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WESTMINSTER MEDICAL SOCIETY. Saturday, April 27th, 1839.
231 observed in the examination, when first presented to his view, produced something like accumulation of feculent matter, then the a feeling of deep regret that a state of things have bid defiance to gradual development of the symptoms and so easily altered sbould the general condition of the patient affected, all efforts, and that the life of one, young would present tolerably clear evidence of and otherwise healthy, should have been the nature of the case. If, on the contrary, thus sacrificed. A discussion, involving the chief points it should be a state of parts which could be more immediately and banefully operative, alluded to, took place ; the cause of the obsuch as invagination of the intestine, rup- struction was considered very peculiar; ture of the layers of the mesenterv or meso- generally speaking, the strangulation in the colon, or girt intestine, trom any cause by situation observed in the present case arose which the bowel might become strangulat. from a portion of the bowel bursting through ed, the case would proceed more rapidly, the mesentery, the edges of the ruptured and the symptoms which unequivocally in- membrane contracting upon the tube, and dicated fatal obstruction would supervene. producing fatal effects. These would generally be severe pain re- As to the employment of operative means ferred to some one part of the abdomen, of relief to any cases of this description, with accompanying tenderness on pressure ; there were many objections to it,—objections the circulation would he rapid, the vomiting which, in the present state of our patholodistressing, the bowels obstinately consti- gical knowledge, were considered fatal to pated, with apeculiar descriptive expression any such trial. Thus, the obscurity existof cuuntenance, too clearly marking the ing with regard to the exact nature and seat of the obstruction, the doubts of our being hopeless condition of the patient. The nature and exact seat of the obstruc- able to remove such obstruction, even when tion, and the probability of its being in onr the peritoneum was opened, would weigh power to afford relief, even when the parts against any operation.
dependent upon ulcerative mischief in the appendix vermiformis coeci, or upon an
’
were exposed to view, must be, to a certain extent, doubtful ; but notwithstanding this, it appeared to him (Mr. Bryant) that there were certain indicatinns which might be WESTMINSTER MEDICAL SOCIETY. usefully borne in mind. When we reviewed the various causes of obstruction in the Saturday, April 27th, 1839. intestinal in reference to the
canal,
natu-
practi-
of relieving them, we were Dr. CHOWNE, President. rally directed and called upon to examine, POISONING FROM GIN.— DEATH AFTER 67 with due consideration, every variety of HOURS. obstruction with which we had become acquainted, and to distinguish, as far as it Dr. CHOWNE related the following case. was possible, those which it was most pro. On March the 11th, 1839, a lad, between bable our art might have the power to rec- seven and eight years of age, got up before tify. There was, perhaps, but little doubt any others uf the family, and went down that in those distressing cases uf disorganis- stairs into the room where the family ed bowel, constituting stricture high up in usually lived. lu rather less than half an the canal, extensive adhesions, producing hour he returned up stairs, and said to his obstruction, or disease of the appendix sister, a girt of ahout twelve years of age, from the irritation of a mechanical "that he fclt funny, and thought he was we had not much to hope for. Was it drunk." The sister having occasion to go out body, s", however, in the case of invagination of for something, it wss arranged that the lad the intestine, in mesenteric or mesocolic should let her in on her return. She was hernia, or in cases analogous to the one he not absent more than five minutes. Her had just rotated?Was it not in our power knock at the door was not answered, and to discriminate to a certain extent, to form a she knocked a second time ; this circumtolerably clear diagnosis as to the character stance brought the father down stairs, and aud seat of the obstruction; and, if so, should he found the lad Iving on the floor Quite we not be justified, under circumstances of insensible, with his nose bleeding; he was such utter hopelessness, in attempting relief ly ing in such a position as to leave no doubt even by the bold step of opening the abdo- that he had fallen from a chair, near a cupinitial cavity t board, in which there was a two-quart 8tollO In the case which he had related the bottle containing gin. The chair was not symptoms clearly indicated the presence ofin its usual place, neither did it stand where obstruction ; and the situation of the pain,, the father found it when the sister went the immediate vomiting after taking food,out. The father considers that the whole and the absence of abdominal tension, in- time from the lad’s first coming down stairs duced him to conclude that the obstruction,, to his finding him on the floor, did not from whatever r cause it arose, existed in the exceed half an hour. The lad when found upper part of the canal. The state of partsi WM quite insensible. He very soon was
cability
232
sick, and threw
some fluid off the stomach, from the cataplasms; the leech-bites had which, the father says, smelled of moderately. The general appearance The state he was in was considered to be was the same. The breathing was still produced by the spirit, to which he had stertorous, with the addition of mucous helped himself. As it was supposed that rale in the thorax. The irides still contime would carry off its effects, be was tracted, the eyes showing no signs of sensimerely put to bed, and kept warm. He bility. The limbs motionless and powercontinued, however, to get worse, and about It-ss; the skin prone to be cold; nothing one o’clock (five hours after the spirit was elicited signs of consciousness; pulse as a medical man was sent for. At before, 144, but rather improved in strength ; taken), this time, according to the father’s state- the countenance still free from anxiety and ment, the tongue appeared to swell, the uneasiness.-Continue the mixture; keep child groaned, and appeared dreadfully the body and extremities warm; keep up the oppressed. The quantity of gin that he had irritation of the scalp; the position to be taken was computed at half a pint. By the kept up. desire of the medical man an emetic was March 18, 12½, P.M. 282 hours after given, and the boy was put into a warm taking the spirit. The general appearance bath, but neither produced any visible had improved; the eyes were cccasionally effect. At about three o’clock (seven hour,. opened ; the pupils, however, were still after the spirit was taken) he was conveyed contracted, and there was no expression in of any consciousness, or of their to the Charing-cross Hospital, where he the became Dr. Chowne’s patient, and was seen being directed to any object ; the face and by him about fifteen minutes after his general surface were still pale, and prone arrival. In the interval warm water had to be cold ; the expression of the face been passed into the stomach, and with- still peculiarly placid ; the face, though pale, drawn, by means of the stomach-pump, not livid ; the stertor of breathing diminishThe fluid had not the odour of gin, or of anythe mucous rale was increased, and thinpeculiarneither was there the odour of had become very audible over the whole gin in the breath. The lad was perfectly chest; the limbs still relaxed; the pulse insensible and motionless ; the limbs were small and treatment, with relaxed and powerless ; the face pale ; the light nourishment and coffee. 102, P.M., general surface pallid, and below the ordi- 38½hours after taking spirit. The eyes The pulse was very opened still better; the pupils were less nary temperature. small, feeble, and quick, 144 in a minute ; contracted; the irides more mobile; there the pupils were contracted. On the ap- was a look almost of consciousness; the proach of a candle, after covering the eyes face and general appearance as before ; the with the hand, it was doubtful whether stertor less, the breathing apparently free; there was a slight further contraction. The the mucous rate undiminished; the pulse exclusion of light by the hand did not pro- 144, rather firmer. duce dilatation. The breathing was rather 19, 12 P.M., 522hours. The general slow, it was difficult, and decidedly ster- appearance, at first sight, much improved. torous; there was involuntary urging of the The eyes opened quite well ; the lad looked stomach, by which a small quantity of fluid about him, as if with intelligence, and and saliva drained from the mouth ; this though he did not answer when shokeu to, had no peculiar odour. The bowels had lie did not appear unable to speak. The not acted, and it was not ascertained that coma appeared to have subsided in a very any urine had passed. The general appear- marked degree; the stertor almost ;,onf-; ance of the patient conveyed the idea that the lungs appeared more loaded,the mucous he was sinking rapidly, except that the râle loud and general ; the breathing rather countenance was peculiarly placid, and free shorter; the cheeks rather flushed; the from the expression visible in the features skin generally had become hot and rather of a person in articulo mortis. The face dry ; the pulse from 160 to 180, distinct. furmed a striking contrast with the general He continued his medicine, and occasionally symptoms. Three leeches were applied to took some tea and arrow-root, but he was each temple ; a purgative dose of calomel, still in the same motionless and powerless and a cathartic enema, were ordered, with state, showing no sign of volition. The an application of liquor ammonia: to the contrast was very striking between the scalp (the hair having been first removed), seeming intelligence of his look and the a blister behind each ear, and mustard cata- inactive state of his will, for he did not even plasms to the feet. He had also a mixture make an effort; yet he looked as if he could of ammonia and camphor, and he was placed have done so without difficulty. Water and with his head and thorax raised on pillows. faeces had passed involuntarily. 51½ hours. At eleven o’clock at night (fifteen hours Nearly the same as at last visit. The cereafter the spirit was taken), the bowels had bral symptoms appeared diminished, the been opened, water had passed ; both with- pulmonary ones increased. The lips had out consciousness. The scalp was red and become slightly livid, the respiration la-
gin.
