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CLINICAL OBSERVATIONS

ON

VARIOUS DISEASES,BY

MR. WARDROP.

ON DISORDERS OF THE RETINA

Occasioned by Derangement of the Aliment-ary Canal.

THE sympathy which exists between thealimentary canal and various parts of thenervous system, more particularly thebrain and organs of sense, has been longwell known to pathologists. The effectsof some kinds of food in producing violentheadach, and the vomitings resultingfrom injuries of the brain, are sufficientproofs of a reciprocal consent betweenthose organs. The senses of sight, hearing,and taste, are all particularly liable to beinfluenced by diseases of the stomach andbowels. How often do worms producesymptoms scarcely to be distinguishedfrom a collection of water in the ventricles

Iof the brain ! They are attended by the Isame imperfections in the function of thebrain, the same loss of voluntary motion,and imperfection in hearing or insen-sibility to light. Children afflicted withworms I have known to lose altogethertheir hearing, and recover it as soon asthe disturbance in the bowels was re-

moved, and it is not uncommon for thosewho are subject to violent headachs andvomitings of bile, to become perfectlyblind during such attacks.There is no class of diseases of the eye

on which so little has been said as thoseaffections of the retina which are caused

by a derangement of one or more of theorgans of digestion, and it is of greatpractical importance to discriminate suchaffections from those which I have alreadymentioned (last Vol.), wherein the nerveof vision is influenced by an unequal dis-tribution of blood within the head, fromchanges in the action of the heart, as wellas fiom those ocular spectra which areproduced by a plethora or congestion ofblood in the brain.One of the most common affections of

the retina, caused by a deranged state ofthe stomach and bowels, is a want of powerto fix the eyes during an ordinary periodof time on a minute object. When, for in-stance, the patient attempts to read abook, he does not proceed above a fewlines before he finds a mistiness or cloudi-ness appearing over the object, and in a

short time, usually but a few minutes, heis unable to read distinctly.

Besides the dimness in vision, there isoften a peculiar feeling of oppression orweight about the eyelids, so that they areopened with difficulty. The surface of theeyeball also feels unusually, and some-times even painfully, dry ; at other times,when viewing a small object, there is anincreased flow of tears. The feeling ofweight and oppression is not generallyconfined to the eyes, but affects the head,and is often much increased if the head beinclined downwards.When these symptoms arise from a de.

ranged state of the digestive organs, thetrue character of the disease is also

pointed out by a furred appearance of thetongue, a disagreeable taste in the mouth(more especially in the morning), a senseof oppression in the region of the stomachafter meals, occasional headachs, acidity,and, above all, an irregular state of thealvine evacuations.There are also other phenomena occa-

sionally observed in these affections ofthe retina, which arise from disease in theprimae vitv. Sometimes, for example,bodies of curious forms appear to floatbefore the sight, or a temporary cloud

comes over one or both eyes. In suchcases, the muscœ volitantes, as they arecalled, present a variety of appearances.Some patients have a small body movingbefore them, as the eye moves, which ap-pear always to be at the same distance.In other cases there are a number of smallparticles, like dust, moving in variousdirections before the eyes. In one lady, acloud seemed gradually to pass over thepupil, so as to diminish the sphere ofvision by degrees, and which she com-pared to the appearance of a half-moon.Indeed, the figures described by those whoare similarly affected, are so various, thatit would be impossible to give a particulardescription of the whole of them.

Treatment.-The necessity of employ-ing purgatives in diseases of the chylo-poietic viscera, has been pointed out bymany writers as a matter of great import-ance ; and I may observe that there is no

department of medicine which has latelyderived more essential benefit than thetreatment of diseases of the alimentarycan al.

Purgatives have been given for two dis-tinct purposes, the one to evacuate anyfeculent matter which may have been col-lected in preternatural quantity,-theother to increase the various secretions inthe alimentary canal.Although to accomplish both these pur-

poses, purgatives have long been verygenerally employed, it was not until Dr.

