Medical Intelligence and Reports.

BOSTON SOCIETY FOR MEDICAL OBSERVATION.

APRIL 4TH. ELIMINATION OF LEAD FROM THE SYSTEM. Dr. Bacon read a paper* on the "Elimination of Lead from the System," in which he stated, as the result of his analyses of the urine in cases of "Lead Disease," that the efficiency of the iodide of potassium in removing the mineral was overrated, so far as the presence of any considerable quantity of lead in the urine was an evidence of this efficiency.

Dr. Minot asked if the iodide was given in any particular form, or amount, of vehicle. Dr. Bacon could not say in what form it was prescribed. Dr. Minot thought it was more likely to be efficient if given in a larger quantity of water than is usually ordered, in the same way that the various salts in mineral waters are more efficient in the natural state than when, after evaporation, they are re-dissolved, and given in a concentrated form.

Dr. Sargent asked Dr. Bacon if he supposed the iodide to be more efficient in proportion to the size of the dose.

Dr. Bacon said his impression was that the small doses were as efficient as the large.

Dr. Minot observed, that as we see in some instances a certain amount of iodide must be taken into the system to produce certain effects, (as in the case of venereal nodes, which do not yield to small deses of the salt, but disappear when the quantity is increased,) it is not unreasonable to suppose that this large quantity is required, though much of it does appear to pass out of the system unchanged.

Dr. Bacon replied that the iodide was supposed to act directly upon the lead in the tissues, and that the amount of lead eliminated was always much less than the iodide of potassium present with it in the urine was capable of holding in solution.

Dr. Slade thought that, in the use of this salt, as much effect could be got from three grains as from sixty grains three times a day. He had seen its specific effects produced in two or three days by this small dose. Dr. Sargent asked if cases did not occur in which there seemed to be

*This paper is given under our head of Selected Papers.-ED.

an induction of the colic by the iodide, which had been prescribed because the blue line, sallow complexion, etc., indicated the existence of lead, though no colic had previously occurred in the case.

Dr. Bacon replied that this appeared to be the case in some instances. Dr. Hodges, referring to Dr. Bacon's statement, that in one case he had obtained 800 of a grain of lead from three pints of urine, asked if this was a large quantity.

Dr. Bacon said it was larger than usual. In answer to the question if any analysis had been made of the amount of lead contained in the tissues of the whole body, he said that he knew of no analysis of the whole body in any case of lead poisoning, but that various parts and organs had been analyzed, and the amount of contained lead had been found to be larger in the liver and spleen than in the other tissues, but no actual quantitative results were obtained.

Dr Stevens asked if "lead disease" was ranked among the "selflimited" diseases.

Dr. Bacon said: The prevalent impression among physicians is that (sufficient time being allowed, and the removal from the source of the poison being complete) the system will relieve itself. Recent experiments upon animals tend to prove the truth of this, though the observations were rather of the effects resulting from the use of large doses of lead, than from the prolonged introduction of minute quantities.

Dr. White. Is it known what proportion of the workmen exposed to the influence of lead suffer from the various forms of lead-poisoning?

Dr. Bacon.—I know of no statement of this proportion. Much would depend upon the care taken by the workmen, and upon the form in which the lead is introduced into the system. It is probable that those salts of lead, which are most readily taken up by the organism, will produce their effects most rapidly, but the alkaline chlorides existing in the system are among the most efficient solvents of lead, and will promote the effect under whatever form the lead is introduced.

Dr. Williams.—Is not the work at the glass-houses, which requires the use of lead, among the most likely to produce lead-poisoning? It is my impression that some form of lead disease is the general rule among those employed in that part of the process, who are exposed for any considerable length of time. Among the workmen employed in grinding lead for paints, the amount of disease has diminished, and the attacks have been less severe since the lead has been ground in oil.