bled
eyes
ed, but
rapid.—Continue
slightly vesicated; the feet were also red, boured, the
mucous
r4le
more
intense. It
233
could be heard withopt the stethoscope or containing a small quantity of dark coagu. blood, and a small qnantity of lymph placing the ear in contact with the chest. To have a blister between the shoulders; lated into a jelly-like mass. Theperirubefacients on the anterior part of the healthy, containing about a drachm of fluid. Nothing observable in the abdothorax. 20. 67j hours. He died. Through the minalcaritv. The stomach was emptv; ils entire period there was neither delirium, outer surface rather paler than usual ; no injection of the conjunctiva, convulsion or remarkable vascularity of any part. The
coagulated cardium
inner surface was uniformly of a pale bue, and free from patches or discolourations, Examination about 12 hours after death. with the exception of a portion about the The scalp was free from any appearance size of the palm of a child’s hand, near the of injury. The surface of the body per- cardiac orifice; this exhibited an arrangefectly natural, and without discolouration. ment of very small vessels visible under, There was no fracture or appearance of and in the mucous coat; they had an arbo. injury anywhere. On removing the scalp rescent form, aud were florid. This might there was not any unusual redness dis- have arisen either during digestion or from covered on its inner surface, nor was there the irritation of abstinence ; there were no any on the pericranium. The dura mater other morbid appearances to be noted. appeared rather more te86e than usual ; the There appeared, however, to be a tendency arteries more visible ; the blood within to dryness in all the surfaces ; those of the rather more fluid; in other respects it was brain, the lungs, the heart, and the intesnatural. On separating the dura mater tines, appeared, almost immediately on from the aracbnoid there was no morbid exposure to the air, to become so dry that adhesion, no escape of fluid. The tuaica they might be touched without communiarachnoidea auneared to be more than com- catinc the least moisture to the Sneer. Dr. Chowne considered that there were a monly vascular, but there was no coagulable lymph or other product of inflammation; few points in this case deserving of notice. there were very slight pearly appearances, It appeared, for example, that after the hoy but not sufficient to indicate that inflamma- was left alone by his sister, lie was well tion had taken place. The veina of enough to remove a chair from one part of membrane were distended with dark blood ; the room to another, and to get upon it; those corresponding with the that before her return he was prostrate and regions especially. The veins on the an- comatose, and that the whole time did not terior part of the membrane were full, as exceed five minutes; this, therefore, formed well as those of the other parts, proving it an instance of the suddenness with which not to be the effect of gravitation after coma might come on. According to most death. On removing the brain a small authors who had written on this subject, a quantity of serum, tinged with blood, was contracted pupil is a favourable circun.found in the fossæ of the base of the cra- stance; in this case the pupils were connium ; the quantity did not exceed three tracted at first, and afterw ards came into a drachms. The under surface of the brain still more favourable state, for the irides natural. Nothing unusual in the medullar) conveyed the stimulus of light quite natu. substance. The right lateral ventricle con- rally. The passing off of coma is generally tdined the usual quantity of fluid. The a very favourable indication, but in this vessels were. honevcr. rather fuller : the case, although terininating fatally, the coma blood within them rather more fluid ; the was almost, if not entirely, removed. The plexus choruides more than cummonly full peculiar placidity of the countenance was of blood; nosuliicieot sign of inflammation. not generally remarked by authors ; in this The left lateral ventricle corresponded with case, however, it was very striking throughthe right. Other parts uf the brain healhy.r out. The ordinarv duration. in fatal caseli. No odour of gin in any part. No effusion was twelve to eighteen hours ; in this it or signs of disease in the cavity of the extended hours. We found that in rax. The lungs, at the part first presented the absence accidentalcauses, as exto view, appeared natural; the posterior,’ posure to cold, falling with the face in mire and under parts were dark and congested,or in water, tight dress, especially about probably from congestion which commenced the neck, and others of a simitar kind, from prior to death, and increased after, froa which the patient could Lot extricate himgravitation. The parenchyma was normal. setf, the usual mode of death was either by The trachea and bronchial tubM were full the coma becoming deeper and deeper, or of froth;, turbid fluid, reseiubling watery by the rupture of u blood-vessel producing mucus, with a very small admixture of Hpoplexy. In this inslince the terminatiun muco-purulent fluid. The lining membrane was not by either of these : tLe cerebral of the air-passages appeared to be natural; symptoms disappeared to an extent which there was, however, a slight blush at thegave a reasonable hope that the termination would have been favourable; and in this upper part of the trachea, bot too slight warrant any inferemo. The heart particular the case bore some resemblance
tendency thereto,
no
peevishness,
or even
anxiety of countenance.
