« ZurückWeiter »
“ After several visits, I have established an acquaintance with two or three, and make them presents of bread and tobacco, for which they are very eager. One captive, quiet, self-collected, and hand some featured, tells a long well-sustained story of female jealousy and a family conspiracy to obtain his property and confine him for life : he stoutly maintains that he is as much in his senses as any man in Muzr-a strong reason for doubting the tale, which is true, would have driven a philosopher crazy. My new servant, Black Omar, who stands interpreter, believes every word, and thinks it no uncommon case ; he tells me that snake broth is the sovereignist thing on earth' for these mental maladies, and that no other medicine is used in the Mooristan, save the iron-chained collar and the bastinado,"—Nozrani in Egypt and Syria.
MANCHESTER PATHOLOGICAL SOCIETY.
Retroversion of Uterus—Retention of Urine for fifteen days— Fatul Inflammation of the Bladder.—Mr. Dumville presented the genitourinary organs of a woman, aged 22, who died in the fourth month of pregnancy from acute inflammation of the bladder consequent on retroversion of the uterus. The body was examined twenty-four hours after death. The bladder contained some urine ; its peritoneal covering was thickened and opaque, and had contracted adhesions with the surrounding intestines. There was also some muscular hypertrophy. The whole inner surface was thickly coated with false membrane, which hung in shreds, and was mixed with earthy maiters. The uterus was firmly impacted in the pelvic cavity ; il contained a four months' fætus, and the right ovary had within it the corresponding corpus luteum.
The woman had borne two children, and in the latter months of the second pregnancy suffered from prolapsus of the Uterus, which disappeared after delivery. She became a third time pregnant, and during the entire four months preceding death she had suffered from pain in the pubic region, and had also the sensations of prolapse, without, however, any well-ascertained descent of the parts. Twenty-two days previous to death, whilst occupied with manual labour, she experienced a sudden and violent pain in the hypogastrium, with great desire, but inability, to void urine. A surgeon drew off three pints of water, but neglected to repeat the operation for sixteen days. During this interval the bladder was never properly evacuated, the urine mosiły escaping guitarim, and with extreme suffering. She was then first visited by Mr. Dum ville, who, on examination, discovered a retroversion of the uterus, with the os resting on the sym: phisis pubis. Marked symptoms of acute inflammation of the bladder presented themselves, which he treated in the usual manner. On introducing the catheter, he withdrew a large quantity of urine, which was strongly ammoniacal, and yielded albumen plentifully. It was of a blood-red colour, and 1012 specific gravity. Microscopically examined, it was found to contain blood-discs, pus globules and crystals of neutral triple phosphate of ammonia and magnesia.
The inflammation of the bladder in this case was, in a certain sense, attributable to the retroversion of the uterus, but still more clearly to the neglect of periodically withdrawing the urine by catheter; for the distension caused by the retained urine, and its irritating properties, determined the fatal issue; so much the more to be regreited, seeing the rules for the management of similar cases have been so distinctly defined that no apology remains for the omission of putting them into practice.-Dub. Med. Press.
Cancer of Pylorus–Obscurity of Symptoms-Suppuration of Gall. bladder.-Dr. Francis sent for exhibition a fine specimen of cancerous ulcer which involved the whole of the pylorus.
Its surface was ragged and burrowing, the margins raised and everted; in length it measured four inches, in breadth two. The stomach was pale, and unusually small; the duodenum was of a deep slate colour.
It was taken from the body of a man, æt. 60, who, within the last eighteen months, had suffered much from privation and severe domestic troubles. He was under the daily and close observation of Dr. Francis for the last six months of his life, during which time he gradually emaciated. There was never any vomiting or complaint of pain, or other symptom indicative of local disease, but he was throughout the subject of a settled gloom, under the influence of which he seemed to be slowly sinking. A few weeks before death he contracted diarrhea, which was then epidemic.
Dr. Francis considers that a very interesting and instructive fealure in this case was the absence of local manifestations of disease, notwithstanding the existence of so formidable a lesion in a part of the stomach so almost uniformly attended with vomiting or pain. It added another to many instances he had had the opportunity of observing at the work house, of the fact, that where strong grief had taken possession of the mind it sometimes happened that sensibility seemed to have become so impaired that the symptoms ordinarily resulting from local irritation had not been developed. In several inspections of persons who had died whilst labouring under the melancholic form of insanity, or under that particular state of mind which, in popular language, is described as "a broken heart," he had never failed to find organic disease of some part or other, however obscure its existence might have been during life.
