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administered that evening, and brought away much grain of opium in the form of pill was administered: fæcal matter. In the course of the day the tumour every hour. became spontaneously much reduced in size ; for When we met the following morning eight doses bad some time subsequently a small swelling remained been taken, and the narcotic influence was manifest,. in the groin, and whether it ever disappeared completely though the medicine was evidently well borne. The I am unaware.

paio and vomiting had ceased, but the bulk of the The second case occurred in the practice of my tumour was not diminished, nor had the bowels: friend and partner, Mr. Allan, of Epsom, and I am been moved. chiefly indebted to him for the particulars. A woman, After the administration of four more doses the aged 70, suffering severely with a catarrhal attack, I tumour was found to lare diminished to one half its presented symptoms of obstruction of the bowels, and former size, the patient still continuing free from pain on examination a femoral hernia was discovered in the

as discovered in the and sickness. A large injection of gruel with castor oil left groin. She said she had first perceived the swelling was then thrown up the rectum, and ample evacuation two or three months previously, and it had seemed of fæces soon took place. The relief was permanent. within the last few days to increase materially from a small swelling remained in the groin, and still con. the violence of the cough. The taxis aud other

tinues, probably containing a portion of incarcerated remedial means were unavailingly resorted to, and the omentum. In the words of Mr. Allan, “ Thus was symptoms had existed 48 hours when Mr. Allan this patient saved the risk and pain of a serious operation, requested me to see the patient with him, that we by a remedy, every dose of which brought relief and might determine as to the operation. At that period I found the tumour the size of a large walnut, free from heat or pain, neither was there any abdominal ! I shall now venture on a few brief observations in tenderness. The tongue was somewhat furred and reference to the modus operandi of opium in hernia, and dry, but there was no great heat of skin ; the pulse my opinions on this subject have emanated rather from did not exceed 84, was regular and not deficient in a long continued investigation of the action of the tope. The woman's chief complaint was of intense various narcotics and sedatives, than from a mere wish nausea and violent sickness, coming on with tlie to cluthe the above isolated facts with an appropriate paroxysms of coughing; any movement or attempt to and well-seeming theory. change her position would also occasion it, and on the pathological elements of strangulated hernia are taking any nourishment, it was immediately rejected; I two-fold :-on the one hand those connected with the with the continued vomiting stercoraceous matter protruded bowel, and on the other those depending on followed in abundance. I applied the taxis some time, the muscular and tendinous tissues which surround the and with considerable force, but unsuccessfully. There opening through which the intestine protrudes. That could be no doubt as to the nature of the case, and the the tendinous structure can only exert a passive influ. ultimate necessity for an operation seemed inevitable, ence is generally allowed, and that permanent spasm but as the constitutional symptoms were not urgent, can under ordinary circumstances affect the fibres of and the operation was strenuously objected to by the the voluntary muscles, or even those which are busband, we agreed to some farther delay. A large instinctive or spinal-motor, would not on reflection eneina with castor oil was administered, and, beyond seem probable; and yet on this latter assumption hare a little gruel, no nourishment was to be attempted. all the theories of hernial strangulation been chieny

No favourable change had resulted the following founded as far as I am cognizant thereof. Now, in a morning, -night bad afforded no repose, and the pathological point of view, beyond the visceral extru. retching and vomiting had been almost incessant. sion, through a narrow and unyielding opening, I The enema had for the most part been retained some believe the active cause of hernial strangulation to be hours, but its evacuation had been upaccompanied essentially connected with the intestine itself. Suppose by fæcal matter. The constitutional depression was a portion of intestine forced into a cavity of which the more manifest, the pulse had become accelera:ed, and neck is somewhat constricted. Now, we know that some pain and tenderness were experienced both in the general effect of superficial pressure on any portion the abdomen and in the tumour. Mr. Allan proposed of the body will occasion a greater obstacle to the that the tobacco enema should be used, and in the venous part of the circulation than to the arterial. event of its failure, that the operation should be had the balance of action of the two circulating media recourse to without farther delay. Bearing in mind being disturbed, the afflux will incline to exceed the the success which had attended opiate treatment on eflux, until such time as circulation is completely the former occasion, I suggested its adoption in the arrested, when gangrene must take place. In accordance present instance, as there was still great aversion to with what I have stated above, any medical attempt the operation on the part of the patient and her to relax the external muscular structures would be husband. Mr. Allan acceding to my proposal, one / unavailing; but on the other hand, if we can relax and. ÆTHER-INHALATION IN TETANUS.