,
the
temporal
tho-
to 67of
‘
to
healthy,
234
quote4i by Christison, in which a abscesses were small, took place contempodied after apparent convalescence. raneously with abscesses in other parts of The Society adjourned until the third the body, and the eyes recovered unimpaired. Saturday in October next. I may as well allude here to a deep-seated now and then occurring, of inflammation, INJURY TO THE EYE FROM SMALL. SMALL. POX. pox. whichI have seen three or four examples; Mr. MARSON read the following paper on it appears to destroy sight very speedily this subject :without producing ulceration of the cornea, There is a popular belief that the eye is and is met with in persons who have smallinjured, or lost, in small-pox, from one or pox in a very severe form, and die on the more of the pustules of this disease forming seventh or eighth day. On looking care. on the cornea. The same opinion is gene- fully into the eyes of these patients the rally entertained, too, by members of the colour appears altered ; there is a general
to
one
man
_____
and by cloudiness and vacant expression, and sight the best writers ; but so far as I have been seems to be wholly gone in a very short able to observe, the opiuion is not well time; the iris, retina, and all the interior founded. My position as surgeon of the and deep-seated parts of the eye, I have no Small-pox Hospital, affords me an opportu- doubt, are involved in this inflammation. nity of seeing this injury frequently, and I Whether or not sight would be regained in have noticed it with attention for the last case the body were restored to health, it is three years, but in no one instance of those impossible to say, as I have never yet seen under my care has it arisen from the cause an instance of recovery. But it is to the to which it is usually ascribed, nor have I destructive ulceration of the cornea, to that ever seen a small-pox pustule formed on the form of the disease which most frequently eye. The eye itself appears to me to possess destroys the eye in small-pox, that I wish complete immunity from the eruption of more particularly to request your attention. small-pox ; it remains uninjured all through It is singular that our writers on ophthalmic the eruptive stage of this disease, although surgery, men of great ability, experience, the pustules are invariably more numerous aud observation, should have followed so on the face than on any other part of the exactly in the steps of each other, in giving body, and extend to the inner margins of the what I consider an entirely wrong descripeyelids ; they never form on the conjuncti- tion of this affection. This error must be val membrane, so far as I have seen, either ascribed to the comparatively limited opporwhere it covers the globe of the eye or lines tunities afforded to them of seeing the disthe palpebræ. Common inflammation, in a ease in its early stage. But I am surprised few instances, attacks the conjunctiva dur- that these writers have not taken the hint ing the first five or six days ; this I do not of its probable nature, from knowing that deny, but then it must be in a great measure the eye is lost precisely in the same way, independent of the eruption, as it occurs but and under similar circumstances, from other very seldom, and is not the inflammation that exanthematous diseases, viz., measles and leads ultimately to the destruction of the scarlatina, and in rare instances, also, from organ. Inflammation has been supposed by erysipelas and typhus. They would not, I some to be caused by the diseased secretion suppose, contend that the papulae of measles of the Meibomian glands being confined destroy the eye, and yet in small-pox they within the closed eyelids, which is further attribute its loss entirely to the eruption. stated by them to cause ulceration. They state that the conjunctival membrane This vitiated secretion might perhaps is continuous with the skin, and separates give rise to slight inflammation, but it does under similar circumstances, and hence apnot produce destructive ulceration; that pro- pear to conclude, and I confess with great cess is the effect of the state of body conse- apparent reason, that it must also be subject quent on a severe attack of small-pox, fol- to the eruption of small-pox ; physiologilowed by violent secondary fever. The two cally they may be correct, so far as regards conditions are quite distinct. There will the skin, but it is mere theory so far as it be in the inflammation arising in the early relates to small-pox. Thereis another strong stage of the disease great redness, with what argument against the ulcer in the eye being is called chemosis, continuing for a few caused by one of the pustules of small-pox. days, but it subsides without future mis- On all other parts of the body they are bechief to the part affected. The common ginning to subside before the eye is attackabscess of small-pox, familiar to all prac- ed. It has been supposed that as the cornea tical men, forms on the eye between the is so-.dense and unyielding, a longer time conjunctival membrane and sclerotic coat, would be required to mature the pustule. and also between the layers of the cornea, of The supposition is not good, for this reason: BB hich I may have seen five or six cases in the great regularity observed in the appearthe treatment of fifteen hundred ; but this ance and disappearance of the spots on could not be well mistaken for one of the other parts of the body, beginning first in characteristic pustules of the disease. These the face, and following in succession on the
profession, otherwise well-informed,
235
extremities, would hardly be departed from the margin of the cornea; this eontinaes to in the eye; if a longer period were really spread with more or less rapidly, according required for their production in this part, it to the degree of secondary fever present;; wonld still be doubtless a determinate one, in the more violent cases, an ulcer being and bear relation as to time in different formed on each side of the cornea at the patients; whereas the ulcer on the eye has same time, showing the disease to be adits commencement at all times, from the tOth saucing with great severity, and prtsenting to the 25th, or 30th day succeeding the day a tolerably certain indication that the eye of eruption. The most confluent cases of will be entirety lost. The ulceration passes small-pox are daily seen where the eruption through the different layers of the cornea is abundantly scattered over the face, with- until the aqueous humour escapea, extendout any affection of the eyes at all ; the ing itself, too, laterally ; and if the part of proportion of those suffering from variolous the cornea destroyed be large the ins will ophtbatmia not being more than one in protrude through the opening. In the worst thirty-nine. This I know from having ex- cases there is usually hypopium, and hen amined the register at the Small-pox Hos- the matter is discharged the cr) stalline tens pital, which is kept with great care, and in and vitreous humour escape ; or the humours which everything of importance regarding may escape from deep and extensive aluugheach patient is always noted, Wbeu I wish ing, in the first instance, without the forlllato arrive at something like a fact on any tion of ttiatter, this being succeeded. of point, I take a thousand successive cases; 1 course, by the total ar-nibilation of the form have done so in this instance, counting those of the eye,as well as the sight. In some inwho died as well as those who recovered, stances the ulceration proceeds very raand find that twenty-six have suffered from pidly ;I have more than once seen the variolous opbthahnia, which is one in thirty- entire cornea swept away within forty-eight nine, and of these eleven had lost an eye, hours from the apparent commencement of - -about one in 100 = precisely one and a the inflammation ; and, what is singular, now and then the mischief goea on without tenth. Thus, then, I think, that we may fairly the least pain to the patient, or his being
conclude, if the conjunctiva were actually aware that anything is amiss with his eye. subject to the eruption of small-pox as wcll An example lately occurred, showing the as the skin, it woulrl hardly escape mischief strong disposition for thr ulcerative process so often ; at the same time it should be to attack the margin of the cornea; it ex-
clearly understood
that this destructive tended all round this anterior part of the ulceration of the cornea is essentially allied eye, to some depth, loosening three or four to the inflammation of the skin, produced by layers of the cornea almust in an entire state, the exanthemata. The injury take* place as they may be separated from the dead e)o when the system has been much reduced by by maceration. This destructive ulceration, or sloughing, inflammatory disease of the surface, and when fever still continues. The body may or whatever term may be given to it with be quite as much debilitated by other dis- most propriety, never takes place iu a severe eases, also inflammatory, without the eye degree but when there is a high stite of suffering. It is met with after small-pox, secondary fever present. That is a point measles, scarlatina, erysipelas, and typhus ; which should particularly be remarked ; the the latter, although not usually accompanied experienced practitioner in the treatment of byeruption, has been associated with a good small-pox will always know beforehaud deal of petechiæ during the last two years, when it is likely to occur. There will be a showing the skin to be implicated in the hot and dry state of skin, rapid pulse, thirst, derangement ; and the liability of the cellu- loaded tongue, these havint;been precedwd lar membrane to slough after typhus, is well by a very confluent state of the disease; and known. then it is that some fearful consequences I have never yet seen any part of the may be apprehended, such as the loss of un conjunctiva sloulth but that covering the eye, formation of large abscesses, and cornea ; hence I suppose the seat of injury sloughing of the cellular mcmbraoe, extendto be in the latter, or more frequently, per- ing often over the greater portion of a limb ; haps, especially in mild cases, in the cellu- or, may be, formation or deposit of matter in lar membrane between it and the coujunc- one side of the chest. Some of these serious tiva. The particular local affection that results may be expected when the secondary causes the destruction of the organ of vision fever runs high, experience alone directing in variola begins generally on the 11th or the practised eye to an early knowledge of 12th day, or later, from the first appearance the probable termination. of the eruption, and when the pustules on The close resemblance between sloughing every other part of the body are subsiding. of the eye and sloughing of the cellular It comes on after the secondary fever has membrane in other situations, and its occurcommenced, with redness and slight pain in ring also about the same time. lead me to the part affected, and very soon an ulcer is suppose that it is easentially of the same formed, having ita seat almost invariably atMttofe ; and whoewef has Ud much expert.
