299

trot the inspiratory effort; and I have never occurring frequently at night-induced at
- known it fail to give temporary relief: in all times by anything that disturbed the
some instances it has saved life. I am tranquillity of the little patient’s mind, and
aware it may be said such compression of particularly during a fit of crying. During
the chest is likely to prove injurious to the these paroxysms the muscles became stif-
infant’s growth ; and, certainly, it should be fened, the features violently distorted, the
discontinued as soon as the cause for its face black, respiration suspended, and the
application disappears ; but where the at- patient very much exhausted. When the
tacks of dyspnoea are threatening daily and spasms gave way there was a peculiar
hourly to cut off the patient, immediate be- croaking sound of the voice, which was not
nefit mnst be sought at the risk of remote ill present after the fit had subsided, and very
consequences. different to the sound produced by croup :
The other points in the treatment may be i, in the intervals, the patient became lively,
summarily recounted-change of air, warm could eat and drink withoutmuch difficulty,
clothing, nutritious diet, great attention to and was free from acute disease of the lungs
the state of the digestive organs, guarding and bronchial tubes; having at most a slight
especially against constipation, are the cough, without much dyspnoea, and only
chief; and to these may be added, local ap- mild febrile symptoms. During the parox-
plications, counter-irritants, iodine ointment, ysms, change of position always gave relief.
&c. to the base of the neck, though the cu- The mode of treatment adopted in these cases
rative effects of such will prove inconsider- was as follows:-One-eighth of a grain of
able. In the instances of laryngismus tartarised antimony with half a grain of
stridulus, complicated with cerebral dis- submuriate of mercury, was taken every
order, the treatment must so entirely be re- four hours, afterwards every six and eight
gulated by the circumstances of each indi- hours, then twice a-day ; in the intervals,
vidual case, that it is impossible in a paper a saline mixture with hyoscyamus or poppy
like the present to give it even in outline ; was given ; and lastly, small doses of mer-
but one precaution the writer will venture cury with chalk once or twice a-day, and a
to suggest to those who have such cases mixture with sulphuric acid and syrup ; to
under treatment, avoid the " nimia medici which may be added, a mild nourishing diet.
diligentia." Where symptoms of congestion The elder of these patients has up to the
or inflammation are present, cautious deple- present time (now more than two years since
tion and the use of mercury may prove u-se- the attack) a peculiar sound of the voice
ful ; but the cerebral irritation may be most whenever she cries or is pettish ; the other
intense, the carpo-pedal contractions at times patient is alive. I am, Sir, yours respect-
present, the laryngismus stridulus most fully,
distinct, and yet the case be benefitted by a JAMES PROWSE.
soothing or even strengthening treatment ; St. James’s, Barton, Bristol,
and the symptoms, on the other hand, be ex- May 14,1841.
asperated to a tenfold degree, by antiphlo-
gistic measures.

ON THE

THYMIC ASTHMA.
To the Editor Of THE LANCET.
SIR:—In answer to your appeal to medi-
cal men respecting the disease called by the
Germans thymic asthma, I beg to say that
I have treated successfully two cases of it.
The whole of the children in Mr. Under-
wood’s family, in which these cases oc.
curred, have soon after birth manifested the
asthmic constitution ; have become ill from
time to time from slight causes ; two of them
have had distortions of the spine and extre-
mities, and five out of nine have died of dis-
eases incident to such a state of body ; such
as subacute disease of the brain, lungs, in-
testinal canal, &c., in which it was found
impossible to have recourse to active deple-
tory remedies without doing injury. The
cases of thymic asthma were characterised
by spasmodic attacks of the muscles of the
upper part of the thorax, neck, and face, oc-
casioning severe stricture of these parts, and
APPLICATION OF LEECHES TO
THE PROSTATE GLAND.
By WILLIAM CRAIG, Esq., Surgeon, Ayr.
To the Editor of THE LANCET.
Sm :-I am glad to haveit in my power
to corroborate the statement made by Dr.
