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MEDICAL INTELLIGENCER.

JOHN G. COFFIN, M. D., EDITOR.

DEVOTED TO THE CAUSE OF PHYSICAL EDUCATION, AND TO THE MEANS OF PRE

VOL. 5.

VENTING AND OF CURING DISEASES.

TUESDAY, NOVEMBER 13, 1827.

From the Medico Chirurgical Review.

PERIODICAL APYRECTIC DISEASES. PROFESSOR FULCI, of Catania, in Sicily, has published five cases of novel apyrectic affections, of a periodical nature, of which we shall here give some particulars. They are very curious and interesting.

Cervicobrachial Neuralgia.-A gentleman of Cantorbi, aged 40 years, of nervous temperament and very studious habits, had been subject, for some years, to a chronic bronchitis, for the relief of which he got into the habit of taking opium to rather an excess. Being subject to considerable perspirations, and having caught some cold, he became suddenly affected with severe pain in the cervicodorsal region of the spine, extending afterwards along the left side of the body, and then fixing itself in the shoulder, shooting occasionally along the arm, and even to the hand of that side. After an accurate examination of the seat of this pain, it appeared evident to our author, that it sometimes followed the divisions of the internal cutaneous brachial nerve,-sometimes the course of the external. The sensations experienced by the patient were very various at different times, but almost always of a very distressing kind, causing him to cry

No. 26.

out loudly. During these accessions, the muscles of the member contracted violently and involuntarily, and the sufferings were mitigated by pressure, especially by lying on the affected side. The countenance was anxious, and there was great uneasiness in the epigastrium,--no sleep,pulse quick. The integuments of the arm affected were two degrees colder than the rest of the body. The paroxysms of pain came on twice in the 24 hours,the first about 11 o'clock, lasting three hours, the other at 10 o'clock in the evening, ceasing towards morning, and giving the patient an interval of repose till 11 o'clock. Vapor baths were employed, under the idea that the neuralgic irritation was occasioned by oppressed transpiration,-and the author was afraid of the sulphate of quinine, as there were symptoms of gastric irritation present. Diluents were therefore prescribed, with nitre and mucilaginous drinks. These means mitigated, in some degree, the symptoms; but did not remove them. On the seventh day of the disease a number of leeches were applied to the upper part of the spine. The immediate consequence was, a reduction of the morning paroxysm entirely, and a mitigation of the evening one.

The leechings were several times repeated. In twenty days the patient returned home cured. Mental Alienation, periodical.A female, aged 40, of highly sanguineous temperament, and very fond of strong liquors and other excesses, started from her bed, one morning, in a state of mental derangement. The phenomenon was attributed by her friends to excesses in drink, and little attention was given to the subject. On the following day she was quite well. On the third day, the same hallucination recurred. Our author was called to the patient, and after an attentive examination of the symptoms, he determined that the disease was an encephalic irritation, accompanied by active sanguineous congestion in the brain, caused by addiction to wine. He therefore ordered ten leeches to the temples,-cold lotions to the head, warm bath to the lower extremities. Rigorous diet was prescribed, and diluent drinks. Returning next day, our author found the patient quite well in mind, and occupied with her domestic concerns. The most positive injunctions as to regimen were given and observed; but, notwithstand ing these, the malady returned the next day, though the phenomena of the hallucination were very different from those previously presented. The bizarreries of the patient we shall not enumerate, as they may be as various as the shapes of the clouds, without any real difference in their nature. In this case, the maniacal paroxysm was so violent that no sanguineous depletion, local or general, could be effected. In 22 hours the agitation subsided, and was succeeded by a state of

exhaustion and depression, but with complete restoration of reason. The author now saw that he had to treat an intermittent encephalitis, in the form of periodical mania, but determined to let the third paroxysm pass before he attempted to stop its course. This attack came on at the expected period, but with still a new form of mental hallucination. The ideas of the patient, this time, were all of a devotional and penitential character,-and she actually forced her husband to repair with her to the church, in order to confess her manifold sins and transgressions. Our author saw her on her retur and, on examination of the other functions of the body, nothing particular could be detected. Her face was rather flushed, and she complained of pain at the summit of the head. A consultation was called, and it was agreed to prescribe the quinine, with cold applications to the head. Twentyfour grains of quinine were given within the 24 hours. The next paroxysm was on the usual day, but greatly mitigated in severity. When over, the quinine was again administered, and the malady now was entirely checked, and did not return.

