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CASE OF PUERPERAL CONVULSIONS, ACCOMPANIED BY ALBUMINOUS URINE, WITH REMARKS.
371 The aortic curve is found to be aneurismatic but not Slight redness of the inner arterial membrane; ossification of the vessel at the diaphragmatic passage. Lungs in a
cavity.
ruptured.
pretty good
state.
Air-tube.-I then proceeded, with the greatest care, by a lateral dissection of the neck, to uncover the larynx, laying open the pharynx, after disarticulation of the inferior jaw-bone, thus leaving the tongue in its natural position and connexions. The epiglottis is closely applied to the root of the tongue, and behind the epiglottis the superior orifice of the larynx is discovered to be entirely filled up with a piece of boiled beef, the end of the morsel not being at all prominent above the edges of the superior opening of the larynx, in such a manner that at first sight it was impossible to ascertain the whole volume of the foreign body. There evidently was the cause of death. I then extracted the boiled beef-it formed a sort of cork of compact meat, partially
chewed,
was
about
an
inch
long,
and
weighed
a
little
more
than It
quarter of an ounce (eight grammes, eight decigrammes.) must have reached, in situ, the cricoid cartilage.
a
The epiglottis was then carefully examined, and found to be rather less in its dimensions than usual. It not only left the posterior angle of the superior opening of the larynx uncovered in a comparatively too large extent, but we felt an unnatural resistance when we attempted to bring down this cartilage over the aperture. We remarked, that in so doing the median glossoepiglottic ligament was so extended as to pull back and elongate those fibres of the root of the tongue to which it is adherent, and when let go, the epiglottis resumed its first position with more than its ordinary elasticity. Having removed the larynx and tongue, I kept them in water, slightly alcoholized, for fortyeight hours; the epiglottis still retained that stiffness and insufficiency in its play, the tongue being placed in its natural relative position. The anatomists and medical observers who have seen the parts agree with me in the opinion that this organic lesion, which con- sists either in atrophy or retraction of the median glosso-epiglottic ligament, has been the first cause of suffocation in this case, by giving a freer access to foreign bodies into the air-tube. The two circumstances first related, where death had necessarily ensued, had not nature and art afforded immediate relief, strengthen the probability of this opinion. No doubt, spasmodic contraction of the parts attended; no doubt, that during the anxious moments previous to death, abrupt or violent inspiration , may have sucked in the foreign body, if such an expression be allowed, to such a depth that all chance of immediate relief was lost. Had even the diagnosis acquired immediate certitude, (and here it had not,) those circumstances may have been minor and concomitant causes of death; but I think it most probable that the i primary cause-the cause, sine quâ non, of suffocation, (in this case, ’ at least)-was this organic deficiency of the opercule, owing to the retraction or to senile atrophy of the ligamentous tissue. This observation was presented by the author to the Parisian Medical Society on the 27th of June, Dr. Daniel M’Carthy, Vicepresident, in the chain. CASE
OF PUERPERAL BY ALBUMINOUS
By
E.
CONVULSIONS, ACCOMPANIED URINE, WITH REMARKS.
CRISP, Esq., Surgeon, Walworth.
(Read before the London Medical Society.)
I WAS called to Mrs. H-, Walworth, aged twenty-two, Feb. 5th, 1844, at two P.M. She had been married eight months, and was supposed to be about seven months pregnant: her person is small; complexion fair; hair light. For the last two or three - weeks she has complained of pain in the back, and has been frequently subject to headache; she also had at intervals, for some years, what she calls "bilous attacks;" these came on with -vomiting, headache, dimness of sight, and werefollowed by great drowsiness, almost amounting to coma. This morning she has had pain in the head, with frequent vomiting of a bilious matter; she is quite sensible, but the sight is somewhat impaired; bowels confined; pulse about eighty, rather soft; pupils dilated. No symptoms of labour. The face and hands present a slight, puffy, oedematons appearance. A cathartic mixture, and pills to be taken till the bowels are well relieved. Five P.M.—Is now quite blind, but perfectly sensible; pupils dilated; has had a convulsive fit of an epileptic character, which lasted five or six minutes. The pulse soft and compressible, bowels not relieved. The os uteri high up and undilated. I took about the following medicine :3x. of blood from the arm, and ordered R—Jalap. 9ij.; compound tincture of cardamoms; liquid acetate of ammonia, of each, 3i.; sulphate of magnesia, 3Î.; carbonate of magnesia,I 3ss.; minth water, 3vj. Mix for a mixture; a fourth to be taken every hour. .
