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herself was most anxious that something should be done. The plan by seton seemed to hold out the best prospect of success, and it was carried into effect, having previously brought the health to the best condition. The first seton was passed on the 30th of November, 1845. A common curved needle of the largest size, with its eye, nearly full of double silk thread, was passed from below directly upwards, through the anterior portion of the tumour, about half an inch from the middle line of the neck, and including a space of at least one inch and a quarter between the entrance and exit of the seton. This was then fixed so as to prevent its slipping out, and the patient was desired to keep a poultice constantly applied, and also to keep her bed for two days; no unpleasant effects followed. It is enough to state here that this first seton was withdrawn at the end of ten days; that at the end of a fortnight a second one was passed; that it was double the size of the first, and its introduction was followed by a very considerable degree of constitutional irritation, which, however, subsided in about four days; suppuration then became very fully established, and the seton was withdraw, after being in twelve days. With the exception of poulticing, nothing was done during the next four months. In this time considerable changes had taken place in all the anterior portion of the tumour, and that part of it which occupied the left side; it had become very hard, and gradually, but steadily diminished in size. The larger portion of the tumour, however, occupying the right side of the neck, remained stationary. It appeared, indeed, as if it had grown somewhat larger; but this was not certain. A third and last seton was passed through this portion of the tumour in the month of April, 1846; its direction was upwards and outwards, so as to take in the longer axis of the swelling. This seton was four times larger than the previous one; it was passed with a large packing-needle, with the edges and point properly ground. After sixteen days the seton was withdrawn, the suppuration being then very considerable. Finally, after four months more, the entire tumour had so much lessened, that it might be considered as cured. The entire process occupied between eight and nine months.
At the present time (January, 1847) the eye cannot detect any tumour, but to the touch one remains, which is probably the size of a small chestnut. There is no deformity whatever, and very trifling marks of where the setons had been passed. The patient, too, feels no difficulty of swallowing, at least none that causes any inconvenience.
As I wish here to confine myself merely to the facts of this case, I have purposely omitted the consideration of several points which inight fairly admit of discussion; such as the nature of the tumour; the question of a more general use of this plan, after the more ordi- . nary means have failed, particularly iodine; the nature of the dysphagia, as to whether it was nervous or mechanical; the causes of those enlargements, and other points connected with the subject in a general way. It is to Quadri, of Naples, that we are indebted for the plan of treatment put in force in the present case. Not being certain
of what the result of the treatment would here be, I did not take the precaution of getting a cast of the tumour when it was of large size. This, probably, is of less consequence, as the patient has been seen by several gentlemen to whom I may here refer. Dr. Clarke, of Herbert street, saw her repeatedly; he took much interest in the case, and kindly gave me his assistance. At a late stage, and after all the setons were withdrawn, the patient was seen by several physicians and surgeons of this city.-Dub. Quar. Journ.
Case of Softening of the Heart in a Person who was believed to have died of Starvation and Exhaustion. By B. G. DARLEY, M. D. Coolock. On the 4th of January, 1847, I was requested by the coroner to examine the body of an elderly female, who was reported to have died of want and starvation in this neighborhood. The history of the case was shortly this: she was a poor woman, who obtained her living by wandering about from place to place, and was in the habit occasionally of stopping a day or two in the house in which she died. She had come there three days before the above date, and complained of much weakness, and was suffering, as the people in the cabin said, from "a kind of asthma." She had some tea to drink, but eat nothing. She died on the 3rd instant, apparently from exhaustion. On opening the chest, the lungs appeared healthy, and collapsed slightly; there was no water in the pericardium, the heart was larger than natural, the auricles greatly distended and full of blood. On lifting up the apex to see the size of the heart, my fingers went through the substance of the left auricle, and this with a very slight pressure indeed; out of the rent made by my finger poured a great quantity of fluid blood which filled the pericardium; the right auricle was in the same condition, literally choked with fluid blood, and in this auricle it was of a very dark colour; but the most remarkable character was the softened state of the walls of both auricles, particularly the left; they were of the same colour and as friable as the liver, and not unlike portions of lung affected with pulmonary apoplexy. The increase size of the heart appeared chiefly made up by the great dilatation and distention of the auricles; the ventricals did not appear larger than natural; they were empty of blood, and their muscular structure was of a pale colour.
