Ascites from Obstruction in the Portal Vein.-Sir W. Jenner gives the details of the case of a man whose abdomen gave way at the umbilicus with a loud report, in a clinical lecture delivered at University College Hospital. In this case the gas was in the peritoneal cavity, and he had previously been tapped; the wound did not heal, and when the gas rapidly accumulated the weak spot ruptured. The real causes of the man's troubles were an impediment to the flow of blood through the portal vein, and an impediment to the escape of bile from the hepatic duct. Sir William describes in succession the mechanical consequences of congestion of the portal system, both when gradual and when sudden, and then gives the history of the patient, who had been in India and indulged from time to time in drinking bouts. He had been tapped, had had hæmatemesis, and suffered from perforation of the bowel, which led to peritonitis. (Lancet, Jan. 3, 1874.)

Extracts from British and Foreign Journals.

Treatment of Chronic Coryza.-Dr. Diruf, sen., of Kissingen, observes that not only is chronic catarrh very troublesome to the patient, but that, owing to its accompaniments and sequelæ, it is often dangerous. It is not unfrequently associated with an eczematous lupus-like cutaneous affection of the nose, polypous growths and ulceration of the mucous membrane, with necrosis of the nasal cartilages and bones, with extension of the inflammatory processes to the accessory cavities of the nose, to the pharynx, and Eustachian tube. Usually the coryza chronica ulcerosa is accompanied by the disagreeable odour of decaying bone ("punaisie"). Amongst the more important sequelae of the affection are, that in consequence of contraction and occlusion of the nasal canals the secretions are retained in the frontal sinuses and in the antrum, in which suppuration may take place; the abscess in the former cavities may even burst internally through the bones into the cavity of the skull. In regard to the treatment that should be adopted, it should be in the first place generally anti-scrofulous; but the local treatment is much more important. Dr. Diruf strongly recommends the employment of Prof. Weber's nasal douche, which consists of an india-rubber tube about a yard and a half long, having a perforated nut at one end which can be inserted into the nostril, and through which a current of fluid can be driven whilst the patient inclines his head a little forwards. The fluid then passes, not through the choana into the pharynx, but, after thoroughly washing all the surfaces of one nostril, through the other nostril, which remains open, and from which masses of inspissated mucus are often expelled. Dr. Diruf has made the nasal nut conical in form, which permits it to fit the nostril more accurately. The inclination of the patient's head should not be too great, as the fluid may then be driven into the frontal sinuses, which causes severe pain and frontal headache lasting for several hours. Instead of pure water, weak solutions of various salts may be employed, and Dr. Diruf recommends about a 12 per cent. solution of the salts of the Kissingen Bath. The


pain over the glabella, often experienced in coryza chronica, disappears after the use of the nasal douche. (Der Praktische Arzt, No. 10, 1873.)

Epidemic Influenza.-Dr. Gerard G. Tyrrell, of Sacramento, gives an account of an epidemic of influenza that has affected the district of Sacramento during the last year. The first patients complained simply of a cold in the head, frontal headache, defluxion from the eyes and nose, pains in the limbs, and sometimes cough. This, with a feeling of lassitude and a desire to abstain from bodily and mental exertion, characterised the invasion of the disease. In these cases herpes labialis was a constant symptom. A very short time afterwards patients presented more serious symptoms; they were seized with an initial chill of shorter or longer duration, which was followed by fever, which generally manifested itself within forty-eight hours of the initial chill; early and sudden prostration of strength was almost invariable; as evening approached, flashes of heat or continued fever succeeded the rigor, with headache accompaniment, suffusion of eyes, smarting of eyelids, with a feeling as if "the nose was stuffed," dryness of mouth and throat, with occasional cough, intolerable pains in the back and limbs, great thirst, sometimes vomiting, and always lassitude. Within about twenty-four hours the feeling of chilliness ceased, and a continued fever of mild type prevailed. Tongue white and creamy, pulse rarely over 100, and the temperature from 99° to 102° F. Cough, if not an initial symptom, now presented itself, hard, dry, and paroxysmal, with a feeling of rawness beneath the sternum and along the trachea. With this was an invariable complaint of sore throat, which presented a dusky redness of the fauces. The bowels were constipated. The urine was scanty, dark red, and acid. Towards morning the skin would become moist, and often perspire freely, but without relief to the muscular pains. During the forenoon the patient always felt better the pulse would perhaps drop to 80, the temperature to 99°, the headache abate but not entirely cease; the cough would still continue hard, dry, and paroxysmal. As evening again approached, the headache, fever, pains, and thirst would return, sleep be disturbed, and the sweating be renewed. Generally upon the fifth or sixth day all the symptoms would be found to have abated except the cough, which would be accompanied by the expectoration of thick viscid mucus. On the eighth day convalescence would be established. In another type of the disease all the symptoms would be aggravated on the fifth or sixth day. After a very restless night with wild delirium, the morning would find the pulse up to 110 or 115, the temperature 102° to 104° F., the tongue dry and parched, the


