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REPORT OF A CASE OF CATALEPSY.
597 this operation, and I presume with a similar manners, and refined and cultivated intellect. But more than I am better satisfied it has been done by another, it one cause served to disturb his mental equilibrium: allusion being the case of all others I am or have been acquainted has been made to his unfortunate attachment ; religious with, I should have selected for a trial of the real value of enthusiasm was now added, and moreover, intense excitement the operation in effecting a permanent cure. and chagrin from zealous though unsuccessful efforts in Mr. Stanley has lately shown me, in St. Bartholomew’s business; perhaps also the large quantities of wine he was Hospital, three persons in whom lie had opened the urethra obliged to take with his customers, chiefly publicans, had some by a central incision, all bad cases, in which effusion of urine influence. Ample cause is thus apparent for the subsequent had begun, rendering the operations imperatively necessary. symptoms. In one done twenty-two months back there is still a fistulous About two years ago, Mr. began to have delusions, with opening in the perinæum, through which half his urine passes. occasional fits of eccentricity of conduct; these at first were In the second, the stricture was divided at the upper part slight, but afterwards became severe. At length, upon his of the scrotum; the opening is fistulous. In the third, the taking one of the children of the medical man in whose house urethra was laid open, in September last, from the upper part he resided, up to the roof, and threatening to throw it and himof the scrotum down between the testes to its lower part, self over the parapet, some restraint was considered absolutely where some urine still escapes. The lives of all three were necessary. He was removed to a private asylum near town. This step appears to have set the seal on the young man’s .saved by the operation. made his mind prey upon itself with redoubled when CASE 7.-G. E---, in 1840, twenty years of age, in misery, and He fancied that his friends had behaved with cruelty vaulting over a gate, fell upon it and struck the perinæum. energy. On trying to pass his water a good deal of blood came towards him, in sending him to the asylum; that his prospects for life were ruined, for how could he possibly hope to marry away, and he suffered much pain. Cold was applied, but the lady of his affections now that he was declared a lunatic ?2 abscess formed in perinseo, which was opened in an It may be ’interesting to those who pay especial attention London. It was now found a bougie would not pass, and after a good deal of force, a false passage was made, which to mental maladies, and not altogether beside the present if the nature of the delusions under which the eventually led to an operation in the I)eriii.-cum for the subject, division of the stricture, winch was done by a lateral incision, patient laboured at this and previous periods were stated. It the disorder was chiefly that which is called enlarged transversely. Fever supervened, but ultimately a appears that believed was No.9 9 catheter was passed, and at the end of ten weeks the wound healed, and he was enabled to pass a No. 6 soft bougie St. John the Evangelist; that he had a mission, and was There was also for himself. In 1843 he went to India, and after an attack of endowed with gif’ts to conquer the devil, &c. constant tendency to iteration-to the repetition of the same dysentery, having neglected the use of his bougie, was attacked awords of times, or to do the same thing over and by a retention of urine, and from that time suffered greatly over an infiuitude again; but there was not a tendency to suicide, except by ,until he returnedhome in 1850, and put himself under the care of Mr. Guthrie. The orifice of the stricture was so the negative act of refusing food. At length Mr. appeared so far recovered from his narrow that a catgut bougie of the smallest size would rarely enter it, the bougie of whatever kind, generally taking the malady, that it was deemed unnecessary to keep him longer false passage, the irritation of the bladder and the desire to in confinement. lie was therefore removed, on the 17thof make water being always great and scarcely relieved by opium. April of the last year (1850), to the house of Mr. Catty, at Putney. That gentleman has kindly furnished me with the were now aggravated by gonorrhœa, after All the which lie went into the country. On hisreturn to London, fo11owing- interesting particulars of the patient’s condition during his residence with him:—When brought to the house advantage was taken of Mr. Avery’s reflector to look at the he refused to move; when there he spoke rationally on all orifice of the stricture, and a small solid silver sound was subjects, but was eccentric in his conduct; always passed through it, but nothing would go further than before, general for instance, in passing under door-ways; would not prayed, nor beyond seven inches, the sens ition described being that of wear a hat, or allow his hair to be cut, &c.; otherwise docile. the gut being raised on the point of the instrument, which could was found in bed in be felt per rectum but not in the bladder. Under these cir- On April 28, at breakfast-time, Mr. a trance, in a perfect state of torpor, passing all his evacuacumstances, I opened the perinæum and urethra, dividing the tions involuntarily, and taking food only when put into his stricture upwards. Great difficulty and delay were experienccd in getting a director, either small or large, into the mouth with a spoon. He had gone to bed the previous night bladder, from his not being able to pass urine, and from the