The viscera of the abdomen were generally healthy; the stomach was contracted, and nothing in it but a half pint of a dark colored fluid; the intestines in parts were occupied by the same. The omentum was destitute of fat; indeed the absence of adipose tissue throughout the whole body was remarkable.
The brain was examined, and was perfectly healthy, but particu larly bloodless.
There was no le
Now what was the cause of death in this case? sion of the brains, lungs, or viscera of the abdomen, and though the heart was as described, it had preserved its integrity, at least there was no solution of continuity within its walls; and this might readily have taken place, considering the softened state of the auricu
lar tissue, had the individual lived a little longer, and the auricles had power to act on their contents; in such case death, most probably, should have been laid to the door of a diseased heart, and not as, in my opinion, the result of an altered state of the contained blood.
The coroner's jury returned a verdict, that "death was caused by want and destitution."
In a physiological point of view, I should say that insufficiency of nutritious food rendered the heart unable to expel its contents, its muscular structure, particularly that of its auricular portions, was so softened and weakened as to allow of dilatation to the greatest possible amount; the blood gradually accumulating, congestion took place, and the woman died of what we may call congestive apoplexy of the auricles of the heart. The manner this is caused by starvation is thus the blood is rendered thin, has little or no fibrin in it; the heart, along with the general muscular system, is weakened, and unable to expel its contents; congestion takes place; its cavities, particularly the auricles, yield to pressure; and, as is the case in all muscular cavities when distended beyond a certain extent, atony supervenes, the muscular fibres no longer contract, and death is the result.
From this examination, the difficulty of breathing during life may be explained, and, had an opportunity been afforded before death, we should probably have found the pulse slow and intermitting.
This case differs from the fatty degenerations of the heart in many particulars. First, this, as we have seen, engages the auricular portions of the heart, while it is the ventricles that are generally occupied by fatty deposition; again, it is in the corpulent and the full habit that the heart is predisposed to the fatty degeneration, whilst the softened auricle will be found in the ill-fed and destitute; again, the mode of death in the former has more of an apoplectic character, whilst in the latter the spark of life ebbs out from want of sustenance and vital power. In the fatty heart, the solids are the first to suffer, whilst in the other the mischief begins in impoverishment of the fluids.
As I fear the profession in this country will have many opportunities of examining the bodies of individuals dying under similar cir cumstances, though the case above noticed might have occurred at any period, I think it might be interesting for medical men to give reports of their examinations, and to observe the state of the several viscera, and especially the heart, in such cases.—Ibid.
A Case of profuse Hæmaturia, the result of Injury, treated successfully with Gallic Acid. By JAMES S. HUGHES, F. R. C. S., Surgeon to Jervis-Street Hospital.-John Hyland, aged 30, a Custom House porter, admitted into hospital on September 8th, 1846; states that, about half an hour before admission, he was employed in lowering a cask full of sugar, when he was struck by the handle of the windlass with great violence in the left lumbar region; he was rendered insensible for a short time, and was carried into the hospital. On examination an extensive ecchymosis was found to exist along the left
side of the spinal column and lumbar region: the ninth, tenth, and eleventh ribs were fractured close to the vertebræ; there was excruciating pain on pressure over the region of the kidney; abdomen tympanitic; testicles retracted; countenance deadly pale, covered with cold perspiration, and highly expressive of pain; pulse quick and feeble. Soon after admission he expressed a desire to make water, and expelled, with much difficulty, more than half a pint of pure blood. Ordered six leeches to the seat of pain, and to have a draught containing acetate of lead and acetum opii every second hour.
9th. Slept very badly; pain in the left lumbar region intense; much increased by the slightest pressure: urine highly leaded with blood; finds considerable difficulty in emptying his bladder; bowels freed during the night; the leeches were repeated, and the draughts continued.
10th. Pain somewhat relieved by the leeches; made several attempts to pass his urine during the night, but could not do so; constant desire to pass water; bladder distended. A gum elastic ca theter having been passed into the bladder, a considerable quantity of blood and urine were drawn off; there were several long clots of blood discharged. My colleague, Doctor Neligan, having suggested to me a trial of gallic acid, I was induced to order it in the form of pills, with extract of gentian, two grains and a half of the acid in each pill, which were taken at intervals of three hours.