36 in the treatment of small-pox, and will Like all other diseases this has various this subject attentive consideration, grades. Patients are usually much reduced will, I think, come to the same conclusion. at the time the ulceration first makes its The cornea is composed of five or six appearance, and all active treatment would layers, which, as they are separable but not be out of the question. But now and then loose, must be allowed to havesome con- the diseaseis seen in a stout, full habit, necting medium ; and it is reasonable to sup- with strong pulse, from whom it is desirable blood generally. This should be pose that this may bear resemblance to the to cellular membrane elsewhere, and hence be done with great care, as few are able to subject to like attacks. It would be diffi- bear it. In others, if the eruption have subsided cult, perhaps, to demonstrate this resemblance further than by analogy. Other soft so that the temple can be pretty well cleared, parts, complete in themselves, but in close bloodmay be taken by cupping. This mode abstracting blood will be found more continuity, have a connecting substance, which we call cellular membrane. This eligible, in most instances, than general substance, whatever it is, between the layers bleeding; or blood may be taken beneficially of the cornea, performs the same office. by leeches. After the fomentation, cold or The beautiful structure of the eye would tepid decoction of poppy should be applied require it to be considerably modified, but to the eye, or a lotion of water with a small still not altogether different, inasmuch as quantity of spirit. I rather prefer simple the object is the same, and Nature being water. Careful sponging of the eye two or simple in her arrangements would vary it, three times aday with warm water, or warlll we may presume, as little as possible. It milk and water, should always be eujoined. may be asked, why does the eye suffer more A purge, given every second day, of calomel frequently in small-pox, from sloughing, and rhubarb, if required, and saline medithan any of the other soft parts ? My an- cine, with antimony, and milk diet. These swer would be, that I doubt whether it means are to be regulated according to cirdoes. I have stated that only one person in cumstances. Cases may be selected in a hundred, in the aggregate, is aftlicted with which it is advisable to touch the ulcerated the loss of an eye from small-pox; and if spot with lunar caustic scraped to a point, note were taken of the sloughing of the cel- as this appears, sometimes, to arrest the lular membrane in other parts, it would he progress of the ulceration. I should rarely, found to take place quite as often, if not however, depend upon this alone; it forms oftener, in any individual part as in the eye. only one of several means worthy of conWhy one part should be fixed on in one per- sideration. Two or three applications of son, and another in another, we are quite at leeches will often be found necessary, or a loss to explain ; but of this I am sure, that cupping, followed on a subsequent day by during the last three years there is not any leeches, regulated in number and repetition one external part of the body that I have not by the violence of the inflammation, and again and again seen the seat of sloughing strength of the patient. When the ulceration is accompanied with great debility, of the cellular membrane. The importance of the eye, and the dis- with but little remaining febrile excitement, figurement occasioned by its loss, mightlead depletion must not be thought of in any The patient should then be well us to believe, perhaps, without careful in- form. quiry, that it formed more frequently than uuurished; perhaps wine may be necessary ; any other part the seat of this injury. The our attention being mainly directed to the scalp, palpebra, about the beard in men, preservation of life on any terms. I disapprove, in most instances, of the neck, elbow, and dorsum of the foot, I feel quite certain, are much oftener assailed than use of mercury, given so as to alfect the the eye, by inflammation and sloughing, mouth ; it only increases the ulcerative We also see in all those situations just process. But we see, sometimes, the inenumerated, as well as in the eye, inflam- nammation get into a chronic state, aud the mation of a less degree of severity, which ulcer remain stationary, in which mercury subsides without being followed by ulcera- may be used with much benefit. The intion and sloughing of the skin and cellular nammation disappears under its use, as if membrane ; still further illustrating the by magic, and returns if the remedy be suddenly discontinued. I would have it given, similarity of the two. in bringing the subject before ’ however, in repeated doses, with great cirMy the Society has been to explain the cumspeciion, as it is calculated to do harm of the injury sustained by the eye m variola, wheu misapplied. Blisters to the temples more thau to oll’er any remarks on its treat- should he tried, as they are often servicement : it may, however, be considered that able. The prolapsed iris may render it that ought not to pass by altogether unno- desirable, in the chronic state, to resort to ticed. Although it is to be lamented that the application of belladonna to the brov% in the severe forms of attack our elforts to or the edges of the ulcer in the cornea may save the eye will be of no avail, there are require to be touched with the nitrate of
ence
give
take
of
object
still others in which
pathology
we can
be of great
use.
silver. It is almost impossible, in
a
paper
237 of this sort, to allude te all the means of relief that may be necessary to suit each individual case, but I have mentioned those most likely to be advantageous; and, finally, I have pleasure in stating, as the result of my experience, that although the appearance of the eye may be very unfavourable in cases where the inflammation and ulceration have been severe, but not so violent as to cause the discharge of the humours, in a few months after the patient has otherwise recovered his health, very great reparation usually takes place also in the eye; the leucomatous state will, in a great measnre, disappear; and unless the ulcer have been deep and exactly in the line of vision, very useful sight may be regained.
Yery full. The liver, spleen, and pancreas, were all very bealthy, the gall-bladder being empty; the pelvic viscera, also, were perfectly healthy. On the stomach and bowels ’being opened, there were no appearances of erosion or inflammation of the mucous membrane, but they contained a consi. derable quantity of semi-liquid matter. The stomach, duodenum, and jejunum, were boiled, with their contents, in distilled water, and filtered, and the following tests were tried, but without effect:1. Chloride of lime. If oxalic acid had been present, it would have produced a were
white
precipitate. Sulphate of copper, with oxalic acid, produces a whitish-green precipitate. 3. Nitrate of quicksilver, with oxalic acid, produces a white precipitate, which gently fulmiaatesvrhen dry. t. Ammoniated nitrate of qnicksilver, INQUESTS IN MIDDLESEX. with arsenic, produces a bright-yellow preSUDI)EB DEATH FROM CEREBRAL DISEASE. cipitate. 5. t’iromate of potash, with arsenic, proPost-.llorteni Examination of Susan Dunha, duces a green. spinster, of36, Brewer-street, Somer’s Co. The stomach, &c., with the contents, Totca, aged 37 years.
SHE had been in the enjoyment of very good health, and had worked for Mr. llailen, of Holborn-hill,during 17 years, in the straiv bonnet business. She arose in the morning of April 7th, as usual, with the exception of having a slight headach, and immediately after taking breakfast wns attacked with violent vomiting which continued for half an hour, when she fell down, and died sud-
2.
were
again infused
alkali, for
in
a
solution of
vegetable
hours ; after which a solution of sulphate of copper was added, which, if arsenic bad been present, would imrneditwo
have been converted into a beautiful green. 7. Some-bird seed was steeped in a very strong solution and given to a linnet. S. A portion of the strong solution was likewise given to a white mouse, without denlv. producing the slightest deleterious effects on On examination, April 11th, 1839, the life. T. W. DAVIES, Surgeon, &c. body appeared plump and xvell-fortied ; a bruise at the internal angle of the right eye 5, Ossulston street, Somers Town. and mouth, which, judging from its appearance, must have been caused in the act of POST-MORTEM EXAMINATION OF A BODY FOUND
falling or after death. On separating the scalp, it was discovered to be exceedingly vascular, and on removing the upper portion of the cranium a large quantity, amounting to four or five ounces, of bloody serum escaped. The dura mater adhered very firmly to the bone; and its vessels, as well as those of the pia mater, were gorged with blood to a very unusual extent, but principally on the right side. On different points the pia mater and arachnoid were very opaque and much thickened ; the cerebrum itself was a good deal injected, but otherwise healthy ; the cerebellum and the medulla oblongata were also perfectly healthy. The lungs themselves seemed very healthy, but on the left side they were firmly and universally adherent to the ribs and pericardium ; this adhesion was evideotty of ancient date. The heart was flaccid, fat, and empty, but its valves and internal struc-
ately
IN THE NEW RIVER.
