meesing

and further on it will be found in the chapter devoted to the syphilis of infants.

4TH. ON TRAUMATIC HEPATITIS.

This is a form of hepatitis entirely different from that just described. It is observed in every age; and in our country, with our temperature, saving the cases of purulent infection, abscesses of the liver are usually the result of contusions of this organ. Here is a case observed by M. Renaud, in a child sixteen months old. The hepatitis was caused by a contusion over the right hypochondrium, it was followed by the formation of an abscess which opened externally and ended in the death of the child.

Case. Abscess of the liver opening externally in a child sixteen months old, by M. Renaud. Called on the 27th of March last to a child sixteen months old, which 44 I learnt had been ill for six weeks, having at that time had a fall from a height more than three feet, receiving a violent blow on the right hypochondrium. Previous to this time it enjoyed very good health; but at the decline of the day of its fall, the physiognomy expressed a continual suffering; it gradually dwindled away. However, the parents, in their culpable negligence, never had recourse to medical aid; they only thought they observed the formation of a tumour which appeared extraordinary to them. The information obtained at the time of my first visit, on the first symptoms experienced by my little patient, is not sufficiently precise to be transmitted here; but I positively ascertained that the child had never had jaundice, nor any derangement referable to the digestive {{ functions.

On December 27th, the child presented a decubitus on the right side; out of the cradle it inclines towards the right side, the position which it preferred from the day of the accident. The skin is pale, dry; the respiration anxious; the pulse small, accelerated. The maternal milk is taken on each occasion with avidity; the alvine excretions are yellow and of natural consistence; no vomiting. The abdomen large, indurated, presents on the right hypochondrium a flattened, fluctuating, pulsative tumour.

considerably

On the 1st of January, 1851, after a slight exploratory puncture, I made a sufficient opening, and an enormous quantity of phlegmonous pus escaped from the interior of the tumour, which collapsed.

4th. The flow of pus has always been abundant; the skin which covers the tumour is thinned; at several points fistulous tracts are observed.

5th. The skin adheres to the poultice, and presents a white surface covered with purulent matter. The wound is circular; it appears as if made with a punch; its dimensions are 2 inches by 24 inches.

7th. The membranes which cover the convex surface of the liver are gangrenous; I removed them. The tenth rib forms a projection of one eighth of an inch in the interior of the wound, and offers resistance to the hepatic gland, when this is carried outwards in the act of inspiration.

8th. The surface of the liver presents a greyish tint; an ulceration has formed on the part compressed by the rib.

9th. The rib is laid bare in its projecting portion; it appears to me floating between the abdominal wall of the liver, simply retained by the vertebral extremity, and attacked with necrosis.

11th. The liver fills up the circular opening, at the superior part of which it presents a notch of 1.2 inch in length and .4 in depth. The pus, always abundant, has become foetid, mixed with the detritus of the hepatic tissue.

15th. The dressings are impregnated with unaltered bile, the escape of which lasted until death. This child is in the most extreme state of marasmus and debility possible; it is seized with hiccough, the face is pinched, the skin of a well marked pallor, the pulse filiform and accelerated. Nevertheless, no disturbance was observed referable to the digestive tube. To the internal treatment, which consisted of cod-liver oil and syrup of bark, a little broth and sweetened wine were added. Death occurred two days afterwards.

MM. Gros, Oviou, and Duhamel assisted at the last stages of this truly rare and interesting disease, and also at the autopsy, which the opposition of the parents rendered incomplete. We remarked adhesion of the liver with the abdominal wall, by means of extensive pseudo-membranes, which were covered with pus; a cavity situated on the superior and external portion of its convex surface, capable of holding a large nut; the walls of this cavity were indurated, of a whitish colour, from one fifth to one fourth of an inch in thickness; the surrounding tissue of the liver bluish and indurated; at a distance of 1.2 inch the organ presented the normal texture, but in. its inferior and external third many small deep-seated abscesses were observed.

BOOK XIII.

ON DISEASES OF THE KIDNEYS.

CHAPTER I.

ON ALBUMINOUS NEPHRITIS.

