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ST. VINCENT'S HOSPITAL, DUBLIN.
167
development
of
a
disease
which, notwithstanding the pre- 13th.—Had slept well. Temperature and pulse normal. first and the conjoint cutting Able to move the right leg freely. Ordered to sit up in bed, dentition, might otherwise never and to continue the salicine three times a day. 15th.—Convalescent. To get up. To continue the salicine
sence of carious teeth of the of a tooth of the second
have ensued.
night and morning for one week.
____________
Remarks.-The first case was of a very acute type, and increased in severity after the patient’s admission to hospital. The temperature, the pulse, and the symptoms CINE ; REMARKS. generally were kept in complete control by the salicine, the (Under the care of Dr. QUINLAN.) administration of which was strictly regulated by the TiiBSE cases were reported by Mary Josephine Hannan, clinical thermometer. Under the old methods of treatment it would probably have run on to five or six weeks, and ward clerk. CASE 1.—M. O’N,wife of a warder in the Dundrum possibly might have been attended with cardiac complicaLunatic Asylum, a strong, well-nourished young woman, tions. In the present instance complete relief was obtained convalescence in a fortnight. The heart was aged twenty-six, was admitted on May 21st. She was in a in a week and examined with the stethoscope morning and carefully the and 92. the high fever, temperature being 1012°, pulse a with view to the early detection of any heart evening She was in great pain, and was sweating profusely. The lesion, but nothing of the kind was met with. From the right knee and right foot were swollen, red, and fluctuating; fact of the patient lying perfectly quiet in the horizontal the left knee was also considerably swollen. She had been ill for three days, the symptoms gradually increasing in position, and being more or less under the influence of time while the salicine was acting), cardiac severity. She was ordered twenty grains of salicine sus- morphia (to gainadvance to a considerable extent without might pended in milk every two hours, also at once a hypodermic mischief the patient noticing any difficulty in this respect. To of a one-fourth of of of acetate injection morphia.grain 6 P.M.: Pain somewhat relieved, but temperature had risen prevent relapse the salicine was continued for three weeks to 102.1°. The salicine to be increased to thirty grains every after convalescence; first, three times, then twice, and finally two hours. To repeat the hypodermic injection of morphia once a day. The second case was of a mild character, and presented no difficulties in treatment. There is no doubt, at 10 P.M. however, that its progress was considerably abridged by the left 22nd.-9 A.M.: A rather The knee May uneasy night. and both wrists are swollen, red, and painful. Tempera- salicine treatment, which appeared at once to control the ture 1032°; pulse 104. Considerable perspiration. Patient is rheumatic symptoms, which in the beginning were, as far as unable to move hand or foot. The hypodermic injection of the right knee was concerned, rather severe. morphia to be repeated and the salicine continued.-6 P.M.: The patient is much relieved. Temperature 1026°; pulse 96. Not able to move, but not in pain when motionless. To continue the thirty-grain doses of salicine every two hours.10 P.M. : To take the following draught: twenty grains of chloral hydrate, thirty of bromide of potassium, an ounce ACADEMY OF MEDICINE IN IRELAND. and a half of cinnamon water, with a drachm of syrup of orange. 23rd.-9 A.M.: Passed a good night; free from pain, but Intra-uterine Polypus. - The Curette in the Diagnosis and unable to move. Treatment of 12?tra-utei-ine Disease.Temperature 102.8°; pulse 108. ’The salicine to be increased to thirty-five grains every two Labial Hæmatoma. hours.-6 P.M.: Very much relieved ; great fall in the temA MEETING of the Obstetrical Section was held on May 7th. perature, which is now 101’4°; pulse 100. To repeat the Dr. BYRNE exhibited a small intra-uterine polypus lately chloral draught. The salicine to be taken during the night, from a pluripara, aged thirty-seven, under his care removed as opportunity arises. 24th.-Passed a very good night; free from pain; tempera- in St. Vincent’s Hospital. The dilatation of the cervical ture 101.6°, pulse 96.-6 P.M.: Going on satisfactorily. canal was commenced with sea-tangle tents and finished Temperature 100’9"; pulse 88. Reduce the salicine to by Hegar’s dilators, and the polypus removed by an twenty grains every two hours. Repeat the chloral draught. ecraseur. 25th.-Temperature risen to 101’6°; pulse 100. A good In the adjourned discussion on Dr. W. J. Smyly’s paper deal of pain. To resume the thirty-grain doses of salicine on the Curette in the Diagnosis and Treatment of Intraevery two hours.-6 P.M.: Temperature 1012° ; pulse 90. uterine Disease, Dr. ATTHILL said that some years since he 26th.-Greatly improved; quite free from pain. Tempera- had been stoutly opposed to the use of the curette. Now, ture 994° ; pulse 78.-6 P.M.: Temperature 99-6° ; pulse 76. however, he had changed his opinion, as well as others At 10 P.M., the patient being inclined to sleep, no draught which he formerly entertained. He now looked on the was given. curette as a most useful instrument, and freely employed it 27th.