By
ROBERT HUNTER
The
SEMt’LE, Esq., Surgeon,
Islington. body of the
woman
named
Ann
inquest sat at the Pied liull, Islington, April 22nd, 1839, was examined aniltomically ou the 20th by my father and my myself. The external appearance of the body is not descnbed, as it must Foster,
upon which
un
be well known to the coroner and the jury. There was no appearance of emaciation, but a considerable quantity of fat, of about three-quarters of an inch in thickness, was found beneath the integuments ; the areola around the nipple was not characteristic of pregnancy. Head.—The jugular veins were not turgid, and when an inci-ion was made only a very small quantity of fluid blood issued from the wound ; no blood was observed between the scalp and the skull, nor between the ture were perfect. latter and the dura mater; but there were The stomach and bowels presented no strong adhesions between the dura mater aassual appearances; the amalt iatestines aad skull, imtaediately belew the croim of
dependent upon ulcerative mischief in the appendix vermiformis coeci, or upon an
’
were exposed to view, must be, to a certain extent, doubtful ; but notwithstanding this, it appeared to him (Mr. Bryant) that there were certain indicatinns which might be WESTMINSTER MEDICAL SOCIETY. usefully borne in mind. When we reviewed the various causes of obstruction in the Saturday, April 27th, 1839. intestinal in reference to the
canal,
natu-
practi-
of relieving them, we were Dr. CHOWNE, President. rally directed and called upon to examine, POISONING FROM GIN.— DEATH AFTER 67 with due consideration, every variety of HOURS. obstruction with which we had become acquainted, and to distinguish, as far as it Dr. CHOWNE related the following case. was possible, those which it was most pro. On March the 11th, 1839, a lad, between bable our art might have the power to rec- seven and eight years of age, got up before tify. There was, perhaps, but little doubt any others uf the family, and went down that in those distressing cases uf disorganis- stairs into the room where the family ed bowel, constituting stricture high up in usually lived. lu rather less than half an the canal, extensive adhesions, producing hour he returned up stairs, and said to his obstruction, or disease of the appendix sister, a girt of ahout twelve years of age, from the irritation of a mechanical "that he fclt funny, and thought he was we had not much to hope for. Was it drunk." The sister having occasion to go out body, s", however, in the case of invagination of for something, it wss arranged that the lad the intestine, in mesenteric or mesocolic should let her in on her return. She was hernia, or in cases analogous to the one he not absent more than five minutes. Her had just rotated?Was it not in our power knock at the door was not answered, and to discriminate to a certain extent, to form a she knocked a second time ; this circumtolerably clear diagnosis as to the character stance brought the father down stairs, and aud seat of the obstruction; and, if so, should he found the lad Iving on the floor Quite we not be justified, under circumstances of insensible, with his nose bleeding; he was such utter hopelessness, in attempting relief ly ing in such a position as to leave no doubt even by the bold step of opening the abdo- that he had fallen from a chair, near a cupinitial cavity t board, in which there was a two-quart 8tollO In the case which he had related the bottle containing gin. The chair was not symptoms clearly indicated the presence ofin its usual place, neither did it stand where obstruction ; and the situation of the pain,, the father found it when the sister went the immediate vomiting after taking food,out. The father considers that the whole and the absence of abdominal tension, in- time from the lad’s first coming down stairs duced him to conclude that the obstruction,, to his finding him on the floor, did not from whatever r cause it arose, existed in the exceed half an hour. The lad when found upper part of the canal. The state of partsi WM quite insensible. He very soon was
cability
232
sick, and threw
some fluid off the stomach, from the cataplasms; the leech-bites had which, the father says, smelled of moderately. The general appearance The state he was in was considered to be was the same. The breathing was still produced by the spirit, to which he had stertorous, with the addition of mucous helped himself. As it was supposed that rale in the thorax. The irides still contime would carry off its effects, be was tracted, the eyes showing no signs of sensimerely put to bed, and kept warm. He bility. The limbs motionless and powercontinued, however, to get worse, and about It-ss; the skin prone to be cold; nothing one o’clock (five hours after the spirit was elicited signs of consciousness; pulse as a medical man was sent for. At before, 144, but rather improved in strength ; taken), this time, according to the father’s state- the countenance still free from anxiety and ment, the tongue appeared to swell, the uneasiness.-Continue the mixture; keep child groaned, and appeared dreadfully the body and extremities warm; keep up the oppressed. The quantity of gin that he had irritation of the scalp; the position to be taken was computed at half a pint. By the kept up. desire of the medical man an emetic was March 18, 12½, P.M. 282 hours after given, and the boy was put into a warm taking the spirit. The general appearance bath, but neither produced any visible had improved; the eyes were cccasionally effect. At about three o’clock (seven hour,. opened ; the pupils, however, were still after the spirit was taken) he was conveyed contracted, and there was no expression in of any consciousness, or of their to the Charing-cross Hospital, where he the became Dr. Chowne’s patient, and was seen being directed to any object ; the face and by him about fifteen minutes after his general surface were still pale, and prone arrival. In the interval warm water had to be cold ; the expression of the face been passed into the stomach, and with- still peculiarly placid ; the face, though pale, drawn, by means of the stomach-pump, not livid ; the stertor of breathing diminishThe fluid had not the odour of gin, or of anythe mucous rale was increased, and thinpeculiarneither was there the odour of had become very audible over the whole gin in the breath. The lad was perfectly chest; the limbs still relaxed; the pulse insensible and motionless ; the limbs were small and treatment, with relaxed and powerless ; the face pale ; the light nourishment and coffee. 102, P.M., general surface pallid, and below the ordi- 38½hours after taking spirit. The eyes The pulse was very opened still better; the pupils were less nary temperature. small, feeble, and quick, 144 in a minute ; contracted; the irides more mobile; there the pupils were contracted. On the ap- was a look almost of consciousness; the proach of a candle, after covering the eyes face and general appearance as before ; the with the hand, it was doubtful whether stertor less, the breathing apparently free; there was a slight further contraction. The the mucous rate undiminished; the pulse exclusion of light by the hand did not pro- 144, rather firmer. duce dilatation. The breathing was rather 19, 12 P.M., 522hours. The general slow, it was difficult, and decidedly ster- appearance, at first sight, much improved. torous; there was involuntary urging of the The eyes opened quite well ; the lad looked stomach, by which a small quantity of fluid about him, as if with intelligence, and and saliva drained from the mouth ; this though he did not answer when shokeu to, had no peculiar odour. The bowels had lie did not appear unable to speak. The not acted, and it was not ascertained that coma appeared to have subsided in a very any urine had passed. The general appear- marked degree; the stertor almost ;,onf-; ance of the patient conveyed the idea that the lungs appeared more loaded,the mucous he was sinking rapidly, except that the râle loud and general ; the breathing rather countenance was peculiarly placid, and free shorter; the cheeks rather flushed; the from the expression visible in the features skin generally had become hot and rather of a person in articulo mortis. The face dry ; the pulse from 160 to 180, distinct. furmed a striking contrast with the general He continued his medicine, and occasionally symptoms. Three leeches were applied to took some tea and arrow-root, but he was each temple ; a purgative dose of calomel, still in the same motionless and powerless and a cathartic enema, were ordered, with state, showing no sign of volition. The an application of liquor ammonia: to the contrast was very striking between the scalp (the hair having been first removed), seeming intelligence of his look and the a blister behind each ear, and mustard cata- inactive state of his will, for he did not even plasms to the feet. He had also a mixture make an effort; yet he looked as if he could of ammonia and camphor, and he was placed have done so without difficulty. Water and with his head and thorax raised on pillows. faeces had passed involuntarily. 51½ hours. At eleven o’clock at night (fifteen hours Nearly the same as at last visit. The cereafter the spirit was taken), the bowels had bral symptoms appeared diminished, the been opened, water had passed ; both with- pulmonary ones increased. The lips had out consciousness. The scalp was red and become slightly livid, the respiration la-
gin.