Albuminous nephritis is an organic affection of the kidneys, accompanied by albuminous urine. It is a very frequent disease in the adult, and one well known since the investigations of M. Rayer. It is sometimes observed in young children, but the fact is rare, and it is not without use to support it by some proofs.

This disease is announced by decoloration of the integument, oedema of the feet and hands, swelling of the abdomen, in consequence of an abdominal serous effusion, puffiness of the countenance, and lastly, by the passage of blood or of albumen into the urine.

This change in the urinary secretion is detected by the addition of several drops of nitric acid to the altered urine, and boiling it in a toninted small glass tube. A whitish granular precipitate reveals the presence of the albumen, which has become solid under the influence of the reagents.

M. Rayer has observed many children from six months to one year old already affected with this disease, and has given me før investigation the bloody and albuminous urine of a child nine months Cold. M. Nöel has communicated to me the case of a child of eighteen months, who became bloated during the course of chronic enteritis, and whose urine gave a precipitate by nitric acid and heat; it died after several months of suffering. M. Grisolle has seen an instance

of it in his practice at St. Antoine Hospital; and this case is one of the most curious, for the albuminous nephritis, in a child of some weeks, only occasioned transient symptoms of dropsy not followed by death. The following is the case:

Case. Charles Désiré, a boy living Rue St. Pierre, five weeks old, born at the Maternité, was admitted the 13th of December, 1849, into the St. Antoine Hospital.

The mother has been in good health since her confinement; there was nothing particular in the delivery. She has commenced to suckle her child; from the second day she had little milk. Her child was large and well developed at the moment of birth.

The mother left at the end of eleven days from the delivery, and lived in a furnished apartment, where she suffered from cold and hunger. She found herself indisposed, was seized with shiverings; the lochiæ were suppressed, were replaced by fluor albus, and she entered the hospital as much for herself as for her child, who had an ophthalmia.

The night previous, the mother having left her child alone in a room without a fire for several hours, found him on her return stiff and blue with cold.

The day of her admission into the hospital, she remarked that her child had a swelling of the left hand. Little notice was taken of this local oedema. It was not until after several days that having noticed that the child got thinner, dwindled away, and that he had become emaciated; he was undressed, and it was remarked that the whole of the left pelvic region was the seat of a soft, whitish oedema, which extended as far as the left region of the scrotum.

The urine is slightly turbid, of a deep lemon colour, with a considerable precipitate on the addition of nitric acid.

The next day, the same trial with the same result.

January 3rd. Iron reduced by hydrogen, sixteen grains for two doses.
From the 5th to the 13th, the oedema which is soft, easily gives way under
the finger which leaves an impression lasting one or two minutes; it is variable
in its intensity and situation, sometimes predominating in the hands, sometimes
in the limbs and scrotum. It has been present for twenty-four hours at the
chin and eyelids.

No fever, respiration natural, a little cough.
13th. Edema much less.

The urine is quite colourless, slightly mucous.

No precipitate on the addition

of nitric acid; boiling heat communicates to it a very slight opaline tint without flakes.

16th. There is no cedema except on the dorsal surface of the feet. The child has recovered; he is less emaciated.

25th. No reappearance of the oedema. Abundant perspirations for several days. Urine unaffected by the acid or by heat.

29th. The child is more lively, his cry stronger; he has always been somewhat emaciated. Disposition to rickets. Omit the iron. Two tea spoonfuls of cod

liver oil.

Februrary 3rd. Urine unaffected by the reagents.

5th. The same.

15th. The child has increased in flesh; the oedema has not reappeared. April 2nd. Visited the mother of the child which has quite recovered and become fat, but which was carried off some days afterwards by a convulsive disease. Note. The urine was at first obtained by the mother, who undressed the child in the cold, and quickly carried him to the utensil; the child passed water. More lately, this means having failed, the parts were enveloped in a belt. Here, moreover, is another case which I have myself observed in a child of more advanced age, ill in consequence of pulmonary and cerebral tubercles.

Case. Tubercles of the lung, bronchial glands, meninges, and kidneys; meningitis, cerebral softening, albuminuria. A girl twenty-seven months old, has her twenty teeth, of general good health; had diarrhoea and fever each time that she cut a tooth.

