- Email: [email protected]
A CASE OF PREGNANCY COMPLICATED WITH TUMOUR; PREMATURE LABOUR INDUCED.
553 directly quitting her home, walked to Cobham, a distance of about eight miles, where she slept out all night on the common. I
A CASE OF PREGNANCY COMPLICATED WITH She said that about two hours after taking it she became sick, TUMOUR; PREMATURE LABOUR INDUCED. ahd continued to be so, at intervals, for some hours. She had BY J. C. LYNCH, ESQ., Sudbury. passed no urine since the previous morning. Being now satisfied as to the substance taken, I administered immediately Orfila’s MRS. H-, aged forty, has been married several years, and antidote-the hydrated sesquioxide of iron, prepared by precipi- had no family; the menses regularly up to Christmas, tating it from the tincture of sesquichloride of iron, by means of 1850. For more than nineappeared months before that time, she had ammonia. A few minutes after each dose she was violently sick, of pain in the lower part of the body, and a and continued to bring up fluid blood. White of egg was also complained hard swelling had, according to her, been perceptible slight freely administered, mucilaginous drinks, castor oil, &c.-Eight low down on the side. Since Christmas, this swelling .o’clock P.M. : The rigors still continue very severe, as also the has increased in right she has suffered from morning sickness, size; pain on pressure in the epigastric region. There is likewise an and the breasts have become enlarged and painful. The abannoying sensation of constriction in the ossophagal region. on examination (March, 1851), was found to be geneFeb. 12th.-Eight A.M.: She now complains of intense pain domen, and tender to the touch; on the right side there rally enlarged about the scrobiculus cordis, extending up the eesophagus ; existed a solid firm tumour, smooth, very sensitive, and appagreat difficulty of swallowing even fluids; breathing hurried; rently springing out of the pelvis; no sounds were audible on countenance flushed and anxious ; is constantly asking for auscultation. About the end of March, the abdomen had incold water; tongue dry and parched, with papillae much creased in and another tumour became apparent in the size, raised; pulse 110, and very small in volume; skin dry and harsh, median line of the abdomen, just emerging from the pelvis, emitting a pungent odour; violent throbbing headache. The and presenting much the same characters as the other one. bowels were very freely relieved, during the night, of a quantity She suffered much from pain in the right side; and the pasof dark-looking faeces. Ten leeches were immediately applied of the fseces and urine was accompanied with much pain sage to the seat of pain, and a large mustard poultice to the front of and straining. On examination, per vaginam, the uterus was the sternum, extending above the clavicles. To have chloride found to be very low down, hard, small, and retroverted. of mercury, three grains, every three hours, and the following In this state, she went to London, and consulted Dr. Farre draught :-Solution of acetate of ammonia, two drachms; spirit and Dr. Locock; the latter pronounced decidedly against the of nitrous ether, two drachms ; solution of tartarized antimony, existence of Dr. Farre’s opinion was more pregnancy. half a drachm ; camphor mixture, an ounce and a half,-to be in the meanwhile, he advised that the uterus guarded, and, taken every four hours.-Ten P.m.: Symptoms considerably should be replaced, and that pessaries should be worn to realleviated; the breathing is not so quick or hurried; countenance tain it in situ. Accordingly, by several well-directed efforts more natural ; eyes less bright and glistening; slight pain still he succeeded, though with much difficulty, in replacing it to on pressure; pulse 90, small and compressible; a slight, smarting a certain extent; the patient, however, was unable to use pain on swallowing fluids; the bowels have been relieved three sponges, pessaries, &c., which all produced a great deal of times during the day ; urine very scanty, and high-coloured. irritation; and on her return to the country, the uterus re13th.-Eight A.M. : Has passed a tolerably comfortable night; sumed its former mal-position, rendering the use of the pain almost gone; skin cool; pulse little above the natural catheter and the clyster occasionally necessary. Gradually, standard ; tongue moist, with the papillae less raised. To pro- however, as the second tumour increased in size, it regained ceed with the chloride of mercury and draught as before.- its natural position. Towards the end of May, both tumours Ten P.m.: The pain has returned very severely, and sets in with were very large, the second being the most considerable, and paroxysms ; it is more diffused towards the righ hypochondriac she felt altogether more comfortable. Still the stethoscope region ; abdomen distended with flatus. To have ten leeches to could detect no sounds, although she now began to feel movethe seat of pain, and hot fomentations over the entire abdomen; ments like those of a foetus in utero. Towards the end of and to have two ounces of castor oil directly. June, there could be no further doubt as to the existence of 14th.