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PASSAGE OF A COIN THROUGH THE PRIMÆ VIÆ.
413
cipating with the rest of the body; for the dog will, times, obey the commands of his master, and at other times cannot understand them. There is not in the dog By J. SMELLIE, Esq., Surgeon. that great dread of water which is generally supposed; IN reference to the case of Mr. Richardson, narrated as he is oftentimes seen to bury his face in it, which, no in your number for the 1st June, of a child of nine years doubt, affords him relief, as the tongue being the perspihaving passed a halfpenny through the primse vise, I ratory organ, is much swollen ; the inability to swallow take the liberty of mentioning a case somewhat parallel is caused by spasm of the fauces, &c., brought on by the that came under my care in May last. A newsman, attempt to drink, forming, in my opinion, the most unset. 35, in showing some juggling tricks to his companions equivocal sign of its convulsive nature. where he could, in part, swallow substances and bring So we find the disease in man,-either severe convulsions them up again at pleasure, in making an attempt with a or spasm of some organ, sometimes raging and subsiding shilling, being too small to find even a temporary resi- in regular intermittent paroxysms; the head particularly dence in the cesophagus, it dropped into the stomach. In denoting the intermission by the occasional delirium and consciousness. That the affection may be contrying his skill upon a pennypiece he found, to his mis- returning fortune, that it was too large, for it got down a certain sidered 11 sympathetic," I rest upon the general resemlength, and become so fixed as to defy his efforts to re- blance of symptoms, but particularly upon the spasm move it. He was brought to me in about ten minutes caused in the attempt to drink. How is it that in many afterwards in a most distressed state, complaining of a a rational being the sight of liquids will sometimes bring On on spasm ? How can we account for the pharynx refusing sense of strangulation, breathing only in gasps. introducing the probang the coin could be readily detected its office and bringing on such a train of distressing lying firmly imbedded in the cesophagus, nearly opposite symptoms, but by sympathetic action ? to the cricoid cartilage, occupying, at its seat, the entire The treatment I should adopt is simple. Emetic (per diameter of the tube, and forming a lid, as it were, to the anum), so as to keep up constant nausea, and also the oesophagus, and required some degree of steadily and dashing of cold water along the spine every fifteen or carefully applied force to displace it. Its further progress twenty minutes; in the interim I would wrap the patient downward was easy, till it arrived at the superior orifice in blankets. The reason for the above course is this : I of the stomach, but it ultimately passed while in the act of conclude the body at the time to be labouring under swallowing some toasted bread. It passed through the great or positive excitement, and by the above treatment bowels in seventeen days, producing in its progress occa- it would be reduced to the lesser or negative state : it is sional insufferable costiveness, with peculiar shooting also calculated to bring on cutaneous perspiration, which pains through the abdomen, lasting but for the moment. is desirable under any opinion we may form of the disThe shilling was voided on the morning of the sixteenth ease. Ibstock, June 7,1844. day, unaltered in appearance. The penny had assumed a dusky, oxidised look, having a most striking resemblance to depositions produced by the electrotype. The ON THE EFFECTS OF SWALLOWING SPONGE. treatment consisted in the continued use of demulcents, By J. H. HORNE, Esq. with occasional purges of castor oil. Measurement, one inch and a quarter. THE subject of swallowing sponge, mooted at a late QHf)’t/.ŅWas this changed appearance of the copper meeting of the Medical Society of London, is an importthe effect of its contiguity to the silver coin during its ant one, therefore I trust you will excuse my following it passage through the stomach and bowels ? up a little beyond what is reported of it in THE LANCET, especially as its mode of operation is evidently not thoON HYDROPHOBIA AND ITS TREATMENT. roughly understood. Now, if the piece of sponge swallowed be of any size, By T. M. C. death most assuredly will follow from simple obstrucALLOW me, through the medium of your highly value tion ; for the sponge rapidly enlarges through readily able and widely read Journal, to offer a few remarks on absorbing the moisture which it freely meets with, and the nature of hydrophobia, and the treatment I would not from its possessing poisonous qualities. This may be adopt had I a case to attend ; hoping by this means to verified by well greasing a piece of sponge, and putting it PASSAGE OF
A COIN THROUGH PRIMÆ VIÆ.
THE
call for a discussion which may lead us to some useful mode of treatment in this perplexing and dreadful disease.
