Obrázky stránek
PDF
ePub

liquid stools, containing fragments of a spongy appearance. The vomitings were succeeded by retchings, with general weakness, coldness of the extremities, paleness of the face, burning thirst, and dryness of the throat and mouth. During the night, cramps came on in the calves of the legs and .soles of the feet; the face was contracted, the limbs cold and livid; the urine was suppressed; and the pulse vanishing. From time to time there were intervals of sinking, but without drowsiness or delirium, and the patient was perfectly himself.

On the 3d, the cramps and vomitings had ceased; the liquid stools continued but were less frequent; there was less colic; no pain in the head, and but slight tendency to drowsiness. Towards the evening, during the night, and particularly on the morning of the 4th, the symptoms, which had seemed to diminish, became frightfully intense; the alvine evacuations, though less frequent, were tinged with deep black blood.

Towards 6 in the evening, the debility made rapid progress, yet the patient still preserved his recollection. In spite of the active employment of stimulants, he sank, after a death-struggle which lasted thirty or forty minutes. M. Pallois [who narrated the case], did not see him till the 2d, after the vomiting and purging had probably carried every particle of food out of the alimentary tube.

M. O., the son, was attacked on the 2d, at daybreak, with vomiting, and had copious stools with but little colic. Repose, and the use of soothing drinks, and emollient clysters, were prescribed. Under the influence of these remedies, the symptoms, which were at first attributed to mere indigestion, lost their severity; but for five days running, the patient experienced retchings, mucous stools of greenish and blood-stained tints, coldness in the limbs, tendency to swoon, and considerable thirst, with dryness of the mouth; the pulse was very weak, but regular; there was a notable diminution of the urine, and considerable agitation with slight delirium during the night. These symptoms gradually increased. On the fourth day a stool was passed, consisting of blood almost entirely pure; yet there was a remarkable mitigation of the other symptoms, with a little diaphoresis during the night.

It was not till the evening of the 6th of October that the patient could be considered as out of danger; but he was still very weak, and passed liquid stools, the colour of which, however, sensibly improved. He was not convalescent till the 8th.

:

During the course of his disease the symptom which harassed him the most was a want of sleep, which was not relieved by the slight narcotics given him.

Madame O. passed the night following the poisoning without feeling any inconvenience, but was severely ill afterwards. However, she experienced a fortunate reaction; the vomitings and purgings having entirely ceased. On the fourth day she was attacked with feverishness; and on the 6th of October, a bleeding from the arm to four ounces cured a dull and wearying headach.

The child, for three days, was seized with vomiting when he drank, and had watery stools of a grayish colour, without much colic; he continued weak and pale, and began to take a little light food about the fifth day after the accident.

Mademoiselle Julie had only frequent liquid stools of a grayish colour and fetid odour, with colic, nausea, and total loss of appetite: she grew pale and

thin.

Rose, the cook, had several liquid stools without any bad consequence. The remains which she threw away in the evening on washing the dishes having been eaten the following morning by a young hound, he died in ten or twelve days, with vomiting, agonising pain, and convulsions. A cat in the house had the same fate.

M. Pallois having gathered mushrooms in the same place as M. O., and

being assured of their identity by persons who were present, soon saw that they were of the kind called agaricus bulbosus by Bulliard; amanita viridis by Persoon; and agaricus phalloides in Chevallier's Paris Flora. Their popular names are orange and petite ciguë blanche, (small white hemlock), and their poisonous action is the more terrible, as it is not felt, according to Vaillant, till twelve or fifteen hours after the mushrooms have been swallowed; an assertion which is completely verified by the preceding facts.-Bulletin Med. du Midi.

Peculiarity in the Transmission of Hydrophobia. By S. H. STEELE.'On the 20th of May last, two ewe sheep were bitten by a dog labouring under hydrophobia. One of them had two lambs at her side, which were allowed to continue with her for a fortnight after the bites were received. She was bitten and torn considerably about the head. The other also had one lamb (a ram) with her. She received one bite only, in the neck; it was, however, a very severe one. The lamb was allowed to remain with

her the same time as the others. About six weeks after the bites had been received, the first named ewe evinced the following symptoms:-she was observed often pawing and striking the other sheep like a ram-a very uncommon circumstance in a ewe; she was convulsed at intervals-she continually turned her head to her side in a convulsive manner; the bowels were very much constipated, and what little came from her was of a red colour; she refused all food. These symptoms continued, increasing in violence, for about eight days, when all hope of her recovery being abandoned, she was destroyed. A day or two afterwards, the other ewe became affected in the same manner, and the whole circumstances of the case were precisely similar to those of the former. She was killed on the seventh day. Nine or ten days after the death of the last sheep, the ram lamb was attacked in the same manner as its mother; it was, however, much more violent, butting at the other sheep, and at the hurdles, and at any thing else that came in its way; it was continually tearing the wool from its side. It expressed no uneasiness at the sight of water in a ditch, part of which was enclosed along with it by some hurdles. It was killed a week after the first appearance of the symptoms. The other lambs were attacked at the same time, and in a similar manner, as the ram, but were not so violent. They were, however, killed together, as their cases appeared equally hopeless.