bled
eyes
ed, but
rapid.—Continue
slightly vesicated; the feet were also red, boured, the
mucous
r4le
more
intense. It
233
could be heard withopt the stethoscope or containing a small quantity of dark coagu. blood, and a small qnantity of lymph placing the ear in contact with the chest. To have a blister between the shoulders; lated into a jelly-like mass. Theperirubefacients on the anterior part of the healthy, containing about a drachm of fluid. Nothing observable in the abdothorax. 20. 67j hours. He died. Through the minalcaritv. The stomach was emptv; ils entire period there was neither delirium, outer surface rather paler than usual ; no injection of the conjunctiva, convulsion or remarkable vascularity of any part. The
coagulated cardium
inner surface was uniformly of a pale bue, and free from patches or discolourations, Examination about 12 hours after death. with the exception of a portion about the The scalp was free from any appearance size of the palm of a child’s hand, near the of injury. The surface of the body per- cardiac orifice; this exhibited an arrangefectly natural, and without discolouration. ment of very small vessels visible under, There was no fracture or appearance of and in the mucous coat; they had an arbo. injury anywhere. On removing the scalp rescent form, aud were florid. This might there was not any unusual redness dis- have arisen either during digestion or from covered on its inner surface, nor was there the irritation of abstinence ; there were no any on the pericranium. The dura mater other morbid appearances to be noted. appeared rather more te86e than usual ; the There appeared, however, to be a tendency arteries more visible ; the blood within to dryness in all the surfaces ; those of the rather more fluid; in other respects it was brain, the lungs, the heart, and the intesnatural. On separating the dura mater tines, appeared, almost immediately on from the aracbnoid there was no morbid exposure to the air, to become so dry that adhesion, no escape of fluid. The tuaica they might be touched without communiarachnoidea auneared to be more than com- catinc the least moisture to the Sneer. Dr. Chowne considered that there were a monly vascular, but there was no coagulable lymph or other product of inflammation; few points in this case deserving of notice. there were very slight pearly appearances, It appeared, for example, that after the hoy but not sufficient to indicate that inflamma- was left alone by his sister, lie was well tion had taken place. The veina of enough to remove a chair from one part of membrane were distended with dark blood ; the room to another, and to get upon it; those corresponding with the that before her return he was prostrate and regions especially. The veins on the an- comatose, and that the whole time did not terior part of the membrane were full, as exceed five minutes; this, therefore, formed well as those of the other parts, proving it an instance of the suddenness with which not to be the effect of gravitation after coma might come on. According to most death. On removing the brain a small authors who had written on this subject, a quantity of serum, tinged with blood, was contracted pupil is a favourable circun.found in the fossæ of the base of the cra- stance; in this case the pupils were connium ; the quantity did not exceed three tracted at first, and afterw ards came into a drachms. The under surface of the brain still more favourable state, for the irides natural. Nothing unusual in the medullar) conveyed the stimulus of light quite natu. substance. The right lateral ventricle con- rally. The passing off of coma is generally tdined the usual quantity of fluid. The a very favourable indication, but in this vessels were. honevcr. rather fuller : the case, although terininating fatally, the coma blood within them rather more fluid ; the was almost, if not entirely, removed. The plexus choruides more than cummonly full peculiar placidity of the countenance was of blood; nosuliicieot sign of inflammation. not generally remarked by authors ; in this The left lateral ventricle corresponded with case, however, it was very striking throughthe right. Other parts uf the brain healhy.r out. The ordinarv duration. in fatal caseli. No odour of gin in any part. No effusion was twelve to eighteen hours ; in this it or signs of disease in the cavity of the extended hours. We found that in rax. The lungs, at the part first presented the absence accidentalcauses, as exto view, appeared natural; the posterior,’ posure to cold, falling with the face in mire and under parts were dark and congested,or in water, tight dress, especially about probably from congestion which commenced the neck, and others of a simitar kind, from prior to death, and increased after, froa which the patient could Lot extricate himgravitation. The parenchyma was normal. setf, the usual mode of death was either by The trachea and bronchial tubM were full the coma becoming deeper and deeper, or of froth;, turbid fluid, reseiubling watery by the rupture of u blood-vessel producing mucus, with a very small admixture of Hpoplexy. In this inslince the terminatiun muco-purulent fluid. The lining membrane was not by either of these : tLe cerebral of the air-passages appeared to be natural; symptoms disappeared to an extent which there was, however, a slight blush at thegave a reasonable hope that the termination would have been favourable; and in this upper part of the trachea, bot too slight warrant any inferemo. The heart particular the case bore some resemblance
tendency thereto,
no
peevishness,
or even
anxiety of countenance.
,
the
temporal
tho-
to 67of
‘
to
healthy,
234
quote4i by Christison, in which a abscesses were small, took place contempodied after apparent convalescence. raneously with abscesses in other parts of The Society adjourned until the third the body, and the eyes recovered unimpaired. Saturday in October next. I may as well allude here to a deep-seated now and then occurring, of inflammation, INJURY TO THE EYE FROM SMALL. SMALL. POX. pox. whichI have seen three or four examples; Mr. MARSON read the following paper on it appears to destroy sight very speedily this subject :without producing ulceration of the cornea, There is a popular belief that the eye is and is met with in persons who have smallinjured, or lost, in small-pox, from one or pox in a very severe form, and die on the more of the pustules of this disease forming seventh or eighth day. On looking care. on the cornea. The same opinion is gene- fully into the eyes of these patients the rally entertained, too, by members of the colour appears altered ; there is a general
to
one
man
_____
and by cloudiness and vacant expression, and sight the best writers ; but so far as I have been seems to be wholly gone in a very short able to observe, the opiuion is not well time; the iris, retina, and all the interior founded. My position as surgeon of the and deep-seated parts of the eye, I have no Small-pox Hospital, affords me an opportu- doubt, are involved in this inflammation. nity of seeing this injury frequently, and I Whether or not sight would be regained in have noticed it with attention for the last case the body were restored to health, it is three years, but in no one instance of those impossible to say, as I have never yet seen under my care has it arisen from the cause an instance of recovery. But it is to the to which it is usually ascribed, nor have I destructive ulceration of the cornea, to that ever seen a small-pox pustule formed on the form of the disease which most frequently eye. The eye itself appears to me to possess destroys the eye in small-pox, that I wish complete immunity from the eruption of more particularly to request your attention. small-pox ; it remains uninjured all through It is singular that our writers on ophthalmic the eruptive stage of this disease, although surgery, men of great ability, experience, the pustules are invariably more numerous aud observation, should have followed so on the face than on any other part of the exactly in the steps of each other, in giving body, and extend to the inner margins of the what I consider an entirely wrong descripeyelids ; they never form on the conjuncti- tion of this affection. This error must be val membrane, so far as I have seen, either ascribed to the comparatively limited opporwhere it covers the globe of the eye or lines tunities afforded to them of