apparently as well as usual, and no cause could be assigned obstruction at the neck of the bladder, on which the end of for the accession. There was no rigidity, but he remained the instrument caught. A gum catheter was however intro- perfectly quiescent, and would answer no question, nor help duced, but; from the irritability of the patient often slipped himself with hand or foot; yet it appears that he was quite out and was replaced with difficulty, and only afrer taking a conscious during the fit, and proved this by referring to conthat had taken place during the trance. This particular curve which carried it over the bar at the cervix versations condition persisted w ith little variation for four of the bladder. The patient can now pass a No. 12 for himself, lethargic at the end of which time he got out of bed, walked up weeks, an will hear the bar not of having especial curvature, and being divided. A small fistulous opening remains in the perinæum, and down the room, to the astonishment of every one, but no notice of the by-standers, merely repeating the words allowing a little urine to pass through, when he does not took - cover it with the point of his finger. lie is otherwise free " See Jesus," incessantly. In a few days he behaved rather eccentrically, prostrating himself on the ground repeatedlyt from uneasiness and in perfect health. and pouring cold water on his head, but by the 2nd of June (To be continued.) had returned to his previous condition. During this state of trance, Mr. —— was seen by Sir R. Morrison, who considered the disorder a paralysis of volition, and prescribed croton oil REPORT OF A CASE OF CATALEPSY. and other medicines. Mr. Catty, also regarding the affection as seated chiefly in the spine, employed the tartar-emetic BY C. T. DOWNING, M.D., London. ointment freely to the surface. It is difficult to determine MR. JOHN was the son of an English merchant; Ins whether these remedies were serviceable. After recovery, Mr. remained for five weeks tolerably parents were healthy and intellectual, and, together with his brothers and sisters, gave no indication of nervous derangement; well, although an evident deterioration of mind was observable. he himself as a boy was of cheerful disposition, but always lIe was able to garden, take his meals with the family, and go to church; still hue had the same delusions of being a prophet, very excitable. As lie approached the age of twenty, and was springing that peculiarity of repetition to which I have previously up and rapidly in height, he was sent to schoo) in France; where it is alluded was further developed. IIe would repeat the same supposed that lie was half-starved; at all eveilts fed chiefly on word incessantly, and if asked by the children to draw somevegetable diet, instead of the generous fare to which he had thing for them, would fill sheets of paper with a hundred been accustomed. His health suffered much, and epileptic images of the same object. 1 have seen a book used by him fits were the consequence. He then resided some time in at this time, wherein page after page has presented row upon recovered In great row of inkstands, or candlesticks, or continuous lines of the Oporto. Here it appears that Mr. measure his health and strength, and, moreover, formed an one word, " Jesus"—facts, I should think, extremely interestattachment to a lady of the neighbourhood. His ing to physiologists. Portuguese On the 5tli of July, new phenomena presented themselves father, disapproving this connexion, removed him to London, and made him his agent in the wine business. At this time he which bear more immediately on the subject before us. was considered a fine young man, of gentle, prepossessing On that day, our patient was found sitting up-stairs with his
performed
result.
-
ambitious monomania.He
that he
-
symptoms
-
-
-
a prophet-
598 by the stethoscope, and the pulse beat I almost heart could be detectedabout in the minute. In addition
eyes closed. He looked very pallid, and scarcely answered when spoken to. He was placed in bed. At this time there may possibly have been some slight control over volition-for the eyes seemed to be voluntarily closed, and the evacuations discharged in bed wilfully. However, the symptoms rapidly increased in intensity. The next morning some slight rigidity of the arms was noticed, and subsequently of other parts of the body. He remained speechless; and would take food from a spoon, but never seek it, and passed his evacuations involun-
imperceptibly
sixty
it may be mentioned that there was a strong, pungent odour proceeding from the body; arising, not merely from the
passed involuntarily, but from the of urine, which was highly ammoniacal. There was no heat of head, throbbing of the carotids, or other indication of cerebral congestion. As the patient remained perfectly quiescent, with the exception of coughing occasiontarily. ally, and evinced no disposition to take food, it was necessary By the 2nd of October, the cataleptic symptoms were fully to administer nourishment by means of the stomach-pump. developed-but without great rigidity. He could be moulded For this purpose the mouth was forcibly opened, by wooden to any form, and his body, as well as limbs, retained for an and iron instruments constructed for the occasion. Considerindefinite time the position, however unnatural, in which they able difficulty was experienced in separating the teeth; and If placed on his legs he was like a post, and if when at length this was effected, and the tube introduced and were placed. taken up by the middle would lie like a log. He did not ap- withdrawn, the jaws remained rigidly open for an hour or pear to be sensible to slight impressions, but contracted his more, and no effort we could make