Reviews and Notices of Books

1869 The Lancet  
13 to amputate during collapse ; and he urged that the good results which followed in this case must be regarded as exceptional. He had once amputated when there was extreme prostration of the nervous system, associated with complaint of urgent pain, but such a case he regarded as quite distinct from instances of ordinary so-called collapse. Mr. CROUCH, in reply, said he had followed the rule distinctly laid down by Abernethy for the treatment of cases similar to the one reported. Dr. PAvy
more » ... ed a case of Diabetes in a female patient, aged sixty-eight, in which the treatment consisted mainly in the exhibition of opium in gradually increased doses, without restriction of diet. The first effect of the drug was limited to a diminution of the quantity of urine, without change in its specific gravity or in the relative quantity of sugar contained in it. But eventually, as the dose was increased, the daily excretion of sugar diminished, until the urine became entirely natural. Throughout the whole period of treatment, the dose of opium, the quantity of urine, and the quantity of sugar excreted in twenty-four hours were recorded daily, so that the effect of the remedy could be accurately judged of. By way of further illustration, Dr. Pavy mentioned two other cases, one treated by opium, the other by morphia, in which the beneficial results obtained were equally striking. A discussion followed, in the course of which Dr. WEBER referred to the occasional recurrence of diabetes in patients apparently cured, whether by diet, regimen, or otherwise ; and suggested that the case should be further reported on after an interval of six months; while the PRESIDENT drew attention to the age of the patient, with reference to the ,question whether diabetes is not more tractable, and at the same time more liable to recur, in elderly persons than in the young. Dr. PAvr, in his reply, admitted that in advanced life diabetes might be regarded as a comparatively trivial disorder. Dr. BEIGEL read a paper, founded on 152 cases of Epilepsy, from which he inferred, that although unconsciousness and convulsion are so frequent as phenomena of the epileptic paroxysm that most writers regard them as characteristic, there are many cases undoubtedly of epileptic nature in which these symptoms are absent. He considered that the only invariable pathognomonic signs of epilepsy were those which arose from disturbances of the circulation, and set forth various facts and observations which had led him to localise these disturbances in the vaso-motor nerves. As regards the treatment of epilepsy, Dr. Beigel believed that the most important remedy for continuous administration was the bromide of potassium. He further strongly recommended the subcutaneous injection of morphia, guarded by atropine in the manner suggested by Dr. John Harley, immediately before an apprehended attack, as a means of warding it off, or at least of modifying its violence. Dr. GREEN related a case, which he described as one of Irritative Hypertrophy of the Heart. The patient, a girl of fifteen, was admitted into hospital in the fourth or fifth attack of acute rheumatism. Soon after pericarditis supervened, and she eventually died, with great hypertrophy, adherent pericardium, and "finely granular " degeneration of the muscular fibres of the whole heart. In explanation of this and other cases in which hypertrophy occurs in young rheumatic persons, independently of any mechanical cause, the author maintained the theory that the overgrowth is intimately connected with chronic myo-carditis. IT is now many years since we, perplexed and wearied by the divergences of opinion and doctrine expressed by different writers on the subjects treated of in these volumes, determined to bring them to the test of our own observation and experience. We had an ample field for doing so, and were untrammeled by an affection for any preconceived theory. Some of the results arrived at were: (1) That there was such a disease as syphilis, and that, in the character and evolution of its phenomena, it was perfectly separate and distinct from any other; that it bore no further relation to the venereal ulcer, whose clinical history, as Diday says, terminates with the cicatrisation of the sore, than the fact that both were the results of impure sexual intercourse, and both were attended by a lesion more or less ulcerative in character. (2) That induration was very generally, but not invariably, the concomitant of that lesion which was the precursor of general symptoms. (3) That the two diseases sometimes rapidly followed one another, or even coexisted. (4) That they could be, as a rule, more easily distinguished from one another than can many cases of typhus from those of typhoid fever, or measles from scarlatina. And (5) that there were a certain number of cases, of a non-conformable type, which served as the battle ground of opposing theorists. These cases led us to perceive that a diagnosis could not always be made at once, or upon a single manifestation; but that, as in every other malady, the disease must be studied as a whole, and the period of observation must not be limited to one day or two, but extended sometimes over the whole period embraced from the appearance of the ulcerative lesion to the date of its cicatrisation. One fact which came out very forcibly was this: that the lesion which appeared from ten days to a month after exposure to contagion was almost sure not to prove a local disease; while another which appeared two, three, or four days after such exposure was so, provided it did not, in its subsequent progress, alter its character and acquire induration at its seat or along the neighbouring chain of glands. The inquiry embraced a great many more points: -. but upon these we need not dwell. Let it suffice, that whilst still prosecuting it, and after we had made up our own mind as to the bearing of a great many facts, we again consulted the works of the latest syphilographers, and Bumstead's book 11 On Venereal Diseases" among them. This was not what might be termed an original book ; it was in great part a compilation. It was too voluminous, and did not contain all that was then known or has been since recognised. Still, Bumstead's work was the first in the English language which afforded a comprehensive and systematic view of the subject as a whole; and it has been the forerunner of others, resembling it very much in their treatment of the same subjects. It is only fair that this should
doi:10.1016/s0140-6736(02)67067-9 fatcat:ti2kdueyajdafbd253bsk2dfau