Along with the cancer of the stomach, the gall-bladder was found to be distended with a puriform fluid untinged with bile, which, under the microscope, was seen to contain pus, mucus, and inflammation globules, and behaved as pus on the addition of liq. potassæ. Several superficial granulating uicers were observed upon the inner surface of the viscus, and, a short distance within its duci, was firmly impacted a round calculus, nearly a third of an inch in diameter, and composed chiefly of cholesterine. The liver did not seem to be unhealthy, and there was no cancer elsewhere than in the stomach.
Two cases of Spina Bifida--one of them Cured.--Mr. Dumville exhibited a preparation of spina bifida taken from a child aged five months. The arrest of developement happened in the spinous processes of the third, fourth, and fifth lumbar, and first and second sacral vertebræ, which gaped widely apart. The sac in which the cauda equina partly expanded was large enough to contain an ounce of fluid. The tumour was punctured at the urgent instance of the friends, but at a period when the failing powers of life offered scarcely a hope of recovery. The child died with the usual symptoms.
Mr. Dumville related the particulars of another case, in which the congenital deficiency was situate in the same locality. He evacuated the sac by puncture, and the recovery was complete. The child, which was nine months old at the time of the operation, has now attained eighteen months; and its health is unexceptionable. The operation was quickly followed, in this instance, by a profuse perspiration; the face immediately became deeply congested; and there was much derangement of the stomach, attended with vomiting. The child was very fretful, had excessive twitchings, but no distinct con. vulsion. When the sac was quite empty all the symptoms were aggravated; but on becoming again distended with secretion, which occasionally took place in consequence of mechanical obstruction of the aperture, the symploms underwent amelioration. The discharge of fluid, with more or less of the symptoms described, having lasted fourteen days, the orifice then healed over, and no further secretion of serum following, the child convalesced without any relapse. This case he adduced rather as an exception to, than as an example of a general rule.
Judging from the aggravation of the symptoms whenever any excess of the fluid happened to drain off, it would appear that too much precaution cannot be taken in order to secure the evacuation of the sac az gradually and in as constanı a manner as possible, in these cases, and that the plan of operation most suitable for the attainment of this desirable end should be adopted, and, above all, timely put in practice.--Ibid.
Treatment of Bursal Disease of the Knee-joint. By John RICHARD, Esq., of Leamington.-The plan of passing a bit of sewing-silk through the centre of the tumour I have practised for the last fifteen years. It has never failed in my hands, and I do not think that I have ever allowed the silk to remain longer than through the third day. When the inflammation has been very considerable, I have always enjoined rest, and applied a few leeches, followed up by a liq. pluinbi lotion, previous to introducing the silk.--Ibid.
History of a case of remarkable coloured Secretion from the Skin. By C. D. PURDON, M. D., Belfası.- Barbara Murphy, æt. 40, an inmaie of the Infirmary attached to the Belfast Charitable Society, the mother of two children: catamenia regular up to the last six months ; autributes the first commencement of her state to a fever with which she was
attacked ahout twenty years ago, immediately after which she experienced a pain in the ball of the great toe of the right foot, terminating in a swelling of the same part. Both ankles became painful and swollen ; a short time after this ascites supervened ; all these symptoms subsided on her becoming pregnant, Juring which time she enjoyed persect health. About three weeks asier her confinement she was seized with pain, accompanied with swelling, in the joint of the first finger of the right hand, which gradually attacked each joint of the upper extremities in succession, and spread thence to the lower, commencing above. After some time the wrists, ankles, and smaller joints of the hands, became distorted and nodose, in which state they have since continued. From this time nothing remarkable was to be observed in her state, but she continued to suffer from occasional attacks of rheumatisın, and was alınost always confined to bed, until three years ago, when; during an attack of rheumatic fever, the heart for the first time became affected, aftor which anasarca and hydrothorax supervened. These were parily relieved by a severe diarrhea, but on its subsidence both beenme greatly aggravated; however, they were not only kept in check but much ameliorated by the different remedies employed. Some months ago they returned with such severity as 10 