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3. What was the first symptom ?
Dr. H. replies, “constriction of the throat and tightness of the chest, with rigidity of the muscles in attempting to move.” Dr. O. says, “ He first complained of a want of air, and requested the window to be raised; whether it was from faintness or a constriction about the respiratory organs, I do not know, although I think the latter."
4. What symptoms ensued from the first till death occurred ?
Says Dr. O., “When I first saw him, he was lying upon the bed in a complete tetanic convulsion ; his head somewhat drawn back ; his countenance completely livid, with some frothy matter issuing from his mouth, with frequent moans. The palpebra constantly in motion. This first paroxysm may have lasted some five minutes, which was succeeded by an interval of partial calm.” “During this interval," continues Dr. O., “it was somewhat difficult for him to articulate with distinctness. He made several attempts to vomit in this interval, by exciting the fauces with his finger. There seemed to be some constriction about the throat, as it was difficult for him to swallow." “ This interval lasted perhaps five minutes, when another paroxysm commenced by a little starting and stiffening of the extremities, and immediately the whole body was thrown into a tetanic paroxysm, in appearance like the first, and lasted two or three minutes, when death ended the struggle.”
“ In about three minutes from the first paroxysm,” says Dr. H., "the tetanus again returned, and in the space of two minutes death closed the scene, with, terrible spasms of the entire system. The pulse remained unaffected till the last struggle. It is my opinion that the immediate cause of death was suspension (?) from spasm.”
“ His appearance," says Dr. O., “ led me to believe that death ensued from asphyxia or suffocation. There must have been great congestion of the brain, which of itself might have proved fatal.”
5. How soon after taking the article did death occur?
Dr. H. says, “ From the best information which I could obtain, I should judge that death ensued in fourteen minutes." “ The time from taking the article till death ensued,” Dr. O. remarks, “could not have been over twenty minutes."
6. Did his mind remain clear till the last struggle ?
“I think,” replies Dr. H.," that he was perfectly conscious from the first to the last, except in the paroxysm of tetanus, from the following facts :-1. His appeal which he made to me, as noted in the first article. 2. On loosening his cravat, he requested me to unbutton his vest, at the same time desiring me to take out his gold watch and take care of it. 3. An emetic having been administered, he applied his finger to his throat to provoke a nausea. 4. And, from the last words he uttered, • I fear, I fear, O God deliver me.'”
7. Whai means were used to prevent the fatal result ?
Dr. H. says, On witnessing the first symptoms, I left the room for the purpose of obtaining medicine. I procured an emetic of sulphate of copper and ipecac.; but returning and finding him in a tetanus, I immediate dashed cold water on his head, face and breast, and
used the most powerful friction on the extremities. He returned to a state of perfect consciousness. I then proceeded forthwith to administer the emetic, making use of diluents copiously. I sent a messenger for some vinegar and ground mustard, and another for a stomach pump. I used the ground mustard, in warm water freely, to all of which the patient submitted, seeming to be very grateful for the efforts which I was making for his relief. The means were used without any apparent effects." 56 When death had ensued, a number of the medical fraternity being present, we retired into an adjoining room, when the fatal bottle was produced, with the wrapper still around it. On removing this, it was found labelled strychnine.'' Dr. O. states, that "till this time, we were in ignorance of what he had taken.” Dr. H. avers, “that here I wish definitely to state, that before the last paroxysm came on, I was fully convinced in my own mind that the fatal drug was not morphia, but strychnia, and I so declared to those present at the time."
From facts before the committee, derived from reliable sources, it appears that on the afternoon of the second day before the fatal accident, Dr. Warner called at an apothecary store in Montpelier, and asked for and purchased what he supposed to have been a bottle of sulphate of morphia. This was handed to him by the apothecary enveloped in a brown paper and iwisted at both ends. That on the fatal morning Dr. W. tore off the envelope surrounding the mouth of the bottle, and took a portion of what he supposed to have been mor. phia. He then proceeded to pour some of the supposed morphia into a small pbial in which he had been in the habit of carrying sulphate of morphia, when he was suddenly arrested by the symptoms narrated. It is quite clear that he never entertained any idea of the fatal drug he had taken. “I am certain,” says his afflicted brother, " that he never for a moment suspected that he had taken strychnia, and was wholly unconscious of the agency which had produced his awfully unprecedented sufferings."
