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EDINBURGH ROYAL INFIRMARY.
336 plied. The bowel may be judged to have been strangulated from ten to twelve hours. March 24th. - slight sickness. Temperature 100’5 °F. Slept four hours. 25th.-No pain ; has not been sick again. Temperature normal; pulse 108. 26th.-Dressings removed. Wound looks healthy, a great part of it having united by first intention. April 7th.-Wires removed; wound healed except where the wires were. 10th.-Slight pain and swelling about the seat of operation, which is flushed. Poultices to be applied, and sulphocarbonate of iron to be taken internally. 14th.-Pain, redness, and swelling gone. The sinuses remaining, where the track of the wire lay, are healing up. 26th.-Patient discharged cured. EDINBURGH ROYAL INFIRMARY. CASE OF SPASMODIC DYSMENORRHŒA.
BELFORD
HOSPITAL, FORT WILLIAM. CASE OF PURPURA.
of Mr. JAMES W. ALLAN.) C. C-,aged twenty, crofter’s daughter, admitted to hospital May 23rd, 1873, suffering from purpura. In the month of March she was treated as an out-patient for an attack of the disorder, by Dr. Blair, of Fort William. When she came under his care she was very ill indeed, the petechiae and vibices being all over the body, limbs, and face ; even the tongue and throat were affected. Discharge of blood from vagina so profuse as to constitute a sort of flooding; at the same time bleeding from gums, epistaxis, hsematemesis, and melsena. Under his care she made a good recovery. The malady returned, however, and as she lived among the hills, out of the way of daily medical attendance, she was advised to come into
(Under the
care
hospital.
The following brief notes were taken on May 24th, the (Under the care of Dr. MATTHEWS DUNCAN.) day after admission : —" About a fortnight ago the THE following case illustrates very clearly the sym- ’spots’ began to come out again. At present the vibices are to be seen on the left forearm only, which looks just as ptoms of the so-called mechanical dysmenorrhosa which, if it had been °blackened’ by violent blows. There is according to some authorities, is in almost every inof left hand, and the affected limb seems of lower swelling than the other. Patient complains of pain stance due to a flexion of the uterus. Whatever may I temperature be the frequency of flexion of the uterus, and it varies stomach; pain never goes away, but is aggravated as after taking food; complexion not bad; no at times, is with different it certain that this practitioners, greatly at present; menstruates every three weeks since vomiting bent condition of the organ may sometimes cause painful former attack; no melsena nor epistaxis; has palpitation and irregular menstruation, but it would appear from the of the heart. Takes her food, but without appetite. Has evidence of good and unprejudiced observers that the part a sinus in thigh which has discharged for many years. which a flexed uterus plays in the female economy has been Pulse about 72, not regular; bowels regular; tongue pretty clean. To have good diet, including milk and porter. Put greatly exaggerated.
across
M. H-, twenty-nine years of age, n arried for four years, has no children, was admitted to Ward 16 on the 26th of June, 1873, complaining of pain during menstruation. Patient is a strong-looking, stout, ruddy-complexioned female, and with the exception of the complaint mentioned, enjoys, and always has enjoyed, good health. The dysmenorrhoea commenced when patient was sixteen years oldat which age menstruation began,-and has continued without intermission ever since. The discharge is preceded generally by vomiting, and the pain accompanying it is of so severe a character that it necessitates her lying in bed for four or five days. The pain is referred by her to the hypogastric and lumbar regions, more especially the former. July 4th.-On vaginal examination during the day preceding a monthly period, nothing particular is discovered. On passing No. 9 of the series of uterine bougies (corresponding to the male urethral series), patient complains loudlv as soon as the internal os is reached, and this number is as large as can be easily passed. July 5th.-Patient is menstruating to-day. No.9 sound passes without pain. No. 12 bougie causes the same pain that No. 9 did on the former occasion. No. 14 was passed. 6th.-The patient declares herself quite free from pain. No. 14 bougie goes into the cervical cavity quite easily. 14th.-Has been quite free from pain since last report. She says that she has never had such an easy monthly
period.
