on the other. It was effected by elevating the varicose veins and tearing them forcibly from their attachment. Cauterization.-This also has long since been rejected. Excision. This was also practised by the ancients. Celsus was accustomed to expose the vein at several points, and then cut out portions of it. Erosion has also been recommended and practised: but, in order that it may succeed it is necessary to apply the caustic deeply, and then it may give rise to abscesses along the course of the vessels, to alarming hæmorrhage, to diffuse phlebitis, and has ended fatally. Sir E. Home instituted the practice of employing ligatures; though occasionally successful, so many fatal consequences have ensued, that it has for the most part been abandoned. Soon after this, Sir Benjamin Brodie proposed the subcutaneous incision; this is recommended only when there are but few varices in the limb, and is performed on the branches, not on the main trunk of the saphena; even this has been followed by fatal inflammation. Of late years several distinct modes have been proposed of interrupting the circulation through the vessel by pins and ligatures, without exposing it. None of these, however, appear to be unattended with danger. The operation which Dr. Watson usually performs in such cases as appear to him actually to demand such interference, is this; having rendered the vessel turgid, he makes an incision over the dilated vein, and raises it on a probe, other incisions are then made in proportion to the extent of the varices and the freedom of their anastomoses. Portions of the vein are then cut out in each of these situations, beginning with the lowest, the edges are brought together, and compression made by means of a roller. Afterwards the starched bandage is applied. Several cases are related in which this operation was performed, but though usually successful, two instances are mentioned in which it proved fatal. HYDROCEPHALUS, OCCURRING AT A PARTICULAR PERIOD OF LIFE. By HENRY KENNEDY, M.B. &c. &.* Dr. Kennedy presents us, in our Dublin contemporary, with an ample account of this affection. We confess that we have our doubts on its hydrocephalic nature. It appears to us to be rather, continued fever terminating in effusion within the cranium. We refer such of our readers as are curious with regard to particulars to the original paper. The following summary, drawn up by Dr. Kennedy, will give an idea of his views. He puts it in the shape of Propositi ons. "1. That an affection of the brain of the hydrocephalic character is not at all unfrequently met with between the ages of 12 and 25 years. "2. That it is more common in females than males, in the proportion of two to one. "3. That in the majority of cases it commences with symptoms of mild fever, which goes on without change for ten, twelve, and fourteen days. 66 4. That it sometimes begins by a distinct complaint of the head for some days, the patient still being able to go about. 5. That when the disease commences by fever, the first signs of anything going wrong take place very commonly at night. "6. That a marked increase in the degree of fever may then be observed. "7. That during the progress of the disease the pulse exhibits the characters of hydrocephalus, and to a marked degree. Dublin Journal, July, 1843. No. LXXVIII. "8. That alterations about the eye are often among the earliest symptoms pointing out that mischief is coming. "9. That the pathology of the affection is confined in great part to the arachnoid at the base of the brain, with more or less effusion into the ventricles. "10. That there are some grounds for supposing the inflammation to be of a specific character, probably strumous. "11. That once the affection has fully declared itself, the treatment has yet to be determined. "12. That local bleedings with mercury and blisters hold out the best prospect of success." SIMPLE MODE OF TREATMENT FOR PROLAPSUS ANI. By We are afraid that the following news is too good to be true, viz. that prolapsus ani is to be cured by simply holding aside the skin round the anus, when the child goes to stool. Dr. M'Cormac, however, relates a case to that effect. The subject of it had laboured under prolapsus from the age of one year till between five and six. The protrusion occurred at every stool, sometimes amounting to an inch or more, and had always to be reduced, a procedure attended with some difficulty, and more or less pain. The child had a relaxed aspect, was easily affected in her bowels, and evidently suffered in her general health. Dr. M'Cormac had tried everything that he could think of, short of an actual operation, painful to say the very least of it. Reflecting on the procedure in question, it occurred to me that the same result might in a measure, at least while the child was at stool, be secured by careful manual traction. I immediately stated my views to the intelligent mother; she entered into them at once, and promised, if possible, to carry them into effect. Accordingly when the child went next to stool, the skin exterior to the anus was drawn to one side by means of the fingers extended around. The little girl submitted to this with some reluctance, and complained that she could not evacuate her bowels. She was encouraged, however; a stool was obtained; from that day and date, now a month since, the bowel has not once descended. The stools, which previously were from two to four every day, have become much ́fewer, as well as of a more formed consistence and natural colour; while the child's health, spirits, and strength, are in other respects much ameliorated. There is now no prospect of the disease ever returning; the little girl requires comparatively little attendance; her mother, in fact, is only required to stand by, and in a short time, it is to be hoped, her onerous and anxious ministry will wholly cease." The method is worth trying, but what with the attention it requires for a length of time, and what with the rather simple