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REMARKABLE CASE OF CYANOSIS,
433
sickness, whenever the testicle touched
or
and painful darting sensations of the mem-
rested upon the scrotum, which perhaps ithers.
The mother described the child as had not done whilst the sac was in a dis- being cool during the time, and very sustended form ; however, this soon went off, ceptible to the impression of cold. In the and frequent bathings in cold water braced year 1831 the mother sought medical aid for the first time. The use of Elix. Acid. up the parts firmly. By a subsequent reading of the letter of Halleri, and frequent washing the body with Mr. Lewis, I found what I had overlooked a stimulating fluid, seemed at first attended before, namely, that Mr. L. states that his with benefit, but the symptoms soon became plan is " to puncture with a fine needle aggravated, and the parents brought the until a drop of fluid oozes out on withdraw- child to the Clinique of the University on ing the needle, and in three days the hydro- the 28th of November, 1833. The patient cele will’disappear, no matter in what quan- was now five years and three quarters old, tity the fluid may be collected." By not and the following appearances were aseerattending to the words a d2-op, I expected tained on careful examination :-Child well that the whole of the fluid must be emptied conformed, but slightly emaciated; during to effect the object. As this is an import- respiration the face was marked with an ant distinction, I am sure that amongst the expression of great anxiety, and the thorax thousands of medical students who read dilated with considerable force ; cough with Tut. LANCET, hundreds will be found as distinct mucous rale had existed for some ignorant as myself, and therefore a discus- time. The pulsation of the heart was ex. sion upon the symptoms, causes, and effects cessively strong, but irregular in quality of hydrocele, would be beneficial. In that and frequence, and sometimes so small discussion, proof should be attempted to be that certain pulsations could scarcely be disafforded whether the scrotum is distended tinguished. The skin was for the most part in such cases with an actual body of water of a dark tint, and in some places, especially daily increasing, or whether there is simply on the front of the chest, marked with deep a single drop of water, operated upon by blue, livid spots, like petechise. The edges the heat of the body, or by some diseased of the nose and lips, the lips, gums, and part, until it becomes rarefied into steam, tongue, were of a dark bluish colour, as also which steam is immediately condensed by the eyelids and surrounding parts; the conthe introduction of a needle, in the same junctivas scleroticap were covered with anum,. way as a jet of cold water condenses in a ber of tnrnefied vessels. The breath of the child was very foul though no symptoms of steam engine. 1 have mentioned the walking and the cab i gastric disorder existed; the appetite irremerely to show that the friction causedi gular ; thirst increased; abdominal and thareby may have hastened the reduction urinary secretions not altered. The skin, of the hydrocele. My name and address especially on the extremities, cool. In a are handed to you in confidence, and I re- short time after his reception into the institution the different symptoms became more main, Sir, your obedient servant, R. B. violent, the anxiety and difficulty of breathLondon, June 15, 1836. ing were especially distressing, and the child died in a few days.
Autopsy forty-eight hours after’ Death. in general of a pale grayish colour, Skin REMARKABLE CASE OF CYANOSIS, and marked in several places with blue PRODUCED BY spots; the face looks extremely composed, and its colour quite changed from what it COMMUNICATION OF THE AORTA WITH exhibited during life. BOTH VENTRICLES. Abdomen— Liver much developed, intestines strongly injected, and mesenteric By Dr. E. LEXIS, Berlin. glancls enlarged. In the mesentery near the colon were several tliscolourecl spots, as ALBERTiNE W., born apparently sound large as pins’ heads. and strong, presented nothing remarkable Chest.—Leftlung united to pleura costalis; for the first year after birth, except now and no effusion into its cavity; the parenchymathen a difficult asthmatic respiration. The tous tissue contains a few tubercles. The peculiar symptoms of an organic disease of heart is evidently enlarged, and extends into the heart did not appear until later ; then, the right side of the thorax, beyond thrs whenever the child made any bodily effort, sternum; on being opened it is found to or was irritated, the body became of a bluish contain no blood; the pa-rictes of the atiri-’ colour, especially the face, and an access of cles are relaxed, and those of the right strong suffocation came on, which the little ventricle thicker than the left; in the seppatient endeavoured to relieve by bending tum auriculorum an opening large enough forwards the body. These symptoms were to receive a swan’s feather, which, however, afterwards joined by convulsive movements, might be closed at the left side by the val.