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HAMILTON published his valuable observations " On the Use of Purgative Medi-cines," that practitioners were aware ofthe extent to which this practice might’be carried, or of its beneficial effects inthe treatment of several diseases whicheven had been considered incurable.These remarks apply to affections of the

retina arising from or connected with adisordered state of the stomach and

bowels ; for in such affections the advan-tages to be derived from a well-directedcourse of purgative medicines I have seenconfirmed in a variety of cases.Whenever in these affections of the re-

tina there is reason to suspect, from thesymptoms which I have enumerated, thata preternatural collection of feculent mat-ter exists in the alimentary canal, it will

generally be found that the certain way ofremoving such an accumulation is by thefrequent and long-continued exhibition ofthose purgatives which act chiefly on thelarge intestines. The more drastic pur-gatives, even when given in large doses,never have the desired effect; they com-monly operate quickly, but instead of

bringing away the matter accumulated inthe large bowels, they merely increase thesecretion of mucus from the surface ofthe small intestines, as well as some of theother secretions. The medicine which Ihave found to answer best is aloes, in theform of a pill.* The operation of thismedicine seldom fails to bring away, inone, two, or three days, a large quantityof feculent matter, and if it irritate thebowels it may be combined with a smallquantity of the extract of hyoscyamus.Most patients may safely begin by tak-

ing two aloetic pills for a dose, repeatingthem every four, six, or eight hours ; forit is a certain though inexplicable circum-stance, that small doses of aloes are muchmore apt to irritate the bowels than largedoses of that medicine. In cases requir-ing this system of treatment, the aloeticpills seldom begin to operate until ten, ortwelve, or a considerable number, havebeen taken, and they should afterwardsbe continued in such quantities as will i,produce three or four plentiful evacua- Itions every twenty-four hours.Sometimes the aloetic pill causes un-

easiness without operating sufficiently, orproducing sufficiently copious evacuations.In such cases they ought to be given inconjunction with other laxatives. Jalap* The following is the formula I have

long been in the habit of employing :-Px Ext. Aloes, gr. ii;

Ext. Gentian6e,Saponi Hispan, aa. gr. i. M. ft.

pilul.No. 580.

and calomel, castor oil, or senna, will

commonly answer the purpose, and adose of one or other of these purgativemedicines may be repeated every secondor third day, the aloetic pill being con-tinued during the intermediate periods.The extent and duration of a course of

purgatives must depend not only on theeffect which they produce on the affectionof the eyes and the system generally, butalso on the quantity and quality of the eva-cuations ; for as long as there is a preter-natural quantity of feculent matter, and,more especially, as long as it is fetid, dis-coloured, and ill-formed, the purgativecourse should be continued.There are some cases where, after a very

active course of purgatives, continued evenfor several weeks, the quality of the eva-cuations has undergone but little im.provement, and the quantity of the dis-charge appears astonishing. In such pa-tients it is impossible to conceive that thewhole matter had accumulated in the ab-domen for any length of time. It is morereasonable to suppose that it had beendaily produced by an increased secretionfrom some of the chylopoietic viscera.Under the circumstances to which I havealluded, it is prudent to intermit the pur-gatives, and merely to keep the bowelsmoderately open; and as there is oftenreason to suspect that the function of theliver is, in such cases, deranged, repeateddoses of calomel, or an alterative courseof mercury, will often be found very bene-ficial.

After the bowels have been freely eva-cuated by aloetic and other purgatives,little remains to be done, but to attendcarefully to keeping them regular, whichmay generally be accomplished by con-tinuing small doses of aloes, rhubarb, orsome mild laxative. When the stomachremains feeble, great advantage will bederived from columba or some other bit-ter infusion, taken two or three times aday; and if the food be apt to create

acidity, the columba, combined with mag-nesia or soda, may be taken immediatelybefore or after each meal.

I ought also to notice, that in someaffections of the retina, like those which Ihave now described, the stomach appearsto be the organ chiefly affected, and whenthis is suspected, from the state of thetongue or the presence of headach, anemetic may be given with much advantageprevious to a course of purgatives.

