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is deprived of his moral liberty, is deprived, by Eighth, 4 P.M., died; one hundred and the uncontrollable influence, of all control over seventy-seven hours from the time she was his will. The intellect may condemn an act found in the yard. which the will is powerless to restrain.
The right side was paralyzed; the face and [Continued in September number ]
tongue were drawn to the left. Although there was complete muscular relaxation, feeble move
ments could be excited during the first and secCONGESTION OF THE BRAIN. ond days. Free perspiration and a free action
of the kidneys were present. Urine passed inBY J. S. BEAMENSDERFER, M.D.
voluntarily in large quantities. Both pupils HE following case is reported to show the
were minutely contracted, and her eyes were length of time life may be preserved in deeply injected. Severe conjunctivitis develan unconscious state, with neither food nor oped on the third day. An autopsy was asked drink:
for, but refused. Mrs. F., aged 70 years, was found in the PENN, PA. yard attached to her house in a prostrate and semi-comatose state, at seven o'clock on Tues
HOSPITAL REPORTS. day morning, April 14, 1885. She was aroused with difficulty, and when spoken to answered
CHARING CROSS HOSPITAL. incoherently, saying that she became dizzy and fell, Assistance was obtained, and she was UNDER MR. J. ASTLEY BLOXAM, F.R.C.S. taken to the house, and, finally, to bed. She Displacement of the Tibia on Right Side, rapidly became more and more comatose, and Outwards and Backwards, as Result of Dislater in the day, when I was called in, she was ease.—Margaret C—, age 16, was admitted on fully unconscious. I tried to get her to swal. January 24th with the following history: Nine low but without avail, even when water was
years ago she fell down stairs, but did not dropped on the back of the tongue, she made call attention to it, and it was only when her no effort to swallow. She vomited frequently leg began to swell that her mother noticed it. during the first day and night. Pulse was Six months later, the leg continuing bad, she round and full, but very feeble and slow the was taken to Kings College Hospital, where first day, and gradually increased in frequency she remained under treatment two months ; and decreased in volume until the sixth and when she left the hospital her leg was straight seventh days, when it became very small and but she was unable to walk without crutches. feeble, so much so that it could scarcely be She gradually, however, recovered strength in felt at all.
the limb to some extent, but in trying to disRespiration was labored and but slightly pense with the crutches the right leg became stertorous and exaggerated. Mouth wide open bent, and this increased as time went on, but and nostrils dilated. Temperature elevated she had no further advice. Patient was born and varied, being higher in the right axilla at and brought up in London, and says she has first, and finally lower, as can be seen in the always had sufficient food and clothing. Her following table, which I deem very interesting brothers and sisters are healthy. She has not as showing the changes of temperature that yet menstruated. On taking measurements, took place in regard to both axilla :
the distance from the head of the fibula to the
external malleolus, on the right side was twelve TEMPERATURE.
and a half inches, and on the left sixteen inches.
From the internal malleolus to the tip of the 9 A.M.
big toe, right side seven inches, left side seven 98.8
and three-quarters inches, while from the anterior superior spine of ilium to sole of foot,
right side thirty-three and a half inches, left 5th.
side thirty-seven inches. The right leg was of 5th.
less size generally. The patella is fixed on the 6th.
right side, and the tibia is displaced outwards 7th.
and backwards, and the inner hamstrings are 38
HOUR. 6 P.M.
ist. 2d. 2d. 3d. 3d. 4th. 4th.