seeing the disthe palpebræ. Common inflammation, in a ease in its early stage. But I am surprised few instances, attacks the conjunctiva dur- that these writers have not taken the hint ing the first five or six days ; this I do not of its probable nature, from knowing that deny, but then it must be in a great measure the eye is lost precisely in the same way, independent of the eruption, as it occurs but and under similar circumstances, from other very seldom, and is not the inflammation that exanthematous diseases, viz., measles and leads ultimately to the destruction of the scarlatina, and in rare instances, also, from organ. Inflammation has been supposed by erysipelas and typhus. They would not, I some to be caused by the diseased secretion suppose, contend that the papulae of measles of the Meibomian glands being confined destroy the eye, and yet in small-pox they within the closed eyelids, which is further attribute its loss entirely to the eruption. stated by them to cause ulceration. They state that the conjunctival membrane This vitiated secretion might perhaps is continuous with the skin, and separates give rise to slight inflammation, but it does under similar circumstances, and hence apnot produce destructive ulceration; that pro- pear to conclude, and I confess with great cess is the effect of the state of body conse- apparent reason, that it must also be subject quent on a severe attack of small-pox, fol- to the eruption of small-pox ; physiologilowed by violent secondary fever. The two cally they may be correct, so far as regards conditions are quite distinct. There will the skin, but it is mere theory so far as it be in the inflammation arising in the early relates to small-pox. Thereis another strong stage of the disease great redness, with what argument against the ulcer in the eye being is called chemosis, continuing for a few caused by one of the pustules of small-pox. days, but it subsides without future mis- On all other parts of the body they are bechief to the part affected. The common ginning to subside before the eye is attackabscess of small-pox, familiar to all prac- ed. It has been supposed that as the cornea tical men, forms on the eye between the is so-.dense and unyielding, a longer time conjunctival membrane and sclerotic coat, would be required to mature the pustule. and also between the layers of the cornea, of The supposition is not good, for this reason: BB hich I may have seen five or six cases in the great regularity observed in the appearthe treatment of fifteen hundred ; but this ance and disappearance of the spots on could not be well mistaken for one of the other parts of the body, beginning first in characteristic pustules of the disease. These the face, and following in succession on the
profession, otherwise well-informed,
235
extremities, would hardly be departed from the margin of the cornea; this eontinaes to in the eye; if a longer period were really spread with more or less rapidly, according required for their production in this part, it to the degree of secondary fever present;; wonld still be doubtless a determinate one, in the more violent cases, an ulcer being and bear relation as to time in different formed on each side of the cornea at the patients; whereas the ulcer on the eye has same time, showing the disease to be adits commencement at all times, from the tOth saucing with great severity, and prtsenting to the 25th, or 30th day succeeding the day a tolerably certain indication that the eye of eruption. The most confluent cases of will be entirety lost. The ulceration passes small-pox are daily seen where the eruption through the different layers of the cornea is abundantly scattered over the face, with- until the aqueous humour escapea, extendout any affection of the eyes at all ; the ing itself, too, laterally ; and if the part of proportion of those suffering from variolous the cornea destroyed be large the ins will ophtbatmia not being more than one in protrude through the opening. In the worst thirty-nine. This I know from having ex- cases there is usually hypopium, and hen amined the register at the Small-pox Hos- the matter is discharged the cr) stalline tens pital, which is kept with great care, and in and vitreous humour escape ; or the humours which everything of importance regarding may escape from deep and extensive aluugheach patient is always noted, Wbeu I wish ing, in the first instance, without the forlllato arrive at something like a fact on any tion of ttiatter, this being succeeded. of point, I take a thousand successive cases; 1 course, by the total ar-nibilation of the form have done so in this instance, counting those of the eye,as well as the sight. In some inwho died as well as those who recovered, stances the ulceration proceeds very raand find that twenty-six have suffered from pidly ;I have more than once seen the variolous opbthahnia, which is one in thirty- entire cornea swept away within forty-eight nine, and of these eleven had lost an eye, hours from the apparent commencement of - -about one in 100 = precisely one and a the inflammation ; and, what is singular, now and then the mischief goea on without tenth. Thus, then, I think, that we may fairly the least pain to the patient, or his being
conclude, if the conjunctiva were actually aware that anything is amiss with his eye. subject to the eruption of small-pox as wcll An example lately occurred, showing the as the skin, it woulrl hardly escape mischief strong disposition for thr ulcerative process so often ; at the same time it should be to attack the margin of the cornea; it ex-
clearly understood
that this destructive tended all round this anterior part of the ulceration of the cornea is essentially allied eye, to some depth, loosening three or four to the inflammation of the skin, produced by layers of the cornea almust in an entire state, the exanthemata. The injury take* place as they may be separated from the dead e)o when the system has been much reduced by by maceration. This destructive ulceration, or sloughing, inflammatory disease of the surface, and when fever still continues. The body may or whatever term may be given to it with be quite as much debilitated by other dis- most propriety, never takes place iu a severe eases, also inflammatory, without the eye degree but when there is a high stite of suffering. It is met with after small-pox, secondary fever present. That is a point measles, scarlatina, erysipelas, and typhus ; which should particularly be remarked ; the the latter, although not usually accompanied experienced practitioner in the treatment of byeruption, has been associated with a good small-pox will always know beforehaud deal of petechiæ during the last two years, when it is likely to occur. There will be a showing the skin to be implicated in the hot and dry state of skin, rapid pulse, thirst, derangement ; and the liability of the cellu- loaded tongue, these havint;been precedwd lar membrane to slough after typhus, is well by a very confluent state of the disease; and known. then it is that some fearful consequences I have never yet seen any part of the may be apprehended, such as the loss of un conjunctiva sloulth but that covering the eye, formation of large abscesses, and cornea ; hence I suppose the seat of injury sloughing of the cellular mcmbraoe, extendto be in the latter, or more frequently, per- ing often over the greater portion of a limb ; haps, especially in mild cases, in the cellu- or, may be, formation or deposit of matter in lar membrane between it and the coujunc- one side of the chest. Some of these serious tiva. The particular local affection that results may be expected when the secondary causes the destruction of the organ of vision fever runs high, experience alone directing in variola begins generally on the 11th or the practised eye to an early knowledge of 12th day, or later, from the first appearance the probable termination. of the eruption, and when the pustules on The close resemblance between sloughing every other part of the body are subsiding. of the eye and sloughing of the cellular It comes on after the secondary fever has membrane in other situations, and its occurcommenced, with redness and slight pain in ring also about the same time. lead me to the part affected, and very soon an ulcer is suppose that it is easentially of the same formed, having ita seat almost invariably atMttofe ; and whoewef has Ud much expert.