Mental alienation has been observed to take on periodical accessions in all ages; but it is rare to see it assume a regular tertian form. The brain, however, being an organ through which both physical and intellectual functions are manifested, we cannot wonder that its derangements should disturb the latter as well as the former class of functions. cases it is by physical, not moral remedies, that we can expect to cure the disease.

Periodical Ascites.-A young woman, 25 years of age, of previous good health, good constitution, and affected with no hereditary disposition to disease, experienced a fright and violent mental agitation, soon after which she perceived her abdomen swell, and her urine to become very scanty. A physician was called in, and after attentive examination, he pronounced the disease to be ascites. Before any medicines could be administered, however, the swelling quickly disappeared after an eruption of the menses. The belly again swelled, and again the urine became deficient. Medicines of the diuretic and evacuant kind were prescribed, but without the least effect. The catamenial discharge, as before, was immediately succeeded by a copious flow of urine, and a subsidence of the ascites. This recurred a third time, in spite of various medicines. Our author was now called in, and discovered some signs of gastroenteric irritation, if not inflammation, with an unusual exhalation from the peritoneal surface. The remedies were, of course, leeches to the abdomen, low diet, and demulcent drinks. External applications of colchicum, antimony, and squills, were also employed over the abdomen. These means failed, and then various physicians, both of Sicily and Italy, were consulted, and exhausted the Pharmacopoeia, without the slightest advantage. The ascites commenced immediately after each menstruation, and continued to increase till the next period, when it entirely subsided. The complaint has now continued for six years, with the most obstinate regularity, and no remedy has ever interrupted its

course.

The above is certainly one of the most curious instances of periodical ascites which we have ever heard of. Stork asserts that he has seen an intermittent ascites, and there a few others on record; but none, we think, so well authenticated and unequivocal as this one.

Anomalous Intermittent Neurosis.-An ecclesiastic of Catania, aged 55 years, of good constitution, but of a family disposed to hypochondriasis, had leď a very regular life. Twenty years ago he became affected with epilepsy, which lasted four years, and then disappeared. Two months ago, the patient, without any known cause, except some bodily fatigue, was suddenly seized with dyspnoea, which obliged him to stop short and sit down quietly, when it ceased. This was considered a thing of no importance, and was not attended to; but the attacks became frequent and severe, and then our author was consulted. On examining the region of the heart, the pulsations were found deep and obscure,the sternocardiac region sounded dull,-the pulse was irregular,there was inability to lie on the left side,-the cheeks were flushed. Prof. Fulci concluded that the disease was angina pectoris, and prescribed accordingly. The attacks of dyspnoea, however, continued two or three times a day, for six days, and then they disappeared. In these attacks the pulse sometimes fell to 45 in the minute, with a strange sense of dragging along the spine, and weakness of the upper extremities.

The attacks of dyspnoea had not ceased more than 24 hours, when a new train of phenomena was developed. In these new

paroxysms, the pain darted from the left side of the chest all round the thorax, to the spot whence it first emanated, accompanied by rapid action of the heart and palpitation. The spinal column was also the seat of violent lancinating pain, and the features became decomposed. There was no dyspnoea, and the attack generally lasted about six minutes, returning three times in the 24 hours. Looking on the complaint, in its present form, as neuritis, leeches were applied along the vertebral column, and counterirritation to the lower extremities, with rigid vegetable diet. In eight days the complaint vanished; but in three days afterwards, he was seized with a burning heat along the lumbar region of the spine, accompanied by convulsive movements of the lower extremities, keeping the whole body in a state of agitation. A sense of coldness spread along the thighs and legs, the pulse was contracted and fréquent, and there was some tendency to delirium. These paroxysms lasted six hours, and then went off, leaving the patient exhausted and depressed. The next day, and nearly at the same hour, the paroxysm returned, preceded by a sense of tightness in the epigastrium. The periodicity of the complaint being now ascertained, thirty grains of the sulphate of "quinine were given in the succeeding interval, The next attack was less violent, and the complaint did not return,-at least in that form. In two or three 'days it made its reappearance in the shape of a violent sciatica, the pain running from the hip to the foot. These attacks were also periodical, returning diurnally. Narcotics failed,--then leech

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es were employed, with baths and blisters. These also failed,-and the disease ultimately gave way to oil of turpentine exhibited night and morning. This last form of the disease harassed the patient for 28 days, but he has since continued well.-Bibliotheque Médicale, March, 1827.