90 22 100
Patient can flex her leg to a little Previously.-Edward S-, aged 34, laborer, beyond a right angle, and can extend it to an was admitted on November 7th. He had angle of ninety degrees. There is no fluctua- gonorrhoea when sixteen years of age, which tion, and very little pain. Temperature nor- was cured, and on one occasion a stoppage of inal. On February 7th, patient being under the water was relieved by the passage of a the influence of ether, Mr. Bloxam made small stone. Three years later he contracted a small incision just along the external border a second attack of gonorrhoea in China. Eighof the patella, when he found it was firmly ad- teen months afterwards he was in the hospital herent to the external condyle of the femur, for three months with pain in the region of kidbut after a little trouble it was shifted, and an neys, relieved when vomiting was induced. attempt was made to straighten the leg, but In 1877 he went into the hospital at Montreal, this did not succeed, owing, it was thought, to on account of a difficulty in passing water, the contraction of the hamstring tendons, so when, on examination, a stone was detected in tenotomy was performed, and another attempt his bladder. He was operated on, and a stone made to put the leg straight, but again did not about the size of a walnut removed. He resucceed. Mr. Bloxam then continued his ex- turned home in December of that year and then ternal incision, converting it into a semilunar drank freely. He noticed that he was unable incision and excised the knee-joint, afterwards to hold his water more than a short time, and wiring the tibia and femur together with metal on passing it, felt a pain in the urethra and at sutures. The wound was then sewn up with end of penis. He has a penile fistula, which horsehair and drainage-tubes put in, the whole was left after the operation, and water often operation being performed under strictly antiescapes by that aperture, preceded by a yelseptic precautions, and an antiseptic dressing low discharge. gih–Examined under ether, applied. In the evening recurrent hemorrhage a stone was discovered impacted in the urethra, set in, and Mr. Bloxam had to be sent for, a which on removal was seen to be about the size of tourniquet was placed on the common femoral a small bean. A stricture which was situated artery, and ice-bags applied to the knee. Some behind the stone was divided and a No. 9 silver six ounces of blood escaped. The dressings catheter left in. Evening temperature 101.4° were then reapplied, and an ordinary T-shaped Fahr. Ith-Carbolic acid dressing was apsplint. Temperature next morning 101° Fahr. plied this morning. The silver catheter came Pulse 120. 9th.—The dressings were removed out in the evening, and was replaced by a No. again to-day, and some blood was still present. 6 gutta percha. There is not much discharge, uth_Temperature this morning 102.6° Fahr.; and the wound appears to be healing rapidly. tepid sponging ordered. Patient complained Temperature 100.8° Fahr. 13th— Patient of a good deal of pain in site of operation. complains of feeling thirsty, but he has slept 12th-Pain is less, and the temperature is now well. His urine contains a small quantity of 99° Fahr. Patient looks brighter. 15th- albumen. Temperature 102.4° Fahr. The Temperature 100.2°; the wound was redressed abscess increased rapidly in size since yesterday, this afternoon and some of the stitches re- and to-day discharged a considerable quantity moved. There is a good deal of discharge of sanious pus. 14th—He complains of great from the wound and some slight pain. Tongue pain in the hypogastric lumbar regions, and ocis furred with red papillæ. 19th-To-day casionally in the back. The abscess is still disMr. Bloxam fixed the leg in position by means charging freely, and there is some scalding on of bags of plaster of Paris. The drainage-tubes micturition since the catheter was removed. were discontinued. The leg feels more com- His urine has specific gravity 1010, alkaline, fortable. 25th—The wound was redressed and contains mucus and pus. 15th— The payesterday afternoon, and a pad of lint was tient was anæsthetized this morning, and a silver, placed under the heel. The wound looked No. 9, catheter introduced. He felt much quite healthy and sweet. Temperature 100° better after this was done, the pain and tenderFahr. ; pulse 116. March 8th_The wound ness being much less. 21st-He has been is now almost completely healed. Patient was much better the last few days, and has no pain discharged on the 15th.
whatever. No urine passes from the wound, Urethral Caiculus; Stricture of the Urethra and the catheter has remained in. 29th—The Posteriorly; Lithotomy Performed Five Years patient complains of pains between the buttocks.
The urine is quite clear and the wound dis- and his hands are tremulous. He was ordered charges a small quantity of healthy pus. m xv of liquor opii sedativus night and morn
The wound ultimately healed up and the pa- ing. 7th—The antiseptic dressing was changed tient was discharged on December 15th. to-day. Several large bullæ had formed over
Sloughing of Dorsum of Foot after Injury. the surface of the leg, which were opened. -Benjamin S—, aged 42, packer, was injured Mr. Bloxam saw the patient in the afternoon, ten days ago by a packing case falling on his and, as the limb was very tense and oedematous, foot. He took no notice of it at the time, but he made six or eight incisions into it. The about a week later he could not get his boot on patient did not seem to notice any pain, and because of the swelling. He applied to his appeared drowsy. Temperature 101.4° Fahr. . club doctor, who at first told him to poultice 8th—A slough formed in the wound, and was it, and subsequently cut into it and evacuated removed, exposing the lower end of the upper a quantity of pus. From this incision the skin fragment. The patient seems a trifle better togradually sloughed away and spread until, at day and answers questions. Temperature present (March 12th), the whole of the outer 102.6°. 9th—The patient is very weak, and side of the left foot is covered with blackish a large triangular slough was formed around sloughs mixed with pus. There is an aperture the original wound, which is dressed with warm in the lower and outer part of the foot filled carbolized gauze every four hours. Temperawith necrosed tissue. The foot was washed ture 101.8° Fahr. ; pulse 138; respiration 40. with warm boracic lotion, and as much as pos- 10th—On removing the slough, the seat of the sible of the sloughs removed. 14th— The sur- fracture became visible. It extended right face from which the skin has sloughed is granu- across at the junction with the lower third, and lating, and the process does not appear to be a large fragment was splinted off the inner side spreading further. The patient looks well and of the upper fragment. The cavity was syringed has a good appetite. 20th—The patient's gen- out with carbolized water and the dressing reeral condition continues good and he sleeps applied. Ith-A large slough is forming on well. The granulation is going on satisfac- the outer side of the ankle; the patient is evitorily. 26th—This morning his temperature dently sinking and is very weak. His breathwent up to 103.5° Fahr., and he looked Aushed. ing is at times quite stertorous. 12thThe He perspired freely, and his urine was scanty slough over the ankle was opened and a large and thick. 28th—The temperature is still amount of discharge set free. A similar slough high, and red lines are visible in the course of is beginning to form on the inner side of the the lymphatics on the outer side of the limb. ankle. The pulse is almost imperceptible. Patient is thirsty, but says he feels well other- 13th—The toes were quite cold this morning wise. April 1st–Patient died to-day from ex- and of a purple color. The leg was removed haustion.
