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13th. Passed urine 134 oz. sp. gr. 1009, urea 670 grs. Albumen 3 grs. to 33 or 402.
14th. Passed urine 92 oz. sp. gr. 1010.5, urea 502 grs. Albumen 3 grs. to 3j or 294.
15th. Passed urine 118 oz. sp. gr. 1010.5, urea 607 grs. Albumen 41 grs. to 3 ) or 521.
16th. Passed urine 135 oz. at sp. gr. 1011, urea 722 grs. Albumen 7 grs. to 3j or 945. The cardiac murmur remains the same in intensity and modes of transmission. Tenderness, still, in kidney and spleen. The latter retains its former dimensions. There is felt a slight venous thrill on pressing lightly over the veins of the neck, and a remarkably musical hæmic murmur is still to be heard. Patient looks much better. Lips are redder. Lepra fading slowly. Ordered beer one pint.
17th. Passed urine 155 oz. at sp. gr. 1011, urea 820 grs. Albumen 6) grs. to 3j. or 1008. Blood examined to-day. White corpuscles in same ratio as before. Red corpuscles do not collect in rouleaux, but aggregate in masses, and when a current is created by pressing on the thin glans that covers them, they adhere to each other in passing, stretch out for some distance, and separate in a tailed form. 18th. Passed urine 124 oz, at sp. gr. 1011, urea 658 grs.
Albumen 4 grs. to 3j. or 496. Tenderness in spleen increased. Stop beer, and apply sinapisms to the spot.
19th. Passed urine 114 at sp. gr. 1011, urea 606 grs. Albumen 3 grs. to 3j. or 342. Pain and tenderness in spleen excessive. Mixture stopped. R ant. tart. gr. }, liq. amm. acet. 3 ij. omn., 4 horis. Torulæ forming a scum in 24 hs. urine. 20th. Passed urine
at sp. gr. 1011.
Alb. 31 grs. to 3j. or — Cannot lie on left side. Stomach very irritable. Mixture to be taken in one-half dose.
21st. Passed urine 41oz. sp. gr. 1013, urea 266 grs. Albumen 2 grs. to 3j. or 103. Many granular casts, none were perfectly hyaline. Urine smoky appearance.
22nd. Passed urine 102 oz. at 1012, urea 602 grs. 3 j. or 204. Slight swelling of the face, and pallor. Spleen measures 9 ins. in a vertical direction. Pain less complained of. Mixture stopped. To have two ounces of Gin. 23rd. Passed urine 115 oz. sp. gr. 1011, urea 550 grs.
Albumen 11 gr. to 3j or 173.
25th. Passed urine 131 oz. at 1010.5, urea 593 grs. Albumen 2 grs. to 3j. or 262. At 4 p. m. suddenly seized with a violent pain over the loins, especially severe on the left side.
Alb. 2 grs. to
26th. Passed urine 122 oz. sp. gr. 1011, urea 648 grs. Albumen 2 grs. to 3 j. or 244. Pain in forehead very severe. Has lost sleep during last 48 hours. Left eye congested, its sight is confused. Face ædematous, especially the left side. Pulse full and frequent. Tongue coated.
, R Pulv. Jalap Co. Dij. Gin to be stopped.
27th. Passed urine 65 oz. at sp. gr. 1010, urea 335 grs. Albumen 64 grs. to 3 or 423. Powder has not operated. Edema of face still greater, and pain almost unbearable. Patient is almost delirious, and experiences twitchings of the limbs. R croton oil mj, castor oil 3 ij. 28th. Passed urine 31 oz. at 1012, urea 182 grs.
Albumen 24 grs. in 3j or 70. Copious watery evacuations. Pain much relieved, and oedema of face visibly subsided. Appetite returns. 29th. Passed urine 79 oz. at 1011, urea 420 grs. Albumen 5
grs. 3j. or 395. Still remains easy. Slight pain still remains over loins, and sensitiveness on pressure. Murmur, as heard at right apex of heart, is more intense than ever before.
30th. Passed urine 77 oz. at sp. gr. 1011, urea 409 grs. Albumen 54 grs. to 3j. or 504.
31st. Passed urine 101 oz. at sp. gr. 1010, urea 516 grs. Albumen 3 grs. to 3 j. or 303. Patient is much improved in appearance. Appetite greater. Sleeps more soundly. Cardiac and venous murmurs remain as before. There is slight oedema of the face. The specific eruption has almost entirely disappeared. There are slight traces of it only on the lower limbs. Urozanthine is not in great excess present in the urine, and oxalate of lime has lately been never found. Blood still exhibits a tendency to fibrinate, and the colourless corpuscles are still in excess. Spleen's vertical dulness nine inches, its anterior border being felt three inches from the middle line of the abdomen.
The following table has been compiled for the purpose of showing at a glance the varying amounts of urine and albumen voided daily, and the totals for one month. Its consideration may also tend to throw some light on the circumstances that attend the occasional appearance of hyaline casts in the urine, and the changes that congestion of the kidney may effect in the material of the casts.
By the rough modes of computation employed, it will be seen that the greatest amount of urine passed in one day was 155 oz, and the least 31 oz. The largest quantity of albumen for the same period, 1008 grs., the smallest 70 grs.
The waxy casts appear to have been desquamated at a time, when, for some cause, the urine was suddenly diminished in amount. The albumen was not materially affected on these occasions.