Hydrophobia is a specific disease, communicable from the brute part of the creation (particularly the dog tribe) to man, but we have no instance of man affecting man, therefore it is an affection sui -eneris. In the dog I am led to consider it as a series of convulsions, and, as regards man, I would add the word" sympathetic," for although symptoms and autopsy may, generally speaking, bear the signs of inflammation, still cases are occasionally met with in which there is so little organic derangement that the surgeon is hindered from pointing out the part affected, consequently we are led to consider what could be the cause of death with so little organic lesion ? Is it impossible to trace it to spasm of some part of the brain ? I think not. The early symptoms in the dog are feverishness, sullenness, restlessness, and snapping, which, in a short time, become of a convulsive nature, for we find him taking food with a quick, single swallow, showing that the pharynx and fauces are affected, as is the head, being carried in a peculiar position, low down, and a little on one side, with a choretic movement; moreover, there is a propensity for biting or catching at some imaginary being; the eye is found bloodshot from contraction of some minute vessel; there is strabismus, from muscular spasm, and distortion of the eye and of one or both sides of the face from spasmodia. As the disease advances we find it assuming a more direct convulsive character, every action and pain being of that nature, and the head parti-
at
a cat to swallow at leisure. The cat is attracted by the grease and not by the sponge, and thus swallows it entire, which is accomplished more effectually on her part by desire to get it down. The method of destroying cats by sponge is well known Providentially, on the other hand, when the cruel hag endeavours to compass the destruction of the almost helpless child committed to her charge, she soon discovers that its struggles prevent the possibility of thus forcing down the cesophagus a large piece without causing instant suffocation and instant detection. Again, Providence has prevented this, not imparting to sponge the qualities of adhesion or attraction, for although the wretch may attempt it by successfully forcing down small pieces, these will not form one mass very readily ; the administration of purgatives may, however, force it to become one; hence the practitioner should be careful in exhibiting them ; and besides, what might readily pass freely without the presence of purgatives, may be, by their action on the intestines, prevented, the irritation induced occasioning a contraction of their calibre, and the contraction may not cease prior to the mass in front becoming too large to pass through. Providentially, also, thefelo de se cannot very easily avail himself of the power of sponge to destroy life, the dry state of the fauces, induced by the consciousness of doing wrong, and heinously offending his maker, preventing the accomplishment, like the guilty Indian in the trial to test his innocence, who finds it utterly impossible to chew with moisture the grain put into his mouth. Princes-street, Coventry-street, June, 1844.
in the way of
cipating with the rest of the body; for the dog will, times, obey the commands of his master, and at other times cannot understand them. There is not in the dog By J. SMELLIE, Esq., Surgeon. that great dread of water which is generally supposed; IN reference to the case of Mr. Richardson, narrated as he is oftentimes seen to bury his face in it, which, no in your number for the 1st June, of a child of nine years doubt, affords him relief, as the tongue being the perspihaving passed a halfpenny through the primse vise, I ratory organ, is much swollen ; the inability to swallow take the liberty of mentioning a case somewhat parallel is caused by spasm of the fauces, &c., brought on by the that came under my care in May last. A newsman, attempt to drink, forming, in my opinion, the most unset. 35, in showing some juggling tricks to his companions equivocal sign of its convulsive nature. where he could, in part, swallow substances and bring So we find the disease in man,-either severe convulsions them up again at pleasure, in making an attempt with a or spasm of some organ, sometimes raging and subsiding shilling, being too small to find even a temporary resi- in regular intermittent paroxysms; the head particularly dence in the cesophagus, it dropped into the stomach. In denoting the intermission by the occasional delirium and consciousness. That the affection may be contrying his skill upon a pennypiece he found, to his mis- returning fortune, that it was too large, for it got down a certain sidered 11 sympathetic," I rest upon the general resemlength, and become so fixed as to defy his efforts to re- blance of symptoms, but particularly upon the spasm move it. He was brought to me in about ten minutes caused in the attempt to drink. How is it that in many afterwards in a most distressed state, complaining of a a rational being the sight of liquids will sometimes bring On on spasm ? How can we account for the pharynx refusing sense of strangulation, breathing only in gasps. introducing the probang the coin could be readily detected its office and bringing on such a train of distressing lying firmly imbedded in the cesophagus, nearly opposite symptoms, but by sympathetic action ? to the cricoid cartilage, occupying, at its seat, the entire The treatment I should adopt is simple. Emetic (per diameter of the tube, and forming a lid, as it were, to the anum), so as to keep up constant nausea, and also the oesophagus, and required some degree of