The great singularity which is observable in the cases is, that the lambs became rabid merely from sucking ewes which had been bitten by a mad dog, for the lambs were removed from them a month before the ewes became affected. The lambs were all carefully examined, in order to discover any bite they might have received, but not the slightest scar could be discovered. The same dog bit a number of other sheep in the neighbourhood, the greater number of which died of hydrophobia. He bit a man, also, in the hand, but excision was performed, and he has hitherto done well. No attempt was made to relieve either the ewes or the lambs.

Ergot of Rye-its Effects on the Fatus.2-Mr. Proctor, in reference to the effect of ergot of rye on foetal life, said, that a friend of his, in extensive midwifery practice in the country, had, from considerable observation, come to the conclusion that it did affect the life of the fœtus. He, Mr. Proctor, thought this conclusion to be well founded. When labour was terminated by this agent, the action was unnatural, the pain was continuous instead of intermittent, and consequently violent. He had been alarmed, in several cases, at the effect of the ergot of rye on the mother. He had seen it in onè instance produce delirium and vertigo, and in another umbilical hernia. His friend in the country, to whom he had alluded, instead of taking ergot of

Lond. Med. Gaz., Oct. 25, 1839, p. 160.

* Reports of Medical Society of London, in Lancet, Oct. 26, p. 168.

rye in his pocket when he went to a labour, had now substituted tea and sugar, and this was acting upon the safe side.

Dr. Bennett inquired in what way it was supposed the ergot acted injuriously to the infant; was it by producing apoplexy in the mother, or by acting directly on fœtal life?

Mr. Statham had administered the ergot of rye in many cases, and he had come to the conclusion that it was injurious to fœtal life. He had at first thought its use admissible in all cases in which the os uteri was dilated to any extent. He now never gave it except when the child's head was in the pelvis, and then he had no doubt of its being advantageous, if the os uteri were flaccid. He considered that the ergot acted injuriously, by producing pressure upon the umbilical chord, and stopping the circulation.

Dr. L. Stewart said, in a discussion which took place in the society a year or two back, he believed it was a generally entertained opinion that the ergot acted specifically, and had no general physiological action.

Dr. Theoph. Thomson said, that the observations of American practitioners upon a large scale, confirmed the opinion that ergot was destructive of fœtal life. The violent and long-continued contraction of the uterus, when influenced by ergot, might so affect the circulation of the mother as to endanger the fœtus. It might be argued that the blood passed very gradually through the placenta, and that therefore this could not be the mode in which the injury was inflicted; but there was still a large quantity of the circulating fluid passing through the placenta in a given time, and it might possibly act in this way.

Mr. Proctor did not consider that the ergot acted upon the infant as a poison through the agency of the mother. He had seen a case of twins, in which the ergot was given; one child was living, the other dead. Had the ergot acted as a poison through the mother, it would have had the same effect on both children.

Dr. Stewart inquired if any member had employed the medicine under consideration in any other cases than labours.

Mr. Statham had used it in a case of chronic bronchitis without effect. It was of great benefit in menorrhagia and abortion, and much superior to acid medicines.

Apparatus for Vapour Baths.-The following is a description of a cheap and commodious apparatus for vapour baths, which was lately presented by M. Duval to the Royal Academy of Medicine :

M. Duval's apparatus consists

1. Of a spirit-lamp, with four wick burners, which contains a decilitre of alcohol at 36 degrees. The centre of the lamp is pierced by a small opening to permit the escape of the alcoholic vapour.

2. Of a three-footed stand, composed of iron wire, and intended to support the reservoir of water. This latter contains four decilitres of water, and is closely covered in; to the cover, however, is fitted a tube through which the vapour may be conveyed to different parts of the body, and which is furnished with a cock for the purpose of stopping the vapour when necessary. When a general bath is administered the body may be enveloped in a blanket supported on hoops, and the blanket covered with oil-cloth.

The quantity of spirit contained in the lamp is sufficient to keep up combustion during fifty or sixty minutes, at a cost of about two-pence. The cost of the whole apparatus is not more than two pounds five shillings, while those commonly in use cost not less than from twelve to twenty pounds.Bul. de l'Acad. de Méd., Nos. 19 and 20, 1839.

'London Lancet, Oct. 12, 1839, p. 102.

[blocks in formation]

ART. I.-CASE OF DIFFICULT LABOUR, WHICH WAS SUCCESSFULLY TERMINATED BY THE USE OF THE FORCEPS.

