Pg. 350

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November 2, 2020

¶ 1 Leave a comment on paragraph 1 0 350

¶ 2 Leave a comment on paragraph 2 0 GENERAL CORRESPONDENCE : CHOLERA IN THE BLACK SEA FLEET.

¶ 3 Leave a comment on paragraph 3 0 Catherine Korff, aged 27, was the subject of ranula on the left side of the fraenum linguae, for which Dr. Writzer performed the following operation:—He punctured the cyst with a trocar to collect the fluid pure. The anterior part of the cyst was then removed, and the remainder touched with tincture of iodine. The case terminated favourably. Dr. Boedeker examined the fluid, and pronounced that it contained neither albumen nor paralbumen in remarkable quantity, but some pyin. Its chief constituent (beside water) was mucus. The characteristic constituents of saliva, namely sulpho-cyanate of potash and phyalin were absent.

¶ 4 Leave a comment on paragraph 4 0 Thus the chemical analysis of the fluid of ranula does not allow us to pronounce the disease to be the dilatation of the duct of a salivary gland; it rather shows the analogy with synovial sacs and mucous cysts. Anatomical investigation points out the following structures under the tongue capable of being developed into cysts. 1. The salivary glands and their ducts, namely, the submaxillary and the sublingual glands and Wharton’s duct. But these ducts are composed of a firm areolar tissue, with elastic and flat muscular fibres; the;interior is covered by cylindrical epithelium. The cyst of a ranula is formed only of areolar tissue, and contains a little tesselated, but no cylindrical epithelium whatever. 2. The mucous glands of the membrane of the mouth. Dupuytren believed that obstruction to the duct of one of these glands might produce ranula; and this view is somewhat supported by the examination of their minute structure; but the author rejects it upon anatomical grounds. 3. The synovial sac described first by Fleischmann (De novis sub lingua bursis, Nurimberg, 1841), the presence of which has been confirmed by Froriep. It lies close to the fraenum linguae, on the outer side of the genioglossus under the mucous membrane of the tongue, sometimes only on one side, sometimes on both, but never between the two muscles. The Author, after pointing out the necessity of taking all these structures into consideration in the examination of cystic tumours in the floor of the mouth, expresses his belief that the cysts described by Fleischmann form the ranula commonly seen in surgical practice.—Virchow’s Archiv., Bd. vi. Heft. 2.

¶ 5 Leave a comment on paragraph 5 0 NEW METHOD OF DIAGNOSIS IN FISTULA ANI.

¶ 6 Leave a comment on paragraph 6 0 In cases of fistula ani, in which the intestinal orifice of the fistula cannot be discovered by the ordinary methods of investigation, M. Limauge suggests that a small quantity of the compound tincture of iodine should be injected through the external aperture of the fistula, while the finger of the operator is retained in the rectum. A permanent stain will thus be produced on the skin of the finger, by which not only the existence of an internal orifice is established, but a pretty correct idea is also afforded of the situation of that orifice, and its distance from the outlet of the bowel.

¶ 7 Leave a comment on paragraph 7 0 M. Limauge observes, that the tincture of iodine is preferable to other coloured solutions that have been recommended as injections into fistulae, because, if the rectal orifice of the fistula should happen to be extremely small, so minute a quantity of the injected fluid may penetrate into the bowel, that its presence may easily escape detection, unless a distinct and indelible stain, such as the tincture of iodine communicates, is imparted to the finger. Arch. Belges de Med. Mil. 1854.

¶ 8 Leave a comment on paragraph 8 0 GENERAL CORRESPONDENCE.

¶ 9 Leave a comment on paragraph 9 0 CHOLERA IN THE BLACK SEA FLEET.

¶ 10 Leave a comment on paragraph 10 0 [To the Editor of the Medical Times and Gazette.]

¶ 11 Leave a comment on paragraph 11 0 110, Jermyn Street, Sept. 8, 1854.

¶ 12 Leave a comment on paragraph 12 0 Sir,—Knowing the great interest which attaches at this moment to the condition of our fleet in the Black Sea, I shall take a liberty with a letter received from a friend by forwarding an extract from it concerning the present condition of the health of the ships, for the information of your readers.

¶ 13 Leave a comment on paragraph 13 0 I am, &c.

¶ 14 Leave a comment on paragraph 14 0 John T. Veitch, M.D., F.R.C.S.E.

¶ 15 Leave a comment on paragraph 15 0 Baljik, August 23, 1854.

¶ 16 Leave a comment on paragraph 16 0 From the great interest you still take in all that concerns the service in which we were once companions, I know perfectly well that you will read with eagerness an account coming direct from the scene of this alarming visitation, which may appear to many to be quite unprecedented; but which has, as far as I can see, conformed to laws already ascertained.