ijt:—Chloride of mercury, eight grs.; comp. extract of colocynthy fifteen grains. Mix, for four pills, two to be taken immediately, and the others at ten o’clock. Eight P.M.-Had another fit during my visit; foaming from the mouth, with much distortion of the countenance; great convulsion of the extremities ; bowels not relieved. Continue med.
poulticesto the feet, and a turpentine enema. Feb. 6th, two A.3.t.-Has had six convulsive fits, but was perfectly sensible during the intervals; pulse soft, about eighty-five; bowels well relieved ; eyes dull and prominent; blood taken not buffed, and very watery. Cold applications to the head; the I tested the urine with heat and nitric enema not administered. acid, and found it highly albuminous. Pi—Tincture of valerian, 3ij.; liquid acetate of ammonia, 3i.; sulphate of magnesia, ss.; carbonate of magnesia, 3ss.; minth water; camphor mixture, of each, three ounces. Mix for a mixture, a fourth to be taken every fifth hour. Eight A.M.-Appeared better for a few hours after I left; could distinguish those around her, and answer questions rationally; had another convulsive fit half an hour since, and is now partly sensible; bowels well relieved. I again examined per vaginam, but found the os uteri as before. Twelve leeches to the temple; blister to the back of the neck. Four P.M.—Rather better than in the morning; vision imperfect ; only two leeches applied, on account of the violence of the patient. Dr. Hodgkin saw her with me, and recommended as follows:— Pi—Liquid acetate of ammonia, 3i.; sesqui-carbonate of ammonia, ten grs. ; camphor mixture, v. ; tincture of hops, 3 ii.; tincture of digitalis, xxiv. 1.; sugar, 3i. A mixture; two tablespoonfuls every fourth hour. Ten r.M.—Rather better. Feb. 7th.-Has had no fit since the last report, and is now quite sensible. I again tested the urine, and found it albuminous. Repeat the medicine. Knowing that Dr. Lever was much interested in this disease, I sent him some of the urine, and requested him to see the patient. Feb. 8th.-Complains of more headache, and is not so well Pulse eighty-five, small and soft; bowels not relieved. 1-An opening draught to be taken immediately; tincture of valerian, 3ii.; camphor mixture, for a mixture; a quarter to be taken every fifth hour. 9th.-Has had seven or eight fits to-day, more violent than before, the first preceded by vomiting. Os uteri undilated. A cathartic mixture; turpentine injection. 10th.-Has not had a fit since last evening; is now quite sensible, and the countenance appears more natural, the eyes less prominent; bowels relieved seven or eight times. Medicine to be omitted; the hair removed, and cold water to be poured upon the scalp for five minutes, morning and evening. I ith. Eleven A.M.—Complains of pain in the head, and is rather drowsy; pulse and carotids the same; eyes more prominent; continue the cold douche. Two P.M.—Has had two fits, (each of ten minutes’ duration,) but did not remain insensible for so long a time as after the last. Three leeches to be applied to each foot. Nine P.M.-Pain in the head still severe; pulse ninety, and soft. Carotids not beating forcibly ; pupils not dilated, and they contract readily on exposure to light. The os uteri now lower down, the point of the finger introduced, and the bones of the head can be felt. Has taken only a little milk and water, and a cup of coffee, during the day. Complains of acidity of stomach. R—Sesqui-carbonate of soda, 3iso.; compound tincture of cardamoms, 3i. ; camphor mixture,iv. ; for a mixture; a third every four hours. 12th. Nine A.M.-Had another fit soon after I left last evening; during the night, complained of frequent pain in the back, with constant bearing-down pains. The edges of the os uteri are now thin, and the soft parts more lax and moist; has less pain in the head than yesterday. Has not felt the child for four days. Five P.M. The labour pains have gradually increased since the morning; the child’s head is low down, (presentation natural,) but the pains are inefficient. Thinking it desirable to terminate the labour as soon as possible, I delivered with the forceps. The child, from the appearance of the skin, (which peeled off in some parts,) must have been dead four or five days. R— Spirit of nitric ether, 3i. ; camphor mixture, vi.; for a mixture ; a fourth every five hours. Ten P.M.—Is going on favourably; pain in the head much diminished; pulse 110. 14th.-Since the last report, has been gradually improving; less pain in the head; bowels act well; lochia rather small in quantity; pulse small and feeble. Repeat the mixture. 16th.-Not quite so well; head painful; face rather swollen, and the eyes more prominent; the pupils dilated, but contract readily on exposure to light. mustard
-
-
372 more unfavourable than at the last report; 132, small and feeble; tongue moist; bowels well relieved.