-Is now under the .influence of the chloride of mercury, pregnancy, and Dr. Farre, on being again consulted, recomwhich has produced depression of the general system ; pulse mended that premature labour should be brought on at the very small and weak; skin cool; lips clean and moist; tongue end of the 7th month. white and furred, but moist. The bowels were relieved during On the 28th of July, I found the os uteri high up in the the night of a large quantity of dark, bilious-looking feces. To vagina, and large enough to admit the tip of the forefinger; have a little beef-tea. Omit the chloride of mercury. Repeat on this and on two other occasions (waiting two days between the mixture. To have two ounces of castor oil in the evening. each, and giving ergot meanwhile), I attempted, though un15th.—Is much better; the countenance has assumed its natural successfully, to bring on labour by separating the membranes appearance; urine highly charged with lithic acid; the thirst has from the walls of the uterus, without rupturing them. Some entirely ceased; has slight griping pains in the epigastrium. slight pain followed, sufficient to bring the head of the foetus within reach of the finger. On the 2nd of August I ruptured Repeat the castor oil in the evening. 16th.-Has got a harsh, dry cough, but no expectoration : it is the membranes, and pains came on vigorously about an hour apparently excited by irritation of the fauces and stomach, which after the operation. The labour proceeded favourably for was speedily relieved by minim doses of hydrocyanic acid every about twenty hours, when the head began to descend into two hours. To have a little beef-tea. Repeat castor oil, one the vagina, carrying down with it part of the anterior lip of the uterus; the pains now gradually ceased, the patient ounce, in the evening. 17th.-Continues to improve. All pain or tenderness on suffering much in the meanwhile. At the end of five pressure has disappeared. Tongue cleaning at the sides; skin hours, as no farther progress had been made, I determined to cool and moist; no thirst; feels an inclination for food. deliverwith instruments; and, unwilling to run any risk for the 18th.-Having most particularly requested a mutton-chop, it sake of a child that I knew must die, if it were not already was given to her, lightly cooked. After eating it, considerable dead, I thought it right to employ the perforator. With this pain and uneasiness was felt in the epigastrium; and this con- the labour was easily finished, and the placenta expelled in tinuing, an emetic was administered on the following morning, ten minutes afterwards. Chloride of mercury, three grains; which removed the irritating cause, in a half-digested state. compound ipecacuanha powder, ten grains: make two pills, to 19th.-She is now perfectly recovered, with the exception of be taken immediately. In the evening the patient appeared the digestive organs, which have not as yet quite regained their very comfortable; pulse 105; she had passed urine freely. tone. She will be removed to the union in a few days. Aug. 4.-Going on well; pulse 104; the tumour in the side On boiling the matter vomited in the first instance, and apply- continues of the same size as before; discharge from the ing the test of the ammoniated sulphate of copper, a copious vagina very foetid. Ordered, injections of warm water. The next day, after a severe rigor, a very sharp attack of deposit of Scheele’s green was thrown down ; and also on applying the ammoniac nitrate of silver, a very copious yellow fever came on, with intense pain in the right side, restlessness, and thirst; pulse 130. This attack lasted five days, and was precipitate of arsenite of silver was produced. This case presents a few interesting features, of which the subdued with leeches, calomel and opium, &c. During her most prominent are, firstly, the length of time intervening convalescence she experienced several similar attacks, prebetween her swallowing the poison and the administration of any ceded by severe rigors, each attack milder than the preceding remedies; and, secondly, the great quantity of blood ejected, both one. The tumour diminished considerably in size, but conbefore and after the exhibition of the remedies, (a handkerchief tinued very sensitive for five or six weeks; she suffered severe having been also found in her pocket, perfectly saturated with pain in it occasionally, which gradually disappeared, and in blood,which she stated had come from her mouth.) From this ten weeks after her labour she was able to get about, and to we must necessarily infer, that the mucous membrane of the attend to her domestic duties as before. stomach was eroded to a considerable extent. Dec., 1851.
