In Ferussac's Bulletin Universel for Jan. 1826, we observe the following notice, from a German Medical Magazine, conducted by M. D. Schmidt.
A female, aged 33 years, had suffered for 9 years from a diseased parotid gland, which had gradually attained a large size. It was extirpated by Dr. Prieger, and the patient soon returned home in good health, and little disfigured. The tumour measured 8 inches in circumference, and weighed three and a half pounds. (Livres.)
Dr. Prieger had previously extirpated a scirrhous parotid successfully. M. Wienhold affirms, that he has extirpated three parotids; the details of these operations are published. M. Schmidt, however, suggests some doubts, as to the nature and seat of the tumours removed.
47. Aneurism from a Wound, cured by Valsalva's method.—This interesting and valuable case, is condensed from Le Propagateur des Sci. Med. for March, 1826. M. Antouard, a healthy female, æt. 18, was wounded on the 18th of June, 1825, by a poniard, in the left carotid artery, below the superior extremity of the sternum; the instrument passing obliquely inwards and downwards. The anterior and lateral portions of the neck, were enormously distended with blood, and syncope supervened. Four days after the injury was received, an aneurismal tumour was observed at the edge of the sternum, the surrounding effusion being greatly diminished by absorption; and at the expiration of a month, when she was first seen by Dr. Souchier, it was of the size of the two fists of the young female. The pulsations at this time, were nearly equal over the whole surface of the tumour; but rather more distinct over the orifice in the vessel. The surrounding blood was entirely absorbed. No pain was experienced, unless from the pressure of the swelling; from which cause also, resulted a troublesome and continued headach. Dr. Souchier, not believing an operation adviseable, during the warm season of the year, and on a tumour, situated so much under the sternum, determined to fulfil the following indications: 1st. To lessen the quantity of blood; and thus, to diminish the stimulus to the heart, the projectile force it exercises, and consequently, the rapidity with which the blood escaped from the ruptured vessel, and the impulse hence imparted to the sides of the tumour, preventing, in some degree, the coagulation of the blood. 2nd. To increase the effect of general and local bleeding by the use of cold, of pressure, and especially, of the digitalis purpurea: that thus the force of the circulation may be lessened, the blood allowed to coagulate, and a radical cure be accomplished.
Mademoiselle Antouard, determined to yield herself to this plan, and was directed: 1st. Rice-water, acidulated with lemon-juice, and an infusion of mallows, for food and drink. 2nd. To employ frictions on the abdomen, and on the insides of the thighs, morning and evening, with eight grains of the pulverized leaves of digitalis, previously macerated for 24 hours in a sufficient quantity of saliva. 3d. To apply every day 12 leeches, near the aneurismal tumour, and after favouring the flow of blood by emollient fomentations, to cover the part with compresses, wet with a saturated solution of the acetate of lead, to be frequently renewed, so as to be kept below the temperature of the skin. 4th. The effect of these means to be augmented by pressure, made by means of the base of a glass tumbler, fixed by the hands of assistants; and 5th. To be kept at rest, and in perfect silence.
Fourth day of treatment, being 2nd of Aug. 1825. Pulsations more central; tumour very sensibly diminished; pulse less strong and reduced from 86 to 74 in the minute; the menses, which had been suppressed for two months, appeared on the 31st ulto. and still flow. Prescription, V. S. ℥xviij. next day, twelve leeches, on the lateral parts of the tumour; gr. xxiv. of digitalis in three applications through the day. Continue ut supra.
Aug. 8th. Patient tranquil; pulse 60, full, not active; face not flushed, but preserving a delicate tinge of red; headach now slight; no nausea; menses continued until the 6th inst. Prescription, V. S. ℥xij.—fifteen leeches to-morrow; increase digitalis to gr. xxviij. daily; the rest, ut supra. The tumour has diminished at least one-fourth.
Aug. 12th. Tumour reduced to 3-5ths of its former volume; pulse at 56; her nights are comfortable; has some headach, and lately, cardialgia; complains of hunger and weakness, and from the fatigue of her assistants, the pressure was made with a bandage less effectually than before. This was allowed, as the pulsations are weakened, and more and more central, while the elevation of the tumour is trifling. For fear her health might be injured, she was permitted to rise a little from bed, and to add to her rice water, some light jellies, (crémes) made from the same grain. V. S. ℥x. and every 2nd day, eight leeches around the tumour; digitalis increased to 32 grains daily; warm pediluvium for one hour, morning and evening; silence as complete as possible.
Aug. 18th. No tumour visible; pulsations can yet be felt; the skin is thickened; pulse at the wrist is at 50. V. S. ℥viij.—six leeches every 4th day until menstrual period; digitalis reduced to gr. xx. and still to the same parts; continue the pressure; allow some rice jelly, vermicelli soup, gentle exercise; silence to be preserved, continue pediluvium, and relieve constipation by simple enemata.
In 15 days, Dr. Souchier again visited his patient. It required an experienced hand to distinguish, at the spot where the artery was cicatrized, an elevation rather more evident, than over the rest of the artery. Pulse 48 per minute; hunger great, and the remedies now unpleasant. Most of them were suspended, and fruit and the white flesh of poultry added to her diet list. The digitalis reduced to 12 grains a day. Compression, silence, and moderate exercise, to be continued as before. The menses appeared at the expiration of twenty-five days, and were more abundant than at the last period.