18th.-Symptoms
pulse
BRITISH MEDICAL JOURNALS.
The motions natural in appearance; has passed large quantities of urine, which is still albuminous; specific gravity, 10.25. Very restless; has not had sound sleep for the last three or four days. Answers questions, but does not know those about her. Half a pint of porter and a mutton chop. A blister to the shaved head, and mustard poultices to the feet. Px-Decoction of aloes, i.; liquid acetate of ammonia, 3i.; camphor mixture, iv. Evening.-The pulse rather improved, and she appears something better. Headache not so violent. 19th.—Has been very restless, but is rather better this morning ; bowels well acted upon. R—Tincture of opium, 3ss; wine of potassio-tartrate of antimony, 3ss; camphor mixture, 3x.
EXCISION OF THE EYEBALL IN CASES OF MELANOSIS.MEDULLARY CARCINOMA, AND CARCINOMA.
Dr. ROBERTSON has had occasion, in the course of his practice, eyeball, in sixteen instances, for one or other of the above diseases. The results of the operations were four ou of five cases of melanosis, perfectly successful, and no return of the disease, after considerable periods. The fifth patient died from a different disease, within twelve months. Five cases of medullary carcinoma were operated on; in four, the disease returned ; the fifth was cured ; but there was somedoubt as to the 20th.—The headache much relieved, but she now complains of real nature of the tumour. Of six cases of carcinoma, three slight pain and swelling of the left leg; the foot and leg are were cured; in two, the disease returned; and one died. Some oedematous. Hot fomentations to be applied frequently. March 1st.—Soon after phlegmasia dolens appeared in the left inference as to the chances of success in operations on the eye, leg, the right became affected; the swelling in the left is confined for malignant disease, may be derived from these results. principally to the leg, but the right thigh is much swollen; great The diagnosis of a simple from a malignant affection of the eye is pain and tenderness is experienced along the course of the larger thus described by the author :vessels. Since the swelling of the legs, the head symptoms have ’’ An much improved ; the urine is not so albuminous as at the last appearance in the eye dependent on a totally different report ; it is rather abundant in quantity. Appetite good; bowels cause, but resembling medullary carcinoma in its early stage, is. rather relaxed. Fourteen leeches have been applied along the occasionally met with. It is when either pure blood or fibrine is course of the veins; bran poultices to both legs ; small doses of effused from the arteria centralis retinas into the cells of the membrane. When blood is effused, it presents, at first, potassio-tartrate of antimony given three or four times daily, hyaloid and ten grains of compound pulverized ipecacuanha at bedtime. when viewed in a clear light, a bright scarlet hue ; but in proThe diet has been light and nutritious, portion as the colouring matter of the blood is absorbed, it 2nd.-Dr. Hodgkin saw her again to-day; he advised the exhibits the peculiar metallic, glistening appearance, which is medicines to be continued, and recommended extract of belladonna seen in the malignant disease. This effusion of blood into the to be rubbed on the thigh over the saphena vein, and punctures vitreous humour may occur spontaneously, or be the result of to be made with a small needle in the legs. I made several external injury. The red colour presented in the early stage, punctures in the right leg, a small quantity of clear serous fluid and the sudden occurrence of the affection, will point out the oozed from the apertures, but it ceased to flow after two or three difference between it and the malignant tumour. " It is more difficult to form a diagnosis between cases of effuhours. sion March 15th.-Is able to leave her bed, and she is in every of fibrine into the hyaloid membrane, and the malignant In the instances of effusion of fibrine which I hate tumour. contains much less the the urine albumen ; better; respect legs still much swollen; the skin having a white appearance, and a witnessed, the metallic lustre, which must arise from the presence of an opaque reflecting substance deeply seated in the eye, was, hard brawny feel. not so clearly marked as in the malignant disease, probably the and hard1st.—Her hpa.lth much April swelling improied; ness of the’ legs considerably diminished ; is able to walk the owing to the effusion being in the substance of, and not posterior distance of a mile without much inconvenience. I tested the to, the vitreous humour; for it is found that, in proportion as the urine several times, at intervals of three or four days, and found opaque reflecting body advances towards the cornea, it loses its metallic lustre. I have observed also, that, in the non-malignant it free from albumen. 