A CASE OF PREGNANCY COMPLICATED WITH She said that about two hours after taking it she became sick, TUMOUR; PREMATURE LABOUR INDUCED. ahd continued to be so, at intervals, for some hours. She had BY J. C. LYNCH, ESQ., Sudbury. passed no urine since the previous morning. Being now satisfied as to the substance taken, I administered immediately Orfila’s MRS. H-, aged forty, has been married several years, and antidote-the hydrated sesquioxide of iron, prepared by precipi- had no family; the menses regularly up to Christmas, tating it from the tincture of sesquichloride of iron, by means of 1850. For more than nineappeared months before that time, she had ammonia. A few minutes after each dose she was violently sick, of pain in the lower part of the body, and a and continued to bring up fluid blood. White of egg was also complained hard swelling had, according to her, been perceptible slight freely administered, mucilaginous drinks, castor oil, &c.-Eight low down on the side. Since Christmas, this swelling .o’clock P.M. : The rigors still continue very severe, as also the has increased in right she has suffered from morning sickness, size; pain on pressure in the epigastric region. There is likewise an and the breasts have become enlarged and painful. The abannoying sensation of constriction in the ossophagal region. on examination (March, 1851), was found to be geneFeb. 12th.-Eight A.M.: She now complains of intense pain domen, and tender to the touch; on the right side there rally enlarged about the scrobiculus cordis, extending up the eesophagus ; existed a solid firm tumour, smooth, very sensitive, and appagreat difficulty of swallowing even fluids; breathing hurried; rently springing out of the pelvis; no sounds were audible on countenance flushed and anxious ; is constantly asking for auscultation. About the end of March, the abdomen had incold water; tongue dry and parched, with papillae much creased in and another tumour became apparent in the size, raised; pulse 110, and very small in volume; skin dry and harsh, median line of the abdomen, just emerging from the pelvis, emitting a pungent odour; violent throbbing headache. The and presenting much the same characters as the other one. bowels were very freely relieved, during the night, of a quantity She suffered much from pain in the right side; and the pasof dark-looking faeces. Ten leeches were immediately applied of the fseces and urine was accompanied with much pain sage to the seat of pain, and a large mustard poultice to the front of and straining. On examination, per vaginam, the uterus was the sternum, extending above the clavicles. To have chloride found to be very low down, hard, small, and retroverted. of mercury, three grains, every three hours, and the following In this state, she went to London, and consulted Dr. Farre draught :-Solution of acetate of ammonia, two drachms; spirit and Dr. Locock; the latter pronounced decidedly against the of nitrous ether, two drachms ; solution of tartarized antimony, existence of Dr. Farre’s opinion was more pregnancy. half a drachm ; camphor mixture, an ounce and a half,-to be in the meanwhile, he advised that the uterus guarded, and, taken every four hours.-Ten P.m.: Symptoms considerably should be replaced, and that pessaries should be worn to realleviated; the breathing is not so quick or hurried; countenance tain it in situ. Accordingly, by several well-directed efforts more natural ; eyes less bright and glistening; slight pain still he succeeded, though with much difficulty, in replacing it to on pressure; pulse 90, small and compressible; a slight, smarting a certain extent; the patient, however, was unable to use pain on swallowing fluids; the bowels have been relieved three sponges, pessaries, &c., which all produced a great deal of times during the day ; urine very scanty, and high-coloured. irritation; and on her return to the country, the uterus re13th.-Eight A.M. : Has passed a tolerably comfortable night; sumed its former mal-position, rendering the use of the pain almost gone; skin cool; pulse little above the natural catheter and the clyster occasionally necessary. Gradually, standard ; tongue moist, with the papillae less raised. To pro- however, as the second tumour increased in size, it regained ceed with the chloride of mercury and draught as before.- its natural position. Towards the end of May, both tumours Ten P.m.: The pain has returned very severely, and sets in with were very large, the second being the most considerable, and paroxysms ; it is more diffused towards the righ hypochondriac she felt altogether more comfortable. Still the stethoscope region ; abdomen distended with flatus. To have ten leeches to could detect no sounds, although she now began to feel movethe seat of pain, and hot fomentations over the entire abdomen; ments like those of a foetus in utero. Towards the end of and to have two ounces of castor oil directly. June, there could be no further doubt as to the existence of 14th.