BUSTEE DISPENSARY. MONTII OP APRIL.
CASES TREATED DURING THE By T. D'O. Paktbidoe, F.H.C.S.,
Civil
Surgeon.
Theke have not been many cases out of tho common and usual run of disease treated during the past month. The daily attendence was 33 ; total treated as out-patients 998, of ?which 515 were new cases. The diseases were, principally, ague?quotidian type, rheumatism, dyspepsia, leprosy and dysentery and diarrhoea, and ozama, a disease by no means uncommon hero : for the past 3 years 71 cases havo been treated. In Dr. Garden's interesting paper on ozama in the May number of this Gazette for 1870, he states that it
principally
THE INDIAN MEDICAL GAZETTE.
142
affects females. I can fully endorse that, for out of the number treated, 27 were males and 44 females. I am also fully of liis opinion that it is a disease confined
to those over puberty and between 21 and 30. I do not remember meeting, amongst the number of cases treated, any with a total loss of the soft parts, or with disease of the bones; I hope it may be that the inhabitants are trying to have more faith in our remedies, and are more inclined to come in for treatment in the early stage. I am inclined to put down ozoeua to be nearly, if not. quite, always due to a syphilitic taint in the constitution; no doubt malarial fevers will aggravate the disease, but I do not myself think them to be the primary cause, but possibly from the general debility usually arising after fever, more particularly in natives, they may form the exciting cause. May not one reason for its being a disease more peculiar to the hot months, arise from the irritation set up in the mucous membrane of the nose by the fine particles of dust floating about in the atmosmore
phere ? Splenitis
and most of the sequela} of fever and ague are comhere and not very amenable to treatment; this I put down to the fault of the patients themselves, who deriving a little benefit from the medicine, have not patience to persevere for a sufficient time under treatment. Nyctalopia affects people a good deal, but yields pretty I have found galvanism very beneficial. to treatment. mon
readily
The number of in-patients of the month, 14. The diseases for which they
was
36 ;
were
being treated
remaining
on
were
the 1st
stricture,
fracture, dysentery, contusions, calculus vesica), and dropsy. Of this disease, dropsy, the returns are unsatisfactory with
regard to cures, in fact treatment gives little more than relief for the time?constant tapping, only for the abdomen to increase again and again with effusion of more fluid ; it is weary work ; and makes one almost feel disposed to forswear such cases; nothing seems to do permanent good.
I should be glad of any hints from others who have had greater experience in the treatment of this disease, and also if
like me, have almost given up than relieve for the time being.
they,
hope
of
doing
much
more
There have been
only a few operations, and these only minor opening abscesses, &c., except two cases of stone, one in a girl aged 10 years. The operation performed was that of Mr. Fergusson, viz., the division of the anterior half of the urethra by a probe-pointed bistoury, avoiding the bladder. The stone on extraction weighed 437 grains, and had I waited cases,
dilate the urethra, it would have taken more time to inthe calibre to a sufficient size, not only to admit the forceps, but to have allowed them to be withdrawn, greatly distended as they would have been by the addition of the
to
crease
calculus.
The patient is exception of the symptom.
far usual
so
progressing favourably pain and soreness, she
that with the shows no bad
"
quite capable of retaining her urine almost after the operation. The other case is that of a boy, 19 years of age; the operation was performed on the morning of the 31st. He had been admitted nine days previously, and I had intended to have operated on the 28th, but could not succeed in either getting him fully under the influence of chloroform or in introducing the grooved staff. She also
was
immediately
There was evidently a great deal of irritability of the bladder also affecting the urethra and amounting to almost a thorough spasmodic stricture. Strange to say, we passed a sound almost without difficulty, though he strained and twisted about more than he should have done; but upon trying to introduce the staff, it was firmly grasped by the urethra and would not stir; a smaller one was tried, but without avail, nor could we afterwards either introduce a catheter or the sound. I thought it better, under these circumstances, to send him back to bed for a day or two, and to try and soothe the irritable bladder and urethra, by warm baths and small doses of hydrate of chloral; finding him apparently better in every respect on the 31st, he was brought into the operating room and placed under chloroform, which had a much quicker effect on him this time than the last.; there was also little dilDin culty introducing either the sound or the staff, though at first I found 1 was to be again baulked by the apparent disappear-
[July 1,
1871.
of the stone, but after more searching about, it was found high up in the bladder aud seemingly impacted. I found no difficulty in reaching the bladder, but had a difficulty in finding and bringing down the stone before being able to take hold of ance
it with the forceps. On extraction it weighed 220 grains and was of an exceedingly external rugged appearance. He progressed favourably up to the evening of tlio 22nd day, when I received a note from my hospital assistant saying he had peritonitis. On visiting hi in that evening, I found him semi-conscious, the abdomen swollen and tympanitic, and complaining of great pain. He passed water freely, and his bowels had acted during the day. I ordered a hot linseed poultice sprinkled with laudanum to be at once applied and frequently renewed during the night, and hydrate of chloral internally, 30minims of which were given him whilst I was there, but he vomited the greater part of it up. I gave directions that two smaller doses should be given him during the night if he did not sleep. On paying my morning visit, I found him a degree better, less restless and more rational, and the belly less hard and tympanitic, pulse very fast and weak, and much pain on pressure of the abdomen, but far less than the night previously. There is also now in hospital a patient sent in by the police. His account of the affair is that another man struck him witli a lattie across the loins ; he felt benumbed at tbe time, but on being brought to the hospital he felt better, though no urine passed for nine hours after admission. On my visiting him I found no mark whatever, only pain on pressing his loins, but his left leg was completely paralysed, and now the paralysis has extended to tbe arm of the same side, the left. He declares lie had nothing of the sort before being struck, nor can I gain any information from the police or his relations that be was affected previously.