27th.-Is still improving in health. I recommended change of affection, although the pupil was dilated, it was regular in form, air; my patient left the neighbourhood, and I have not seen her and the texture and colour of the iris were not altered. In some since. instances, also, vision was not entirely lost, whereas, in malignant Remarks.—Puerperal convulsions is a disease of such frequent diseases, total blindness, I believe, always exists." Tlte points of analogy and difference between encephaloid, scirrhous, occurrence, and one now generally considered to be so well un.. derstood, especially as regards its treatment, that it may appear and melanotic disease, are clearly and accurately stated in the fohn strange to some of the members present that I should bring the lowing table:case just related before the society. I am disposed to think, howSCIRRHUS (as in common ever, that there are some points of interest connected with the MELANOSJS. ENCEPHALOID. cancei- of mamma.) subject which will afford matter for useful discussion. And first, respecting the state of the urine. Dr. Lever has lately directed Of consistence of brain in Of firm consistence in Of soft consistence in cellulo-fibrous septa.thin cellular septa. thin cellular septa. the attention of the profession (in a paper published in the Guy’s or sepia colour. an opaque white Hospital Reports) to "The Albuminous state of the Urine in Oflour. yellow colour. bloodvessels have Puerperal Convulsions." Dr. Lever found, in nine out of ten Numerous minute ves- Sparingly supplied with been traced. bloodvessels. sels. cases in which this secretion was examined, that it contained cells. No cau- Pigment cells round, albumen. The case related affords another example of the cor- Consists of globules and Nuclear date caudate corpuscules. oval, or irregular, and corpuscules. rectness of his views. The patient had had scarlet fever some sometimes caudate. urine was not known pre- Maybecomeofenormous Seldom of large size. They attain a large size. years before, and the condition of the bulk. vious to the convulsive attacks. There is, I think, but little of variable radoubt that this affection was only temporary, and arose probably Often of rapid growth. Progress generally slow. Growth pidity. from congestion of the kidneys, these organs, after a few weeks, Often interstitial effusionRarely interstitial interstitial lieof blood. morrhage. morrhage. having performed their functions naturally. Not disposed to form firmly connect disposed to form adAnother point worthy of consideration, is the question respected with hesions to surrounding surrounding hesions to surrounding in of these cases. alThe the parts. parts. parts. depletion patient, ing propriety skin becomes The skin becomes stretchsubcutaneous, the though not in an anæmie condition, had a soft compressible When skin is distended and ered and assumes the ed and distended, and pulse, and I therefore took only a small quantity of blood, as a stretched, and gives cancerous ulceration. yields by simple ulcerathat most this It tome writers measure. tion. appears upon precautionary way usually by simple ulceration. disease have not made sufficient distinction between the two classes After After ulceration progress ulceration, rapid After ulceration of cases-viz., the anæmic and the sthenic, and the young practiprogress, and often not so rapid, and sel- of tumour more rapid tioner is too apt to suppose that in this affection depletion can dom - no hemorrhage. hemorlarge fungous growths, profuse and frequently hemorrhage, provided it does - scarcely be carried too far. In the sthenic form, blood may be not assume the encerhage. taken to an enormous amount, with great benefit to the patient, phaloid structure. but I fear that indiscriminate depletion has not unfrequently This Most common in about or after species -added to the number of fatal cases. middle age. most frequently metvanced life. with in and Lastly.-The phlegmasia dolens appeared first in the leg, and youth. on the left side; the iliac vein was quite free from tenderness, Liable to be propagatedEven more liable to tendency to be proshewing that the hypogastric veins, as supposed by Dr. Lee, are through the propagated through pagated through the not always primarily affected. organs. the absorbent organs.absorbent organs. to remove the
.
co-ISemi-transparent hluish-IBlack No
-
ad-Becomes
he-I
Never
Not
puck-
r
The progres of carcinoma
mfancy
absorbent
Oct. 1844.
ad-beUsually No
__
cavity.
ruptured.
pretty good
state.