was sufficient to close features if much injured; his eyes were firmly closed; to no them. During this rather severe operation, in which the question would he give answer, and only occasionally would front teeth were loosened, the patient uttered no cry nor gave he take food. On this account, and to sustain life, the cm- other indication of suffering, except by a certain altered ployment of the stomach-pump was required. expression of countenance; yet there is every reason to believe In this wretched condition, lying on his back motionless, that he was perfectly conscious of all that was done to Irim" and of every word uttered in his presence. Great attention our unfortunate patient remained during the months of October, November and December. He had short intervals was now paid to the comfort and cleanliness of the patient. of respite certainly, occurring at periods varying from three The room was kept well warmed and ventilated. Ilichuroths to seventeen days, during which lie was able to speak and take were administered by means of the pump in the morning., and food, but the general rigidity continued. It is curious that per rectum in the evening. As the bowels were inatctive, an he spoke quite rationally at these times, but chiefly about enema was given every third day. For a week little change food. He would mention the dishes that had been offered was perceptible, except that the surface of the body became to him during the time that he lay apparently insensible, and warmer, the countenance calmer, and the rigidity of the when they were placed before him, or rather, fed with them, muscles somewhat lessened. Jan. 22.-Dr. Todd attended to-day, in consultation with would eat enormously. Like Captain Dalgetty, he seemed Small doses of the sulphate of to lay in a stock of viands that should serve him in seasons Mr. Beale and myself. of scarcity, magnesia with liquor cinchonæ, were prescribed. On the 27th, some tumblers of tepid water were poured Various remedial measures were employed at this time. In October, for a fortnight a mild form of electro-magnetism over the head in the morning, and in the middle of the day an assafœtida enema was administered. Soon afterwards more was administered by Mr. Taxon, but the patient evidently lost ground, becoming weaker in consequence. About Christmas, evidence of animal vitality was apparent; the patient seemed the cold effusion was applied to the head, but from the alarm- more restless, and on extending the fingers of one hand ing symptoms that ensued, the experiment was not repeated, gently, uttered a feeble cry of impatience or suffering. The and the rigidity seemed greater than ever afterwards. Dr. joints of the fingers were observed to be swollen, as if with Todd, of King’s College Hospital, was now consulted, and took rheumatic gout. On the morning of Jan. 28th, the cold affusion was again principal charge of the patient from that period. In order to be near his friends, Mr. was brought to applied with no other effect than to cause the extensors of town on Jan. 18, of the present year, (1851,) and placed in my the neck and trunk to be much contracted. At about three house. He was still in the same rigid, cataleptic condition, P.M. the bowels acted naturally for the first time. In the and how the attendants contrived to remove him alive is to afternoon, as the food given in the morning had been rejected, me a mystery. I used the stomach-pump once more, and added a glass of When I first saw him, on the afternoon of that day, he was port-wine to the soup. Patient opposed considerable resistin bed, and there being occasion to remove the clothes, I ob- ance to the passage of the tube, closing the fauces firmly with served the following particulars, which were certainly calcu- the tongue and soft palate. The fluid was, however, injected lated to excite feelings of awe and deep commiseration :-The and retained. Soon after this, to the horror of the nurse, he patient was lying nearly on his back, straight in bed, his long, opened his mouth and spoke, demanding " something solids" lank figure, six feet three inches in height, reduced to an ex- He required, in rapid succession, "poached eggs, pudding, treme degree of emaciation; scarcely a sign or vestige of life hashed mutton," &c. He expressed impatience if it was not was perceptible; the surface was pale and cold, and the vital brought fast enough, and ate freely when the food was placed stream could scarcely be detected in the arteries; the eyes in his mouth. He seemed to have no control over any other were constantly closed, and any attempts made to open them muscles than those of the mouth and throat. He could not, were forcibly resisted; the pupils seemed turned upwards; the apparently, open his eyes, andhis limbs were as rigid as before. teeth were firmly clenched, but the lips strongly separated, so Subsequently he spoke kindly and rationally to those about as to give to the countenance the expression of a horrible him. seemed in some respects so sardonic grin. Upon attempting to move the trunk, the perOn the following day Mr. feet rigidity of the whole mass was perceptible. It was one much better that we began to hope that the crisis was passed. block of flesh, and reminded me of the frozen carcases of Throughout the day he spoke at various times quite rationally, animals brought to the market of St. Petersburg, so stiff and but rarely in answer to questions. As I was sitting in the cold as to break up only on the application of the saw or room he suddenly asked me how I did, entered into a discushatchet. The lower limbs were almost immoveable, but the sion as to the supply of water to the metropolis, expressed an upper extremities, which lay stiffiy by the side of the body, opinion with