Dr. Bacon. The workmen of the glass-houses are very liable to be attacked. The old process of grinding lead for paints without oil must have been an active cause of disease, since the dust arising was not only inhaled, but was absorbed by the skin, which became so impregnated with the lead that it was difficult to remove it, even by repeated washings.

Dr. Sargent. How is the colic, which occurs from sleeping in newlypainted rooms, accounted for?

Dr. Bacon. It is not satisfactorily explained. Experiments give no trace of lead in the exhalations from the walls, and yet cases are given by reliable observers, for which no other cause can be assigned. Dr. Taylor (of London) has himself suffered from severe colicky symptoms,

which he could ascribe to no other cause than having slept in a freshlypainted room.

Dr. Stevens.--Is there lead enough in the Cochituate water to be detected by analysis? and does not a deposit form upon the surface of the pipes?

Dr. Bacon.-Perceptible traces of lead are found in the water, even of the largest mains. A red coating of the salts of iron and lead is formed in the lead pipes, which is supposed by its insolubility to protect against further injury to the water, but this coating has been proved to be slightly soluble, especially in the presence of the alkaline chlorides.

Dr. Stevens. Is the action of the water upon the pipes greater in the new than the old pipes?

Dr. Bacon.-It is usually less in the old than in the new pipes. The amount of action depends very much upon the character of the water, and still more upon the galvanic action which is set up in the pipe wherever particles of the undecomposed sulphide of lead are imbedded in the lead of the pipe.-Boston Medical and Surgical Journal.

EXTRACTS FROM PROCEEDINGS OF THE NEW YORK PATHOLO GICAL SOCIETY.

cause.

Nov. 10, 1858.

SURFACE ABSCESS OF BRAIN.-Dr. Krakowitzer presented an interesting specimen which occurred in a patient twenty-three years of age. His history presented the following points: When but a boy, he remembered having a discharge from the right ear, but was ignorant of the As a consequence of this trouble, the hearing upon the affected side was less acute than the other. The discharge, after a time, subsided; and he continued in good health until about a year ago, when he received a stab behind the same ear, in a drunken broil. This wound healed up at the end of a week after it was inflicted. A short time after it had healed over, there was marked pain and swelling of the part. The wound was then laid open by a physician, and a free discharge of pus took place. He suffered a great deal, from time to time, which was caused by the closure of the wound. This, however, was relieved on allowing a free exit to the pus. Last July, when he married, the attacks became more frequent and severe. He was then obliged, when suffering from an attack, to hold his head stiff, and when he wished to rise, to hold it with his hands. On the 22d of last October the pain of an attack, which he had at that time, was so severe that he fainted away. On the 27th, Dr. Vos was called in. Soon after this the patient was seen by Drs. Krakowitzer and Jacobi. They found an opening behind the ear about the size of a pea, into which a probe being introduced, dead bone could be felt. There was also found a hole in the mastoid process which connected with the cells, about one inch and a half in length. The

general symptoms, as has been stated, were those of intense suffering from pain. The skin was natural, pulse eighty-four, head cool, pupils normal, answering readily to the stimulus of light. There was no distortion of the face, and the tongue protruded in a straight line. The symptoms in the course of the disease never changed. The patient never had a chill, nor was the appetite ever entirely destroyed. He improved somewhat from the enlargement of the wound, but considering this provision to be insufficient for the discharge of matter from the mastoid cells, an operation was performed on the sixth of the month, in order to give the discharge a freer exit. The external layer of the mastoid process was removed by a trephine, and a free oozing of matter followed the teeth of the saw. The cavity of the mastoid process was filled with thick purulent matter, which gave forth an abominably offensive odor. A large quantity of the dead bone was removed by Luer's forceps. The patient was not much relieved by the operation. The pain continued about the same, and he required opiates until yesterday morning, when he rather suddenly became comatose, and died.