205

Teduce the bulk of the intestinal substance, we might of a portion of intestine. The relocity of the then hope for advantage. Now, let us look at the capillary circulation is found to diminish on the applicainfluence of the various sedatives, and see how far any tion of opium; and where a person is under the one of them may be expected to conduce to the desired poisonous influence of the drug, I need scarcely end. Warm baths and bleeding may lower the remark that blisters and sinapisms will fail to produce general system, and relax the muscular structures, but the slightest irritant effect, so completely is organic the result of their employment do not sufficiently sensibility destroyed. In conclusion I may remark, indicate a decided bearing on the local morbid state. tbat in my experience, the safest and most effectual Antimony exerts a special depressing cerebral influence; method of bringing the constitution under the influence it diminishes the power of the heart, and lowers respi- of opium, in ordinary cases, is by the repeated and Tatory action; it also affects the contractility of the freqưent administration of moderate doses; and I am voluntary muscles, but it does not diminish the therefore inclined to advocate the same plan in hernia, peristaltic contraction of the intestines in the first care being taken to carry the administration to a instance, neither does it immediately influence the sufficient extent. capillaries; moreover, it is objectionable on account Since writing the above, the influence of æthereal of exciting irritation in the mucous membrane of the inbalation, in cases of hernia, has come to my knowalimentary canal. Belladonna exerts its chief influence on ledge; whether the medicinal action thereof is superior the voluntary muscles ; so likewise does tobacco, which to that of opium remains to be seen; but be that as it in its cerebral influence will subseqnently determine may, the lately recorded facts support my view of the to the heart; over that centre of the circulation, pathology of hernia. Mr. Tuson's case, published in digitalis appears to exert a direct control, but it has the Medical Gazette, is especially remarkable. On no peculiar action on the capillaries. Aconite, on the the abdomen being opened, large masses of intestine other hand, seems to have a special relation to the escaped, but on æther being used, the bowel returned sensitive power, and to exert no direct influence orer spontaneously, apparently collapsing rather than concontractile or motor structures. The diminution or tracting under the inedicinal influence. eren destruction of organic sensibility appears to result from the action of prussic acid, so as to destroy the connection between action and re-action. Now ON ÆTHER-INHALATION IN TETANUS, WITH opium is essentially one of the most powerful sedatives

A CASE. We possess, although undoubtedly stimulation may be By W. H. RANKING, M.D., Norwich. primarily consequent on its administration under A careful analysis of the recorded experience of the peculiar circumstances. Its action is very general. athereal inhalation in surgical cases cannot fail to conWhen freely administered it relaxes all the contractile

vince any unprejudiced person that a discovery has tissues, acd primarily and essentially those which are

been made, no matter by whom, wbich is not surpassed involuntary. It soon reduces the force of the circula

in the annals of the healing art. We now know tion, and though at first it may tend to produce a state

tolerably well what are the circumstances under which of capillary congestion, yet as soon as the balance of

it may be exhibited in surgical practice, and when it action between the centre and periphery of the circula

should be withheld, but of its effects in medical praction is restored somewhat, the capillaries of the surface

tice we are comparatively ignorant. It has been sugand of the membranous viscera will be deficient in

gested, amongst other diseases, that tetanus is one in their usual contents, and lose their natural irritability. I which the stupifying agency of æther would be of Now, with emptied and inactive capillaries, and great service, but with the exception of myself, i relaxed contractile fibre, is it not to be expected that beliere as yet no one has had practical demonstration the hernial tumour would become reduced in bulk, of its effects. These effects were, as the subjoined motionless, insensible, and flaccid ?--the intestinal struc

case will indicate, not only not beneficial, but to all ture is in fact utterly paralysed, and the state which has caused strangulation being removed, as well as In a disease so uniformly fatal as tetanus, I regard the undue internal pressure by which it was originally experimentalism, even in tbe teeth of physiological caused, may we not fairly hope for the spontaneous deduction, as pardonable, otherwise I should not have reduction of the protruded viscus, even as it seemed | ventured upon the inhalation of æther in the present to occur iu the instances which I have adduced ?