respect to the advantages which water passed could, by some exertion, be raised to an angle with it, and through granite had over that through lime, the way in which then retained immoveably the same position; in fact, they Oporto and some other continental towns were &c. could be moulded at pleasure, as if constructed of wax or lead. Towards evening he declined again. The equality of action observable in the muscles of the arm, 30th, the next day. The patient has quite relapsed into by which they retained this given position, was not so evident his former condition; will not speak or take food; perfectly in the neck and trunk. The extremes were more powerfully rigid, especially about the jaws. Dr. Todd saw him; prescribed brought into action, so as somewhat to arch the body back- various medicines ; cliloric ether and laudanum were given wards. At times this curvature was so great as to resemble by the rectum, and five-grain doses of quinine ; these and that form of tetanus called opisthotonos. The patient rested other remedies unfortunately proved unsuccessful; the strength of the patient evidently declined, while the muscular rigidity mainly upon his occiput and heels. It is difficult to say how far the muscles of organic life were increased. After a while, without risk of fracture it was no affected with rigidity. The diaphragm seemed to be much longer possible to separate the jaws;I passed a Eustachian contracted, and the intercostal and other muscles of respira- tube, therefore, through the nostril, and injected some wine tions acted so feebly that the breathing appeared suspended, and broth into the pharynx; this appeared to occasion some and could only be ascertained with certainty by the slight distress, but was swallowed. In this way, and by cnemata, halitus deposited upon a mirror held before the mouth. No the life of the patient was supported until Sunday, Feb. 16, respiratory murmur was audible. A very feeble action of the when nature gave way. motions, which constant
were
dribbling
-
-
supplied,
599 On the morning of that day a complete change came over the All symptoms of catalepsy vanished; the limbs were soft and flexible, and completely subject to the will of the as far as consistent with his failing strength. The power of speech was restored; the poor fellow recounted his sufferings: he had heard every word uttered in his presence, and was perfectly conscious of all that had been done to him. He had felt, he said, exeruciating pain at times; he had felt the strongest inclination to express his feelings; but had been unable to utter a word or raise a finger for the purpose. The horror of this position may be imagined. In the afternoon the patient felt conscious of approaching dissolution-he knew that he should die that night. About midnight I was summoned to his bed; he was then in the throes of death; in a few minutes all was quiet-he was dead. Yet for some time the appearance was so similar to the previous cataleptic condition, that this fact could not be determined with certainty. However, the expression of the face was changed; no halitus appeared on the mirror, and the heart ceased to flutter: the soft and flexible limbs soon began to stiffen with the true rigidity of death. Unfortunately no inspection of the body was allowed. scene.
patient,
Great
Russell-street, Bloomsbury.
PLACENTA PRÆVIA. BY G. F.
KNIPE, ESQ., M.R.C.S.,
SURGEON TO THE LEIGH DISTRICT OF THE MARTLEY UNION.
Mrs. J---, of this parisb, aged thirty-four, pregnant with her fourth child, on March 1, 1851, after a long walk, was seized with severe uterine haemorrhage, being then in the eighth month of her pregnancy. This yielded to the local use of cold, the internal administration of astringents, and the recumbent position; but recurred, from time to time, on her endeavouring to attend to her household work. On the 23rd of March, at eleven A 111., when coming down stairs, she was attacked with flooding, accompanied by expulsive pains. At four P.M., I saw her: countenance pallid, and its expression anxious; pulse small and thready, scarcely perceptible; skin cold, clammy, and bathed in perspiration; uterine contractions, I was told, had ceased for nearly two hours; she was actually deluged with blood. I gave her fifty drops of tincture of opium, in a glass of brandy. In ten minutes, I introduced my hand, and found the os uteri slightly patent, but easily dilatable; I passed my hand under the anterior margiu of the placenta, and immediately felt the head in its proper position, but high up; I grasped the legs, and brought them down into the vagina, without my hand exciting the slightest contraction in the womb, or any resistance from the patient. I then administered half a drachm of secale,in some brandy, and caused pressure to be made over the uterine region. In about five minutes, contraction of the uterus was excited, slight at first, but increasing in strength as the pains recurred. In half an hour the child was born; the placenta was expelled in a few minutes after; and from that time, setting apart the large mass of clotted blood which accompanied its expulsion, she lost no more than is common in the best labours. Slie is gradually recovering. The only thing in the above case I should wish to draw the attention of the profession to, is, the marked benefit derived from ergot of rye. With regard to the question at present in agitation—viz., extraction of the placenta, or turning the child—I can giveno opinion, having never tried the former plan; but out of three cases of placenta prsevia which have unfortunately occurred in my practice, two I have treated as above, with success as to the mothers and the loss of one child. The third was unfortunately dead when I arrived at her house. Leigh, JE5).