15th.-Dismissed at her
own
request.
very little, but this is a good example of the efficiency of treatment by bougies. The success certainly astonished the woman very much. This case also illustrates very distinctly one branch of the argument against the mere mechanical character of this dysmenorrhosa, which is more justly called spasmodic. It was a characteristic case of what is called mechanical dysmenorrhcea. The internal os uteri was very sensitive, tender, and rigid, yet it easily passed a No. 9 bougie, indicating a passage of dimensions quite natural, and more than sufficient to transmit the menstrual flow. Moreover, in this case the state of the internal os during the flow was examined, and it was then found enlarged, not contracted; it then allowed a No. 14 bougie to pass easily. In short, with all the symptoms of so-called mechanical dysmenorrhaea, there was not only no obstruction, but more than usual enlargement of the passage of exit for the menstrual fluid. One
case proves use and
tincture of muriate of iron and infusion of calumba. It was found on inquiry that patient’s usual diet for two and milk, tea, years before first attack consisted in porridge and salt meat in the form of° bragy: " on
May 26th.-Epistaxis. June 2nd.-Patient threatened with a fainting fit, and in a state of nervous tremor. Rapid pulse; pain over middle of sternum. No haemorrhage. Menstruated last exactly two weeks ago. 3rd.-Patient is better; but a dusky spot has come out on
right
arm.
4th.-Urine examined and found to be normal in colour; very low specific gravity; considerable amount of mucous sediment; tested with nitric acid and heat, no albumen detected. 8th.-Patient began to menstruate yesterday. 10th.-Brought up some blood. Ordered a mixture containing gallic and sulphuric acids. 14th. Colouration of arm varying from purple to greenish-yellow. Ordered five grains of citrate of iron and quinine three times a day. 17th.-In spite of a good supply of fresh animal food, porter, and ferruginous tonics, a fresh outburst of petechise has taken place. An examination disclosed the following state of affairs:-Petechiae on arms, legs, chest, &c. ; pulse 90; respiration 26; temperature 976°. Of the spleen, owing to circumstances, nothing satisfactory was ascertained. Extensive dulness existed in left hypochondrium, extending down into abdomen. Heart-sounds normal in rhythm, but faint and muffled. The microscope revealed the red corpuscles of the blood crowded on the field, not arranged in -
They appeared crenated and shrivelled. Bowels quite regular; tongue pretty clean; urine normal. Patient states that when an attack comes on the sinus previously mentioned discharges a fluid coloured like blood. 18th.-Very slight knock on cheek produced typical rouleaux.
" black eye." 29th.-The patient was ordered cod-liver oil, and to continue the ferruginous tonic. It was resolved to give her a trial of lime-juice, which has been recommended in this affection. Ordered a tablespoonful three times a day. July lst.-Patient is menstruating. Discharge of blood very copious. She changed a fortnight ago. 3rd.-Discharge of blood much lessened. Large dark vibices out on thigh. 8th.-Patient’s appetite and spirits have been rather better of late, but large dark spots have come out on leg.
BELFORD
HOSPITAL, FORT WILLIAM. CASE OF PURPURA.
of Mr. JAMES W. ALLAN.) C. C-,aged twenty, crofter’s daughter, admitted to hospital May 23rd, 1873, suffering from purpura. In the month of March she was treated as an out-patient for an attack of the disorder, by Dr. Blair, of Fort William. When she came under his care she was very ill indeed, the petechiae and vibices being all over the body, limbs, and face ; even the tongue and throat were affected. Discharge of blood from vagina so profuse as to constitute a sort of flooding; at the same time bleeding from gums, epistaxis, hsematemesis, and melsena. Under his care she made a good recovery. The malady returned, however, and as she lived among the hills, out of the way of daily medical attendance, she was advised to come into
(Under the
care
hospital.
The following brief notes were taken on May 24th, the (Under the care of Dr. MATTHEWS DUNCAN.) day after admission : —" About a fortnight ago the THE following case illustrates very clearly the sym- ’spots’ began to come out again. At present the vibices are to be seen on the left forearm only, which looks just as ptoms of the so-called mechanical dysmenorrhosa which, if it had been °blackened’ by violent blows. There is according to some authorities, is in almost every inof left hand, and the affected limb seems of lower swelling than the other. Patient complains of pain stance due to a flexion of the uterus. Whatever may I temperature be the frequency of flexion of the uterus, and it varies stomach; pain never goes away, but is aggravated as after taking food; complexion not bad; no at times, is with different it certain that this practitioners, greatly at present; menstruates every three weeks since vomiting bent condition of the organ may sometimes cause painful former attack; no melsena nor epistaxis; has palpitation and irregular menstruation, but it would appear from the of the heart. Takes her food, but without appetite. Has evidence of good and unprejudiced observers that the part a sinus in thigh which has discharged for many years. which a flexed uterus plays in the female economy has been Pulse about 72, not regular; bowels regular; tongue pretty clean. To have good diet, including milk and porter. Put greatly exaggerated.