case, for I am induced to believe, from a careful noting Experimental enquiry supports the opinion I have of the operation of the agent, that it has no power, advanced respecting the medicinal influence of opium. 1 tbe neart, while yet pulsating, be removed from the • Since the above was written, two trials of æther in body of an animal, the muscular contraction will

tetanus have been recorded, -one in this country, one in

France. In the former some slight relief was thought to immediately cease on applying a solution of opium, have been afforded; in the second death was indubitably and the same is the case with the vermicular motion precipitated by its use.

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at all erents, immediate upon that portion of the being furnished, and two ounces of the purest æther nervous system which we know to be engaged in the we could obtain being put into it, the patient was got manifestation of tetanic symptoms-namely, the spinal into a bath at 108°, and the inhalation commenced, marrow. I am aware that this opinion is at variance

The warm water had partially relaxed the board-like with that of some French physiologists, Longet among

rigidity of the body, and the poor fellow expressed

some relief, when the attempt to insert the pipe again the number, who maintains that æther does induce

excited a strong spasm. Being however, anxious to insensibility of the spinal marrow as well as of the

persevere, he contrived to push it into his mouth, but cerebral lobes, though only secondarily to the latter, the first breath be drew aggravated the spasm in a tenand when carried to a degree in itself all but fatal; but rold degree, the body became perfectly opisthotonic, I still consider, that therapeutically considered, æther roam issued from the mouth, and the man altogether cannot be employed in diseases of spinal origin, as presented so frightful a spectacle that we might fairly grantiag that it is possible to influence that part of the bave been excused had we desisted from that moment. nervous system, it can only be done at the risk of We, however, after allowing the effects to subside, seriously prostratiog the functions of the cerebral

made one more attempt, when the recurrence of the

same symptoms convinced us of the worse than use portion.

| lessness of the proceeding. If the spinal marrow either cannot be affected at

The subsequent treatment need scarcely be alluded all by æthereal inhalation, or only as secondarily to to, as my object is solely to point out the failure of the the production of deeper cerebral insensibility, than æther, but I may state that he was bled largely and most people would consider themselves justified in continued the cannabis, with some amendment, and in inducing, it must be obvious, on reflection, that it is the evening bad a tobacco enema, (half a drachm to half not likely to act beneficially in tetanus, for we know a pint of water,) which acted effectually in relaxing the that the functions of the true spinal marrow gain an spasms. A warm perspiration ensued, the patient was increased intensity by the abolition of the controlling

enabled to open his mouth to the extent of an inch, and power of the brain. Such being the case, we might

expressed bimself as in erery respect better. He

remained quiet for nearly an hour, with a good pulse, expect that the spasms of tetanus, so far from being

when a sudden spasm seized him, in which he died. mitigated, would be aggravated by the inhalation. This was not actually the case in the instance which I am about to record, for the plair reason that in

OBSTINATE CASE OF CONSTIPATION. halation could not be carried on to the point of inducing insensibility. The mere attempt to insert BY JOAN

i inser By John Elliott WOOD, Esq., Surgeon, Rochdale. the pipe into the mouth caused the spasms to re- Nancy Sladen, a married woman, the mother of appear; and the first contact of the æther rapour with

several children, was seized on February 19th, 1847, the bronchial membrane induced such fearful con

with pain in the abdomen, vomiting, hiccough, and vulsions, that to proceed with it was out of the question.