the
____
CASE OF POISONING BY THE DATURA. STRAMONIUM. BY II. PARKER LAURENCE, ESQ., Assistant-Surgeon
Second Belooch Battalion. Ox the evening of the 10th of Fehmary, a prisoner was brought to the General Hospital, from Bukkur Fort, in the following state :—He was quite insensible to sound, seeming not to hear the loudest talk; rousing and shaking him had no effect; his eyes were partially open, and the pupils more dilated than I have ever seen. The stupor was of a drunken kind; there was
disposition to sleep, but a constant restlessness and turning. body, attended by a most peculiar fidgety manner of twisting the fingers and catching at some imaginary object. This was varied now and then by grasping the bed-clothes very tight; his body was warm, more from this exercise of the arms than any other perceptible cause; the tongue was always rolling; the pulse rather quick; and the patient often shrunk,. as if suffering from a creeping sensation over his body. Nobody knows when or how he became so ;but he was
no
of the
found in this state at two A.M. It was my belief that the man was under the influence of some vegetable poison. Accordingly, a dose of seventeen grains of sulphate of zinc was given, followed by warm drinks, wet cloths ordered to be kept to the head. The zinc having no effect, a second dose was given, a good scruple ; this likewise failed. I then used the stomach-pump, but brought nothing from the stomach. After waiting a little time, I gave fifteen grains of sulphate of copper, and directed an enema to be used, and that mustard sinapisms be placed on the nape of the neck and some way down the.
and
spine.
11.—In the same state; the emetic not acted; nor have the bowels been moved ; the pulse very quick and sharp. Ordered, ipecacuanha powder, one scruple; potassio-tartrate of antimony, one grain ; and an enema, of sulphate of magnesia and warm water; vomited once, and brought up several seeds of the datura; the bowels unmoved. I now bled him at the arm, taking away fully ten ounces of blood; ordered another enema of oil of turpentine, castor oil, and tepid water; head to be shaved; cold applications thereto, and the emetic as before at two P.M. Evening—Still insensible; bowels unmoved; slight sickness, and more of the datura seeds. 12.-Bowels twice freely moved during the night, when several of the datura seeds came away. To get demulcent drinks only. Evening—Appears to be coming round, and takesa childish notice of signs, but unable to talk. 13.-Is disposed to be very happy; laughs and talks incessantly ; bowels open. Evening—Has sobered down; quite sensible, and says, that the seeds of some plant had been. given him by another man, at his own request, as medicine. Hydraball, Scinde, April 5, 1851.
A Mirror OF THE PRACTICE OF
MEDICINE
AND
SURGERY
IN THE
HOSPITALS OF LONDON. Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum, et dissectionum historias, tum aliorum proprias, collectas habere et interset comparare.—MORGAGNI. De Sed. et Caus. Morb., lib. 14. Proœmium.
ST. BARTHOLOMEW’S HOSPITAL. Lesion
of the Kidney; Hæmaturia; Suppuration; Death; Autopsy. (Under the care of Mr. STANLEY.) IDIOPATHIC affections of the kidney have of late been so carefully studied and elucidated, that the physician is, in general, enabled to form a pretty accurate diagnosis, when the symptoms are sufficiently distinct. Among the latter, hsematuria. might be mentioned as likely to cause a little embarrassment, as it is not always easy to ascertain from which portion of the extensive mucous membrane-beginning at the meatus and ending at the kidney—the blood proceeds. When it has been discovered that the haemorrhage does not proceed from the urethra or bladder, and that the kidney seems at fault, it has generally been found that the most frequent cause of haematuria is the laceration of vessels of the infundibula or pelvis, produced by sudden displacement of a calculous concretion. The effect of lacerations is shown in a very instructive in cases where an external injury has caused such a. lesion, for the careful observation of symptoms, in these instances where the laceration is almost certain, will go far to guide us in idiopathic cases. This is, however, not the only interesting point in the case which we desire to put upon record, for an admirable opportunity is afforded by the different phases of the same, to observe the effects of certain substances used to control hsemorrhage, and likewise to follow manner
performed
result.