steadily and dashing of cold water along the spine every fifteen or carefully applied force to displace it. Its further progress twenty minutes; in the interim I would wrap the patient downward was easy, till it arrived at the superior orifice in blankets. The reason for the above course is this : I of the stomach, but it ultimately passed while in the act of conclude the body at the time to be labouring under swallowing some toasted bread. It passed through the great or positive excitement, and by the above treatment bowels in seventeen days, producing in its progress occa- it would be reduced to the lesser or negative state : it is sional insufferable costiveness, with peculiar shooting also calculated to bring on cutaneous perspiration, which pains through the abdomen, lasting but for the moment. is desirable under any opinion we may form of the disThe shilling was voided on the morning of the sixteenth ease. Ibstock, June 7,1844. day, unaltered in appearance. The penny had assumed a dusky, oxidised look, having a most striking resemblance to depositions produced by the electrotype. The ON THE EFFECTS OF SWALLOWING SPONGE. treatment consisted in the continued use of demulcents, By J. H. HORNE, Esq. with occasional purges of castor oil. Measurement, one inch and a quarter. THE subject of swallowing sponge, mooted at a late QHf)’t/.ŅWas this changed appearance of the copper meeting of the Medical Society of London, is an importthe effect of its contiguity to the silver coin during its ant one, therefore I trust you will excuse my following it passage through the stomach and bowels ? up a little beyond what is reported of it in THE LANCET, especially as its mode of operation is evidently not thoON HYDROPHOBIA AND ITS TREATMENT. roughly understood. Now, if the piece of sponge swallowed be of any size, By T. M. C. death most assuredly will follow from simple obstrucALLOW me, through the medium of your highly value tion ; for the sponge rapidly enlarges through readily able and widely read Journal, to offer a few remarks on absorbing the moisture which it freely meets with, and the nature of hydrophobia, and the treatment I would not from its possessing poisonous qualities. This may be adopt had I a case to attend ; hoping by this means to verified by well greasing a piece of sponge, and putting it PASSAGE OF
A COIN THROUGH PRIMÆ VIÆ.
THE
call for a discussion which may lead us to some useful mode of treatment in this perplexing and dreadful disease.
Hydrophobia is a specific disease, communicable from the brute part of the creation (particularly the dog tribe) to man, but we have no instance of man affecting man, therefore it is an affection sui -eneris. In the dog I am led to consider it as a series of convulsions, and, as regards man, I would add the word" sympathetic," for although symptoms and autopsy may, generally speaking, bear the signs of inflammation, still cases are occasionally met with in which there is so little organic derangement that the surgeon is hindered from pointing out the part affected, consequently we are led to consider what could be the cause of death with so little organic lesion ? Is it impossible to trace it to spasm of some part of the brain ? I think not. The early symptoms in the dog are feverishness, sullenness, restlessness, and snapping, which, in a short time, become of a convulsive nature, for we find him taking food with a quick, single swallow, showing that the pharynx and fauces are affected, as is the head, being carried in a peculiar position, low down, and a little on one side, with a choretic movement; moreover, there is a propensity for biting or catching at some imaginary being; the eye is found bloodshot from contraction of some minute vessel; there is strabismus, from muscular spasm, and distortion of the eye and of one or both sides of the face from spasmodia. As the disease advances we find it assuming a more direct convulsive character, every action and pain being of that nature, and the head parti-
at
a cat to swallow at leisure. The cat is attracted by the grease and not by the sponge, and thus swallows it entire, which is accomplished more effectually on her part by desire to get it down. The method of destroying cats by sponge is well known Providentially, on the other hand, when the cruel hag endeavours to compass the destruction of the almost helpless child committed to her charge, she soon discovers that its struggles prevent the possibility of thus forcing down the cesophagus a large piece without causing instant suffocation and instant detection. Again, Providence has prevented this, not imparting to sponge the qualities of adhesion or attraction, for although the wretch may attempt it by successfully forcing down small pieces, these will not form one mass very readily ; the administration of purgatives may, however, force it to become one; hence the practitioner should be careful in exhibiting them ; and besides, what might readily pass freely without the presence of purgatives, may be, by their action on the intestines, prevented, the irritation induced occasioning a contraction of their calibre, and the contraction may not cease prior to the mass in front becoming too large to pass through. Providentially, also, thefelo de se cannot very easily avail himself of the power of sponge to destroy life, the dry state of the fauces, induced by the consciousness of doing wrong, and heinously offending his maker, preventing the accomplishment, like the guilty Indian in the trial to test his innocence, who finds it utterly impossible to chew with moisture the grain put into his mouth. Princes-street, Coventry-street, June, 1844.
in the way of