from the splint and wrapped in wadding. The Compound Comminuted Fracture of Lower tongue was covered with a thick brown fur, and Third of Left Tibia and Fibula ; Delirium sordes are forming on lips and teeth. Tremens ; Extensive Sloughing of Wound; tient died at 3 P.M. At the post mortem exDeath.—Henry A—, aged 40, potman, was amination the fibula was found to be fractured admitied on November 4th, having fallen down in two places, above, two inches below the stairs. He was found to have a compound head—comminuted ; and below, about an inch comminuted fracture of the tibia and fibula at above the malleolus, also extensively commitheir junction with the lower third. The upper nuted. The fracture of the tibia has already fragment protruded about an inch and a half been described. There were no signs of pythrough a wound the size of a shilling. The æmia, death being apparently due to exhaustion displacement was remedied, and the limb put from the injury, intensified by the delirium up on a back and side splints, the wound being tremens. dressed antiseptically. 5th-The dressing was Ankylosis of Knee-Joint; Forcible Flexion. changed this morning, his temperature last - Sarah W-, aged 33, married, was admitted evening was 99.4° Fahr.; pulse 132. Patient on the roth of September with the following is very tremulous, excited and nervous. He history: Eight years ago she suffered from inwanders rather in talking, but will answer sen- flammation of the bursa patellæ of both knees, sibly when questioned. His tongue is furred the right knee however recovered. Some time
after she fell down stairs, straining her left some oedema of scalp, and the patient appears knee, which was still imperfectly recovered drowsy. 300h— The swelling is very much from the previous inflammation. The injury less to-day, but patient complains of feeling ill was treated by a doctor at the time, but ever all over. He has some tightness in breathing, since the joint has been growing larger, and is and at times can scarcely speak. Temperature both painful and tender. When she stands 100.6o. Pulse 95; hard and firm. April 8th upon it, it rapidly swells even more than at Patient has now recovered from his attack of present. At first she was able to move her leg erysipelas. A central incisor was removed toeasily, but the power was gradually lost, and day, as it was lying loose in the fracture at the now only very slight movement is possible symphysis, and prevented the fragments uniting. either way, the ordinary position being one of 20th-The swelling at the angle of the jaw has slight flexion.
been increasing in size, and yesterday a large After a day or two of rest in bed the swell- quantity of pus was evacuated. Patient is very ing went down, but the joint is very hot and hoarse to-day, but a slight congestive condition tender. The patient was placed under chloro- of the fauces and palate was all that could be form and the leg forcibly extended. This pro- seen. 27th—Poultices are being applied to the ceeding was followed by a good deal of pain incisions at the angle of the jaw, and there is a and swelling of the joint. 26th—The knee is good deal of discharge. Endeavors have been still swollen and very tender, the slightest move made to secure apposition of the fragments by ment causing considerable pain; the joint was wiring the teeth, but no satisfactory result was therefore wrapped in cotton wool and a plaster- obtained. The gutta percha splint was reapof-Paris bandage applied. 28th—No pain at plied. May 8th—The teeth have been secured present except on being moved; patient is able together by means of a fine cord, and the fragto get up for an hour or two in the afternoon. ments appear inclined to unite. Ioth-He 30th-Passive movement is to be carefully re- was made an outpatient to-day, as matters seem sorted to every day. October 10th—The patient to be going on all right, and there is every hope was discharged with a very fair amount of move of proper union. This patient subsequently ment in the joint, which was free from pain. made a good recovery, with perfect union.