434 vula foraminis ovalis, yet existing. The ductus arteriosus was absent. The aorta o6 its usual size. On dividing the aorta it was found to lead into the left ventricle, but another communication existed, with an opening in the septum ventriculorum sufficiently large to pass the tip of the index finger ; thus one half the aorta opened into the left ventricle, the other half into the right; the edges of this opening were smooth and equal. On passing a probe into the pulmonary artery it went on with difficulty in,to the ventricle, and on laying open the vessel there were found between the edges of the artery and the semilunar valves, a number of blind sacs, into which the probe passed more than half an inch. The communication of the pulmonary artery with the ventricle was not larger than would admit a moderately sized crow’s quill.
of the left ventricle. It does not’ascend up quite so far as the semilunar valves (kk) of the aorta, but terminates in a smooth edge, leaving an opening three lines broad and five long, which leads from one ventricle to the other, and is traversed by the probe
M.
g, Posterior surface of the left ventricle.
h, Wall of the ventricle which is thrown
upwards. i, A cornea columna, attached to the mitral valve, also thrown upwards. kk, Semilunar valves of the aorta. l, Trunk of the aorta. m, Innominata. M, Left carotid. o, Left subclavian. p, Opening in the septum auricularum. q, External wall of the left auricle.
BRONCHOCELE. ITS CAUSES.—SINGULAR CASE.
BRONCHOCELE is common in Worcesterand many cases are witnessed in the district around Malvern. In some females the diseased gland grows to a large size without producing any, or only trifling inconvenience-a little difficulty of breathing in walking up hill. Persons afflicted with
shire,
this
unsightly complaint are chiefly, but not universally, females ; in one or two instances I have observed male children born
a, Anterior surface of the heart. b, Anterior edge of the right
opened, heart. c, A
and
slit, leading from
the
ventricle, from the
slightly separated
pulmonary
artery (d) into the right ventricle. e, A probe passing from the right ventricle under the origin of the pulmonary artery, and coming out through the opening in the septum ventricularum. f, Septum ventric. laid open from the side
with a decided fulness and enlargement of the thyroid gland. Very few of the common people use any remedy for it. Bronchocele is not confined to the peasantry, a tendency to the disease often showing itself in young females in the mid. dle and higher classes; these generally have recourse to medical treatment. Iodine given internally, and used externally in the form of ointment, usually reduces the incipient enlargement; it is, however, liable to recur. It is very difficult to ascertain the causes producing bronchocele. Of twenty-two cases which I examined a few years ago, some lived in situations where the water was hard; others where it was soft; some lived very well, i. e. had animal food daily; others chiefly on potatoes and bacon, the ordinary food of the labouring classes. Ina great majority the right lobe of the gland was the largest, and there was no appearance of scrofulous disease. In females of the same family, more than one generally had the disease. Bronchocele almost invariably increases in size, and becomes more troublesome during gestation ; and, in many instances, remains, after delivery, permanently of a larger size than before. It has been supposed that the offspring of parents afflicted with this complaint, evince more or less deficiency in their intellectual en-
sickness, whenever the testicle touched
or
and painful darting sensations of the mem-
rested upon the scrotum, which perhaps ithers.
The mother described the child as had not done whilst the sac was in a dis- being cool during the time, and very sustended form ; however, this soon went off, ceptible to the impression of cold. In the and frequent bathings in cold water braced year 1831 the mother sought medical aid for the first time. The use of Elix. Acid. up the parts firmly. By a subsequent reading of the letter of Halleri, and frequent washing the body with Mr. Lewis, I found what I had overlooked a stimulating fluid, seemed at first attended before, namely, that Mr. L. states that his with benefit, but the symptoms soon became plan is " to puncture with a fine needle aggravated, and the parents brought the until a drop of fluid oozes out on withdraw- child to the Clinique of the University on ing the needle, and in three days the hydro- the 28th of November, 1833. The patient cele will’disappear, no matter in what quan- was now five years and three quarters old, tity the fluid may be collected." By not and the following appearances were aseerattending to the words a d2-op, I expected tained on careful examination :-Child well that the whole of the fluid must be emptied conformed, but slightly emaciated; during to effect the object. As this is an import- respiration the face was marked with an ant distinction, I am sure that amongst the expression of great anxiety, and the thorax thousands of medical students who read dilated with considerable force ; cough with Tut. LANCET, hundreds will be found as distinct mucous rale had existed for some ignorant as myself, and therefore a discus- time. The pulsation of the heart was ex. sion upon the symptoms, causes, and effects cessively strong, but irregular in quality of hydrocele, would be beneficial. In that and frequence, and sometimes so small discussion, proof should be attempted to be that certain pulsations could scarcely be disafforded whether the scrotum is distended tinguished. The skin was for the most part in such cases with an actual body of water of a dark tint, and in some places, especially daily increasing, or whether there is simply on the front of the chest, marked with deep a single drop of water, operated upon by blue, livid spots, like petechise. The edges the heat of the body, or by some diseased of the nose and lips, the lips, gums, and part, until it becomes rarefied into steam, tongue, were of a dark bluish colour, as also which steam is immediately condensed by the eyelids and surrounding parts; the conthe introduction of a needle, in the same junctivas scleroticap were covered with anum,. way as a jet of cold water condenses in a ber of tnrnefied vessels. The breath of the child was very foul though no symptoms of steam engine. 1 have mentioned the walking and the cab i gastric disorder existed; the appetite irremerely to show that the friction causedi gular ; thirst increased; abdominal and thareby may have hastened the reduction urinary secretions not altered. The skin, of the hydrocele. My name and address especially on the extremities, cool. In a are handed to you in confidence, and I re- short time after his reception into the institution the different symptoms became more main, Sir, your obedient servant, R. B. violent, the anxiety and difficulty of breathLondon, June 15, 1836. ing were especially distressing, and the child died in a few days.