Dr. W. had never possessed very firm health, and for about two years before his death he had suffered from an inordinate action of ihe heart, for which he had occasionally taken morphia. This affection of the heart had been the sequence of an inflammatory affection of the chest, which he had early in the year 1844.
The committee have taken considerable pains to ascertain the facts in this melancholy instance of death from a mysterious mistake. The mistake was certainly a singular and mysterious one, both in relation to the apothecary and the unfortunate man. It appears that Dr. W. asked for sulphate of morphia ; the apothecary intended and supposed he had sold him morphia till after the fatal event, when he found, through mistake, he had given him, enveloped in a paper, a bottle of sulphate of strychnia in lieu of morphia. This exposition of facts appears to be demanded in justice to the character of the de. ceased, to the apothecary and to the medical profession.
In a medical point of view, the case is one of much and deep interest, since it so clearly manifests the true and energetic character of this somewhat new medicinal agent. And in a medico-legal consideration, it may prove of immense importance. In the suddenness of the effects, and in the quickness of the fatality, from the use of strychnia, this case is probably without a precedent. Christison, Pereira, and several monographical writers, in the periodicals, have recorded some bad results, and some fatal cases, from over dosing with this agent; but no instance has fallen under our notice in the buman subject in which its administration, either accidentally or otherwise, has so speedily and terrifically proved fatal.
“No poison," says Christison, “ is endowed with more destructive energy than strychnia." "I have," he adds, " killed a dog in two minutes with the sixth part of a grain, injected in the form of an alcoholic solution into the chest. I have seen a wild boar killed in the same manner with a third of a grain, in ten minutes; and there is little doubt that half a grain thrust into a wound might kill a man in less than a quarter of an hour. It acts in whatever way it is introduced into the system, but most energetically when injected into the veins."
With the exception of prussic and oxalic acids, there is probably no agent possessing an equally destructive power. Strong prussic acid is well known to be sufficiently energetic to destroy cats or dogs, when properly administered, in less than a minute. And Pereira examined the body of a man who had accidently taken oxalic acid in lieu of Epsom salts, and died in twenty minutes.
JONATHAN A. ALLEN, M.D.,
A Case of Pregnancy and Parturition during the existence of Cancer of the Uterus. By Joseph A. Eve, M. D., Professor of Obstetrics, &c., &c., in the Medical College of Georgia.-Carcinoma of the uterus was formerly supposed to be incompatible with prego nancy; but the possibility of this complication with this disease in all its stages is acknowledged, and its influence in hastening its progress admitted, by all or nearly all authors who have recently written on the diseases of females. A record of cases, or an allusion to this unfortunate complication, will be found in the works of Clarke, Davis, Ashwell, Churchill, Ramsbotham, Waller, Ferguson, Duparcque, Colombat, Boivin & Duges, Velpeau, Siebold, and many others. But it is, in an excellent practical treatise on Organic Diseases of the Womb, by Mr. Lever, of London, that we find the most satisfactory account of pregnancy in connection with cancer, and the most extensive reference to cases.
Pregnancy and cancer have each a prejudicial influence over the other—the former hastening the progress and fatal termination of the latter; and the latter in a considerable number, I believe in a large majority of cases, causing either an abortion or the death of the fætus when delivery occurs at the full term. The fætus sometimes perishes
in utero, its farther development being prevented, and abortion the necessary consequence; in other instances the death of the fætus is the result of impediment to delivery, from the schirrous enlargement of the mouth or neck of the uterus.
Of one hundred and twenty cases of malignant disease of the uterus, referred to by Mr. Lever, abortion occurred in forty per cent.; in twenty-seven of delivery, fifteen children were born dead, ten living, and in two the result was not known, or we may say fifteen out of twenty-five were lost.
The object of the present communication is to give a brief history of a remarkable case of pregnancy and parturition in connexion with cancer of the uterus.
