1
257 phalanges. At the end of the fourth day formidable symp- toms, both local and general, had manifested themselves. The I carpus and entire forearm were swollen, painfully distended, and intensely red. There was no fluctuation. M. Richet opened the little wound on the thumb. A small quantity of I pus exuded. The Professor expressed his conviction that the sheath of the tendon of the flexor pollicis had been injured, ’ and was full of pus. A general and local treatment was adopted. Among the topical applications, a large blister was applied to the tumefied region. M. Richet states that he has seen admirable results follow the application of a blister in profound phlegmon. It gives considerable relief to the patient, sometimes brings on resolution, and limits the purulent col- lection. M. Richet showed how different had been the progress of the disease in the two cases. A simple puncture of the thumb had determined extensive and formidable inflammatory symp- toms ; whereas the whitlow, after having produced necrosis of the three phalanges, had presented comparatively slight danger. No infectious matter had been observed through the puncture in the thumb, as the extent of the lesions and severe general symptoms (delirium, &c.) might have led one to suppose. The difference between the two cases took its rise solely from the anatomical disposition of the parts. "The tendons of the flexors of the fingers are enclosed in serous sheaths, which facilitate their sliding. The sheaths of the index, medius, and annular fingers stop short at two or three centimetres above the root of the fingers; whereas those of the thumb and of the little finger follow the tendons up to the serous sheath common to all the flexors which pass under the anterior annular liga- ment of the carpus. As a consequence of these anatomical arrangements, inflammations of the thumb and of the little finger extend with great rapidity to the anterior surface of the forearm; while those of the other fingers are confined to the diseased fingers. In the latter case the puncture had reached the sheath of the tendon of the flexor pollicis near its inser- tion at the phalanx. Inflammation had extended along the serous sheath up to the one common to the flexors, and from this sheath to the intermuscular cellular tissue of the forearm." " The Professor remarked that it would be necessary, in order , to give issue to the pus, to make a deep incision down to the pronator quadratus. The incision was made along the flexor pollicis, a large quantity of pus escaped, and a drainage- tube was placed in the wound. Fifteen days after the opera- tion the patient was in a satisfactory condition. OVARIOTOMY. A few days ago M. Richet attempted ovariotomy under cir- cumstances which deserve to be mentioned. The patient was forty-five. The tumour for two years and a half had been gradually acquiring an enormous distension. The abdomen, however, instead of bulging forwards or presenting a globular form, was flattened and enlarged. M. Richet therefore sus- pected the presence of extensive adhesions, and operated only at the patient’s urgent request. On opening the abdomen, the adhesions between the cyst and the abdominal walls were found so numerous and resisting that M. Richet declined proceed- ing with the operation. Judging from the adhesions between the cyst and the abdominal walls, he felt convinced that the adhesions between the cyst and the pelvic organs would be such as to render the operation impossible. The incision was ’, therefore closed by means of a suture, and the following night the patient died from peritonitis. The autopsy justified , M. Richet’s prognosis. The adhesions between the cyst and pelvic organs, especially the uterus, were such that they could not be got rid of even by means of the most careful dissection. ____ A HOPITAL NECKER. PHOSPHORUS IN THE TREATMENT OF PARALYSIS. (Under the care of M. DELPECH.) M. Delpech has obtained the best results from the employ- ment of phosphorus in paralysis. There are at present three cases in his wards submitted to this mode of treatment. In one case the disease had been brought on by the prolonged employment of sulphide of carbon; in another, by the effects of cold; and in the third, by an attack of apoplexy. The phosphorus acted at first as an aphrodisiac, producing erections, and thus manifested its peculiar action on the genital organs ; mobility and sensibility were then favourably modified, with- out any apparent inconvenience attributable to the employ- ment of the remedy. LA CHARITF. PROLAPSUS OF THE UTERUS AXD RECTUM. (Under the care of Prof. GoSSELIN.) Both the uterus and rectum protruded to a considerable extent. The rectum measured five or six centimetres. ibl. Gosselin, confining his intervention for the time being to the rectum, reduced the tumour by making a semilunar incision through the skin and sphincter ani towards the coccyx. The parts were then brought together and united by means of a twisted suture with metallic threads. - -- - -,..- Medical Societies. ROYAL MEDICAL AND CHIRURGICAL SOCIETY. TUESDAY, FEB. 11TH, 1868. MR. SAMUEL SOLLY, F.R.S., PRESIDENT. INFANTILE REMITTENT FEVER, ERRONEOUSLY CALLED TYPHOID. BY J. BRENDON CURGENVEN, M.R.C.S. ETC. THE author observed that the points of analogy between typhoid and infantile remittent were not so well marked as between typhoid and typhus, or scarlet fever and measles. The error of confounding the two diseases had arisen from the continued character of the fever in severe cases, the duration of the fever, the diarrhcea that exists in most cases, and the eruption that appears on a few. Several English physicians had been misled by the writings of M. Rilliet, M. Barthez, and other French authors. " To M. Rilliet," says Dr. West, " we are indebted for a most ela- borate inquiry into this subject, which shows so close a resem- blance to subsist between the two diseases as must, I think, remove all doubt with reference to their identity. Medicine," he says, " has not been able to cut short the course even of their mildest forms......And it will tend," continues Dr. West, ’’ greatly to the avoidance of errors ...... if, for the future, we altogether discard the term infantile remittent fever’ from our scientific nomenclature, and speak, as many French writers do, only of typhoid fever in children." The symptoms of typhoid fever in’children, as given by Dr. West and Dr. Tanner, were related, and shown to correspond entirely with the symptoms of infantile remittent fever. They were-loss of appetite, listlessness, drowsiness, an exacerba- tion of fever at night with delirium, exacerbation also at 11 A.M. and 3 P.1%i., the remission being accompanied by a sub- sidence of most of the symptoms. In severe cases the remis- sions became less marked, and might be altogether overlooked, the fever then appearing continuous. There is mostly consti- pation at first, which is succeeded by diarrhoea, the stools being dark and offensive. There is pain and often tenderness in the abdomen; this is at the epigastrium, and not in the right iliac region. There is short hacking cough, with sibilus and rhonchus in the lungs. The rose spots are stated to ap- pear in the second week; but, as Dr. West remarks, "they are often very few in number, and not infrequently are alto- gether absent." "The fever," he says, "cannot be considered as passed before the thirtieth day. The convalescence is slow, and it is often prolonged for months." The right course to follow in the treatment, we are told, "is to carry the patient through an affection which we cannot cut short, with as small an amount of suffering and danger; as possible." Diluents, laxatives, alteratives, leeches to the abdomen and the head when the symptoms so indicate; tartar emetic and opium; blisters to the occiput. In convalescence it is said that "tonics either do no good, or are actually injurious by rekindling the fever. " One of the most important features of the disease is the temperature of the body, which falls quite, or nearly, to that of health between the exacerbations ; and, when such is the case, the disease is not, nor can it be, associated with con- tinued fever or typhoid, in which the temperature is above that of health, and continues so with but slight variation through the whole course of the disease. The characteristic symptom of the disease is the remission