Air-tube.-I then proceeded, with the greatest care, by a lateral dissection of the neck, to uncover the larynx, laying open the pharynx, after disarticulation of the inferior jaw-bone, thus leaving the tongue in its natural position and connexions. The epiglottis is closely applied to the root of the tongue, and behind the epiglottis the superior orifice of the larynx is discovered to be entirely filled up with a piece of boiled beef, the end of the morsel not being at all prominent above the edges of the superior opening of the larynx, in such a manner that at first sight it was impossible to ascertain the whole volume of the foreign body. There evidently was the cause of death. I then extracted the boiled beef-it formed a sort of cork of compact meat, partially
chewed,
was
about
an
inch
long,
and
weighed
a
little
more
than It
quarter of an ounce (eight grammes, eight decigrammes.) must have reached, in situ, the cricoid cartilage.
a
The epiglottis was then carefully examined, and found to be rather less in its dimensions than usual. It not only left the posterior angle of the superior opening of the larynx uncovered in a comparatively too large extent, but we felt an unnatural resistance when we attempted to bring down this cartilage over the aperture. We remarked, that in so doing the median glossoepiglottic ligament was so extended as to pull back and elongate those fibres of the root of the tongue to which it is adherent, and when let go, the epiglottis resumed its first position with more than its ordinary elasticity. Having removed the larynx and tongue, I kept them in water, slightly alcoholized, for fortyeight hours; the epiglottis still retained that stiffness and insufficiency in its play, the tongue being placed in its natural relative position. The anatomists and medical observers who have seen the parts agree with me in the opinion that this organic lesion, which con- sists either in atrophy or retraction of the median glosso-epiglottic ligament, has been the first cause of suffocation in this case, by giving a freer access to foreign bodies into the air-tube. The two circumstances first related, where death had necessarily ensued, had not nature and art afforded immediate relief, strengthen the probability of this opinion. No doubt, spasmodic contraction of the parts attended; no doubt, that during the anxious moments previous to death, abrupt or violent inspiration , may have sucked in the foreign body, if such an expression be allowed, to such a depth that all chance of immediate relief was lost. Had even the diagnosis acquired immediate certitude, (and here it had not,) those circumstances may have been minor and concomitant causes of death; but I think it most probable that the i primary cause-the cause, sine quâ non, of suffocation, (in this case, ’ at least)-was this organic deficiency of the opercule, owing to the retraction or to senile atrophy of the ligamentous tissue. This observation was presented by the author to the Parisian Medical Society on the 27th of June, Dr. Daniel M’Carthy, Vicepresident, in the chain. CASE
OF PUERPERAL BY ALBUMINOUS
By
E.
CONVULSIONS, ACCOMPANIED URINE, WITH REMARKS.
CRISP, Esq., Surgeon, Walworth.
(Read before the London Medical Society.)
I WAS called to Mrs. H-, Walworth, aged twenty-two, Feb. 5th, 1844, at two P.M. She had been married eight months, and was supposed to be about seven months pregnant: her person is small; complexion fair; hair light. For the last two or three - weeks she has complained of pain in the back, and has been frequently subject to headache; she also had at intervals, for some years, what she calls "bilous attacks;" these came on with -vomiting, headache, dimness of sight, and werefollowed by great drowsiness, almost amounting to coma. This morning she has had pain in the head, with frequent vomiting of a bilious matter; she is quite sensible, but the sight is somewhat impaired; bowels confined; pulse about eighty, rather soft; pupils dilated. No symptoms of labour. The face and hands present a slight, puffy, oedematons appearance. A cathartic mixture, and pills to be taken till the bowels are well relieved. Five P.M.—Is now quite blind, but perfectly sensible; pupils dilated; has had a convulsive fit of an epileptic character, which lasted five or six minutes. The pulse soft and compressible, bowels not relieved. The os uteri high up and undilated. I took about the following medicine :3x. of blood from the arm, and ordered R—Jalap. 9ij.; compound tincture of cardamoms; liquid acetate of ammonia, of each, 3i.; sulphate of magnesia, 3Î.; carbonate of magnesia,I 3ss.; minth water, 3vj. Mix for a mixture; a fourth to be taken every hour. .
