Billeder på siden

in which so little can be done; and, from analogy, I concluded the same might be useful in typhus, when there seemed great excitement in the brain, with heat, want of sleep, great restlessness, and sometimes delirium, and I have fully succeeded. In a few instances of typhus, when recovery seemed hopeless in the evening, the patients have been declared the following morning to be out of danger, after the application of cold water to the head and warm water to the feet, as above mentioned.

I might have observed how particularly desirable such means of relief are for children, with whom there is often a difficulty in giving medicine—means that afford a complete power,-general, quick, and decided.

Newcastle; August 20, 1817.

For the London Medical and Physical Journal.
Case of obstinate Constipation; by R. H. KING, Esq.

case was owing to the remedies, or to the efforts of 1. Nature, it appears worthy of being recorded, as shewing to

what an extent certain remedies may be safely employed, and encouraging us not to despair of recovery under circumstances apparently the most unfavourable.

Mrs. B., aged 40, a hard-working woman, and the mo. ther of two children, had lost her father and two sisters from obstruction in the bowels, after very short illnesses. One of the latter was under my care, and her complaint was decidedly peritoneal inflammation.

Mrs. B. is of a spare habit, naturally costive, but had been particularly so for a month previous to the present attack. On Wednesday, July 16th, she complained of considerable uneasiness in the bowels, in consequence of which, she took a dose of castoroil, which produced three scanty motions, but without relieving her:--to use her own words, “ it did not seem to have work'd off properly.". She continued very much indisposed during the following day (the 17th), attending to her domestic concerns, till night, when she had a severe rigor, which was soon followed by acute pain round the umbilicus, and excessive vomiting. About two o'clock on Friday morning (18th), my assistant was sent for to her, the pain and sickness continuing. He immediately took sixteen ounces of blood from the arm, and sent her a pill containing hydrarg. submur. gr. vj. and a purging saline mixture to take after it. The mixture was rejected, and, the pain con

tinuing tinuing without any evacuation from the bowels, about nine o'clock she took another pill, containing hydr. submur. gr. viij. and after it a full dose of castor-oil, which was di.. rected to be repeated, if necessary, and if the stomach would bear it. The pain, however, continued, increasing' at in.' tervals; and the stomach rejected every thing. The pulse: was about 80, not hard; the blood did not exbibit the least. mark of inflammation; and the pain in the abdomen was not increased by pressure. During the night and the following day (19th) the sickness abated, the pains became less severe, and, for some moments, almost ceased entirely, when she passed two or three scanty motions, perfectly fuid, of a dark green colour, with particles floating in them resembling tea-leaves. From this time till early in the morning of the 27th, she had no evacuation whatever from the bowels, except about two table-spoonfuls of a matter resembling, both in colour and consistence, melted pitch, with scarcely any smell. During this period she had several intervals of ease, although, at times, the pain recurred with great severity, and she suffered greatly from nausea, vomiting, and occasionally hiccup. She was sometimes so extremely ill, with a low and Auttering pulse, sunken countenance, and cold extremities, that her death was almost looked upon as cer. tain,—when she would again rally, the pulse becoming moderately full and soft, varying in frequency from 72 to 86, which latter it never exceeded. During the whole of her illness, the tongue was moist, very little furred, and she seldom or never complained of thirst. There was no fullness in any part of the abdomen, uor was the pain ever increased on pressure, till after she had swallowed the quicksilver, when, on strong pressure being made in the left hypochondrium, some degree of hardness might be felt, and it occasioned slight pain. During the first five or six days she passed very little urine, which was extremely high-coloured and turbid, resembling coffee-grounds. Almost every variety of purgative, and in every form, was tried, both by the mouth and in clysters, which last were thrown up with considerable force, in the quantity of five or six pints at once, and retained in the rectum as long as she could bear it; but they always returned very slightly discoloured, almost as soon as the pipe was withdrawn. Fomentations were applied to the abdomen, she went several times into the warm bath, and, on the 23d, the pain having returned with increased violence, and continued for several hours without the slightest intermission, she was again bled very freely, the blood exhibiting the same healthy appearance as before. Opiates were administered once or twice to proNo. 224.