pretensions of the remedy itself, we feel some misgivings with respect to the result. ON THE DIAGNOSIS OF VALVULAR DISEASE OF THE HEART. Mr. O'Ferrall gives several cases and makes some very interesting remarks on the diagnosis of disease of the left auriculo-ventricular valve. Passing over the cases, we shall allude to Mr. O'Ferrall's views. * Dublin Journal, July, 1843. + Ibid. He observes, with justice, that when disease of the mitral valve proves fatal in its earlier or middle stages, the event is generally found to be owing, either to complication with renal, or some other chronic disease, or to one of the many accidents, in the lungs or pleuræ, to which this affection so often leads. Pulmonary apoplexy, pneumonia, bronchitis, or pleurisy, frequently interpose to prevent the completion of the morbid process. Now, in cases of this kind, witnessed by Mr. O'Ferrall, there was a systolic bruit beneath the left mamma, persistent to the last, and looked on by him as characteristic. But, in some cases, this bruit disappears with the advance of the disease; and, in such, he has found the contraction of the opening so great, that even the shortened valves were rendered capable of preventing a reflux, and, consequently, performed their function once more. He asks, if it can be doubted that, should such cases be seen for the first time in this stage, by those who follow the text of Dr. Hope, a corresponding diagnosis would have been made, and the existence of valvular disease altogether denied. "I am far," he adds, "from believing the rule to be, that in the advanced stage of disease of the left auriculo-ventricular opening, the phenomena of regurgitation shall cease. On the contrary, I have records of many cases, in which great contraction did not prevent the occurrence of a refluent current through the aperture. But in these cases, the inadequacy of the valve was still apparent, on inspection. I only maintain, that a valve, so shortened as to be incapable of closing the normal opening, may become adequate to its task, in consequence of progressive contraction, combined with a favourable adaptation of the aperture itself." He subjoins the following propositions: "1st. That regurgitant disease of the mitral valve is attended by persistent murmur with the first sound. 66 2nd. That the subsequent disappearance of this murmur does not lessen the value of the sign, nor contradict the diagnosis, at the time it was made. "3rd. That the order of the phenomena here described in combination with the general symptoms of this disease, constitute a rational evidence of the supervention of contraction of the opening, to a degree proportioned to the previous shortening of the valve. "4th. That uncomplicated obstruction of the aperture is not necessarily attended by a murmur. "5th. That the general symptoms of disease of the mitral valve are not to be distinguished from those of softening, merely by the presence of murmur, as has been asserted by authors. "6th. That the diagnosis can be made, only, by the observation, that a wellmarked systolic murmur had previously existed, in combination with the general symptoms of the disease." ON A PECULIAR MORBID AFFECTION OF THE STOMACH, CHARACTERIZED BY REGURGITATION OF ITS CONTENTS, WITHOUT NAUSEA. By SIR HENRY MARSH, Bart., M.R.I.A. &c.* Sir Henry defines regurgitation to be that act whereby, without nausea, without convulsive effort, the contents of the stomach, gaseous, liquid, or solid, by a species of anti-peristaltic motion, are expelled. He remarks the utility of the function in the lower animals, particularly in the ruminants, as well as in the human subject, under particular circumstances. Thus the infant gets rid of the * Dublin Journal, July, 1843. superabundant quantity of milk-at all ages the gases of the stomach are so extricated-in pyrosis, fluid is thrown up. In reference to pyrosis, we would make this observation. Without disputing the fact, that the fluid may come from the stomach, we are sure that, in many instances, it is the product of the salivary glands. We are ourselves prone to suffer from the affection, and have distinctly made out, in our own persons, that such is the fact. The peculiar sense of contraction and nausea at the pit of the stomach precedes a distinct and copious secretion from the salivary glands of the mouth. This fills with their secretion, and may be swallowed again and again until the flux subsides. But even rumination may occur in men. Sir Henry relates two instances, the first, apparently, an unexceptionable one. "I knew, many years ago, a remarkable example of rumination in a gentleman, who was a clerk in a bank; he enjoyed good health, lived at his desk, took but little exercise, and dined hurriedly, scarcely allowing himself time to masticate his food. Soon after dinner, portions of food, with little or no effort on his part, ascended into his mouth, were remasticated and again swallowed. In this manner, according to his own account, the whole of the food he had taken underwent this secondary process. It was a source of much enjoyment to him, and he prided himself upon the possession of this novel, but not very enviable, capability. "I was called upon, not long since, to see a boy about fourteen years of age, and was informed by his mother that after every meal he regularly vomited his food, and that in consequence he had lost flesh, looked ill, and caused to his parents much uneasiness and anxiety. Upon examination, I found that there was no real derangement of the health, that his appetite was good, his bowels regular, and that the expression of his countenance did not indicate serious disease. By minute inquiry I ascertained that he did not vomit his food, but that it ascended from the stomach in successive portions, without nausea, without the least convulsive effort, and without any distress whatever to himself. I was present on one occasion whilst he was in the act of regurgitating his food; it was received into a basin; the