CASES TREATED DURING THE By T. D'O. Paktbidoe, F.H.C.S.,
Civil
Surgeon.
Theke have not been many cases out of tho common and usual run of disease treated during the past month. The daily attendence was 33 ; total treated as out-patients 998, of ?which 515 were new cases. The diseases were, principally, ague?quotidian type, rheumatism, dyspepsia, leprosy and dysentery and diarrhoea, and ozama, a disease by no means uncommon hero : for the past 3 years 71 cases havo been treated. In Dr. Garden's interesting paper on ozama in the May number of this Gazette for 1870, he states that it
principally
THE INDIAN MEDICAL GAZETTE.
142
affects females. I can fully endorse that, for out of the number treated, 27 were males and 44 females. I am also fully of liis opinion that it is a disease confined
to those over puberty and between 21 and 30. I do not remember meeting, amongst the number of cases treated, any with a total loss of the soft parts, or with disease of the bones; I hope it may be that the inhabitants are trying to have more faith in our remedies, and are more inclined to come in for treatment in the early stage. I am inclined to put down ozoeua to be nearly, if not. quite, always due to a syphilitic taint in the constitution; no doubt malarial fevers will aggravate the disease, but I do not myself think them to be the primary cause, but possibly from the general debility usually arising after fever, more particularly in natives, they may form the exciting cause. May not one reason for its being a disease more peculiar to the hot months, arise from the irritation set up in the mucous membrane of the nose by the fine particles of dust floating about in the atmosmore
phere ? Splenitis
and most of the sequela} of fever and ague are comhere and not very amenable to treatment; this I put down to the fault of the patients themselves, who deriving a little benefit from the medicine, have not patience to persevere for a sufficient time under treatment. Nyctalopia affects people a good deal, but yields pretty I have found galvanism very beneficial. to treatment. mon
readily
The number of in-patients of the month, 14. The diseases for which they
was
36 ;
were
being treated
remaining
on
were
the 1st
stricture,
fracture, dysentery, contusions, calculus vesica), and dropsy. Of this disease, dropsy, the returns are unsatisfactory with
regard to cures, in fact treatment gives little more than relief for the time?constant tapping, only for the abdomen to increase again and again with effusion of more fluid ; it is weary work ; and makes one almost feel disposed to forswear such cases; nothing seems to do permanent good.
I should be glad of any hints from others who have had greater experience in the treatment of this disease, and also if
like me, have almost given up than relieve for the time being.
they,
hope
of
doing
much
more
There have been
only a few operations, and these only minor opening abscesses, &c., except two cases of stone, one in a girl aged 10 years. The operation performed was that of Mr. Fergusson, viz., the division of the anterior half of the urethra by a probe-pointed bistoury, avoiding the bladder. The stone on extraction weighed 437 grains, and had I waited cases,
dilate the urethra, it would have taken more time to inthe calibre to a sufficient size, not only to admit the forceps, but to have allowed them to be withdrawn, greatly distended as they would have been by the addition of the
to
crease
calculus.
The patient is exception of the symptom.
far usual
so
progressing favourably pain and soreness, she
that with the shows no bad
"
quite capable of retaining her urine almost after the operation. The other case is that of a boy, 19 years of age; the operation was performed on the morning of the 31st. He had been admitted nine days previously, and I had intended to have operated on the 28th, but could not succeed in either getting him fully under the influence of chloroform or in introducing the grooved staff. She also
was
immediately
There was evidently a great deal of irritability of the bladder also affecting the urethra and amounting to almost a thorough spasmodic stricture. Strange to say, we passed a sound almost without difficulty, though he strained and twisted about more than he should have done; but upon trying to introduce the staff, it was firmly grasped by the urethra and would not stir; a smaller one was tried, but without avail, nor could we afterwards either introduce a catheter or the sound. I thought it better, under these circumstances, to send him back to bed for a day or two, and to try and soothe the irritable bladder and urethra, by warm baths and small doses of hydrate of chloral; finding him apparently better in every respect on the 31st, he was brought into the operating room and placed under chloroform, which had a much quicker effect on him this time than the last.; there was also little dilDin culty introducing either the sound or the staff, though at first I found 1 was to be again baulked by the apparent disappear-
[July 1,
1871.
of the stone, but after more searching about, it was found high up in the bladder aud seemingly impacted. I found no difficulty in reaching the bladder, but had a difficulty in finding and bringing down the stone before being able to take hold of ance
it with the forceps. On extraction it weighed 220 grains and was of an exceedingly external rugged appearance. He progressed favourably up to the evening of tlio 22nd day, when I received a note from my hospital assistant saying he had peritonitis. On visiting hi in that evening, I found him semi-conscious, the abdomen swollen and tympanitic, and complaining of great pain. He passed water freely, and his bowels had acted during the day. I ordered a hot linseed poultice sprinkled with laudanum to be at once applied and frequently renewed during the night, and hydrate of chloral internally, 30minims of which were given him whilst I was there, but he vomited the greater part of it up. I gave directions that two smaller doses should be given him during the night if he did not sleep. On paying my morning visit, I found him a degree better, less restless and more rational, and the belly less hard and tympanitic, pulse very fast and weak, and much pain on pressure of the abdomen, but far less than the night previously. There is also now in hospital a patient sent in by the police. His account of the affair is that another man struck him witli a lattie across the loins ; he felt benumbed at tbe time, but on being brought to the hospital he felt better, though no urine passed for nine hours after admission. On my visiting him I found no mark whatever, only pain on pressing his loins, but his left leg was completely paralysed, and now the paralysis has extended to tbe arm of the same side, the left. He declares lie had nothing of the sort before being struck, nor can I gain any information from the police or his relations that be was affected previously.
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