threaten a sudden termination of her life; when at the worst a miliary eruption appeared on the trunk, greatest in the cpigastric region, from which a clear serous discharge flowed in such quantities as literally 10 wet the bed; there was also a great moisture on the legs, which had blisters on them, in place of the eruption ; this of course was attended with the greatest relief, and the breathing became almost free. The discharge continued for some days, after which it ceased, and symptoms of dyspnea returned with great severity for fourteen days, when. after having a sense of prickling over the whole body for about twelve hours, the eruption again appeared, attended with the discharge, and causing the same relief. In this state of alternate relapse and recovery she has been for the last two months, the duration of the paroxysms being either eight or fourteen days; but the most curious point in the case is, that the serous discharge has changed very much in its character for the last four or five attacks, being nearly alternately blue and straw. coloured, or yellow, almost like pure bile. When the blue discharge arpears she is aware of its advent by a mouldy smell and a prickly sensation, which precedes it invariably for twelve hours; the yellow is not attended by either of these. The blue always appears along the posterior part of the chest; the yellow generally proceeds from the abdomen and back of the neck, and rarely from the back: the blue never has appeared on the abdomen ; the two colours have been procured from the different parts at the same time. The discharge from the extremities has never been coloured. In place of catanenia there is a discharge of a reddish green colour.
As to treatment every remedy has been tried without relief to any of the symptoms, either of the rheumatic or cardiac affections The yellow colour is tolerably permanent, the blue, however, fades; she has not taken any preparation of iodine for some vears, and at present uses only opiates and saline draughts. In addition, it is worthy of remark, that a very peculiar elongation of the quick under each great toe nail has takea place. This became manisest on the nail being paired, and now appears like a loose fold of flesh, which hangs over the ball of the toe, and resembles in shape the bony nail.-Dublin Quarterly Journal of Medical Science.
Ertirpatiou of a Tumour from the Antrum Maxillare, with remoral
of the superior Maxillary Bone, including the Palate Plate. By Č. Aston Key, F. R. C. S. E., Senior Surgeon to Guy's Hospital, Communicated by Sir Philip Crampton, Bari., F. R. S., &c.
Merrion-square, Sept. 20, 1846. DEAR SIR-- By the kind permission of Mr. Aston Key, I have the gratification of communicating to you the particulars of a case of tumour in the antrum maxillare, which was successfully removed by that excellent surgeon. The lumour was of great size, and must soon have proved fatal, as it had already pressed down the soft palate to such an extent as materially to interfere with deglutition. The aspect of the young woman was healthy; the tumour seemed to be of a firm nature; and there was no soft or fungoid-like protrusion through the nostril. These circumstances, no doubt determined Mr. Key to undertake the operation,
I remain, dear Sir, faithfully yours,
Philip CRAMPTON. To the Editor of Dub. Quarterly Journ. of Med. Science.
St. Helen's-place, Aug. 25, 1846. MY DEAR SIR,—The operation of removing the superior maxillary bone in the young woman whom you saw at Guy's was done a fortnight ago, and she is now quite convalescent; so far the case, as you predicted, has proved quite satisfactory. The whole of the bony palate on one side, the nasal process, and the bone, with the exception of the floor of the orbit, were taken away, and exposed a large tumour of simple structure, which readily turned out from the back of the antrum. There was no difficulty in the operation, and the diseased mass was detached with ease from its bed. On examining the structure of the tumour we could discover no trace of malignant disease; it consisted of fibro-albuminous deposit, and, being of so benign a character, there is every prospect of its not returning. The incision in the cheek, which extended from the outer canthus of the eye to the angle of the mouth, healed by adhesion. I thought that you would like to know the result of the case.
I am, dear Sir, yours most truly,
C. Aston Key. To Sir Philip Crampton, Bart.
Dub. Quart. Journ. of Med. Science.
Medical Court Martial.- A kind of medical court-martial has been lately held at the hospital of Val de Grace, under the presidency of Colonel François, to try a surgical pupil of the hospital on a charge of having caused the death of a patient by giving him an overdose of opium.
The deceased, a military patient, was admitted into the hospital for ophthalmia, and the physician prescribed for him a sudorific syrup; but it so happened, that the first dose which was given to him con