middlesex hospital
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pleasant symptoms from their use. Probably this may insome measure be due to the fact that I am in the habit ofprescribing the hyposulphites in combination with bicar-bonate of soda and sulphate of magnesia in peppermint-water. For children 1 simply give it with syrup and
oaraway-water. Though my experience is not sufficient toestablish the value of this remedy decidedly, it is so far
satisfactory that I unhesitatingly prescribe it in any caseswhere there seems to be symptoms of blood-poisoning. In
aphthag, for instance, it seems to work like a charm, and inboils, scrofulous abscesses, &c., it really appears to do greatgood. I have also prescribed it with success in diphtheria andpuerperal fever. It seems to me that, as hydrophobia iswithout doubt a form of septicaemia, the hyposulphitesmight do good in this terrible disease. They certainly coulddo no harm, and therefore I would suggest a fair trial of thisremedy, not only when the disease has developed itself, butas a prophylactic. After a bite by a mad dog I would givefive or ten grains of the hyposulphite of sodium or magnesium(the latter is richer in sulphurous acid) for the first threeor four days every four hours; then three times a day for aweek; then twice a day for another week; then every morn-ing early for one month; recommending a Turkish bathtwice a week. When the disease has developed I °wouldprescribe the hyposulphite every hour or every two hours,with vapour or dry hot-air baths, or prolonged warm-waterbaths containing some hyposulphite in solution. The hypo-dermic injection might also be tried, especially if the patientis unable to swallow. In other cases the sulphurous gasmight be given per rectum. By such means as these Ifirmly believe hydrophobia may be cured, and trust thatthose who have the opportunity to do so will try them.
A MirrorOF
HOSPITAL PRACTICE,BRITISH AND FOREIGN.
MIDDLESEX HOSPITAL.A CASE OF LONG-CONTINUED PRIAPISM AFTER COITUS;
REMARKS.
(Under the care of Mr. HULKE.)
Nulla autem est alia pro certo noscendi via, nisi quamplurimas et mor-’borum et dissectionum historias, tum aliorum tum proprias collectashabere, et inter se oompara.re.—MoBeACrNi De Sed. et Caus. Morb.,4ib. iv. Frocemium. -
IT is seldom that cases such as the following come underthe notice of the surgeon, and the question as to future lossof sexual function, which is raised by Mr. Hulke, is important.In the Mirror of Hospital Practice for Feb. 16th, 1867, in theremarks on a case of Mr. Birkett’s, attention was drawn toother cases: in one which had been under the care of Mr. Luke,a patient aged twenty-six, who suffered for four months, isstated to have recovered, but information is not definitelygiven as to the continuation of the sexual function; inanother, recorded by Callaway in 1824, the ultimate result isnot mentioned. It would be advisable to have furtherevidence on this point before coming to a conclusion.Incision into the affected part for the relief of pain andswelling has been tried, but is not recommended, measuressimilar to those employed by Mr. Hulke proving generallysuccessful.On Dec. 27th, 1886, an artisan, aged thirty-four, was
admitted into Founder ward with priapism. His penis wasstiffly erect, very turgid, hard, tender, and painful. Thegreatest tenderness corresponded to the attached part ofthe left crus. The patient said that one week previously,after drinking heavily of cider, he had intercourse with his*wife on going to bed at night. Neither he nor his wife wasaware of the occurrence of anything unusual in the sexualact. He afterwards fell asleep. On waking next morninghis penis was still erect, and it was also very painful. Thiscondition persisting, and the painfulness of the organ in-creasing, he was at length constrained to come to thehoEpitaJ for relief. A mixture containing sulphate ofmagnesia and tartar emetic was given to the man at short
intervals until he was nauseated and purged, and after thishe was directed to take bromide of potassium in doses offifteen grains three times daily. The penis was smearedwith extract of belladonna and unguentum hydrargyri.On January 3rd, 1887, a week later, no obvious alteration
in the state of the organ having occurred, the above treat-ment was abandoned and the continuous application of icesubstituted for it. This was followed by a marked, butvery slowly progressive, decrease of the turgescence. On
January 17th the penis had become soft, pendulous, andpainless, so that he was then able to bear the pressure ofhis dress and to leave his bed. Next day he returned to hishome. At that date the only remaining objective trace ofthe former condition was a small hard knot near theposterior extremity of the attached part of the left corpuscavernosum. Abstention from coitus during several weekswas strictly enjoined. He was next seen on February 19th,when he reported that he had obeyed the injunction tilltwo nights previously, when he attempted coitus, but failedthrough incompleteness of erection. The further history isunknown.Remarks by Mr. HULKE.-Cases of persistent priapism
other than those associated with lesions of the spinal cordappear sufficiently rare to warrant this instance being placedon record. The turgescence in the spinal cases is seldomcomplete; the organ, being only semi-turgid, droops-it isnot stiffly erect. In this instance it was tensely distendedand rigidly erect. The occurrence has been attributed toinflammation of the organ, to a local neurosis, obstructionof the erectile tissues by extravasated and coagulated blood.The depressant and sedative measures adopted when theman first entered the hospital were prescribed on the firstand second supposition, but they produced little or no effect,whereas the application of ice proved decidedly useful. Aprobable explanation of the case is that, owing to the mal-adroitness incidental to intoxication, the organ receiveda wrench that produced a partial laceration of the attachedpart of the left crus, which was, in short, spl’ained. The
injury was attended with extravasation of blood andfollowed by inflammation. The excessive tension of thepart sufficiently accounts for the great pain. In cases ofthis class permanent disability of the organ is believed tohave not unfrequently resulted. Whether this has occurredin the instance now recorded is unknown, but the failure ata date when an almost normal condition of the organ inquiescence was apparently present lends some degree ofprobability to the idea that this patient will also havebecome permanently incompetent for the sexual act.
HOSPITAL FOR SICK CHILDREN.INTUSSUSCEPTION TREATED BY INFLATION OF AIR;
RECOVERY; REMARKS.
(Under the care of Dr. CHEADLE.)FOR the following notes we’ are indebted to Dr. Penrose,
registrar of the hospital.S. P-, a slightly rickety infant of fifteen months, was-
brought to the hospital about 5 P.M. on Nov. 8th, 1887. Themother’s account was as follows. On Nov. 5th the childseemed restless, for which she could find no cause. Onthe two following days it seemed perfectly well. At 6 A.n.on the morning of the 8th she noticed that the child wasevidently in great pain. At 8 A.M. she gave it a little pepper-mint-water, which was almost immediately vomited. Soonafter this the child passed a motion consisting of thick blood,and continued to pass blood almost hourly until 3 P.M. Ithad also vomited three times altogether between 8 A.M. and3 P.M. From 6 A.M. until 3 P.M. the infant had been in verygreat pain, and the passage of the blood was always accom-panied by very severe straining. At 3 P.M. the little patientwas seen by Dr. Garlick, who made a rectal examination, andreports that he found " a tumour in the rectum of unmis-takable shape; the fingers could be swept quite round it,and there was a dimple at the apex of the conical or
sausage-shaped mass." The mother said this examinationseemed greatly to relieve the child, as all straining ceased,and only one small motion consisting of blood and slimepassed afterwards.On admission at 5 P.M. the child seemed remarkably
comfortable, sleeping quietly in a perfectly natural position.On palpating the abdomen a distinct oblong tumour couldbe felt in the left iliac fossa, situated in the position of theleft sigmoid flexure, On passing the finger up the rectum,