Case of Comminuted Fracture of the Lower Jaw.-John P-, aged 42, cab driver, fell off his cab about five weeks ago, and the wheel
THERAPEUTIC NOTES. passed over the left side of his face, obliquely, fracturing the lower jaw in two or three places. It was set in the accident room, and he attended R. Tinct. capsici
3ij. regularly for some weeks, but, as it did not ap
Giss. appear to be progressing satisfactorily, he was Spts. frumenti
ziv. admitted into the hospital on March 17th.
M. Ft. loti. There is a good deal of swelling on the right side, and beneath the chin fluctuation appeared
Sig.-Rub into the affected area night and
morning. to be perceptible. The patient's breath is very offensive. 215-A small incision under the
Dr. Thomas M. Nolan (Provincial Medical chin, made this morning, allowed a small quan- Journal) recommends tity of pus to come away. 25th— There is some
R. Acidi arseniosi swelling on the right side of the face and neck,
Ferri sulphatis with signs of commencing erysipelas. The Quinia sulphatis patient was therefore put in a special ward.
Ext. nucis vomicæ Temperature 103° Fahr. He has had some
gr. xx. shiverings, not actually amounting to rigors. M. Ft. pilulæ No. xx. hard and firm. 27th-The ery
Sig.-One pill after meals. sipelas has spread all over the face as far back
MENORRHAGIA. as the ears. Patient did not sleep at all last
R. Strychnia sulphatis night, but has no difficulty in swallowing.
fzij. 29th—The face was ordered to be painted with
M. Sig.–Teaspoonful in water four times a tincture of the perchloride of iron. There is day.
gr. ss. gr. xx. gr. xx. gr. v.
In such cases Professor Davis usually diProfessor N. S. Davis recommends
rectsR. Acidi carbolici
R. Phloridzyniæ .
Tinct. opii camphorata .
zss. M. Sig.–Give to children between six and
ziss. eighteen months' old from ten to twenty minims M. Sig.–To children under two years
age after every paroxysm of vomiting, and every give from ten to twenty minims three or four hour or two during the acute serous diarrheal times a day. The phloridzyne is derived from the stage.
bark of the apple-tree root, and is a mild, agreeThe important clinical fact must be remem- able and pleasant tonic, while the camphorated bered, that in all cases of copious intestinal tincture of opium supplies the necessary anodyne
and astringent influence. evacuations, the urine is liable to become scanty, and that the suppression of such evacu- Another formula which is occasionally used ations by opium and astringents often exerts an by Professor Davis, is unfavorable influence upon the function of the
R. Morphia sulphatis kidneys, resulting in more or less complete Quiniæ tannatis
gr. xx. suppression of the urinary secretions.
Erigerontis canadensis Ziv. This complication can be avoided by the Mix and add to one part of boiling water to following combination :
make an infusion. When it is cold, give one teaR. Tinct. digitalis
3j. spoonful every four hours to a child one year Potassii acetatis
old. This combination has the advantage of Spts. ætheris nitrosi
3ss. being diuretic and tonic, as well as anodyne and Syr. simp.
3ss. astringent. Aqua
3ij. M. Sig.–From ten minims to a teaspoonful
, anæmia, excellent results may be obtained
In protracted cases, accompanied by marked according to age, every two or three hours.
from suitable doses of the liquor ferri nitratis In some cases of summer diarrhea and after meals and the administration of one of cholera infantum, after the acute stage has the following powders at bedtime :passed, the vomiting ceased, and the intestinal
R. Pulv, opii discharges reduced to one in two or three hours,
Quiniæ tannatis .
gr. iij. a low grade of febrile action ensues, charac
Hydrarg. cum creta terized by thirst, restlessness, and more or less
Sacchara alba griping pains before each evacuation. In these M. Ft. charta No. vi. cases, Professor Davis has found the following emulsion to be of invaluable service :
3ss. M. Sig.–One teaspoonful in water every hour. Sacchara alba
mx. months' old from eight to twelve minims every
Morphia sulphatis two or three hours, according to the frequency
Aqua menth. pip.
Zj. of the discharges, until the latter become consis- M. Sig.–Teaspoonful every hour and a half. tent and natural.
DYSMENORRHEA. When cases of serous diarrhoea or summer
R. Tinct. veratri viridi complaint have become chronic, and are ac
mxvj. Tinct. stramonii
mxij. companied by marked emaciation, the intes
Tinct. opii deod. .
3j. tinal discharges continuing thin and frequent, Tinct. cimicifuga
Giss. but without tenesmus or mucus, the remedies
Aqua camphoræ .
3v. should consist of tonics as well as of astringents. M. Sig.–Half teaspoonful every three hours.
gr. iij. gr. xx.