Diseases of an intermittent type are, we apprehend, becom ing more prevalent in the present day than formerly; probably from the nervous system being more susceptible in modern times than in the days of our ancestors. The more accurately we observe phenomena in sickness, the more frequently will we find a regular or irregular periodicity in the march of maladies, especially those of the nervous kind.

BROUSSAIS ON ASTHMA.

M. Bonnez, assistant surgeon of the 10th regiment of Chasseurs, in garrison at Libourne, aged 36 years, had the imprudence to bathe in a river, after a hearty dinner, on the 18th of July. In the middle of the night he was seized with general malaise, suèceeded next day by fever, headache, coryza, and cough. During the night of the 19th he had no rest. On the 20th the phenomena changed into a complete attack of convulsive asthma, the second paroxysm which he had experienced, the first being three years before, and he then sent for his medical colleague. Ten ounces of blood were taken from the arm, and pediluvia applied to the feet. By these means the symptoms were relieved, and the night of the 20th was spent less miserably. 21st, the paroxysm returned, and continued till near the evening. The anhelation this

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day was very distressing, and an antispasmodic julep was ordered, which augmented the dyspnoea, and brought on another paroxysm of asthma. The night was spent in a state of agitation. 23d, Ipecacuan had been taken in small doses, and also castor; but the paroxysm returned this day, with as much violence as before. 24th, The asthmatic paroxysm came on at the usual hour, six in the evening. On the 25th, Dr. Bagard was called in, and found the patient with the following phenomena:-Dejected countenance, eyes sunk, breathing short, pulse small and quick,--tongue coated, great tenderness at the epigastrium,-oppression under the sternum, abdomen rather tense,--urine scanty and highcolored. Sixteen leeches were applied to the sternum and epigastrium, the bites to be encouraged by cataplasms,--very low diet,--diluents,--lavements. The succeeding paroxysm, 26th, was very much milder, being only a simple dyspnoea. 27th. When 27th. When Dr. B. visited his patient, the latter observed that he was quite well, and had a strong desire for food. But it was evident that the patient was not well. At the usual hour, the dyspnoea returned, accompanied by some cough. 28th, Felt very well all day, till six o'clock, when the dyspnoea returned as usual. Dr. B. now being struck with the periodicity of the complaint, and seeing nothing wrong with the digestive organs, prescribed the sulphate of quinine, in doses of three grains every three hours. The next paroxysm was prevented. The remedy was continued for three days, and the patient was free from complaint. On the 6th of

August, however, when M. Bonnez thought himself in complete security, he was suddenly seized with pain in one side of the chest, with fever, cough, headache, &c. Cuppingglasses were applied to the side, and afterwards a large blister. But these means were of no avail. The symptoms became exasperated, and the sputa sanguinolent. When Dr. B. was again called to the patient, he found him with violent headache, acute pain in the right side of the thorax, intense fever, full pulse, burning skin, and countenance indicative of despair. It was now evident to Dr. B. that the inflammation had spread from the mucous membrane to the pulmonary parenchyma, and even to the pleura. Dr. B. advised the application of 25 leeches to the chest; but the regimental surgeon protested against any more leeches, and our author took his leave. Two other physicians were called in, and ventured on the abstraction of six ounces of blood from the arm. the arm. This made no impres sion on the complaint, and Dr. Bagard was called. He applied 25 leeches to the chest, which, with a blister, completely removed the disease.

M. Broussais' Remarks.-Most cases of Asthma depend on some obstacle to the course of the blood; and this obstacle is most commonly a disease of the heart. This, however, is not always the case. A determination, however induced, of blood to the mucous membrane of the lungs, in a sanguineous subject, will often give rise to a paroxysm of asthma, as was the case in the above instance. M. Broussais has known inflammation and irritation in the mucous membrane of the stomach

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