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257

phalanges. At the end of the fourth day formidable symp-toms, both local and general, had manifested themselves. The Icarpus and entire forearm were swollen, painfully distended,and intensely red. There was no fluctuation. M. Richet opened the little wound on the thumb. A small quantity of Ipus exuded. The Professor expressed his conviction that the sheath of the tendon of the flexor pollicis had been injured, ’and was full of pus. A general and local treatment was

adopted. Among the topical applications, a large blister wasapplied to the tumefied region. M. Richet states that he hasseen admirable results follow the application of a blister inprofound phlegmon. It gives considerable relief to the patient,sometimes brings on resolution, and limits the purulent col-lection.M. Richet showed how different had been the progress of

the disease in the two cases. A simple puncture of the thumbhad determined extensive and formidable inflammatory symp-toms ; whereas the whitlow, after having produced necrosis ofthe three phalanges, had presented comparatively slight danger.No infectious matter had been observed through the puncturein the thumb, as the extent of the lesions and severe generalsymptoms (delirium, &c.) might have led one to suppose. Thedifference between the two cases took its rise solely from theanatomical disposition of the parts. "The tendons of theflexors of the fingers are enclosed in serous sheaths, whichfacilitate their sliding. The sheaths of the index, medius,and annular fingers stop short at two or three centimetres abovethe root of the fingers; whereas those of the thumb and of thelittle finger follow the tendons up to the serous sheath commonto all the flexors which pass under the anterior annular liga-ment of the carpus. As a consequence of these anatomical

arrangements, inflammations of the thumb and of the littlefinger extend with great rapidity to the anterior surface of theforearm; while those of the other fingers are confined to thediseased fingers. In the latter case the puncture had reachedthe sheath of the tendon of the flexor pollicis near its inser-tion at the phalanx. Inflammation had extended along theserous sheath up to the one common to the flexors, and fromthis sheath to the intermuscular cellular tissue of the forearm." "

The Professor remarked that it would be necessary, in order, to give issue to the pus, to make a deep incision down to

the pronator quadratus. The incision was made along theflexor pollicis, a large quantity of pus escaped, and a drainage-tube was placed in the wound. Fifteen days after the opera-tion the patient was in a satisfactory condition.

OVARIOTOMY.

