, and the evident decrease of his vital powers induced her to seek for him the benefits of the Hospital. When first seen by the writer, the child was sitting in a corner of his bed, a soft pillow being behind him, he being in such a position that if a line had been carried from-the end of tho spine, over it, to the back of his head and continued on the same curve, it would have formed a circle, or nearly so.On tho day after admission, Dr. Webber saw the patient with me, and at once recognized the disease* Wo caused him to stand upon the floor, and he walked a few steps in a tottling or shambling manner. The spine presented a regular and exaggerated curve inward, from the third or fourth dorsal vertebra to the sacrum. This shape comes well under the name given by Duchenne-"saddle-back." A perfect nieturc of this child may bo seen in Duchenne's book, electrisation localisée, 2ud edition, 1861, p. 355. The head, while he was standing, and indeed while he was in any position which might have been called upright, gave to the spectator tho idea that it was large and heavy, for tho chin rested upon the sternum, and was inclined moro to the right shoulder than to the left. A copy from Duchcnne is presented.The muscles of the calves were largely developed, and the nates seemed to be so.
the vital forces, in which depression, of course, the muscular system largely participated ; while thus relaxed the replacing efforts were made, and it must be acknowleged that something waB gained and some replacements easily accomplished. But it was noticed that however faint and relaxed the patient might seem to be, as soon as the first attempts at reduction were made, the muscles were excited to resistance, and it soon became evident that we had not removed but ouly diminished the resistance which we desired to abolish. While cousciousneBB remained, and the spinal reflexes were not abolished, no method we were acquainted with would altogether prevent muscular resistance ; and sometimes, to our chagrin, the harsh and spoliative methods above mentioned, proved perfectly unreliable and unsuccessful in the very cases where we expected most from them. It is only when we compare the ease and promptness with which, under ether, we now reduce by manipulation alone a dislocation of the femur or shoulder, with the former laborious, tediouB and painful efforts with pulleys and straps, that we fully appreciate the great blessing of anesthesia in enabling us to abolish all opposition from muscular action iu the class of cases now under consideration. It seems as if we might fairly say that anesthesia, in this class of cases, is the most direct and positive addition to our surgical resources that the century has produced. For while all heartily concur in glorifying anesthesia as the aiuiihilator of pain in surgical operations, in no department can it claim so direct a share in the success of the surgeon's efforts as in this, and in none does it form so essential a part of the successful procedure.Iu conclusion, I cannot refrain from relating a circumstanco in this connection which gave us no little anxiety and annoyance during the reduction of a luxation of the hip, but which caused us all to smile when the procedure was over. During my term in the hospital we had come to rely for the relaxation of resisting muscles, on the introduction into the rectum of a small but strong iufusioii of tobacco. This usually produced its effect in«a few minutes, and was commonly followed by a depression and relaxation which was eminently favorable to our purpose; but the reduction being accomplished, perhaps, in a few minutes, the action of the tobacco continued for an hour to affect, and sometimes very seriously to depress the patient. We had come, therefore, to the plan of introducing into the rectum a cigar, instead of the more rapid and abiding infusion. This cigar had a string tied around its big end to enable us to withdraw it, and then being dipped for a moment into hot water was introduced by the small end into the rectum.The object of this plan was to enable us to remove the tobacco as soon as we had no longer any occasion for its effects. The case in question was that of a man with a dislocation of the femur, in which the pulleys and counterextending bands being all prepared, the cigar was introduced as usual, and we waited a few...
Whether wc have genius to originate new methods of treatment of disease, or industry and acumen to gather from masters, or from those whom we may consider such, their propositions and dicta, and so adapt them to the cases which present themselves to us for our care, I presume the accumulation of testimony as to the efficacy or inertness or actual harm of certain methods or materials used, is a positive benefit to humanity through our profession. In this communication there will be nothing original, but what is written has been put to the proof. Of the cases of consumption that have been under my charge within or during the past ten years, I have selected two to report tonight which are the opposites of each other ; the first is somewhat at length, the second in brief, and they form the basis of my subject. In February, 1855, Mrs. B., an Irish widow, resident in this country for fifteen years, and for six or seven of them in Winchester, about 45 years of age, mother of several children, came under my care. She had been a rather hard-working woman all her life, but has always been ablo to " pay her way and get along comfortably " ; "has enjoyed a fair degree of health up to New Year." About the first of January, after imprudent exposure in sloppy weather during Christmas week, she was seized with " chilly turns " and pains in limbs and chest, with, at first, moderate cough, which became, during January, irksome by night as well as by day, with failuro of appetite and irregularity of bowels and loss of flesh and strength. I found her in bed, presenting plumpness of body and limbs, but not firmness of flesh, with considerable emaciation of temporal region and cheeks, which latter were flushed during the first part of my visit and became rather pale during the remainder; the eyes glistening, sclerotica pearly ; tongue not clean ; pulso 114 at first, after
October 4, 1872, I was called to see Mrs. G. and attended her through a miscarriage. December 9th I was called again on account of excessive flowing, which had continued more or less since her miscarriage. It was at this time that she drew my attention to a trouble with her bladder, from which she had suf-, fered for years. I learned the following concerning her previous history : She was thirty-one years old ; her father died in California at the age of ninety-eight from the results of vaccination ; her mother at the age of forty-five at the City Hospital after an amputation of the thigh, for disease of the knee-joint ; she had four brothers and two sisters in good health ; one brother had recently died of consumption. She was married at the age of fifteen, soon after her first menstruation. The menstrual discharge has always been profuse. She has had two children and two miscarriages. Her labors were natural.In 1859, about two years after marriage, she began to suffer from frequent aud painful micturition, which became so distressing that she finally submitted to an examination, which disclosed a uterine polypus as large as a good-sized orange; this was removed by Dr. Storer, and she regained perfect health.In 1864, while sitting in a chair partially asleep, and resting the left side of her head on a table, she was struck from behind a severe blow on her right side and back with a chair. This blow was followed by severe illness, which obliged her to keep her bed for several days ; she had great pain and soreness in the region injured, from which she never entirely recovered.In March of the next year, 1865, on stepping from a horse car, she was seized with intense pain in the region of the right kidney ; it was with great difficulty that she could be got home and into bed. The pain extended down the thigh and leg, and was so severe that morphia in large doses failed to control it, and she was kept for hours under the influence of ether; she had constant nausea and vomiting, aud frequent, painful, and scanty micturition. She was confined to her bed for three weeks, and it was five weeks before she could use the right leg. She slowly recovered, but for more than a year at each menstruation she had a return of her distressing symptoms. She has never been free for any length of time from trouble while urinating. Some time iu 1869 or 1870 she first noticed, in addition to the brick-dust sediment, which was almost constant, a deposit of thick white matter in the chamber ; her distress increased rapidly, and finally the desire to pass water was so frequent at night as to seriously interfere with her rest, and she would frequently find herself asleep sitting on the vessel ; she could relieve herself by pressing with her hands over the bladder, and forcing out what she said looked more like white soft soap than anything else. When about the house, she wore a napkin constantly. What follows is from notes.December 10th. An examination of the urine 1 Read before the Surgical Section of the Suffolk District Medical Society, ...
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