ijt:—Chloride of mercury, eight grs.; comp. extract of colocynthy fifteen grains. Mix, for four pills, two to be taken immediately, and the others at ten o’clock. Eight P.M.-Had another fit during my visit; foaming from the mouth, with much distortion of the countenance; great convulsion of the extremities ; bowels not relieved. Continue med.
poulticesto the feet, and a turpentine enema. Feb. 6th, two A.3.t.-Has had six convulsive fits, but was perfectly sensible during the intervals; pulse soft, about eighty-five; bowels well relieved ; eyes dull and prominent; blood taken not buffed, and very watery. Cold applications to the head; the I tested the urine with heat and nitric enema not administered. acid, and found it highly albuminous. Pi—Tincture of valerian, 3ij.; liquid acetate of ammonia, 3i.; sulphate of magnesia, ss.; carbonate of magnesia, 3ss.; minth water; camphor mixture, of each, three ounces. Mix for a mixture, a fourth to be taken every fifth hour. Eight A.M.-Appeared better for a few hours after I left; could distinguish those around her, and answer questions rationally; had another convulsive fit half an hour since, and is now partly sensible; bowels well relieved. I again examined per vaginam, but found the os uteri as before. Twelve leeches to the temple; blister to the back of the neck. Four P.M.—Rather better than in the morning; vision imperfect ; only two leeches applied, on account of the violence of the patient. Dr. Hodgkin saw her with me, and recommended as follows:— Pi—Liquid acetate of ammonia, 3i.; sesqui-carbonate of ammonia, ten grs. ; camphor mixture, v. ; tincture of hops, 3 ii.; tincture of digitalis, xxiv. 1.; sugar, 3i. A mixture; two tablespoonfuls every fourth hour. Ten r.M.—Rather better. Feb. 7th.-Has had no fit since the last report, and is now quite sensible. I again tested the urine, and found it albuminous. Repeat the medicine. Knowing that Dr. Lever was much interested in this disease, I sent him some of the urine, and requested him to see the patient. Feb. 8th.-Complains of more headache, and is not so well Pulse eighty-five, small and soft; bowels not relieved. 1-An opening draught to be taken immediately; tincture of valerian, 3ii.; camphor mixture, for a mixture; a quarter to be taken every fifth hour. 9th.-Has had seven or eight fits to-day, more violent than before, the first preceded by vomiting. Os uteri undilated. A cathartic mixture; turpentine injection. 10th.-Has not had a fit since last evening; is now quite sensible, and the countenance appears more natural, the eyes less prominent; bowels relieved seven or eight times. Medicine to be omitted; the hair removed, and cold water to be poured upon the scalp for five minutes, morning and evening. I ith. Eleven A.M.—Complains of pain in the head, and is rather drowsy; pulse and carotids the same; eyes more prominent; continue the cold douche. Two P.M.—Has had two fits, (each of ten minutes’ duration,) but did not remain insensible for so long a time as after the last. Three leeches to be applied to each foot. Nine P.M.-Pain in the head still severe; pulse ninety, and soft. Carotids not beating forcibly ; pupils not dilated, and they contract readily on exposure to light. The os uteri now lower down, the point of the finger introduced, and the bones of the head can be felt. Has taken only a little milk and water, and a cup of coffee, during the day. Complains of acidity of stomach. R—Sesqui-carbonate of soda, 3iso.; compound tincture of cardamoms, 3i. ; camphor mixture,iv. ; for a mixture; a third every four hours. 12th. Nine A.M.-Had another fit soon after I left last evening; during the night, complained of frequent pain in the back, with constant bearing-down pains. The edges of the os uteri are now thin, and the soft parts more lax and moist; has less pain in the head than yesterday. Has not felt the child for four days. Five P.M. The labour pains have gradually increased since the morning; the child’s head is low down, (presentation natural,) but the pains are inefficient. Thinking it desirable to terminate the labour as soon as possible, I delivered with the forceps. The child, from the appearance of the skin, (which peeled off in some parts,) must have been dead four or five days. R— Spirit of nitric ether, 3i. ; camphor mixture, vi.; for a mixture ; a fourth every five hours. Ten P.M.—Is going on favourably; pain in the head much diminished; pulse 110. 14th.-Since the last report, has been gradually improving; less pain in the head; bowels act well; lochia rather small in quantity; pulse small and feeble. Repeat the mixture. 16th.-Not quite so well; head painful; face rather swollen, and the eyes more prominent; the pupils dilated, but contract readily on exposure to light. mustard
-
-
372 more unfavourable than at the last report; 132, small and feeble; tongue moist; bowels well relieved.