The quicksilver which appeared in the motions was unaltered; but, as the small quantities which sometimes passed could not be accurately collected and weighed, it is impossible to say whether the whole of it came away in its metallic form.

Mortlake; Aug, 13, 1817.

For the London Medical and Physical Journal.
On the Pupil, and Accidents_attending it; by

YOMMUNICATIONS that to the superficial glance apa

pear trilling, may, from the experience of utility in practice, be thought deserving more attention. If what I am about to mention be one of these, it may, perhaps, be admitted into your Journal.

A little girl, in play, pushed the eye of a wooden doll into the meatus auditorius externus. The eye was made of coarse porcelain, having its shortest or conjugate axis about three quarters of the diameter of the meatus, and, by its turning a little obliquely to its long axis, it readily stuck in the passage,

and so far in, that it could be just seen when the external ear was pulled so as to render the meatus less tortuous.

The bead, thus situated, I could not remove with such forceps, curved probe, &c. as were at hand; and, as the touching of the tender lining of the meatus also caused the child to cry, such attempts were given over. I afterwards injected some warın water, in order to remove any cerumen that might prevent the bead from being so clearly seen. At first I injected it slowly, and gradually used more force, as I saw that it did not make the bead to recede further, which probably arose from its already resting on the membrana tympani. At last I forced the water in with as much power as a urethral syringe would allow, and soon observed that the bead moved outwards, so as readily to be removed with a probe.

Having thus succeeded, I was desirous of knowing the greatest retropulsive force of fluids thus injected. I therefore took a goose-quill, two inches long, and having plugged one end of it, introduced a pebble of such a size as to stick slightly at the bottom of the quill. With the syringe I found it was readily removed, as was also any other pebble thus slightly stuck, provided that it was not so perfectly fitted to the interior of the quill as to prevent the water from passing behind it. 0 0 2


Now the great power which fluids have when thus used in dislodging such bodies, and to what extent we may trust to injection, is what I wish to make more known, for even Celsus mentions syringing with the same intention, and also concussion of the body, in the following ingenious manner :“ Tabula quoque collocatur media, inhærens capitibus utrinque pendentibus, superque eam homo deligatur, in id latus versus, cujus auris eo modo laborat, sic, ut extra tabulam non emineat: tum mulleo caput tabulæ, quod à pedibus est, feritur; atque ita concussa aure, id quod inest, excidit.".

In the 36th volume of your valuable Journal, I have mentioned some facts relating to the size of the pupil. With regard to my remarks on the effects of convulsion, it becomes my duty to make early mention of a case which I have lately attended to.

M. H., æt. about 40, of a delicate constitution, has been subject to fits twenty-three or twenty-four years. I was called to her a few nights since, when 'affected with violent pain in the bowels, accompanied with vomiting and purging. Judging, by pressure on the abdomen, by the pulse, &c. that the pain was spasmodic, I gave her tinct. opii gtt. 100. In a few minutes, on asking her concerning the pain, I found her incapable of answering, lying with her countenance con posed, eyes closed, and her breathing so easy as hardly to be perceptible. Soon after, she became convulsed, struggled violently, and shrieked loudly, which recurred at intervals for an hour, during which I had frequent opportunities of examining the pupil, as sometimes the eyes were open during the convulsion, and occasionally I opened them during her struggling purposely to examine the irides. Towards the termination of the convulsion, she talked inco. herently, and gave incoherent answers, and it finally ended with sorrowful crying:

During the convulsion, the pupil was as small as I should expect it to be during sleep, but, in the intervals between the returns of spasm, the pupil enlarged on removing the candle irom the eyes just as much as it did after the convulsion had entirely ceased, and she had become sensible and reasonable. I have since seen her similarly attacked with pain, when I gave her the opiate as before, and she becanie similarly convulsed, when I had an opportunity of agali observing the same state of the pupil as before,

Now, this state of the pupil in convulsion is what I have never before observed, although I have particularly attended to it for some years past. On the contrary, I had always observed its enlargement in all cases where there was much

« ForrigeFortsæt »