—Passed a very good night. Temperature normal; in many cases. The principal question was, ought they to pulse 78. Totally free from pain. Twenty-five grains of use the curette as a diagnostic means without previous salicine every three hours.-6 P.M.: Temperature 988°; dilatation of the uterus, or ought they to dilate the uterus pulse 84. Patient comfortable and free from pain. and use the curette afterwards? He believed, however, first 28th.-Temperature normal; pulse 76. Able to move that the instrument was appropriate only to a certain prolimbs slightly. Swelling of joints beginning to diminish. portion of cases. If the patient were a woman who had had Thirty grains of salicine every four hours. several children, and who had a patulous cervix through During the 29tb, 30th, and 31st the pulse and tem- which a finger could be thrust, and if she were suffering perature continued normal, and the articular swelling dis- from a thickened and unhealthy mucous membrane, a small appeared. curette might be introduced without any anaesthetic, and the June 1st.—Patient able to sit up in bed. To continue the bleeding part removed. Generally, there should be dilatathirty-grain dosesof salicine three times a day. tion first and then the use of the curette; but there were 4th.—Patienc convalescent and able to get up. To continue cases in which the curette, without previous dilatation, as the salicine night and morning for a week. a diagnostic process, was justifiable and advisable. In many CASE 2.—M. M, aged thirteen, a schoolgirl, was cases it was impossible by any digital examination to admitted on June 10th, suffering from acute rheumatic ascertain what was the exact condition of the fundus. He symptoms. She was very feverish; temperature 101.1°; believed that, for twenty years, in no case in which there pulse 92. Right knee swollen, fluctuating, and painful, but was hæmorrhage, and in which he found no polypus, had not red. Could not move the right foot, which was some- he applied nitric acid without first using the curette. He what swollen ; sweating a good deal. Ordered ten grains of agreed with Dr. Smyly that the curette per se was safer salicine every third hour. than dilatation. With a soft cervix dilatation was perfectly June llth.-Rather better. Right knee and foot in the safe, provided antiseptic precautions were used. But there same condition. Temperature 100°; pulse 88. Perspiration was danger in dilatation if attempted rapidly with a rigid ceased. Had slept well. To continue salicine. cervix, neglecting antiseptic precautions. Most serious 12th.-Greatly improved. Temperature 99.4°; pulse 84. symptoms resulted from attempts to dilate the uterus Able to movethe right knee and foot a little. where there was an exceedingly rigid cervix. He would
ST. VINCENT’S
HOSPITAL,
DUBLIN.
CASES OF ACUTE RHEUMATISM QUICKLY CURED BY SALI-
Medical Societies.
development
of
a
disease
which, notwithstanding the pre- 13th.—Had slept well. Temperature and pulse normal. first and the conjoint cutting Able to move the right leg freely. Ordered to sit up in bed, dentition, might otherwise never and to continue the salicine three times a day. 15th.—Convalescent. To get up. To continue the salicine
sence of carious teeth of the of a tooth of the second
have ensued.
night and morning for one week.
____________
Remarks.-The first case was of a very acute type, and increased in severity after the patient’s admission to hospital. The temperature, the pulse, and the symptoms CINE ; REMARKS. generally were kept in complete control by the salicine, the (Under the care of Dr. QUINLAN.) administration of which was strictly regulated by the TiiBSE cases were reported by Mary Josephine Hannan, clinical thermometer. Under the old methods of treatment it would probably have run on to five or six weeks, and ward clerk. CASE 1.—M. O’N,wife of a warder in the Dundrum possibly might have been attended with cardiac complicaLunatic Asylum, a strong, well-nourished young woman, tions. In the present instance complete relief was obtained convalescence in a fortnight. The heart was aged twenty-six, was admitted on May 21st. She was in a in a week and examined with the stethoscope morning and carefully the and 92. the high fever, temperature being 1012°, pulse a with view to the early detection of any heart evening She was in great pain, and was sweating profusely. The lesion, but nothing of the kind was met with. From the right knee and right foot were swollen, red, and fluctuating; fact of the patient lying perfectly quiet in the horizontal the left knee was also considerably swollen. She had been ill for three days, the symptoms gradually increasing in position, and being more or less under the influence of time while the salicine was acting), cardiac severity. She was ordered twenty grains of salicine sus- morphia (to gainadvance to a considerable extent without might pended in milk every two hours, also at once a hypodermic mischief the patient noticing any difficulty in this respect. To of a one-fourth of of of acetate injection morphia.grain 6 P.M.: Pain somewhat relieved, but temperature had risen prevent relapse the salicine was continued for three weeks to 102.1°. The salicine to be increased to thirty grains every after convalescence; first, three times, then twice, and finally two hours. To repeat the hypodermic injection of morphia once a day. The second case was of a mild character, and presented no difficulties in treatment. There is no doubt, at 10 P.M. however, that its progress was considerably abridged by the left 22nd.