18th.-Symptoms
pulse
BRITISH MEDICAL JOURNALS.
The motions natural in appearance; has passed large quantities of urine, which is still albuminous; specific gravity, 10.25. Very restless; has not had sound sleep for the last three or four days. Answers questions, but does not know those about her. Half a pint of porter and a mutton chop. A blister to the shaved head, and mustard poultices to the feet. Px-Decoction of aloes, i.; liquid acetate of ammonia, 3i.; camphor mixture, iv. Evening.-The pulse rather improved, and she appears something better. Headache not so violent. 19th.—Has been very restless, but is rather better this morning ; bowels well acted upon. R—Tincture of opium, 3ss; wine of potassio-tartrate of antimony, 3ss; camphor mixture, 3x.
EXCISION OF THE EYEBALL IN CASES OF MELANOSIS.MEDULLARY CARCINOMA, AND CARCINOMA.
Dr. ROBERTSON has had occasion, in the course of his practice, eyeball, in sixteen instances, for one or other of the above diseases. The results of the operations were four ou of five cases of melanosis, perfectly successful, and no return of the disease, after considerable periods. The fifth patient died from a different disease, within twelve months. Five cases of medullary carcinoma were operated on; in four, the disease returned ; the fifth was cured ; but there was somedoubt as to the 20th.—The headache much relieved, but she now complains of real nature of the tumour. Of six cases of carcinoma, three slight pain and swelling of the left leg; the foot and leg are were cured; in two, the disease returned; and one died. Some oedematous. Hot fomentations to be applied frequently. March 1st.—Soon after phlegmasia dolens appeared in the left inference as to the chances of success in operations on the eye, leg, the right became affected; the swelling in the left is confined for malignant disease, may be derived from these results. principally to the leg, but the right thigh is much swollen; great The diagnosis of a simple from a malignant affection of the eye is pain and tenderness is experienced along the course of the larger thus described by the author :vessels. Since the swelling of the legs, the head symptoms have ’’ An much improved ; the urine is not so albuminous as at the last appearance in the eye dependent on a totally different report ; it is rather abundant in quantity. Appetite good; bowels cause, but resembling medullary carcinoma in its early stage, is. rather relaxed. Fourteen leeches have been applied along the occasionally met with. It is when either pure blood or fibrine is course of the veins; bran poultices to both legs ; small doses of effused from the arteria centralis retinas into the cells of the membrane. When blood is effused, it presents, at first, potassio-tartrate of antimony given three or four times daily, hyaloid and ten grains of compound pulverized ipecacuanha at bedtime. when viewed in a clear light, a bright scarlet hue ; but in proThe diet has been light and nutritious, portion as the colouring matter of the blood is absorbed, it 2nd.-Dr. Hodgkin saw her again to-day; he advised the exhibits the peculiar metallic, glistening appearance, which is medicines to be continued, and recommended extract of belladonna seen in the malignant disease. This effusion of blood into the to be rubbed on the thigh over the saphena vein, and punctures vitreous humour may occur spontaneously, or be the result of to be made with a small needle in the legs. I made several external injury. The red colour presented in the early stage, punctures in the right leg, a small quantity of clear serous fluid and the sudden occurrence of the affection, will point out the oozed from the apertures, but it ceased to flow after two or three difference between it and the malignant tumour. " It is more difficult to form a diagnosis between cases of effuhours. sion March 15th.-Is able to leave her bed, and she is in every of fibrine into the hyaloid membrane, and the malignant In the instances of effusion of fibrine which I hate tumour. contains much less the the urine albumen ; better; respect legs still much swollen; the skin having a white appearance, and a witnessed, the metallic lustre, which must arise from the presence of an opaque reflecting substance deeply seated in the eye, was, hard brawny feel. not so clearly marked as in the malignant disease, probably the and hard1st.—Her hpa.lth much April swelling improied; ness of the’ legs considerably diminished ; is able to walk the owing to the effusion being in the substance of, and not posterior distance of a mile without much inconvenience. I tested the to, the vitreous humour; for it is found that, in proportion as the urine several times, at intervals of three or four days, and found opaque reflecting body advances towards the cornea, it loses its metallic lustre. I have observed also, that, in the non-malignant it free from albumen. 