11th. Considerably improved; the quantity of blood in the urine much diminished; after the third pill, the presence of gallic acid in the urine was detected by the addition of a few drops of tinctura ferri, sesq. chlorid., which converted it into a perfect ink. The pills were repeated.
12th. Passed a good night; made water freely; urine limpid, quite devoid of blood; pain in the lumbar region considerably decreased; pulse sixty-four, soft. Discharged cured on the 18th.
Gallic acid has proved a most useful addition to our list of astringents. Both as an external and an internal remedy in hæmorrhages its character stands high, and justly so; it is now generally alleged to be the active principle in Ruspini's celebrated Styptic, which Dr. Thompson is of opinion consists of gallic acid, sulphate of zinc, opium, alcohol, and rose water; the gallic acid evidently being the active ingredient. Sometime since I saw the power of Ruspini's Styptic put to the test in the case of a gentleman who had some of the branches of the palmar arch of arteries opened by the bursting of a bottle of soda water; profuse hæmorrhage having ensued, and attempts to secure the bleeding vessels having been tried in vain, graduated pressure was applied, but to such an extent, and for such a length of time, that sloughing of the palin of the hand ensued, with inflammation extending up the forearm, and considerable fever, together with repeated periodical hæmorrhages, by which the patient was considerably reduced at this stage I saw the case in consultation, when it was agreed to give a trial to this powerful styptic, and a single application of it was followed by an immediate arrest of the hæmorrhage,
and recovery. As a local application in aphthous ulceration of the mouth and tongue, I can speak highly of gallic acid; it is also a valuable injection in the gleety stage of gonorrhea. As an internal remedy, gallic acid has been used with great success by Dr. Simpson and others in certain forms of uterine hæmorrhage, and with this advantage over most other anti-hæmorrhagic medicines, that it had no constipating effect on the bowels; but as gallic acid passes directly to the kidneys, acting thereby as a direct astringent, the urine becoming impregnated with it very soon after its exhibition, it consequently is an astringent peculiarly suited to hæmorrhages from the urinary organs, and as such has been strongly recommended by Drs. Steevenson, Golding Bird, and others. Dr. Steevenson has published in the Edinburgh Medical and Surgical Journal, the following case of obstinate hæmaturia, successfully treated by gallic acid. The patient was a boy fourteen years of age, who had been passing blood with his urine for several months, supposed to have been caused by a blow which he had received in the lower abdomen from one of his school-fellows. After ineffectual attempts to arrest the discharge of blood, three grains of gallic acid were given every three hours for four days, when the discharge subsided, and did not return. In the case which I have brought forward, we found that the large doses of acetate of lead, combined with opium, did not check the hæmorrhage; whereas the bleeding ceased altogether after the exhibtion of the third dose of the gallic acid, at which time the presence of the acid in the urine was proved by the addition of the tinct. ferri sesq. chlorid. -Ibid.
Source of the Catamenial Discharge.-BY GEORGE KING, M. D.— The physiology of the source of the catamenial discharge, so peculiar to the human female, and the functions of the interior of the uterus positively ascertained, are subjects comparatively of very recent discovery, and as the opportunities are so rare of our having proof or of our obtaining any decisive means of determining the matter or establishing the fact that the uterus is the source of this healthy and proper sexual secretion, I think the following evidence may be interesting to the readers of the Provincial Medical and Surgical Journal. Should you be of that opinion perhaps you will find room for it in an early number :—
On Saturday, the 27th ult., I was applied to by a medical friend to assist him at a post-mortem examination, under an order from the city coroner, of a woman who had hung herself, the jury not being able to agree in their verdict. It is not often that a medical man is called on to make a post-mortem examination for the purpose of assisting the jury in coming to a correct verdict after death from hanging, the cause of death being so palpably visible; and how those twelve wiseacres could suppose that we should, by an examination after death, be able to discover the motive that could have induced this poor creature to commit such a rash act, I cannot conceive. But their ignorance was bliss to us, as it gave us an opportunity of making a very interesting examination.