other symptoms of strangulated hernia. She had been

the subject of irreducible femoral hernia for several In recording this case, however, I would not omit to state, that the inhalation was attempted with a common

years. The hernial tumour, however, though large,

was not larger than usual, nor more tender to the touch bladder and pipe; as the more effective instruments

than the abdomen generally. Pills of calomel with which ingenuity has devised in such abundance, bad

croton oil were administered, and injections used, none of them at the time been brought into existence. without producing any discharge from the bowels. The case is briefly as follows:

The symptoms gradually increased in urgency, and on A man aged about 60, of intemperate habits, but of February 21st the usual operation for femoral hernia. remarkably fine and athletic proportions, ran a nail was practised, the patient being at the time under the through his boot into the sole of his foot, near the influence of æther. The bowel and omentum were ball of the great toe, while walking across some old found in a natural state, no strangulation existing. timber. The accident gave him no uneasiness until Large doses of calomel were now administered by the expiration of a week, when he complained of the mouth, and injections of castor and croton oils stiffness in the neck, and placed himself under the diligently persevered in, without any relief to the care of Mr. Coe, a surgeon of Bury St. Edmunds. The symptoms. The abdominal tenderness increased; the next day the tetanic symptoms were general, and my hiccough and vomiting continued; there was a remark, co-operation in the treatment of the case was requested. | able anxiety of countenance. On visiting the patient, abont eleven in the morning, I On February 22nd, a solution of :morphia was prefound the jaw completely locked, the spasms frightfully scribed, which afforded the patient more relief than violent, and considerable opisthotonos; in fact, every anything hitherto had recourse to. symptom was present of tetanus of the most acute from this time to March 31st, a period of more than character. Our treatment was coinmenced with the five weeks, croton oil, castor oil, compound extract of Cannabis Indica, full doses of which were with difficulty colocynth, large doses of calomel, jalap, injections of got down; but this medicine was for a period croton and castor oils, of turpentine, of tobacco infu. omitted in favour of the æther-inbalation, which sion, of large quantities of warm water, friction to the we determined to essay. A common bladder and pipe abdomen with castor oil, with turpentine, the cold

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douche, every remedy, in short, calculated to produce prenonitory symptom; she did not receire any treatment, a purgative effect, was tried without effect. The and was brought to the hospital at six o'clock the same morpbia was continued during the whole time with morning. At present the patient lies upon her back, great benefit. Beef tea, jellies, wine, and eggs, were rolls her head from side to side, throws her arms about, ordered, and taken with appetite.

and moans as if in great pain; the skin is moist and On March 31st she felt an inclination to go to stool, natural; the expression of the countenance is anxious, and parted with a motion, perfectly natural in consistence the lips and cheeks are florid; the respiration is hurried and colour ; this was followed by several others in the and laboured, fifty-five in the minute; she speaks intercourse of the day, till she had discharged a very large ruptedly, catching her breath between each word. quantity of fæcal matter. There was no blood, or There is no cough, the physical signs of the lungs are mucus, or scybalæ, and no portion of intestine voided. quite natural. She complains of severe pain, (which

The incision over the hernial tumour, it should be has continued since one o'clock this morning,) shoot. stated, healed in a week. The night before the ing through from the xyphoid cartilage to the spine. re-establishment of the action of the bowels, the hernia She states that she feels a tightness about the chest, became large and painful, but was reduced to its usual and a sensation as if she were being suffocated. There size by pressure without difficulty.

are no external marks of injury in the epigastric The patient is now (April 3rd,) in a fair way for region. On auscultation, the heart's beat is found to recovery, though reduced in strength and flesh.

be slower than natural, there is a slight degree of harshRochdale, Lancashire.

ness with the first sound, and the sounds are heard over a larger surface than usual. On percussion, the

heart is found to be enormously enlarged, measuring Hospital Reports.

from above downwards four inches and a half, and

from base to apex five inches and a half ; the dulness HÔPITAL DE LA PITIÉ, PARIS.