-
ambitious monomania.He
that he
-
symptoms
-
-
-
a prophet-
598 by the stethoscope, and the pulse beat I almost heart could be detectedabout in the minute. In addition
eyes closed. He looked very pallid, and scarcely answered when spoken to. He was placed in bed. At this time there may possibly have been some slight control over volition-for the eyes seemed to be voluntarily closed, and the evacuations discharged in bed wilfully. However, the symptoms rapidly increased in intensity. The next morning some slight rigidity of the arms was noticed, and subsequently of other parts of the body. He remained speechless; and would take food from a spoon, but never seek it, and passed his evacuations involun-
imperceptibly
sixty
it may be mentioned that there was a strong, pungent odour proceeding from the body; arising, not merely from the
passed involuntarily, but from the of urine, which was highly ammoniacal. There was no heat of head, throbbing of the carotids, or other indication of cerebral congestion. As the patient remained perfectly quiescent, with the exception of coughing occasiontarily. ally, and evinced no disposition to take food, it was necessary By the 2nd of October, the cataleptic symptoms were fully to administer nourishment by means of the stomach-pump. developed-but without great rigidity. He could be moulded For this purpose the mouth was forcibly opened, by wooden to any form, and his body, as well as limbs, retained for an and iron instruments constructed for the occasion. Considerindefinite time the position, however unnatural, in which they able difficulty was experienced in separating the teeth; and If placed on his legs he was like a post, and if when at length this was effected, and the tube introduced and were placed. taken up by the middle would lie like a log. He did not ap- withdrawn, the jaws remained rigidly open for an hour or pear to be sensible to slight impressions, but contracted his more, and no effort we could make was sufficient to close features if much injured; his eyes were firmly closed; to no them. During this rather severe operation, in which the question would he give answer, and only occasionally would front teeth were loosened, the patient uttered no cry nor gave he take food. On this account, and to sustain life, the cm- other indication of suffering, except by a certain altered ployment of the stomach-pump was required. expression of countenance; yet there is every reason to believe In this wretched condition, lying on his back motionless, that he was perfectly conscious of all that was done to Irim" and of every word uttered in his presence. Great attention our unfortunate patient remained during the months of October, November and December. He had short intervals was now paid to the comfort and cleanliness of the patient. of respite certainly, occurring at periods varying from three The room was kept well warmed and ventilated. Ilichuroths to seventeen days, during which lie was able to speak and take were administered by means of the pump in the morning., and food, but the general rigidity continued. It is curious that per rectum in the evening. As the bowels were inatctive, an he spoke quite rationally at these times, but chiefly about enema was given every third day. For a week little change food. He would mention the dishes that had been offered was perceptible, except that the surface of the body became to him during the time that he lay apparently insensible, and warmer, the countenance calmer, and the rigidity of the when they were placed before him, or rather, fed with them, muscles somewhat lessened. Jan. 22.-Dr. Todd attended to-day, in consultation with would eat enormously. Like Captain Dalgetty, he seemed Small doses of the sulphate of to lay in a stock of viands that should serve him in seasons Mr. Beale and myself. of scarcity, magnesia with liquor cinchonæ, were prescribed. On the 27th, some tumblers of tepid water were poured Various remedial measures were employed at this time. In October, for a fortnight a mild form of electro-magnetism over the head in the morning, and in the middle of the day an assafœtida enema was administered. Soon afterwards more was administered by Mr. Taxon, but the patient evidently lost ground, becoming weaker in consequence. About Christmas, evidence of animal vitality was apparent; the patient seemed the cold effusion was applied to the head, but from the alarm- more restless, and on extending the fingers of one hand ing symptoms that ensued, the experiment was not repeated, gently, uttered a feeble cry of impatience or suffering. The and the rigidity seemed greater than ever afterwards. Dr. joints of the fingers were observed to be swollen, as if with Todd, of King’s College Hospital, was now consulted, and took rheumatic gout. On the morning of Jan. 28th, the cold affusion was again principal charge of the patient from that period. In order to be near his friends, Mr. was brought to applied with no other effect than to cause the extensors of town on Jan. 18, of the present year, (1851,) and placed in my the neck and trunk to be much contracted. At about three house. He was still in the same rigid, cataleptic condition, P.M. the bowels acted naturally for the first time. In the and how the attendants contrived to remove him alive is to afternoon, as the food given in the morning had been rejected, me a mystery. I used the stomach-pump once more, and added a glass of When I first saw him, on the afternoon of that day, he was port-wine to the soup. Patient opposed considerable resistin bed, and there being occasion to remove the clothes, I ob- ance to the passage of the tube, closing the fauces firmly with served the following particulars, which were certainly calcu- the tongue and soft palate. The fluid was, however, injected lated to excite feelings of awe and deep commiseration :-The and retained. Soon after this, to the horror of the nurse, he patient was lying nearly on his back, straight in bed, his long, opened his mouth and spoke, demanding " something solids" lank figure, six feet three inches in height, reduced to an ex- He required, in rapid succession, "poached eggs, pudding, treme degree of emaciation; scarcely a sign or vestige of life hashed mutton," &c. He expressed impatience if it was not was perceptible; the surface was pale and cold, and the vital brought fast enough, and ate freely when the food was placed stream could scarcely be detected in the arteries; the eyes in his mouth. He seemed to have no control over any other were constantly closed, and any attempts made to open them muscles than those of the mouth and throat. He could not, were forcibly resisted; the pupils seemed turned upwards; the apparently, open his eyes, andhis limbs were