a good recovery. Two days before the present visit, her calls to make water became very frequent, without any known cause. (Ever since her confinement, however, she acknowledged that she had made water more frequently than formerly.) She now felt a dull uneasy weight in the loins, with slight pain in both groins. Her pulse was quick, feeble, even tremulous-pain in the umbilical and hypogastric regions, apparently agonizing-urine and fæces lately evacuatedno menstruation since last confinement. Sixty drops of laudanum were ordered, followed by a dose of castor oil and calomel. This was productive of temporary relief and sleep; but next morning she was as bad as before-principally complaining of her pubes, back, and groins-of frequent micturition and inclination to stool, the latter accompanied by much bearing-down pains. On examining, per vaginam, Dr. R. found the uterus very low down, and enlarged, as nearly as he could guess, to about the bulk of one's fist, "the fundus being directed backwards into the hollow of the sacrum, while the mouth, which was tumid and much indurated, was felt facing the lower edge of the symphisis pubis." The whole body of the womb was so tender, that she screamed when the most trifling pressure was made on it. Her pulse was quick, small, and more feeble than hard, During the night, she had been attacked with frequent vomiting. Venesectio ad 3viij. which produced fainting. Fomentations and opium were then used to allay the pain. Pills, composed of calomel and opium, were next administered, with the view of reducing the bulk of the uterus. Leeches were, also, applied to the vagina and labia pudendi. On the 4th day from the commencement of the pills, the gums became tender. The uterus now felt somewhat flaccidthe tenesmus and dysury, in two days more, had almost subsided. The pills were continued at proper intervals so as to keep up a trifling irritation on the mouth, and on the 16th day from the time our author first saw her, she was well-the uterus feeling light, buoyant, and of the natural size. The symptoms and mode of treatment, in this case, were nearly the same as in the other, which we shall not notice. That the phenomena, in these instances, were to be attributed to a congested, or sub-acutely inflamed state of the uterus, we can scarcely doubt; and that this state of turgescence produced the malposition, or retroversion, as it is called, we think is not very improbable. These inflammatory affections of the uterus are more common than is generally imagined, and the antiphlogistic treatment, especially by local blood-letting, rest, horizontal position, semicupia, and abstinence, is not sufficiently attended to. A farrago of remedies, supposed to have some specific influence on the uterine system, are too often substituted by the routinist for this rational treatment. 17. "Test for Arsenic.* Dr. Cooper, president of Columbia * Dr. Cooper. Sulliman's Journal. College, finds a solution of chromate of potash to be one of the best tests of arsenic. One drop is turned green by the fourth of a grain of arsenic, by two or three drops of Fowler's mineral solution, or any other arsenite of potash. The arsenious acid takes oxygen from the chromate, which is converted into green oxide. To exhibit the effect, take, he says, five watch glasses; put on one, two or three drops of a (watery) solution of white arsenic; on the second, as much arsenite of potash; on the third, one-fourth of a grain of white arsenic in the substance; on the fourth, two or three drops of solution of corrosive sublimate, either in water or alcohol; in the fifth, two or three drops of a solution of copper. Add to each three or four drops of solution of chromate of potash. In half an hour, a bright, clear grass-green colour will appear in numbers 1, 2, 3, un, changeable by ammonia; number 4 will instantly exhibit an orange precipitate; number 5, a green, which a drop of ammonia will instantly change to blue. Dr. Cooper, however, does not recommend that this test should be exclusively relied on, but merely that it should be used in conjunction with others, of which the most unequivocal is certainly the actual exhibition of arsenic in a metallic form. The Mar 18. Remarkable Case of Hepato-pulmonic Disease.