is very strongly marked; the aorta is also distended ; the pulse is laboured and compressible, seventy in the

minute. There is no nausea nor vomiting ; the large A CASE OP ENGORGEMENT OF THE HEART AND intestines are filled with solid matter, and the stomach INTERNAL ORGANS, PRODUCED BY A SEVERE

is distended with gas; the bowels have not been KICK UPON THE EPIGASTRIUM, AND FOLLOWED

moved for the last eight days; the liver is somewhat BY SYMPTOMS OF INTERMITTENT FEVER, AND

enlarged; the spleen is of the usual size ; the urine PERIODIC NEURALGIA, WITH REMARKA.

| is natural in quantity and quality; the catamenia (Communicated by Septimus Lowe, Esq., M.R.C.S.) are regular. Oer History of the case : present attack ; symptoms on The extent of the heart being marked out upon the

admission.- Treatment : its effects ; progress of the skin with nitrate of silver, Professor Piorry ordered the case; convalescence ; cure.- Remarks : importance of patient to be bled to the amount of thirty-two ounces; percussion; nature of the attack ; engorgement of during the bleeding she experienced great relief, and at the heart, lungs, and liver.-Cause: anervismie;" the conclusion she expressed herself nearly free from benefit derived from bleeding. After symptoms : pain; the dyspnea was almost entirely removed, but "hypernervismie ;" intermittent fever ; intercostal

there still remained some degree of tenderness in the neuralgia ; periodicity referred to the ganglionic

epigastrium. On again percussing the heart, it was system and spleen.

found to have diminished to the extent of an inch from S. P., a female aged 18, admitted into the Hôpital | above downwards, and three quarters of an inch on its de la Pitié, under Professor Piorry, March 19, 1847. left border; the dulness was much less intense in its She is a needle-woman, of the ordinary stature, san character; the aorta was considerably lessened, and the guine temperament, and florid complexion. She is liver was also diininished about half an inch, both on a native of Paris, and bas resided all her life in the its inferior and superior borders; there was no tenRue Mouffetard, inhabiting a small ill-ventilated apart. dency to syncope, nor was there any sensible effect bent, and sleeping in the same room with eight other produced upon the patient's strength; the pulse persons. She has never suffered from rheumatism or mounted to eighty, and became firmer, and more bysteria. About three months since she had a severe natural. Ordered to abstain from all food, and to have cold, with pain in the epigastrium, and loss of appetite, a purging enema. but she was not put under any treatment. Her Vespere. About five o'clock she was again attacked bealth has been generally very good. About six with severe pain and dyspnea. Ordered a grain and a o'clock on the evening of the 18th of March, whilst half of opium. restraining a patient during an attack of hysteria, she At eleven o'clock the opium was found to have had received a severe kick in the epigastric region; she not the slightest influence in subduing the symptoms, suffered but little at the moment, and continued her and they had, in fact, become almost as urgent as usual occupations. About one o'clock in the morning on her first admission; the heart was again enlarged to of the 19th, she was suddenly seized with violen: pain about midway between the first limitation and the one below the left breast, shooting through to the inferior made after the bleeding. Ordered to be bled to the posterior part of the chest on the same side, with very amount of thirty-two ounces. After the second great difficulty in breathing, and considerable anxiety bleeding the extent of the heart was found to be and restlessness ; she had no shivering fit nor other diminished considerably within the limitation made

ches

after the former bleeding, and to be, in fact, almost in the quinine and warm baths, and apply a blister to its normal condition. The distressing symptoins were the epigastrium. again completely removed, and the patient obtained a From this time until the 29th, the patient bad an few hours sleep.

attack every day, but each day it became shorter and 20tb. About three o'clock this morning she experi- less intense ; the tenderness in the epigastrium and enced a return of the pain and dysprea, but less spine continued, and she complained of some degree intensely than before. The heart was found to be in of feebleness. its normal condition, so that a third bleeding was not 31st. The tongue is clean and moist; the appetite deemed necessary. A warm bath was ordered, which has returned; she has not had an attack since the succeeded in removing the distressing symptoms. At 29th. Convalescent, Full diet. present she is quite calm and composed, but complains April 2nd. Cured. of tenderness in the epigastrium and left intercostal