Henderson, of Perth, in THE LANCET for
January 30th, of the good effects of leeches
applied to the prostate gland through the
rectum. I may state, however, that this
kind of treatment is not perfectly new ; and
Dr. Henderson is not the first who recom-
mends it, although from his method of ap-
plying leeches in this situation, it is evident
that he deserves the credit of originality, in
so far as he seems to have had no assistance
from the mode described by M. Bégin, who
gives, in the " Dictionnaire de Medecine et
Chirurgie Pratique," an account of a me-
thod of applying leeches to the prostate
through the rectum. I applied leeches in
300
this situation fourteen or fifteen months end of the tube, one end being made into a
anterior to the time mentioned by Dr. H. ; handle, and the other being made to termi.
and this mode of treatment seems to have nate conically in a blunt point. The
been common among the French, as M. tapering form of the pointing end is gradu.
Bégin mentions it, without making allusion ally to dilate the anus, by which injury and
to the period when it was first commenced, uneasiness to the patient may be avoided.
or the individual by whom it was first pro- The little box, fig. B, is of a proper size to
posed. fit the tube, and capable of containing three
The following extract is from the paper of or four leeches : from the bottom of the box
M. Bégin, and contains his description of a wire projects to form a handle, by which
the method of applying leeches to the pros- it may be pushed through the tube when the
tate *- wooden dilator is withdrawn.
La prostatite aigue reclame Femploi d’un
traitement antiphlogistique tres actif. Au
debut une on plusieurs saignes générales
seront pratiqués avec avantage. On aura
recours ensuite aux applications de sangsues
sur la partie la plus recul6e du périnée, ou
meme sur la face rectale de la prostate.
Pour les placer sur ce dernier point, it con-
vient d’introduire dans l’anus un spéculum,
d’un pouce a un pouce et demi de diametre,
obturé à son extrémité libre, et offrant dans
toute sa longueur, une échancrure large de
huit a dix lignes, fermée par une plaque .
coulisse. Lorsque l’instrument est entrée
dans l’intestin, son echancrure correspon-
dant a la prostate, on retire la plaque, et les
sangsues peuvent être facilement portées sur
la portion dela membrane muqueuse quélle
a laisse a découvert. Après la chute des
annélides, le doigt port dans le spéculum
refoule aisément les tissus qui tendent a l5’y
engager par son échancrure et l’instrument
est retiré sans le moindre effort. Ces saig-
nées capillaires imrnediates ont été souvent
employees et toujours avec avantage.
In April, 1839,I was consulted by a gen-
tleman, about 70 years old, who had, in an
aggravated form, all the usual symptoms of
diseased prostate. There was very great
effusion of blood into the bladder, the tu.
mour was very large, and he had complete
retention of urine during fourteen days,
which rendered indispensable the daily use
of the catheter. When using this contrivance, it was ne-
He was treated by cupping, and leeching cessary to lubricate the wood and the tube
in the perinæum, and subjected to the usual with oil, by which dilatation was produced
routine of medicinal remedies, but quite un- without the slightest uneasiness, and might
availingly. Having failed to relieve the pa- have been carried to nearly double the
tient by these means, I had recourse to extent with equal facility. To avoid coming
leeching the gland through the rectum. in contact, and thereby injuring the tender
With a view to the accomplishment of this prostate, it was necessary to direct the point-
object, the means of applying the leeches ing end towards the sacrum. When one
were different from those adopted in the half of the tube had passed through the
case of Dr. Henderson, or those described anus, the wood was withdrawn, and the end
by M. Begin. I procured a tube, as is repre- of the tube which was in the rectum directed
sented in the accompanying draught, about the prostate, and gently made to
towards
two and a half inches in length, and three rest on it : the small box B was then fitled
quarters of an inch in diameter. Through with leeches, and pushed close up to the
this tube as in fig. A, in the same manner as and left there till the leeches, by
swelling,
the trocar is passed through the canula, is their increased size, pushed it down.
fitted a piece of boxwood, in such a way as This operation was but once had recourse
to allow two inches to project beyond each to in the case of this patient, as he immedi-

*
ately became more easy, the swelling had
Article, Prostatite, Dictionnaire de Me- greatly subsided, the retention had ceased,
decine et Chirurgie Pratique.—Paris, 1835. all the other symptoms were sensibly
and
 301
relieved ;and shortly after be became per-
elastic catheter to be retained, but the suf-
fectly well, and has since continued so. fering it induced was so great as to compel
In almost all cases of diseased prostate its removal after a few hours. An attempt
where leeches are indicated, this method of to introduce a silver catheter in the usual
applying them may be resorted to, and pre- manner failed, and occasioned the discharge
ferred before any other, as it is accomplished of a considerable quantity of blood. In
with the greatest facility to the operator, this dilemma five grains of acetate of mor-
and with ease to the patient. There can be phia were mixed with half an ounce of£
little doubt of the efficacy of this practice, spermaceti ointment, and the urethra was
as M. Bégin says that it is always attended
lubricated therewith by means of a bougie.