across
M. H-, twenty-nine years of age, n arried for four years, has no children, was admitted to Ward 16 on the 26th of June, 1873, complaining of pain during menstruation. Patient is a strong-looking, stout, ruddy-complexioned female, and with the exception of the complaint mentioned, enjoys, and always has enjoyed, good health. The dysmenorrhoea commenced when patient was sixteen years oldat which age menstruation began,-and has continued without intermission ever since. The discharge is preceded generally by vomiting, and the pain accompanying it is of so severe a character that it necessitates her lying in bed for four or five days. The pain is referred by her to the hypogastric and lumbar regions, more especially the former. July 4th.-On vaginal examination during the day preceding a monthly period, nothing particular is discovered. On passing No. 9 of the series of uterine bougies (corresponding to the male urethral series), patient complains loudlv as soon as the internal os is reached, and this number is as large as can be easily passed. July 5th.-Patient is menstruating to-day. No.9 sound passes without pain. No. 12 bougie causes the same pain that No. 9 did on the former occasion. No. 14 was passed. 6th.-The patient declares herself quite free from pain. No. 14 bougie goes into the cervical cavity quite easily. 14th.-Has been quite free from pain since last report. She says that she has never had such an easy monthly
period.
15th.-Dismissed at her
own
request.
very little, but this is a good example of the efficiency of treatment by bougies. The success certainly astonished the woman very much. This case also illustrates very distinctly one branch of the argument against the mere mechanical character of this dysmenorrhosa, which is more justly called spasmodic. It was a characteristic case of what is called mechanical dysmenorrhcea. The internal os uteri was very sensitive, tender, and rigid, yet it easily passed a No. 9 bougie, indicating a passage of dimensions quite natural, and more than sufficient to transmit the menstrual flow. Moreover, in this case the state of the internal os during the flow was examined, and it was then found enlarged, not contracted; it then allowed a No. 14 bougie to pass easily. In short, with all the symptoms of so-called mechanical dysmenorrhaea, there was not only no obstruction, but more than usual enlargement of the passage of exit for the menstrual fluid. One
case proves use and
tincture of muriate of iron and infusion of calumba. It was found on inquiry that patient’s usual diet for two and milk, tea, years before first attack consisted in porridge and salt meat in the form of° bragy: " on
May 26th.-Epistaxis. June 2nd.-Patient threatened with a fainting fit, and in a state of nervous tremor. Rapid pulse; pain over middle of sternum. No haemorrhage. Menstruated last exactly two weeks ago. 3rd.-Patient is better; but a dusky spot has come out on
right
arm.
4th.-Urine examined and found to be normal in colour; very low specific gravity; considerable amount of mucous sediment; tested with nitric acid and heat, no albumen detected. 8th.-Patient began to menstruate yesterday. 10th.-Brought up some blood. Ordered a mixture containing gallic and sulphuric acids. 14th. Colouration of arm varying from purple to greenish-yellow. Ordered five grains of citrate of iron and quinine three times a day. 17th.-In spite of a good supply of fresh animal food, porter, and ferruginous tonics, a fresh outburst of petechise has taken place. An examination disclosed the following state of affairs:-Petechiae on arms, legs, chest, &c. ; pulse 90; respiration 26; temperature 976°. Of the spleen, owing to circumstances, nothing satisfactory was ascertained. Extensive dulness existed in left hypochondrium, extending down into abdomen. Heart-sounds normal in rhythm, but faint and muffled. The microscope revealed the red corpuscles of the blood crowded on the field, not arranged in -
They appeared crenated and shrivelled. Bowels quite regular; tongue pretty clean; urine normal. Patient states that when an attack comes on the sinus previously mentioned discharges a fluid coloured like blood. 18th.-Very slight knock on cheek produced typical rouleaux.
" black eye." 29th.-The patient was ordered cod-liver oil, and to continue the ferruginous tonic. It was resolved to give her a trial of lime-juice, which has been recommended in this affection. Ordered a tablespoonful three times a day. July lst.-Patient is menstruating. Discharge of blood very copious. She changed a fortnight ago. 3rd.-Discharge of blood much lessened. Large dark vibices out on thigh. 8th.-Patient’s appetite and spirits have been rather better of late, but large dark spots have come out on leg.