She had been four months in the hospital, St. Therese Ward, No. 11. The twentieth tooth has just come through; she had fever and diarrhoea for some weeks; she had an eruption on the lips.

She had then inflammation of the eyes for some time.

She had afterwards a catarrh which became developed into hooping cough at the end of some days.

A pneumonia on the left side caused it to cease; then it reappeared and has continued until now. She had an attack of fever each day.

Since eight days, the attacks have ceased, the fever has assumed a continued type, and the abdomen is painful. The cough is small, dry; nothing can be discovered on the examination of the chest.

To-day, 29th of November, 1841. She is in the following state:

Depression, somnolence; the eyes are continually closed, general resolution. Skin warm, face injected; pulse 142.

Cough dry, unfrequent; nothing abnormal can be discovered on the chest ; respiration puerile posteriorly, a little sibilant râle anteriorly.

Abdomen large, apparently indolent; several stools; urine turbid, albuminous. The liver is of very large size.

30th. The prostration continues. Yesterday evening this child had a fainting fit; afterwards ground the teeth and bit the fingers. Cough unfrequent, dry; nothing abnormal on the chest. The belly is always hard; bowels relieved twice. Tongue red, dry; lips dry. Skin warm, pulse frequent, 142.

Gruel, milk.

31st. In the same state. The weakness increases when it is endeavoured to lift the child. She feels very ill. Dorsal decubitus; the eyes closed; complete resolution; pulse 136.

Gruel, two calomel pills.

February 1st. Two attacks of loss of consciousness; muttering, grinding of the teeth, slight convulsive movements of the arms and legs. The right pupil is more dilated than the left, the head is thrown back, and the child is at once entirely raised by lifting the back of the head. Considerable fever in the evening; this morning the skin is natural. Digestive organs healthy; no vomitings, two stools; pulse 136.

Gruel, three calomel pills.

2nd. Two stools; muttering, convulsive movements of the arms and legs Diminished sensibility in the arms, which she can draw back. The same irregularity in the pupils; general stiffness, no injection of the eyes; drowsiness, dorsal decubitus, head inclined to the right side. Skin warm; occasionally the head very intense; pulse regular, 140. Trismus, respiration irregular, intermittent, sighing.

3rd. Convulsive movements of the limbs; trismus, strabismus. The weakness of the limbs on the left side has slightly disappeared. The eyes are open, but vision is lost. Same state of respiration. Several consecutive inspirations and

a long pause. Skin very hot; pulse 200 to 220. Less general rigidity.
Died at eight o'clock.

The lungs sprinkled with gelatiniform miliary tubercles. Some of them are observed in the midst of red, hard, and evidently inflamed lobules. There is posteriorly, on both sides, a slight degree of hypostatic pneumonia. The bron chial glands are for the most part tuberculous; they enclose a yellow hard matter, precisely similar to Indian chestnut paste.

The membranes of the brain are considerably and uniformly injected; there are no adventitious membranes. The arachnoid is dry, thick, and opaline at the base. The adhesions of the fissure of Silvius are internal; they also exist at the anterior part of the great central fissure. On the convex surface of the hemispheres, as much to the right as to the left, five of the small white specks called tubercular granulations are observed.

The arachnoid and the pia mater of the base of the brain and of the anterior part of the cerebral fissure are opaque and considerably thickened. On incision they are hard and resisting; it was said they were infiltrated with tubercular matter; it is possibly concrete pus.

The grey substance of the brain appears more injected than is usual, and presents a transparency like agate.

The white substance is slightly injected, firm at the superior portion of the hemispheres.

The superior wall of the ventricles possesses the natural consistence, but the inferior wall, the optic thalamus, the ancyroïde cavity, the fissure of Bichat, are quite softened and diffluent, on both sides alike. The fornix appears dense at its superior part, but not at its inferior. There was but slight effusion of serum into the ventricles.

The same changes exists on both sides; no foreign body in the cerebral substance. The kidneys contain several slightly developed and ill-defined tubercles. Thus only small whitish very opaline bodies are observed in the centre, the tint of which gradually becomes less decided and is lost in the tissue of the kidney. The remainder of the organ appears healthy.