¶ 17 Leave a comment on paragraph 17 0 I shall, therefore, relate to you a few of the circumstances which I have witnessed, or which have come to me on reliable authority.

¶ 18 Leave a comment on paragraph 18 0 We all know there are peculiar conditions of the general health that precede an approaching epidemic of cholera, and these have not been wanting in this instance.

¶ 19 Leave a comment on paragraph 19 0 From the early part of July, bowel complaints—fatal in some cases—have existed in the camp at Varna. To have called these cases “ Asiatic cholera ” would have laid one open, then, to the charge of being “ an alarmist;” but now no one doubts their true character.

¶ 20 Leave a comment on paragraph 20 0 In the fleet, too, and especially in the division of it anchored at Varna, diarrhoea of a bad form has been frequent from the early part of the summer. The peculiar characters of this diarrhoea have been depressed animal spirits, prostration of muscular power, a dusky dry skin, or a damp chilled surface, with a lurid heavy expression of the eye, the vivacity and rapidity, of its glance being lost, and its orbit surrounded with a darkened areola. Digestion and assimilation, especially of vegetable food, were suspended, and the excretory functions of the liver and kidneys were diminished, or even temporarily suppressed. In. most cases, the re-action of the system after this stage of depression amounted to ephemeral fever.

¶ 21 Leave a comment on paragraph 21 0 This ought to have been regarded as ah epidemic condition, pregnant with evils of a more formidable nature, or, at all events, as offering a congenial bed on which poisonous seeds, brought from a distance, would find everything conducive to their speedy development.

¶ 22 Leave a comment on paragraph 22 0 It may seem far-fetched to speak of any “unfavourable circumstances of place ” influencing ships lying at anchor in an open roadstead, off a narrow strip of shore, from which the land rises in cliffs, broken here and there by water-channels; because all the features of such a scene wear a health-giving aspect. If, standing oh the cliffs of Dover, and admiring a noble fleet at anchor in the Downs, you were told that diseases existed among them from local circumstances, you would ridicule the idea; nor would you think it probable, that before to-morrow’s noon the majority of them might be afflicted with pestilence, that should leave forty healthy men of to-day dead on the decks of a single ship : but all this has occurred with us.

¶ 23 Leave a comment on paragraph 23 0 With regard to local cause of disease, if you were here you. would think with me, that man may convert even the pebbly beach into a source of disease by neglect of ordinary sanitary precautions.

¶ 24 Leave a comment on paragraph 24 0 To feed the large community of 20,000 who man the Allied fleet requires a daily hecatomb of slaughtered beasts; and, for three months past, this Commissariat operation has been performed close to the sea-side; the offal,—paunches, heads, and feet, of horned cattle, have been cast into the sea, carried alongshore by the current, arid stranded again at some distant spot; so that the beach, for two miles from the butchery, is strewed with putrid animal remains.

¶ 25 Leave a comment on paragraph 25 0 Now, the seamen who are sent ashore on duty rarely have permission to go away from the beach; sometimes they are detained an hour or two waiting for some person, or while their boats are being loaded with freshwater. They saunter along .the shore; perhaps they trespass on the neighbouring gardens, and help themselves to unripe fruit; or they stretch themselves on the sand and fall asleep amidst all the odours of putrefying remains,—which cannot be healthy when the thermometer ranges from 80 to 90 degrees. I have often remarked on the evil consequences that might be expected from such gross carelessness of seamen to the commonest dictates of prudence, 

¶ 26 Leave a comment on paragraph 26 0 Such facts as these may explain much of the condition of the general health as to bowel complaints which has reigned here; but a certain something was still wanting to give the prevalent disorder the true cholera characters. No case pf collapse had occurred in the combined fleet, as far as I am aware, until after the arrival of a vessel which had Asiatic cholera among her crew.

¶ 27 Leave a comment on paragraph 27 0 On the 14th of July, a small steamer arrived from the South of France, having lost four men by cholera on her voyage, and one on the night preceding her arrival. She anchored inshore of the English squadron, and landed her men, to live in tents. Another French steamer, similarly situated, joined her on the 25th, and, while thus encamped, they buried several of their men.

¶ 28 Leave a comment on paragraph 28 0 Soon after the arrival of this vessel, cases of collapse occurred in ships of the fleet. The Diamond, which was near to the encampment, had a case on the night of the 16th; and the French three-decker, Valmy, sailed out of the bay on the 25th, on account of having had several cases.

¶ 29 Leave a comment on paragraph 29 0 In the meantime, on the 21st of July, the main body of the Allied fleet left this, to reconnoitre the Crimea, and returned to