-Is now under the .influence of the chloride of mercury, pregnancy, and Dr. Farre, on being again consulted, recomwhich has produced depression of the general system ; pulse mended that premature labour should be brought on at the very small and weak; skin cool; lips clean and moist; tongue end of the 7th month. white and furred, but moist. The bowels were relieved during On the 28th of July, I found the os uteri high up in the the night of a large quantity of dark, bilious-looking feces. To vagina, and large enough to admit the tip of the forefinger; have a little beef-tea. Omit the chloride of mercury. Repeat on this and on two other occasions (waiting two days between the mixture. To have two ounces of castor oil in the evening. each, and giving ergot meanwhile), I attempted, though un15th.—Is much better; the countenance has assumed its natural successfully, to bring on labour by separating the membranes appearance; urine highly charged with lithic acid; the thirst has from the walls of the uterus, without rupturing them. Some entirely ceased; has slight griping pains in the epigastrium. slight pain followed, sufficient to bring the head of the foetus within reach of the finger. On the 2nd of August I ruptured Repeat the castor oil in the evening. 16th.-Has got a harsh, dry cough, but no expectoration : it is the membranes, and pains came on vigorously about an hour apparently excited by irritation of the fauces and stomach, which after the operation. The labour proceeded favourably for was speedily relieved by minim doses of hydrocyanic acid every about twenty hours, when the head began to descend into two hours. To have a little beef-tea. Repeat castor oil, one the vagina, carrying down with it part of the anterior lip of the uterus; the pains now gradually ceased, the patient ounce, in the evening. 17th.-Continues to improve. All pain or tenderness on suffering much in the meanwhile. At the end of five pressure has disappeared. Tongue cleaning at the sides; skin hours, as no farther progress had been made, I determined to cool and moist; no thirst; feels an inclination for food. deliverwith instruments; and, unwilling to run any risk for the 18th.-Having most particularly requested a mutton-chop, it sake of a child that I knew must die, if it were not already was given to her, lightly cooked. After eating it, considerable dead, I thought it right to employ the perforator. With this pain and uneasiness was felt in the epigastrium; and this con- the labour was easily finished, and the placenta expelled in tinuing, an emetic was administered on the following morning, ten minutes afterwards. Chloride of mercury, three grains; which removed the irritating cause, in a half-digested state. compound ipecacuanha powder, ten grains: make two pills, to 19th.-She is now perfectly recovered, with the exception of be taken immediately. In the evening the patient appeared the digestive organs, which have not as yet quite regained their very comfortable; pulse 105; she had passed urine freely. tone. She will be removed to the union in a few days. Aug. 4.-Going on well; pulse 104; the tumour in the side On boiling the matter vomited in the first instance, and apply- continues of the same size as before; discharge from the ing the test of the ammoniated sulphate of copper, a copious vagina very foetid. Ordered, injections of warm water. The next day, after a severe rigor, a very sharp attack of deposit of Scheele’s green was thrown down ; and also on applying the ammoniac nitrate of silver, a very copious yellow fever came on, with intense pain in the right side, restlessness, and thirst; pulse 130. This attack lasted five days, and was precipitate of arsenite of silver was produced. This case presents a few interesting features, of which the subdued with leeches, calomel and opium, &c. During her most prominent are, firstly, the length of time intervening convalescence she experienced several similar attacks, prebetween her swallowing the poison and the administration of any ceded by severe rigors, each attack milder than the preceding remedies; and, secondly, the great quantity of blood ejected, both one. The tumour diminished considerably in size, but conbefore and after the exhibition of the remedies, (a handkerchief tinued very sensitive for five or six weeks; she suffered severe having been also found in her pocket, perfectly saturated with pain in it occasionally, which gradually disappeared, and in blood,which she stated had come from her mouth.) From this ten weeks after her labour she was able to get about, and to we must necessarily infer, that the mucous membrane of the attend to her domestic duties as before. stomach was eroded to a considerable extent. Dec., 1851.