* quis de T, sixty-eight years of age, had enjoyed good health till the year 1794, when he underwent excessive fatigue during the emigration, and was, soon after, seized with violent pain in the right hypochondrium, with all the symptoms of acute inflammation. A tumour now appeared in that region, and fluctuation soon became evident. This tumour burst spontaneously, and discharged an enormous quantity of a greenish purulent liquor, together with a great number of biliary calculi. It was long before this abscess healed. In the course of the succeeding ten years, four similar abscesses formed in the same place, and all accompanied by a discharge of gall-stones. After this epoch the Marquis's breathing was never very free, and he felt a tightness about the region of the liver, which inclined him to stoop in that direction, and which he attributed to adhesions formed during the different inflammatory attacks. Extreme emaciation now took place, accompanied by a slight cough, a very deep tinge of the skin, and a tout ensemble indicative of suffering yet his appetite was good, his sleep tranquil, and the general functions of the system very little deranged. During the next twelve years he was frequently threatened with a return of the hypochondriac abscesses, but they were always prevented by local bleedings, diluent regimen, and topical emollients. About six months before his death an excessive difficulty of swallowing came on, which was sometimes mitigated by opiate embrocations, leeches, blisters, &c. but always returned, and was soon afterwards accompanied by * M. Nacquart. Journal Gen. de Med. Juillet 1822. an habitual and copious expuition of a glairy fluid. There was also occasional expectoration, without cough, of thick and puriform substance. The dysphagia now became so great that swallowing was nearly annihilated, and when any thing was got down, it was at the expense of pain the most intolerable. The whole hypochondriac region was now exceedingly sensible; the pulse became frequent ; the puriform expectoration and glairy expuition increased, and the emaciation arrived at the most extraordinary pitch, notwithstanding the difficulty of swallowing decreased towards the close of life. Diarrhea now supervened, and he died a perfect skeleton in June last. Dissection. Peritoneum sound. Mucous membrane of the stomach was of a violet colour, and that of the colon sprinkled with ulcerations, some of them of considerable size. The liver was not half the natural size, and firmly agglutinated to the diaphragm by a white fibrous substance, in some places nearly as firm as cartilage. It was firmly adherent to the pylorus and other adjacent parts by similar fibrous substance. There was no trace of gall-bladder; but in its place was a depression occupied by fibrous substance similar to that which glued the liver to the neighbouring parts. The ductus communis choledochus was perfect, and the structure of the liver itself did not appear diseased, but was nearly white in colour. The left lung was sound, as were also the heart and pleura. The right lung was converted into a mass of tubercles, among which were several excavations produced by suppuration, (foyers de suppuration et des cavernes,) the whole firmly adherent to the pleura, which was itself disorganized. The fauces, pharynx, and œsophagus, examined with the greatest care, presented not a single trace of disease. The pia mater spread over the hemispheres of the brain was covered with a transparent gelatinous layer, but the brain itself was sound. The above case will furnish food for much reflection and some speculation. The state of the lung on one side does not at all surprize us, for it would really appear that one lung is a great deal more than is necessary to support life, and even a tolerable degree of health. We have seen so many instance where the functions of respiration and circulation were kept up by a few cubic inches of permeable lung that nothing hardly can astonish us on that head. The dysphagia is a puzzler. The scoffers at "inexplicable sympathy" will, we apprehend, have some difficulty in accounting for this distressing symptom in any other way. How far the destruction of the gall-bladder and diminution of the liver itself were connected with the extreme emaciation and other phenomena, we will not pretend to say; but we are disposed to think that the disease in one side of the chest was not likely to be the sole cause of this emaciation. That the unnatural colour of the skin was connected with the hepatic derangement, will, we think, not he questioned. The state of integrity in which the parenchymatous structure of the liver was found (although the colour was altered) would lead us to suppose that the series of abscesses in the right hypochondrium were confined to the gall-bladder itself, of which we have seen some instances, and of which several other instances are on record. 19. Epilepsy.