as rigid as before. teeth were firmly clenched, but the lips strongly separated, so Subsequently he spoke kindly and rationally to those about as to give to the countenance the expression of a horrible him. seemed in some respects so sardonic grin. Upon attempting to move the trunk, the perOn the following day Mr. feet rigidity of the whole mass was perceptible. It was one much better that we began to hope that the crisis was passed. block of flesh, and reminded me of the frozen carcases of Throughout the day he spoke at various times quite rationally, animals brought to the market of St. Petersburg, so stiff and but rarely in answer to questions. As I was sitting in the cold as to break up only on the application of the saw or room he suddenly asked me how I did, entered into a discushatchet. The lower limbs were almost immoveable, but the sion as to the supply of water to the metropolis, expressed an upper extremities, which lay stiffiy by the side of the body, opinion with respect to the advantages which water passed could, by some exertion, be raised to an angle with it, and through granite had over that through lime, the way in which then retained immoveably the same position; in fact, they Oporto and some other continental towns were &c. could be moulded at pleasure, as if constructed of wax or lead. Towards evening he declined again. The equality of action observable in the muscles of the arm, 30th, the next day. The patient has quite relapsed into by which they retained this given position, was not so evident his former condition; will not speak or take food; perfectly in the neck and trunk. The extremes were more powerfully rigid, especially about the jaws. Dr. Todd saw him; prescribed brought into action, so as somewhat to arch the body back- various medicines ; cliloric ether and laudanum were given wards. At times this curvature was so great as to resemble by the rectum, and five-grain doses of quinine ; these and that form of tetanus called opisthotonos. The patient rested other remedies unfortunately proved unsuccessful; the strength of the patient evidently declined, while the muscular rigidity mainly upon his occiput and heels. It is difficult to say how far the muscles of organic life were increased. After a while, without risk of fracture it was no affected with rigidity. The diaphragm seemed to be much longer possible to separate the jaws;I passed a Eustachian contracted, and the intercostal and other muscles of respira- tube, therefore, through the nostril, and injected some wine tions acted so feebly that the breathing appeared suspended, and broth into the pharynx; this appeared to occasion some and could only be ascertained with certainty by the slight distress, but was swallowed. In this way, and by cnemata, halitus deposited upon a mirror held before the mouth. No the life of the patient was supported until Sunday, Feb. 16, respiratory murmur was audible. A very feeble action of the when nature gave way. motions, which constant
were
dribbling
-
-
supplied,
599 On the morning of that day a complete change came over the All symptoms of catalepsy vanished; the limbs were soft and flexible, and completely subject to the will of the as far as consistent with his failing strength. The power of speech was restored; the poor fellow recounted his sufferings: he had heard every word uttered in his presence, and was perfectly conscious of all that had been done to him. He had felt, he said, exeruciating pain at times; he had felt the strongest inclination to express his feelings; but had been unable to utter a word or raise a finger for the purpose. The horror of this position may be imagined. In the afternoon the patient felt conscious of approaching dissolution-he knew that he should die that night. About midnight I was summoned to his bed; he was then in the throes of death; in a few minutes all was quiet-he was dead. Yet for some time the appearance was so similar to the previous cataleptic condition, that this fact could not be determined with certainty. However, the expression of the face was changed; no halitus appeared on the mirror, and the heart ceased to flutter: the soft and flexible limbs soon began to stiffen with the true rigidity of death. Unfortunately no inspection of the body was allowed. scene.
patient,
Great
Russell-street, Bloomsbury.
PLACENTA PRÆVIA. BY G. F.
KNIPE, ESQ., M.R.C.S.,
SURGEON TO THE LEIGH DISTRICT OF THE MARTLEY UNION.
Mrs. J---, of this parisb, aged thirty-four, pregnant with her fourth child, on March 1, 1851, after a long walk, was seized with severe uterine haemorrhage, being then in the eighth month of her pregnancy. This yielded to the local use of cold, the internal administration of astringents, and the recumbent position; but recurred, from time to time, on her endeavouring to attend to her household work. On the 23rd of March, at eleven A 111., when coming down stairs, she was attacked with flooding, accompanied by expulsive pains. At four P.M., I saw her: countenance pallid, and its expression anxious; pulse small and thready, scarcely perceptible; skin cold, clammy, and bathed in perspiration; uterine contractions, I was told, had ceased for nearly two hours; she was actually deluged with blood. I gave her fifty drops of tincture of opium, in a glass of brandy. In ten minutes, I introduced my hand, and found the os uteri slightly patent, but easily dilatable; I passed my hand under the anterior margiu of the placenta, and immediately felt the head in its proper position, but high up; I grasped the legs, and brought them down into the vagina, without my hand exciting the slightest contraction in the womb, or any resistance from the patient. I then administered half a drachm of secale,in some brandy, and caused pressure to be made over the uterine region. In about five minutes, contraction of the uterus was excited, slight at first, but increasing in strength as the pains recurred. In half an hour the child was born; the placenta was expelled in a few minutes after; and from that time, setting apart the large mass of clotted blood which accompanied its expulsion, she lost no more than is common in the best labours. Slie is gradually recovering. The only thing in the above case I should wish to draw the attention of the profession to, is, the marked benefit derived from ergot of rye. With regard to the question at present in agitation—viz., extraction of the placenta, or turning the child—I can giveno opinion, having never tried the former plan; but out of three cases of placenta prsevia which have unfortunately occurred in my practice, two I have treated as above, with success as to the mothers and the loss of one child. The third was unfortunately dead when I arrived at her house. Leigh, JE5).