Professor Piorry, in remarking upon this case, spaces; the pulse is regular, compressible, and 78;

obserred, that if we consider the astonishing progress there is considerable tenderness on pressure over the

medicine bas nade within the last few years, if we sixth, seventh, and eighth dorsal vertebræ; the bowels

look at the rapid strides it bas taken towards perfecbare not yet been relieved. Ordered a warm bath, a

tion, and the degree of certitude in the investigation mustard poultice to the epigastrium, and a purging

of disease which is now obtained, we can have no enema.

difficulty in admitting it to be a " veritable science; ". 21st. The pain is greatly relieved; the bowels have

while chemistry and physics are limited by certain been moved once; the tongue is slightly furred; no

and peculiar laws, or carried away into abstract theory appetite; heart in its normal condition ; pulse rather

and speculation. Medicine has arrived at such an weak and compressible. Ordered low diet. Continue

amount of accuracy and exactitude, that by the the warm bath and enemata.

assistance of anatomy and physiology, on the one hand, 22nd. The countenance is again anxious; there is

and by that of auscultation, percussion, the use of the considerable jactitation, interruption in speaking, and

speculum, &c. &c., on the other, we can now measure catching of the breatb. There is not the same kind and mark out the different organs with the greatest of dyspnea wbich was observed on her admission. nicely and precision; and by reasoning upon, and She complains of violent lancinating pain, darting comparing them with, the natural condition, we may through from the epigastriurn to the left intercostal detect the almost sligbtest lesion, and arrive at results spaces and spine, so that she cannot fully expand the the most positive and satisfactory.

or take a deep inspiration, without great agony. The case before us illustrates most admirably the The heart continues in its normal state; there is no

truth of these observations, and is another amongst the harshness with the first sound; the large intestines

many proofs we have lately had of the utility and are still filled with fæcal matter, and the stomach

importance of percussion, and an “organo-patholois distended with gas. Ordered thirty leeches to the

gical" investigation of disease, showing most clearly epigastrium, followed by a large linseed poultice; / the surprising light they often throw upon phenomena friction over the abdomen with olive oil; a blister

apparently the most obscure. over the spine, to be dressed with a quarter of a grain

This patient was admitted with most distressing of hydrochlorate of morphia; a purging enema, and

symptoms of dyspnea and troubled circulation, fol. a warm bath.

lowing a severe kick upon the epigastrium. On aus. 23rd. She had another attack of the same nature

cultation nothing abnormal was detected in the lungs, Jast night, which lasted several hours. The bowels

there was a slight barsliness with the heart's first sound, have been freely relieved; the pulse is somewhat

and the heart's impulse was extended over a larger fuller, and quite regular, 80; there is still considerable

surface than natural, but there was nothing positive to tenderness in the epigastrium and spine. Ordered point out the true pature of the case. On percussion five grains of sulphate of quinine erery six hours, in the heart was found to be greatly enlarged, and the dul. the intervals of the attack.

ness more marked than usual, but it retained its ordi24th. The attack commenced last night about ten | nary form. Could it be effusion into the pericardium ? o'clock, with well-marked symptoms of intermittent Certainly not; for, in the first place, the bruits were fever; sbivering, which contined alout an hour; heat, not distant or indistinct; 2nd, the rapidity of the which lasted about an hour and a half, followed by attack, and gravity of the symptoms, prerented the sweating. This was succeeded by the same kind of supposition; and, 3rd, the shape was altogether differeat intense pain as before. Continue the quinine. to what is observed in hydro-pericarditis, where,

25th. She again had an attack last night of the according to numerous experiments made by Professor same nature, and at the same bour as the former Piorry, both upon the living and dead subject, the dul. one. She was ordered ten grains of quinine, which ness is found to extend upwards and outwards to the immediately arrested the symptoms, and she remained left side, and to assume a figure totally different to free until the following day.

what is observed either in the normal or the hyper26th. There is still considerable tenderness in the trophied heart. epigastrium and spine ; the heart retains its normal What then was the true nature of the case ? Evi. condition; the bowels are regular; the appetite dently engorgement of the heart and great vessels, and improred; the tongue is clean. Ordered to continue Iconsecutive engorgement and congestion of the lungs,

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