* In a well written paper on epilepsy, in which Dr. Shearman advocates the doctrine of nervous, rather than cascu→ lar, disturbance, as the first link in the causation of the disease, we find the following passage. "The medicine which, in my hands, has more frequently succeeded than any other in removing epilepsy, is the elutriated oxyd of tin, given in the dose of from Jij. to 3j. to an adult, night and morning, for about four days, at the end of that time giving a purgative, and again resuming the medicine or not, according to its effects upon the system, or its apparent power over the disease. That it possesses powers different from, and superior to the other preparations of the same metal, I am fully convinced, and I think it deserves a trial by practitioners after they have been disappointed of success in the exhibition of other remedies." Knowing Dr. Shearman to be a man of correct judgment and strict candour, we offer the above passage to the notice of our brethren at large 20. Strictured Esophagus.+ Dr. Kinglake's case of real stricture in the œsophagus exhibits a striking contrast to the supposed case of stricture in the same number of our respected cotemporary. The site of the obstruction is not stated; but it was three inches in extent, and of almost cartilaginous hardness. The poor man died of inanition. Quicksilver to the extent of one or two ounces was given twice or thrice a week, which passed the strictured part, and descended through the bowels " rather in an unctuous than in a globular or metallic form." No pain or inconvenience was experienced by this process. Our readers will remember that a few numbers back we stated a remarkable case of volvulus, where no traces could be found of the quicksilver which we exhibited to the patient the day before death. 'T'he above observation of Dr. Kinglake's seems to be somewhat similar. While we congratulate Dr. Kinglake on the great increase of perspicuity in his language of late, we cannot help observing that it is still too redundant. The substance of this case might have been communicated in one page, as well as in four-and, as Pat says, "we should have gained by the loss." Dr. Kinglake, however, is not singular in his powers of amplification. It but 21. Extraction of a living Fætus from a dead Mother. rarely falls to the lot of a surgeon to have an operation of this kind on hand. • Dr. Shearman. Medical Repository for September, 1822. On the 15th of April, 1820, a woman in the last month of pregnancy was run over by a stage-coach near the end of St. Thomas's Street, Southwark. She was immediately conveyed to St. Thomas's Hospital, and expired in twenty minutes after the accident. Mr. Green and Dr. Blundell, after a short consultation, agreed on the propriety of the Cæsarean section, which was performed in less than a quarter of an hour from the death of the mother. On extracting the child it exhibited no signs of life. The umbilical cord was tied and divided—a tracheal pipe introduced, and the lungs inflated. After fifteen minutes artificial respiration the child shewed symptoms of returning life. The infant was then immersed in warm water, but the pulse diminished in force and frequency, and the breathing became embarrassed. It was now dipped in cold water, without any marked effect. After a time the breathing became natural, and in 52 minutes the child opened its eyes. It was taken by the friends to a house in the neighbourhood, and put under the care of a wet nurse. On the visit next day it was found that little nutriment had been taken-that the child had not cried-and that its breathing was embarrassed. The infant lived but 34 hours after emancipation from the womb of its unfortunate mother. On opening the body of the latter, it was discovered that the liver was rent through its substance by the crush of the wheels of the coach, and much blood extravasated in the abdomen. This case, as Mr. Green observes, affords a proof that a fœtus may be recovered, if promptly extracted from the uterus, when the mother has been killed by violence-and this too, under the unfavourable circumstances of death, accompanied by a profuse hæmorrhage. The case detailed is creditable to the zeal, humanity, and ability of the two distinguished practitioners concerned. 22. Puerperal Fever. When Dr. Brennen proposed and exhibited so drastic a purgative as oil of turpentine in puerperal fever, it was considered preposterous, and our continental brethren still quote the circumstance as a fine example of British temerity in the exhibition of what they term heroic remedies. The medicine alluded to is now creeping into use in a great variety of complaints, and among others puerperal fever. Dr. Payne exhibits his experience in rather vague facts. Most of them are from memory, and all have happened at more or less remote periods. He declaims against blood-letting-trembles for the consequences that are likely to happen from the use of the lancet-"agrees that the disease in question is of an inflammatory nature"-but believes that parturient women are less able to bear the loss of blood than under other circumstances. This is a rambling and inconsistent kind of pathology, which we do not much * Dr. Henry Payne, of Nottingham. Ed. Journal, No. 73. |