the
____
CASE OF POISONING BY THE DATURA. STRAMONIUM. BY II. PARKER LAURENCE, ESQ., Assistant-Surgeon
Second Belooch Battalion. Ox the evening of the 10th of Fehmary, a prisoner was brought to the General Hospital, from Bukkur Fort, in the following state :—He was quite insensible to sound, seeming not to hear the loudest talk; rousing and shaking him had no effect; his eyes were partially open, and the pupils more dilated than I have ever seen. The stupor was of a drunken kind; there was
disposition to sleep, but a constant restlessness and turning. body, attended by a most peculiar fidgety manner of twisting the fingers and catching at some imaginary object. This was varied now and then by grasping the bed-clothes very tight; his body was warm, more from this exercise of the arms than any other perceptible cause; the tongue was always rolling; the pulse rather quick; and the patient often shrunk,. as if suffering from a creeping sensation over his body. Nobody knows when or how he became so ;but he was
no
of the
found in this state at two A.M. It was my belief that the man was under the influence of some vegetable poison. Accordingly, a dose of seventeen grains of sulphate of zinc was given, followed by warm drinks, wet cloths ordered to be kept to the head. The zinc having no effect, a second dose was given, a good scruple ; this likewise failed. I then used the stomach-pump, but brought nothing from the stomach. After waiting a little time, I gave fifteen grains of sulphate of copper, and directed an enema to be used, and that mustard sinapisms be placed on the nape of the neck and some way down the.
and
spine.
11.—In the same state; the emetic not acted; nor have the bowels been moved ; the pulse very quick and sharp. Ordered, ipecacuanha powder, one scruple; potassio-tartrate of antimony, one grain ; and an enema, of sulphate of magnesia and warm water; vomited once, and brought up several seeds of the datura; the bowels unmoved. I now bled him at the arm, taking away fully ten ounces of blood; ordered another enema of oil of turpentine, castor oil, and tepid water; head to be shaved; cold applications thereto, and the emetic as before at two P.M. Evening—Still insensible; bowels unmoved; slight sickness, and more of the datura seeds. 12.-Bowels twice freely moved during the night, when several of the datura seeds came away. To get demulcent drinks only. Evening—Appears to be coming round, and takesa childish notice of signs, but unable to talk. 13.-Is disposed to be very happy; laughs and talks incessantly ; bowels open. Evening—Has sobered down; quite sensible, and says, that the seeds of some plant had been. given him by another man, at his own request, as medicine. Hydraball, Scinde, April 5, 1851.
A Mirror OF THE PRACTICE OF
MEDICINE
AND
SURGERY
IN THE
HOSPITALS OF LONDON. Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum, et dissectionum historias, tum aliorum proprias, collectas habere et interset comparare.—MORGAGNI. De Sed. et Caus. Morb., lib. 14. Proœmium.
ST. BARTHOLOMEW’S HOSPITAL. Lesion
of the Kidney; Hæmaturia; Suppuration; Death; Autopsy. (Under the care of Mr. STANLEY.) IDIOPATHIC affections of the kidney have of late been so carefully studied and elucidated, that the physician is, in general, enabled to form a pretty accurate diagnosis, when the symptoms are sufficiently distinct. Among the latter, hsematuria. might be mentioned as likely to cause a little embarrassment, as it is not always easy to ascertain from which portion of the extensive mucous membrane-beginning at the meatus and ending at the kidney—the blood proceeds. When it has been discovered that the haemorrhage does not proceed from the urethra or bladder, and that the kidney seems at fault, it has generally been found that the most frequent cause of haematuria is the laceration of vessels of the infundibula or pelvis, produced by sudden displacement of a calculous concretion. The effect of lacerations is shown in a very instructive in cases where an external injury has caused such a. lesion, for the careful observation of symptoms, in these instances where the laceration is almost certain, will go far to guide us in idiopathic cases. This is, however, not the only interesting point in the case which we desire to put upon record, for an admirable opportunity is afforded by the different phases of the same, to observe the effects of certain substances used to control hsemorrhage, and likewise to follow manner