27th.-Is still improving in health. I recommended change of affection, although the pupil was dilated, it was regular in form, air; my patient left the neighbourhood, and I have not seen her and the texture and colour of the iris were not altered. In some since. instances, also, vision was not entirely lost, whereas, in malignant Remarks.—Puerperal convulsions is a disease of such frequent diseases, total blindness, I believe, always exists." Tlte points of analogy and difference between encephaloid, scirrhous, occurrence, and one now generally considered to be so well un.. derstood, especially as regards its treatment, that it may appear and melanotic disease, are clearly and accurately stated in the fohn strange to some of the members present that I should bring the lowing table:case just related before the society. I am disposed to think, howSCIRRHUS (as in common ever, that there are some points of interest connected with the MELANOSJS. ENCEPHALOID. cancei- of mamma.) subject which will afford matter for useful discussion. And first, respecting the state of the urine. Dr. Lever has lately directed Of consistence of brain in Of firm consistence in Of soft consistence in cellulo-fibrous septa.thin cellular septa. thin cellular septa. the attention of the profession (in a paper published in the Guy’s or sepia colour. an opaque white Hospital Reports) to "The Albuminous state of the Urine in Oflour. yellow colour. bloodvessels have Puerperal Convulsions." Dr. Lever found, in nine out of ten Numerous minute ves- Sparingly supplied with been traced. bloodvessels. sels. cases in which this secretion was examined, that it contained cells. No cau- Pigment cells round, albumen. The case related affords another example of the cor- Consists of globules and Nuclear date caudate corpuscules. oval, or irregular, and corpuscules. rectness of his views. The patient had had scarlet fever some sometimes caudate. urine was not known pre- Maybecomeofenormous Seldom of large size. They attain a large size. years before, and the condition of the bulk. vious to the convulsive attacks. There is, I think, but little of variable radoubt that this affection was only temporary, and arose probably Often of rapid growth. Progress generally slow. Growth pidity. from congestion of the kidneys, these organs, after a few weeks, Often interstitial effusionRarely interstitial interstitial lieof blood. morrhage. morrhage. having performed their functions naturally. Not disposed to form firmly connect disposed to form adAnother point worthy of consideration, is the question respected with hesions to surrounding surrounding hesions to surrounding in of these cases. alThe the parts. parts. parts. depletion patient, ing propriety skin becomes The skin becomes stretchsubcutaneous, the though not in an anæmie condition, had a soft compressible When skin is distended and ered and assumes the ed and distended, and pulse, and I therefore took only a small quantity of blood, as a stretched, and gives cancerous ulceration. yields by simple ulcerathat most this It tome writers measure. tion. appears upon precautionary way usually by simple ulceration. disease have not made sufficient distinction between the two classes After After ulceration progress ulceration, rapid After ulceration of cases-viz., the anæmic and the sthenic, and the young practiprogress, and often not so rapid, and sel- of tumour more rapid tioner is too apt to suppose that in this affection depletion can dom - no hemorrhage. hemorlarge fungous growths, profuse and frequently hemorrhage, provided it does - scarcely be carried too far. In the sthenic form, blood may be not assume the encerhage. taken to an enormous amount, with great benefit to the patient, phaloid structure. but I fear that indiscriminate depletion has not unfrequently This Most common in about or after species -added to the number of fatal cases. middle age. most frequently metvanced life. with in and Lastly.-The phlegmasia dolens appeared first in the leg, and youth. on the left side; the iliac vein was quite free from tenderness, Liable to be propagatedEven more liable to tendency to be proshewing that the hypogastric veins, as supposed by Dr. Lee, are through the propagated through pagated through the not always primarily affected. organs. the absorbent organs.absorbent organs. to remove the
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co-ISemi-transparent hluish-IBlack No
-
ad-Becomes
he-I
Never
Not
puck-
r
The progres of carcinoma
mfancy
absorbent
Oct. 1844.
ad-beUsually No
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