July 28th, 1845. I was called in haste, eleven or twelve miles in the country, to visit Mrs. --, who I was informed had been some time in violent labour. There was considerable time lost in consequence of my absence from town. On my first examination I found the head very low in the pelvis, the mouth of the womb extinguished, except a small portion, which had a tumid, hard, rough, unnatural feel. This labor was far more difficult, painful, and protracted than her two preceding labours, in which I had attended her. The child was expelled about a half hour after my arrival. I remarked a smell very similar to that of cancer of the womb, but did not at the time suppose it possible that it could be identical with it, for she was apparently in most excellent health, remarkably robust and stout, weighing not less than two hundred and fifty pounds, and being about twenty-eight years old, and furthermore, as the child to which she gave birth was large and healthy.
Two or three months previous to her confinement, I was consulted by her family physician in reference to a sanguine discharge to which she had been subject for some time, and which I feared might depend on placenta prævia, but which I have no doubt now was consequent on carcinoma. I have since learned, upon enquiry, that as early as January, she complained of severe pains in the region of the uterus, and that in the very commencement of gestation she experienced unusual sensations that caused her for a long time to doubt whether she was pregnant.
After her confinement Mrs. had an offensive discharge from the vagina. On expressing the opinion, when consulted in reference to it, that she was laboring under organic disease of the uterus, I was requested to visit her, October 5th, with a professional friend, and make an examination with the speculum.
The touch discovered an extensive schirrous enlargement of the neck of the uterus. We could not determine satisfactorily the extent of the ulceration by the speculum, because, before we could make a proper inspection, we were compelled to remove the speculum, for she became so excessively agitated that we feared an hysteric convulsion would have been induced.
As she was young and remarkably robust, we considered this was a case in which every possible effort should be made, although even under such favorable circumstances we had scarcely the slightest shadow of hope-favorable, I mean, in reference to her age, constitution and general health, but quite the contrary when viewed with respect to her recent gestation.
We put her on the internal use of proto-iodide of mercury, and chloride of soda as a vaginal injection, with an occasional resort to the sulphate of morphine, whenever pain might call it into requisition ; she was however at this time, and for a considerable time after, comparatively free from suffering. We proposed to apply some cautery, at another visit, when she might be sufficiently composed to bear its application, either the nitrate of silver or nitrate of mercury.
I was requested to visit her again, the 21st of the same month, sixteen days after my first visit. She had not yet lost her embonpoint, but the cancerous ulceration had made most frightful and destructive progress, having involved not only the posterior lip, but the posterior part of the cervix or body. It was now too late to think of anything beyond palliative measures. We advised a lotion of the nitrate of silver, with the view of correcting the fetor and improving the condition of the ulcers, perhaps in some degree checking their course. After this she became subject to most alarming and exbausting hæmorrhages at each menstrual period. She now began to lose flesh, and strength rapidly, and to suffer severe lancinating pains.
I visited her again the 6th of November. The disorganization was still more rapid, far exceeding anything I had ever before witnessed. We endeavored to support her strength by tonics, to alleviate her sufferings by opiates, to restrain the hæmorrhages by styptics and astringent lotions, and to correct the horrible fetor by the chloride of soda.
After the destruction of the posterior lip, posterior portion of the neck and body of the uterus, the ulceration extended through the vagina and rectum, allowing the fæces to pass from the latter through the former, and must have involved even the sacral plexus of nerves from the excruciating paroxysmal pains she suffered in that region.
I never saw her after the 23d December, but was informed by my friend that she continued to linger in the most painful and deplorable condition until the 25th of June, when death kindly released her from sufferings indescribably severe, almost beyond endurance.
It is impossible, from any thing we could learn of the history of this case, to determine how long the schirrus may have preceded the commencement of gestation : it is probable not very long, from the excellence of her general health and the fact that she did not com. plain of pain, or any unusual sensation in the pelvis, until about the time she became pregnant.
This case is remarkable, from having occured in so young, healthy and robust a subject, from the fact, that the process of gestation was conducted most perfectly, notwithstanding the presence of schirrous certainly, and I think we may safely say cancerous ulceration, from the discharge and the characteristic fetor, parturition only being rendered somewhat more tedious and difficuli. But if it is remarkable