with benefit, and it was eminently useful in The catheter was again had recourse
the case of Dr. Henderson, of Perth, and in to, and care being taken to pass it so as
that related above. to describe a curve towards the right,
In contrasting the three methods of ap- which the enlargement of the left lobe of
plying leeches to the prostate, the French the prostate rendered necessary, I succeeded
one appears to be most objectionable, as it in emptying the bladder with more facility,
cannot be done withoutcausing considerable and with far less pain to the patient than on
pain to the patient ; 1st, by the pressure of any previous occasion. This method was
the blunt end of the speculum through the continued night and morning till Feb. 2,
undilated anus; 2nd, when withdrawing the three weeks after the accident, when, upon
speculum, by the friction and pressing of introducing the instrument, I experienced
the edges of the slit on the tender tissues, some difficulty; and after the contents of the
and the traction of the projecting part which bladder were discharged, upon withdrawing
exists at the end of the slit, where the whole the catheter, three or four ounces of pus
circumference of the speculum becomes per- flowed from the urethra. Two days after-
fect. wards the bladder recovered its powers, the
Ayr, April 3,1841. obstruction was removed, and the patient
has experienced no subsequent inconve-
CASE OF ABSCESS nience.
The means employed to allay the irrita-
OF THE
bility of the urethra in this case, simple as
PROSTATE GLAND. they were, merit the attention of the young
By GIDEON ALGERNON MANTELL, Esq., practitioner ; for, although the instrument
LL.D., F.R.S. was previously introduced dripping with
oil, such was the heated, dry, and tender
A gentleman, aged 70, of a florid com- state of the canal, that the tube could not
plexion and sanguine temperament, and be passed without much difficulty, and occa-
of extremely regular habits, and who had sioning great suffering. The expedient of
occasionally been subject to cystic irritation first introducing a bougie covered with mor-
from a slight enlargement of the prostate, phine ointment, to use the words of the pa-
fell down a flight of stone steps, injured the tient, " made him quite in Heaven." I
right knee, and received a slight concussionneed not occupy the valuable pages of THE
of the brain. On being brought home andLANCET with the details of the medical treat-
put to bed he experienced a severe shiver-. ment of this case : suffice it to state, that in
ing, to relieve which a tin vessel of hotthis, as in instances of a like nature, ano-
water was placed between his thighs, anddyne enemata, according to my experience,
almost instantly he felt a severe darting paini are the most effectual palliatives.
through the neck of the bladder. This was Crescent Lodge, Clapham.common
followed by a frequent and distressing de. April, 1841.
sire to micturate, which ended in complete
retention of urine. The following day
(Jan. 11) a catheter was introduced with TOOTHACH.
some difficulty and great suffering, and
about a pint of urine was withdrawn. The IT is well worthy of being more generally
operation was repeated in the evening. For known that the following formula will al-
five successive days the catheter was em- ways remove the toothach in a few minutes,
ployed night and morning, but the difficulty say ten or fifteen, if the bowels are not un-
of passing it increased, partly from the ex- healthily confined. The dose of the opiate
treme irritability of the urethra, and partly should be proportioned, as well as may be,
from a progressive enlargement of the left to the violence of the pain ; for it will pro-
lobe of the prostate, which so altered the duce no constitutional effect whatever, while
normal course of the urinary canal, as to it has a violent toothach to grapple with :-.
cause the instrument, in its passage to the Px Carbonate qf ammonia, gr. x ;;
bladder, to describe a considerable curve to Sedative solution of opium, M. xv ;
the dextral side. Ipecacuan tvine, M. xv;
An eminent surgeon, who attended this Colchictini wine, M, x ;
case in consultation with me, advised an Camphoi- mixture, 3x. M.