In affections of the retina, arising fromderangement of the digestive organs, littlegood can be expected from local applica-tions, and nothing should be applied tothe eyes until the deranged state of theprimae viæ is relieved. Should the eyes,

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owever, after that has been accomplish-ed, remain weal,:, irritable, and incapableof exertion, advantage may then be do-rived from a judicious application of sti-mulants, such as the vapour of the waterof ammonia or ether, or the applicationof blisters behind the ears, and on thenape of the neck.

OPERATION OF

SYMPHYSEOTOMY,

Performed by Professor PETRUNI, Naples’

M. VERDEROSA, twenty-four years of

age, rachitic, and of a diminutive stature, ’,wishing to marry, was conducted by herparents to M. Galbiati, in order to ascer-tain whether the size of the pelvis per-mitted her to run the chance of becoming amother without risk. She was accordinglyexamined, and the measure of a line ex-tending from the mons veneris to the su-perior spine of the sacrum gave five inchesand a quarter; the surgeon therefore ad- I,vised her not to marry, but his recom- Imendations were neglected, and the womansoon became pregnant. After a period ofnine months, she commenced, on the 31stof May, to feel the first labour pains, at sixo’clock in the evening, and at two the fol-lowing day the membranes were ruptured;the pains now relaxed a little, as is usual,and then returned, but the neck of theuterus did not dilate, and the head of thechild was stopped at the inlet of the pel-vis, which was too narrow to permit itsdescent. The midwife now called up M.Galbiati, who sent for me. ’,Our first care was to endeavour, by

every possible means, to determine theseveral diameters of the pelvis, whichwere found to be as contracted as before

marriage. It now remained to decideon our conduct. Should we wait a little

longer, although the waters had come

away for ten hours, the pains were violent,and the head was arrested at the superiororifice? But what chance was there ofthe case terminating successfully, with a

child at full term, and a sacro-pubic dia-meter of two inches and a quarter ? IHence, regarding the time which hadelapsed, and the excessive smallness ofthe pelvis, we decided upon an operation.,But as to the choice of the peculiar ope-ration which was applicable, the csesareanhad always caused the death of the motherwhen practised amongst us, whereas sym-physeotomy presented many chances ofsaving both mother and child. Besides, inthe case before us, symphyseotomy wascapable of increasing the antero-posterior

diameter by one inch and a half to twoinches and a quarter, and would thereforegive us a superior diameter of three inchesand three quarters, which is sufficient fora natural labour. I therefore performed theoperation, and in a few minutes, althoughthe symphysis was somewhat deviated;but I took fur my guide the softncss ofthe fibro-cartilagc. The completion of thesection was announced hy a loud sound,which clearly indicated the degree of dis-tention in which the inlet of the pelviswas placed. The labour was now aban-doned to the force of nature, as we hadagreed upon; the thighs were merely sup-ported, and it required a separation at thesymphysis pubis of two inches, before thehead began to descend into the superioraperture. The interval was greater to-wards the right side than to the left,whence the passage was there more free.The head acted as a wedge, dilating thepelvis, and forced on by the uterus. Aftersome pains, determined by a single doseof the secale cornutum, we perceived thehead of the child descend into the pelvis,presenting its occiput completely engagedin the interval of the symphysis. At theend of an hour, the labour terminated inthe first position, and a child was born ina state of asphyxia, from which it wassoon recovered; the child has continuedto do well; the head appeared elongated,and had therefore undergone some reduc-tion, but not more considerable than in anatural labour when it is protracted. Itscircumference was thirteen inches, its

greater diameter five, and the biparietaldiameter, measured the next day, gavethree inches and some lines. The incisionmade through the pelvis and soft partsgave disciiarge to a very small quantity ofblood ; the lochia appeared as usual, anda bandage with buckles was fixed roundthe patient’s pelvis. With common dress-

ing the wound was completely cicatrizedin thirty-five days.—Il Filaitre-Sebezio

CURIOUS CASE OF

IRREGULAR LOCOMOTION

CONSEQUENT ON

CEREBRAL INJURY.

1,N a late number of the Filaitre-Sebeziowe find the following curious case ofirregu-lar locomotion resulting from an injury tothe brain. Our readers cannot have forgot-ten the experiments of Magendie and Ro-lando, from which it would seem to followthat there exist four different impulsions