cough aggravated, and the breathing painful; auscultation would reveal pleuritic frottement. Perhaps the next day under treatment the pain would have abated, and bronchial râles be developed over the chest. Still oftener, within twenty-four hours consolidation of lung would have occurred, with high temperature, frequent pulse, and great prostration. These latter cases proved very fatal. The epidemic seldom attacked old men. Diarrhoea was not noticed as a common complication. The treatment that seemed to be the most successful in Dr. Tyrrell's hands in abridging the duration of the muscular and rachitic pains, in allaying fever and promoting expectoration, was a mixture of nitrate of potash, tinct. aconite, spt. of ether, syrup, and liq. ammon. acetatis; followed, when the initiatory symptoms had subsided, by muriate of ammonia, quinine, and compound elixir of cinchona combined. When pleurisy supervened, he found nothing to allay the pain so speedily as a well-made and large-sized blister. In bronchitis the muriate of ammonia in fifteen to twenty grain doses did efficient service, both by promoting expectoration and thinning the viscid sputa. In the pneumonia complicating this disease, quinine in full doses was found to be the most reliable agent of any used in promoting resolution, and lowering and giving tone to the pulse. Stimulants were found to be also good allies in battling with asthenia, and were generally prescribed either in the volatile form, as carb. ammonia or chloric ether, or in a more persistent shape, as whisky, brandy, egg-nog, &c. In the few cases in which diarrhoea supervened, tannin, either combined with bismuth or added to the quinine mixture, generally fulfilled the indications desired. Opium was seldom needed, and refrained from as much as possible, as it dried up the secretions and produced headache. Hydrate of chloral was often used, without any apparent benefit. In those cases in which sweating was excessive, Dr. Tyrrell found the old-fashioned remedy of sage tea a most trustworthy agent, whilst the mineral acids and oxide of zinc met with most signal failure. Where headache was a prominent and persistent feature, fifteen or twenty grain doses of the bromide of ammonium or potassium usually gave speedy relief; it also seemed to possess some influence in mitigating the troublesome coryza, and in some cases appeared to arrest this symptom; it also allayed the paroxysmal character of the cough when continued to be given for some time. Where pneumonia or severe bronchitis was present, the jacket poultice was universally employed, sometimes the plain poultice, but often moistened with turpentine or tinct. of opium. (Pacific Med. Journal, No. 5, 1873.)

Treatment of Caseous Epididymitis and Tubercle of the Testis. For many years past it has been customary to



apply the term tubercle of the testis to a disease which, though less intimately connected with pulmonary phthisis than tubercular inflammation of the serous membranes, is not the less to be regarded as closely associated with it. Mangin, who has recently written an essay upon this subject, proposes to apply the term caseous epididymitis instead of tubercle of the testis. Is this, says M. Malherbe in a review of M. Mangin's work, an appropriate term and one that it is advisable to adopt? The term caseous inflammation, so far as it is applied to the testis, would only be of value in two points of view; first, and chiefly, supposing it to be true, were it to establish a distinction of the highest importance clinically between a disease serious enough, it is true, but curable, and the tuberculisation which is almost a condemnation to death; and secondly, were it a mere question of scientific dilettanteism, the new term designating precisely and exactly a process of pathological anatomy. In either case it might be worth accepting that suppuration of the epididymis, in consequence of its caseification, can lead to the production of pulmonary phthisis. Let us see whether caseous epididymitis fulfils either of these conditions. Is it true that caseous inflammations differ from tuberculosis in their nature, and can they merely predispose to it as Niemeyer paradoxically maintains? The Germans say yes, the French say no. Clinical experience appears to be with the French. Looking at it from the latter point of view, notwithstanding that statistics have been obtained showing that in fifty cases of tuberculous testis there was only one of pulmonary tubercle, it may be doubted whether such a ratio is of ordinary occurrence; and M. Malherbe thinks that he has seen many cases where the two diseases have been concomitant, and that those who are of a different opinion may have seen cases at a time when tuberculous disease, or at least when the symptoms of tuberculous disease of the lungs, had not yet made their appearance. In regard to the consecutive development of pulmonary phthisis, M. Mangin and Prof. Richet are in accord; for the latter remarks, "If the glands of the neck in young persons be allowed to suppurate for an indefinite period of time, a general tuberculisation may be induced:" whilst the former believes that epididymitic suppuration consequent on its caseification is capable of causing pulmonary phthisis. Is not this pushing the idea of post hoc ergo propter hoc too far, and would it not be more conformable to sound views of general pathology to regard caseous degeneration either of the epididymis or of the ganglia of the neck as lesions due to tuberculosis developing itself by producing changes in various organs before attacking the lung? Let us now see whether pathological anatomy does not demonstrate that the affection of the testis we are now considering is

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