URINE IN OZ.
256 470 561 740 662 650 639 508 552 628 670 502 607 722 820 658 606
442 239 354 560 255 440 759 333 416 305 402 294 521 945 1008 496 342
30, 4 31,
41 102 115 131 122 65 31 79 77 101
103 204 173 262 244 423
70 395 404 303
On the Diseases, Injuries, and Malformations of the Rectum and Anus,
with Romarks on Habitual Constipation. By T. J. ASHTON, formerly Surgeon to the Blenheim Dispensary, Fellow of the Royal Medico-Chirurgical Society, Corresponding Fellow of the Pathological Society of Montreal, &c., &c. With illustrations. Second American, from the fourth English edition. Philadelphia : Henry
C. Lea. 1866. Montreal: Dawson Brothers. Of the numerous diseases which come under the observation of the surgeon, none, perhaps, are met with more frequently, or cause more trouble than those which are embraced under the various heads of this work; and a somewhat singular fact is, that authorities on the subject are not at all numerous. Standard writers upon surgical topics glance but briefly at this class of diseases; and often, indeed, will the enquiring student search such works for the desired information, but in vain. This is to be regretted, for there are many practitioners unable to afford frequent additions to their library, and depend upon text books for all necessary information in time of need. When, however, such an addition can be afforded, we can recommend this volume of Mr. Ashton's in the strongest terms, as containing all the latest details of the pathology and treatment of diseases connected with the rectum. We have read the greatest portion of the work with a good deal of care, and although we cordially recommend it as an authority of great merit upon the subjects of which it treats, yet there are one or two faults, to us so conspicuous, that we feel that we cannot omit to mention them. First of all then, to our idea, Mr. Ashton commits a fault-one which is common to many authors -and that is, instead of simply writing a work for the benefit of his professsional brethren, there is an attempt, every here and there, to show what wonderful cures were performed by him upon Mr. So-and-so, who came from some great distance for the purpose of obtaining the benefit of his experience. We do not for a moment doubt the correctdess of the statements made, and no one who reads the book will doubt that its author has both talent and experience on the subject on which he writes; but we do object that, in a work of such practical utility as the one in question, there should be anything which would give rise even to a possible suspicion that the author's object in publishing the work was to push his own professional reputation and extend his practice, rather than to benefit the science and art of medicine. One more slight fault that we have noticed is that here and there we have come upon repetitions, following close one upon the other. Perhaps this latter is hardly avoidable, and, therefore, we do not lay much stress upon it; but the former is so often noticed in works that, however unwilling, we feel that it was not right to pass it over without comment. The first chapter of the volume is on itching and irritation of the anus, a very prevalent disease, which Mr. Ashton states is often regarded as a local complaint, while, in truth, it is but a symptom of a constitutional disease. Local remedies are, however, at times useful, and he speaks favourably of lotions of acetate of lead, with vinum opii, black wash, and ointments of zinc and lead. Chapter V. is on Fissure of the Anus, and Lower Part of the Rectum. This disease is of very frequent occurrence, and gives rise to more suffering, in proportion to the pathological condition of the structures involved, than, perhaps, any other ills to which the human frame is liable.
“ If the fissure exists at the verge of the anus, and is of recent origin, the patient must be directed to have recourse to ablution with soap and water, night and morning: after evacuating the contents of the bowels, half a pint of cold or tepid water should be thrown up; and when this has been ejected, a small piece of lint, saturated with a lotion of a solution of lead with opium, or one of similar properties, must be kept applied to the part. When there is much spasm of the sphincter, the extract of belladonna, in the proportion of a drachm of the extract to an ounce of spermaceti ointment, or ointment of acetate of lead, is commonly successful in relieving this distressing symptom. Belladonna has been employed in combating pain and spasm in diseases of the rectum by many eminent surgeons for a number of years.
“ If, after a fair trial of the simple means that have been recommended, the fissure does not heal, but on the contrary, the edges become indurated, and the surface pulpy and indolent, the free application of the nitrate of silver, at intervals of a few days, for two or three times, will generally induce a healthy reparative action in the part, though often at the cost of much pain to the patient. The use of belladonna ointment and enemata after stool must be continued.
“But cases will occur in which both these plans fail, and it will be necessary to have recourse to a modification of the operation recommended by M. Boyer, namely, incision, through the ulcer; but it needs not be carried through the sphincter, as he advised, though since his time, and even at present, the greater number of surgeons divide the parts to the extent he recommended.
“The operation may be performed in two ways, either by cutting from within outwards, or without inwards. In either mode the patient must rest on his side, with his knees drawn up and the buttocks projecting over the edges of a sofa or bed, or he may lean over a table or back of a chair. For the purpose of cutting from within outwards—the plan hitherto generally adopted—a straight probe-pointed knife will be most useful; it is made thicker at the back than an ordinary bistoury, by which a ridge or button on the end is rendered unnecessary. The forefinger, previously oiled, being introduced into the rectum, the knife must be pressed flat upon it till the point reaches the upper margin of the fissure or ulcer, when its edge must be turned, and an incision made through the mucous membrane, without extending it through the other structures. The other mode of making the incision is that advocated by Mr. Syme, and is performed by transfixing the ulcer beneath its base with a small, sharp-pointed curved bistoury, and cutting inwards through its centre; the opposite side of the bowel must be protected by the introduction of the finger, as previously directed.”