A few days ago M. Richet attempted ovariotomy under cir-cumstances which deserve to be mentioned. The patient wasforty-five. The tumour for two years and a half had beengradually acquiring an enormous distension. The abdomen,however, instead of bulging forwards or presenting a globularform, was flattened and enlarged. M. Richet therefore sus-

pected the presence of extensive adhesions, and operated onlyat the patient’s urgent request. On opening the abdomen, theadhesions between the cyst and the abdominal walls were foundso numerous and resisting that M. Richet declined proceed-ing with the operation. Judging from the adhesions betweenthe cyst and the abdominal walls, he felt convinced that theadhesions between the cyst and the pelvic organs would besuch as to render the operation impossible. The incision was ’,therefore closed by means of a suture, and the following nightthe patient died from peritonitis. The autopsy justified

, M. Richet’s prognosis. The adhesions between the cyst andpelvic organs, especially the uterus, were such that theycould not be got rid of even by means of the most carefuldissection.

____

A

HOPITAL NECKER.

PHOSPHORUS IN THE TREATMENT OF PARALYSIS.

(Under the care of M. DELPECH.)M. Delpech has obtained the best results from the employ-

ment of phosphorus in paralysis. There are at present threecases in his wards submitted to this mode of treatment. Inone case the disease had been brought on by the prolongedemployment of sulphide of carbon; in another, by the effectsof cold; and in the third, by an attack of apoplexy. The

phosphorus acted at first as an aphrodisiac, producing erections,and thus manifested its peculiar action on the genital organs ;mobility and sensibility were then favourably modified, with-out any apparent inconvenience attributable to the employ-ment of the remedy.

LA CHARITF.PROLAPSUS OF THE UTERUS AXD RECTUM.

(Under the care of Prof. GoSSELIN.)Both the uterus and rectum protruded to a considerable

extent. The rectum measured five or six centimetres. ibl.Gosselin, confining his intervention for the time being to therectum, reduced the tumour by making a semilunar incisionthrough the skin and sphincter ani towards the coccyx. The

parts were then brought together and united by means of atwisted suture with metallic threads.

- -- - -,..-

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, FEB. 11TH, 1868.

MR. SAMUEL SOLLY, F.R.S., PRESIDENT.

INFANTILE REMITTENT FEVER, ERRONEOUSLY CALLEDTYPHOID.

BY J. BRENDON CURGENVEN, M.R.C.S. ETC.

THE author observed that the points of analogy betweentyphoid and infantile remittent were not so well marked asbetween typhoid and typhus, or scarlet fever and measles.The error of confounding the two diseases had arisen from thecontinued character of the fever in severe cases, the durationof the fever, the diarrhcea that exists in most cases, and theeruption that appears on a few.

Several English physicians had been misled by the writingsof M. Rilliet, M. Barthez, and other French authors. " ToM. Rilliet," says Dr. West, " we are indebted for a most ela-borate inquiry into this subject, which shows so close a resem-blance to subsist between the two diseases as must, I think, remove all doubt with reference to their identity. Medicine,"he says, " has not been able to cut short the course even of

their mildest forms......And it will tend," continues Dr. West,’’ greatly to the avoidance of errors ...... if, for the future, wealtogether discard the term infantile remittent fever’ from ourscientific nomenclature, and speak, as many French writersdo, only of typhoid fever in children."The symptoms of typhoid fever in’children, as given by Dr.

West and Dr. Tanner, were related, and shown to correspondentirely with the symptoms of infantile remittent fever. Theywere-loss of appetite, listlessness, drowsiness, an exacerba-tion of fever at night with delirium, exacerbation also at11 A.M. and 3 P.1%i., the remission being accompanied by a sub-sidence of most of the symptoms. In severe cases the remis-sions became less marked, and might be altogether overlooked,the fever then appearing continuous. There is mostly consti-pation at first, which is succeeded by diarrhoea, the stoolsbeing dark and offensive. There is pain and often tendernessin the abdomen; this is at the epigastrium, and not in theright iliac region. There is short hacking cough, with sibilusand rhonchus in the lungs. The rose spots are stated to ap-pear in the second week; but, as Dr. West remarks, "theyare often very few in number, and not infrequently are alto-gether absent." "The fever," he says, "cannot be consideredas passed before the thirtieth day. The convalescence is slow,and it is often prolonged for months." The right course tofollow in the treatment, we are told, "is to carry the patientthrough an affection which we cannot cut short, with as smallan amount of suffering and danger; as possible." Diluents,laxatives, alteratives, leeches to the abdomen and the headwhen the symptoms so indicate; tartar emetic and opium;blisters to the occiput. In convalescence it is said that "tonicseither do no good, or are actually injurious by rekindling thefever. "

One of the most important features of the disease is thetemperature of the body, which falls quite, or nearly, to thatof health between the exacerbations ; and, when such is thecase, the disease is not, nor can it be, associated with con-tinued fever or typhoid, in which the temperature is above thatof health, and continues so with but slight variation throughthe whole course of the disease.The characteristic symptom of the disease is the remission