-9 A.M.: A rather The knee May uneasy night. and both wrists are swollen, red, and painful. Tempera- salicine treatment, which appeared at once to control the ture 1032°; pulse 104. Considerable perspiration. Patient is rheumatic symptoms, which in the beginning were, as far as unable to move hand or foot. The hypodermic injection of the right knee was concerned, rather severe. morphia to be repeated and the salicine continued.-6 P.M.: The patient is much relieved. Temperature 1026°; pulse 96. Not able to move, but not in pain when motionless. To continue the thirty-grain doses of salicine every two hours.10 P.M. : To take the following draught: twenty grains of chloral hydrate, thirty of bromide of potassium, an ounce ACADEMY OF MEDICINE IN IRELAND. and a half of cinnamon water, with a drachm of syrup of orange. 23rd.-9 A.M.: Passed a good night; free from pain, but Intra-uterine Polypus. - The Curette in the Diagnosis and unable to move. Treatment of 12?tra-utei-ine Disease.Temperature 102.8°; pulse 108. ’The salicine to be increased to thirty-five grains every two Labial Hæmatoma. hours.-6 P.M.: Very much relieved ; great fall in the temA MEETING of the Obstetrical Section was held on May 7th. perature, which is now 101’4°; pulse 100. To repeat the Dr. BYRNE exhibited a small intra-uterine polypus lately chloral draught. The salicine to be taken during the night, from a pluripara, aged thirty-seven, under his care removed as opportunity arises. 24th.-Passed a very good night; free from pain; tempera- in St. Vincent’s Hospital. The dilatation of the cervical ture 101.6°, pulse 96.-6 P.M.: Going on satisfactorily. canal was commenced with sea-tangle tents and finished Temperature 100’9"; pulse 88. Reduce the salicine to by Hegar’s dilators, and the polypus removed by an twenty grains every two hours. Repeat the chloral draught. ecraseur. 25th.-Temperature risen to 101’6°; pulse 100. A good In the adjourned discussion on Dr. W. J. Smyly’s paper deal of pain. To resume the thirty-grain doses of salicine on the Curette in the Diagnosis and Treatment of Intraevery two hours.-6 P.M.: Temperature 1012° ; pulse 90. uterine Disease, Dr. ATTHILL said that some years since he 26th.-Greatly improved; quite free from pain. Tempera- had been stoutly opposed to the use of the curette. Now, ture 994° ; pulse 78.-6 P.M.: Temperature 99-6° ; pulse 76. however, he had changed his opinion, as well as others At 10 P.M., the patient being inclined to sleep, no draught which he formerly entertained. He now looked on the was given. curette as a most useful instrument, and freely employed it 27th.—Passed a very good night. Temperature normal; in many cases. The principal question was, ought they to pulse 78. Totally free from pain. Twenty-five grains of use the curette as a diagnostic means without previous salicine every three hours.-6 P.M.: Temperature 988°; dilatation of the uterus, or ought they to dilate the uterus pulse 84. Patient comfortable and free from pain. and use the curette afterwards? He believed, however, first 28th.-Temperature normal; pulse 76. Able to move that the instrument was appropriate only to a certain prolimbs slightly. Swelling of joints beginning to diminish. portion of cases. If the patient were a woman who had had Thirty grains of salicine every four hours. several children, and who had a patulous cervix through During the 29tb, 30th, and 31st the pulse and tem- which a finger could be thrust, and if she were suffering perature continued normal, and the articular swelling dis- from a thickened and unhealthy mucous membrane, a small appeared. curette might be introduced without any anaesthetic, and the June 1st.—Patient able to sit up in bed. To continue the bleeding part removed. Generally, there should be dilatathirty-grain dosesof salicine three times a day. tion first and then the use of the curette; but there were 4th.—Patienc convalescent and able to get up. To continue cases in which the curette, without previous dilatation, as the salicine night and morning for a week. a diagnostic process, was justifiable and advisable. In many CASE 2.—M. M, aged thirteen, a schoolgirl, was cases it was impossible by any digital examination to admitted on June 10th, suffering from acute rheumatic ascertain what was the exact condition of the fundus. He symptoms. She was very feverish; temperature 101.1°; believed that, for twenty years, in no case in which there pulse 92. Right knee swollen, fluctuating, and painful, but was hæmorrhage, and in which he found no polypus, had not red. Could not move the right foot, which was some- he applied nitric acid without first using the curette. He what swollen ; sweating a good deal. Ordered ten grains of agreed with Dr. Smyly that the curette per se was safer salicine every third hour. than dilatation. With a soft cervix dilatation was perfectly June llth.-Rather better. Right knee and foot in the safe, provided antiseptic precautions were used. But there same condition. Temperature 100°; pulse 88. Perspiration was danger in dilatation if attempted rapidly with a rigid ceased. Had slept well. To continue salicine. cervix, neglecting antiseptic precautions. Most serious 12th.-Greatly improved. Temperature 99.4°; pulse 84. symptoms resulted from attempts to dilate the uterus Able to movethe right knee and foot a little. where there was an exceedingly rigid cervix. He would
ST. VINCENT’S
HOSPITAL,
DUBLIN.
CASES OF ACUTE RHEUMATISM QUICKLY CURED BY SALI-
Medical Societies.