BY W. II. MÜLLEr, member of dr. warrington's obstetric class. Mrs. R. C., aged 30, in her eighth pregnancy, was taken with labourpains about 6 o'clock in the evening of Wednesday, Oct. 9th, 1839. She having been confided to my charge by Dr. Warrington, I was sent for shortly after 9 P. M., on Wednesday. On reaching her, about 10 o'clock, I found the pains pretty severe, and succeeding each other at intervals of from three to five minutes; there appeared also to be an alternation of weak and strong pains. On examination to ascertain the progress of labour, the lips of the os uteri were found to be large and soft, but as yet there was no perceivable dilatation. A second examination, about one hour afterwards, discovered the orifice considerably enlarged, the edges of the os uteri being very thin, sharp, and relaxed. Finding that after the lapse of another hour no progress was making, while the pains continued severe and frequent, Dr. Warrington was sent for, and arrived about 1, A. M. The uterine contractions at this time were very active. The position which the patient had all along found most convenient was that upon the knees, while she supported herself by resting the elbows on a chair, and was loud in her entreaties to the attendants to bear down upon her back. The membranes were ruptured by Dr. Warrington soon after his arrival; these were so soft posteriorly as to present a sort of pad, and give an idea of a portion of the placenta. There was, however, no hemorrhage. The vertex was found posteriorly, sometimes presenting to the right, and sometimes to the left sacro-iliac symphysis. The promontory of the sacrum was much greater than usual; a spine of bone was thrown backward from the symphysis pubis to the extent of one eighth of an inch; a projection of bone appeared also to spring from the linea ileo-pectinea, opposite the left acetabulum, sufficient to interfere with the usual dimensions of the pelvis. The patient complained of the most severe and intolerant pains in the back when uterine contractions occurred, and would press her hands with the utmost force into the lumbar region; insisting, moreover, as above remarked, upon "taking her pains on her knees, and having two women to press with their whole weight upon her back." Under the most severe contractions, the fœtus was scarcely at all advanced. At 4, A. M., having summoned two other members of his obstetric class, viz. John R. Justice, and Edward Hartshorne, the former of whom arrived very shortly, Dr. Warrington attempted the introduction of the long forceps, (the patient being placed upon her back at the foot of the bed.) Both blades could be passed in easily, but it was impossible to bring them to lock, though both blades were frequently alternately withdrawn and rein

troduced. Thinking it might be possible to introduce and lock the narrowbladed short-handled forceps of Professor Davis, of London, Dr. Warrington went home, and returned with Davis's narrow, and also his broad-bladed forceps. The narrow blades were passed into the pelvis, but owing to the relation of the child's head with the tumour, he was unable to adjust them so as to make them lock. Dr. W. then proposed a consultation with Professor Hodge at 8, A. M., requesting me in the mean time to take some repose and refreshment. Mr. Justice left at the same time, to meet another engagement. Messrs. Edward Hartshorne and Moore now arrived, and thirty-eight drops of laudanum were given to the patient, with the hope of enabling her to take some repose. The contractions continued incessant and severe, and upon a subsequent examination (as Dr. W. has recorded in his notes of the progress of the case during my absence,) it occurred to him that if he would change the position by the vectis, so as to place the left temple of the child in the situation now occupied by the right parietal protuberance, he might apply the blades advantageously. Dr. W. then introduced the vectis under the right ramus of the pubis, and applied the hollow surface to the side of the child's face, swept it round under the arch, and succeeded in bringing the occiput to the second position. This was done while the patient was upon her left side. As she was firmly fixed and well supported by Messrs. Hartshorne and Moore, Dr. W. passed in the widebladed forceps of Davis, locked them readily, and began to act with some effect, when the bolt which is intended to secure the joint made in one of the blades for its more ready introduction in certain cases gave way, and rendered that blade useless. Dr. W. immediately withdrew the blade, and adapting it to the opposite blade of the narrow forceps, found that they had the same lock and curve, and determined to slide in the narrow blade, which could be opposed to the broad one still in the pelvis. The attempt succeeded most satisfactorily. Having every thing now well adjusted, some vibratory motion was used in the direction of the bi-parietal diameter of the child's head, at the same time traction effort was made to the entire extent of his physical strength, for several seconds; the patient, making a most vigorous expulsive effort, the child began to advance slowly-rotation was éffected, and in probably five minutes the occiput appeared at the anterior commissure of the vulva. The perineal tumour now became large; it was supported, and the head was extruded. The shoulders were equally retained for several minutes; by strong assistance, however, the whole foetus was delivered by about 8 o'clock;-the placenta being delivered by Mr. G. Hartshorne, and the bandage applied by the assistance of Mr. E. J. Moore. The patient was then placed comfortably in bed, with directions that she should be kept entirely quiet. The child, which, contrary to expectation, was living, was washed and dressed. The left side of its forehead gave evidence of the pressure to which it had been exposed, as the cuticle was stripped off to the extent of one by two inches. This was dressed with simple cerate.

1

Thursday evening, Oct. 10th.-Patient has slept well since this morning. Has had considerable thirst. Drink-toast water, and oat-meal gruel. Complains of feeling very sore about the vulva, and of general weakness. Abdomen tender; has slight oppression of the chest. When ordered to cough, complains of pain in pelvic region. Patient was seen this afternoon by Dr. Warrington, who drew off a considerable quantity of urine by the catheter. An additional quantity is now again drawn off by the same means. Pulse not much disturbed, nor is heat of skin great, but rather cool and moist; no headach; doing very well.

Ordered a bread poultice over pubis, and the cloths to be changed every three hours.

Friday morning.-Slept soundly all night, and was not disturbed to change the poultice.

« PředchozíPokračovat »