Post-mortem Examination-Dura mater and pia mater quite healthy. -On the anterior surface of the middle lobe there was a large abscess lined with a pyogenic membrane. On the anterior aspect of the petrous portion of the temporal bone, the dura mater was ulcerated to the size of a three-cent piece. At the bottom of this ulcer necrosed bone was exposed. No connection could be found between the cavity of the skull and these cells. The portio dura, it seems, was not in any way involved in the diseased action. There was found a communication between the cavity of these cells and tympanum. Pus was found in the cavity of the third ventricle.

Dr. James R. Wood remarked, that surface abscess, as the result of syphilis, was a very common affection; that it might exist for a long time without interfering with the functions of the brain. He had trephined several for this abscess with marked relief.

Dr. Krakowitzer stated that his case was a syphilitic one; that a welldeveloped chancre was about the only inheritance he left his wife.

Dr. Willard Parker presented a cancerous testis removed from a child ten months old. The exciting cause of the disease seems to have been a slight blow upon the testis about six or eight months ago. About six months after the accident, it was noticed that the testicle began to increase; this was particularly marked within the last week or two. ing all this time the little one complained of no very considerable amount of pain. The organ was removed by Dr. P., and was found to be encephaloid in its character. He stated that it was the youngest subject in which he had met with that disease.

Dur

Dr. Wood asked how long it was possible for a patient to survive after an operation was performed? According to his experience he had never seen one live over two years.

Dr. Parker never had a patient to live over a year. Dr. G. Buck could only state the sequel of one case, and that one terminated fatally within a year after the operation.

Nov. 24. WOUND OF CAROTID ARTERY.-Dr. W. Detmold presented a specimen of wound of the carotid artery with the following history: He was called a fortnight before to see a child who had the day previous fallen down a flight of stairs upon an open scissors, causing an incised wound about half an inch in length, situated about half or three-quarters of an inch above the clavicle in the course of the common carotid. It appears that the wound bled a good deal, but the physician who was called in at the time succeeded in arresting it, and closing up the opening with sutures. When Dr. D. saw the child the morning after, it was in a comatose condition; around the wound referred to .there was a diffuse false aneurism, which gave a distinct aneurismic thrill. He concluded from the facts of the case that the carotid had been wounded, but as there was no hemorrhage present at the time, he did not deem it advisable to cut down and attempt to tie the vessel. He watched the child, and did nothing. A day or two after, the child became hemiplegic on the left side, the wound being situated on the right. This paralysis disappeared in a day or two. He saw the child a second time, after which the wound was left open, but no hemorrhage followed; the child progressing very well, with a pulse never over 120, until the tenth day after the accident, when he died.

Autopsy the next day. The injured vessel was exposed by a careful dissection, and there was found some blood in the sheath. The carotid was found to be severed entirely across with the exception of a small posterior band. The edges of the wound were found to be related to each other in such a way that the smallest amount of pressure was sufficient to cause coäptation of the parts. He supposed that the child died of phlebitis. The case was an interesting one, inasmuch as it proved that such an extensive wound of a large vessel could exist for ten days and be controlled by such a slight amount of pressure.

Dr. A. Clark asked if the paralysis was not due to a temporary interruption of the circulation through the part, and that when the force of the circulation was sufficiently restored to overcome the obstacle, the brain was again supplied with its normal amount of blood, and the paralysis disappeared. He thought if the paralysis was due to the closure of a vessel by a clot, it would hardly disappear in two days.

Dr. Detmold believed that a small filament of coagulated blood was separated from the main mass, carried into the brain until it came to an artery that was too small to let it pass, and in this way a small portion of the substance of the brain was deprived of its nourishment. The clot at the end of that time might have been absorbed, and every thing go on as usual. In conclusion, he stated that he was not aware that paralysis was the result of ligature of the carotid in cutting off simply the supply of blood to the brain.

Dr. Clark stated that Dr. Jas. R. Wood related six instances where such a result followed the ligature of the carotid.

Dr. Van Buren stated that he had a distinct recollection of three cases that occurred under his observation, in which ligature of the carotid pro