Autopsy forty-eight hours after’ Death. in general of a pale grayish colour, Skin REMARKABLE CASE OF CYANOSIS, and marked in several places with blue PRODUCED BY spots; the face looks extremely composed, and its colour quite changed from what it COMMUNICATION OF THE AORTA WITH exhibited during life. BOTH VENTRICLES. Abdomen— Liver much developed, intestines strongly injected, and mesenteric By Dr. E. LEXIS, Berlin. glancls enlarged. In the mesentery near the colon were several tliscolourecl spots, as ALBERTiNE W., born apparently sound large as pins’ heads. and strong, presented nothing remarkable Chest.—Leftlung united to pleura costalis; for the first year after birth, except now and no effusion into its cavity; the parenchymathen a difficult asthmatic respiration. The tous tissue contains a few tubercles. The peculiar symptoms of an organic disease of heart is evidently enlarged, and extends into the heart did not appear until later ; then, the right side of the thorax, beyond thrs whenever the child made any bodily effort, sternum; on being opened it is found to or was irritated, the body became of a bluish contain no blood; the pa-rictes of the atiri-’ colour, especially the face, and an access of cles are relaxed, and those of the right strong suffocation came on, which the little ventricle thicker than the left; in the seppatient endeavoured to relieve by bending tum auriculorum an opening large enough forwards the body. These symptoms were to receive a swan’s feather, which, however, afterwards joined by convulsive movements, might be closed at the left side by the val.
434 vula foraminis ovalis, yet existing. The ductus arteriosus was absent. The aorta o6 its usual size. On dividing the aorta it was found to lead into the left ventricle, but another communication existed, with an opening in the septum ventriculorum sufficiently large to pass the tip of the index finger ; thus one half the aorta opened into the left ventricle, the other half into the right; the edges of this opening were smooth and equal. On passing a probe into the pulmonary artery it went on with difficulty in,to the ventricle, and on laying open the vessel there were found between the edges of the artery and the semilunar valves, a number of blind sacs, into which the probe passed more than half an inch. The communication of the pulmonary artery with the ventricle was not larger than would admit a moderately sized crow’s quill.
of the left ventricle. It does not’ascend up quite so far as the semilunar valves (kk) of the aorta, but terminates in a smooth edge, leaving an opening three lines broad and five long, which leads from one ventricle to the other, and is traversed by the probe
M.
g, Posterior surface of the left ventricle.
h, Wall of the ventricle which is thrown
upwards. i, A cornea columna, attached to the mitral valve, also thrown upwards. kk, Semilunar valves of the aorta. l, Trunk of the aorta. m, Innominata. M, Left carotid. o, Left subclavian. p, Opening in the septum auricularum. q, External wall of the left auricle.
BRONCHOCELE. ITS CAUSES.—SINGULAR CASE.
BRONCHOCELE is common in Worcesterand many cases are witnessed in the district around Malvern. In some females the diseased gland grows to a large size without producing any, or only trifling inconvenience-a little difficulty of breathing in walking up hill. Persons afflicted with
shire,
this
unsightly complaint are chiefly, but not universally, females ; in one or two instances I have observed male children born
a, Anterior surface of the heart. b, Anterior edge of the right
opened, heart. c, A
and
slit, leading from
the
ventricle, from the
slightly separated
pulmonary
artery (d) into the right ventricle. e, A probe passing from the right ventricle under the origin of the pulmonary artery, and coming out through the opening in the septum ventricularum. f, Septum ventric. laid open from the side
with a decided fulness and enlargement of the thyroid gland. Very few of the common people use any remedy for it. Bronchocele is not confined to the peasantry, a tendency to the disease often showing itself in young females in the mid. dle and higher classes; these generally have recourse to medical treatment. Iodine given internally, and used externally in the form of ointment, usually reduces the incipient enlargement; it is, however, liable to recur. It is very difficult to ascertain the causes producing bronchocele. Of twenty-two cases which I examined a few years ago, some lived in situations where the water was hard; others where it was soft; some lived very well, i. e. had animal food daily; others chiefly on potatoes and bacon, the ordinary food of the labouring classes. Ina great majority the right lobe of the gland was the largest, and there was no appearance of scrofulous disease. In females of the same family, more than one generally had the disease. Bronchocele almost invariably increases in size, and becomes more troublesome during gestation ; and, in many instances, remains, after delivery, permanently of a larger size than before. It has been supposed that the offspring of parents afflicted with this complaint, evince more or less deficiency in their intellectual en-