morsels of meat successively returned had no acid taste, and did not appear to have been acted upon by the gastric juice. This occurred immediately after he had eaten plentifully and with an excellent appetite. The process of regurgitation was not preceded by any sense of distention or repletion; and whilst engaged in the act he talked and laughed as usual. He had acquired the habit, he could not tell how, since he had been sent to school, and it was quite obvious that he made use of it to induce his parents to remove him from school and to restore him to his horses, dogs, and gun. He was taken home, and there was a speedy termination of the supposed vomiting which had so much alarmed his parents.' Sir Henry observes, in continuation, that rejection of the food, without nausea, sometimes constitutes a distressing and intractable disease. It is seen in hysterical females. Of this he relates two instances. He then details the case of a girl, between 11 and 12 years of age, of stunted growth, in whom it followed diarrhoea and violent epileptic paroxysms. He adds:-"I have seen several other well-marked instances of the same disease in young children, but in every instance connected with, and resulting from, innate constitutional delicacy, and co-existing with various disturbances of the nervous system, and derangements of the digestive function. I have seen instances of it in conjunction with chorea. In many cases of hooping-cough, the partial or total evacuation of the stomach, at the close of the paroxysm, is the result, not of the act of vomiting, but of the act of regurgitation, and in such cases, so little is there of sickness or distress connected with the expulsion of the food from the stomach, that we often find the desire for food immediately to return, and children to eat greedily after having apparently vomited; but in many of those cases if the manner in which the food is expelled be closely examined, it will be found that it is accomplished without the effort and the sickness which characterize the act of vomiting. This distinction is of some practical importance, because it stands opposed to a method of treatment which is sometimes adopted, that of treating hooping-cough principally by emetics. Doubtless, emetics are of use in the treatment of hoopingcough, and especially in such cases as are complicated with severe bronchitis. The frequent termination of the fit of coughing in the rejection of the contents of the stomach, has given rise to the notion, that the treatment by emetics is indicated; but if the manner in which the food is rejected be carefully examined, it will appear, that the practice of treating hooping-cough by exciting nausea cannot, in many instances, be fairly deduced from any natural indication." In other instances, regurgitation forms one of the symptoms of obstinate and protracted dyspepsia. In the same individual the food is sometimes vomited, and sometimes regurgitated; the contents of the stomach are sometimes rejected en masse without nausea or straining, and sometimes discharged morsel after morsel, till the whole of the contents of the stomach be disgorged. The food is in different individuals, and sometimes in the same individual, regurgitated at various stages of digestion, so that the ejected morsels present every variety of appearance and taste, from that which belongs to food just swallowed, until it be converted into perfect chyme, and mixed with the various morbid secretions which are found in a disordered stomach. Sometimes the act by which food and other matters in the stomach are propelled upwards, is accompanied with so much of nausea, and with so much of convulsive effort, as to give it rather the character of vomiting than of regurgitation, so that in fact it becomes not easy to distinguish the one act from the other. They run imperceptibly into each other, although in extreme cases, no two acts in nature can be more distinct." Of this form of regurgitation, also, Sir Henry relates instances, and concludes the paper by some remarks upon the treatment. For the hysterical and neuralgic form of regurgitation, the plan he has found answer best" consists of small blisters applied simultaneously to the pit of the stomach and to the spine; this, in some few instances, has been at once and permanently effectual; more generally, however, its salutary effects are only temporary; small detractions of blood by cupping in both situations have in some instances been equally successful. Benefit has been derived from small, and often-repeated doses of hydrocyanic acid, belladonna, morphine, stramonium, and other narcotics. Tonics, such as iron, bark, and bismuth, have also occasionally been found useful; but no remedy has been so often successful, in this form of the disease, as a total change of habits, change of air and scene, and travelling. In one case electricity was completely effectual in curing the complaint; it failed in others. In another instance, a sudden and powerful mental emotion totally and permanently removed the disease." He has found it useful to advise the recumbent posture for an hour or more after each meal-to eat slowly, and to masticate the food well-to eat less than the appetite demands-to be moderate with fluids, and avoid distention of the stomach. The affection has coexisted with tubercular disease of the lungs in not a few instances. When combined with dyspepsia, "it is generally traceable to long-continued mental anxieties; to over thoughtful, studious, sedentary, and solitary habits; to the swallowing of food hastily without sufficient mastication and insalivation; to the utter neglect of the two most excellent promoters of healthy digestioncheerful society, and full, free, enjoyable muscular exercise. "In some cases it may be traced to excesses in sexual indulgences, and abuses of the sexual propensity." Every violation of the laws of Nature may give rise to it, and struma strongly predisposes to it. An interesting communication. |