36 in the treatment of small-pox, and will Like all other diseases this has various this subject attentive consideration, grades. Patients are usually much reduced will, I think, come to the same conclusion. at the time the ulceration first makes its The cornea is composed of five or six appearance, and all active treatment would layers, which, as they are separable but not be out of the question. But now and then loose, must be allowed to havesome con- the diseaseis seen in a stout, full habit, necting medium ; and it is reasonable to sup- with strong pulse, from whom it is desirable blood generally. This should be pose that this may bear resemblance to the to cellular membrane elsewhere, and hence be done with great care, as few are able to subject to like attacks. It would be diffi- bear it. In others, if the eruption have subsided cult, perhaps, to demonstrate this resemblance further than by analogy. Other soft so that the temple can be pretty well cleared, parts, complete in themselves, but in close bloodmay be taken by cupping. This mode abstracting blood will be found more continuity, have a connecting substance, which we call cellular membrane. This eligible, in most instances, than general substance, whatever it is, between the layers bleeding; or blood may be taken beneficially of the cornea, performs the same office. by leeches. After the fomentation, cold or The beautiful structure of the eye would tepid decoction of poppy should be applied require it to be considerably modified, but to the eye, or a lotion of water with a small still not altogether different, inasmuch as quantity of spirit. I rather prefer simple the object is the same, and Nature being water. Careful sponging of the eye two or simple in her arrangements would vary it, three times aday with warm water, or warlll we may presume, as little as possible. It milk and water, should always be eujoined. may be asked, why does the eye suffer more A purge, given every second day, of calomel frequently in small-pox, from sloughing, and rhubarb, if required, and saline medithan any of the other soft parts ? My an- cine, with antimony, and milk diet. These swer would be, that I doubt whether it means are to be regulated according to cirdoes. I have stated that only one person in cumstances. Cases may be selected in a hundred, in the aggregate, is aftlicted with which it is advisable to touch the ulcerated the loss of an eye from small-pox; and if spot with lunar caustic scraped to a point, note were taken of the sloughing of the cel- as this appears, sometimes, to arrest the lular membrane in other parts, it would he progress of the ulceration. I should rarely, found to take place quite as often, if not however, depend upon this alone; it forms oftener, in any individual part as in the eye. only one of several means worthy of conWhy one part should be fixed on in one per- sideration. Two or three applications of son, and another in another, we are quite at leeches will often be found necessary, or a loss to explain ; but of this I am sure, that cupping, followed on a subsequent day by during the last three years there is not any leeches, regulated in number and repetition one external part of the body that I have not by the violence of the inflammation, and again and again seen the seat of sloughing strength of the patient. When the ulceration is accompanied with great debility, of the cellular membrane. The importance of the eye, and the dis- with but little remaining febrile excitement, figurement occasioned by its loss, mightlead depletion must not be thought of in any The patient should then be well us to believe, perhaps, without careful in- form. quiry, that it formed more frequently than uuurished; perhaps wine may be necessary ; any other part the seat of this injury. The our attention being mainly directed to the scalp, palpebra, about the beard in men, preservation of life on any terms. I disapprove, in most instances, of the neck, elbow, and dorsum of the foot, I feel quite certain, are much oftener assailed than use of mercury, given so as to alfect the the eye, by inflammation and sloughing, mouth ; it only increases the ulcerative We also see in all those situations just process. But we see, sometimes, the inenumerated, as well as in the eye, inflam- nammation get into a chronic state, aud the mation of a less degree of severity, which ulcer remain stationary, in which mercury subsides without being followed by ulcera- may be used with much benefit. The intion and sloughing of the skin and cellular nammation disappears under its use, as if membrane ; still further illustrating the by magic, and returns if the remedy be suddenly discontinued. I would have it given, similarity of the two. in bringing the subject before ’ however, in repeated doses, with great cirMy the Society has been to explain the cumspeciion, as it is calculated to do harm of the injury sustained by the eye m variola, wheu misapplied. Blisters to the temples more thau to oll’er any remarks on its treat- should he tried, as they are often servicement : it may, however, be considered that able. The prolapsed iris may render it that ought not to pass by altogether unno- desirable, in the chronic state, to resort to ticed. Although it is to be lamented that the application of belladonna to the brov% in the severe forms of attack our elforts to or the edges of the ulcer in the cornea may save the eye will be of no avail, there are require to be touched with the nitrate of
ence
give
take
of
object
still others in which
pathology
we can
be of great
use.
silver. It is almost impossible, in
a
paper
237 of this sort, to allude te all the means of relief that may be necessary to suit each individual case, but I have mentioned those most likely to be advantageous; and, finally, I have pleasure in stating, as the result of my experience, that although the appearance of the eye may be very unfavourable in cases where the inflammation and ulceration have been severe, but not so violent as to cause the discharge of the humours, in a few months after the patient has otherwise recovered his health, very great reparation usually takes place also in the eye; the leucomatous state will, in a great measnre, disappear; and unless the ulcer have been deep and exactly in the line of vision, very useful sight may be regained.
Yery full. The liver, spleen, and pancreas, were all very bealthy, the gall-bladder being empty; the pelvic viscera, also, were perfectly healthy. On the stomach and bowels ’being opened, there were no appearances of erosion or inflammation of the mucous membrane, but they contained a consi. derable quantity of semi-liquid matter. The stomach, duodenum, and jejunum, were boiled, with their contents, in distilled water, and filtered, and the following tests were tried, but without effect:1. Chloride of lime. If oxalic acid had been present, it would have produced a were
white
precipitate. Sulphate of copper, with oxalic acid, produces a whitish-green precipitate. 3. Nitrate of quicksilver, with oxalic acid, produces a white precipitate, which gently fulmiaatesvrhen dry. t. Ammoniated nitrate of qnicksilver, INQUESTS IN MIDDLESEX. with arsenic, produces a bright-yellow preSUDI)EB DEATH FROM CEREBRAL DISEASE. cipitate. 5. t’iromate of potash, with arsenic, proPost-.llorteni Examination of Susan Dunha, duces a green. spinster, of36, Brewer-street, Somer’s Co. The stomach, &c., with the contents, Totca, aged 37 years.
SHE had been in the enjoyment of very good health, and had worked for Mr. llailen, of Holborn-hill,during 17 years, in the straiv bonnet business. She arose in the morning of April 7th, as usual, with the exception of having a slight headach, and immediately after taking breakfast wns attacked with violent vomiting which continued for half an hour, when she fell down, and died sud-
2.
were
again infused
alkali, for
in
a
solution of
vegetable
hours ; after which a solution of sulphate of copper was added, which, if arsenic bad been present, would imrneditwo
have been converted into a beautiful green. 7. Some-bird seed was steeped in a very strong solution and given to a linnet. S. A portion of the strong solution was likewise given to a white mouse, without denlv. producing the slightest deleterious effects on On examination, April 11th, 1839, the life. T. W. DAVIES, Surgeon, &c. body appeared plump and xvell-fortied ; a bruise at the internal angle of the right eye 5, Ossulston street, Somers Town. and mouth, which, judging from its appearance, must have been caused in the act of POST-MORTEM EXAMINATION OF A BODY FOUND
falling or after death. On separating the scalp, it was discovered to be exceedingly vascular, and on removing the upper portion of the cranium a large quantity, amounting to four or five ounces, of bloody serum escaped. The dura mater adhered very firmly to the bone; and its vessels, as well as those of the pia mater, were gorged with blood to a very unusual extent, but principally on the right side. On different points the pia mater and arachnoid were very opaque and much thickened ; the cerebrum itself was a good deal injected, but otherwise healthy ; the cerebellum and the medulla oblongata were also perfectly healthy. The lungs themselves seemed very healthy, but on the left side they were firmly and universally adherent to the ribs and pericardium ; this adhesion was evideotty of ancient date. The heart was flaccid, fat, and empty, but its valves and internal struc-
ately
IN THE NEW RIVER.
By
ROBERT HUNTER
The
SEMt’LE, Esq., Surgeon,
Islington. body of the
woman
named
Ann
inquest sat at the Pied liull, Islington, April 22nd, 1839, was examined aniltomically ou the 20th by my father and my myself. The external appearance of the body is not descnbed, as it must Foster,
upon which
un
be well known to the coroner and the jury. There was no appearance of emaciation, but a considerable quantity of fat, of about three-quarters of an inch in thickness, was found beneath the integuments ; the areola around the nipple was not characteristic of pregnancy. Head.—The jugular veins were not turgid, and when an inci-ion was made only a very small quantity of fluid blood issued from the wound ; no blood was observed between the scalp and the skull, nor between the ture were perfect. latter and the dura mater; but there were The stomach and bowels presented no strong adhesions between the dura mater aassual appearances; the amalt iatestines aad skull, imtaediately belew the croim of